"Sustain Gains, Save Lives"

“Sustain Gains, Save Lives” was the theme for this year’s World Malaria Day which was on the 25^th of April.

Global efforts to combat malaria have saved over one million lives worldwide and reduced malaria deaths in Africa by over 33% in 10 years according to the World Health Organisation. Despite this reported success there is a need to sustain this progress in the global campaign against malaria, and this can be done through increased investment and smarter inventions.

Tony Blair, the former UK Prime Minister, does not see any reason why malaria – an utterly preventable disease – cannot be eradicated in Africa and elsewhere.  Prevention and treatment of malaria is cheap. One insecticide-treated net plus distribution costs less than $10 while anti-malaria drug is less than $2 per person.

Rapid Diagnostic Tests (RDTs) help in the diagnosis of malaria by detecting evidence of malaria parasites in human blood. They allow the testing of people who cannot access diagnosis based on microscopy. Photo by Novartis AG

There is a challenge at present to raise around $3.2 billion to get to the point of a near-zero deaths by 2015. This additional funding would be used to purchase bed nets, which needs to be replaced every three years – this help control malaria as well as address the issue of drug resistance – and facilitate access to medicines and rapid diagnosis.

Children holding bed nets. Photo by Afrika Force

The African Leaders Malaria Alliance with Liberian President Ellen Johnson Sirleaf as its new chairman has agreed to close this resource gap through the following measures:

• Using World Bank funding to protect the eradication campaign’s progress and prevent a resurgence of the disease

• Increasing domestic financing for health services to achieve a previously agreed target allocation of 15% of public sector budgets to the health sector

• Considering innovative financing approaches to further expand Africa’s resource pool for health

However several donors and organization are doing a lot to eradicate malaria.

• Partnership for Transforming Health System 2 is working with the Clinton Health Access Initiative to help distribute artemisinin-based combination therapies in five Nigerian states through the Affordable Medicines Facility for malaria initiative, an innovative financing mechanism designed to expand countries access to ACT.

• African Development Bank meanwhile is helping support the control of communicable diseases in the Southern African Development Community region with a $30 million grant.

• The World Health Organization is also playing a part by launching a new initiative tagged T3: Test, Treat, Track. This initiative urges the global health community to scale up diagnostic testing, treatment and surveillance of malaria.

These new initiatives are a welcome addition to the many other program working to bring malaria deaths to a near-zero.

Lassa Fever In Nigeria

At the beginning of 2012, the Federal Ministry of Health in Nigeria notified the World Health Organisation of an outbreak of Lassa Fever in the country. As of 22^nd March 2012, 623 suspected cases have been recorded and this includes 70 deaths from 19 out of the 36 States since the beginning of the year. Among the fatalities are 3 doctors and 4 nurses. The presence of the Lassa virus has been confirmed in 108 patients by laboratory analysis at the Irrua Specialist Teaching Hospital, Irrua, Edo State.   (It must be noted that this information is provisional and subject to change as more laboratory results of suspected cases becomes available.)

The Federal and State government have responded to the outbreak by setting up an emergency response team for the purpose of enhancing the disease surveillance to enable early detection, reinforce treatment of patients and conduct awareness campaigns among the affected population.

WHO does not advise or recommend any restriction on travel or trade with Nigeria but travellers returning from affected areas are however advised to seek medical advice if they develop symptoms of fever, malaise, headache, sore throat, muscle pain, chest pain, nausea, vomiting, diarrhoea and abdominal pain.

Source: WHO Global Alert and Response(GAR), Disease Outbreak News

From this report it can be seen that Lassa fever cases have continue to increase in Nigeria. A previous report dated 22^nd February 2012 stated that in the first six weeks of 2012 there had been 392 cases of Lassa fever and 40 fatalities across the country. The Minister of Health reported that 2 doctors and 4 nurses were among the dead and cases were reported in 12 states: Edo, Nasarawa, Plateau, Ebonyi, Taraba, Yobe, Ondo, Rivers, Gombe, Anambra, Delta and Lagos. Currently the outbreak has spread to 19 states.

Map of Nigeria

Lassa fever is a zoonotic disease caused by the Lassa virus. The rodent of the genus Mastomys – commonly known as the “multimammate rat” – is the animal reservoir host for the Lassa virus. Mastomys rodents infected with the Lassa virus do not become ill and they shed the virus in their excreta.

Image from CDC: Special Pathogen Branch

The virus was first discovered in 1969 when two missionary nurses died in the town of Lassa, Borno State, Nigeria.

