World Health Day : Nestlé Nutrition Institute Africa empowers Health Care Professionals

As people across the globe joins World Health Organisation to celebrate World Health Day on April 7, Nestlé Nutrition Institute Africa (NNIA) commemorated the Day in collaboration with the Ogun State Ministry of Health by training primary healthcare professionals in Abeokuta on Friday April 6, 2018.

With the 2018 year theme, “Universal Health Coverage: Everyone, Everywhere,” NNIA in observance of the organisation’s vision which focuses on ensuring that all people can get quality health services, where and when they need them, without suffering financial hardship embarked on the training of healthcare professionals to key into the mandate.

The one day training held at Nigeria Medical Association (NMA) house in Abeokuta by experts from NNIA witnessed various primary healthcare professionals from 110 Primary Health Care Professionals from Abeokuta North local government area of Ogun state who participated in the training on Malnutrition in the First Years of Life: Its Assessment and Management.

Giving a welcome address at the flag-off of the training, the NNIA representative, Dr. Omotayo Omoteso shed light on the objectives of the training. He said, “Global studies have shown that malnutrition is an underlying factor in 55 percent of all child deaths, with Nigeria largely affected by the scourge. Each year, about 1 million Nigerian children die and more than half of these deaths are traceable to malnutrition.”

According to him, this situation calls for urgent multi-stakeholder action. “Nestle Nutrition Institute Africa is therefore happy to collaborate with the Ogun State Government in its efforts to address malnutrition in the first 1000 days of life. This is in line with our commitment to bridge the gap between science and the practical application of nutrition to ensure a healthier, brighter future for children. We therefore welcome this opportunity to contribute through the development of the capabilities of Primary Health Care Professionals here in Ogun State.”

Addressing the press at the Ogun State Secretariat where the training took place, Ogun State Commissioner for Health, Dr. Babatunde Ipaye said it is sad to note that millions of people across the globe suffer financial hardship in obtaining essential health services due to poverty.

“Currently, about 800 million people, which constitute 12 per cent of the world’s population, spend at least 10 per cent of their household budget on health needs. Of this number, about 100 million suffer financial hardship because of out of pocket health expenditure and half of the world’s population is unable to obtain essential health services, due to poverty.” Ipaye stressed.

Dr. Ipaye said that the World Health Day 2018 celebration and intervention programme provided another opportunity for strengthening the health care system in Ogun State which was made possible by the partnership with stakeholders like Nestlé Nutrition Institute Africa (NNIA) who supported the state’s efforts by delivering a capacity building training to primary Health Care Professionals (HCPs) on Friday.

Dr. Babatunde Ipaye also revealed some of the measures the state has put in place to improve maternal and child health. One of these according to him is a state funded social insurance scheme popularly called “Araya”. He disclosed that since its inception in 2014, the scheme has enrolled over 23,000 people. The commissioner expressed his appreciation to Nestlé Nutrition Institute Africa (NNIA) for providing support towards the delivery of the health mandate of the administration. He also thanked the HCPs for making themselves available for the training and encouraged them not to keep the knowledge to themselves, but also to do well to transfer the same to their family members and colleagues who did not have the opportunity to participate in the training.

Meanwhile, Nestlé Nutrition Institute Africa, NNIA is an institute that shares leading science-based information and education with Health Care Professionals. It was founded on the credo that good nutrition begins before birth, continues through the lifecycle and is nurtured by the knowledge and consumption of a nutritionally adequate and appropriate diet. It aims for a future across the African continent where individuals are nourished healthier and live longer lives.

Furthering the understanding of the science of nutrition of the HCPs is envisioned to go a long way in bridging the gap between the science of nutrition and its practical application. Right now, there are over 20,000 Health Care professionals who have registered and benefits on the Nestlé Nutrition Institute Africa’s website.

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Tuberculosis services in Moscow extend “health for all” even to the most vulnerable

Karam is a 23-year-old from the Khatlon region of Tajikistan. He came to Moscow in 2015 to work in construction, and 2 years later fell ill with a high fever and headache. He felt as though he had no strength, but nevertheless tried to carry on. When his condition became so severe that he was barely conscious – a state described by his doctors as the edge of life and death – Karam’s uncle, with whom he lives, called an ambulance.

