Tanzania on high alert after Marburg outbreak

Tanzania has heightened disease surveillance and prevention measures to contain its first-ever outbreak of Marburg Virus Disease (MVD), which is highly infectious and potentially fatal.

MVD is a hemorrhagic fever in the same family as Ebola, with no vaccines or treatments approved to treat it.

The virus is initially transmitted to people from fruit bats and spreads among humans through contact with the bodily fluids of infected people, according to the World Health Organization (WHO).

Rapid response teams have been deployed to investigate the outbreak and implement interventions such contact tracing and "risk communication activities" in the affected area of Tanzania, said the WHO.

A 23-year-old fisherman who had traveled to Goziba Island in Lake Victoria fell ill on return to his home village in Bukoba municipality in the Kagera region of the country. He died on 1 March. His symptoms included vomiting, fever, bleeding, and kidney failure.

Four other people died with similar symptoms, including a health worker who was in contact with the patients at a health center in the village of Maruku.

The deaths sparked fears of an outbreak of what the Tanzanian ministry of health described as a "contagious disease" in the region. Tanzania's Ministry of Health confirmed last week (21 March) that it was an outbreak of MVD after laboratory testing.

"These emerging and re-emerging infectious diseases are a sign that the health security of the continent needs to be strengthened to cope with the disease threats," says Ahmed Ogwell Ouma, acting director, Africa Centers for Disease Control and Prevention.

A total of eight cases had been reported as of 22 March—four of them from the same family as the fisherman. The three surviving patients, including a second health worker, were undergoing treatment at health facilities in Bukoba.

So far, 205 people have been quarantined in Bukoba where there is an outbreak of Marburg, said health minister Ummy Mwalimu during a press briefing on 25 March. No case had been reported from outside the Bukoba district.

Tumaini Nagu, Tanzania's chief medical officer, told SciDev.Net that health advocacy campaigns had been scaled up in rural communities where the outbreak was first reported.

Residents are encouraged to adhere to hand washing and safe and dignified burials involving municipal authorities.

"We are getting good support from the community," Nagu said.

She explained that interventions were in place to ensure effective case management while observing infection prevention and control to prevent further transmission of the disease.

"Contacts have been quarantined and are followed up daily," Nagu added. "Should they develop any symptoms, samples will be taken for testing."

Gideon Rugumamu, a resident of Bukoba town, says responses are mixed among members of the community. "There are people who believe it's Ebola," he told SciDev.Net. "There is a bit of anxiety here after deaths were reported. But there are people who still ignore warnings, believing it's not a serious disease."

MVD is caused by a virus of the Filoviridae family that causes hemorrhagic diseases such as Ebola. According to the WHO, patients are offered supportive care and treatment of specific symptoms to improve survival in the absence of approved treatments.

On average, around half of those infected die from the disease, the WHO says.

Ibrahim Simiyu, a Tanzanian doctoral researcher in health systems at the Liverpool School of Tropical Medicine in the United Kingdom, says the Tanzania outbreak highlights the need to invest in primary health systems that can respond to epidemics.

"Health workers in primary health facilities are the first line of contact in such outbreaks," he told SciDev.Net. "They need to be trained to detect such disease threats and protect themselves and the communities.

"Without well-equipped primary health facilities, such outbreaks could go undetected and lead to more fatalities."

Protective gear needed

Deusdedit Ndlanha, president of the Medical Association of Tanzania, stressed that the government should ensure access to personal protective equipment for health workers.

"My advice to medical personnel is, they should also observe infection prevention control measures," he said.

Tanzania has updated its international travel guidance to prevent cross-border transmission of the virus. Passengers who exit the Kagera region through formal and informal ports of entry will be screened.

Elsewhere in Africa, Equatorial Guinea has been battling an outbreak of Marburg since February—the first ever in the country. Seven people have been confirmed dead from the disease and a further 20 people suspected to have been infected have also died.

The WHO says there is no evidence of a link between the two outbreaks. It says the Marburg virus in Tanzania has been isolated from Egyptian fruit bats (Roussettus aegyptiacus) and countries such as Rwanda and Uganda near the affected Kagera region could be at risk.

"These emerging and re-emerging infectious diseases are a sign that the health security of the continent needs to be strengthened to cope with the disease threats," said Ahmed Ogwell Ouma, acting director of Africa Centers for Disease Control and Prevention (Africa CDC).

He urged members of the public to share relevant information in a timely manner with the authorities to enable an effective response.