National Institute for Communicable Diseases

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01 June 2010 The FIFA World Cup poses specific health challenges - The NICD gears up to offer best public health services South Africa is putting the final touches in preparations for hosting one of the biggest sports tournament in the world, the 2010 FIFA World Cup. The National Institute for Communicable Diseases (NICD) is also gearing up to offer the best public health services during this time. Major anticipated health risks may include cold-related illness, foodborne and waterborne illness, communicable diseases and incidents related to trauma and other types of injuries. The diseases which can occur during such events might be from conditions which are endemic to the country or can be imported by the visitors. A number of opportunities arise to reduce the risk of acquiring communicable diseases during a mass gathering such as the World Cup, including pre-travel consultation, enhanced epidemic intelligence to timeously detect incidents, the provision of standard operating procedures for epidemic response, and training and pre-accreditation of food suppliers to reduce foodborne disease outbreaks. This NICD has put together a short guide, accessible on the NICD website (www.nicd.ac.za), covers important health topics, including: food and water safety, hepatitis A, influenza, malaria, measles, meningococcal disease, polio, rabies, Rift Valley fever, sexually transmitted infections, tick bite fever, tuberculosis and yellow fever. We provide general travel recommendations focusing on preventive measures that will assist visitors in experiencing a healthy World Cup. For more information please contact Nombuso Shabalala on 011 386 6400 or 082 8864238
22 April 2010 Rift Valley cases increase but pose no threat to World Cup Currently there are 140 laboratory confirmed human cases of Rift Valley fever in South Africa, and there have been 9 deaths to date. The majority of cases have had mild flu-like symptoms and have not developed complications. There is no vaccine for humans or specific treatment. The risk of disease is to persons having direct contact with blood or tissues of infected animals and the majority of people affected have been persons working on farms, veterinary workers and slaughter-men. There is no human to human spread. Mosquitoes are important in transmission of the virus from animal to animal but not in transmission to humans in the South African outbreak as the mosquitoes involved prefer feeding on animals and don’t generally feed indoors. The disease is generally seen on farms, and not in the cities other than related to the occasional informal slaughter of infected animals. The eating of well- cooked meat poses no risk, nor does the drinking of pasteurized milk. It is likely that the number of animal cases and therefore human will decrease as the weather gets cooler. There is also an animal vaccination programme on farms not yet affected to protect livestock. Visitors coming to South Africa for the FIFA World Cup are not at risk unless they handle infected carcasses on farms or handle raw meat from infected animals. It is highly unlikely that visitors would be involved in these activities. The formal meat supply is well controlled and affected animals are excluded from the food chain in abattoirs. There is no risk to visitors to Game Parks as the disease typically only affects ruminants such as sheep, cattle and goats. South Africa is looking forward to extending a warm welcome to the country for the 2010 FIFA World Cup, and to reassure visitors that everything will be done to ensure their safety and health. Please go to our website www.nicd.ac.za for further information on the disease and the current outbreak. For more information please contact Nombuso Shabalala on 011 386 6400 or 082 8864238
08 April 2010 INFLUENZA 2010 VACCINE UPDATE The influenza season in South Africa generally starts towards the end of May and peaks in June with transmission continuing generally but tailing off to the end of July and August. South Africa has well established national influenza monitoring system run by the National Institute for Communicable Diseases that provides information on influenza, and circulating influenza virus strains. Currently no cases with influenza have been identified through this surveillance. There is some uncertainty regarding the influenza strains of the forthcoming season but it is likely that the pandemic influenza A (H1N1) strain also known as ‘swine flu’ will in all probability reappear as the dominant influenza strain this winter. This is based on what was experienced during the northern hemisphere winter season. In the United States and the UK between 70-99% of the viruses identified were the pandemic influenza A (H1N1) strain. What is often seen is that a new pandemic strain goes on to replace the previous seasonal influenza strains and then it circulates in the following seasons with minor changes each year. No significant changes in the virus to suggest an increase in severity or a change in drug resistance were identified during the northern Hemisphere influenza season. The 2010 trivalent influenza vaccine contains three different influenza strains and includes the influenza A H1N1 (pandemic) strain. It is currently available in the private health sector as well as the first phase of the public sector influenza vaccination programme. There is however a shortage of the vaccine in the private sector for a number of reasons, including production problems because one of the strains in the vaccine did not grow well; some manufacturers switched to producing the monovalent (swine flu) vaccine last year in response to the pandemic; an increased demand due to people’s fears following the pandemic last year as well as a large purchase of vaccines for the public programme. Generally, in