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.

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.

Nicole Wolter, National Institute for Communicable Diseases

Pneumonia is a respiratory infection that affects the lungs. The viruses and bacteria that cause the disease are spread through airborne droplets from a cough or sneeze. An infection can cause the lungs to fill with pus and fluid, making breathing and oxygen intake difficult. And while anyone can get pneumonia, children with weakened immune systems or underlying illnesses are more susceptible. That’s why pneumonia kills more than a million children every year across the world.

There have been some critical advances in preventing and treating the disease. These include vaccines, antibiotics and providing supplemental oxygen. In 2009, South Africa became the first African country to include the pneumococcal conjugate vaccine in its routine infant immunisation programme. By 2012 an estimated 81% of one-year-old babies had received three doses of the vaccine.

South Africa has also reduced its pneumonia burden through the mass roll-out of antiretroviral therapy and the HIV prevention of mother-to-child transmission programme. This has made a difference because children born to HIV-infected mothers have a significantly increased risk of pneumonia disease and death.

But much work remains. In 2016 influenza and pneumonia were the second leading cause of death in children younger than five years in South Africa. That’s why we at the country’s National Institute for Communicable Diseases are monitoring key areas related to the cause and effects of pneumonia.

There is reason to be optimistic: a number of advances currently in development will almost certainly strengthen our artillery in the fight against pneumonia. Some of these are complicated and expensive, such as developing additional and more effective vaccines. But there are also many tools that don’t involve expensive, complicated medical interventions such as providing adequate nutrition, clean air and water.

There is an argument to be made for getting back to basics in a bid to tackle pneumonia. The answer to stopping children dying from preventable diseases may simply lie in basics such as reducing poverty and inequity.

Advances

As with any other disease, data is crucial when it comes to understanding and, ultimately, controlling pneumonia. At the institute, we examine what pneumonia-causing pathogen strains are circulating at any given time. We also keep a close eye on population groups at risk of infection and death (such as children) and monitor the effect that existing vaccines have on the disease.

All this data helps to detect increases in disease. This helps us to prepare rapid responses and work towards containment should an outbreak occur.

The information we collect can also help those who are trying to develop new pneumonia vaccines and improve current vaccine schedules. For instance, immunisation of women in their third trimester of pregnancy to provide protection to their babies in their first few months of life when they are most vulnerable.

In addition, vaccine candidates targeted against one of the viruses responsible for a significant proportion of childhood pneumonia – the respiratory syncytial virus (RSV) – are in the late stages of development.

Other advances are being made to improve pneumonia diagnosis. These include improved radiological methods, point-of-care tests which are used at or near patient care to speed up diagnosis, and the use of host biomarkers that examine the type of immune response a person develops to identify the cause of infection.

Back to basics

We know that malnutrition, indoor household air pollution, poverty, poor hygiene and sanitation all significantly increase a child’s risk of infection and death.

In South Africa, about 30,3 million people were living below the poverty line in 2015. Two-thirds of children younger than 18 years were living in poverty.

It is critical to provide children with basic human needs like adequate nourishment, access to clean water and air, and equitable access to vaccines and basic healthcare.

The costs associated with improving children’s living conditions must be evaluated against the high costs associated with the clinical management of childhood pneumonia. The residual burden of pneumonia can be reduced by prioritising child health through simple interventions. These include improving living conditions and accessibility to affordable medication, vaccines and care.

Nicole Wolter, Principal Medical Scientist, National Institute for Communicable Diseases

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

Nazir Ismail, National Institute for Communicable Diseases

The world marks World Tuberculosis (TB) Day on March 24 every year. Most people assume that TB only affects the lungs – but the disease can also attack other organs. The Conversation Africa’s Ina Skosana spoke to Professor Nazir Ismail to find out more. Professor Ismail works and conducts his research in South Africa, one of the world’s TB hot spots.

What parts of the body does TB affect?

TB most commonly affects the lungs – what’s known as the body’s pulmonary system. But it affects other organs too, what’s known as extrapulmonary TB.

