Neighbor Tuesday: Suspected Marburg in Tanzania and mysterious Congo outbreak
How the US pulling out of the WHO impacts response.
At the beginning of January, WHO received reports of 9 suspected cases in the upper western portion of Tanzania, the Kagera region. Of the cases, 8 had died. Let me tell you why this matters and how the US pulling out of the WHO could impact the response.
The importance of rapid response systems. After being notified of the first few cases, WHO sent out an alert to all Member States (think countries) through the Event Information Site (EIS). EIS was set up to serve as a communication hub to quickly and efficiently share alerts about acute public health needs. Think of the EIS like a weather map for disease outbreaks. Without the coordinated rapid response systems used by all member states, rapid dissemination of necessary public health information (like a suspected bird flu outbreak) is impacted. In other words, it takes more time to get alerts out to people. And, time matters in an outbreak like Marburg.
What is Marburg? Marburg Virus Disease, formally known as Marburg haemorrhagic fever, is like Ebola (although they are caused by different viruses) with similar symptoms and high fatality rates. Symptoms can be awful and include severe headaches, lots of severe GI distress, and muscle aches in the first week. After day 5-7, patients could develop blood in their vomit/feces and bleeding from the nose, gums, or vagina, hence the haemorrhagic name. Death usually happens at the week and a half point after profuse blood loss. It’s a horrific disease. I had a friend who served as a public health doctor during the 2013 Ebola outbreak in West Africa and described how horrible the disease was. Especially when so many people have it at the same time and you can’t treat them all.
Is Marburg deadly? Yes. Marburg has a high fatality rate - around 50%. HOWEVER, the range can be as low as 22% and as high as 90%.
So, why the wide range is survival rates? Marburg, similar to Ebola, does not have a high fatality rate when there is supportive clinical care available. I can’t stress this point enough. When countries and hospitals are equipped with supportive clinical care like IV hydration and intensive care and when patients can reach that care in time, survival is improved dramatically. So, it’s not a deadly disease, per se. It’s a deadly inequity. Marburg is deadly where there aren’t hospitals and medical care to help care for the patient.
In late 2024, Rwanda reported a Marburg outbreak. However, the fatality rate was 22.7%, the lowest rate reported. Of the 66 patients, 15 died. The low fatality rate was a result of incredibly swift contact tracing (think door to door surveillance), lots and lots of testing, and medicines. We need to highlight that the life-savings medicines or systems to deploy those to hospitals were already set up in Rwanda! An outbreak is not the time to set up a new system. But proactive planning pays off during outbreaks and is exactly what we saw in Rwanda. Equitably equipping health systems is certainly pat of neighboring.
What about the mysterious disease in the Congo? The WHO said that as of February 27, 1,096 are sick with an unknown disease and 60 have died in the Democratic Republic of the Congo. The median time from onset of symptoms to death is one day. Initial tests are negative for Ebola and Marburg. Half of tests came back positive for malaria, but that’s not unusual for this area and malaria does not have the swift symptoms like they are seeing. Rapid response teams have been deployed for more testing, contact tracing, and trying to figure out what the disease is and where it came from. The areas where the outbreaks are occurring are remote areas of the country, reachable by “road or via the Congo River’. Local health authorities are being helped by WHO teams but the WHO noted that “Further efforts are needed to reinforce testing, early case detection, and reporting, for the current event but also for future incidents.”
Why should we pay attention? Marburg is spread easily from person to person, especially when lots of people live in the same house or healthcare settings are crowded. It looks like the mysterious disease in the Congo is too. The combination of this with the high fatality rate and the need for early diagnosis to reduce the fatality rate makes for a perfect storm. You can imagine that this combination, though, is not equal. It depends on where you live. So, to me, it’s a disease of poverty or inequity. I think we should pay attention as global neighbors.
This brings me back to the outbreaks in Tanzania and the Condo. When the first cases were reported, rapid response teams have been deployed to conduct contact tracing (trying to find people who came into contact with someone infected), setting up mobile labs to test for additional suspected cases, and other surveillance activities. These activities are on-the-ground, intense, and take a coordinated team. In other words, it takes people. The WHO and CDC teams are trained to rapidly respond to outbreaks just like Marburg. However, if funding cuts happen at WHO (like if the US pulls out of the WHO), those rapid response teams could be limited. With the swift nature of how quickly something like Marburg could spread, rapid response is essential.
At this point, surveillance is ongoing. This is really important in the Kagera district. It serves as a major transport hub between Tanzania, Rwanda, Uganda, and Burundi. At least one of the suspected cases live in districts close to one of the borders, showing the need for continued surveillance and cross-country collaboration. Not closed borders or WHO funding cuts.
In solidarity,
Emily
PS: A special ‘hello’ to those of you in Tanzania, Rwanda, Uganda, and Burundi. This FNE newsletter is read in 150 countries with many of you on the African continent. Hello and thanks for reading!