South Africa the uptake of the influenza vaccine in previous years has been low and lots of vaccine doses went unused and vaccine supplies are to some extent based on previous usage. While the majority of persons will not develop complications of influenza, those at risk for severe disease should be vaccinated. These include pregnant women irrespective of the stage of pregnancy, persons over the age of 6 months with underlying medical conditions– chronic lung disease, chronic cardiac disease, diabetes, HIV infected persons and other who are immunosuppressed, and those over 65 years of age. The National Department of Health has embarked on an immunization campaign in the public sector which will be rolled out in two stages. The first phase which started this week will initially target front -line workers at ports of entry and in health care institutions and children 15 years and younger on antiretroviral therapy for HIV. The second phase which will be in May will target amongst others persons with chronic diseases and pregnant women. The best prevention against influenza is to be vaccinated. You can also protect yourself and others by practicing good hand hygiene, cough and sneezing etiquette. Most people ill with influenza will recover without complications. Persons that are at highest risk of influenza-related complications should be prioritized for early treatment with influenza antiviral drugs. Issued by the National Institute for Communicable Diseases, a division of the National Laboratory Service For more information please contact Nombuso Shabalala on 011 555 0545 or 082 886 4238
24 March 2010 ROTAVIRUS VACCINE STILL SAFE, CONTINUED VACCINATION STRONGLY RECOMMENDED A recent announcement has been made by the Food and Drug Administration of the USA (FDA) that an independent academic team has found traces of the DNA of a virus of pigs called porcine circovirus type 1 (PCV1) in Rotarix vaccine, the vaccine used to vaccinate children against gastroenteritis caused by the rotavirus, a diarrhoea causing virus. This finding was subsequently confirmed by scientists employed by the company manufacturing the vaccine, GlaxoSmithKline. Consequently the FDA has recommended that doctors in the USA should temporarily suspend using this vaccine until more is learnt about this contaminant. The FDA, however, has stressed that there is no safety risk. This recommendation has only been made by the FDA and has not been made by the European Medicines Agency. It is the view of the National Institute for Communicable Diseases that, at this stage, there is no reason to suspend administration of Rotarix vaccine which is used for routine immunization in South Africa. The PCV1 virus, which was discovered in pigs some 35 years ago, is not known to cause any ill effects either in pigs or in any animal or in humans and may, at any rate, be found in consumed meat - the vaccine is also administered orally. On the other hand, rotavirus is an important cause of severe disease and mortality in South Africa which is effectively prevented by this vaccine For more information please contact Nombuso Shabalala on 011 555 0545 or 082 886 4238 Issued by the National Institute for Communicable Diseases, a division of the National Laboratory Service
October 30, 2009 Media Advisory Global response to the H1N1 pandemic- Public world health leaders to gather in Johannesburg Public health leaders from nations around the world will gather in Johannesburg, next week and share how their countries are responding to the H1N1 pandemic. Their presentations will highlight the Fourth Annual Meeting of the International Association of National Public Health institutes (IANPHI), November 1-4, at South Africa’s National Institute for Communicable Diseases. More than 80 public health leaders representing 40 countries are expected to attend this gathering of IANPH, which connects and strengthens national public health institutes (NPHIs) such as the United .States’s, Centre for Disease Control (CDC), the China CDC, the UK Health Protection Agency, and Mexico’s National Institute of Public Health. NPHIs are often on the frontlines against widespread disease and national outbreaks, and IANPHI’s plenary session on Monday, Nov. 2, at 10:45 a.m. will feature a panel discussion on how six nations have responded to the H1N1 pandemic. Panelists will include: Dr. Peter Nsubuga of the U.S. CDC’s Coordinating Center for Global Health Dr. Wang Yu, director of the China CDC Prof. Barry Schoub, executive director general of South Africa’s National Institute for Communicable Diseases (NICD) Dr. Patricia Allen Flores, director, Costa Rica National Institute for Research on Nutrition and Health Dr. Mario Henry Rodriguez Lopez, director general, Mexico National Institute of Public Health Dr. Amha Kebede, deputy director general of the Ethiopian Health & Nutrition Research Institute. Panelists will address topics such as screening and containment of H1N1, the impact of international travel, and preparation for the fall/winter flu season, including vaccinations, outreach education, and collaboration with other countries. Dr. Jeffrey Koplan, former director of the U.S. CDC, president of IANPHI, and director of Emory University’s Global Health Institute, will moderate the panel. For more information please contact Nombuso Shabalala on 082 886 4238 or 011 386 6462 To view the agenda, click here. Note to editors Representing more than 60 percent of the world’s nations, IANPHI is based jointly at Emory University’s Global Health Institute and Finland’s National Institute for Health and Welfare (THL). IANPHI was established in 2006 as an international advocacy and profession organization for NPHI directors as well as a major investor in public health infrastructure projects in low-resource countries. It is funded through Emory University by a grant from the Bill and Melinda Gates Foundation.
