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Kinyenje E, Hokororo J, Ngowi R, Kiremeji M, Mnunga E, Samwel A, Sylvanus E, Mnken E, Yango M, Mtalika M, Mmbaga V, Saitoti N, Malecha A, Kundy F, Rwabilimbo M, Kaniki I, Mwisomba G, Charles E, Mughanga P, Kitambi M, Paul R, Richard E, Musyani A, Rabiel I, Haule G, Marandu L, Mwakapasa E, Manasseh G, Sindato C, Beyanga M, Kapyolo E, Jacob F, Mcharo J, Mayige M, Msemwa F, Saguti G, Kauki G, Masuma J, Mrema G, Kohi M, Yoti Z, Habtu M, Mwengee W, Mukurasi K, Gatei W, Ruggajo P, Kwesi E, Eliakimu E, Horumpende P, Magembe G, Nagu T. Infection prevention and control of highly infectious pathogens in resource-limited countries: an experience from Marburg viral disease outbreak in Kagera Region - Tanzania. BMC Infect Dis 2024; 24:628. [PMID: 38914946 PMCID: PMC11197355 DOI: 10.1186/s12879-024-09508-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 06/13/2024] [Indexed: 06/26/2024] Open
Abstract
Marburg viral disease (MVD) is a highly infectious disease with a case fatality rate of up to 90%, particularly impacting resource-limited countries where implementing Infection Prevention and Control (IPC) measures is challenging. This paper shares the experience of how Tanzania has improved its capacity to prevent and control highly infectious diseases, and how this capacity was utilized during the outbreak of the MVD disease that occurred for the first time in the country in 2023.In 2016 and the subsequent years, Tanzania conducted self and external assessments that revealed limited IPC capacity in responding to highly infectious diseases. To address these gaps, initiatives were undertaken, including the enhancement of IPC readiness through the development and dissemination of guidelines, assessments of healthcare facilities, supportive supervision and mentorship, procurement of supplies, and the renovation or construction of environments to bolster IPC implementation.The official confirmation and declaration of MVD on March 21, 2023, came after five patients had already died of the disease. MVD primarily spreads through contact and presents with severe symptoms, which make patient care and prevention challenging, especially in resource-limited settings. However, with the use of a trained workforce; IPC rapid needs assessment was conducted, identifying specific gaps. Based on the results; mentorship programs were carried out, specific policies and guidelines were developed, security measures were enhanced, all burial activities in the area were supervised, and both patients and staff were monitored across all facilities. By the end of the outbreak response on June 1, 2023, a total of 212 contacts had been identified, with the addition of only three deaths. Invasive procedures like dialysis and Manual Vacuum Aspiration prevented some deaths in infected patients, procedures previously discouraged.In summary, this experience underscores the critical importance of strict adherence to IPC practices in controlling highly infectious diseases. Recommendations for low-income countries include motivating healthcare providers and improving working conditions to enhance commitment in challenging environments. This report offers valuable insights and practical interventions for preparing for and addressing highly infectious disease outbreaks through implementation of IPC measures.
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Affiliation(s)
- Erick Kinyenje
- Health Quality Assurance Unit, Ministry of Health, P. O. Box 743, Dodoma, Tanzania.
| | - Joseph Hokororo
- Health Quality Assurance Unit, Ministry of Health, P. O. Box 743, Dodoma, Tanzania
| | - Ruth Ngowi
- Health Quality Assurance Unit, Ministry of Health, P. O. Box 743, Dodoma, Tanzania
| | - Michael Kiremeji
- Emergency Preparedness and Response Unit, Ministry of Health, P. O. Box 743, Dodoma, Tanzania
| | - Elice Mnunga
- Department of Pediatrics and Child Health, Bugando Medical Center, P. O. Box 1370, Mwanza, Tanzania
| | - Angela Samwel
- Emergency Preparedness and Response Unit, Ministry of Health, P. O. Box 743, Dodoma, Tanzania
| | - Erasto Sylvanus
- Emergency Preparedness and Response Unit, Ministry of Health, P. O. Box 743, Dodoma, Tanzania
| | - Emmanuel Mnken
- Health Promotion Section, Department of Preventive Services, Ministry of Health, P. O. Box 743, Dodoma, Tanzania
