Whenever there’s an outbreak of flu – usually over the winter months – various myths begin to circulate, some as contagious as the flu itself. These range from confusion about what flu actually is, to speculation about how it’s transmitted.

Flu is a contagious respiratory tract illness caused by the influenza virus. There are three different strains that can cause seasonal flu in humans. They are called influenza A(H1N1), influenza A(H3N2) and influenza B. Here are six common myths which regularly do the rounds.

Flu is just a bad cold

False: Both flu and colds are respiratory illnesses, but they are caused by different viruses. Flu is generally worse than a cold. Flu presents with a sudden onset (within a few hours) of some or all of the following: fever, upper respiratory symptoms (such as runny and congested nose), cough, tiredness, muscle pains, body aches, headaches, cold shivers and hot sweats.

A cold presents with a runny nose or congestion and generally does not result in serious complications.

Flu can lead to serious complications including pneumonia. Pneumonia is an infection of the lung which results from either the influenza virus alone (viral pneumonia) or from co-infection with a bacteria (secondary bacterial pneumonia). Other possible serious complications triggered by flu can be heart, brain or muscle tissue inflammation and multi-organ failure. This happens when the flu virus in the lungs causes an inflammatory response throughout the body causing a number of organs to fail. This could include respiratory and kidney failure.

A serious flu infection may require admission to the hospital, especially in high-risk groups for severe influenza complications. These include pregnant women, people over 65, children under 2, people with underlying medical conditions such as kidney or lung disease and diabetes.

Most people will recover from flu within three to seven days.

The influenza vaccine can give you flu

False: The vaccine does not contain live virus so you cannot ‘catch’ flu from the vaccine. At the time when influenza vaccine is recommended (just before the flu season), there are many other types of respiratory viruses around that can cause similar signs and symptoms to flu. There is a high chance of being infected with one of these viruses and people often – incorrectly – attribute the illness to a flu shot they’ve just had.

The vaccine also takes two weeks to work so you could catch flu during this period, especially if you receive the influenza vaccine after the flu season has started.

One more fact on vaccines: the flu vaccine needs to be repeated every year as the flu viruses change slightly each year.

A vaccination is enough to prevent flu

False: The vaccine is not 100% effective. In addition, effectiveness depends on the age and health of the person being vaccinated. The efficacy of the vaccine also varies from year to year depending on how the vaccine matches the circulating influenza strain.

To prevent being infected with flu you need to wash your hands frequently with soap and water or an alcohol-based hand rub. It’s also important to avoid contact with sick people.

Being exposed to cold weather will give me flu

False: The only way to catch flu is by being exposed to the flu virus. The flu season coincides with the cold weather and so naturally people associate the two.

The influenza virus spreads mainly by droplets from infected people when they cough, sneeze or talk. You can also come in contact with the influenza virus through contaminated surfaces or objects (for example, door handles) and then touching your mouth, eyes or nose.

People can get swine flu

False: The term swine flu is sometimes used to incorrectly refer to the influenza A(H1N1) strain which emerged globally during the 2009 pandemic. When the strain emerged, scientists noted that it was similar to some strains of flu which had been seen in pigs. That’s why some people started calling it ‘swine flu’.

Since its emergence in 2009 influenza A(H1N1) has become one of our normal seasonal influenza circulating strains in humans. The term swine flu should not be used as this term means flu in pigs. Patients infected with influenza A(H1N1) strain should be treated as if they have any other seasonal strain of influenza.

Antiviral medication should always be prescribed for flu

False: Treatment for flu is largely directed at reducing the signs and symptoms of flu, like a runny nose, body pains and tiredness. Bed rest, plenty of fluids and symptom relief of cough, congestion and fever are advised.

Individuals at risk of serious complications or very sick individuals may be prescribed antiviral medication. But this needs to be prescribed in the first 24-48 hours from onset of symptoms for it to be most effective.

Dr Bracha Chiger, a medical doctor at the NICD Centre for Respiratory Diseases and Meningitis, contributed to this article.

