Madagascar – Tackling Plague

political banner

The death toll from the plague spreading in Madagascar has risen close to 100, and the Red Cross has warned that growing stigma attached to the disease could undermine efforts to contain the outbreak.

While cases of bubonic plague occur in Madagascar nearly every year, this year’s epidemic is “much more dangerous”, said Elhadj As Sy, secretary general of the International Federation of Red Cross and Red Crescent Societies (IFRC).

Plague arrived earlier than expected, and has become much more contagious as it is now being transmitted from person to person as well as from animals to humans, reported the Thomson Reuters Foundation.

The infection is also spreading in urban centres and in areas that until now had not been affected, the World Health Organisation (WHO) said in October. IFRC staff on the ground say panic is exacerbating the stigma around the plague.

There is a risk this could “drive people underground and that may result in us losing some of the contacts we are tracing in order to contain the outbreak”, Sy warned.

The Red Cross is using burial practices that avoid contact with corpses and has opened a plague treatment centre to help Madagascar tackle its worst outbreak of the plague this century.

The latest figures from the country’s health ministry show there have been 911 recorded cases of the plague across 17 of the island nation’s regions since August, killing 95 people so far.

Hospitals in Madagascar are on high alert and are implementing preventative measures, medical staff said. International agencies are also providing ambulances to ensure patients with suspected cases do not spread the virus by taking crowded buses and taxis.

1021 plague
Council workers clear garbage during the clean-up of the market of Anosibe in Antananarivo – CNN

Sy said building partnerships and trust at the community level is critical, as well as reinforcing an existing referral system for suspected cases.

But overcoming the plague will require longer-term assistance, he emphasised – “not just intervening at the peak and then forgetting about it”.

The outbreak has also hit sectors of society outside impoverished communities, who are typically most at risk, London-based The Guardian reported.

“Normally, the people who catch the plague … live in poor areas, but in this case we find the well-to-do, the directors, the professors, people in every place in society, catching the disease,” said Dr Manitra Rakotoarivony, Madagascar’s director of health promotion.

Plague is curable if detected in time. “Our teams are working to ensure that everyone at risk has access to protection and treatment. The faster we move, the more lives we save,” said the WHO’s Madagascar representative, Charlotte Ndiaye.

Over the course of less than a decade, the country’s plague problem appears to have intensified, driven by a combination of economic and environmental factors.

Madagascar has a per capita GDP of about $400 (£300), and national programmes to control the disease have been “hampered by operational and management difficulties”, according to a report by the European Centre for Disease Prevention and Control.

Plague was first introduced to the island in 1898, when steamships from India brought rats infected with the disease. Within two decades or so, it virtually disappeared from Madagascar for 60 years, only to re-emerge in recent decades.

Find out more in the Africa Research Bulletin:

VANILLA: Madagascar
Economic, Financial and Technical series
Vol. 54, Issue 8, pp. 21834C–21835C

MADAGASCAR: Tackling Corruption?
Political, Social and Cultural series
Vol. 54, Issue 5, pp. 21423C–21424C

MADAGASCAR: Enduring Poverty
Economic, Financial and Technical series
Vol. 54, Issue 3, pp. 21636A–21636B

Subscribe to the Africa Research Bulletin today.

South Sudan – Cholera Epidemic

arbp_synergy

The threat of an uncontrollable outbreak looms large as the rainy season progresses. 

The International Organisation for Migration (IOM) has called for rapid action to prevent a cholera epidemic in South Sudan; more than 18,000 cases, including 328 deaths, have been reported in the country since June 2016.

The IOM warned that the number of cases and deaths is likely to increase significantly as the rainy season approaches, which will leave as much as 60% of the country inaccessible by road, hindering the delivery of important services.

IOM spokeswoman Olivia Headon said that a combination of factors including the rainy season, the movement of displaced persons and the ongoing conflict in the country, means that the disease is becoming increasingly difficult to contain.

“If you are maybe infected with cholera or someone in your family, if you come in contact with this and then you move to a different part of the country, you are also bringing the infection with you,” Headon said.

The scale of the problem in South Sudan is said to be unprecedented, with more than 7.5 million people dependent on humanitarian aid. Headon said that IOM and partners are promoting cholera vaccination campaigns, distributing cholera kits, repairing boreholes and conducting hygiene promotion campaigns, reported Voice of America (VOA). 

On July 28th the World Health Organisation (WHO) also launched a vaccination campaign. The WHO received 500,000 doses of oral cholera vaccine and between July 28th and August 3rd carried out a vaccination campaign in four high risk areas: Tonj East, Kapoeta South, Kapoeta North, and Kapoeta East.

