No longer a numbers game as swine flu spreads inevitably across southern Africa

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No longer a numbers game as swine flu spreads inevitably across southern Africa

In South Africa the focus would shift from "counting cases" to strengthening monitoring and surveillance systems, cluster outbreaks, serious cases requiring hospitalization and high-risk communities.

South Africa has recorded over 114 laboratory confirmed H1N1 influenza cases - more commonly known as swine flu - but the executive director of the National Institute for Communicable Diseases (NICD), Prof Barry Schoub, conceded at a Johannesburg media briefing on 13 July that "there are probably many more [cases]".

Dr Frew Benson, of South Africa's National department of Health, said: "The problem in Africa is that the surveillance systems are not as good as in the western world ... there will be more cases," but the vast majority of infections were mild.

So far, all the cases have been detected by private health care services, but most South Africans use the overburdened public health care system for medical treatment.

Gauteng province, the country's economic hub, has recorded 39 infections, most of which occurred at a Johannesburg university squash tournament, but cases of swine flu have been identified in all of the country's nine provinces.

Schoub said the incidence of swine flu was expected to increase with the end of the public school holidays on 20 July, as "all respiratory infections go down during school holidays and go up again when schools start" because children were "reservoirs" for viruses.

A total of 193 confirmed swine flu cases have been recorded in 10 African countries, but as yet there have been no fatalities.

Shifting focus

Benson said in South Africa the focus would shift from "counting cases" to strengthening monitoring and surveillance systems, cluster outbreaks, serious cases requiring hospitalization and high-risk communities.

High-risk communities were similar to those classified as at higher risk of common influenza, such as people managing existing conditions like diabetes, emphysema, chronic bronchitis, HIV/AIDS, those aged 65 years or older, and pregnant women.

Dr Lucille Blumberg, head of epidemiology at the NICD, said there had been "no confirmed community transmissions" as yet in South Africa, and no indication that swine flu would have a more severe impact on people living with HIV/AIDS than other influenzas.

Most of the world's people living with HIV/AIDS are in southern Africa.

Zimbabwe

Zimbabwe, which was unable to contain a recent cholera epidemic that killed more than 4,000 people and has a health system close to collapse, said it was prepared to combat swine flu.

One Zimbabwean competing in the Johannesburg squash tournament was confirmed as infected. Henry Madzorera, Zimbabwe's health minister, told IRIN: "At this stage, we don't know if he was infected in Zimbabwe or South Africa."

Madzorera said the World Health Organization had supplied antiviral drugs to Zimbabwe. "So far, I can say we are prepared to deal with swine influenza to some degree, as we have 21,400 courses of drugs to treat it."

Botswana

In Botswana, Health Permanent Secretary Newman Kahiya said in a statement: "The public is hereby informed of the first confirmed case of Pandemic Influenza A(H1N1) 2009 in Gaborone [the capital], Botswana. Laboratory confirmation was received this morning (10th July 2009)." It is understood that the reported case is a male patient in the capital.

"The Ministry of Health has been working on a prevention, control and mitigation strategy ever since reports of the outbreak were reported in other parts of the world," Kahiya said. "Systems and structures are in place to monitor and address the situation. The public will be continuously updated as and when new developments unfold."

The government has established a toll-free number for reporting any suspected cases of swine flu - IRIN

More information:

National Institute for Communicable Disaeases: SA http://www.nicd.ac.za/

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July 2009	Article

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