Sibongile Walaza, Medical Epidemiologist at the National Institute of Communicable Diseases and Lecturer at the School of Public Health, University of the Witwatersrand and Cheryl Cohen, co-head of the Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases

This article is republished from The Conversation under a Creative Commons license. Read the original article.

What causes sepsis?

Bacterial, fungal and viral infections can lead to sepsis and septic shock. The condition can occur from infections acquired while an individual is hospitalised, however, it can also occur from infections acquired in the community.

There are common causes of sepsis. These include infections of the respiratory system (pneumonia for example), genitourinary system (such as urinary tract and or kidney infections), gastrointestinal infections, and in the healthcare setting, indwelling catheter sites. Infections of the central nervous system (meningitis) as well as skin and soft tissue (surgical site, wounds or burns) are also common causes of sepsis.

The most common infection in septic patients worldwide is pneumonia caused mainly by bacterial pathogens.

Who is at risk of sepsis?

Any patient with an infection can develop sepsis. But babies up to one month old and people older than 65 years have a higher risk of developing the condition.

The risk of sepsis is also high among people with weakened immune systems such as those with HIV or patients undergoing chemotherapy. Prolonged hospital stays or admission to an intensive care unit (ICU) can also increase the risk of sepsis.

Other risk factors include chronic diseases such as diabetes, kidney disease or chronic obstructive pulmonary disease, patients with medical devices inserted into the body and having history of prolonged use of antibiotics.

What are the symptoms of sepsis and septic shock?

Symptoms of sepsis are not specific. These may include one or more of these:

• Fever
• Tachycardia (elevated heart rate)
• Tachypnea (rapid breathing)
• Altered mental state (confusion)
• Lethargy especially in children

Septic shock is a progression of sepsis. It’s characterised by hypotension (low blood pressure), hypovolaemia (loss of bodily fluids such as water and blood) and organ dysfunction.

Patients typically present with extreme confusion or loss of consciousness.

How is sepsis and septic shock diagnosed?

There are various tests available to diagnose sepsis and septic shock. Sepsis and septic shock are clinical syndromes defined by a combination of signs, symptoms, laboratory and physiological abnormalities.

A variety of clinical variables and tools such as vital signs (heart rate, respiratory rate, temperature and blood pressure), laboratory blood tests (confirmation of infection) and clinical examinations have to be reviewed for sepsis screening.

Commonly, blood samples are taken to test for causative bacterial and fungal pathogens. Other laboratory tests can be performed to try find the source of the infection.

Imaging studies can be used to identify or detect the site of infection. Chest x-ray for example, is used to diagnose pneumonia. An ultrasound can show infections in the gallbladder and kidneys. Computerised tomography (CT) scans are used for infections in the liver, pancreas or abdomen. And magnetic resonance imaging (MRI) can detect soft tissue or bone infections.

How is sepsis managed?

Once diagnosed, sepsis needs early, thorough, aggressive and appropriate management to increase the likelihood of patient recovery. Patients with sepsis need close monitoring and treatment in a hospital ICU. This is because septic patients may need lifesaving measures to be stabilised.

Intravenous fluids should be started as soon as possible, preferably within the first three hours of sepsis being identified.

It is also recommended that patients are admitted to an ICU and that mechanical ventilation is used for respiratory support in patients with acute respiratory distress syndrome. The source of sepsis should also be controlled. This could take place by draining an abscess or changing of an intravenous line.

How is sepsis prevented?

To prevent sepsis, both the community and healthcare workers have a responsibility to ensure that infections don’t develop.

In the community, infections can be prevented by controlling chronic medical conditions. Vaccinations, for example, prevent between four and five million deaths annually by preventing infections or reducing their severity. Practising proper hand hygiene reduces the risk of diarrhoea by 40%. And safe water and sanitation reduces the global burden of disease by 10%.

