Friday, 24 August 2012

CHOLERA OUTBREAK


Cholera in Sierra Leone

 Since the beginning of the year, Sierra Leone has recorded 11 653 cases of cholera, with 216 deaths (Case Fatality Rate of 1.9%). The rate of new cases has accelerated rapidly since the beginning of August: since then, 5 706 cases have been recorded, and two new districts, Bonthe and Kono, have been affected by the epidemic. Ten of the country’s 13 districts are now registering cases and this spread emphasizes the need to rapidly scale up the response.
The two most heavily affected districts are Western Area and Tonkolili.
The President of Sierra Leone has declared the escalating cholera epidemic a “humanitarian crisis”. Consequently, a multi-sectoral approach to the response has been adopted involving the Ministry of Health and Sanitation (MOHS), as well as other line ministries such as finance, information and communication, and local government, together with partners and stakeholders. A National Emergency Task force has been established with sub-committees dealing with surveillance, case management, water and sanitation, logistics and social mobilization. The WHO Country Office (WCO) in Sierra Leone is chairing a weekly meeting of partners and stakeholders to better coordinate harmonize and strategize support.
The MOHS, in partnership with Médecins sans Frontières (MSF), UNICEF, WHO, and other partners, is implementing the following prevention and control activities: epidemiological investigation, surveillance, case management at established cholera treatment centres, water and sanitation control measures, social mobilization and community education.
WHO is supporting Sierra Leone in the areas of epidemiology, social mobilization and surveillance. WHO has deployed two epidemiologists, and three cholera experts from Zimbabwe to support coordination, public information, social mobilization, case management and infection control.
WHO does not recommend that any travel or trade restrictions be applied to Sierra Leone.

Thursday, 23 August 2012

OUTBREAK NEWS


Ebola outbreak in Democratic Republic of Congo - update

 As of 20 August 2012, a total of 15 (13 probable and 2 confirmed) cases with 10 deaths have been reported in Province Orientale in Eastern DRC. The reported cases and deaths have occurred in 3 health zones as follows: 12 cases and 8 deaths in Isiro, including three (3) health care workers who have died; 2 cases and 1 death in Pawa; and 1 fatal case in Dungu.
The Congolese Ministry of Health has convened a National Task Force and is working with several partners including WHO, UNICEF, Médecins sans Frontières (MSF) Suisse, MSF Belgique and the United States Centres for Disease Control and Prevention (CDC). Similar Task Forces have been established at provincial and district levels to oversee and guide the response.
A joint MoH, WHO and MSF emergency response team is in the field to conduct a detailed epidemiological investigation and support case management. Control activities that are being carried out include active case finding and contact tracing, enhanced surveillance, case management, public information and social mobilization, and reinforcing infection control practices.
WHO is supporting the Ministry of Health in the areas of coordination, surveillance, field epidemiology, laboratory, case management, outbreak logistics, public information and social mobilization. An additional team of epidemiologists, a logistician, an anthropologist and social mobilization officers is being mobilized from the DRC, Republic of Congo, the WHO AFRO regional rapid response team, WHO Inter-Country Support team (IST) based in Gabon, and WHO HQ, for possible deployment in the field.
WHO does not recommend that any travel or trade restrictions be applied to Democratic Republic of Congo.

Wednesday, 15 August 2012

AVIAN INFLUENZA UPDATE


Avian influenza – situation in Indonesia – update

 The Ministry of Health of Indonesia has notified WHO of a new case of human infection with avian influenza A(H5N1) virus.
The case is a 37 year old male from Yogyakarta province. He developed fever on 24 July 2012, was hospitalized on 27 July and died on 30 July.
Epidemiological investigation on the case found that the case had four pet caged birds in his home, which is about 50 metres from a poultry slaughter house and near a farm.
Infection with avian influenza A(H5N1) virus was confirmed by the National Institute of Health Research and Development (NIHRD), Ministry of Health and reported to WHO by the National IHR Focal Point.
To date, the total number of human influenza A(H5N1) cases in Indonesia is 191 with 159 fatalities, 8 (all fatal) of which occurred in 2012.