12046874976_5d315dbe16_k.jpg
Children collecting water, South Sudan – CC 2014

Since April 2017 around 2,500 new cases have been recorded, a significant increase on previous months. Persistent drought has also led to the drying of water points, leading to populations in some regions relying on contaminated water, reported CISA

Speaking on July 19th, WHO epidemiologist Joseph Wamala said, “South Sudan has suffered from several major cholera outbreaks in the last four years. Following other successful oral cholera vaccine campaigns, WHO and partners can make a real difference in controlling the outbreak.”

However preventative measures are difficult as the country continues to grapple with ongoing conflict which emerged in 2013, pitting President Salvir Kirr against and his former deputy Riek Machar, with the ethnic Dinka, loyal to Kirr, clashing with the Nuer, allied to Machar.

The conflict has killed tens of thousands of people and displaced millions, many of whom have sought refuge in neighbouring countries. The United Nations (UN) children’s charity (UNICEF) estimates that 900,000 children in South Sudan need psychological help, with at least 150,000 living in camps

“South Sudan has a generation of traumatised children, but there aren’t enough therapists – neither in Juba, nor in remote local communities,” explained Duop Dak, one of the country’s few practicing psychologists, reported Reuters.

The German Foreign Minister Sigmar Gabriel issued a statement on August 10th, following a visit to the capital Juba, urging President Kirr to include the opposition and rebels in national dialogue. The conflict, tensions and factional violence is only exacerbating the risk of a deadly epidemic.

Find out more in the Africa Research Bulletin: 

SOUTH SUDAN: Fresh Offensive Against Rebels
Political, Social & Cultural Series
Vol. 54, Issue. 7, Pp. 21517B–21518B

South Sudan – Graft Claims Denied
Political, Social & Cultural Series
Vol. 54, Issue. 6, Pp. 21484B–21484C

SOUTH SUDAN: Humanitarian Relief Impeded
Political, Social & Cultural Series
Vol. 54, Issue. 4, Pp. 21410A–21411A

Subscribe to the Africa Research Bulletin today. 

 

Health – Malaria Vaccine Trials

arbp_synergy

Three Africa countries are selected for first phase of a Malaria vaccine pilot. 

The World Health Organisation (WHO) has announced that Ghana, Kenya and Malawi a are to be pilot countries for a new Malaria vaccine for young children from 2018. The vaccine has the potential to save tens of thousands of lives.

The vaccine was developed by GlaxoSmithKline and will be tested on children aged five to 17 months; it has taken decades of scientific and medical expertise to produce, and hundreds of millions of US dollars in funding.

The funding of US$49m for the first pilot phase is being funded by the Global Vaccine Alliance (GAVI), UNITAID and the Global Fund to Fight Aids, Tuberculosis, and Malaria.

However, the vaccine only has partial effectiveness, and the challenge is whether countries can deliver the required four doses per child, said WHO Africa Regional Director, Matshidiso Moeti.

4443583700_e7fedf8fd9_o
CC Radio Okapi 2006

Malaria infects roughly 200 million people each year, killing roughly half a million people, and Sub-Saharan Africa is hit particularly hard, with 90% of the world’s cases in 2015.

According to the WHO, modelling and data gathering has been so bad that it has been hard to tell if cases have been rising or falling over the last 15 years.

Kenya, Ghana and Malawi already have fairly strong prevention and vaccination programmes, but were chosen as they still have a high number of malaria cases. The vaccine will be delivered through existing health provisioning systems.

The WHO has stated its aim to wipe out the disease by 2040, although so far it has proven stubborn, with resistance problems to both drugs and insecticides.

According to Kathryn Maitland, Professor of Tropical Paediatric Infectious Diseases at Imperial College London, writing in a academic paper published in December 2016, “the slow progress in this field is astonishing, given that malaria has been around for millennia and has been a major force for human evolutionary selection…contrast this pace of change with out progress in the treatment of HIV, a disease a little more than three decades old.” (The Independent 24/4)

Find out more in the Africa Research Bulletin:

HEALTH: Malaria
Political, Social & Cultural Series
Vol. 54, Issue. 4, Pp. 21416A–21417C

HEALTH: Wiping Out Polio
Political, Social & Cultural Series
Vol. 54, Issue. 3, Pp. 21381B–21381C

HEALTH: HIV Treatment Soars
Political, Social & Cultural Series
Vol. 53, Issue. 11, Pp. 21236A–21237C

Subscribe to the Africa Research Bulletin today. 

 

Nigeria – Lassa Fever Concerns

arbp_large

New outbreak of haemorrhagic fever burdens an already strained healthcare system.

Concerns have mounted over an increase in cases of Lassa fever in Nigeria with 44 people having died and authorities warning of the difficulties in combating the virus in a region still suffering from the effects of the Ebola outbreak.

Lassa fever is a haemorrhagic virus similar to that of Ebola; the outbreak was announced only in January despite the first case being confirmed in August 2015, with deaths reported across ten states, including in Abuja.

Chikwe Ihekweazu, an infectious disease epidemiologist said, “it is possible we are only seeing the tip of the iceberg”, the disease may have criss-crossed the country during the busy festive season.