In healthcare facilities prevention of the sepsis include practising appropriate infection prevention and control measures which can reduce infections by 50%. Recognising sepsis early and introducing antibiotics treatment early can reduce the likelihood of sepsis progressing to mortality. Anyone who has signs and symptoms of sepsis, even when the underlying infection is not apparent, should seek medical care immediately.

Sepsis is a major public health burden. Controlling it can create healthier societies.

Caroline Maluleka, Senior Pathologist, National Institute for Communicable Diseases

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The progress made between 2000 and 2015 is proof of what can be achieved. Support from global donors helped drive down malaria deaths among children under five from 723,000 to 306,000. Most of the deaths prevented were in sub-Saharan Africa. Fifty-five of the 106 malaria-endemic countries showed a 75% decrease in new malaria cases by 2015 compared to 2000. But in 2016, the global malaria response plateaued. In some regions it even backtracked. Malaria cases and deaths increased as national malaria control programmes competed with other health challenges.

The World Health Organization (WHO) and other partners issued urgent calls to address the challenges national programmes were facing. But the gap in funding and technical capacity widened. Malaria control efforts in Africa remained woefully off-track to meeting 2030 elimination targets.

And then the COVID-19 pandemic hit. At the start of the pandemic, there were dire warnings of catastrophic disruptions to routine malaria services. These were expected to lead to a doubling of malaria deaths in Africa. There were disruptions, but national malaria control programmes have shown impressive resilience over the past three years. Innovative actions saw malaria deaths increase by only 10% between 2019 and 2020. Malaria deaths didn’t double and have remained stable in 2021.

Now, the battle to eliminate and eventually eradicate malaria has become even more challenging. The challenges include the impact of climate change on the distribution of malaria-carrying mosquitoes; the invasion and rapid spread of new mosquito species; as well as emerging drug-resistant malaria parasites and insecticide-resistant mosquitoes. However, there is hope on the horizon. After decades of intense research, two new malaria vaccines have come to market. And researchers are developing new treatments and experimenting with different drug combinations. It may not happen by 2030, but malaria can be eradicated.

History

In 2000, the United Nations launched the millennium development goals. One of the goals was to reduce the malaria burden by 75% by 2015. This catalysed significant investments, particularly in sub-Saharan Africa. Between 2000 and 2015, international donor funding primarily from the Global Fund to Fight AIDS, Tuberculosis and Malaria and the American government-led President’s Malaria Initiative, enabled national malaria control programmes in Africa to replace failing interventions with more effective ones.

By 2015, over 150 million insecticide-treated bednets; 179 million malaria rapid diagnostic tests; and 153 million doses of the malaria treatment recommended by the WHO – artemisinin-based combination therapies (ACTs) – had been distributed across Africa. Encouraged by the progress in rolling back malaria, the WHO launched the Global Technical Strategy for Malaria. This strategy provided malaria-endemic countries with a roadmap for reducing malaria transmission. The ultimate aim was to have a world free of malaria by 2030. Unfortunately, the release of this strategy coincided with a levelling off in domestic and international funding, which led to an uptick in malaria cases.

In 2016, there were 216 million cases – five million more than in 2015. Ninety per cent of the new cases were in Africa where funding had dropped to less than 42% of what the continent required for effective malaria control.

Setbacks

Now the global malaria response faces new challenges.

Climate change experts predict that as the Earth warms up, malaria will spread into malaria-free areas. The malaria mosquito and parasite will develop faster. And that malaria transmission rates in areas where the disease is currently will increase. In addition, environmental changes linked to human activities, such as deforestation, are also likely to change the distribution of mosquitoes and the diseases they carry.

The recent invasion and rapid spread of the Asian malaria vector, Anopheles stephensi, through the Horn of Africa and as far west as Nigeria, may be an example of this. It has been identified as a threat to malaria elimination efforts in Africa. This mosquito species is extremely difficult to control. It thrives in urban areas, bites both in and outdoors, feeds on animals and humans, and is resistant to several insecticide classes. Acutely aware of the threat that this mosquito poses to malaria control in Africa, the WHO released an initiative to slow the spread of this vector into the rest of Africa.

