Disease-hardened Africa already on alert for swine flu
Christina Scott, Deodatus Balile, Aimable Twahirwa, Lexy
Abutu
No swine flu has been reported yet in Africa, where there are so many
diseases with similar symptoms that researchers worry that they may not be able
to identify cases rapidly enough to prevent infection spreading.
In South Africa, researchers are being ''vigilant,'' according to Lucille
Blumberg, head of the Johannesburg-based Epidemiology & Surveillance Unit at
South Africa's National Institute for Communicable Diseases (NICD).
An article in Monday's International Herald Tribune claimed that there are
only two labs in the world that have developed the reagents that can “do a
positive test” for this strain, the Centres for Disease Control in the USA, and
the Canadian National Laboratory in Winnipeg.
However, Blumberg disputed this claim, saying today (April 29) ''we can test
and we will have the specific PCR (polymerase chain reaction) primers by the end
of the week.''
In some respects, many African researchers are already well prepared, with
rapid response medical teams accustomed to reacting to diseases ranging from
meningitis to Rift Valley fever to completely unknown new infections. South
Africa's NICD, for example, was widely praised for its prompt quarantining of
feverish suspects and its quick analysis and identification of a new arenavirus
infection which killed four people (including medical staff who treated the
initial case from Zambia) in October last year.
''Many African countries have surveillance for epidemics, and some systems
work well,'' Blumberg noted, highlighting the laboratories run across the
continent (including Madagascar) by the Pasteur Institute.
The problem, she said, was identifying swine flu when so many people were
sick with similar illnesses causing fevers.
''We have a huge burden of respiratory disease anyhow so it's not always
possible to tease out something that is a little different, when it presents
with similar symptoms,'' Blumberg told SciDev.Net this week (April 28).
''We are overwhelmed with tuberculosis, pneumonia and malaria, all of which
present similar symptoms to swine flu,'' she said.
However, many predominantly Muslim countries in West and North Africa have
good disease surveillance programmes in place to combat the risk of communicable
diseases such as cholera spreading after the annual pilgrimmages of millions to
Mecca in Saudi Arabia. Such existing surveillance programmes would assist such
countries to act against swine flu.
And researchers in many countries are in a far stronger position to detect
swine flu due to training and laboratory equipment upgrading to combat avian
flu. A notable exception is Zimbabwe, where medical staff have not been able to
monitor or contain the current outbreak of cholera due to electricity cuts,
petrol shortages and lack of even basic drugs.
No swine flu has yet been detected in East Africa, according to researchers
at the Nairobi-based Kenyan Medical Research Institute (KEMRI), which has
provided technical support for investigators tracking other disease outbreaks in
countries such as Uganda, Nigeria, Ethiopia, and southern Sudan. Laboratory
director Kariuki Njenga said KEMRI hosts the International Emerging Infections
Program (IEIP), part of the Global Disease Detection project, under the auspices
of the US-based Centres for Disease Control.
Tanzania's deputy minister for health and social welfare, Aisha Omar Kigoda,
told SciDev.Net this week (April 28) that the directorate of preventive services
was monitoring for swine flu at airports and other entry points on the mainland
and the island of Zanzibar. Blood samples from visitors showing signs of fever
will not be sent abroad for analysis due to recent laboratory equipment and
staff upgrading. Samples will instead be taken to the national influenza centre
laboratory at the National Institute for Medical Research (NIMR) in Dar es
Salaam for more rapid analysis.
The Tanzania government this week (April 28) issued a press release urging
people to cover their face with a cloth, especially if they are suffering from a
cough, to reduce the chances of spreading any infection at this time. The
government also appealed to the World Health Organization to provide additional
supplies of influenza medications such as Tamiflu or Zanamivir.
Researchers in Egypt, which has already had several outbreaks of avian flu,
is preparing on the assumption that it may well be hit soon by the new form of
swine virus, given its proximity to Europe, Africa and the Middle East and its
importance as both a trade route and a major urban centre.
Staff at Cairo’s Abbassia Fever Hospital, who are working closely with the
WHO Eastern Mediterranean office and the IEIP under Erica Dueger, say they have
the equipment and the skills to detect the virus. Abassia Fever hospital borders
the campus of the U.S. Naval Medical Research Unit 3 (NAMRU-3), which
specialises in influenza research, and the teams of researchers are already
collaborating.
In central Africa, even countries without coastlines, ports or major airports
have taken immediate precautions.
Rwandan health minister Richard Sezibera said this week (April 28) that
mobile medical teams are screening passengers for flu at all 10 border crossings
and Kigali airport.
Gamaliel Binamungu, director general of the Rwanda Health Communication
Centre, encouraged residents to respond to the global crisis by updating their
vaccinations. He urged people to go to the country's four main hospitals,
including Kigali University Teaching Hospital, for influenza shots, but warned
that there is no vaccine yet for swine flu.
Binamungu said Rwanda immediately installed a sentinel system to monitor for
swine flu outbreaks this week and will refer all suspect cases to the country's
five-year-old national reference laboratory, run by Odette Mukabayire Kramer.
However, in parts of West Africa, there are concerns that countries like
Niger and Nigeria - already hard-hit by meningitis outbreaks this year - lack
the surveillance and notification systems to detect the early signs of many
disease outbreaks, including swine flu. Nigeria's Ministry of Health announced
plans last year to establish a Centre for Disease Prevention and Control (CDC),
modelled on the US body, but it is not yet up and running. Nigeria only
introduced a basic national disease monitoring process in 1988 following an
major country-wide outbreak of yellow fever in the previous two years, which
went undiagnosed due to a lack of staff, equipment and procedures.
However, Nigerian Minister of Health Babatunde Osotimehin this week said the
country had adequate stocks of Tamiflu to treat swine flu. He urged health
workers to report any suspected swine flu cases to the epidemiology division of
the department of public health. The national hospital in Abuja said it had all
the equipment needed to identify cases of swine flu.
The Nigerian aviation authorities claimed monitoring for fever had been
strengthened at all ports of entry.
Osotimehin said that it would be difficult to provide a vaccine against swine
flu "because influenza viruses change very quickly and the match between the
vaccine and the circulating virus is very important to give adequate protective
immunity to vaccinated people.''
Anthony Mbewu of South Africa's Medical Research Council warned this week
(April 28) that although vaccine researchers had asked for samples of the
mutated swine flu virus, it could take ''three to four months'' at the minimum
to produce a more vaccine, and far longer to produce and distribute the drug. -Scidev.net
More information:
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This story was originally published on the Africa section of the Science and
Development Network website, http://scidev.net/en/sub-suharan-africa/
Nigeria federal ministry of health:
http://www.fmh.gov.ng/policies.htm
South Africa NICD http://www.nicd.ac.za
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