By Mary Hearty
The Ministry of Health in Kenya has urged the general public to stay on high alert following the confirmation of Marburg Virus Disease (MVD) outbreak in Tanzania.
This is because the disease is often considered serious and fatal as it has a case fatality ratio of up to 88%, though can be much lower with good patient care.
First reported in Bukoba, Kagera Province in the North-Western part of Tanzania and the South-Western shores of Lake Victoria, the disease has affected eight people and resulted in five deaths. This equates to a 63% case fatality rate, according to a press statement by Dr. Patrick Amoth, the Director General of the Ministry of Health in Kenya.
The epicenter of the outbreak- Bukoba- is 611 kms to Kisumu and 1079 kms to Nairobi by road. Bukoba is the second largest port after Mwanza on Lake Victoria in Tanzania. The town is served by the Bukoba Airport and regular ferry connections to and from Mwanza that has connections with Kisumu in Kenya.
Moreover, there are a number of buses that ply the route between Bukoba and Kampala in Uganda on a daily basis and some of which end up in certain destinations in Kenya.
Further, it has been established that at least two buses with a capacity of 100 passengers ply the Mwanza- Sirare-Isebania border route. Some of the passengers originate from the epicenter of the current MVD outbreak.
Also, there is substantial human traffic between Tanzania and Kenya through informal land and maritime border crossing points along the South Western border with Northern Tanzania.
According to the health authorities, the patients had presented with symptoms of fever, vomiting, diarrhea, and bleeding through body opening as it is closely related to the Ebola Virus Disease.
“The Ministry wishes to inform the public to report any unusual increase in individuals presenting with high fever (hotness of the body) of unknown cause, and especially those with history of travel to Tanzania. Such individuals are advised to immediately report to the nearest health facility for assessment and management,” the statement reads.
The Ministry has assured Kenyans that it will remain vigilant as it has activated its surveillance and response mechanisms and enhanced surveillance at all border points between Kenya, Tanzania and Uganda. The Ministry has also directed all County Health Officials to be vigilant to identify and isolate any suspect cases for proper and timely management.
MVD is a febrile illness characterized by abrupt onset of high fever, severe headache and severe malaise, commonly associated with muscle aches and pains.
Severe watery diarrhea, abdominal pain and cramping, nausea and vomiting may follow shortly, with the diarrhea persisting for a week.
Many patients develop severe bleeding manifestations between five and seven days, and fatal cases usually have some form of bleeding, often from multiple areas. Fresh blood in vomitus and faeces is often accompanied by bleeding from the nose, gums, and vagina.
The incubation period (interval from infection to onset of symptoms) varies from two to 21 days. In fatal cases, death occurs most often between eight and nine days after symptom onset, usually preceded by severe blood loss and shock.
The statement also notes that Marburg spreads through human-to-human transmission via direct contact (through broken. skin or mucous membranes) with the blood, secretions, organs or other body fluids of infected people, and with surfaces and materials like bedding and clothing contaminated with these fluids. People remain infectious as long as their blood contains the virus.
The World Health Organization (WHO) advises use of a range of interventions to control the MVD. They include prompt isolation and case management; surveillance including active case search, case investigation and contact tracing; an optimal laboratory service; infection prevention and control, including prompt safe and dignified burial; and social mobilization as community engagement is key to successfully controlling MVD outbreaks.
Healthcare workers caring for patients with confirmed or suspected MVD are advised to apply additional infection prevention control (IPC) measures beyond standard precautions to avoid contact with patients’ blood and body fluids and with contaminated surfaces and objects.
WHO also recommends that male survivors of MVD practice safer sex and hygiene for 12 months from onset of symptoms, or until their semen twice tests negative for the Marburg virus. Contact with body fluids should be avoided and washing with soap and water is recommended.
WHO does not recommend isolation of male or female convalescent patients whose blood has tested negative for the Marburg virus.