Response to 8/14 comment

In response to my first posting (Wading Into Blogdom), a commenter asked for an update on the H5N1 situation in Africa.  I’d like to pass on a report given to me by Dr. Marina Manger Cats of the CDC, who is based in South Africa.

Dear Sir,

At the reception held in your honor on Monday 20 August in Johannesburg, we spoke very briefly about Avian Influenza Preparedness (my work at CDC South Africa) and you requested an update, to possibly use for your blog.

We were having a regional training on Avian Influenza Rapid Response Training in South Africa this week, from 20-23 August, for countries of the Southern Africa Development Community (SADC). I am giving you an update only now, after completion of this Trainer of Trainers course, to be in a better position to give a more up to date picture.

South Africa – CDC Avian Influenza (AI) Pandemic Preparedness 

Background

South Africa has developed its own Emerging and Re-Emerging Infectious Diseases Epidemic Preparedness and Response Guidelines (2006) and an Influenza Pandemic Preparedness Plan (2006). The National Department of Health (NDOH) is developing country specific guidelines for Highly Pathogenic Avian Influenza (HPAI) Pandemic Preparedness and Response, with the assistance of the National Institute for Communicable Diseases (NICD), based in Johannesburg. A “roll-out” plan for provincial and district level training in HPAI preparedness and response has been implemented in 3 of the 9 provinces and is supported indirectly by CDC-South Africa (through funding to NICD), together with others.

CDC Areas of AI Activity

• Preparedness and Communications
• Surveillance and Detection
  • Laboratory Capacity
• Response and Containment

CDC  AI  Focus:

• Sentinel Surveillance
• Rapid Response Training
• Laboratory Strengthening
• Outbreak Response
• Infection Control
• Communications

Overview

The NICD is part of the National Health Laboratory Services (NHLS), which consists of 3 geographic branches in the country encompassing 250 laboratories. The NICD functions as a reference laboratory for the region and has highly specialized expertise in house.  For example: in the recent Marburg outbreak in Angola, NICD served as a GOARN (Global Outbreak Alert and Response Network) partner and reference centre.

With CDC AI funds (CDC’s Coordinating Office of Global Health 2006 and 2007), the NICD is strengthening its diagnostic capacity for HPAI. The Onderstepoort Veterinary Institute (OVI) in South Africa serves as a reference centre for diagnosing types of HPAI (in animals), and provides training of personnel for the Southern and Eastern regions of Africa in early detection and containment of HPAI.

Inadequate financial resources were identified as a major bottleneck to operationalization of national strategic HPAI Preparedness plans. Linkage and improvement of avian and human influenza surveillance, was identified as one of the main areas needing strengthening. The NDOH is interested in strengthening HPAI surveillance through training. The coordination between the veterinary and human health sector for HPAI preparedness, is also an area needing strengthening in South Africa, as it is in many countries.

Budget / Funding:

CDC Avian Flu funds for 2006 and 2007 for South Africa have been earmarked to the amount of USD 1Million for each year.

Training:

With CDC-South Africa and CDC-Kenya (GDD) support, a Rapid Response Training for HPAI Preparedness and Response for participants from 13 countries from the SADC region was held South Africa. This training was hosted by NICD from 20-23 August 2007 in Johannesburg with the assistance of CDC, FAO, WHO, USAID and with the concurrence of the South African National Department of Health. There were 54 participants from SADC countries as well as The Seychelles. The participants were senior human and veterinarian health epidemiologists, as well as laboratorians and health educationists. It was a unique opportunity for these professions to work together through HPAI preparedness and response (paper) exercises. It was also an opportunity to liaise with the NICD, which is a reference laboratory for the region.

Partners:
Partners for Preparedness and Rapid Response Highly Pathogenic Avian Human Influenza in South Africa:

South African Partners

• NHLS (National Health Laboratory Services )/
• NICD (National Institute of Communicable Diseases
• OVI (Onderstepoort Veterinary Institute)
• NDOH (National Departments of Health)
• NDOA  (National Department of Agriculture)
• NOD  (National Department of Defense )
• NDFA (National Department of  Foreign Affairs)
• Private sector: SAPA (SA Poultry Ass.)
• Other: Wildlife Conservation Society

Other Partners

• SADC
• AU-IBAR
• UN Agency Partners:
• OCHA
• UNSIC
• FAO
• WHO
• USG Partners:
• CDC
• USAID
• IFRC

Sir, I hope this information covers some of the areas you are interested to know more about.

