Dar es Salaam ‒ Mishana* was taken ill at Bujunangoma Hospital in Kagera, a region in north-western Tanzania, in mid-March. The facility had just been designated as an isolation centre for suspected cases of a then yet-to-be-confirmed outbreak of an infectious disease that had been reported in the region.

The hospital hosted a mobile laboratory set up earlier as part of response readiness to viral infectious diseases, as neighbouring Uganda was combatting an outbreak of Sudan Virus Disease in October 2022. The laboratory – established with support from World Health Organization (WHO) and the United States Centers for Disease Control (US CDC) – along with another one allowing for bedside testing, enabled rapid investigation of suspected cases isolated at the facility.

Within 48 hours of Mishana being taken ill, Tanzania’s Public Health Laboratory in Dar es Salaam confirmed that the illness reported in Kagera was Marburg Virus Disease.

Meanwhile, a rapid response team had already deployed to Kagera by the time Mishana was admitted thanks to response capacity built through training and simulation exercises conducted in early 2023 and in 2019 during an Ebola outbreak in the Democratic Republic of the Congo, as well as routine readiness efforts and experience gained in response to the COVID-19 pandemic.

The readiness capacity was also the result of years of collaboration between the Tanzanian government and its partners, including WHO, United States CDC, Africa CDC, the United States Agency for International Development and other partners. Together they identified five regions – all border regions, highly populated, or international travel hubs – including Kagera, for health emergency preparedness and response support.

“We got tremendous support from central government and national and international partners in this response,” says Dr Issessanda Kaniki, Kagera’s regional medical officer. “The swift disbursement of funds from the Ministry of Health and partners enabled the rapid response team in Kagera to move quickly to wherever they were most needed, and to deliver critical support. It made a lot of a difference.”

Just prior to the Marburg outbreak, 135 first responders from several ministries had completed a month-long WHO training to reinforce emergency response. This qualified them for immediate deployment in the event of a health emergency. Nineteen were deployed to Kagera to remain there until the end of the outbreak.

To further bolster emergency response preparedness, WHO has also rolled out training on the third edition of its Integrated Disease Surveillance and Response technical guidelines, which help all people from all levels of the health system to conduct surveillance activities for responding to priority diseases and conditions.

In support of the outbreak control efforts, WHO deployed four technical officers to reinforce coordination, surveillance and contact tracing, treatment and infection prevention and control measures. Finding people who have been exposed to an infected person and closely watching them after exposure helps the contacts to get care and treatment and prevent further transmission of the virus.

A total of eight confirmed and one probable cases, and six deaths, including a health worker, were recorded in the outbreak. Eighty-nine health workers who came in contact with cases were monitored for Marburg symptoms for 21 days. None fell ill. They have all since returned to work.

Dr Joseph Hokororo, head of infection prevention and control at Tanzania’s Ministry of Health, credits the training and on-site support that health workers received. “Health workers now strictly observe IPC (infection prevention and control) procedures and are more confident in their work.”

As the country counted down to the end of the outbreak, key emergency response aspects were maintained to quickly detect and response to any new cases. Laboratory technicians continued to take samples from people with Marburg-like symptoms to ensure robust surveillance, while Marburg survivors received mental health and psychosocial support.

Members of the Emergency Operations Centre at the Kagera regional referral hospital continue to monitor all the aspects of the Marburg outbreak control measures as they learn from the experience to boost their capacity to tackle any future outbreaks.

Now back home, Mishana, who was discharged from hospital after almost three weeks, welcomes the visits of social workers who regularly check on him and his family.

“This family has gone through a lot,” says Rebeccah Gwambasa, head of the mental health and psychosocial support division of the outbreak response. “We continue supporting them, and the community around them, to heal mentally and accept survivors back into the community.”

*Pseudonym to protect identity