| | - Missana Yango
- Department of Internal Medicine, Dodoma Regional Referral Hospital, P. O. Box 904, Dodoma, Tanzania
| | - Mikidadi Mtalika
- Wildlife Research Institute, Kingupira Wildlife Research Centre, P. O. Box 16, Utete- Rufiji, Tanzania
| | - Vida Mmbaga
- Epidemiology Section, Department of Preventive Services, Ministry of Health, P. O. Box 743, Dodoma, Tanzania
| | - Noel Saitoti
- Bukoba District Council Hospital, Kagera Region, P. O. Box 491, Bukoba, Tanzania
| | - Alex Malecha
- Chato Zonal Hospital, P. O. Box 43, Chato- Geita, Tanzania
| | - Faith Kundy
- Department of Internal Medicine, Iringa Region Referral Hospital, P. O. Box 1260, Iringa, Tanzania
| | - Martin Rwabilimbo
- Bukoba Regional Referral Hospital, P. O. Box 299, Bukoba, Kagera, Tanzania
| | | | - Godwin Mwisomba
- Mirembe National Mental Health Hospital, P. O. Box 910, Dodoma, Tanzania
| | - Erica Charles
- Singida Regional Referral Hospital, P. O. Box 104, Singida, Tanzania
| | - Patrick Mughanga
- Department Emergency Medicine, Bugando Medical Center, P. O. Box 1370, Mwanza, Tanzania
| | - Mary Kitambi
- Emergency Preparedness and Response Unit, Ministry of Health, P. O. Box 743, Dodoma, Tanzania
| | - Radenta Paul
- Health Quality Assurance Unit, Ministry of Health, P. O. Box 743, Dodoma, Tanzania
| | - Erick Richard
- Emergency Preparedness and Response Unit, Ministry of Health, P. O. Box 743, Dodoma, Tanzania
| | - Atuganile Musyani
- Amref Health Africa in Tanzania, P. O. Box 2773, Dar es Salaam, Tanzania
| | - Irene Rabiel
- Amref Health Africa in Tanzania, P. O. Box 2773, Dar es Salaam, Tanzania
| | - Gift Haule
- Quality Assurance Department, Bugando Medical Center, P. O. Box 1370, Mwanza, Tanzania
| | - Laura Marandu
- Health Quality Assurance Unit, Ministry of Health, P. O. Box 743, Dodoma, Tanzania
| | - Emmanuel Mwakapasa
- Epidemiology Section, Department of Preventive Services, Ministry of Health, P. O. Box 743, Dodoma, Tanzania
| | - Gerald Manasseh
- President's Office - Regional Administration and Local Government, Dodoma, Tanzania
| | - Calvin Sindato
- Department of Clinical Research, National Institute for Medical Research, Tabora Medical Research Centre, P. O. Box 482, Tabora, Tanzania
| | - Medard Beyanga
- National Public Health Laboratory, P. O. Box 60000, Dar es Salaam, Tanzania
| | - Eliakimu Kapyolo
- Department of Clinical Research, Dodoma Medical Research Centre, National Institute for Medical Research, P. O. Box 805, Dodoma, Tanzania
| | - Frank Jacob
- Epidemiology Section, Department of Preventive Services, Ministry of Health, P. O. Box 743, Dodoma, Tanzania
| | - Jonathan Mcharo
- National Institute of Medical Research, Head Quarters, P. O. Box 2769, Dar es Salaam, Tanzania
| | - Mary Mayige
- National Institute of Medical Research, Head Quarters, P. O. Box 2769, Dar es Salaam, Tanzania
| | | | - Grace Saguti
- World Health Organization, Dar es Salaam, Tanzania
| | - George Kauki
- World Health Organization, Dar es Salaam, Tanzania
| | | | - George Mrema
- Epidemiology Section, Department of Preventive Services, Ministry of Health, P. O. Box 743, Dodoma, Tanzania
| | - Mugendi Kohi
- University of Iringa, P. O. Box 200, Iringa, Tanzania
| | - Zabulon Yoti
- World Health Organization, Dar es Salaam, Tanzania
| | - Michael Habtu
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | | | | | - Wangeci Gatei
- Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | - Paschal Ruggajo
- Directorate of Curative Services, Ministry of Health, P. O. Box 743, Dodoma, Tanzania
| | - Elias Kwesi
- Emergency Preparedness and Response Unit, Ministry of Health, P. O. Box 743, Dodoma, Tanzania
| | - Eliudi Eliakimu
- Health Quality Assurance Unit, Ministry of Health, P. O. Box 743, Dodoma, Tanzania
| | - Pius Horumpende
- Unit of Research Coordination, Directorate of Curative Services, Ministry of Health, P. O Box 743, Dodoma, Tanzania
- Department of Research and Innovation, Peoples' Defence Forces (TPDF) es Salaam, Lugalo Military College of Medical Sciences (MCMS) and General Military Hospital (GMH), P. O. Box Dar, Dar es Salaam, Tanzania
| | - Grace Magembe
- Office of Permanent Secretary, Ministry of Health, P. O. Box 743, Dodoma, Tanzania
| | - Tumaini Nagu
- Office of Chief Medical Officer, Ministry of Health, P. O. Box 743, Dodoma, Tanzania
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