Micchael Asuzu, Professor of Public Health at the University of Ibadan, in southwest Nigeria, said the Lassa response took so long because residents in the initial infected village of Foka, in the northwest state of Niger, attributed deaths to supernatural forces. There are also concerns that doctors could be misdiagnosing, facilitating the spread of the disease.

Lassa fever is an acute haemorrhagic illness that belongs to the arenavirus family of viruses, which also includes the Ebola-like Marburg virus. The virus is transmitted by rodents, often through contact with food or household items contaminated with faeces and urine.

The US Centre for Disease Control and Prevention said that Lassa fever infections in West Africa range from between 100,000 to 300,000 each year, with about 5000 deaths. (© AFP 15/1 2016; PANA, Lagos 9/1)

Find out more in the Africa Research Bulletin

HEALTH: Sierra Leone
Political, Social & Cultural Series
Vol.52, Issue.11, Pp.20804A–20804C

HEALTH: Ebola
Political, Social & Cultural Series
Vol.52, Issue.9, Pp.20733A–20733C

Subscribe to the Africa Research Bulletin today

Africa – Malaria Vaccine Approved

arbp_large

Malaria ‘vaccine’ given the go ahead by European regulators, but some warn of difficult decisions with its implementation on the ground

European drug regulators have given the green light for a ‘Malaria vaccine’, called RTS,S or Mosquirix, set to be the first such vaccine for the mosquito-born disease,which resulted in an estimated 584,000 deaths in 2013, of which 90% were in the African region and mostly children under five.

The vaccine was developed by British GlaxoSmithKline (GSK) in partnership with the PATH Malaria Vaccine Initiative, and received funding from the Bill & Melinda Gates Foundation. It works by triggering the immune system to defend against the first stages of infection by the Plasmodium falciparum parasite after it enters the bloodstream.

Andrew Witty, GSK CEO, cited by Al-Jazeera, said the European Medicines Agency’s (EMA) positive recommendation was a further important step towards making the world’s first malaria vaccine available for young children.

“While Mosquirix on its own is not the complete answer to malaria, its use alongside those interventions currently available such as bed nets and insecticides would provide a very meaningful contribution to controlling the impact of malaria on children in those African communities that need it the most,” he said in a statement.

A GSK Scientist involved in the Mosquirix process since 1987, Joe Cohen, said that he had no doubt the vaccine could be significantly reduce the toll of sickness and death caused by the malaria; “I have absolutely no reservations in terms of rolling this vaccine out”, reported Al-Jazeera.

4443583700_e7fedf8fd9_o

CC, Radio Okapi

However the vaccine does not offer any final solution; trial data released in 2011 and 2012 showed that it only reduced the prevalence of malaria in babies aged 6-12 weeks by 27%, and around 46% in children aged 5-17 months.

Some medical experts and analysts have expressed concern at the complexities and potential costs of deploying this first vaccine, particularly as it only provides partial protection, making it less attractive and heightening risk.

However CEO of the GAVI Alliance Dr Seth Berkley and CEO of the Global Fund to Fight Aids, Tuberculosis and Malaria, Dr Mark Dybul, speaking in a report by the GAVI Alliance, said that the decision to supply the vaccine is not straightforward.

“None are 100% effective. So in the cold light of day, for most countries it comes down to a complex calculation based on the cost effectiveness, lives saved, illness avoided and the availability of other effective interventions”, they said

“Clinical trial data suggests that Mosquirix offers only partial protection, preventing one in three cases of clinical malaria, a relatively low success rate compared to other approved vaccines…What’s more, the clinical trials were carried out with the vaccine used in conjunction with high use of other interventions, such as long-lasting insecticide treated bed-nets and anti-malarial drugs”.

“So we don’t really know how effective the vaccine is by itself or how well it would perform outside the controlled setting of a clinical trial. The problem is…Mosquirix is about five to 10 years ahead of any other candidate malaria vaccines, and there’s no guarantee any of them will be better”, the report stated.

According to an article from the BBC, while GSK have not released a price for the vaccine, they have pledged not to make a profit. But it is the effectiveness of the vaccine, that is under the most scrutiny, as it wanes over time making a booster shot essential.

The vaccine will now move on to the World Health Organisation (WHO) who will decided how and where it will be used; facing tough decisions, considering that the vaccine was not nearly as effective as scientists hoped but also the urgency and lack of comparable alternatives in the fight against the disease.

Find out more in the Africa Research Bulletin

Health: Malaria
Political, Social  Cultural Series
Vol.52, Issue.7, Pp.20660A-20661C

Health: New Malaria Drug
Political, Social & Cultural Series
Vol.44, Issue.2, Pp.16992A–16993A

Health: Africa
Political, Social & Cultural Series
Vol.51, Issue.9, Pp.20298A–20300A

Subscribe to the Africa Research Bulletin today