Humans become infected with the Lassa virus when they are exposed to the excreta of infected Mastomys rodents and the infection can spread further between humans through direct contact with the blood, urine, faeces or other bodily secretions of persons with Lassa fever. Person-to-person transmission occurs in both community and health care settings where the virus may spread through contaminated medical equipment such as re-used needles. The virus is present in semen for up three months after the disease begins, thus sexual transmission of Lassa virus can occur however there is no epidemiological evidence supporting airborne spread of the virus between humans.

In the absence of an effective vaccine, rodent control is the best option for the control of the current outbreak. Health care workers should also follow strict hygiene procedures during nursing of patients so as to prevent secondary cases.

Other preventive measures include:

• Good personal hygiene
• Good environmental hygiene
• Blocking all rodent hideouts
• Food items like grains, garri, yam powders etc which are used at homes should be stored in plastic sealed containers or rodent-proof containers and not in cartons or bags.
• Do not spread or keep food where rats can have access to them
• Clean the top of any can drink before mouthing or better still use a straw
• Public awareness about the outbreak of Lassa fever is also vital

Ongoing Investigation On The Outbreak Of Shigella flexneri Among MSM in UK

Shigellosis, also called bacillary dysentery, is caused by four species namely: Shigella dysenteriae, Shigella flexneri, Shigella boydii and Shigella sonnei. Shigella was discovered over 100 years ago by the Japanese microbiologist, Kiyosi Shiga for whom the genus is named.

Bacillary dysentery is primarily a human disease often transmitted by the consumption of food or drinking water contaminated with human faeces. Shigellosis can also be transmitted sexually. Sexual transmission of Shigella was first described in the United States during the 1970s. Since then, several outbreaks of sexually transmitted Shigella, predominantly in Men who have Sex with Men (MSM), have been reported. In 2006, an outbreak of Shigella among MSM in London coincided with a similar outbreak in Berlin suggesting that travel plays a role in introducing Shigella species to populations at risk. Man is the only significant reservoir of Shigella infection.

Other enteric illnesses, such as those caused by hepatitis A, Entamoeba histolytica, Giardia lamblia, Campylobacter, and Salmonella, also can be transmitted sexually. Because faeces can contain multiple pathogens, polymicrobial infections can result from a single sexual exposure. Outbreaks of sexually transmitted shigellosis might be observed more frequently than outbreaks of other sexually transmissible enteric organisms because the infectious dose is lower - as few as 10 to 100 organisms can cause disease - the illness produces symptoms that are more likely to bring patients to medical attention, and laboratory diagnosis is simpler.

The incubation period is between 12 and 96 hours. Illness is characterized by diarrhea, sometimes with blood and mucus and is common amongst young children although infection can occur in all ages after travel to areas where hygiene is poor. Invasive disease is rare but extra intestinal complications such as Haemolytic Uraemic Syndrome can occur. Cases maintain a low level of infectivity for as long as the organism is excreted in the stool. Shigella species may survive for up to 20 days in favorable environmental conditions and this may lead to transmission through contact with contaminated fomites.

In the Eurosurvelliance an article was published on an ongoing investigation by the Health Protection Agency (HPA) into the outbreak of Shigella flexneri serotype 3a in men who have sex with men in England and Wales using data from 2009 to 2011. An increase in UK-acquired cases of the infection was detected in London in November 2010 and Greater Manchester during the spring of 2011 and as a result a national outbreak control team (OCT) was established in September 2011 and an enhanced surveillance was set up to collect additional information for all laboratory-confirmed cases with sample dates between 1 September and 31 December 2011.

S. flexneri diagnoses reported by the national laboratories between 2001 and 2011 were also analysed to provide context to the current outbreak and to produce historical time trends.

One hundred and forty-five S. flexneri cases were diagnosed during the enhanced surveillance period between September and December 2011. Thirty-seven (25.5%) of these cases were non-travel related – a non-travel related case was defined as a laboratory confirmed case of S. flexneri with a specimen date between 1 September and 31 December 2011 with no recent travel.

Thirty-one of these cases were confirmed as being UK-acquired whereas six reported diagnoses were likely to be secondary cases linked to a symptomatic contact with recent travel to a high-risk country.

Eighty-six cases (59.3%) were associated with travel to high-risk countries - high-risk travel-associated diagnoses was defined as individuals who returned to the UK in the four days before onset of illness after travel to countries with high risk for Shigella infection (South America, Asia and Africa) - and the travel history was unknown for 22 individuals (15.2%). No low-risk travel-associated cases of S. flexneri were reported during the enhanced surveillance period - low-risk travel-associated individuals was defined as individuals who returned to the UK in the four days before onset of illness after travel to countries with low risk for Shigella infection (Europe, North America and Australia).

