29 March 2011 (IRIN) – A cholera outbreak in Katanga Province is likely to exacerbate the measles epidemic that for the past six months has been sweeping through the Democratic Republic of Congo (DRC). Aid workers warn it is now likely to get out of control and spread from five provinces to the rest of the country.
“Children who contract cholera and haven’t received any inoculations against measles will be more vulnerable to the disease. We need to act quickly to control the epidemic,” Ayigan Koffi, health coordinator of the World Health Organization (WHO) in the DRC, told IRIN.
“We are working on ways to increase and better coordinate the response. If nothing is done, the epidemic is likely to spread further,” Koffi told IRIN.
Measles is a highly contagious infection of the respiratory system that is only preventable by vaccination and can be fatal in children if not treated. According to Médecins Sans Frontières (MSF) data, measles can kill between one and 15 percent of un-vaccinated children who contract the disease and up to 25 percent of malnourished or vulnerable groups with limited access to healthcare.
WHO says the total number of cases since the beginning of the year has reached 6,524 cases, with 33 deaths.
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Pakistan had looked to be winning its battle against polio until 2007 when 32 new cases were detected. Since then, things have deteriorated, with the president declaring a national emergency in January 2011, and describing the failure to eradicate the disease as “criminal negligence”.
The discovery of the polio virus in water samples obtained from five cities in February is believed to be just one of the reasons why the disease is spreading so rapidly in the country.
Pakistan had more polio infections in 2010 (144 cases confirmed) than any other country. Fifteen new cases have been recorded this year.
Whether or not negligence is involved is debatable. But there are many dimensions to what is a complex problem; lack of access for polio vaccination teams to certain areas of the country due to the activities of armed militant groups is one key factor.
According to media reports earlier this year, a worker for Pakistan’s Expanded Programme for Immunization (EPI) was kidnapped and later killed in the North Waziristan tribal agency on the Pakistan-Afghan border.
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Health officials in Ethiopia’s capital, Addis Ababa, are concerned about the spread of tuberculosis in the city’s crowded public transport networks and tightly packed “DSTV [satellite television] houses” where ardent fans come to watch English and Spanish football. During big matches, a single “DSTV house” can hold up to 100 people.
“I sometimes open windows to avoid bad smells but on most occasions people say they will catch cold and TB… [they think that the] cold that comes through the window gives them the disease, so the windows and doors remain closed most of the time,” said Daru Shifa in Addis’s Merkato area.
Health officials say there is an urgent need to address the misconceptions about how TB is spread in order to curb the further spread of the disease in the city, whose population is more than 2.7 million.
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UNAIDS has released a new policy brief to help countries make intellectual property rights work for them, amid growing concern that an impending free trade agreement between the European Union (EU) and India could threaten the world’s supply of generic antiretroviral (ARV) drugs.
The World Trade Organization’s Trade Related Aspects of Intellectual Property Rights (TRIPS) allows countries to override patents – for public health purposes – by issuing “compulsory licenses” that enable the generic manufacture of drugs still under patent.
The UNAIDS brief, published on 15 March, noted that few developing countries had exercised this right and cited a lack of capacity to deal with the complicated legal paperwork required. Nevertheless, the flexibility afforded by TRIPS has brought increased competition, helping to lower the cost of first-line generic ARVs by as much as 99 percent in the last decade.
Recent changes in World Health Organization (WHO) HIV treatment guidelines substituted stavudine, a cheaper ARV, for tenofovir, a more expensive one, making it even more important for countries to take advantage of TRIPS to keep treatment costs low and extend coverage.
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A go-slow by nurses at Pumwani Maternity Hospital in Nairobi’s Eastleigh area has exposed serious challenges at Kenya’s largest maternity hospital, with officials calling for urgent intervention to improve services.
“Working conditions at the hospital remain deplorable,” Festus Ngare, secretary-general of the Kenya Local Government Workers’ Union, which represents the nurses, told IRIN on 17 March. “Although we have reached agreement with the hospital’s management on some of the issues and others are still pending, the working environment at the hospital is a major concern for all.”
The 180 nurses at the hospital staged the go-slow on 16 March to protest at being overworked and the withholding of their uniform and other allowances by the hospital’s management.
Ngare said: “As a matter of urgency, the [Nairobi City] Council should have not less than 30 doctors and not less than 100 nurses posted to the hospital immediately to help ease the workload. At the moment, some nurses find that after working a 6pm to 8am shift, there is no one to relieve them. They find themselves working for many more hours and this is not only a danger to the mothers and their newborn babies but a danger to the nurse herself.”
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Outbreaks of H5N1 bird flu among poultry in Bangladesh – already three times higher this year than the same period last year – have caused “serious concern” for the authorities.
“We are undertaking heavy surveillance at farms and teams are supervising markets to prevent sick chickens from being sold,” Director-General of the Department of Livestock Mohammad Ashraf Ali told IRIN.
The avian flu death toll may mount given how such outbreaks typically occur up to June, said the chief technical adviser for the Food and Agriculture Organization, Mat Yamage.
But reports of increases may not be a bad thing, he noted. “One hypothesis [for the increased number of outbreaks], though unconfirmed, is that farmers are more willing to report bird flu because the rate of compensation more than doubled this year. This is a positive development, as farmers generally no longer opt to sell sick poultry.”
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The World Health Organization (WHO) has declared Nepal polio-free following a six-month period of no reported infections.
“This is an example of what can be achieved by emphasizing the importance of routine immunization, high quality mass vaccination campaigns and a sensitive surveillance system,” William Schluter, WHO medical officer for the expanded programme on immunization, told IRIN.
Endemic transmission of the debilitating virus was interrupted in 2000 – at which point Nepal was polio-free for the next four years, he said.
Between 2005 and 2008, 20 cases were reported due to cross-border transmission. In 2009, the country was again polio-free.
In 2010 six cases were reported, following two separate importations of the virus from the Indian state of Bihar, he said. In February, a single case outbreak occurred in Mahottari District, followed by a second outbreak in Rautahat District (both districts are on the border with India); the most recent case was reported on 30 August 2010.
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