Pandemic influenza A H1N1 ("Swine" flu) update		Frequently Asked Questions: Novel Influenza A/H1N1 (“swine flu”)
PANDEMIC A (H1N1) 2009 UPDATE 01 September 2009		National Institute for Communicable Diseases 08 July 2009 What is novel influenza A/H1N1? This is a new influenza virus infecting humans. It was first detected in humans in the USA in April 2009 but was probably causing infections in Mexico for a period before this. Initially this new influenza virus was thought to be a type of influenza virus that infects pigs and sometimes spreads to humans (hence the initial name of “swine flu”). However, further studies have revealed that it is not a virus that came directly from pigs but is rather a new virus formed by the recombination of several different genetic elements from pigs, avian and human species. Why is there a risk of a pandemic from this virus? An influenza pandemic occurs when a new influenza virus emerges to which the majority of humans are non-immune and which can spread efficiently and sustainably amongst humans. Thus far, this virus appears to meet these criteria and has already affected a large number of countries across the globe. It has therefore been essential to activate global responses. How do people get infected with influenza A/H1N1? Available information on this new virus suggests that it spreads from person to person much like “seasonal influenza” which is mainly via respiratory droplet transmission. Individuals are infected when they breathe in droplets that are generated when an infected person coughs or sneezes. In addition, infection can result if there is contact with inanimate surfaces e.g: door knobs or hands that are contaminated with the influenza virus and then the person touchs their mouth, nose or eyes. How long can an infected person spread this virus to others? At the current time, it is believed that this virus has the same properties in terms of spread as seasonal flu viruses. With seasonal flu, studies have shown that people may be contagious from one day before they develop symptoms to up to 7 days after they get sick. Children, especially younger children, might potentially be contagious for longer periods. It is therefore important for people to stay at home for at least 7 days when they have symptoms to reduce spread to other people. What kills influenza virus? Influenza virus is destroyed by heat (167-212°F [75-100°C]) and by various chemicals, alcohol containing rubs, and antiseptics. How long can influenza virus remain viable on objects (such as books and doorknobs)? Studies have shown that influenza virus can survive on environmental surfaces and can infect a person for up to 2-8 hours after being deposited on the surface. Can a person get infected with novel H1N1 virus from eating or preparing pork? No. Novel H1N1 viruses are not spread by food. You cannot get infected with novel HIN1 virus from eating pork or pork products. Eating properly handled and cooked pork products is safe. Should people be alarmed about the increase in cases of swine flu in south Africa ? Experience in other affected countries indicates that this virus spreads rapidly through communities . It is not possible to contain this virus by quarantine of contacts and travel restrictions. Social distancing of affected persons usually by home isolation’ may to some extent reduce spread. From the experience of this disease in other countries spread is inevitable. What is most important is to reduce potential complications of the disease by focusing on diagnosis and treatment of persons with severe illness and those at risk for complications What should I do if I get sick? If you live in areas where people have been identified with novel H1N1 flu and become ill with influenza-like symptoms, including fever, body aches, runny or stuffy nose, sore throat, nausea, or vomiting or diarrhea, you should stay home and avoid contact with other people. Staying at home means that you should not leave your home except to seek medical care. This means avoiding normal activities, including work, school, travel, shopping, social events, and public gatherings If you have severe illness or you are at high risk for flu complications, contact your health care provider or seek medical care. Your health care provider will determine whether flu testing or treatment is needed If you become ill and experience any of the following warning signs, seek emergency medical care. In children, emergency warning signs that need urgent medical attention include: Fast breathing or trouble breathing Bluish or gray skin color Not drinking enough fluids Severe or persistent vomiting Not waking up or not interacting Being so irritable that the child does not want to be held Flu-like symptoms improve but then return with fever and worse cough In adults, emergency warning signs that need urgent medical attention include: Difficulty breathing or shortness of breath Pain or pressure in the chest or abdomen Sudden dizziness Confusion Severe or persistent vomiting Flu-like symptoms improve but then return with fever and worse cough Who is at high risk of severe illness? Complications of seasonal influenza occur more commonly in persons of 65 years and older, children younger than five years old, pregnant women, and people of any age with certain chronic medical conditions that increase the risk of influenza-related complications, like asthma and diabetes