At the hospital, Karam was diagnosed with tuberculous meningitis. Up until that point, he knew nothing about tuberculosis (TB). He felt afraid and unsure, wondering how he would pay for the treatment he needed to get well. But then he learned that his treatment would be completely free, provided by the Moscow Research and Clinical Center for Tuberculosis Control. This was part of an initiative undertaken by the city of Moscow to ensure that all people, including migrants like Karam, have access to the TB services they need.

A new model of TB services

The city launched the initiative in 2012. Though at that time the TB rate among the resident population of Moscow was declining, increasing numbers of migrants, who are often more susceptible to the disease, made it necessary to change the traditional approach to TB control efforts.

The city created a new organizational model in the spirit of providing universal health coverage to everyone, without causing financial hardship. It based the model on key components that include:

  • providing people-centred care;
  • strengthening human resource capacity for TB; and
  • monitoring the epidemiological situation.

The Chief TB Specialist of the Moscow City Department of Health oversees these activities.

In 5 years, the new model resulted in significant changes to TB care in Moscow. Most importantly, it allowed the city to provide quality services to all vulnerable populations, including migrants and homeless people.

Intensive work with latent TB infection and TB contacts has helped to reduce TB notification rates among permanent residents in Moscow by 11.7% (to 12.8 per 100 000 population) and among children by 23.8%. New approaches to treating multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) have also been applied, with positive outcomes.

In 2016, an increased focus on prevention among the migrant population in Moscow contributed to the detection of an additional 1605 TB cases. Since 2012, the number of TB deaths in the capital has decreased by 22%, and the number of registered patients with MDR-TB has decreased by 44% (to 3.4 per 100 000 population), making it the lowest in the country.

The benefits of Moscow’s new approach to TB services are perhaps felt most deeply on the individual level. For Karam, the news that his treatment would be provided free of charge came as a great relief. It took 2 months of intensive therapy before his condition stabilized and began to improve. He was treated and observed by several specialists over the course of 11 months.

Today, Karam has made a near-complete recovery. He appreciates the work of the doctors who have treated him, supported by the city of Moscow. “When I got here, I felt very bad. I had no strength at all,” he says. “After the treatment started, gradually I became better. I believe I will one day have enough strength to return to work.” When he is well, he hopes to return to his native Tajikistan and his large extended family still living there. He plans to work in his family’s lemon grove.



Building Resilient Health Systems to Climate Change Among SIDS

Health Ministers and Environment Ministers, Experts, Officials and other key stakeholders from Small Island Development States (SIDS) of Africa and South East Asian regions, namely Cabo Verde, Comoros, Madagascar, Maldives, Mauritius, Reunion Island, Sao Tome and Principes and Seychelles participated in the World Health Organization (WHO) Third Global Conference on Climate Change and Health on 21-22 March 2018 in Mauritius. This special Initiative was launched by the WHO in view of supporting SIDS countries in the adoption of a streamlined and concerted approach to climate change and health. During the conference, the participants focused on climate change and health, with a vision that by 2030 all health systems in SIDS will be resilient to climate variability and change. The importance of a collaborative approach towards having a regional and national institutional mechanism for mitigating the impacts of climate change has been stressed upon by the WHO.

Dr (Mrs) Joyce St John, Assistant Director-General Climate and Other Determinants of Health in WHO Head Quarters, Geneva, Dr Magaran Bagayoko, delegated by Dr Moeti, Regional Director of the WHO Regional Office for Africa, and representatives from various international institutions, including United Nations Environment Programme (UNEP) and the Indian Ocean Commission participated in the conference. Dr St John addressed the representatives from the different SIDS countries at the opening of the conference and said that ‘SIDS should speak in one strong voice to make them heard by the whole world as SIDS countries contribute little to climate change and yet, they suffer most of the adverse effects of climate change.’ She reiterated her full support and commitment in supporting SIDS countries in mitigating the impacts of climate change. She pointed out that ‘the outcome of the deliberations once finalized will be submitted in the form of a Regional Action Plan at the forthcoming World Health Assembly in May 2018 in view of obtaining support and assistance to enable SIDS to cope with health and climate challenges’. During the two days conference, the SIDS countries recognised that climate change cannot be dissociated from health as it affects, in profoundly adverse ways, some of the most fundamental determinants of health, including clean air, safe drinking water, sufficient food and secure shelter.

