Infection prevention and control of highly infectious pathogens in resource-limited countries: an experience from Marburg viral disease outbreak in Kagera Region - Tanzania
Authors: Kinyenje Erick , Hokororo Joseph , Ngowi Ruth , Kiremeji Michael , Mnunga Elice , Samwel Angela , Sylvanus Erasto , Mnken Emmanuel , Yango Missana , Mtalika Mikidadi , Mmbaga Vida , Saitoti Noel , Malecha Alex , Kundy Faith , Rwabilimbo Martin , Kaniki Issessanda , Mwisomba Godwin , Charles Erica , Mughanga Patrick , Kitambi Mary , Paul Radenta , Richard Erick , Musyani Atuganile , Rabiel Irene , Haule Gift , Marandu Laura , Mwakapasa Emmanuel , Manasseh Gerald , Sindato Calvin , Beyanga Medard , Kapyolo Eliakimu , Jacob Frank , Mcharo Jonathan , Mayige Mary , Msemwa Faraja , Saguti Grace , Kauki George , Masuma Janeth , Mrema George , Kohi Mugendi , Yoti Zabulon , Habtu Michael , Mwengee William , Mukurasi Kokuhabwa , Gatei Wangeci , Ruggajo Paschal , Kwesi Elias , Eliakimu Eliudi , Horumpende Pius , Magembe Grace , Nagu Tumaini 
Published: June 2024

Marburg viral disease (MVD) is a highly infectious disease with a case fatality rate of up to 90%, particularly impacting resource-limited countries where implementing Infection Prevention and Control (IPC) measures is challenging. This paper shares the experience of how Tanzania has improved its capacity to prevent and control highly infectious diseases, and how this capacity was utilized during the outbreak of the MVD disease that occurred for the first time in the country in 2023.

In 2016 and the subsequent years, Tanzania conducted self and external assessments that revealed limited IPC capacity in responding to highly infectious diseases. To address these gaps, initiatives were undertaken, including the enhancement of IPC readiness through the development and dissemination of guidelines, assessments of healthcare facilities, supportive supervision and mentorship, procurement of supplies, and the renovation or construction of environments to bolster IPC implementation.

The official confirmation and declaration of MVD on March 21, 2023, came after five patients had already died of the disease. MVD primarily spreads through contact and presents with severe symptoms, which make patient care and prevention challenging, especially in resource-limited settings. However, with the use of a trained workforce; IPC rapid needs assessment was conducted, identifying specific gaps. Based on the results; mentorship programs were carried out, specific policies and guidelines were developed, security measures were enhanced, all burial activities in the area were supervised, and both patients and staff were monitored across all facilities. By the end of the outbreak response on June 1, 2023, a total of 212 contacts had been identified, with the addition of only three deaths. Invasive procedures like dialysis and Manual Vacuum Aspiration prevented some deaths in infected patients, procedures previously discouraged.

In summary, this experience underscores the critical importance of strict adherence to IPC practices in controlling highly infectious diseases. Recommendations for low-income countries include motivating healthcare providers and improving working conditions to enhance commitment in challenging environments. This report offers valuable insights and practical interventions for preparing for and addressing highly infectious disease outbreaks through implementation of IPC measures.