The UK-acquired cases were mainly males (n=26) with eleven of these male cases reporting MSM activity in the week before developing gastroenteritis. Interviews with seven MSM cases showed that they all had one long term partner and attended regular medical examinations. However, all cases reported having a casual sexual partner in the week preceding illness. These interviews revealed lack of awareness about Shigella and of the risks associated with unprotected oral and oral-anal sex. Ten of the thirty-one reported UK-acquired S. flexneri cases were serotype 3a.

From there investigations it was discovered that the historical time trends in diagnosed cases of shigellosis between 2001 and 2011 showed a gradual increase in the number of cases in both males and females with no or unknown history of travel up until 2008. However, from 2009 onwards, the number of diagnosed male cases increased rapidly compared to that of females.

Based on this study a strong association was observed between UK-acquired S.flexneri and transmission in MSM despite the fact that some individuals refused to disclose their sexual orientation. This outbreak will continued to be monitored, in the mean time some control measures aimed at effective management of cases and prevention of transmission have been put in place.

These include:

• Awareness among clinicians and MSM
• Prompt diagnosis and treatment
• Increased testing of MSM with diarrhoea
• Treatment of laboratory confirmed cases

As well as behavioural changes such as:

• Wash hands after use of toilets, before preparing or eating food and after sexual activity;
• Avoid anal sex, oral-anal, scat and rimming whilst symptomatic and until test for infection shows clearance;
• Use of condoms, gloves, dental dams during sex;
• Avoid sharing douching materials and sex toys;
• Avoid swimming pools and spa centres whilst ill and for two weeks after recovery.

Work is still ongoing by the investigators into identifying other risk factors for infection and evaluating other possible control measures such as screening of asymptomatic contacts.

Source: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20137

Doctor die of Lassa fever in Abakaliki

Doctor die of Lassa fever in Abakaliki
Source: The Nation


A Doctor has reportedly died of the Viral Hemorrhagic Fever, otherwise known as Lassa fever, in Ebonyi State.

Some other doctors are being treated for the disease at the Federal Teaching Hospital (FTH), Abakaliki.
Though no official confirmation has been made by the Ministry of Health, doctors have raised the alarm over the outbreak of the disease.

Some doctors at the FTH, who spoke to our reporter, regretted the outbreak of the disease, adding that doctors are prone to it since they are exposed to infected patients.

The doctors called for the quick intervention of the Federal Ministry of Health to forestall the spread of the disease.

The outbreak of Lassa fever was first reported in the state in 2008. Several people died. They included two doctors and other health workers. 

Last year, four persons said to be residing at the Military cantonment, Nkwoagu, near Abakaliki also died of the disease.

The government said it has set up an emergency response team for the treatment and control of outbreak of communicable diseases, such as Lassa fever, gastroenteritis and meningitis, usually associated with dry season.

The Commissioner for Health, Sunday Nwangele, said this while addressing stakeholders in Abakaliki.
Nwangele said epidemiologists from the ministry had been deployed to health facilities in the state to check the possible spread of the disease.

He urged the people to report any suspected case to a hospital or the epidemiology unit of the ministry.
The commissioner said the ministry had procured drugs for the treatment of the disease, adding that more was still expected from the Federal Ministry of Health.

Polio In Nigeria

Polio in Nigeria

Source: Bill and Melinda GatesFoundation.

Map: Global Polio Eradication Initiative

Nigeria’s thirty-six Executive Governors and the Federal Capital Territory have signed up for the Nigeria Immunization Challenge. The Nigeria Immunization Challenge is an initiative launched October last year by the Bill and Melinda gates Foundation.

The challenge was launched in conjunction with the Nigeria Governor’s Forum and calls on Governors and Local Government Area Chairmen to be proactive in their campaign against polio eradication, release funds in a timely manner for immunization and to work closely with traditional leaders to ensure that all children are vaccinated. 

The performance of each state will be assessed on a monthly and quarterly basis. The state that meets all the necessary threshold criteria by the end of 2012 will be awarded a $500,000 grant from the Bill and Melinda Gates Foundation to support their top health priorities. This could include priority initiatives in public health such as malaria and tuberculosis, HIV prevention and treatment or safe drinking water and hygiene promotion.

Fifty-one cases of wild poliovirus (WPV) were reported in eight Nigerian states for the year 2011 compared to 21 cases in 2010. The most recent case was a WPV1 with onset of paralysis on 27 November, 2011 in Niger state.  This is approximately a 59% increase showing that progress made in 2010 was not sustained in 2011.

 Figure: Showing cases of Wild Poliovirus in Nigeria for the year 2011.

“In 2012, Nigeria will need to redouble its efforts to finally get rid of this devastating disease,” said A.B. Okauru, the forum’s director general. Each state is also expected to achieve more than 90% coverage and this will be verified through an independent monitoring system managed by the World Health Organization.