Dr. M. Bagayoko from WHO AFRO highlighted the global initiatives taken by WHO to mitigate impacts of climate change such as the United Nations Framework Convention on Climate Change (UNFCC) in 1992 which recognises human health and welfare as a priority response for climate change and Paris Agreement 2015 which cites the right to health to implement the agreements as a public health treaty. It was recalled that WHO launched the Small Islands Development States (SIDS) initiatives in collaboration with UNFCC and Fijian Presidency of COP-23 in view of providing the SIDS countries all the necessary technical and financial support to build climate resilient health system to address the effects of climate change. According to Dr Bagayoko, SIDS countries from African and South East Asian Region (SEAR) will have to lead the way for developing sustainable climate resilient model of health systems that will also focus on diseases prevention through integrated diseases surveillance and early warning system. In the same line, he emphasized the need for SIDS countries to ensure sustainable funding for addressing the impacts of climate change at national and regional levels. It was noted that the WHO special initiative on climate change and health in SIDS was launched by Dr Tedros Adhanom Ghebreyesus, Director General of WHO, who made health impact of climate change and environment on SIDS Countries ‘one of his main priorities’ and consequently, climate change and health was incorporated in the WHO Global Programme of Work for 2019-2022.

At the opening of the Global Conference, the Health Minister, Dr Hon. Anwar Husnoo, pointed out that ‘climate change constitutes potential threats to SIDS due to their small size, geographical remoteness, level of development and vulnerability to national disasters’. He added that ‘SIDS are in the front line exposed from acute to long term risks, from extreme weather events including torrential rains, flash floods, storm to impending risks as a result of water and food borne infectious diseases, and the rise in sea level constitutes imminent danger and hazard to healthcare facilities especially those on coastal areas.’ He highlighted that the average temperatures in Mauritius have increased over the region by 0.74 °C to 1.2 °C since 1950 and the minimum temperature has increased by a larger magnitude. On the other hand, summer temperatures have been observed to be increasing more rapidly than winter ones and the number of days with maximum temperatures above the threshold value of 30 degrees Celsius is on the rise over the entire Republic of Mauritius. He recalled that Mauritius has already been experiencing the adverse effects of climate change during the flash flood that occurred in 2013 causing the loss of lives.

Dr Husnoo stated that as a small island, Mauritius remains highly vulnerable to climate change, given that the Aedes mosquito and Anopheles mosquitoes, the local vectors of dengue and malaria are present in the country, and with the recent heavy rainfalls, there is high risk of proliferation of these mosquitoes, rendering the country highly vulnerable to emergence of mosquito related infectious diseases. He stressed upon all the precautionary measures taken by the Government of Mauritius at points of entry to reinforce surveillance of communicable diseases. Mauritius though not endemic for dengue fever, has already experienced several outbreaks so far, namely in 2009, 2014 and 2015 when locally transmitted cases were reported. About ten years ago, an epidemic of Chikungunya affected about 30% of the population. Dr Hon A. Husnoo also highlighted the ageing of the population of Mauritius as a factor that increases the vulnerability of the country to communicable and non-communicable diseases.

Dr Laurent Musango, the WHO Representative in Mauritius, in his opening remarks said that ‘climate change among SIDS is no longer a distant threat’. He added that climate change is ‘a shared problem in need of a global solution, and above all, multilateral, integrated and coordinated approach and solutions’ It was pointed out that SIDS countries will require massive technology transfer and financial support to take climate-friendly measures. Dr Musango, stated that ‘developed countries not only need to reduce their emissions adequately but they are also expected to help meeting the technology and financial needs of developing countries, including SIDS countries.’ He made an appeal to all the representatives of the SIDS countries present to join forces to build solidarity and re-commitment to a global partnership for sustainable development.

During the course of the meeting, the Framework for action on climate change was discussed. SIDS countries realise that the challenges for small islands are the same and joint actions are necessary to raise a strong common voice at global level. Action points along the four strategic line actions, namely empowerment of leadership, building evidence, implementation and facilitating access to resources were discussed and targets and indicators were identified to address the challenges through participative approach.

The deliberations of the Conference will adequately inform the formulation of a regional action plan on climate change for the period of 2019 to 2023 for SIDS in the African and South East Asian Regions. In the same vein, the SIDS countries agree to leverage the existing regional mechanism to ensure that health and climate change is placed high on the agenda at regional and global levels. It was also agreed to strengthen the collaboration between different sectors at country level for evidence generation, surveillance, building capacities and resource mobilisation. Further, it was highlighted that existing networks for evidence generation needs to be strengthen in terms of human resource capacity in the areas of data generation, data use and dissemination across various regional and global platforms. Other recommendations from the participants from the Global Conference include placing the health agenda item at the UNFCC and AOSIS (Alliance of Small States) so that voices of SIDS countries are heard at the highest level possible, be it at WHO level or other bodies.