Tuesday, 14 August 2012

EBOLA IN UGANDA- UPDATE


Ebola in Uganda – update

 The Ministry of Health of Uganda (MoH) continues to work with partners including WHO, CDC, Red Cross, MSF, World Vision, PREDICT, among others to control the outbreak of Ebola haemorrhagic fever in Kibaale district. The national and district task forces continue to meet daily to coordinate the response to the outbreak.
To date, 24 probable and confirmed cases including 16 deaths have been reported. 10 cases have been laboratory confirmed by the Uganda Virus Research Institute (UVRI) in Entebbe. The most recent confirmed case was admitted in Kagadi isolation facility on 4 August 2012.
Suspected cases which tested negative during the laboratory investigations have been discarded as Ebola patients, treated symptomatically for their ailments and discharged following recovery. A total of 43 people have been discharged from the isolation facility including one confirmed case. With the support of the psychosocial team, these 43 people have been counselled prior to discharge and reintegrated into the community. Even for the people who were negative for Ebola, psychosocial counselling of the communities to which they are returning, has been very important. It has allayed fears and reduced stigma, enabling them to be accepted back in the community.
All contacts of probable and confirmed cases are followed up daily for 21 days and are monitored for any possible signs or symptoms of illness. All alerts of suspected cases in the other districts have been investigated and are negative for Ebola.
In Kibaale district, the MoH is working in close coordination with Médecins Sans Frontières (MSF) in clinical management of suspected and confirmed cases.
Social mobilization teams comprising Red Cross volunteers and village health teams have reached most of the villages and households in the most affected sub-counties in Kibaale district. These activities are reinforced by the distribution of Information, Education and Communication (IEC) materials, and by the broadcast of health awareness messages on radio and by film vans.

Neighbouring countries

Countries sharing borders with Uganda are taking steps to enhance surveillance for Ebola; at the time of this update, none of them have reported any confirmed cases.
WHO does not recommend that any travel or trade restrictions are applied to Uganda.

Thursday, 26 July 2012

contradictions for yellow fever vaccination.


You must not be given Stamaril if you or your child:
• are allergic (hypersensitive) to eggs, chicken proteins or any of the ingredients of Stamaril
• have experienced a serious reaction after a previous dose of any yellow fever vaccine
• have a poor or weakened immune system for any reason such as illness or medical treatments (for example corticoids or chemotherapy)
• have a weakened immune system due to HIV infection. Your doctor will advise you if you can still have Stamaril based on the results of your blood tests.
• are infected with HIV and have active symptoms due to the infection
• have a history of problems with your thymus gland or have had your thymus gland removed for any reason.
• have an illness with a high temperature or acute infection. The vaccination will be postponed until you have recovered
• are less than 6 months old.