“The sooner we end polio, the sooner we can ensure that our children, and the children of the world, stop suffering from this debilitating disease,” said Hon. Chibuike Rotimi Amaechi, Governor of Rivers State and Chair, Nigeria Governors’ Forum. “Meeting this Challenge will enable us to focus on other health priorities and also help Nigeria to join other countries that have eliminated this disease.”

Food-borne Trematodiasis

Food-borne Trematodiasis

Trematodes or flukes are flatworms belonging to the Phylum Platyheminthes. They are small parasitic flatworms that use vertebrates as their definitive host and mollusc as their intermediate host.

Trematode infections such as schistosomiasis have emerged as important tropical infections. An estimated 200 million people in the tropical belts of the world may have schistosomal infection. This makes Schistosoma infection the second most prevalent tropical infectious disease in areas such as sub-Saharan Africa after malaria.

Depending on the habitat in the infected host, flukes can be classified as blood flukes, liver flukes, lung flukes or intestinal flukes.

 

Blood flukes include Schistosoma haematobium, Schistosoma mansoni, Schistosoma japonicum, Schistosoma mekongi, and Schistosoma intercalatum.

Liver flukes include Fasciola hepatica, Fasciola gigantica, C sinensis, Opisthorchis felineus, O viverrini, Dicrocoelium dendriticum, and Dicrocoelium hospes.

Pancreatic flukes include Eurytrema pacreaticum, Eurytrema coelomaticum, and Eurytrema ovis.

Lung flukes include Paragonimus westermani, Paragonimus mexicana, and Paragonimus skrjabini.

Intestinal flukes include F buski, M yokogawai, Echinostoma ilocanum, Watsonius watsoni, H heterophyes, and Gastrodiscoides hominis.

In The Lancet Infectious Disease, Thomas Fürst and colleagues conducted a systematic review and meta-analysis to determine the global burden of human food-borne trematodiasis. Food-borne trematodiasis is a cluster/group of disease transmitted by the consumption of undercooked aquatic food contaminated with the larval stage of the fluke (i.e the metacercariae). The species of significant importance that affect human health are Clonorchiasis (infection with Clonorchis sinensis), Opisthorchiasis (infection with Opisthorchis viverrini or O.felineus) and Fasciolasis (infection with Fasciola hepatica or F. gigantic), which affect the liver and Paragonimiasis (infection with Paragonimus spp), which affect the lungs.

Food-borne trematodes have a complex life cycle which entails definitive hosts (humans and animal species that act as reservoirs of infection), a first intermediate host (a freshwater snail) and a second intermediate host (a fish or a crustacean) in which the infective metacercariae develop. Fasciola spp. is however an exception as the metacercariae are found attached to water plants or float freely in fresh water.

  Life Cycle of Five Different Food-borne Trematodes.

Fürst and colleagues used quantitative and qualitative data on prevalence, incidence, infection intensity, remission, mortality and duration to develop three simplified disease model and estimated the global burden of food-borne trematodiasis.

From their investigation they estimated that in 2005, 56.2 million people were infected with food-borne trematodes, 7.9 million people had severe sequelae and 7158 people died, while the global burden of the disease was 665 352 DALYs – 351 026 years lived with disability and 314 326 years of life lost. They also reported more men than women were infected by Clonorchis sinensis, Opisthorchis spp, all intestinal flukes and Paragonimus spp, whereas more women than men were infected by Fasciola spp.

 

These are findings are quite interesting as they show food-borne trematode infections as an emerging neglected disease. These infections occur in parts of the world where poverty persists, especially in East Asia, Southeast Asia and South America. However within a country, infection is usually focal and limited to specific regions or geographical areas. Many factors contribute to these high prevalence rate and they include: lack of education, malnutrition, poor sanitation, inability to recognise asymptomatic infections and neglect by local and international health authorities.

In their study, Fürst and colleagues highlighted several limitations one of which was high quality data. As such the global burden of food-borne trematodiasis might be much higher than reported by Fürst and colleagues. Therefore as Fürst and colleagues said, “the ultimate goal for future assessments of the burden of food-borne trematodiasis is to minimise the gap between actual and reported prevalence and between the complex natural histories of the diseases and the simplified models as applied in our calculations” .

Note:

Opisthorchis viverrini and Clonorchis sinensis have been designated carcinogens by the International Agency for Research Cancer.

Source:

Thomas Fürst, Jennifer Keiser und Jürg Utzinger.

Global burden of human food-borne trematodiasis: a systematic review and meta-analysis.

Lancet Infectious Diseases, Published online 21 November 2011,

doi:10.1016/S1473-3099(11)70294-8.

WHO: Initiative to estimate the Global Burden of Food-borne Diseases, 2011 http://www.who.int/foodsafety/foodborne_disease/ferg/en/index.html. (Accessed Sept 30, 2011)