Not to be outdone, the malaria parasite has also thrown a few curve balls into the mix. Plasmodium falciparum is the deadliest and most prevalent human malaria parasite in Africa. It has mutated and can go undetected by the most widely used point-of-care diagnostic tool in rural malaria endemic regions. This leaves malaria-infected individuals at risk of developing severe illness, and still capable of transmitting malaria. In addition, African malaria parasites from Eritrea, Rwanda and Uganda have become resistant to the artemisinin part of ACTs. ACTs are the only class of effective antimalarial currently available. The WHO has developed a strategy for tackling emerging resistance in Africa.

Way ahead

In 2021, the WHO took the bold step of approving the use of the RTS,S malaria vaccine in high-burden countries, despite its very modest efficacy of less than 40%. A newer version of the RTS,S vaccine, the R21 vaccine produced by Oxford University’s Jenner Institute, has shown much high efficacy in a Phase III trial. This has prompted Ghana and Nigeria to approve its use this month without pre-approval from the WHO. Researchers are developing newer, more effective antimalarials. Others are investigating using different combinations of existing drug and antibodies to effectively treat malaria. Newer, more effective insecticide-treated nets are being rolled out. And genomic surveillance is a new tool in the malaria elimination toolbox to assist with evidence-based decision-making.

Jaishree Raman, Principal Medical Scientist and Head of Laboratory for Antimalarial Resistance Monitoring and Malaria Operational Research, National Institute for Communicable Diseases

This article is republished from The Conversation under a Creative Commons license. Read the original article.

How common are hospital-acquired infections?

The World Health Organization (WHO) defines healthcare-associated infections, or “hospital” infections, as those affecting patients admitted to a healthcare facility. These are infections not present at the time of admission. They also include infections that appear shortly after discharge. Healthcare-associated infections are a significant cause of illness and death in hospitals.

In low- and middle-income countries such as South Africa, the WHO estimates that 15 out of every 100 patients in hospitals will get an infection. In high-income countries, the estimate is seven patients out of 100.

Which are the major infections?

Common types of healthcare-associated infections include bloodstream, cerebrospinal fluid, respiratory system, surgical sites, skin and soft tissue, and urinary tract infections. Intravenous and other devices are likely sources of infections in hospital settings.

Microorganisms such as bacteria, viruses, fungi and parasites cause infections. The most common bacterial agents are Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and enterococci.

Patients are at higher risk of getting infections if they have underlying conditions. These include but are not limited to diabetes, renal failure and malignancies. Long stays in hospital, surgical or invasive procedures, insertion of medical devices, intravenous tubing, and artificial joint replacement, also pose a risk. Patients may develop infection caused by microorganism with emerging antimicrobial resistance while on antimicrobial treatment or have been treated a few months to a year before. This makes individuals with antimicrobial resistance less able to fight infection.

Which infections are related to the availability of water?

Delivery of quality healthcare should take place in a hygienically clean and safe environment. This environment must have an adequate supply of clean running water and good sanitation for both patients and staff. The cornerstone of all infection prevention and control programmes is hand hygiene. Hand wash stations with water, soap, clean towels or alcohol-based hand rub should be available in key areas such as toilets and at the points of care. Standards for water quality, sanitation and environmental health should be met. Hand sanitisers must have at least 70% alcohol by volume.

Pathogens such as Legionella and non-tuberculous mycobacteria can contaminate the deep infrastructure such as pipes and drains or outlets of hospital water distribution systems. Other bacteria and moulds tend to adhere to surfaces at or near taps and sinks. Hospital management teams should have systems to address Water, Sanitation and Hygiene (WASH) malfunction or other related issues such as infrastructure.

Infection prevention and control programmes in healthcare facilities are important approaches to help protect vulnerable patients, as well as staff and visitors.

How can hospitals maintain infection control – even during water cuts?

Municipal water supplies to hospitals and communities must be pathogen-free and regularly monitored. Municipalities should have water quality assurance systems in place to ensure clean water. Contaminated municipal water can cause outbreaks that affect community and healthcare settings.

