Introduction
Marburg virus disease (MVD) is a highly fatal viral haemorrhagic fever (VHF), like Ebola, in the filoviridae family with a fatality rate that can reach as high as 88%.1 2 To curb the MVD outbreak, a rapid coordinated emergency response alongside stringent infection prevention and control (IPC) measures is required. MVD outbreaks have occurred sporadically in specific regions since the disease was first identified in 1967 during outbreaks in Marburg, Germany and Yugoslavia, linked to infected monkeys imported from Uganda.3 Subsequent outbreaks have been reported in the Democratic Republic of Congo,4 Angola,5 Uganda6 7 and, most recently, Equatorial Guinea in 2023 and Rwanda in 2024. The absence of specific antiviral treatments or approved vaccines further exacerbates its devastating impact.
On 21 March 2023, Tanzania experienced its first MVD outbreak in the Kagera region, located in the northwestern part of the country. The outbreak was triggered by a cluster of illnesses and deaths in Bukoba district, which were confirmed as MVD through laboratory testing. The outbreak lasted for 72 days, ending on 1 June 20238 9 and six patients died. The second outbreak in Tanzania occurred in the same region but in a different district (Biharamulo) on 20 January 2025.10
VHF treatment units play a crucial role in responding to these outbreaks by providing a safe environment for optimal patient care and reducing transmission risks through the isolation and treatment of infectious patients in a bio safe healthcare facility.11 The need for a designated treatment unit closer to areas of transmission has been emphasised to enhance the quality of care for patients and mitigate possible transmission risks; this has been termed decentralisation. While the advances in clinical care of MVD have significantly evolved and are well documented,12 the health system and infrastructure modifications of healthcare facilities during the outbreaks have been rarely addressed.
In response to the MVD outbreak in Tanzania in 2025, a Marburg treatment unit (MTU) was rapidly established within an existing district hospital building constructed in 2018 to enhance outbreak management. All patients accessing healthcare in the hospital were transferred to other nearby facilities to continue with medical care, a critical intervention to prevent human-to-human transmission, which is the predominant form of MVD transmission. The facility was strategically repurposed into a dedicated MTU, with a structured layout designed to optimise patient management and IPC to meet the standards for the highly infectious disease treatment unit (IDTU).13 The MTU was organised into multiple treatment zones, effectively separating suspected and confirmed cases while implementing strict protocols to minimise viral transmission, cross contamination and observe biosecurity measures. The design emphasised controlled circulation, clear demarcation between high-risk and low-risk zones, and efficient management of personnel, patients, personal protective equipment (PPE), IPC and medical supplies and waste.
This paper highlights the approaches adapted in the transformation of the Biharamulo district hospital facility into a treatment unit for MVD response, detailing its structural modifications, biosecurity and IPC strategies, and overall impact on the safety of frontline healthcare workers (HCWs), outbreak containment and patient outcomes.
This article aims to document innovative solutions used in transforming an existing hospital into an MTU and to share such best practices for adapting healthcare infrastructure in resource-limited settings for future outbreaks of highly infectious diseases.
Study design
This is real-time operational research conducted at MTU in Biharamulo, Tanzania, a facility rapidly adapted from an existing hospital structure established in 2018. A comprehensive data collection approach was employed, incorporating observational assessments, facility design analysis and clinical data review.
Study setting
Tanzania is a country of 67 million people, with 26 geopolitical regions and 139 districts. Kagera region is one of the 26 regions and is in the north-western part of Tanzania, bordering Uganda in the north, Rwanda and Burundi in the west. Biharamulo district is one of the eight districts of the Kagera region of Tanzania with 457 114 population.14 It is bordered to the north by Karagwe district and Muleba district, to the east and south by Geita Region, to the west by Ngara District and to the southwest by the Kigoma Region. Its administrative seat is Biharamulo town. Biharamulo Game Reserve is located within the borders of the district. Biharamulo has 17 wards and the outbreak occurred only in Ruziba ward in which one village was affected. figure 1.
Facts Only
* Marburg virus disease (MVD) has a fatality rate up to 88%.
* MVD outbreaks occurred in Marburg, Germany and Yugoslavia in 1967.
* Outbreaks have been reported in the Democratic Republic of Congo, Angola, Uganda, Equatorial Guinea (2023), and Rwanda (2024).
* Tanzania's first MVD outbreak occurred in the Kagera region from 21 March 2023 to 1 June 2023.
* Six patients died during the 2023 Tanzania outbreak.
* A second MVD outbreak began in the Biharamulo district of the Kagera region on 20 January 2025.
* A Marburg treatment unit (MTU) was established within a district hospital building constructed in 2018.
* All existing hospital patients were transferred to other facilities during the MTU activation.
* The MTU design includes multiple treatment zones to separate suspected and confirmed cases.
* The study uses real-time operational research including observational assessments, design analysis, and clinical data review.
* Biharamulo district has a population of 457,114.
Executive Summary
Marburg virus disease is a severe viral haemorrhagic fever with high mortality rates and no approved vaccines or specific antiviral treatments. In Tanzania, the Kagera region has faced two distinct outbreaks: one in 2023 resulting in six deaths, and a second starting in January 2025 in the Biharamulo district. To manage the 2025 event, health authorities repurposed a 2018 district hospital into a dedicated Marburg treatment unit (MTU).
The transformation involved clearing the facility of all other patients to prevent human-to-human transmission and restructuring the layout to meet infectious disease treatment unit standards. The design focuses on decentralizing care—placing treatment closer to transmission sites—and utilizes strict zoning to isolate suspected and confirmed cases. This operational approach aims to optimize infection prevention and control (IPC) and protect frontline healthcare workers in a resource-limited setting.
Full Take
This operational research utilizes ACADEMIC MODE, documenting the rapid adaptation of healthcare infrastructure during a public health emergency.
1. Methodology Check: The study is described as "real-time operational research." While the use of observational assessments and design analysis is appropriate for describing a facility's layout, there is a lack of quantitative baseline data regarding the "impact" on patient outcomes or worker safety. A peer reviewer would note that without a control group or a pre-intervention comparison, the claims regarding "effectiveness" are descriptive rather than causative.
2. Claims vs Evidence: The text claims the MTU design optimizes patient management and IPC. However, the provided excerpt focuses on the *intent* and *structure* of the design rather than the *measured results* of that structure. The conclusion that this was a "best practice" requires data on transmission rates within the facility to be fully substantiated.
3. Literature Context: The work extends existing knowledge by shifting focus from clinical care (well-documented) to the systemic and infrastructural modifications of healthcare facilities. It justifies its novelty by addressing the "rarely addressed" topic of physical facility repurposing in resource-limited settings.
4. Real-World Implications: If this model of rapid decentralization and repurposing is validated, it provides a blueprint for other regions to respond to filoviridae outbreaks without needing to build new structures from scratch.
5. Bridge Questions: What was the specific rate of nosocomial transmission among healthcare workers in this repurposed facility compared to the 2023 outbreak? How did the total evacuation of the district hospital impact the general health outcomes of the non-MVD population in Biharamulo?
Counterstrike Scan: The content is a technical description of emergency medical infrastructure; it lacks the emotive drivers or strategic distortions characteristic of an influence campaign.
Sentinel — Human
The text reads like a factual summary of an epidemiological event and a subsequent operational study, exhibiting the logical structure typical of human-authored reporting or research documentation.