Global Health Bulletin - January 2020
Author: Dr Simon Worrell, Global Medical Director
Dr Worrell has over 20 years of experience in the delivery of international medical assistance and emergency care, and has significant specialist expertise in immunology and communicable diseases. Simon leads Collinson’s medical team and provides expert advice on medical issues including pandemics from Ebola to Zika, helping to keep travellers and expatriates safe as they work and holiday internationally.
This month's health bulletin focuses on:
- The mystery epidemic in China
- The measles epidemic in Samoa
- The ongoing Ebola outbreak in the Democratic Republic of Congo
In the last few weeks, China has reported cases of one of the oldest infections known to us - the plague - and also one so new, we don’t as yet know what the illness is.
Last month’s Global Medical Bulletin included 4 cases of plague found from the same region of Inner Mongolia. Since that time, around 60 patients have now been diagnosed with an unknown infection in Wuhan city, the capital city of the central Chinese Hubei province. Much is not known at present. What is clear is that the infections are associated with a particular location, the South China Seafood Wholesale Market, where some of the patients worked. Despite its name, the market also houses wild animals, including chicken, bats and marmots, sold for their meat. These animals are the most likely source of the novel infection, which has produced severe disease in around 10 of those affected. Although many patients have simply suffered high temperatures, others have progressed to pneumonias requiring admission to hospital.
A full gamut of tests to identify the infection has been completed. Certain diseases have been ruled-out: it is not a Bird Flu, SARS, MERS, or the more common adenovirus. At time of writing the illness is thought to be a new form of coronavirus, but we await confirmation. Of importance is the fact that no healthcare worker has so far been infected. This is not mentioned simply out of a solidarity with our Chinese counterparts, but the fact hints at a more fundamental issue concerning the emerging illness. If the disease were easily transmitted from human to human, healthcare workers should have been affected. This is the sad case with many infectious illnesses, from Ebola to MERS: nurses and doctors are commonly infected by those they care for. In an emerging epidemic, when cases of an infectious disease are unexpected, this is doubly so – as precautions to protect medical staff from viruses and bacteria, are often not yet instigated.
As medical staff in Wuhan have not been so far affected, it suggests that transmission has occurred directly from infected animals to humans, and also that close contacts of the patients will probably remain uninfected or develop only mild symptoms. Despite this, around 120 close contacts are still being observed for signs of disease.
The importance of this outbreak was clearly demonstrated by the Chinese authorities, who contacted the WHO within a matter of weeks of the first case occurring. The same authorities had received far-reaching criticism following a similar situation in 2003, which within days led to the spread of the SARS virus across the globe. Much has been learned since then: efforts are not only going into the disease’s identification, but the isolation of those affected, so a SARS situation does not happen again. This is easier said than done, however. As the infectious agent is unknown, there is no test for the illness. Therefore, new cases can only be confirmed once an exhaustive process of testing for known diseases has been unsuccessful. In this situation, validating true patients becomes particularly difficult.
Neighbouring countries are looking in with interest and concern: the Philippines has now instructed their Bureau of Quarantine to intensify surveillance of travellers arriving from China. As 8 patients have already been released from hospital, however, this new illness may prove to be only a weak relation to previous global epidemics.
Following international help and expertise, the measles epidemic in Samoa is now receding. Resulting from a much reduced uptake of the measles vaccine, the outbreak has produced around 5,700 cases of the viral illness, the vast majority in children – 83 have died. For the small island community, the burden of the illness has been catastrophic: approaching 2,000 children required admission, most with chest infections. The height of the epidemic has passed, however, allowing 95% of patients to be discharged and return home. To prevent yet further infections, almost 135,000 individuals were vaccinated. This is a terrible example of the effects of some viruses, and the power of immunisation: no further proof should be needed.
The Ebola outbreak in Eastern DRC although reduced is still producing regular cases. In the past 3 weeks, 42 new Ebola patients have been reported from 13 health districts. The issues that make the outbreak difficult to eradicate are still continuing. Ongoing militia activity, and mistrust in those providing help, are particularly important factors that must abate if the outbreak is to be controlled. To date, almost 3,400 cases of Ebola have occurred, proving fatal in over 2,200 individuals. Although the second largest number of deaths from Ebola in history, it is dwarfed by the 6,000 deaths that have also recently occurred during the ongoing measles epidemic in Congo. The chief answer to both diseases likely lies in the increased uptake of their respective immunisations – the Ebola vaccine received its final sign-off from the FDA this week. As the continued militia activity disrupts immunisation programmes, as well as contract tracing, both illness are set to continue for some time.
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