as well as any other immuno suppressive condition. While overwhelmingly the experience of this new virus has been of mild disease, there have been a small number of deaths reported in other countries to date. Some of these have been in persons with underlying chronic illness or in pregnant woman, but a number of the deaths have been in young persons who are otherwise healthy. This is a typical feature of new pandemic virus strains. It is unknown how this virus will affect persons who are immuno-suppressed due to the presence of HIV infection. Adults older than 60 may have antibodies against this virus by previous exposure to a similar strain. Do we have tests available in SA for influenza A/H1N1? Yes. The National Influenza Centre at the National Health Laboratory service at the National Institute for Communicable Diseases and Virology Laboratory at University of Stellenbosch are currently providing the testing for the virus where indicated. It is likely that additional laboratories will be providing testing in the coming weeks. Who should be tested for novel influenza A/H1N1 (“swine flu”)? At present suspected cases will be tested. A suspect case is currently defined as follows: An individual with recent onset of influenza-like illness: fever of 38°C PLUS ONE OR MORE of the following acute respiratory symptoms (sore throat, runny nose/nasal congestion, cough or muscle pains) AND gives one of the following histories: Travel within 7 days prior to onset of symptoms to countries with confirmed community-wide outbreaks. Close contact with an individual who is a suspected/confirmed case of swine influenza A/H1N1 in the 7 days prior to onset of symptoms i.e. having cared for, lived in the same household with, or had direct contact within 2 metres of a suspected or confirmed case of novel influenza A/H1N1. There is no indication to test healthy contacts of confirmed cases, unless they develop symptoms. As the numbers of suspected cases increase and community transmission is identified, the testing strategy will change to focus on confirming illness in patients with moderate or severe disease, and there will not be routine testing of persons with mild influenza –like illness. A number of existing monitoring systems for seasonal influenza will rather be used for monitoring the general trend of the novel influenza outbreak. Is there any effective treatment for this virus? Currently this pandemic is of moderate severity globally. The majority of patients experience mild symptoms and make a rapid and full recovery, often in the absence of any form of medical treatment. Oseltamivir (Tamiflu®) are drugs currently recommended in SA. It is recommended that treatment be given only to suspected and confirmed cases showing severe symptoms as well as those at high risk of severe illness. If I have a family member at home who is sick with novel H1N1 flu, should I go to work? Employees who are well but who have an ill family member at home with novel H1N1 flu can go to work as usual. These employees should monitor their health every day, and take everyday precautions including washing their hands often with soap and water, especially after they cough or sneeze. Alcohol-based hand cleaners are also effective. If they become ill, they should notify their supervisor and stay home. Employees who have an underlying medical condition or who are pregnant should call their health care provider for advice, because they might need to receive influenza antiviral drugs to prevent illness. Steps to Lessen the Spread of Flu in the Home When providing care to a household member who is sick with influenza, the most important ways to protect yourself and others who are not sick are to: keep the sick person away from other people as much as possible (see “placement of the sick person”) Remind the sick person to cover their coughs, and clean their hands with soap and water or an alcohol-based hand rub often, especially after coughing and/or sneezing. have everyone in the household clean their hands often, using soap and water or an alcohol-based hand rub household contacts of the sick person—who may have chronic health conditions—should take antiviral medications such as oseltamivir (Tamiflu®) to attempt to prevent the flu. What can a person do to protect themselves from getting sick? There is no vaccine available right now to protect against novel H1N1 virus. There are everyday actions that can help prevent the spread of germs that cause respiratory illnesses like influenza. Cover the nose and mouth with a tissue when coughing or sneezing. Throw the tissue in the bin after use Wash hands often with soap and water, especially after coughing or sneezing Alcohol-based hand cleaners are also effective. Avoid touching the eyes, nose or mouth. Germs spread this way. Try to avoid close contact with sick people. Keep a distance of at least 2 metres from people with respiratory symptoms Stay home if you are sick for 7 days after your symptoms begin or until you have been symptom-free for 24 hours, whichever is longer. This is to keep from infecting others and spreading the virus further. Are there vaccines against this new virus? There is currently no vaccine against this new virus. Does the current seasonal influenza vaccine protect against this new virus? Available data suggest there will be little or no protection offered by the seasonal vaccine against this new virus.