Hospital management should have a risk assessment plan for water shortages. They should communicate with municipalities about the provision of an alternative supply of clean water to the affected areas. Possible solutions could include a permanent (quality-assured borehole water) or temporary (water tanks) backup water supply. Those solutions must also be maintained properly to avoid contamination and subsequent infection of patients.

Husna Ismail, Epidemiologist, National Institute for Communicable Diseases and Olga Perovic, Principal Pathologist, National Institute for Communicable Diseases

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Since May 2022, monkeypox has been reported in more than 4,000 individuals from several European countries, the USA, Canada, Australia, Morocco and the United Arab Emirates. This is the first multi-country outbreak of monkeypox and is already the largest outbreak of monkeypox recorded. Person-to-person transmission involves close contact with an infected person or materials that have been contaminated by an infected person. Although the data indicates that persons with multiple sexual partners present an increased risk of acquiring monkeypox, any persons can acquire the virus if they have had close contact with an infected person. The virus is not highly transmissible and close physical contact is required for transmission.

Monkeypox presents with an acute illness characterised by fever and general flu-like symptoms, followed by the eruption of a blister-like rash on the skin. The disease is rarely fatal and cases typically resolve within two to four weeks. Most cases do not require hospital treatment. Prevention of infection hinges on the isolation of cases until fully recovered. The risk to the general population is considered low, given the low transmissibility of the virus.

As per WHO recommendations, the NICD will continue increasing vigilance for cases with contact tracing and monitoring of laboratory-confirmed cases. To read more click here.

Substantially lower numbers of hospitalisations and deaths were observed in this resurgence compared to any previous wave including the Omicron BA.1 wave. High levels of population immunity are likely a major contributor to the reduction in the burden of severe illness and death in South Africa, with a recent study by the South African National Blood Service estimating that 98% of South Africans have detectable antibodies to SARS-CoV-2. These antibodies are a result of infection, vaccination or a combination of the two.

In the context of high population immunity and lower disease severity the decision has been made to lift the COVID-19 regulations implemented as part of the National State of Disaster. However, it is important to keep in mind that SARS-CoV-2 will continue to circulate in the community, and therefore the potential for new variants or subvariants to emerge, and in turn cause surges in the number of cases exists. Therefore, continued monitoring of the SARS-CoV-2 trends and changes in early warning system indicators is important.

The National Institute for Communicable Diseases (NICD) will continue to monitor the trends in the number of SARS-CoV-2 tests performed, the positivity rate, and the number of cases. In addition, the trends in COVID- 19-related admissions and deaths will be monitored through the DATCOV hospital surveillance programme. We will also continue to monitor levels of SARS-CoV-2 in wastewater. Should there be any trend in these data suggesting a potential resurgence, the National Department of Health, NICD and others will be alerted to the early warning signals from the above surveillance programmes, and take early action to inform appropriate public health response.

Recommendations for control of COVID-19 following the lifting of COVID-19 regulations

Vaccination is the most effective method for preventing and controlling severe COVID-19, and people eligible for COVID-19 vaccines must get vaccines and boosters as indicated in the national programme. A South African study found that among individuals vaccinated with the Ad26.COV2.S (Johnson & Johnson–Janssen) vaccine, the vaccine effectiveness against hospitalization for COVID-19 was 74% (95% confidence interval [CI], 57 to 84) at 14 to 27 days post vaccination, and 72% (95% CI, 59 to 81) at 1 to 2 months.

Read more here 

Monkeypox is a rare viral infection that is harboured by certain animals, most likely certain species of rodents in deep forested areas of some countries in the Western and Central Africa Region. Occasionally, the virus may spill over from the infected animals to humans. There is no risk of monkeypox virus infection from animals in South Africa. Once, a person was infected by an animal, person-to-person transmission may then occur through very close contact.

How does monkeypox spread and how contagious is it?     

