For the first time in the history of the United Republic of Tanzania, an outbreak of Marburg Virus Disease (MVD) was reported by the Ministry of Health on 21 March 2023. The Ministry declared the outbreak in Bukoba District, Kagera region, North Western Tanzania. The Kagera region borders Uganda to the north, Rwanda to the west and Burundi towards the southwest, making it one of the regions with the highest cross-border trade interactions.
A public announcement was made on 16 March by the Ministry of Health about the existence of an unknown illness in Kagera, where patients presented symptoms of high fever, body weakness, diarrhoea, vomiting and bleeding from different parts of the body and renal failure and malaise. The first index case was admitted on 27 February and died on 1 March 2023. The cases were later confirmed as Marburg virus infection at the Tanzanian National Public Health Laboratory.
According to World Health Organization (WHO), the Marburg virus is part of the family of viruses that cause Ebola. Once an individual is infected with the virus, it can spread through direct contact with blood or other body fluids from infected or deceased people.
As of 28 March, a total of eight cases, including five deaths had been reported, with a case fatality rate of 62.5%. Two of the cases were healthcare workers, one of whom unfortunately died. Three cases are still on treatment, with at least 204 contacts under active follow-up.
Public Health Interventions
The Prime Minister’s office is leading the overall coordination of the country’s response, while the Ministry of Health is the main technical arm for the response working closely with the President’s Officer – Regional Administration and Local Government Authorities, among other partners.
So far, national and regional Public Health Emergency Operation Centers have been activated, and National and Regional Rapid Response teams have been deployed. An emergency response budget has been developed amounting to $12,264,417 for the next two to three months. Additionally, the development of MVD Situation Reports (SitReps) has commenced, and national coordination meetings with partners have been called at various stages looking into surveillance, case management, Infection prevention and control (IPC), laboratory, water sanitation and hygiene (WASH) logistics, commodity supply and community engagement, among other core aspects of emergency response.
Support by Amref Health Africa
Amref Tanzania has been working in Kagera region through our existing U.S CDC- funded Global Health Security project that targets border regions and works with Community Health Workers (CHWs) who are playing a critical role in community based and events-based surveillance (EBS). Through the project, we have trained 734 CHWs, 280 HCWs and 61 local influential leaders from all eight councils of Kagera region who work to support disease surveillance and provide reports. Regional and district coordinators in the region have also been trained in data management and public health bulletin development for data sharing.
Additionally, Amref rolled out electronic event-based surveillance (EBS) to 159 CHWs and 40 HCWs from the borderline wards and villages of Kagera among the already trained health workers. While we also support points of entry (POE) assessment for outbreak preparedness capacity, we facilitate population connectivity across borders training at the borders of Kagera region as part of surveillance at the ports of entry.
Since the announcement of MVD outbreak, Amref Tanzania is working with the Ministry of Health and other partners to provide technical assistance in disease surveillance at the sub-national level, and offer weekly virtual mentorship and supportive supervision to regional alert management desk operators on the management of alerts. Jointly with the ministry and the PORALG, we provide virtual supportive supervision to CHWs and HCWs through WhatsApp groups on the early detection and reporting of alerts from the community level.
Challenges identified so far in the response, include inadequate financial resources, human resources, vehicles, speed boats, ambulances, personal protective equipment (PPEs), working tools, myths and misconceptions about the disease, as well as the limited diagnostic capacity of the laboratories.
Call to Action
- There is an urgent need to put in place appropriate infection control measures, including training for healthcare workers who are at the frontline in taking care of patients with confirmed or suspected cases. This should be implemented in addition to standard precautions to avoid contact with contaminated surfaces, objects, and patients’ blood and other body fluids.
- Urgently implement crisis communication measures to create awareness of the Marburg infection, risk factors and the protective measures that communities and individuals can take to reduce the spread of the virus.
- Strengthen surveillance, detection efforts, contact tracing and active case management to help contain the outbreak in all areas including remote villages.