Other organs that can be affected include the lining covering the lungs (pleural TB); the central nervous system (TB meningitis); bone and joints (musculoskeletal system); lymph nodes; abdomen – where the liver, spleen and the intestines can be affected (abdominal TB); kidney and bladder (urogenital TB); and blood.

A study conducted in Johannesburg showed that the most common sites of extra pulmonary TB were the pleura (39.1%), lymph nodes (31.0%), blood (21.8%), central nervous system (7.3%), and abdomen (2.9%).

Another study conducted in the KwaZulu-Natal province also showed pleural TB to be the most common form of extra pulmonary TB (36% of patients).

How common is this form of TB? What causes it?

According to the World Health Organisation’s most recent TB report, extrapulmonary TB accounted for 14% of TB cases recorded globally in 2017. Across the African continent, extrapulmonary TB accounted for 16% of the 1 323 450 cases recorded. In South Africa it accounts for 11% of all TB cases reported.

Importantly – unlike pulmonary TB, which is spread through the air from person to person – extrapulmonary TB is not infectious.

A key risk factor for developing extrapulmonary TB is a compromised immune system which is why it is more common in patients infected with HIV. It can also occur in people with diabetes, cancer, low body weight and chronic kidney disease. Smoking and the use of drugs that can suppress the immune system also increase the risk of extrapulmonary TB.

Though the risk factors differ, all types of TB develop in the same way. TB infection occurs when a person inhales droplet particles containing the TB bacterium. Once inhaled, the bacteria then heads for the lungs. If the immune system is fully functional, several mechanisms are put in place by the body’s response to the foreign agent to contain the bacteria. The end result is usually a walled off “granuloma”, preventing the TB bacteria from multiplying and making the person ill.

In some patients, the TB escapes to another part of the body before the lungs can wall it off. In healthy people with strong immune systems, other organs or systems will put up a “barrier” that’s similar to the lung’s granuloma.

But if this defence mechanism fails, the bacteria multiply and cause disease in that specific organ system. This is called primary TB and is usually seen in young children.

Sometimes, a person can successfully wall off TB when they are healthy. But as their immune system weakens – because of old age, or conditions like HIV and diabetes – the wall can break down. If that happens, the bacteria can multiply and lead to active disease.

How is extrapulmonary TB diagnosed and treated?

Clinicians find it challenging to diagnose extrapulmonary TB. This is because the patient doesn’t present with the typical signs and symptoms of pulmonary TB – chronic cough, fever, loss of weight and night sweats. In some cases, the presenting signs and symptoms can be very vague and can mimic other conditions. All this means the clinician must have a strong suspicion that their patient has extrapulmonary TB to even start seeking this diagnosis.

Investigations include X-rays, CT scans or MRIs and sending appropriate specimens to the laboratory to detect the TB bacterium. The type of specimen that should be sent depends on the organ system involved. For example, in the case of lymph node TB, a biopsy (tissue specimen) of the lymph node should be sent to the laboratory; in the case of pleural TB, pleural fluid should be sent for testing.

It is important to note that in certain instances, even though the laboratory result might be negative, the clinician may still opt to treat for tuberculosis based on the high clinical suspicion, constellation of clinical signs and symptoms; and adjunct special investigations (biopsy, CT scans).

The drugs used to treat extrapulmonary TB are the same as those used for the treatment of pulmonary TB. The only difference is that the duration of treatment for extrapulmonary TB is longer and depends on the organ system involved. Most extrapulmonary TB is treated for nine months but can sometimes be longer. Treatment is taken orally and is a combination tablet that is dosed based on a person’s weight. Hospital admission is not required for treatment unless the patient is severely ill. Patients can continue to take their medication at home.

How does a person know they’ve got it?

The presentation of extrapulmonary TB depends on which organ is involved. An example is lymph node TB on a person’s neck which would present as a noticeable growth or lump. There are multiple causes for such a growth, one of which is TB, which the doctor would know to investigate. Thus seeking medical advice early when you are unwell is an important starting point.

