Category Archives: Infectious Disease Control

Quarantine works against Ebola but over-use risks disaster

LIBERIA HEALTH EBOLA

A man in the United States has become the first known international traveller to be infected in the West Africa Ebola epidemic and carry the virus abroad. He is thought to have been infected in Liberia and developed symptoms six or seven days after arriving in the United States to visit family. He’s being treated in isolation in Dallas, Texas.

 

Quarantine, in the form of isolation, is an important component of the response to Ebola infection. As people are infectious only once they develop symptoms, isolating them and having health-care workers use personal protective equipment significantly reduces the risk of onward transmission.

 

The director of the US Centers for Disease Control and Prevention (CDC) says the man will continue to be treated in isolation. In a process known as contact tracing, everyone he has come in contact with since he became symptomatic on September 24 will be located and monitored for 21 days (the maximum incubation period of the virus). Anyone who shows symptoms will also be isolated and treated.

 

The Ebola virus is unlikely to spread further in the United States because these measures are known to be effective. Indeed, their absence has contributed significantly to the spread of the virus in resource-poor nations of West Africa.

 

The benefits of quarantine

 

Countries have been practising this measure against infectious diseases well before we understood what caused and transmitted infections. The earliest mention of isolating people in this way is in the books of the Old Testament, for leprosy and other skin diseases.

 

The word “quarantine” comes from the Italian “quaranta giorni” which simply means “40 days”. It refers to the 40-day isolation period imposed by the Great Council of the City of Ragusa (modern day Dubrovnik, Croatia) in 1377 on any visitors from areas where the Black Death was endemic. In its most basic form, quarantine is the isolation of people with a disease from unaffected people.

 

The measure has clear benefits; it was effective during the 2003 pandemic of SARS-coronavirus when the isolation of cases and their contacts for ten days was arguably one of the most significant interventions for containing the outbreak in only five months.

 

And it has frequently been used to control Ebola outbreaks. Since the virus' first and most severe outbreak in 2000, Uganda has used quarantine measures to good effect, isolating contacts of cases for up to the 21 days of the viral incubation period.

 

Surveillance, a more Ebola-educated populace and targeted quarantine measures have meant Uganda had only 149 cases with 37 deaths, one case and death, and 31 cases with 21 deaths in subsequent outbreaks in 2007, 2011 and 2012.

 

Nigeria has also demonstrated the efficacy of a contact tracing and isolation approach. Despite being one of the most populous countries in Africa and having cases introduced into Lagos, a city of 21 million people, its last case was seen on September 5.

 

Removing infected and potentially infectious people from the community clearly helps reduce the spread of disease, but it still requires a place for people to be isolated and treated. That’s what’s missing in countries still in the midst of the epidemic, and also what continues to drive it.

 

Too much of a good thing

 

While quarantine is an important weapon in our arsenal against Ebola, indiscriminate isolation is counterproductive.

 

The World Health Organisation has warned that closing country borders and banning the movement of people is detrimental to the affected countries, pushing them closer to an impending humanitarian catastrophe. Stopping international flights to the affected countries, for instance, has led to a shortage of essential medical supplies.

 

Still, this didn’t stop Sierra Leone from imposing a stay-at-home curfew for all of its 6.2 million citizens for three days from September 19 to 21. Results from this unprecedented lockdown are unverified, with reports of between 130 and 350 new suspect cases being identified and 265 corpses found. But in a country where the majority of people live from hand to mouth with no reserves of food, the true hardship of the measure is difficult to quantify.

 

In addition to the three-day lockdown, two eastern districts have been in indefinite quarantine since the beginning of August. On September 26, Sierra Leone’s president, Ernest Bai Koroma, announced that the two northern districts of Port Loko and Bombali, together with the southern district of Moyamba, will also be sealed off. This means more than a third of the country’s population will be unable to move at will.

 

Sierra Leone’s excessive quarantine measures are having a significant impact on the movement of food and other resources around the country, as well as on mining operations in Port Loko that are critical for the economy.

 

The country had one of Africa’s fastest-growing economies before the outbreak, with the IMF predicting growth of 14%. The World Bank estimates the outbreak will cost 3.3% of its GDP this year, with an additional loss of 1.2% to 8.9% next year.

 

Rice and maize harvests are due to take place between October and December. There’s a significant risk that the ongoing quarantines will have a significant impact on food production.

 

Quarantine is an excellent measure for containing infectious disease outbreaks but its indiscriminate and widespread use will compound this epidemic with another humanitarian disaster.

 

Source: http://theconversation.com/quarantine-works-against-ebola-but-over-use-risks-disaster-32112

Unthought of Impacts: Orphans as a result of Ebola deaths

Ebola Children being orphaned

At least 3,700 children in Guinea, Liberia and Sierra Leone who have lost one or both parents to Ebola this year face being shunned, the UN has said.

 

Carers were urgently needed for these orphans, Unicef said. A basic human reaction like comforting a sick child has been turned “into a potential death sentence”, it added. The World Health Organization (WHO) says more than 3,000 people have died of Ebola in West Africa – the world’s most deadly outbreak of the virus. The fear surrounding Ebola is becoming stronger than family ties” Manuel Fontaine Unicef.

 

The figure on the number of Ebola orphans follows a two-week assessment mission by the UN children’s agency to the three countries worst-affected by the outbreak. An earlier version of this story said that 4,900 children had lost parents but the correct figure is 3,700. It found that children as young as three or four years old were being orphaned by the disease.

 

Children were discovered alone in the hospitals where their parents had died, or back in their communities where, if they were lucky, they were being fed by neighbours – but all other contact with them was being avoided. “Thousands of children are living through the deaths of their mother, father or family members from Ebola,” Unicef’s Manuel Fontaine said in statement about his two-week visit to the region.

