The looming threat of Marburg disease outbreak in Tanzania, East Africa – an Editorial

Dear Editor,

On the 21st of March 2023, Tanzania’s Ministry of Health (MoH) announced its first-ever Marburg virus disease (MVD) outbreak. The initial recorded case had a travel history from Goziba Island in Tanzania and exhibited symptoms of diarrhea, vomiting, and renal failure upon returning and died in his village in Bukoba. Later on, four members of the same family got infected, and two healthcare workers who had treated them also fell ill, with one loss to death. The eighth case is still under investigation, with no currently available information¹. Amidst coronavirus disease 2019 (COVID-19) and the newly discovered monkey-pox disease, this deadly MVD is certainly a global health concern that needs serious global health attention, especially in Tanzania. And as a result of the first outbreak of MVD in Tanzania, its looming effect could be dangerous to the Tanzanians and, eventually, the world if nothing is done to mitigate it as soon as possible. As researchers, we believe that it is our responsibility to identify these looming threats of MVD outbreak in Tanzania and to proffer possible interventions in preventing future outbreaks of MVD in Tanzania.

The Marburg virus (MARV), is a close relative of the Ebola virus, which is a member of the Filoviridae family (filoviruses), which causes serious viral hemorrhagic fever in humans². It is classified as a category A pathogen by the Centers for Diseases and Prevention Control (CDC) and the National Institute of Allergy and Infectious Disease (NIAID), having a mortality rate of up to 90% worldwide³. The first MVD outbreak was reported in Marburg, Germany, in 1967, when laboratory personnel got infected while working on African green monkeys that were imported from Uganda in order to create a polio vaccine. Following this epidemic, different sporadic outbreaks were later reported in South Africa, Kenya, Europe, the USA, Congo, Angola, Uganda, Ghana, and Equatorial Guinea⁴.

Sadly, Tanzania, one of the Eastern African countries, recently recorded its first-ever confirmed case. The high population mobility within the Eastern African region poses a risk of cross-border spread of MVD as Tanzania shares a porous border with Uganda⁵. Another obstacle for the Tanzanian government and health authorities is the poor infrastructure and lack of resources, particularly in rural areas where the outbreak was first identified. This situation could also be aggravated by the long incubation period of the virus, which ranges from 2 to 21 days or 28 days⁶. Again, we speculate that there are possibilities that there may be many more cases that have not been identified or reported or even underreported.

A class of fruit bat, named Egyptian rousette bat or Rousettus aegyptiacus, which is primarily found in African caves and mines, serves as the Marburg virus’ reservoir host. Because of the bat’s wide geographical distribution, there may be more places at risk for an MVD outbreak⁷. The Marburg virus can spread to humans through infected intermediate animals or direct contact with bodily fluids (e.g. blood, semen, saliva, urine, tears, mucus, and breast milk of individuals infected with the virus) and improper handling of corpses. Healthcare workers treating individuals affected with the Marburg virus can also increase the risk of transmission². Marburg virus can survive in aerosols causing airborne transmission and on surfaces for extended periods of more than 3 weeks, increasing fomite transmission risk during outbreaks⁸. Clinical manifestations are difficult because they resemble more widespread infectious diseases like malaria, dengue, and Ebola virus in that region. Vomiting, diarrhea, and abdominal discomfort suddenly appear, along with a high fever, acute myalgia, headaches, and upper respiratory symptoms (cough, chest pain, pharyngitis). A serious hemorrhagic rash manifest after 5–7 days of infection⁹. Fresh blood is frequently seen in the vomit and feces of deceased patients, along with bleeding from the nose, gums, or vagina, which results in shock or multiorgan failure 8–9 days after infection¹⁰.

It can be difficult to make an early diagnosis of MVD during an outbreak due to its incubation period. A number of methods, such as polymerase chain reaction (PCR) and immunoglobulin M capture enzyme-linked immunosorbent assay (ELISA), are utilized to confirm a diagnosis. Procedures for virus isolation must be carried out in extremely secure labs. In the advanced stages of the illness, immunoglobulin G capture ELISA may be helpful¹¹. These pathogens can only be handled in maximum containment facilities and are categorized as selective agents because there are no licensed treatments or vaccinations for MARV infections. Stopping transmission remains the best measure that can be taken to prevent the spread of this zoonotic disease¹². Patient management entails both symptomatic and supportive care, including rehydration, correction of electrolytes abnormalities, hemodynamic support, adequate oxygenation, pain control, blood transfusion, and treating any complications that may arise in the patient¹³.

According to the World Health Organization (WHO) regional officer in Tanzania, the Tanzanian government and health ministry are striving hard to contain the epidemic of MVD and quickly scaled up control measures to stop the spread of the virus with the assistance of WHO specialists⁵. To control the spread of MVD, especially in Tanzania, more measures should be taken by avoiding contact with fruit bats R. aegyptiacus and infected individuals². Similar control measures to those used for other hemorrhagic fevers should be employed by healthcare providers and family members in Tanzania, such as wearing personal protective gear, isolating infected individuals, and proper sterilization and disposal of equipment and waste⁹. To lessen the challenges encountered as a result of the COVID-19 mutation, researchers in Tanzania should concentrate more on identifying any virus mutations and developing a novel treatment for MVD. The Tanzanian government should also focus on mass education through awareness and campaigns about the signs and symptoms of MARD among the Tanzanian population.

Furthermore, we are urging the international communities, especially the neighboring countries of Tanzania, to provide valuable assistance by supplying medical equipment, personnel, and funding to strengthen the health system in the country. Furthermore, the Tanzanian government should temporarily restrict travelers and foreigners traveling to Tanzania for now, and visitors that are already present in Tanzania should take extra precautions and monitor their own symptoms for at least 1–2 months after leaving certain Tanzanian regions to ensure that there is no further transmission of the virus among the Tanzanian people.

Overall, in general, efforts must be made to address the root causes of disease outbreaks in Tanzania, such as deforestation, climate change, and population displacement, which disrupt the natural habitats of fruit bats, the natural reservoir of the MARV¹⁴. Improved surveillance, rapid response teams, and investment in research for new treatments and vaccines are crucial to better prepare for and respond to outbreaks like MVD in Tanzania and the world at large, which are likely to occur more frequently in the future. If all our recommendations are well implemented in Tanzania, we are optimistic that together we can stop the spread of the Marburg virus and other deadly infections in the country and will be able to safeguard public health and well-being worldwide.

Ethical approval

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Consent

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Sources of funding

No funding received for this editorial work.

Author’s contribution

M.B.T. and K.F.: conceptualization of ideas; A.A.: funding acquisition; D.D.: investigation; K.F.: project administration; M.B.T. and K.F.: resources; A.A.: software; M.O.O.: supervision; All authors: validation; M.O.O.: visualization; M.B.T. and K.F.: writing–original draft; M.O.O. and K.F.: writing – review and editing. All authors were involved in the final approval of the manuscript for publication.

Conflicts of interest disclosure

The authors declare that they have no conflicts of interest.

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Guarantor

Malik Olatunde Oduoye.

Data availability statement

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Provenance and peer review

Not commissioned, externally peer-reviewed.