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Tanzania declared a Marburg Virus Disease (MVD) outbreak on March 21, 2023, reporting nine cases and six deaths (case fatality rate (CFR) 66.7%). Detection began when a Community Health Worker (CHW) reported unexplained illness via the electronic EBS (e-EBS) system, triggering a national outbreak response. This study documents the Early Warning, Alert and Response (EWAR) interventions carried out during the MVD outbreak response in the Kagera region to identify strengths and bottlenecks for strengthening future outbreak preparedness and response efforts. We documented EWAR interventions using retrospective surveillance document review. MVD outbreak detection and reporting timeliness were compared with Tanzania's EBS indicators and the 7-1-7 target. Surveillance interventions included additional staff deployment, equipment addition, and tool adoption. Community sensitization efforts utilized Swahili-translated informational cards to facilitate early detection and reporting of signals through multiple channels, including the 199-hotline number, EBS desk numbers and via e-EBS and verified using the standard case definition (SCD). Signals were compiled in Microsoft Excel, where descriptive analysis using frequencies to show trends was conducted. Suspected MVD cases were sent for laboratory confirmation. On March 15, 2023, a CHW reported a signal in the e-EBS system within 24 hours. However, a community member and HCWs missed unusual signs of the MVD index case. Five additional members were deployed to support data management using the equipment provided, including three laptops, ten smartphones, and adapted tools. A total of 6,260 informational cards were distributed during community sensitization; 176 MVD signals were reported, where 48 (27.3%) met the SCD, and 37 were sent for laboratory confirmation, of which 2.7% tested positive for the virus. Most signals, 107 (60.8%), were reported in April. The government should adopt the 7-1-7 target and strengthen community and health facility EBS through ongoing mentorship for EWAR.

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.

Chytridiomycosis, caused by the fungus Batrachochytrium dendrobatidis (Bd), is fatal to some amphibian species, whereas others can carry the pathogen without developing disease. Among the vulnerable species is the Kihansi Spray Toad, Nectophrynoides asperginis, endemic to the Kihansi Gorge spray wetlands in Tanzania's Udzungwa Mountains. By 2009, chytridiomycosis had driven N. asperginis to extinction in the wild, though it survives in captivity. Re‐introduction efforts have faced difficulties, underlining the importance of understanding Bd's prevalence in the wild to guide re‐introduction programs. Twenty years after Bd was first detected in Tanzania's Kihansi Gorge spray wetlands, we re‐evaluated its prevalence and examined whether the pathogen was responsible for the 98% mortality observed among the 1000 captive‐bred N. asperginis released there in February 2022. In December 2022, time‐constrained surveys were conducted across three spray wetlands covering N. asperginis habitat. Amphibians were skin‐swabbed following a protocol developed by the University of California, resulting in two sets of 44 samples from seven species. These samples were analyzed for Bd presence using conventional and real‐time quantitative polymerase chain reaction, followed by nucleotide sequencing of PCR products. Bd was detected in 32% of samples, representing four out of the seven species: Arthroleptides yakusini (14%), N. asperginis (9%), Ptychadena anchietae (7%), and Hyperolius substriatus (2%). Whereas N. asperginis was severely affected, the other species did not show signs of the disease. The other three species, namely, Hyperolius mitchelli, Afrixalus fornasinii, and Arthroleptis xenodactyloides, were not detected with Bd. A lineage‐specific qPCR diagnostic test confirmed Bd‐CAPE as the cause of the mass deaths of the released toads. The continuing presence of Bd‐CAPE in the spray wetlands remains a barrier to the successful re‐introduction of N. asperginis, necessitating further experimentation to develop strategies for coexistence. How to manage the continued impact of Chytrid fungus on Kihansi Spray Toad population in the wild.

Background Marburg virus disease (MVD) is a deadly illness caused by the zoonotic Marburg virus, which has led to outbreaks with fatality rates up to 100% in some African countries. On March 21, 2023, Tanzania had its first MVD outbreak, resulting in nine cases and six deaths, leading to a fatality rate of 66.7%. Following that, the Risk Communication and Community Engagement (RCCE) approach was promptly initiated to create community awareness regarding the MVD. A descriptive cross-sectional assessment was conducted in May 2023 in Bukoba District Council and Bukoba Municipal Council in the Kagera region to document the community awareness and sources of information regarding MVD during the outbreak. Data were collected using a structured questionnaire developed using the WHO COVID-19 RCCE Rapid Quantitative Assessment Tool. Descriptive analysis was conducted using Microsoft Excel 2021. Results There were a total of 714 community respondents, of whom 456 (63.9%) were from Bukoba District Council. The majority 628 (88%) were aged 18 years and above. There were 393 (55%) females, and 407 (57%) of respondents had completed primary education. All respondents reported being informed about MVD through different channels, with 588 (82.4%) receiving information from Community Health Workers. Most of them 573 (80.3%) were satisfied with implemented RCCE interventions, 651 (91.2%) perceived MVD to be an extremely severe disease, and 698 (97.76%) mentioned hand washing as one of the recommended preventive measures. Conclusions During the Marburg virus disease outbreak response, where risk communication and community engagement interventions were implemented, the community was aware of the Marburg virus disease and community health workers emerged as the most frequently mentioned channel of communication during the outbreak.