The support of the HHS through CDC and other USG agencies has helped to support local initiatives for HPAI preparedness. The challenge is to keep the interest and commitment in HPAI preparedness high on the agenda.

We are working on that and we hope that through your assistance, this will be continued.

Sincerely yours,

Marina Manger Cats, MD, MPH
CDC-South Africa Avian Influenza Officer

Comments

Aug 30, 2007
Dr. Leavitt,

Thank you for the South Africa update on their H5N1 "country specific guidelines." Hearing they have also done some paper based exercises is good. Dr. Cats wrote that it was an unique opportunity for "54 participants from SADC countries as well as The Seychelles. The participants were senior human and veterinarian health epidemiologists, as well as laboratorians and health educationists."

The brining together of many minds from different disciplines to work together does not happen often. Worlds fairs, some science fairs and the $3 million dollar concert Steve Wozniak of Apple put on to showcase *all* computers are rare exceptions. Although the events stimulate thinking and the exchange of information.

I have to say my knee jerk reaction is that the peoples of Africa will not be able to store two weeks to two months of food, water, cooking fuel, medicines and money in case of a pandemic or disaster. Dr. Cats letter opened my eyes to that and other problems. In the U.S. stocking up on a months supplies is just one big trip to CostCo, Sams Club or internet shopping.

I wonder how they would implement quarantine, surveillance and culling. Culling might be harder since it is not just a families profit but their food supply of eggs and chickens that is being killed.

The History Channel did a special on New Orleans and Katrina. The government did a lot. Volunteers either unpaid or using their vacation / spring break time did a lot of the work. The use of special crushers and shredders helped recycle most of the refuse. This all happened without a plan. My point is that a group of skilled folks without a plan may do more that a bunch of un skilled strangers trying to read "the plan."

Yesterday I talked with a doctor half way through her residency about H5N1. She said one of her professors from Wisconsin where she studied lectured about this and went to Asia a few times. However she was un-moved and un-concerned. Even with the WHO printouts of the last few months showing the growing rate of H5N1 she felt it was a non issue. I wish I had her faith. So often when things have gone wrong there was no time to sit, think or prepare. There was only time to act.

To close on a good note, happy Labor Day, thanks for the feed back, please keep posting.

Regards,
Allen
"Everything I know never changed my mind as much as the one thing I did not" - Kobie M, FluWiki

Posted by: Allen | August 31, 2007 at 08:35 AM

Your report on the effort for pandemic preparedness was interesting. Consider the effort in light of these statistics for the Southern Africa Development Community (SADC http://www.sadc.int/member_states/index.php) countries. Angola has 1 physician for 12,500 population, Botswana has 1 physician for 2500 population, Democratic Republic of the Congo has 1 physician for 9090 population, Lesotho has 1 physician for 20,000 population, Madagascar has 1 physician for 3448 population, Malawi has 1 physician for 50,000 population, Mauritius has 1 physician for 943 population, Mozambique has 1 physician for 33333 population, Namibia has 1 physician for 3333 population, South Africa has 1 physician for 1298 population, Kingdom of Swaziland has 1 physician for 6250 population, United Republic of Tanzania has 1 physician for 50000 population, Zambia has 1 physician for 8333 population, Zimbabwe has 1 physician for 6250 population. You also mentioned Kenya which has 1 physician for 7142 population, and The Seychelles, which has 1 physician for 662 population. For comparison the U.S. average is one physician for every 454 Americans. Except for the Seychelles, who would they have to respond to a pandemic? Should preparedness begin with training a hundred times the number of physicians?

Source http://www.who.int/globalatlas/dataQuery/reportData.asp?rptType=1
Global Atlas of the Health Workforce Category: Human Resources for Health, Topic Aggregated data 2006, density per 1000, physicians total, world

Posted by: J.I.M.C. | January 28, 2008 at 04:43 PM