 

“These children urgently need special attention and support; yet many of them feel unwanted and even abandoned,” he said.

 

Source: http://africajournalismtheworld.com/tag/ebola-west-africa/

Ebola: How bad can it get?

How bad can it get 1

This isn't just the worst single Ebola outbreak in history, it has now killed more than all the others combined.

 

Healthcare workers are visibly struggling, the response to the outbreak has been damned as "lethally inadequate" and the situation is showing signs of getting considerably worse.

 

The outbreak has been running all year, but the latest in a stream of worrying statistics shows 40% of all the deaths have been in just the past three weeks.

 

So what can we expect in the months, and possibly years, to come?

 

Taking off

 

Crystal-ball gazing can be a dangerous affair, particularly as this is uncharted territory.

 

Previous outbreaks have been rapidly contained, affecting just dozens of people; this one has already infected more than 3,900.

 

But the first clues are in the current data.

 

Dr Christopher Dye, the director of strategy in the office of the director general at the World Health Organization, has the difficult challenge of predicting what will happen next.

 

He told the BBC: "We're quite worried, I have to say, about the latest data we've just gathered."

How bad can it get 2

Up until a couple of weeks ago, the outbreak was raging in Liberia especially close to the epicentre of the outbreak in Lofa County and in the capital Monrovia.

 

However, the two other countries primarily hit by the outbreak, Sierra Leone and Guinea, had been relatively stable. Numbers of new cases were not falling, but they were not soaring either.

 

That is no longer true, with a surge in cases everywhere except some parts of rural Sierra Leone in the districts of Kenema and Kailahun.

 

"In most other areas, cases and deaths appear to be rising. That came as a shock to me," said Dr Dye.

 

Cumulative deaths – up to 5 September

How bad can it get 3

Only going up

 

The stories of healthcare workers being stretched beyond breaking point are countless.

 

A lack of basic protective gear such as gloves has been widely reported.

 

The charity Medecins Sans Frontieres has an isolation facility with 160 beds in Monrovia. But it says the queues are growing and they need another 800 beds to deal with the number of people who are already sick.

 

This is not a scenario for containing an epidemic, but fuelling one.

 

Dr Dye's tentative forecasts are grim: "At the moment we're seeing about 500 new cases each week. Those numbers appear to be increasing.

 

"I've just projected about five weeks into the future and if current trends persist we would be seeing not hundreds of cases per week, but thousands of cases per week and that is terribly disturbing.

 

"The situation is bad and we have to prepare for it getting worse."

 

The World Health Organization is using an educated guess of 20,000 cases before the end, in order to plan the scale of the response.

 

But the true potential of the outbreak is unknown and the WHO figure has been described to me as optimistic by some scientists.

 

International spread?

How bad can it get 4

The outbreak started in Gueckedou in Guinea, on the border with Liberia and Sierra Leone.

 

But it has spread significantly with the WHO reporting that "for the first time since the outbreak began" that the majority of cases in the past week were outside of that epicentre with the capital cities becoming major centres of Ebola.

 

Additionally one person took the infection to Nigeria, where it has since spread in a small cluster and there has been an isolated case in Senegal.

 

Prof Simon Hay, from the University of Oxford, will publish his scientific analysis of the changing face of Ebola outbreaks in the next week.

 

He warns that as the total number of cases increases, so does the risk of international spread.

 

He told me: "I think you're going to have more and more of these individual cases seeding into new areas, continued flows into Senegal, Cote d'Ivoire, and all the countries in between, so I'm not very optimistic at the moment that we're containing this epidemic."

How bad can it get 5

There is always the risk that one of these cases could arrive in Europe or North America.

 

However, richer countries have the facilities to prevent an isolated case becoming an uncontrolled outbreak.

 

The worry is that other African countries with poor resources would not cope and find themselves in a similar situation to Guinea, Liberia and Sierra Leone.

 

"Nigeria is the one I look at with great concern. If things started to get out of control in Nigeria I really think that, because of its connectedness and size, that could be quite alarming," said Prof Hay.

 

End game?

 

It is also unclear when this outbreak will be over.

 

Officially the World Health Organization is saying the outbreak can be contained in six to nine months. But that is based on getting the resources to tackle the outbreak, which are currently stretched too thinly to contain Ebola as it stands.

 

There have been nearly 4,000 cases so far, cases are increasing exponentially and there is a potentially vulnerable population in Sierra Leone, Liberia and Guinea in excess of 20 million.

 

Prof Neil Ferguson, the director of the UK Medical Research Council's centre for outbreak analysis and modelling at Imperial College London, is providing data analysis for the World Health Organization.

 

He is convinced that the three countries will eventually get on top of the outbreak, but not without help from the rest of the world.

 

"The authorities are completely overwhelmed. All the trends are the epidemic is increasing, it's still growing exponentially, so there's certainly no reason for optimism.

 

"It is hard to make a long-term prognosis, but this is certainly something we'll be dealing with in 2015.

 

"I can well imagine that unless there is a ramp-up of the response on the ground, we'll have flare-ups of cases for several months and possibly years."

 

It is certainly a timeframe that could see an experimental Ebola vaccine, which began safety testing this week, being used on the front line.

 

If the early trials are successful then healthcare workers could be vaccinated in November this year.

 

Here forever

 

But there are is also a fear being raised by some virologists that Ebola may never be contained.

 

Prof Jonathan Ball, a virologist at the University of Nottingham, describes the situation as "desperate".