Nazir Ismail, Head of the Centre for Tuberculosis, National Institute for Communicable Diseases

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

Sexually transmitted infections (STIs) are a serious public health issue. It’s estimated that globally, more than a million people are diagnosed with one or more sexually transmitted infections like gonorrhoea, chlamydia or syphilis every day. What’s more concerning is that the prevalence of infection with chlamydia for example, have remained unchanged over the past 10 years despite better screening in developed countries.

As the name suggests, STIs are spread mainly through sexual contact. This includes vaginal, anal and oral sex; some infections can also be spread by non-sexual means – for example, from mother to child during pregnancy or childbirth.

STIs can have devastating effects on sexual, reproductive and general health. They can also lead to a number of complications. If left untreated chlamydia and gonorrhoea can cause damage to reproductive organs and result in long term complications such as infertility. People can even die if certain STIs such as syphilis are left untreated, or if they have complications such as pelvic inflammatory disease in the case of chlamydia.

To make matters worse, STIs increase the risk of HIV infection and transmission. This is because the body’s response, which is meant to help fight the sexually transmitted infection, causes a concentration of “activated” immune cells in the infected area. It then becomes easy for HIV to infect and replicate in the immune cells that are “activated”.

So it’s cause for concern that South Africa, with – 7.9 million people living with HIV in 2017 – also has a high volume of STIs.

In 2017 there were an estimated 2.3 million new cases of gonorrhoea, 1.9 million new chlamydia cases and 23,175 new syphilis cases among women aged between 15 and 49. Among men of the same age there were an estimated 2.2 million new cases of gonorrhoea, 3.9 million new cases of chlamydia and 47,500 new cases of syphilis.

These high numbers of STI cases in South Africa have partly been due to inadequate prevention and treatment gaps. Some people with STIs such as chlamydia, may go untreated because they don’t show any symptoms.

Better STI screening for high risk clients – regardless of symptoms – and better training of healthcare workers is necessary. In addition, structural problems such as limited access to client-friendly STI detection and treatment services need to be addressed. Of course, all of this costs money, which is in short supply. That’s why the need for better prevention cannot be overstated.

STI prevention in the past

Prevention of STIs other than HIV has largely taken a backseat while the country focused on HIV prevention. HIV prevention concentrated on reducing the number of sexual partners people have, increasing the correct and consistent use of condoms, early detection and treatment, and promotion of male circumcision. These measures were of some benefit in preventing other STIs.

But the increasing availability of antiretroviral drugs and advances in research have brought a new message to people living with HIV: an HIV positive person with an undetectable viral load can’t transmit the virus to their HIV negative partner.

This message, however, does not directly address the transmission of STIs other than HIV. It focuses on HIV and how to manage it, but forgets that people with HIV may be vulnerable to other STIs.

Pre-exposure prophylaxis – another HIV prevention tool – involves taking antiretroviral medication to prevent HIV infection. Research has shown that, if taken consistently and as intended, it can reduce the risk of acquiring HIV. But pre-exposure prophylaxis doesn’t protect people from other STIs.

Services to test for and treat STIs are included in pre-exposure prophylaxis services as a way of assessing levels of unprotected sex and sexual risk taking among users. But the take home message about the prevention of STIs in these settings is not clear. What counselling on STIs are pre-exposure prophylaxis clients receiving or should they be receiving? How should pre-exposure prophylaxis be promoted without compromising STI prevention?

Renewed focus on STI prevention

Strategies to prevent STIs must take into account the changes and advances in HIV prevention and treatment. Policies must answer a number of questions.

For instance, how can having fewer sexual partners, the correct and consistent use of condoms, the early STI detection and treatment of oneself and one’s partners, and male circumcision be made “fashionable” when HIV is not the death sentence that it used to be?

And what’s the best way to communicate that the knowledge of infections in oneself and the partner are key to preventing both HIV and other STIs?

It’s also important to explore how best to design prevention services that communicate how STIs and HIV happen in the context of transient, short-term or longer relationships. Policy makers need to understand, too, how people can be empowered to form, maintain or terminate relationships in a manner that does not place them in harm’s way with respect to HIV, STIs or intimate partner violence.

