Global Health Bulletin - September 2019
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 outbreak of listeria in Spain
- The consequence of poor vaccine uptake in Ghana
- The ongoing Ebola outbreak in the Democratic Republic of Congo
Many people know to shun soft cheeses during pregnancy to avoid the bacterial infection listeriosis. But the outbreak of Listeria in Spain at present, has been caused by a roast pork product, and found to be the culprit of several serious infectious in Andalusia. The chilled meat preparation, sold under the name La Mechá, has so far been responsible for over 220 infections; with 40 still hospitalised. At first causing diarrhoea, vomiting, and abdominal pain, listeria can also cause death in up to 20% of those affected. Which has sadly been the case in three individuals.
All three of the patients that have recently succumbed to the illness were senior citizens. Pregnant women have also been infected during this outbreak, and although the disease is not usually harmful to the mother, the developing child in the womb can be at risk following infection with the disease. And sadly, 6 miscarriages have been attributed to listeriosis at present. Those particularly at risk include, patients who have compromised immune systems, individuals with long-standing diseases, or people above the age of 60.
The FCO have issued warnings to avoid the packaged roast meat that has initiated this spate of infections. There has also been a recall of all associated La Mechá products and its factory has been closed.
General precautions against listeriosis should still be followed for those in the region, especially those at particular risk of severe infection. This includes eating only well-cooked food, passing over soft cheeses and pâtés.
There are several consequences that follow when a population is not adequately immunised. Firstly, there is of course a threat to those who are unvaccinated of the disease itself. But a more complicated consequence occurs when a sizeable percentage of the population have not been vaccinated, so that the ‘herd immunity’ is decreased. This means that the protective effect of so many people being immunised is lost, and an unvaccinated person may now catch the disease from a large range of potential individuals with whom they may well come into contact.
Another consequence of poor vaccine uptake in the community can sometimes be caused by the vaccine itself. When certain vaccines are administered, the vaccine can also cause disease in those who are unvaccinated. This is true of the oral polio vaccine, which has resulted in outbreaks of vaccine-derived polio in several countries recently. The oral vaccine is a live, attenuated vaccine. And as the vaccine is not dead, sometimes the vaccine may reactivate in the body of an immunised person and be excreted in their faeces. If the patient lives in a country where there is poor sanitation, the drinking water supply can be contaminated, facilitating the infection of unvaccinated people – usually children, in whom severe symptoms such acute paralysis can occur. Recent outbreaks have occurred in Ghana, Myanmar, Nigeria, Niger and Mozambique. With the Democratic Republic of Congo having had the largest recent outbreak, resulting in 31 cases.
It should be borne in mind that the solution to vaccine-derived polio infections is the increased uptake of the polio vaccine in the community. In this way, people will be protected from both polio itself and the vaccine-derived disease. So, reducing the polio immunisation programme will only make things worse. Since the year 2000, 10 billion doses of the oral polio vaccine have been administered, preventing an estimated 13 million infections of the disease. This represents an astonishing reduction of 99% of the world’s burden of polio.
But these days, there is often misunderstanding concerning vaccines and their use and it is of vital importance to continue immunising adults and children so that the incidence of many diseases dramatically decreases. Furthermore, as a health intervention for resource-poor settings, vaccination is particularly effective since only one or two applications of the vaccine are usually required to provide life-long protection. Rather than providing expensive treatment when symptoms develop, a vaccine will stop the disease occurring in the first place.
Democratic Republic of Congo
The epidemic in Eastern DRC continues as before; around 40-60 new cases are being diagnosed each week and security incidents hindering the efforts of the WHO and partners still occur regularly. It is true to say that there is no end in sight to the outbreak at present. The WHO report that they have funds to last until only the end of next month: if amounts that are pledged do not materialise, their efforts on the ground will be affected.
Of particular importance this month, are the reports of an Ebola-like illness that has now occurred in Dar es Salaam, Tanzania.
A 34-year-old doctor, studying in central Uganda, is said to have returned to Tanzania exhibiting symptoms of a severe disease. As there have been cases of Ebola in Uganda that had spread from neighbouring DRC, concern was raised that the doctor had been infected with Ebola. Sadly, she passed away on September 8th. Although there are few reliable reports, it is said that the patient’s relatives are being quarantined in several parts of Dar es Salaam, and that there may be some individuals who have further symptoms of the disease. The Tanzanian authorities have been slow to share much information regarding the patients, causing the WHO to issue a rebuke calling for immediate transparency of information and a full disclosure. As Tanzania relies heavily upon tourism, particularly in Dar es Salaam, the results of such a disclosure may well have severe ramifications for the country in several ways.
In the DRC, attention has recently been paid to those providing essential help in their Ebola Treatment Centres.
There are groups of Ebola-survivors, who being protected from new Ebola infections, are able to provide care to affected patients without the need for all of the personal protective equipment – particularly scary to poorly children. Pictures of these Ebola survivors cuddling infected babes-in-arms have been issued by several agencies. What should be realised is that for more than 90% of those who have beaten Ebola, life continues to be very challenging: survivors are often exhausted, suffering from headache, and abdominal pains. In over half, joint pains continue, as do problems with their eyes, which are often painful, particularly in bright sunlight. Whilst caring for current Ebola patients, Ebola-survivors suffer in silence; in this continuing disaster, yet more heroes emerge.
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