 

His concern is that the virus is being given its first major opportunity to adapt to thrive in people, due to the large number of human-to-human transmissions of the virus during this outbreak of unprecedented scale.

How bad can it get 7

Ebola is thought to come from fruit bats; humans are not its preferred host.

 

But like HIV and influenza, Ebola's genetic code is a strand of RNA. Think of RNA as the less stable cousin of DNA, which is where we keep our genetic information.

 

It means Ebola virus has a high rate of mutation and with mutation comes the possibility of adapting.

 

Prof Ball argues: "It is increasing exponentially and the fatality rate seems to be decreasing, but why?

 

"Is it better medical care, earlier intervention or is the virus adapting to humans and becoming less pathogenic? As a virologist that's what I think is happening."

 

There is a relationship between how deadly a virus is and how easily it spreads. Generally speaking if a virus is less likely to kill you, then you are more likely to spread it – although smallpox was a notable exception.

 

Prof Ball said "it really wouldn't surprise me" if Ebola adapted, the death rate fell to around 5% and the outbreak never really ended.

 

"It is like HIV, which has been knocking away at human-to-human transmission for hundreds of years before eventually finding the right combo of beneficial mutations to spread through human populations."

 

Collateral damage

How bad can it get 8

It is also easy to focus just on Ebola when the outbreak is having a much wider impact on these countries.

 

The malaria season, which is generally in September and October in West Africa, is now starting.

 

This will present a number of issues. Will there be capacity to treat patients with malaria? Will people infected with malaria seek treatment if the nearest hospital is rammed with suspected Ebola cases? How will healthcare workers cope when malaria and Ebola both present with similar symptoms.

 

And that nervousness about the safety of Ebola-rife hospitals could damage care yet further. Will pregnant women go to hospital to give birth or stay at home where any complications could be more deadly.

 

The collateral damage from Ebola is unlikely to be assessed until after the outbreak.

 

No matter where you look there is not much cause for optimism.

 

The biggest unknown in all of this is when there will be sufficient resources to properly tackle the outbreak.

 

Prof Neil Ferguson concludes: "This summer has there have been many globally important news stories in Ukraine and the Middle East, but what we see unfolding in West Africa is a catastrophe to the population, killing thousands in the region now and we're seeing a breakdown of the fragile healthcare system.

 

"So I think it needs to move up the political agenda rather more rapidly than it has."

 

Ebola virus disease (EVD)

How bad can it get 9

·         Symptoms include high fever, bleeding and central nervous system damage

·         Spread by body fluids, such as blood and saliva

·         Fatality rate can reach 90% – but current outbreak has mortality rate of about 55%

·         Incubation period is two to 21 days

·         There is no proven vaccine or cure

·         Supportive care such as rehydrating patients who have diarrhoea and vomiting can help recovery

·         Fruit bats, a delicacy for some West Africans, are considered to be virus's natural host

 

By James Gallagher

6 September 2014

Source: www.bbc.com/news/health-29060239

Ebola death toll reaches 2,288, says World Health Organization

The Ebola outbreak in West Africa has killed 2,288 people, with half of them dying in the last three weeks, the World Health Organization (WHO) says.

Ebola 1

It said that 47% of the deaths and 49% of the total 4,269 cases had come in the 21 days leading up to 6 September.

The health agency warned that thousands more cases could occur in Liberia, which has had the most fatalities.

The outbreak, which was first reported in Guinea in March this year, has also spread to Sierra Leone and Nigeria.

In Nigeria, eight people have died out of 21 cases, while one case of Ebola has been confirmed in Senegal, the WHO said in its latest update.

ebola 2

'Latter-day plague'

On Monday, the agency called on organisations combating the outbreak in Liberia to scale up efforts to control the outbreak "three-to-four fold".

Ebola spreads between humans by direct contact with infected blood, bodily fluids or organs, or indirectly through contact with contaminated environments.

However, the WHO says conventional means of controlling the outbreak, which include avoiding close physical contact with those infected and wearing personal protective equipment, were not working well in Liberia.

ebola 3

The reason for this remains unclear; however, experts say it could be linked to burial practices, which can include touching the body and eating a meal near it.

There are also not enough beds to treat Ebola patients, particularly in the capital Monrovia, with many people told to go back home, where they may spread the virus.

Sophie-Jane Madden, of aid agency Medecins Sans Frontieres, told the BBC that health workers at the largest treatment centre in Monrovia were completely overwhelmed: "Our teams are every day turning away people who are desperately seeking healthcare."

ebola 4

Meanwhile, the US says it will help the African Union mobilise 100 African health workers to the region and contribute an additional $10m (£6.2m) in funds to deal with the outbreak.

The announcement comes as a fourth US aid worker infected with the deadly virus was transported to a hospital in Atlanta for treatment.

The identity of the aid worker has not yet been revealed.

Two other aid workers who were treated at the same hospital have since recovered from an Ebola infection.

Separately on Tuesday, the UN's envoy in Liberia said at least 80 Liberian health workers had died from Ebola, according to the Associated Press.

Karin Landgren described the outbreak as a "latter-day plague" that was growing exponentially. She added that health workers were operating without proper protective equipment, training or pay, in comments to the UN Security Council.

By BBC News Africa

9 September 2014

Source: http://www.bbc.com/news/world-africa-29131065

Premature School Resumption Involving Up to 80 million Children, Adolescents, Students & Teachers is High-Risk Strategy – For Children, Parents, Nigeria & ECOWAS.

Ebola

Has the Nigerian Ministry of Education taken a high-risk decision to bring forward re-opening of primary and secondary schools before the country’s Ebola outbreak is certifiably over?

