Africa must ramp up its surveillance and detection infrastructure in the sunshine of an outbreak of the deadly Marburg virus in Ghana, public health leaders have warned.

Last month, Ghana recorded its first-ever Marburg outbreak after tests confirmed that two men had died from the disease.

The director-general of the Ghana Health Service (GHS), Patrick Kuma-Aboagye said the tests were conducted on the Noguchi Memorial Institute for Medical Research in Accra and corroborated by the Institute Pasteur in Dakar, Senegal.

On 2 August a World Health Organization (WHO) official said a toddler who had contracted the disease had also died, while a fourth case was also identified.

Kuma-Aboagye says community-based surveillance volunteers were deployed to assist detect and report cases of the Marburg virus disease that had killed three people in Ghana’s Ashanti region.

The director of public health of the GHS, Franklin Asiedu-Bekoe, told journalists that 98 people had been placed under strict surveillance and 39 had been discharged.

“Our approach is about containment. So, what we’re doing is that we’re ensuring that we discover all contacts by involving the community members who’ve higher knowledge in order that if the case should occur, we detect and manage,” he said at a press conferencein July.

That is the second time the zoonotic disease has been detected in West Africa. Guinea confirmed a single case in an outbreak that was declared over on 16 September 2021, five weeks after the initial case was detected.

Before Guinea, the disease had appeared in Central and East Africa.

Marburg is transmitted to people from fruit bats and spreads amongst humans through direct contact with the bodily fluids of infected people, surfaces, and materials, in response to the WHO. It’s a highly infectious viral haemorrhagic fever in the identical family because the better-known Ebola virus disease.

An outbreak of the disease within the Democratic Republic of Congo from 1998 to 2000 had a fatality rate of greater than 83 per cent.

Emily Lebughe Nzimo, a health care provider on the Kinshasa General Hospital, DR Congo, witnessed how deadly Marburg is, particularly in an under-resourced setting. She tells SciDev.Net that disease control measures have to be implemented at borders.

Faced with an absence of approved treatment and vaccine, we must develop public health mechanisms. We want to strengthen passenger control on the border.”

Emily Lebughe Nzimo, Doctor, Kinshasa General Hospital, DR Congo

Nzimo tells SciDev.Net that managing the Congo outbreak was difficult, particularly because drugs and protective gear for healthcare staff were limited.

“The Congo has never been prepared to face a generalised epidemic throughout the country,” she said. “So, it is admittedly not a wish that an epidemic arrives at this magnitude that we had.”

Nzimo said the present Marburg outbreak have to be treated as a public health problem.

“Of the 154 cases of contamination (in DR Congo), there have been 128 deaths. So though it’s a rare disease, Marburg ought to be considered a public health problem given its severity,” she said.

Nzimo says that countries in Sub-Saharan Africa must collaborate and pool resources to fight the disease. She says lessons might be learned from DR Congo’s management of the virus.

“Africa, Ghana and the DRC must collaborate on prevention. In countries where there’s an outbreak, that is the most effective approach,” she said.

“The indisputable fact that DR Congo has a history with the disease can grow to be an asset. Now that we understand how the disease presents itself and what we did to administer the disease, we are able to train other health staff within the region.”

Ebola’s ‘big brother’

Titus Beyuo, general secretary of the Ghana Medical Association (GMA), told SciDev.Net that Ghana health services had acted appropriately to contain the situation.

“We must, nonetheless, bear in mind that it is a disease that some people have described as Ebola’s senior brother,” he said. “It is a disease that has high fatality.”

Public health authorities in other countries have also sounded warning bells.

On 14 August, news of an outbreak of Marburg spread across Nigeria following a leaked memo from the University of Abuja Teaching hospital, titled Marburg Disease: Nigeria prepares for a possible outbreak. Nonetheless, the university denies that the country has witnessed an outbreak of the disease.

The hospital’s public relations officer, Sani Suleiman, tells SciDev.Net that there was no outbreak of Marburg virus disease within the hospital.

Suleiman said that the memo was imagined to be an internal one sent to staff to remind them to take proactive measures in case of an outbreak in Abuja or elsewhere in Nigeria.

“Unfortunately, one in every of our staff decided to send it to most people, without attaching the precautionary measures that we posted on our platform. The message was meant for proactive measures in case there was an outbreak in Nigeria because Ghana recently recorded cases of the disease.”

The top of communications on the Nigeria Centre for Disease Control, Yahya Disu tells SciDev.Net that Nigeria has no case of Marburg virus disease.
He said the country had intensified surveillance at the purpose of entry, to scale back the chance of importation from Ghana.

Disu says that Nigeria can test for the virus.

“The National Reference Laboratory in Abuja and the University of Lagos Teaching Hospital laboratory Centre for Human and Zoonotic Virology have the equipment to check and discover the virus. We now have the human, technical and laboratory capability to discover and manage the disease, in case it finds its solution to the country,” Disu explained.

Call to motion

Solomon Woldetsadik, emergency response officer of the WHO’s Africa Regional Office, told SciDev.Net that while Ghanaian authorities responded quickly, surveillance and detection systems have to be ramped up.

“Most countries try to step up surveillance, especially after Ebola,” he said. “There may be the hassle being made to discover and detect diseases like Marburg, but we will not be there yet.”

Woldetsadik said the WHO will proceed to work with countries within the region to assist discover and contain diseases.

WHO regional director for Africa Matshidiso Moeti said: “Health authorities have responded swiftly, getting a head-start preparing for a possible outbreak.
This is sweet because, without immediate and decisive motion, Marburg can easily get out of hand.”

Physician and project manager for the Kenya-based non-profit Amref Health Africa, Kabinet Kourouma told SciDev.Net that Ghana’s neighbours must implement safety measures at borders, including screening at entry and exit points, following up with passengers to see in the event that they develop symptoms, maintaining physical distancing and observing cough and sneezing etiquettes.

“It’s crucial to strengthen measures at the assorted borders by controlling the temperature, controlling the symptoms,” Kourouma said. “Alternatively, African countries normally and people of West Africa all have porous borders, we don’t have total control of all our borders. The official ones or not. This can also be a challenge.”

Constantin Bashengezi, a pharmacognosy researcher and CEO of Creppat laboratories in Kinshasa, DR Congo, tells SciDev.Net that as treatment and vaccines don’t yet exist, existing drugscould be adopted within the management of Marburg.

He cited locally known antivirals: the Ebanga treatment approved in December 2020 to fight the Zaire Ebola virus and antiviral Doubase C. developed by Creppat Laboratories.

“We should always extend the usage of existing antiviral drugs to other varieties of virus corresponding to Marburg or Ebola,” he said.