Lassa fever: The killer disease with no vaccine

Since the beginning of the year, Nigeria has been gripped by an outbreak of a deadly disease. Lassa fever is one of a number of illnesses which can cause dangerous epidemics, but for which no vaccine currently exists.

Lassa fever is not a new disease, but the current outbreak is unprecedented, spreading faster and further than ever before.

Health workers are overstretched, and a number have themselves become infected and died.

The potentially fatal disease is a so-called "viral haemorrhagic fever", which can affect many organs, and damage the body's blood vessels.

But it is difficult to treat.

Most people who catch Lassa will have only mild symptoms such as fever, headache and general weakness. They may have none at all.

However, in severe cases, it can mimic another deadly haemorrhagic fever, Ebola, causing bleeding through the nose, mouth and other parts of the body.

Lassa fever normally has a fatality rate of about one per cent. But in the Nigerian outbreak it is thought to be more than 20% among confirmed and probable cases, according to the country's Centre for Disease Control.

Lassa fever outbreak in Nigeria

22% fatality rate among confirmed and probable cases

1081 suspected cases (1 January - 25 February)

90 deaths

14 health care workers affected in six states

Nigeria Centre for Disease Control and World Health Organization

About 90 people are thought to have died so far, but the true number may be much higher, because Lassa is so hard to diagnose.

Women who contract the disease late in pregnancy face an 80% chance of losing their child, or dying themselves.

In the early stages it's almost impossible to distinguish from other common diseases like malaria and dengue.

With no readily available test, the only way to confirm a diagnosis is to analyse a blood or tissue sample in one of small number of specialised laboratories.

The disease was first identified in the Nigerian town of Lassa in 1969, after an outbreak in a mission hospital.

It has since been seen in many West African countries including Ghana, Mali and Sierra Leone.

However, this outbreak is causing particular concern because the number of cases is unusually high for the time of year.

Health officials are working to understand why.

Outbreaks can be influenced by seasonal weather conditions, which affect the numbers of the virus's natural host - the multimammate rat.

These small mammals are common across West Africa, where they easily find their way into homes.

Another possibility is that the high number of cases reflects heightened public awareness.

Or it's possible that something about the virus has changed.

Most people catch Lassa fever from anything contaminated with rat urine, faeces, blood or saliva - through eating, drinking or simply handling contaminated objects in the home.

It can also pass from person to person through bodily fluids, meaning healthcare workers and people taking care of sick relatives without protective equipment are particularly at risk.

The incubation period for Lassa is up to three weeks. Researchers are trying to work out whether - like Ebola - Lassa can stay in the body and be passed on through sexual contact even after illness subsides.

Nigeria has a strong public health system, and is used to dealing with epidemics like this.

The World Health Organization (WHO) is working with Nigerian authorities to help coordinate the response and the UK government has deployed a team of experts from its Public Health Rapid Support Team.

Those living in affected areas are being advised to take basic precautions: blocking holes that may allow rats to enter their homes, disposing of rubbish in covered dustbins, and storing food and water in sealed containers.

People are advised to wear protective gloves when caring for anyone who may have Lassa fever, and to carry out safe burial practices.

Despite these measures, the fight against Lassa - and other infectious diseases - is hampered by a lack of effective medical tools like diagnostic tests, treatments and vaccines.

It is likely that a vaccine could be found for Lassa - reducing the possibility of an outbreak becoming a global health emergency - but as with other epidemic diseases that mainly affect poorer countries, progress has stalled.

Vaccine development is a long, complex and costly process. This is especially true for emerging epidemic diseases, where a prototype vaccine can usually only be tested where there is an outbreak.

A new organisation called CEPI (Coalition for Epidemic Preparedness Innovations) - set up in 2017 with financial support from the Wellcome Trust, national governments and the Bill & Melinda Gates Foundation - hopes to accelerate vaccine production.

Lassa is one of the diseases on its hit list and it's hoped one or more promising vaccines will be ready for large-scale testing in the next five years.

The WHO has drawn up a list of other serious, but often poorly understood diseases, with the potential for devastating outbreaks, including MERS, Nipah, Rift Valley Fever and, of course, Ebola.

It plans to highlight gaps in our knowledge of these diseases and to begin further research.

