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  • Africa's disease burden could conceal swine flu cases


Researchers in Africa fear they may not be able to identify swine flu cases swiftly enough to prevent the spread of infection because there are so many diseases around with similar symptoms.

Although swine flu has spread from Mexico to several other continents it has not yet been reported in Africa and in some respects the continent is well prepared, say researchers. Rapid response teams are accustomed to reacting to diseases such as meningitis and Rift Valley fever, as well as completely unknown new infections.

South Africa's National Institute for Communicable Diseases (NICD), for example, was widely praised for its prompt quarantining of feverish suspects and quick analysis of a previously unknown acute infection — thought to be a type of viral haemorrhagic fever — which killed four people in October last year. The institute said it will have the specific PCR (polymerase chain reaction) primers required for confirmation of the presence of the virus by the end of the week.

''Many African countries have surveillance for epidemics, and some systems work well,'' says Lucille Blumberg, head of the Johannesburg-based Epidemiology and Surveillance Unit at the NICD, highlighting laboratories run across the continent by the Pasteur Institute.

The problem, she says, is identifying swine flu when so many people are sick with similar fever-causing illnesses.

''We are overwhelmed with tuberculosis, pneumonia and malaria, all of which present similar symptoms to swine flu,'' Blumberg told SciDev.Net. 

Preparedness varies across the continent. Researchers in many countries are in a far stronger position than before to detect swine flu because of training and the upgrading of laboratory equipment in order to combat the threat of avian flu. A notable exception is Zimbabwe, where medical staff have not been able to monitor or contain the current outbreak of cholera due to electricity cuts, petrol shortages and lack of even basic drugs. In many predominantly Muslim countries in West and North Africa, good disease surveillance programmes are in place to combat the risk of communicable diseases such as cholera spreading after the annual pilgrimages of millions to Mecca in Saudi Arabia.

But in parts of West Africa there are concerns that countries such as Niger and Nigeria — already hard-hit by meningitis outbreaks this year — lack the necessary surveillance and notification systems.

Nigeria's Ministry of Health announced plans last year to establish a Centre for Disease Prevention and Control, modelled on the US body, but it is not yet up and running.

In Senegal, health authorities have reactivated an early warning health system put into place in 2006 following the resurgence of the H5N1 avian flu virus, according to the UN news agency IRIN.

In East Africa, the Nairobi-based Kenyan Medical Research Institute has provided technical support for investigations of previous outbreaks of diseases in countries such as Ethiopia, Nigeria, southern Sudan and Uganda.

Tanzania's deputy minister for health and social welfare, Aisha Omar Kigoda, told SciDev.Net that the directorate of preventive services was watching for swine flu at airports and other entry points on the mainland and the island of Zanzibar. Blood samples from suspected cases will go to the recently upgraded national influenza centre laboratory at the National Institute for Medical Research (NIMR) in Dar es Salaam.

Egypt, which has already had several outbreaks of avian flu, is expecting to be hit soon by the virus, given its proximity to Africa, Europe and the Middle East and its importance as both a trade route and a major urban centre.

Staff at Cairo's Abbassia Fever Hospital are working closely with the WHO Eastern Mediterranean office and the International Emerging Infections Program. The hospital borders the US Naval Medical Research Unit 3, which specialises in influenza research, and the teams of researchers are already collaborating.

In central Africa, even countries without coastlines, ports or major airports have taken immediate precautions.

Rwandan health minister Richard Sezibera said today (28 April) that mobile medical teams are screening passengers for flu at all ten border crossings and Kigali airport.

Gamaliel Binamungu, director general of the Rwanda Health Communication Centre, says the country has installed a sentinel system to monitor for swine flu outbreaks and will refer suspect cases to the country's five-year-old national reference laboratory.


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