Disease outbreaks and Africa’s healthcare crisis

When a contagious virus such as coronavirus strikes, the other disease outbreaks are not given equal attention. As countries fight the Covid-19 pandemic, there is looming danger of other outbreaks that are equally deadly such as Ebola and yellow fever.

Yellow fever is an acute haemorrhagic disease transmitted by infected Aedes Aepyti mosquitos found in the tropics and sub-tropics and has the potential to spread rapidly and cause serious health impact.

Vaccination, which provides immunity for life, is the most efficient way of preventing it.

The symptoms of yellow fever include fever, chills, loss of appetite, headache, jaundice, muscle pain, nausea, vomiting, and fatigue.

Although an effective vaccine has been available for 60 years, the disease is still a serious public health threat in the yellow fever belt in Africa and the Americas.

However, due to the Covid-19 lockdown and curfew that was imposed on Uganda on March 30, health workers are stranded with vaccines that could help respond to the yellow fever outbreak in midwestern and northwestern Uganda.

On January 23, the Health minister, Dr Jane Ruth Aceng, declared a yellow fever outbreak after three people died of the virus.
Dr Aceng assured Ugandans that a vaccine would be available within two weeks and vaccination would commence in Moyo and Buliisa districts.

Dr Joyce Moriku Kaducu, the Minister for Primary Healthcare, says Uganda was set to launch a vaccination campaign against yellow fever but cannot at the moment.

“We were set to start yellow fever vaccination in Moyo, Obongi, Yumbe, Maracha, Koboko and Buliisa. We got 18 million doses to vaccinate 16 million plus people. But the [lockdown] could not allow the launch and vaccination,” Dr Kaducu told Daily Monitor.

Other routine vaccinations for children have equally been affected since the lockdown put restrictions on transport means and people cannot easily access health facilities.

Two suspected yellow fever cases were tested through a response investigation at the border between Kajo Keji in South Sudan and Moyo District in Uganda and 41 blood samples from five villages close to the proximity of Moyo, all tested negative.

On March 3, South Sudan Ministry of Health reported two presumptive positive cases of yellow fever in Kajo Keji in Central Equatoria State. The results later tested negative from the National PublicHealth Laboratory in Juba.

According to the World Health Organisation (WHO), the cases were identified through a cross-border rapid response investigation from 12 to February 18 in response to the declared outbreak in Moyo District in Uganda.

A press statement released by WHO on April 15 indicates that it is the responsibility of South Sudan Ministry of Health to declare an outbreak.

“Further tests, which were conducted in the regional centre for yellow fever diagnosis, (Uganda Virus Research Institute) in Uganda confirmed yellow fever in the two cases, which suggests ongoing transmission of yellow fever in the area as at the time the samples were taken. The necessary guidance and recommendations will be made to the Ministry of Health (South Sudan) for appropriate action,” reads part of the press statement.

South Sudan has experienced several yellow fever outbreaks with the worst being in May 2003, where 178 cases with 27 deaths were reported in Imatong region, Torit County. A reactive vaccination campaign response contained the spread to other areas.

Whether the region will be able to contain the spread of Covid-19 and other outbreaks is a worry for many frontline healthcare workers.

On April 10, the Democratic Republic of Congo reported its first death from Ebola as the WHO prepared to declare the country free from the virus. This crashed hopes that, the second worst outbreak of the disease, could be over

Congo, like any other country, is putting more effort on sensitising the population to stay safe through social distancing and other measures put in place to contain Covid-19.

Babah Mutuzu Iusungu, a doctor at a research clinic in Beni, Eastern Congo, told Reuters News Agency that the country cannot cope with an epidemic and an outbreak at the same time.

“It is really a step backwards. You see today, if we are going to start managing a pandemic and an epidemic at the same time, it is going to be impossible. It is going to be very difficult to manage,” Dr Babah said.

Spread

Two new vaccines had a major impact on controlling the Ebola virus, although rebels have prevented health workers from reaching some areas in the villages.

Health experts say Ebola transmission can remain in semen for up to 550 days and can be transmitted through sex long after the patient has recovered.

But there are possibilities of containing the spread since outbreaks or spot transmissions are common towards the end of Ebola epidemic and it does not mean that the virus is spreading out of control.

Currently, Congo is investigating 2,600 Ebola alerts in two affected provinces.

Ebola has killed more than 2,200 people in Congo since August 2018. The country has suffered 10 outbreaks of the disease since it was first detected in humans near Ebola River in 1976.
Between 2013 and 2016, Ebola killed more than 11,000 people in West Africa.

Yellow fever in Uganda

From November 4, 2019, to February 14, 2020, eight laboratory confirmed cases of yellow fever were reported in Buliisa (3), Maracha (1) and Moyo (4); including four deaths, which were detected through the national surveillance system.
On December 10, the Ministry of Health (MoH) was notified by the Uganda Virus Research Institute Regional Reference Laboratory of another case.

The case was a 37-year-old male with suspected viral haemorrhagic fever. His occupation was cattle farming with a history of travel to trade milk between Kizikya cell, Buliisa District and the Democratic Republic of Congo.
During an in-depth investigation in December, eight samples were collected from close contacts, including family members and neighbours, and tested for yellow fever.

On January22, 2020, UVRI notified the MoH of a second case of yellow fever confirmed by serological testing in Buliisa with connection to the index case and with similar occupation. The other samples collected during investigation were negative for yellow fever.

Two other confirmed cases of yellow fever were identified in Moyo in West Nile region which shares a border with South Sudan. The cases were aged 18 and 21 years.

Subsequently, Moyo notified a second cluster of suspected and confirmed yellow fever infection in a different village. The confirmed case in the suspected cluster was a 59-year-old patient. A blood sample collected tested positive for yellow fever at UVRI. His death was preceded by the death of two of his family members in early January with similar symptoms.

The MoH declared an outbreak of yellow fever on January 23.

Ebola in DR congo

The tenth Ebola epidemic in DR Congo was declared over on April 12, after it killed more than 2,200 people in the east of the country since its outbreak on August 1, 2018.

More than 320,000 people were given two different experimental vaccines to stop the spread.

From March 9 to March 15, more than 32,000 alerts were reported and investigated. Of these, 2,550 alerts were validated as suspected cases, requiring specialised care and laboratory testing to rule-out EVD. During this same period, 2,760 samples were tested, including 1565 blood samples from alive suspected cases, 405 swabs from community deaths, and 790 samples from re-tested patients.

No funding for the Ebola response has been received by WHO since December 2019. An urgent injection of $20 million is required to ensure that response teams have the capacity to maintain the appropriate level of operations through to the beginning of May. If no new resources are received, WHO risks running out of funds for the Ebola response before the end of the outbreak.