As at Monday the 31st August 2009, there have been 5 841 laboratory confirmed cases and 27 deaths with laboratory confirmation by the National Institute for Communicable Diseases of the National Health Laboratory Service. Of the 27 fatal cases to date, 12 were pregnant women, five of whom had no identified underlying conditions, two were HIV-positive, two were HIV-positive with TB, one had TB and one was obese with a history of substance abuse. Details of one case are still outstanding. Underlying conditions were identified for 12 of the remaining fatal cases; one with asthma, one who was obese, two who were HIV-positive, three patients with chronic cardiac diseases plus obesity plus diabetes, two patients with diabetes, one with hypertension and chronic renal failure. Any persons with co-morbidity or pregnant women in the second or third trimester, or in the puerperal period must receive early treatment with antivirals if Influenza-like illness is present. Treatment should be instituted prior to any laboratory results in this group. The majority of illness in persons without any underlying conditions remains mild and self-limiting. Issued by the National Institute for Communicable Diseases of the National Health Laboratory Service. For further information please contact Nombuso Shabalala on 011 386 6462 or 082 886 4238
PANDEMIC A (H1N1) 2009 UPDATE 24 August 2009
As of the 24th August 2009, there have been 5118 laboratory-confirmed cases of pandemic influenza A H1N1 (2009) in South Africa. These include 18 fatal cases with laboratory confirmation at the National Institute for Communicable Diseases of the National Health Laboratory Service. Nine of the deaths have been in pregnant women, with the majority in the third trimester of pregnancy. The third trimester of pregnancy has been identified as a particular risk factor for severe H1N1 illness in many other countries to date. It is critical that influenza H1N1 be highly considered in any pregnant woman with influenza-like illness (fever, muscle pain and/or dry cough). In the earlier stages of pregnancy the decision to treat must be made by the doctor based on the clinical condition of the patient. In the third trimester of pregnancy treatment with the appropriate antiviral drugs must be given urgently particularly if there is any sign of pneumonia (shortness of breath) and prior to any laboratory testing and results being received. Other risk factors for severe illness may include HIV/Aids, asthma, diabetes, any chronic heart and lung condition and any cause of depressed immunity. Early treatment may be indicated. Currently there is a wide- spread community outbreak of pandemic influenza A H1N1 in South Africa. The majority of illness remains mild and self- limiting. Routine testing of all persons with influenza-like illness for H1N1 is not recommended, and laboratory focus has to be on identifying persons with more severe illness. The likelihood of influenza –like illness being due to the pandemic influenza strain is very likely at this moment because of the widespread outbreak and a positive laboratory test is not necessary to guide treatment where indicated. Issued by the National Institute for Communicable Diseases of the National Health Laboratory Service. For further information please contact Nombuso Shabalala on 011 386 6462 or 082 886 4238
PANDEMIC H1N1 2009 – UPDATE 20 August 2009
An eighth death due to the A (H1N1) virus has been confirmed today, the 20 August 2009, by the National Institute for Communicable Diseases of the National Health Laboratory Service. This follows the case of the 21 year old Pretoria young woman who became the first Gauteng victim and seventh death in the country. The eighth case is that of a 38 year old, pregnant woman who was in her third trimester, she died at the Dora Nzinga hospital in Port Elizabeth in the Eastern Cape. She was also a TB patient on treatment. Out of the eight confirmed cases, three have been pregnancies, four had no underlying conditions while the other had hypertension and was diabetic. Containment of the influenza A H1N1 is not possible given the highly infectious nature of the virus. The focus should therefore be on identifying persons at risk for complications, those with moderate or severe illness and those close contacts who may be at risk for complications. Persons at risk for complications include the elderly, pregnant women, and anyone with chronic underlying illness, such diabetes, those living with HIV and AIDS, chronic lung or chest infections. It is important that for those persons who are in the high risk category and present with moderate/severe respiratory disease