FAKE YELLOW FEVER CARDS


On March 2 this year, 125 Nigerians on Arik Airlines plane to Johannesburg were denied entry and deported by the South African port health authority. The authority had concerns about the validity of the yellow fever vaccination cards, which the passengers had as proof of having been vaccinated against yellow fever. Nigeria reciprocated by deporting more than 60 South Africans; thus a diplomatic feud ensued until South Africa apologised.
Yellow fever, which is a viral haemorrhagic fever,  is endemic in West Africa since 50 per cent of the population is not vaccinated. And Nigeria, according to a WHO report, is at risk of yellow fever outbreak while South Africa is not. 
Tony, who works at one of the airlines’ stalls at the international airport said: “Yes, the fake cards were being sold freely before the disagreement between South Africa and Nigeria, but now things are a little different. I would even advise you to get vaccinated. It would help you and it is cheaper; it is just N500. People buy the fake cards because they want to get it for someone else or they don’t want to be injected.”
A visit by The Nation to the Port Health Services at MMIA ascertained the persistence of the fake cards. The Chief Nursing Officer, who did not acquiesce to the publication of her name in print, said, “The fake yellow fever cards, which had been seized by the port authority from passengers, still bear 1969 as the year of inception of issuance. Whereas it has been reviewed; now the new original ones bear 2005.
She described the incorrect vaccine batch numbers that were filled in the counterfeit cards. These, particularly, were the features the South African port health authority said they found unrecognisable and unacceptable. She said of intending passengers interested in fake cards, “These people claim they are healthy. They say, ‘I don’t have malaria; I don’t have fever.’ They don’t know yellow fever is a disease on its own and the vaccine prevents it. Yellow fever has the tendency to perforate any organ. It can kill a lot of people within 72 hours.”
Known symptoms of yellow fever are jaundice (yellowness of the skin and membranes), congestion of the face, widespread haemorrhage, nausea, and vomiting of blood. According to Wikipedia, every year, 30,000 deaths out of 200,000 cases of yellow fever occur in endemic areas. 
The Chief Nursing Officer, who is also a community health expert said: “The essence of vaccination is to prevent trans-boundary communication of the disease. We shouldn’t let citizens of this country infect citizens of another country, and vice-versa.” 
It should be noted that danger associated with the international transmission of yellow fever is the high mortality that accompanies the infection of population that has not been infected (non-endemic areas), while natives in endemic areas are relatively protected by acquired immunity. 
On the status of the relationship of the Port Health Services with South Africa, the Chief Nursing Officer said, “South Africa does not accept vaccination cards from any other health facility, be it University of Benin Teaching Hospital or University College Hospital. They only accept those of Port Health Services. Also, there is a secret way we fill the original cards, and this is only known by us and the port health officers in South Africa.” She, however, did not say if any secret arrangements had been made with other countries to ensure authenticity of the cards. 
She lamented the plight and ignorance of those who were deported in the past for possessing fake cards, 
“A woman and her daughter had purchased the fake cards at N2,500 per card, only to be sent back to Nigeria. Deportees had bought the fake cards because of sheer ignorance, and because Nigerians just like short-cut to everything. These people don’t know that the yellow-fever vaccine should be administered 10 days before travelling, because it is by this time the traveller would be immunised. Also, some travel agents had also helped prospective travellers acquire fake yellow fever vaccination cards.”
A prospective traveller on the queue at the departure section of MMIA, who refused to be named, showed his yellow fever vaccination card. It was worn out and did not have the real stamp of the Port Health Services; it only had the Nigerian Coat of Arms imprint. “I have been using this card for a while. My agent procured it for me. It cost N1000. I wasn’t given any injection; In Nigeria, we don’t do that jare.” 
When asked if she would attribute the sale of fake cards to laxity in the manner the Port Health Services officers discharge their duty, the Chief Nursing Officer said: “We had the vaccines, but travellers did not come. Even though it was just N500 and we administered the vaccine to them, they would rather buy the expensive fake ones without being vaccinated. However, after the South Africa problem, a lot of people have been coming here to get vaccinated. We also have a 24-hour operational clinic at the airport where people can be vaccinated.” 
This reporter saw would-be passengers being vaccinated at the MMIA clinic. When a nurse was asked if the yellow fever vaccination cards could be obtained without vaccination or for someone else, she said, “No.”
On the implementation of plans by the Federal Government to curb the peddling of the fake cards, the Chief Nursing Officer said: “Directives have been given to the Nigerian Air Force and State Secret Service to arrest those printing and selling the cards. The Federal Government has said it would commission the Central Bank of Nigeria to formulate and print new cards so that they will not be easily copied.” 
The yellow fever vaccination card, also known as International Certificate of Vaccination or Prophylaxis, had been used to certify vaccinations against yellow fever, cholera and small pox for long. It could also be used to certify other vaccinations that individual countries may require before entry is permitted. 
After the certificate was revised in 2005, only yellow fever vaccination remained mandatory. In 1973, Cholera vaccine was stopped, while WHO declared on May 8, 1980 the eradication of small pox vaccination. Immunisation against yellow fever lasts for 10 years.