All of these issues must be urgently considered if South Africa is to tackle its STI problem as effectively as it’s been able to deal with HIV.

Tendesayi Kufa-Chakezha, Epidemiologist and Public Health Specialist, National Institute for Communicable Diseases

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

Jacqueline Weyer, National Institute for Communicable Diseases

Vaccines are recognised as one of the most powerful tools in controlling and preventing infectious diseases. This despite strong anti-vaccination movements around the globe.

It was with vaccine in hand that one of the most dreaded diseases of the last two centuries, smallpox, was eradicated. Likewise, the eradication of vaccine preventable diseases such as poliomyelitis and measles remain global goals. And vaccines have lessened the burden of many other diseases around the world.

Ebola outbreaks have been sporadically reported since 1976. Before 2014, these outbreaks occurred mostly in countries located in the equatorial belt of Africa. Often outbreaks occurred in remote locations, affecting very isolated communities. They could be controlled by identifying sick people and isolating them, tracing contacts of the sick, monitoring them and in turn isolating them if they developed illness. This essentially allowed for the chain of transmission of the virus to be interrupted and, eventually, the containment of the outbreak.

This approach was more effective in earlier Ebola outbreaks because they happened in areas that were fairly isolated geographically.

But this changed dramatically during the course of the West Africa Ebola outbreak from 2014 to 2016. Communities were more mobile. They crossed borders more easily, spreading the disease across three countries – Guinea, Liberia and Sierra Leone – in a matter of months. This rendered the conventional containment approach problematic, and led to the outbreak spreading rapidly and widely. This resulted in the largest Ebola outbreak recorded to date.

It took a massive multinational effort to bring the outbreak under control. The scale of response efforts were historic.

The fear of Ebola spreading across a region have once again surfaced during the current outbreak in the Democratic Republic of Congo (DRC). Extensive efforts are again being undertaken to prevent this from happening.

Controlling the outbreak

The outbreak in the DRC has been raging on for six months. A total of 759 people had been infected and 468 deaths reported by the end of January 2019. This makes it the second worst outbreak in recorded history, after the outbreak in West Africa.

But the World Health Organisation recently announced that an experimental vaccine that has been rolled out in the affected area of the DRC that has been highly effective. Although the vaccine, known as rVSV-ZEBOV, is yet to be licensed, evidence to date indicates that it protects against the strain of the Ebola virus behind the current outbreak.

The vaccine underwent limited testing during the West Africa outbreak and the outbreak in the DRC between May and July 2018. More than 60,000 doses of the vaccine have been used in the current outbreak. It was primarily provided to front-line health workers and other at-risk contacts. Health workers in Uganda, South Sudan and Rwanda have also been vaccinated to help prevent the disease from spreading across borders.

The ability to vaccinate and protect proactively may largely remove the proverbial sting from Ebola.

Ebola is a feared disease, not only for the communities directly affected by an outbreak, but for countries around the world nervous that it can spread closer to home. The direct and indirect effects of the West Africa outbreak are well appreciated and demonstrated how these fears play into economies, travel and trade beyond the affected countries.

Much of this was driven by a disease that seemed to be an unstoppable killer. This may no longer be the case.

The Ebola vaccine – like others – should have the obvious advantage of protecting the outbreak-affected communities. But there are other advantages to having a vaccine in use in the ongoing outbreak. These include:

• Vaccinating and protecting health care and other front-line workers during an outbreak supports improved care for patients, and containment efforts due to a lower or removed risk of infection for workers who come into contact with sick individuals;
• Vaccinating and protecting contacts and possible contacts of people known to be infected with the virus allows health workers to create a barrier of immunity (called “herd immunity”) that prevents the virus from proliferating and spreading. This aids with the interruption of an outbreak;
• The psychological impact of having prophylaxis – a tangible tool to address the problem, allowing fears to be allayed and approached in a way that was not possible before.

It’s with great anticipation that the world awaits the final outcome of the efficacy testing of this vaccine. This would allow for licensing and pave the way for its availability in the future.

