by Ben Taylor
Tanzania experiences first Marburg virus outbreak, now considered to be contained
On March 21, the Ministry of Health confirmed an outbreak of the Marburg virus in the district of Bukoba in the far north-west of the country, four days after reports of a “possibly contagious disease” emerged in the district. The Ministry stated that five people including a health worker had died as a result of the outbreak, after developing symptoms of fever, vomiting, bleeding, and kidney failure.
The Ministry issued a travel advisory notice on March 22, which requires that all departing and domestic travellers from Kagera region will be required to complete an online traveller’s surveillance form, and that at all points of entry (airport, ground crossing or port), body temperature of all travellers will be checked. All persons with feverish conditions should be prevented from traveling in and out of the country until they complete the monitoring period and are given clearance to travel by the Port Health Authority.
The Ministry also initiated an urgent contact tracing process, identifying over 200 contacts of those infected. All persons in the contact tracing list are monitored regularly and prevented from leaving their places of isolation and travel.
As of April 25, six people have died out of nine confirmed cases, according to the World Health Organisation (WHO). Of 212 contacts, 206 had completed their monitoring period. Two of the cases involved healthcare workers, including one of those who died. Many of the contacts under monitoring were healthcare workers.
A few days later, the Ministry announced that they were confident that the outbreak had been contained. However, according to best practice procedures for managing such outbreaks, it will not officially be declared over until at least the end of May, 2023, six weeks after the final two patients were confirmed to be Marburg free. In the interim, authorities will maintain active surveillance.
The Health Minister, Ms Ummy Mwalimu, urged the general public to continue taking precautionary measures against the disease and other infectious diseases. She thanked the health experts, especially those on the front line in Kagera Region, including those who provided services to patients, and the contract tracing team.
This was the first ever outbreak of Marburg virus in Tanzania, though outbreaks have been recorded in the DRC, Uganda and Kenya, as well as other parts of the continent. The highly-infectious disease is similar to Ebola, with symptoms including fever, muscle pains, diarrhoea, vomiting and, in some cases, death through extreme blood loss. Hundreds of people have died from the virus in recent years, almost all in Africa. A 2005 outbreak in Angola killed more than 300 people.
According to the WHO, the Marburg virus kills around half of the people it infects. Marburg is considered much more dangerous than Ebola because, unlike with Ebola, there is “no vaccine or post-exposure treatment”, explained Cesar Munoz-Fontela, a specialist in tropical infectious diseases at the Bernhard Nocht Institute for Tropical Medicine in Hamburg. There is no vaccine because, until now, there has been “no market” for one. “Without the 2014 Ebola epidemic in West Africa, we wouldn’t have an Ebola vaccine,” he continued, referring to the Everbo jab created in 2015.
The virus can be carried by African green monkeys and pigs, as well as the Egyptian Rousette fruit bat. Among humans, it is spread mostly by people who have spent long periods in caves and mines populated by bats. Between humans, it spreads through bodily fluids and contact with contaminated bedding.
A major success story: reduction in child mortality
Tanzania’s marked reduction in child mortality over the past 2-3 decades is the kind of story that rarely makes headlines, but which should do so. A steady decline in the child mortality rate over this period means that currently 43 children die before reaching the age of five for every thousand children who are born. This is down by more than two thirds since 1999, when the figure was 147 per thousand.
Dr Felix Bundala, the assistant director for child health in the Ministry of Health ascribed the achievement to the successful adoption of Integrated Management of Childhood Illness (IMCI). IMCI is an integrated approach that aims at reducing preventable mortality, minimize illness and disability of children under five years of age, he explained. This includes focussing on increasing coverage of cost-effective interventions like immunizations.
According to Dr Bundala, between 2013 and 2018 over 7,000 providers from over 3,000 health facilities in 101 out of 185 councils had been trained in IMCI.
Dr Bundala listed pneumonia, malaria, diarrhoea as among the leading child killer diseases. Diarrhoea alone is responsible for nearly 20% of all under five deaths, but receives considerably less development assistance as compared to HIV, Malaria and Tuberculosis.
“It is only through IMCI where Pneumonia and Diarrhoea are captured. And therefore, it remains to be a priority intervention,” he pointed out.
He added that more work was needed to end preventable child deaths. In particular, he noted, there was a need for increased investment in primary health care interventions for children.