After a concerning update from WHO in March 2023 on the Marburg virus situation in Equatorial Guinea and Tanzania, Gavi shares an interview with WHO’s Anaïs Legand. Legand is a viral haemorrhagic fever expert who spoke to Gavi’s Linda Geddes about Marburg virus and why we are seeing more outbreaks appear. The resounding message throughout her answers is the importance of working with and in the affected area, engaging the community in the response. 

What is the situation at the moment? 

On 7th April 2023 the total cases in Tanzania stood at 8, 7 of which were confirmed. The outbreak is seemingly confined to the Kagera Region of the northern side of the country. An investigation is ongoing to determine where exposure of the index case occurred. However, in Equatorial Guinea the outbreak is “likely to have started in December”, says Legand, meaning that “chains of transmission have gone undetected or not yet recognised”.  

“Equally concerning is that cases have been confirmed in five districts within four provinces throughout the mainland part of the country.”  

Legand states that “retrospective epidemiological investigation” has traced the source to a “fairly remote rural area” where some bats may be kept for food consumption.  

Why are we seeing more outbreaks? 

Geddes asked Legand why the spread and surge of cases seem to be increasing. Legand suggests that, on a map, the outbreaks are all within the “home range” of a specific bat species. However, although she recognises that we have had two outbreaks in different coutnries, this “doesn’t necessarily mean that there is an increased frequency”. 

“More likely, the capacity of countries to be able to detect cases has improved.” 

Thanks to improved surveillance in these countries, cases that previously might have gone unnoticed are now being identified. Still, due to the tendency of these cases to occur in “remote places” where access to healthcare facilities is limited, we are unlikely to know the “true number of events per year”.  

“We shouldn’t stigmatise countries for reporting cases, we should encourage them. If more events are reported, we are better prepared to respond, and we can save lives.”  

Although Legand acknowledges that there are no approved vaccines or therapeutics for Marburg virus disease, outbreaks can be stopped, and chance of survival improved.  

How, then, can we curb the spread? 

Legand identifies “several pillars of activities”, beginning with “surveillance and epidemiology”. Then community outreach is essential, to encourage people to seek treatment early. WHO works with the national laboratory or establishes a testing lab as “close as possible to the outbreak” with a system for sample transportation. Referring to “very specialised logistical work”, Legand highlights the importance of transport to facilitate these interventions. 

The next steps include “ensuring that health facilities in affected districts have adequate infection prevention and control procedures”. Reducing transmission within healthcare settings is essential. Another area is “working with the community” to encourage safe and “culturally acceptable” funeral practices. For example, washing the body of a dead patient is common in many areas, but there may still be fluids that contain the virus.  

“The most important thing is to make sure you build trust within affected communities. If the community is with you, everything is fine.”  

Community engagement means coordinating with local health and administrative authorities, as well as political and religious leaders. Legand is sensitive to the fact that no progress can be made without the community’s trust in the local health authorities. 

“The challenge is never the sick people, or their contacts. The challenge always comes when you’ve missed several of the steps from the beginning, starting with engaging these communities.”  

Practice is key 

Although every new outbreak is unique, Legand does identify interventions from previous experience. An example is the 2014 Ebola epidemic, during which medical staff found it hard to treat the high numbers of patients. Since that time the Alliance for International Medical Action developed the CUBE, which is a “portable single patient room with transparent plastic walls”. This allows medical teams to provide care from outside the unit. Additionally, we have “better diagnostic tests”.  

Hopefully with concerted and collaborative efforts these outbreaks will soon be declared over, and the affected communities and countries can continue to strengthen their surveillance and response strategies. 

To read the interview in full, click here. For more insight into the importance of community engagement from some of our experts at the World Vaccine Congress a few weeks ago, make sure you have subscribed to hear when the interviews are released.