Time will also tell how the unprecedented approach to accelerating the testing and rollout of an Ebola vaccine will affect the development of vaccines for other infectious diseases.

It also remains to be seen if a successful Ebola vaccine could aid in restoring public faith and interest in vaccinations, and support longstanding efforts to eradicate disease such as polio and measles.

Jacqueline Weyer, Senior Medical Scientist, National Institute for Communicable Diseases

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

Melinda Suchard, National Institute for Communicable Diseases

Polio is a disease that struck fear into the hearts of parents just a generation ago.

Poliomyelitis, known as polio, is a viral illness which spreads through faeces and respiratory secretions. Polio causes sudden onset of weakness, often permanent paralysis, in otherwise healthy individuals. One arm or leg can become useless, or the whole body from the neck down can be paralysed. Often multiple children in the same household would die of the disease, with survivors left in wheelchairs. South Africa still had polio cases well into the 1980’s, with the last case of wild poliovirus in 1989.

The Global Polio Eradication Initiative has not gone according to plan. The first eradication target date of 2000 was missed. 2018 is the latest target that we are about to miss. This is due to hard-to-reach areas of instability, unrest and fundamentalism in Nigeria, Pakistan and Afghanistan where it’s a struggle to achieve the high vaccination coverage required to eliminate the disease. Health workers in these areas risk their lives to conduct vaccination programmes amid hostile communities.

Unfortunately, pockets of polio transmission provide reservoirs for resurgence at any time, with even one traveller able to bring polio back to a polio-free country.

Polio is targeted to be the second human disease ever eradicated through vaccination. Smallpox was the first success story in 1974. Other diseases, like measles, wait in the wings to be selected for third place. Eradication initiatives are too labour intensive for the world to commit to more than one at any given time.

In South Africa, the National Institute for Communicable Diseases investigates every child with sudden neurological weakness for polio – processing hundreds of samples from South African children annually, despite not having a wild polio case for almost thirty years. Such a situation is unsustainable for more than one disease at a time.

The poliovirus has biological characteristics which have proven harder to combat than smallpox. Polio is a tough and hardy organism that can survive in the environment even when not carried by a human host. It’s stealthy, and can infect a hundred individuals silently before resulting in even one case of paralysis. This makes it difficult to trace and contain.

The big successes

Despite the setbacks, triumphs of the programme have been notable. Globally, polio caused more than 350 000 cases of paralysis in 1988 when the global polio eradication initiative was launched. In comparison, in 2017, there were only 21 people paralysed by wild poliovirus. Of three viral strains, poliovirus type 2 has been eradicated, with wild poliovirus types 1 and 3 remaining.

But it’s too early to celebrate. Hotspots of wild poliovirus and related strains remain detectable. For this reason, a global public health emergency of international concern was declared for polio in 2014, the same level of threat given to the Ebola crisis the same year.

Ebola eclipsed polio in public perception. Despite the fear that strikes parents when hearing of Ebola, we have forgotten the potential devastation wreaked by polio. Unlike the gusto with which novel Ebola vaccines were embraced for Ebola epidemics, vaccination for polio has become “bread and butter”. Mothers take their children for vaccination with a sense of duty and purpose, hardly realising that they are participating in the largest social movement in the history of mankind.

Vaccination is a powerful example of social change; demonstrating impact of purpose united across geography and sustained through multiple generations. Every caregiver is participating in the most ambitious social endeavour in human history – to systematically eradicate dreaded diseases through immunisation.

What happens to the diseases waiting in the wings if the polio programme fails?

Cynics will ask if the smallpox success was merely a lucky break. Critics will query whether systematic disease eradication is an attainable human goal. The global polio eradication initiative comprises billions of dollars, hundreds of millions of children, millions of health workers and 30 years of work in hundreds of countries. We have gone too far to go back. It has been said that the global polio eradication initiative will be either a spectacular success or a spectacular failure.

Failure is unthinkable.

Melinda Suchard, Head, Centre for Vaccines and Immunology, National Institute for Communicable Diseases

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