We are not prepared to handle Marburg virus, experts say

East Africa continues to grapple with the growing threat of deadly viruses, with the Marburg virus now posing a significant risk to the region.

Recently, Tanzania reported a suspected outbreak of viral hemorrhagic fever in its Kagera region, which has already claimed eight lives, raising alarms about the capacity of East African health systems to handle such threats.

Public health experts are warning that despite the region’s endemic history with diseases like Marburg, healthcare systems remain dangerously underprepared to effectively manage outbreaks of this deadly virus.

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Dr Joseph Kariuki Gichui, a public health specialist focusing on infectious diseases, provides a sobering assessment of the region's readiness.

"We are not anywhere close to being prepared if it were to become an outbreak of large proportions," he warns, pointing to concerning trends in mortality rates.

The virus's historical trajectory tells a troubling story. When first discovered in 1967 in Marburg, Germany, the case fatality rate was approximately 23 per cent. However, modern outbreaks in African nations often see mortality rates soaring to 60-88 per cent, highlighting a stark disparity in healthcare capabilities.

While Kenya's Director General of Health, Dr Patrick Amoth, has assured the public that the country has heightened its surveillance following Tanzania's outbreak, public health expert’s express skepticism about the system's robustness.

"The Ministry of Health has reactivated our systems including surveillance, risk communication, and infection prevention control," Dr Amoth stated during a media briefing on the state of health in Kenya on Wednesday.

However, Dr Gichui argues that the current approach to disease outbreaks remains too reactive. "We need continuous and consistent surveillance," he says.

"These diseases are not going away. We need to create systems that accommodate these sporadic outbreaks, not be caught completely unprepared each time."

Rwanda's recent experience with Marburg offers a promising contrast. The country's outbreak, declared over in December 2024, infected 66 people and resulted in 15 deaths – achieving a remarkably low fatality rate of 23 per cent, the lowest ever recorded for Marburg in Africa.

This success is attributed to robust pandemic preparedness, rapid deployment of specialized treatment facilities, and early access to experimental drugs and vaccines.

The challenge of containing Marburg is complicated by its initial symptoms, which mirror common ailments like malaria. "In the first week, somebody is still shedding the virus but presenting with non-specific symptoms like fever and joint pains," Dr Gichui explains.

"In a malaria-endemic zone, these cases are often misdiagnosed initially, leading to  household transmission before the true nature of the illness becomes apparent."

The virus's progression is particularly concerning. Rather than causing dramatic external bleeding, Marburg attacks blood vessels, leading to internal fluid loss and organ failure. "If during that phase, somebody was given IV fluids and drugs to stop coagulation, they could survive," says Dr Gichui.

"But this requires well-equipped facilities and trained personnel – resources that are often lacking in primary healthcare settings."

Kenya's situation remains particularly vulnerable due to recurring healthcare worker strikes and under-resourced primary health facilities. The country's position as a major transit hub, especially in regions bordering Tanzania, adds to the concern.

The Kagera outbreak's location near the Kenyan border has prompted increased vigilance, but experts question whether existing measures are sufficient.

Regional statistics paint a concerning picture. Since its discovery, Marburg virus has caused numerous outbreaks across Africa, with the largest recorded outbreak occurring in Angola in 2004-2005, resulting in 374 cases and 329 deaths (an 88 per cent fatality rate).

The virus has also appeared in Uganda, the Democratic Republic of the Congo, and South Sudan, with varying mortality rates but consistently challenging health systems.

The WHO emphasizes that more cases may emerge in Tanzania, given the delayed detection and ongoing contact tracing efforts. Health authorities are currently monitoring contacts of infected individuals, including healthcare workers, while awaiting laboratory confirmation from Tanzania's national laboratory.

The key to fighting Marburg, according to experts, isn't just about sophisticated surveillance systems or specialized laboratories – it requires strengthening basic healthcare infrastructure from the ground up.

"If the health systems don't work, these viruses can, with concerted effort, be prevented and also the amount of death and disease can be controlled," Dr Gichui states. "But for that to happen, the healthcare system has to be robust."