Kenya enhances preparedness for Marburg after Tanzania's outbreak

Kenya has stepped up its preparedness for Marburg virus disease (MVD) following the recent outbreak in the neighbouring Tanzania, which has reportedly claimed eight lives as of January 16.

Dr Patrick Amoth, the director-general of health, said that although Kenya has not recorded any cases of MVD, the Ministry of Health is proactively strengthening surveillance and response strategies to mitigate potential risks.

"Marburg virus disease is a haemorrhagic fever similar to Ebola and Great Valley fever. We are implementing a response plan that we will reactivate in the future. The Kagera region of Tanzania is close to the Migori border and serves as a transit hub for traffic to Rwanda, Burundi, Uganda and eastern DRC. Because of the interconnectedness of our region, we are at risk and have reactivated our systems, including surveillance, risk communication, community engagement and disease prevention control," Dr Amoth said.

These measures are designed to ensure a rapid and effective response should cases occur. Last year, the Ministry of Health developed a comprehensive training plan to equip health workers with the necessary skills to manage both Mpox and Marburg.

According to the World Health Organization (WHO), Kenya reported its first case and death of MVD in 1980. The disease reappeared seven years later, with two recorded cases and one death. 

In light of the situation, WHO has placed Kenya and five other countries on high alert for the viral disease. In a statement issued on January 15, WHO issued alerts for neighbouring countries including Uganda, Rwanda, Burundi, the Democratic Republic of Congo (DRC) and Mozambique.

"On January 10, WHO received reliable reports from national sources of suspected cases of MVD in the Kagera region of Tanzania. Six people were reportedly affected, five of whom died. The cases presented with similar symptoms, including headache, high fever, back pain, diarrhoea, haematemesis (vomiting blood), malaise (body weakness) and, in later stages, external haemorrhage (bleeding from orifices)," the WHO statement said.

In addition, nine suspected cases have been reported since January 11, resulting in eight deaths and a case fatality rate of 89 per cent in two districts, Biharamulo and Muleba. Samples from two patients have been collected and tested by the National Public Health Laboratory, but results are being awaited for official confirmation. Contacts, including health workers, have been identified and are being followed up in both districts.

Initially, Tanzania had dismissed the WHO report of a suspected outbreak of the Marburg virus in the north-west. In a statement, Tanzania's Health Minister Jenista Mhagama said that after analysing the samples, all suspected cases were found to be negative for the virus. But she stressed that the country had strengthened its surveillance systems and disease monitoring. 

However, Tanzania’s President Samia Suluhu has confirmed an outbreak of the virus in the country. Speaking on Monday at a press conference, she said: Laboratory tests conducted at Kabaile Mobile Laboratory in Kagera and later confirmed in Dar es Salaam identified one patient as being infected by Marburg virus.”

 Bukoba District in Kagera Region experienced its first MVD outbreak in March 2023, with zoonotic reservoirs such as fruit bats endemic to the area. This outbreak lasted almost two months and resulted in nine cases, including six deaths.

What you need to know about Marburg virus disease

What is Marburg virus?

The WHO says that Marburg virus is similar to Ebola and belongs to the filovirus family. Like Ebola, it affects the body in different ways, causing haemorrhagic fever with very high temperatures, muscle pain and gastrointestinal symptoms. The disease often leads to severe and extensive internal and external bleeding. 

Although some people can survive Marburg infection, it is one of the deadliest known human diseases. On average, about half of those infected will die, and in some outbreaks the case fatality rate has been as high as 88 per cent.

When was the Marburg virus discovered?

According to WHO, the Marburg virus was first discovered in 1967 in the German town of Marburg. That year, two large outbreaks occurred simultaneously in Hamburg and Marburg and were linked to laboratory work with monkeys from Uganda. 

Since then, sporadic outbreaks have been reported in Angola, the Democratic Republic of Congo, Kenya, South Africa and Uganda. In 2023, a Marburg outbreak in Equatorial Guinea infected at least 17 people, resulting in 12 deaths. A separate outbreak in Tanzania around the same time infected eight people and led to five deaths. Rapid containment measures brought these outbreaks to an end within a few months. 

On September 27, 2024, Rwandan health authorities reported the first outbreak of the disease in the country.

How is Marburg transmitted and what are the symptoms?

Marburg virus is transmitted from animals to humans primarily by fruit bats (Rousettus aegyptiacus), which are thought to be its natural reservoir. Human-to-human transmission occurs through direct contact with infected bodily fluids, contaminated materials or unprotected handling of infected corpses. The virus can also be spread by contaminated surfaces.

Symptoms typically appear suddenly after an incubation period of two to 21 days and include high fever, severe headache, muscle aches and extreme weakness. Gastrointestinal symptoms such as vomiting and diarrhoea may follow, along with severe bleeding (both internal and external), organ failure and shock. Without proper medical care, death can occur within eight to nine days of the onset of symptoms. It is important to note that Marburg is not airborne, meaning it does not spread through the air.

Can Marburg be treated or cured? Is there a vaccine?

Currently, there is no cure for Marburg and no licensed vaccines to prevent it. However, several potential drug treatments and vaccine candidates are in development phase. Three experimental Marburg vaccines are in early-stage (phase I) trials, and one developed by the Sabin Vaccine Institute has progressed to mid-stage (phase II) clinical trials. In April 2023, a WHO Vaccine Advisory Group recommended that the Sabin Marburg vaccine candidate be prioritised for inclusion in an emergency trial. From October 6, 2024, the Sabin vaccine was part of a clinical trial to control the outbreak in Rwanda.

Could this virus become a pandemic like SARS-CoV-2 and Covid-19?

It is unlikely that Marburg virus will cause a pandemic like SARS-CoV-2 and Covid-19. Similar to the Ebola virus outbreaks in the Democratic Republic of Congo and West Africa, large outbreaks can occur without adequate resources, patient isolation, clinical support and effective contact tracing. 

Although Marburg has the potential to cause severe illness, it does not spread as easily as SARS-CoV-2, which caused a global pandemic due to its highly contagious nature. The likelihood of Marburg virus causing a pandemic depends on several factors, including its mode of transmission and the effectiveness of public health measures to contain its spread. Therefore, although Marburg virus is a serious public health concern, current evidence does not suggest that it is likely to become a pandemic similar to SARS-CoV-2.

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