The evidence indicates that this may be so.

Two full incubation periods (21 days x 2 / 42 days) without cases is the global health standard for declaring an Ebola outbreak over in a particular location.

Going by the official Ministry of Health Ebola update (of 1st September) – “the total number of cases of EVD in Nigeria stands at sixteen (16); the number of contacts under surveillance in Lagos stands at 72 while in Port Harcourt, the total number of contacts under surveillance stands at 199” – i.e. for a minimum of 21 days.  The update further confirmed that “No contact in Port Harcourt has completed the 21 day observation period”. The Ministry of Health has also warned that it is likely there will be more confirmed cases of Ebola

Yet – on the 5th of September, the Ministry of Education announced that it has reversed its earlier decision (of 26th August) to postpone schools resumption till the 13th of October – and announced that schools would now re-open sooner – on the 22nd of September.

This negated a key pillar of the 26 August announcement that the Minister of Education and Commissioners of Education from the 36 states of the federation “will meet on 23rd September to review the situation in all states”.

What has prompted this apparently hasty review?

Would it not have been much safer – to wait for some time after the outcomes of the minimum 21 day incubation period covering the last batch of persons placed under surveillance – before reviewing the date for school resumption?

There Is Far Too Much At Stake For Questions Not To Be Asked.

Moving millions of children and adolescents within and across 36 states before the Ebola outbreak is fully under control may turn out to be an unwise decision.

The percentage of Nigerian population under 15 years of age is estimated at 44.23%, and although not every child is in school, this reflects in the country’s school population.

The total population of students in Nigeria surpasses the combined population of Guinea, Liberia and Sierra Leone where the current Ebola epidemic has been declared by experts as out of control:  Pre-primary (ages 3 to 5) – population of Nigerian students is estimated at 15.9 million; Primary (ages 6 to 11) 27.04 million; Secondary (ages 12 to 17) 21.8 million; and Tertiary (ages 18 years and above) 15.3 million.

The populations of Guinea, Liberia and Sierra Leone are: 11.4 million; 4.1 million; and 5.9 million respectively.

Throwing about 80 million Nigerian children, adolescents, and young adults – (across an estimated 100,000 or more schools) into a potential Ebola mix, at a time when an abundance of caution is crucial – can hardly be described as a low, or even medium risk strategy.

If the Ministry of Education strategy goes horribly wrong – all the hard work of the Lagos, Rivers State and Federal Ministry of Health in containing the outbreak could be undone, with serious consequences for Nigeria, ECOWAS and all of Africa.

Is the Call for Caution Misplaced?

The evidence from Liberia and Sierra Leone where there have been riots, disruption to food production, manufacturing, mining, education, retail; and announcements of nationwide lock downs suggests not.

To quote the Deputy director of US Centre for Disease Controls National Centre for Emerging Zoonotic and Infectious Diseases:

“If there was no cases identified after today, we would still be committed to waiting 42 days from today to declare the outbreak fully over.  The concern is that the outbreak can be reseeded much like a forest fire, with sparks from one tree reseeding it.  That is clearly what happened in Liberia".

Liberia was a situation they did not have any new cases for more than 21 days in the first wave of the outbreak and they were reseeded by cases coming across the border.  Until we can identify and interrupt every chain of transmission, we will not be able to control the outbreak.”

Some Luck, Courage, Sacrifice and Efforts of Health Officials Have So Far Contained the Ebola Outbreak in Nigeria

In Nigeria, all 18 cases (so far) in the transmission chain are linked to a single person who travelled from Liberia to Lagos on 20 July. A combination of circumstances, incredible courage by two brave women – a doctor and nurse (now dead from Ebola) –  that identified the index case and restrained him – and round the clock work by health officials and partners has so far ensured that – the transmission chain has been traceable and contained.

Among the contacts of the index case, one person knowingly evaded surveillance and travelled to Port Harcourt (to seek private treatment) triggering another chain of transmission, which killed the doctor that treated him. The doctor in turn infected his wife (also a doctor) and she helped alert the authorities. The involvement of health workers affected, and their ability to recognise the situation, has so far been key to halting a disaster in the making.

If there is an Ebola outbreak in Nigeria’s massive 80 million strong school population after the 22nd of September, can the health system cope with tracing, containment and treatment?  The evidence indicates that the answer is a resounding NO. To put this in context Nigeria has only 4.1 doctors per 10,000 of the population (an estimated 58,363 doctors) – way below the 23 per 10,000 required for successful primary health care interventions.

And if schools shut down again after a new outbreak involving children and adolescents – and millions of students are reshuffled back home including across 36 states – what happens?

The Question Then Has To Be Asked – Why Has the Ministry of Education Reversed Its Earlier Decision Re-Open Schools In October?

Even basic disease prevention in Nigerian schools is a challenge as majority of schools are notorious for their lack of water and sanitation facilities, including lack of personal hygiene facilities for female students

The Ministry of Education directive that – “at least two (2) staff in each school, both Public and Private, are trained by appropriate health workers on how to handle any suspected case of Ebola” by 15th September – is ill informedEven doctors with 6 – 7 years of training cannot identify Ebola just by looking at patients with early symptoms that could be anything from Malaria to Typhoid fever. (See appendix to Editorial for questions about the precautionary measures directed by the Ministry of Education)

The WHO listed Ebola symptoms include: fever, intense weakness, muscle pain, headache and sore throat – followed by vomiting, diarrhoea, rash, impaired kidney and liver function. To these the Nigerian Ministry of Information Facebook page has ominously added “red eyes, cold, depression and confusion” – as symptoms of Ebola.  The potential for chaos when schools resume can only be imagined.