When a person is infected with the monkeypox virus, the virus can spread to others through close contact such as kissing, cuddling, or touching parts of the body with monkeypox lesions (wound). People who do not have monkeypox symptoms cannot spread the virus to others. Monkeypox can spread from the time symptoms start until the rash has fully healed and a fresh layer of skin has formed. The virus is not very contagious and does not spread in the same way as viruses such as influenza and SARS-CoV2.

 How will you know if you have monkeypox?

Initial symptoms include fever, headache, muscle aches, backache, chills and exhaustion. Within 1-3 days of onset of fever, a rash that can look initially like pimples, but develops to blister-like appearance. The rash can be  present on the face, inside the mouth, and on other parts of the body, like the hands, feet, chest, genitals, or anus. The skin lesions form roughly at the same time and during the course of the illness the skin lesions appear similar until they resolve (i.e. scab falls off). This is unlike some other rash disease where lesions would be at different stages of progression at any given stage of the disease, up to resolution.

Can you get monkeypox from sex?

Even though it is not considered a sexually transmitted infection (i.e. it doesn’t spread only through contact with bodily fluids, but rather through contact with the skin rash), monkeypox can spread during intimate physical contact between people.  This contact can happen when you have sex, including:

• Oral, anal, and vaginal sex, or touching the genitals or anus of a person with monkeypox
• Hugging, massage, kissing or talking closely
• Touching fabrics, shared surfaces, and objects, such as bedding, towels and sex toys, that were used by a person with monkeypox

Anyone – regardless of gender identity or sexual orientation – can catch monkeypox if they have close contact with someone infected with the virus.

 Is it monkeypox or chickenpox?

Swollen lymph nodes are more commonly reported for monkeypox than chickenpox. With monkeypox most lesions arise almost at the same time and there for their appearance is similar. With chickenpox the lesions are at different stages of progression at a given time point (i.e. vesicles and scabbed lesion can be present at the same time).

How is it treated?

Most human cases of monkeypox virus do not require any specific treatment and the disease resolves on its own. Treatment is symptomatic and a doctor may prescribe medication to treat pain, fever and other discomforts.. It’s  Important to keep hydrated, and prevent scratching or bursting the blisters to prevent infection with bacteria. The rash is generally not itchy, but may become itchy when the skin lesions are almost healed.

What should you do if you think you have monkeypox?

It is important seek medical attention promptly if you are suffering from a rash and you think you may have monkeypox. There are many other causes of rash, many of which can be treated and any discomfort or pain you may be experiencing may be addressed. It is also important to diagnose monkeypox promptly to aid in the efforts to contain the transmission of the virus and avoid more cases from occurring.

Can you die from monkeypox?

Monkeypox is rarely fatal. Severe cases may occur in children, pregnant women, and in individuals that are immunocompromised.

Monkeypox is a rare viral infection in humans. Since May 2022, monkeypox has been reported in more than 3 000 individuals from several European countries, the USA, Canada, Australia, Morocco and the United Arab Emirates. This is the first multi-country outbreak of monkeypox and is already the largest outbreak of monkeypox recorded. The cases to date mostly involve individuals that self-identify as men having sex with men. Risk factors include reporting multiple sexual partners. Recent large social events are thought to have served as super spreader events.

Person-to-person transmission involves close contact (for example kissing, cuddling, sexual contact) with an infected person or materials that have been contaminated by an infected person (for example sharing linen, clothes and other household items).  The virus is not highly transmissible and close physical contact is required for transmission. It does not spread similarly to influenza or the SARS-CoV-2 virus.

Monkeypox presents with an acute illness characterised by fever and general flu-like symptoms, followed by the eruption of a blister-like rash on the skin. The disease is rarely fatal and cases typically resolve within two to four weeks. Most cases do not require hospital treatment. Prevention of infection hinges on the isolation of cases until fully recovered. The risk to the general population is considered low, given the low transmissibility of the virus.

The World Health Organization recommends increasing vigilance for cases with contact tracing and monitoring of laboratory-confirmed cases. Isolation of confirmed cases allows for the prevention of transmission and interruption of the cycle of transmission. Circulation of the monkeypox virus in humans may be eliminated through this classic containment approach. Mass vaccination against the monkeypox virus is not currently recommended.