But research alone isn't enough.

Stronger health systems are needed in the countries where epidemics are most likely to arise.

This could mean building better healthcare facilities and training staff to recognise and respond to outbreaks.

It will also mean working with communities to understand how to identify outbreaks at an early stage and prevent their spread.





The World Health Organization Wants You To Worry About “Disease X”

Every year, the World Health Organization commissions an expert committee identify the most threatening infectious diseases of the upcoming year. The idea is to prioritize research and development on diseases and pathogens that pose a major risk to global health, but lack effective treatments or vaccines.

The committee met early in February this year, and the prioritized list of diseases has been released. The list is made up of familiar threats, including Ebola, Zika, Lassa Fever and a respiratory illness in the Middle East known as MERS.

And then there’s “Disease X.” It is the last on the list, and most mysterious.

What is Disease X?

Disease X is quite literally a mystery disease. It’s a recognition that we can’t see everything coming. In 2018, it’s entirely possible that we’ll see a brand-new pathogen. Or, as with Zika, an old disease will suddenly demonstrate a new way to harm us.

Disease X is a placeholder for disaster we can’t imagine yet.
New diseases appear all the time. Deadly Nipah virus appeared in Malaysia in the late 90s; we have no prior evidence of the disease. Severe fever with thrombocytopenia syndrome appeared in China in 2009, mostly likely carried by a tick from a wild animal reservoir. Heartland virus, another tick-borne pathogen with a wild animal reservoir, was first isolated in the US in 2009. Disease X could be one of these such diseases.

Will Disease X come from animals?
While there are a lot of possible sources for Disease X, one very likely reservoir of pathogens is the zoonotic disease. These are disease present in animals – wild or domestic – than can also be transmitted to humans. HIV was originally a zoonotic disease, which probably transmitted to humans for the first time when someone killed and ate a wild chimpanzee. HIV was present in chimpanzees long before it made the jump to humans – at some point the virus evolved to infect us well. Ebola virus disease is also a zoonosis; the most recent pandemic began when a one-year-old boy in Guinea was bitten by an Ebola-infected bat. Approximately 70% of new diseases are zoonotic.

One candidate for disease x could be Brucellosis. This is a bacterial infection that’s a lot like tuberculosis and is prevalent in an estimated 10% of farmed dairy cattle around the world. Humans are infected when they eat dairy products from infected animals. Right now, it’s kept in check by testing of commercial dairy products and cattle vaccination, and it doesn’t spread among people. Raw milk consumption, and a minor bacterial mutation could change that.

Avian influenza is a similar case. It can already be transmitted by birds to humans, but it doesn’t spread human-to-human — not yet, at least. There are plenty of flu viruses that do spread person-to-person, though, so it is probably just a matter of time before avian influenza evolves to do it. Avian influenza and brucellosis, or other domestic livestock diseases, then, could be Disease X.

Disease X could also be a previously unknown pathogen from an animal reservoir. Human beings are pushing into the last wild spaces on the planet, and those wild places also contain new diseases. Farming the rainforest or developing the jungles of Madagascar means exposing humans to diseases we’ve never met before. In 1999, Nipah virus killed 109 people in Malaysia – infected fruit bats infected pigs which infected people – and we’d never even heard of the virus before 1998. Disease X could be an utter wild card like Nipah, a hemorrhagic virus or virulent airborne bacteria previously unknown to global health.

Will Disease X come from people?
Humans have been using diseases as weapons since 1500 BC, when the Hittites sent people infected with plague into enemy territories. In recent history, both the US and the USSR experimented with bioweapons. One favorite among the Soviets was anthrax; an accidental release in 1979 killed 66 people. Anthrax can last for decades in storage and remain dangerous, and we don’t know how many former Soviet republics still possess poorly protected anthrax stockpiles.

Newer bioweapons are a threat, too. Just a year ago, North Korean leader Kim Jong-Un’s half-brother was killed by a biological nerve agent called VX. In December, a North Korean defector was found to have anthrax antibodies in his immune system, indicating he had probably been vaccinated for anthrax. Security observers are reasonably certain that North Korea develops secret bioweapons on an ongoing basis.

Disease X could come from a deliberate attack. It could be an act of war from a state entity using bioweapons developed for the purpose, or a terrorist attack from a group who was able to purchase a bioweapon on the black market.

How do we prepare for Disease X?
Disease X thinking is big thinking.

