Rapid response to Marburg Virus Disease outbreak in the United Republic of Tanzania leading to containment within 92 days (2024)

On 16 March 2023, an unknown disease was reported in the Kagera region of the United Republic of Tanzania, prompting immediate investigation by health authorities. Within five days, the Ministry of Health identified the illness as Marburg virus disease (MVD), a highly virulent virus that causes haemorrhagic fever with a fatality ratio of up to 88 percent. This discovery triggered prompt implementation of well-coordinated response strategies by the World Health Organization (WHO) in support of the Ministry of Health effort to respond the outbreak, including the activation of Public Health Emergency Operation Centres, rapid mobilization of resources through the WHO's Contingency Fund for Emergencies, and real-time sample testing. A coalition of various stakeholders rallied to effectively manage the outbreak. Despite the highly infectious nature of MVD, these strategic efforts contained the outbreak within 92 days to just 9 cases of which 6 died. This successful intervention was the result of the focused priority on rapidly containing public health events which is articulated as one of the four strategic priority areas of the Country Cooperation Strategy (CCS 2022-2027) that aligns with the Health Sector Strategic Plan V (HSSPV) of the country.

“The swift and efficient response to the Marburg virus outbreak needs the utmost recognition. Thanks to the tremendous support from the government, WHO, and other partners, we were able to fight and win this health emergency.”

- Dr Kaniki, Regional Medical Officer for Kagera, United Republic of Tanzania

How did the United Republic of Tanzania, with the support of WHO, achieve this?

Upon notification of the outbreak, WHO promptly activated its Contingency Fund for Emergencies (CFE) to rapidly escalate operations and respond to the crisis within 24 hours. Furthermore, it sought additional support from Member States, including the United States Agency for International Development (USAID), and the United Kingdom’s Foreign, Commonwealth & Development Office (FCDO). Under the leadership of the Ministry of Health (MoH) and with WHO's technical guidance, national and regional Public Health Emergency Operation Centers (PHEOCs) were activated, and a detailed response plan was swiftly formulated and enacted.

The Incident Management System (IMS) was activated on 21 March 2023, with WHO providing orientation to national and regional officials on its framework and reallocating its staff to fully support the Ministry in managing the outbreak. Moreover, WHO collaborated closely with partners such as Médecins Sans Frontières (MSF), Save the Children, the United Nations Children's Fund (UNICEF), the United States Centers for Disease Control and Prevention (US CDC), and the World Food Programme (WFP). These organizations convened daily at the WHO-established Emergency Operations Centre (EOC) to oversee the crisis and direct PHEOCs toward appropriate actions.

^{WHO and partners strategizing for the Marburg virus disease (MVD) response at the WHO Emergency Operations Centre (EOC) in the United Republic of Tanzania in March 2023.}
Photo credit: Priscilla Mawuena Adjeidu, Communications Officer

To bolster support in the affected area, WHO dispatched a team comprising its own staff and local experts to provide essential training to local health workers. This training encompassed critical measures such as surveillance, contact tracing, infection prevention, case investigations, laboratory processes, and clinical management. Additionally, the team adapted various response tools to suit the local context. WHO also intensified efforts in risk communication, community engagement, point-of-entry screening, and mental health and psychosocial support (MHPSS), assuming the role of technical lead and co-chair of the national task force to ensure effective coordination.

A pivotal strategy employed was the 7-1-7 approach, designed to detect suspected outbreaks within 7 days, notify public health authorities and initiate investigations within 1 day, and implement effective response measures within an additional 7 days. Furthermore, WHO advocated for and facilitated the establishment of a mobile laboratory by the Ministry of Health, augmenting testing capabilities with additional kits donated by WHO and its partners. This initiative streamlined testing processes and enhanced the overall efficiency of the response effort.

“God gave me another chance at life and helped me survive up to this moment because what I experienced was out of this world.”

- Dr Mahona Ndulu, Marburg virus disease survivor and doctor at Maruku Health Centre in Kagera, United Republic of Tanzania

The Minister of Health's decisive leadership, in tandem with WHO's coordination and robust collaboration with partners, exemplified an exceptional response to the Marburg virus outbreak. Furthermore, the United Republic of Tanzania benefitted greatly from the readiness activities in the sub region implemented during the Ebola outbreak in Uganda (in 2022), coordinated by WHO, which enhanced the country operational readiness and enabled them to rapidly mount an effective response. This scenario underscored the critical imperative for readiness and rapid intervention in combating infectious diseases. Honourable Ummy Mwalimu, the United Republic of Tanzania's Minister of Health, emphasized that “the end of this outbreak should be the beginning of preparedness for any future outbreak” and affirmed that “the Government will continue to take timely and appropriate measures to ensure welfare of Tanzanians as well as the international community.” WHO remains committed to providing continual guidance and essential support to the Government in this endeavour. To achieve this, the commendable synergy among stakeholders demonstrated during this crisis must be sustained to maintain and build on the progress achieved.

References

1. World Health Organization. Marburg Virus Disease outbreak in Tanzania declared over [news] (accessed 9 February 2024).
2. World Health Organization. Marburg virus disease – United Republic of Tanzania [Disease outbreak news] (accessed 9 February 2024).
3. Frieden et al. (2021). 7-1-7: an organising principle, target, and accountability metric to make the world safer from pandemics. The Lancet (accessed 9 February 2024).