Importantly, the WHO underlines that other diseases to be ruled out before a diagnosis of Ebola can be made include: malaria, typhoid fever, cholera, plague, rickettsiosis, relapsing fever, meningitis, and hepatitis to mention a few. How can a teacher with 3 weeks ‘Ebola training’ and no diagnostic equipment on site manage this? And if they suspect it is Ebola what do they do? There is no effective states or national ambulance service to call.

Even without Ebola, a look at some annual and cumulative health indicators for children, adolescents and young adults in Nigeria demonstrates the country's healthcare system is already inadequate, with successive Ministers of Health struggling to perform miracles with insufficient resources

  • Distribution of causes of death in children under 5 years include: Malaria – 20%; Acute Respiratory Infections – 16%; Diarrhoea – 10%; HIV/AIDS – 3%; Measles – 1%.
  • Only 31% of children under 5 years with Acute Respiratory Infection (ARI) symptoms are taken to health facilities.
  • Only 38.1% of children under 5 years with diarrhoea receive oral rehydration therapy (ORT).
  • Only 41.9% of children under 5 years with fever received treatment with any anti malarial.
  • Only 18% of pregnant women living with HIV received antiretroviral for preventing mother to child transmission.
  • Number of children living with HIV – 400,000.
  • Polio vaccination coverage – 59%
  • Measles cases – 6,447

Some other overall annual or cumulative health indicators for the general population – indicative of capacity to deal with Ebola outbreak:

  • Malaria cases = 2,087,086 (2.08 million) / Malaria Deaths = 7,734
  • People living with TB- 270,000 / TB Deaths, 27,000
  • People living with HIV – 3,200,000 (3.2 million) / Treatment Coverage 20%

Nigeria’s HIV indicators are especially significant given that men who have recovered from Ebola can still transmit the virus through their semen for up to 7 weeks after recovery from illness.  As immune systems are  critical to survival of Ebola; sexual and reproductive health education and commodities are crucial for adolescents and young adults .

If the health care system is unable to cope as illustrated above in ‘normal times’, how can teachers be expected to manage an Ebola outbreak?

The federal government and the Ministry of Education need to re-consider the announcement to re-open schools on the 22nd of September – and to do this before the 22nd – especially if more cases of Ebola are detected.

No one hopes for the worst – but even as we hope for the best – we must make every effort, and take every precaution to prevent the worst. Ebola is currently a disease with no treatment and no vaccine.

If the Ministry of Education and government maintain the decision to re-open schools by the 22nd of September especially if there are more confirmed Ebola cases – the 21 days (Ebola incubation period) following September 22nd 2014 will be the most tension soaked and longest 21 days in Nigeria’s health and education history.

While schools cannot remain closed indefinitely, and we cannot rule out a separate Ebola outbreak in the future – The situation in Liberia and Sierra Leone demonstrates that waiting 21 to 42 days could make the difference between complete chaos, and a resolution of the present Ebola outbreak in Nigeria.

Statement Ends: For further information contact kindly contact us through email: media[a]afri-dev.net

 

Appendix:

Excerpts And Questions Arising – From Initial Ministry Of Education Announcement Postponing Schools Resumption Till 13th Of October

“All Primary and Secondary schools, both Public and Private are to remain closed until Monday 13thOctober, 2014 which is the new school resumption date for all schools throughout the Federation.  This is to ensure that adequate preventive measures are put in place before the students report back to school.”

“All Summer Classes currently being conducted by some private schools should be suspended with immediate effect until 13th October, 2014.”

“All Private Primary and Secondary Schools must comply with the directives given under these preventive measures”

“All Tertiary Institutions are advised to suspend exchange of staff and students programs, visits and major International seminars and workshops until further notice.  They are also to monitor the movement of foreign students in their campuses.  They are to liaise with appropriate Government Health Institutions to organize and ensure effective sensitization program for all their teaching and non-teaching staff”

“The Minister of Education and all State Commissioners of Education will meet again on 23rd September, 2014 to review the situation in all States.”

The New Announcement of 5th September Negating This Previous One and Re-directing Schools to Re-open By 22nd September Raises Many Questions.

  • What changed in the 10 days since the earlier announcement was made?
  • Have all the precautionary conditions announce by the Minister of Education been met?
  • Where those conditions adequate in the first instance?

Key Amongst The Precautionary Conditions Announced Where?

1). “ All State Ministries of Education are to immediately organize and ensure that at least two (2) staff in each school, both Public and Private, are trained by appropriate health workers on how to handle any suspected case of Ebola – and also embark on immediate sensitization of all Teaching and Non-Teaching Staff in all schools on preventive measures. This training of staff must be concluded not later than 15th September, 2014.”

  • Has this training been concluded? Even if concluded is it sufficient?

2). “All State Ministries of Education should establish a Working and Monitoring Team for effective supervision of school activities before and after opening of schools.”

  • Have these monitoring teams been put in place?
  • What is the composition of these teams?
  • What is their mandate and how will the monitoring be carried out?
  • Are they empowered to make recommendations for school closure?

3). “Each State Ministry of Education should appoint a designated [Ebola] Desk Officer not later than 1st September, 2014, who should also receive appropriate training and who must report on daily basis to the Honourable Commissioner on situation in the schools.  The names of such Desk Officers, their phone numbers and e-mail addresses should be communicated to the Headquarters of the Federal Ministry of Education not later than 1st September, 2014.”

  • Have these desk officers been appointed?
  • Who has been designated to train them?
  • What is the composition of this training?
  • Has the training been accomplished?
  • Could any such training have been done in 6 days (between 26th August and 1st September)?
  • Have their details been forwarded to the Federal Ministry of Education as of the 1st of September?