First, it admits that even the best tools we current possess cannot forecast every problem. We had absolutely no idea that Zika could cause microcephaly in pregnancies until 2015, even though the disease was first identified in Uganda almost seventy years prior.

To fight a disease outbreak – any disease outbreak – you need health care providers who can treat the disease, laboratories to diagnose the disease, and supplies and equipment to support diagnostics and treatment. Those things together make up a health system. Strengthen the health system means better preparedness for Disease X, no matter what X may be.

That means we prepare for disease X by using systemic approaches that make us better at fighting every disease. If we improve the skills of laboratory technicians in developing countries, and equip those laboratories with better equipment, we increase our global ability to diagnose and treat all diseases. If vaccine manufacturers are able to rapidly change their production lines from one kind of vaccine to another, we’re more prepared to fight a new pandemic. New technology can also help – the faster and closer to an outbreak we can start lag diagnostics, the more rapidly we can develop treatments, cures, and vaccines.



Human infection with avian influenza A(H7N4) virus – China

On 14 February 2018, the National Health and Family Planning Commission (NHFPC) of China notified the World Health Organization (WHO) of one case of human infection with avian influenza A(H7N4) virus. This is the first human case of avian influenza A(H7N4) infection to be reported worldwide.

The case-patient was a 68-year-old woman from Jiangsu Province with pre-existing coronary heart disease and hypertension and she developed symptoms on 25 December 2017. Seven days later, she was admitted to a local hospital for treatment of severe pneumonia and was discharged after 21 days. On 12 February, the Chinese Center for Disease Control and Prevention (China CDC) confirmed that the case-patient’s samples were positive for avian influenza A(H7N4). The NHFPC confirmed the diagnosis on 13 February 2018. The case-patient had reported a history of exposure to live poultry before onset of symptoms.

Genetic sequencing of this A(H7N4) virus shows that all the virus segments originated from avian influenza viruses. This virus is sensitive to adamantanes and neuraminidase inhibitors based on genetic sequencing.

Twenty-eight close contacts of the case-patient have been under medical observation. Among close contacts, no abnormal findings have been found and all throat swabs from her contacts have tested negative.

Public health response
The Chinese government conducted a risk assessment, and has enhanced prevention and control measures, surveillance and epidemiological investigations including contact tracing and laboratory testing. Public risk communication and information sharing is ongoing.

WHO is in contact with national authorities and is following the event closely. WHO is facilitating information-sharing with Member States and is closely monitoring the situation, in line with the International Health Regulations (2005).

WHO risk assessment
This is the first report of a human case of avian influenza A(H7N4) infection globally and the case reported exposure to live backyard poultry before illness onset. Genetic analysis of this influenza A(H7N4) virus indicates that it is of avian origin.

Close contacts of the case-patient tested negative for avian influenza A(H7N4) and remained asymptomatic. Current evidence suggests that this virus does not have the ability of sustained transmission to humans, thus the likelihood of sustained human to human transmission is low. Any animal influenza virus that develops the ability of human to human transmission can theoretically cause a pandemic.

It is possible that additional human cases of avian influenza A(H7N4) will be detected, however only one human case has been detected so far, and information on the circulation of avian influenza A(H7N4) in birds is not currently available. Further information needs to be gathered to increase the confidence in this assessment.

WHO advice
The public should avoid contact with high-risk environments such as live animal markets/farms and live poultry, or surfaces that might be contaminated by poultry feces. Hand hygiene with frequent washing or use of alcohol hand sanitizer is recommended. WHO does not recommend any specific different measures for travellers.

WHO does not advise special screening at points of entry with regard to this event, nor does it recommend that any travel or trade restrictions be applied.



Building health resilience in a fast-changing climate

By Mashida Rashid

When I visited my hometown of Dhaka last September I was shocked. Many of my family and friends were writhing from a mysterious new disease that no one really knew. In my ten years as a public health specialist, I had worked in health systems approaches to malaria, dengue, and other vector borne diseases in Bangladesh, but this was a new one for me. The joint pain that accompanied the fever could stay for months afterwards, and was debilitating. It left previously healthy people hobbling on walking sticks, and apparently there was no cure. The only practical advice was to avoid being bitten by mosquitoes.

So, when ‘Chikunguniya’ was mentioned again at the Prince Mahidol Award Conference in Bangkok — one of the world’s premier public health meets — during a session on climate change and emerging diseases I listened intently.