requiring hospitalization be identified and treated early and appropriately There have been 3485 laboratory confirmed cases and the majority of cases have mild disease. Members of the public are advised to practice basic hygiene which includes regular washing of hands with water and soap, cough or sneeze into a tissue or sleeve, coughing into one's elbow instead of hands The Department of Health hotline number for all queries related to swine flu from the public is 0861 DOH CDC or 0861-364-232. There’s also an email query service, at H1N1@health.gov.za. Issued by the National Institute for Communicable Diseases of the National Health Laboratory Service. For further information please contact Nombuso Shabalala on 011 386 6462 or 082 886 4238
UPDATE: PANDEMIC H1N1 2009 17 August 2009
As at 17 August 2009, there are 3 485 laboratory confirmed cases of pandemic influenza A (H1N1) 2009, ‘swine flu’, in South Africa. There is an established outbreak in South Africa with community-wide transmission. Pandemic influenza A (H1N1) is the likely cause of influenza-like illness currently. Six A H1N1-related -deaths have been confirmed by the National Institute for Communicable Diseases of the National Laboratory Health Service. Four of the cases had no underlying conditions, one patient was pregnant and another was pregnant and diabetic. Severe illness is well documented to occur in young, previously healthy persons with pandemic influenza, but this remains a rare event. While the majority of cases remain mild with self–limiting illness, do not require a laboratory test or specific viral treatment, it is important that pandemic influenza A H1N1 must be considered in the diagnosis of any persons with moderate or severe influenza–like illness, including healthy young persons with progressive pneumonia and appropriate treatment needs to be instituted. In addition, early treatment with antivirals is advised for people with moderate and severe influenza-like illness who are pregnant, those living with HIV and AIDS, and those with chronic medical conditions including chronic lung disease and diabetes. . Issued by the National Institute for Communicable Diseases of the National Health Laboratory Service. For further information please contact Nombuso Shabalala on 011 386 6462 or 082 886 4238
UPDATE: PANDEMIC INFLUENZA (A H1N1) 03 August 2009
There has been a fatal case of pneumonia due to the pandemic A H1N1 virus (‘swine flu’) which was confirmed in the Western Cape and by the National Institute for Communicable Diseases of the National Health Laboratory Service, in an apparently healthy Stellenbosch University student. Severe illness and deaths related to pandemic influenza are rare events and the experience both globally and in South Africa has, to date, in the majority of cases been mild. The experience so far in other countries where these rare severe cases have occurred, have mainly been in patients with underlying conditions such as diabetes, obesity and pregnancy, but also in a small group of otherwise apparently healthy people. The guidelines for diagnosis and treatment remain unchanged. People with mild illness do not require a specific laboratory diagnosis or treatment with anti-viral drugs. It is always important that persons with risk factors and those who are showing progression of illness or who have signs of complications must seek urgent medical attention Issued by the National Institute for Communicable Diseases of the National Health Laboratory Service. For further information please contact Nombuso Shabalala on 011 386 6462 or 082 886 4238
Note to Editors
The National Institute for Communicable Diseases (NICD) is no longer doing daily updates of laboratory confirmed cases of pandemic influenza A/H1N1, but will provide on a weekly update every Friday. This is in line with a recommendation from the World health Organisation(WHO)– that the ’counting of individual cases is now no longer essential for monitoring either the level or risk posed by the pandemic virus or to guard implementation of the most appropriate responses A strategy that concentrates on the detection, laboratory confirmation, and investigation of all cases, including those with mild illness, is extremely resource-intensive and not recommended. The NICD is a division of the National Health Laboratory Service (NHLS). The NHLS mandate from national government is to provide cost-effective and efficient health laboratory services, support health research to provide training for health science education. Visit www.nhls.ac.za for more information

Global response to the H1N1 pandemic- Public world health leaders to gather in Johannesburg