4). “All Primary and Secondary schools, both Public and Private should be provided with a minimum of two (2) appropriate/recommended Temperature Measuring Equipment by the State Ministries of Education.  The State Ministries should determine the number of such equipment required and forward same to the Federal Ministry of Education not later than 1st September, 2014.  The Federal Ministry of Education will liaise with the Federal Ministry of Health to ensure that appropriate equipment are procured.”

  • Have all the 36 state Ministries of education determined the number of temperature measuring equipment to be procured in each state?
  • Have the requests been forwarded to Federal Ministry of Education by the 1st of September?
  • Has the order for them been placed? Will these be supplied and be in place by the 22nd of September?
  • What about protective clothing?

i.e. WHO recommendation is that – “When in close contact (within 1 metre) of patients with Ebola, health-care workers should wear face protection (a face shield or a medical mask and goggles), a clean, non-sterile long-sleeved gown, and gloves (sterile gloves for some procedures).” Will these be provided in schools?

If the answer to any of these questions is No – then the Ministry of Education has failed even by the precautionary standards it set for itself.

Why take the risk of daily movement of a combined school population of about 80 million children, adolescents and young adults – including secondary school and higher education students that will travel within and between the 36 states of the country.

But Two Even Bigger And More Important Questions Should Be Answered.

  • Why has the government and the Ministry of Education decided that it is not necessary to wait for the two full incubation periods (21 days x 2 / 42 days) without cases – which is the global health standard for declaring an Ebola outbreak over in a particular location?
  • Is the decision to convert teachers to emergency health workers conditions appropriate?

Teachers are trained to teach, not be health workers. Should teaching staff be placed in the trenches to fight Ebola, or should health workers have been designated to assist schools?

The House of Representatives, the teaching unions and health workers unions and associations need to be brought into this discussion and unravel how and why this decision was taken, and if it should stand.

By Afri-Dev

Source: http://www.afri-dev.info/content/special-afri-devinfo-editorial

In Sierra Leone, “HIV/AIDS, TB & Malaria Pose Serious Threats to Development in Africa”…President Koroma tells Counterparts

 

President Dr. Ernest Bai Koroma has said that HIV/AIDS, Tuberculosis and Malaria pose serious threats to the socio-economic development of Africa.He made this statement on the occasion of the Special Summit of the African Union on HIV/AIDS, Tuberculosis & Malaria in the Nigerian capital, Abuja on Monday 15th July, 2013.

The theme of the two-day summit is ‘Ownership, Accountability and Sustainability of HIV/AIDS, Tuberculosis and Malaria Response in Africa: Past, Present and the Future’.


President Koroma informed his colleague Heads of State and Government that Sierra Leone has drastically reduced HIV infections and was now aiming towards a zero tolerance plan against the malaise. Whilst acknowledging the challenges facing the fight, he however maintained, “We have shown leadership as a nation”.


The president also informed the Summit that in the fight against malaria & TB, the Government of Sierra Leone has made tremendous progress and was still making the necessary efforts to minimize the presence of these syndromes in the country.

President Koroma further used the platform to continue to appeal to donors to increase funding to enable performing governments accomplish their struggle against HIV/AIDS, Malaria and Tuberculosis in Africa.He also called on all to renew their vow and fight against these diseases so that the continent will realize sustainable socio-economic development.

He commended his Nigerian counterpart His Excellency Goodluck Jonathan and the African Union for the initiative to organize a Special Summit to implement the Abuja Call for Accelerated Action towards Universal Access to HIV/AIDS, Tuberculosis and Malaria treatment services in Africa.


In his opening remarks, the Nigerian President Goodluck Ebele Jonathan said the presence of his colleagues at the Summit signifies the importance they attach to the development of Africa. He pointed out that these diseases were crucial to the socio-economic development of the continent and still remain major causes of morbidity and mortality. President Jonathan therefore urged his colleagues to give the relevant attention needed to address these syndromes.


Commending Global Fund for being the major funding agency that continues to sustain the fight against malaria, TB and AIDS, which he dubbed a “noble mission”, President Goodluck Jonathan called on his colleagues Heads of States and Government to take ownership of the process. He also implored them to sustain their commitment, noting that the Summit was also to review their total achievements so far and make a renewed commitment towards the challenge.


The President also acknowledged other development partners for their immense support and efforts towards the fight against malaria, TB and HIV/AIDS in Africa.

According to the World Health Organization (WHO), of the World’s thirty four million people living with HIV, 23.5 million are in Sub-Saharan Africa, and 21 of the Global Plan’s 22 focus countries are in Africa. Similarly, the World Health Organization (WHO) estimates that there were about 219 million cases in 2010 and about 90% of the estimated 660,000 deaths from malaria in that year occurred in Africa. Africa also carries a large burden of the TB disease with 30% percent of the approximately 9 million new TB cases each year and 9 of the 22 most affected countries coming from Africa.


Recognizing the devastating impact of HIV/AIDS, TB and Malaria and other related infectious diseases on the socio-economic development of Africa, the Heads of State and Government of Africa adopted the 2000 and 2001 Abuja Declarations and Action Frameworks committing Africa Union Member States to take measures to halt the progression of these diseases in Africa. This high level commitment, reinforced on multiple occasions at the continental level over the past five years, marked a turning point in the continental response to the three diseases stimulating a sharp increase in resources and the scaling-up of programs to fight HIV/AIDS, TB and Malaria.