The name Chikunguniya originates from Tanzania, meaning ‘to become contorted’, describing the stooped appearance of the person who contracts this disease; an apt description of what I had seen in Dhaka.

At the session, organized by the United Nations Development Programme (UNDP), the case study presented was from the mountains of Bhutan. The contrast struck me — geographically the region, at 2000m above sea level, is the very opposite of deltaic, flat land Bangladesh.

Whereas Dhaka’s latest Chikunguniya outbreak comes in the heels of the wettest monsoon in 35 years, this vector-borne disease hadn’t previously made an appearance in the Himalayan range because of its temperate climate. As far away as Italy, a Chikunguniya outbreak followed one of the driest summers in years.

This then is the crux of it: climate change over the years has changed the nature of infectious diseases both spatially and temporally. Diseases are spreading in new and unpredictable ways, and at surprising rates, leaving scientists and policy-makers grappling to understand their etiology and the ramifications.

Several recommendations emerged from the session, as ways to ensure preparedness and build resilience among at-risk communities. Evidence from complex, long-term research has paved the way for modeling, and risk predictions, but there needs to be a thrust on translating that research into practical, actionable policy, and communication of those policies in effective language.

Policy makers not only have to take into account health as a driver, but other non-health sectors such as tourism, transport, and urbanization, in a real effort to understand these complexities.

Integrated, coordinated, multi-sectoral systems responses are what can prevent an outbreak from reaching epidemic proportions.

With advances in data integration and technological innovations, surveillance systems and early warning systems are becoming more sophisticated. This allows for preparedness, which goes a long way in prevention. For example, in 2011 in Singapore there was a three-month advance warning for the next outbreak of dengue: the early warning meant pregnant mothers had three months to prepare themselves for mosquito season, and could ward off potentially life threatening situations. This model, with the right planning, can be replicated for other infectious diseases.

The Building Resilience of Health Systems in Asian Least Developed Countries to Climate Change project, supported by UNDP and the World Health Organization (WHO) with funding from GEF, is strengthening institutional capacities in six Asia Pacific countries to integrate climate risks into health sector planning, improve surveillance and early warning systems, and integrate health into the national adaptation planning processes, among others.

Building resilience to shocks is a step-by-step process. At national levels, it involves providing data to inform government and decision-makers, sharing economic cases that highlight where a country’s finances can deliver the best development gains, and tailoring health systems so that during times of outbreaks, there are well-established processes in place.

At community levels, health resilience requires us to better understand behaviour, adaptive capacity and vulnerabilities. Ultimately, our actions need to empower people, so that they can take stewardship of their future, and be prepared for environmental or health calamities, or both.



Brazil yellow fever: WHO warns travellers to Sao Paulo

The Brazilian state of Sao Paulo, the country's most populous, is at risk of yellow fever, the World Health Organization (WHO) is warning.

The WHO is recommending that travellers to the state and its capital, Sao Paulo, get a yellow fever vaccine before visiting.

The warning comes after a significant rise in numbers of suspected and confirmed cases was reported.

Local officials say travellers will not be at risk if they stay in cities.

Brazilian Health Minister Antonio Nardi said the WHO advice stemmed from "an excess of concern".

What is yellow fever?

  • Caused by a virus that is transmitted to humans by mosquitoes
  • Difficult to diagnose and often confused with other diseases or fevers
  • Most people recover after the first phase of infection that usually involves fever, muscle and back pain, headache, shivers, loss of appetite, and nausea or vomiting
  • About 15% of people face a second, more serious phase involving high fever, jaundice, bleeding and deteriorating kidney function
  • Half of those who enter the "toxic" phase usually die within 10 to 14 days

Source: WHO

He said that while there had been an increase in the number of reported cases it did not constitute an "outbreak".

He also said that most people attending Brazil's famous carnival celebrations in February should be safe as they are held in large cities and not the rural and forested areas which have seen the biggest increase in yellow fever cases.

However, the WHO's advice is for all travellers to the state to get a vaccination at least 10 days prior to travel and to take measures to avoid mosquito bites.

Brazilian health authorities said that since July 2017, 35 cases of yellow fever had been confirmed. Of those, 20 cases proved fatal. Sao Paulo has been the worst-affected state, with 20 confirmed cases.

Mr Nardi said Sao Paulo state authorities would speed up their vaccination campaign with the aim of vaccinating half of the state's population by the end of February.

More than 45 million people live in the state of Sao Paulo.