For more information on monkeypox, click here.

The cross-sectional study concluded that flucytosine-based treatment is associated with a substantial survival benefit when delivered routinely. “I am optimistic that these data will prompt urgent revision of the current South African guideline which still recommends treatment without this essential antifungal medicine,” comments Prof Nelesh Govender, Head of the NICD’s Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses and senior author of the paper.

The World Health Organization has recommended flucytosine as a key life-saving component of cryptococcal meningitis treatment since 2018, yet this medicine was not available or registered in South Africa. A national access programme was initiated to confirm if flucytosine-containing regimens reduced the length of hospital stay (a major driver of costs) and improved survival compared with other regimens in routine care. Using its flagship national laboratory-based surveillance system (GERMS-SA), the NICD monitored almost 2 000 people with cryptococcal meningitis from July 2018 to March 2020.

These individuals were treated with or without flucytosine-containing regimens at 19 hospitals. “Our findings revealed that the 24% in-hospital mortality among patients treated with a flucytosine-containing regimen (vs. 37% mortality among patients treated with the standard care) in public-sector hospitals was comparable to the mortality reported in the Advancing Cryptococcal Treatment in Africa clinical trial. This was a 47% reduction in mortality,” Govender highlights.

While the burden of cryptococcal meningitis has declined in high-income countries with widespread access to antiretroviral treatment (ART), this health problem persists in countries where many people remain at risk because they are unaware of their HIV infection status and are thus ART-naïve, or interrupt ART after starting treatment. According to Rajasingham R, et al., authors of A global burden of disease of HIV-associated cryptococcal meningitis: an updated analysis, 73% of cryptococcal meningitis deaths occur in sub-Saharan Africa. “The data collected through the programme were invaluable in expediting flucytosine registration in December 2021 by the South African Health Products Regulatory Authority,” adds Govender. He concludes that to save lives, individuals diagnosed with HIV-associated cryptococcal meningitis need flucytosine-based treatment without further delay.

Click here to read the paper.

Measles is a highly contagious disease and it spreads through infectious airborne respiratory droplets from infected persons when coughing or sneezing.  Measles commonly presents with respiratory tract symptoms and any of the three C’s: conjunctivitis, cough, and coryza. Other symptoms can include fever, fatigue, and muscle pain, which typically appear before the onset of the disease’s characteristic maculopapular rash. Children under 1 year of age may develop complicated measles including bronchopneumonia, keratoconjunctivitis, and rarely, encephalitis. These complications may lead to irreversible damage and or death, especially in immunocompromised or malnourished children. Furthermore, even healthy children who develop measles develop transient immunosuppression and are more susceptible to common childhood illnesses for at least one year after infection.

The Gauteng Department of Health is working together with City of Tshwane and the West Rand district health teams, the National Department of Health, the NICD, and WHO staff members to investigate and respond to the outbreak. Measles is a notifiable medical condition (NMC) according to the National Health Act. Health care workers should notify all suspected cases via the NMC app (https://www.nicd.ac.za/nmc-overview/overview/ ). Practitioners should submit a blood specimen for antibody testing and a throat swab along with a completed case investigation form available here .  Samples should be submitted to the NICD, marked ‘NICD Measles Laboratory– attention CVI’. Testing is done free of charge.

Non-pharmaceutical measures such as social distancing and hand-washing might not be sufficient to prevent transmission of the measles virus.  Measles is preventable through a safe and effective vaccine. Caregivers and mothers are urged to ensure that children are up to date with their routine vaccinations. According to the South African Expanded Programme on Immunization (EPI), children are given the MeasBio® (Biovac) vaccine at 6 months old and a booster at 12 months old. These vaccines are available free of charge at public health facilities. The measles-mumps-rubella vaccine (MMR) is also available, at cost, in private sector clinics and is equally effective and safe.

For more information on measles and related documents click here