Although countries have strengthened their interventions in many of the priority targets set by the Abuja Call, they still continue to face constraints due to the lack of financial, material, technical and human resources for addressing health needs. Increase access to Anti-Retroviral Treatment (ART) is imperative. It is against this background that the Heads of State and Government during their Twentieth Ordinary Session of the January 2013 Summit held in Addis Ababa, endorsed the offer made by the Federal Republic of Nigeria, to host the Special Follow-up Summit on the Abuja 2001 Africa Union Summit on HIV/AIDS, Tuberculosis, Malaria and other related communicable diseases in the third quarter of 2013 to address the numerous challenges that will enable Africa realize the Abuja Call objectives and the Millennium Development Goal (MDG) on health.

On arrival in Abuja, Nigeria, President Koroma was received by the Special Adviser to President Goodluck Jonathan on Performance Monitoring and Evaluation, Professor Sylvester Monye, where he was taken to CGOCC Company Limited for a brief presentation on projects undertaken by the company on hydro electricity and water supply.

 

By State House  Communications

17 July 2013

http://news.sl/drwebsite/publish/article_200523238.shtml

ARVs for the almost healthy.

Bottles of antiretroviral drug Truvada. File photo. Image by: AFP / AFP

The Health Department wants to use antiretrovirals to treat patients with a CD4 count of 500 or more next year, as recommended by the World Health Organisation’s new guidelines.

Currently pregnant women and patients with a CD4 count (a measure of immunity) of 350 or less qualify for treatment.

Health Minister Aaron Motsoaledi told The Times: “The guidelines we are currently following are from WHO, so I see no reason why we should not adopt the new guidelines. If they come with new guidelines, ours is to follow.”

But activists and doctors say the department needs to sort out its drugs stocks first.

On Sunday, the UN organisation announced the new guidelines. It said because treatment makes HIV-positive people less infectious, giving it to more people would save millions of lives by 2020.

South Africa has 2million people on ARVs, a regime that resulted in life expectancy jumping by six years last year.

Professor Francois Venter, of the HIV Clinicians’ Society, said doctors debated giving ARVs to healthier people extensively last year.

He said that giving ARVs to a million more people would create jobs and keep people in the health system.

“Patients hate being told to come back later [to get treatment].”

But, he said, “It would have been good to sort out supply issues first.”

However, with more people on treatment for longer, there is a greater chance of people developing resistance to the drugs, as happened with TB medications.

This can result in premature deaths.

Venter said the research on starting treatment earlier has not factored in “drug interruptions that we are seeing throughout our region”.

Mluleki Zazini, general secretary of the National Association for People Living with HIV and Aids, said his organisation had raised concerns about ARV stocks.

Zazini said Motsoaledi had promised to implement a centralised hi-tech stock-monitoring system for drugs.

By SIPHO MASOMBUKA and KATHARINE CHILD

5 July 2013

http://www.timeslive.co.za/thetimes/2013/07/05/arvs-for-the-almost-healthy

US Supreme Court strikes down policy requiring AIDS groups to oppose prostitution in order to receive US Government funds.

Clinical Director Chuck Cloniger (R) seeing his patient, Tanesh Watson for medical counseling at St. James Infirmary in San Francisco, a medical and social service organization for current and former sex workers of all genders, on 14 June 2012 in California. Credit: UNAIDS/K.Hoshino

On 20 June 2013, the United States (US) Supreme Court struck down section 7631(f) of the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (The Leadership Act). This provision which the Court called the “policy requirement” mandates that no funds made available under the Leadership Act may “provide assistance to any group or organization that does not have a policy explicitly opposing prostitution and sex trafficking.”

The US Supreme Court ruled in response to a challenge filed on 23 September 2005 by 5 civil society organizations against the provision and its negative impact on their efforts to address HIV.  The organizations include: Alliance for Open Society International; the Open Society Institute; Pathfinder International; the Global Health Council; and InterAction.

The US Supreme Court held that the policy requirement violates the First Amendment of the US Constitution which protects free speech. In particular, the Court held that the “policy requirement compels as a condition of federal funding the affirmation of a belief that by its nature cannot be confined with the scope of the Government program.”  The Court noted that “the First Amendment prohibits the government from telling people what they must say.”

Commenting on the decision of the Court, Purnima Mane of Pathfinder International said, “It has been a long and uphill battle, but we are very happy that the Court has spoken out in defense of our ability to engage with sex workers so we can better put in place programs that protect them and their clients from HIV.”

Respondents had claimed, among other things, that adopting a policy explicitly opposing prostitution may diminish the effectiveness of some of their HIV programs by making it more difficult to work with sex workers—a population at higher risk of HIV infection.

In its 2012 report, the Global Commission on HIV and the Law already noted that, “The pledge puts grantees in an impossible bind. If they don’t sign, they are denied the funds they need to control and combat HIV. If they sign, recipient organisations are barred from supporting sex workers in taking control of their own lives.”

Female sex workers are 13.5 times more likely to be living with HIV than other women of reproductive age in low-income and middle-income countries. In sub-Saharan Africa, the region with the highest HIV prevalence, the pooled HIV prevalence among sex workers is 36.9%.

The involvement and empowerment of sex workers with regard to HIV prevention, treatment and care services has shown to have great impact in reducing HIV infections among both female sex workers and the overall adult population. “The end of this requirement is a significant victory for sex workers and their advocates globally. Our contributions to effective HIV responses have now been recognised,” said Ruth Morgan-Thomas of the Global Network of Sex Work Project.

Given the importance of the case for the global AIDS response, the UNAIDS Secretariat participated as an amicus curiae (friend of the court). In that role, UNAIDS provided public health evidence and human rights arguments to support greater access to funding and resources for organisations engaged in HIV prevention, treatment, care and support services with and for sex workers. UNAIDS main points to the Supreme Court included:  1) Sex workers are among the populations most affected by HIV; 2) engagement with sex workers is essential to an effective response to HIV; and 3) any effective response requires adequate funding for programmes designed to ensure HIV prevention, treatment, care and support for sex workers.

UNAIDS Executive Director, Michel Sidibé praised the groups that were courageous enough to challenge the provision. “This shows civil society at its best – advocating for global health for all.  No group, including sex workers, should be left behind in our efforts to bring the AIDS epidemic to an end.”

US funding critical to HIV response

US leadership and generosity has been instrumental in the progress made in the global AIDS response over the last decade. Since the adoption of the Leadership Act, some 45.7 billion dollars have been made available to address HIV worldwide. The President’s Emergency Plan for AIDS Relief (PEPFAR), authorized by the Leadership Act, has been the largest health initiative ever undertaken by one country to address a global health epidemic. Thanks to US funding, access to HIV treatment has been expanded in low- and middle-income countries, and millions of lives are being saved. The decision of the US Supreme Court to strike down the policy requirement will greatly contribute to expand and improve the global AIDS response even further.

By UNAIDS

21 June 2013

http://www.unaids.org/en/resources/presscentre/featurestories/2013/june/20130621ussupremecourtdecision/

 

More people living longer with HIV in SA.

South Africa has more people living longer with HIV, which is attributed to the country’s anti-retroviral (ARV) treatment programme. The National HIV Household Survey for 2012 shows about 6.4 million people in South Africa are living with HIV, or about 12.3% of the population.

These figures are up from 5.6 million or 10.3% of the population, in 2008. Over 2 million people are on ARV treatment.

Dr Khangelani Zuma of the Human Sciences Research Council presented some of the survey’s findings at the 6th South African Aids Conference in Durban.

“When we looked deeper into the results is that the prevalence of HIV has increased among people who are 25 years and above, but among those that are 15 years to 24 years HIV prevalence has gone down, which means actually fewer youth is HIV positive. But more people who are 25 and above are HIV positive which has a steady increase that could be attributed to the success of ARV therapy,” says Zuma.

A more worrying finding is that condom use among the youth between 15 to 24 years, and among adults aged 25 to 49 has significantly declined.

The Health Department’s Dr Yogan Pillay says they’re extending condom distribution.

“The department is currently working on condom distribution plans at district level which is far more targeted for both male and female condoms because we recognise that while we need combination prevention, condoms work,” says Pillay.

Pillay adds: ” We buy a lot of condoms, 500 male condoms are not enough but 12 million female condoms. The question is who is using it and for those that are not using it why aren’t they using it and what can we do about it. Those are critical questions that we need to answer.”

20 June 2013

By The SABC

http://www.sabc.co.za/news/a/fe35ca80400ec8cbb054f20b5d39e4bb/More-people-living-longer-with-HIV-in-SA-20132006

 

Male circumcision could save Zimbabwe US$3 billion.

Zimbabwe could save up to US$3 billion in treatment of HIV and Aids and downstream costs if the country can scale up its Voluntary Medical Male Circumcision (VMMC), a health official has said.

Report by Christopher Mahove

Ministry of Health and Child Welfare, HIV and Aids and TB Specialist, Owen Mugurungi, said if the VMMC was to make an impact in the country, there was need for a rapid scaling up of the programme among the 15 to 49 age groups to above the 80% mark, which translated to 1,9 million men.

“If we do that, we will be able to reduce the rate of HIV infection from the current 130 000 new infections to less than 50 000 per year by 2020,” said Mugurungi.

“What it means is we would have also prevented close to 750 000 new HIV infections throughout the country and we would have invested around between US$100-US$120 million, but in terms of treatment and downstream costs, we will probably save US$2,9 billion.

“So you can see from an investment perspective, of saying where should we put our money, this is one of the high return areas in which we should be able to put our money.”

He said at community level, there were also even more benefits for partners of circumcised men and others, as it contributed to more than 75% prevention of HIV and Aids transmission to spouses.

Circumcision, Mugurungi said was also crucial in the elimination of the human papiloma virus, which affected the male organ and was the major cause of cervical cancer in women.

“This is because we know that if we circumcise all men, 60% of them are more likely to have reduced risk and if they have reduced risk, they are also less likely to transmit the disease, so that cascades to situations where even at community level, there is higher or better prevention,” he said.

Mugurungi said although the male circumcision programme had started on a slow note in 2009 in terms of uptake, the trend was slowly improving, with high hopes that the country would be able to reach its target.

“….but we are happy that in 2010, we circumcised the whole year, about 15 000, and already this year, 2013, during this previous campaign, which just happened during the holiday, we have circumcised more than 15 000.

“We are happy that we have achieved in less than six weeks what we achieved in 12 months. If that is anything to go by, we are happy to say that at least people are beginning to take it up and we will be able to circumcise more,” Mugurungi noted.

He said there was need for extensive educational campaigns to take the correct message to the people.

There are also other benefits that have for a long time been associated with circumcision, among them the prevention of genital ulcerations and general personal hygiene.

Mugurungi said studies done in South Africa, Kenya and Uganda had shown evidence that HIV infection rate among circumcised males was 60% lower than in those who were not.

Before the introduction of the male circumcision programme only a handful of private health institutions were offering the service and mostly for reasons other than as an HIV intervention measure.

In Africa, the vulnerability of women and girls to HIV remains high, with women constituting 59% of people living with HIV.

19 May 2013

http://www.thestandard.co.zw/2013/05/19/male-circumcision-could-save-zimbabwe-us3-billion/