Is swine flu screening too late?
May 01, 2009
From April 14 when swine flu was confirmed to have crossed Mexican borders, at least 28,000 travellers entered Uganda without screening. Uganda receives an average of 2000 visitors daily through Entebbe alone according John Nuwagira, the immigration assi
By Lydia Namubiru
From April 14 when swine flu was confirmed to have crossed Mexican borders, at least 28,000 travellers entered Uganda without screening. Uganda receives an average of 2000 visitors daily through Entebbe alone according John Nuwagira, the immigration assistant commissioner in charge of the airport. Of those that came in unscreened, eight were Mexicans, 1,237 US citizens and 315 Canadians, the three countries where the virus was first confirmed. It is, however, not known if these individuals had been to their countries before coming to Uganda. The Ministry of Health only started screening travellers at immigration entry points on April 29.
World wide, other countries started their surveillance earlier. By April 27, Russia, Hong Kong and Taiwan had begun identifying all travellers from affected areas, and were promising to isolate those with fevers. Singapore, Thailand, Japan, Indonesia and the Philippines were using thermal scanners to check for signs of fever among passengers from North America. In Spain, passengers from Mexico were told to fill out forms detailing where they had been in the country and whether they had felt any flu-like symptoms.
Many other countries had also stepped up airports checks for people from affected countries. Argentina and Cuba simply banned travel to Mexico in order to lock out the influenza virus that has compelled the World Health Organisation to raise its international health alert to the second highest level.
While it is not known whether or not the virus has already come into Uganda, late response to epidemic reports has in the past cost Uganda dearly. When surveillance is delayed, the disease spreads to more people before it is detected and everything in the response process is delayed. During the 2000 Ebola epidemic in Gulu, active surveillance began in second week after the initial reports of the outbreak according to a report by CDC. This contributed to the 53% death toll in that outbreak.
In a meeting last year on the 2007-2008 Ebola outbreak in Bundibugyo, health officials decried the lack of emergency response planning, noting that even after the outbreak had been reported, they had trouble deploying doctors and got tied up in negotiations with doctors over small issues like per diem and transport. As a result, precious time and lives were lost.
Drawing from his experience with last year’s ebola outbreak, Bundibugyo district health officer, Dr Sikyewunda, advised that emergency response preparedness be a permanent feature on the national health budget.
Other epidemiologists said the country needs a register for rapid response health workers and argued that issues like remuneration and facilitation should be agreed upon in advance.
In addition to delayed screening of travellers, Uganda has only 500 doses of antiviral drugs to treat the virus should the epidemic get here. In contrast, the US is currently distributing drugs and test kits enough for 11 million people in each of its 50 states, the UK has enough drug to treat 50% of its population, WHO has a stockpile of three million doses in Dubai to be distributed to the middle east should there be an outbreak, France has 30 million doses and Italy has ten million but has powder enough for 30 million more doses.
Limited amounts of Tamiflu are available in a few Kampala pharmacies and a dose is sh80,000 which is too high for the ordinary Ugandan.
Dr. Sam Zaramba, the director for clinical services in the Ministry of Health, says Uganda’s supply is adequate. “Even in Mexico, where the outbreak started, they have only recorded 1,500 (2,000 by press time -ed) cases. There is no need to worry,†he says.
But what seems adequate today could seem far less than enough if the epidemic spreads as much as some health experts fear. WHO has warned that poor countries like Uganda will not find it easy to access drugs once if this epidemic becomes global. Richer countries and drug makers are likely to enter into deals that will divert most of the drugs to richer countries’ citizens.
What does being ready mean?
It may seem that countries like Uganda are so overwhelmed with already existing epidemics that they cannot afford to plan for potential ones but epidemiologists warn that it is crucial for developing countries to prepare now as they are likely to suffer the biggest harm in any future pandemic.
One 2006 study published in the Lancet medical journal estimates the 96% of the deaths from such an epidemic will be in the developing world. The U.S. Centres for Disease Control and Prevention (CDC) in June last year published a paper on what developing countries can do to prepare themselves for the next flu pandemic.
Recognising that developing countries face unique limitations, the paper recommends that countries like Uganda should improve their planning process by including a list of strategies that do not depend on drugs.
“Since the availability of pharmaceutical interventions in developing countries is less likely, non pharmaceutical interventions such as social distancing and personal hygiene may be the only available interventions,†the paper, Pandemic Preparedness argues.
Perhaps more significantly, the paper suggested that the best defense against an outbreak may be better routine care – and the time to start providing that is now.
“The health consequences of a pandemic, including deaths, can be substantially reduced by providing better medical care,†the CDC writes.
“Essential medical supplies such as masks, gloves and antimicrobial agents should be available in hospitals and clinics. The stockpiles of these basic supplies can be more cost-effective in developing countries than the stockpiles of more expensive antiviral agents.â€
The paper also calls on international health bodies like WHO to ensure that developing countries get more access to antiviral drugs. Donors are also called on to increase health funding for pandemic preparedness activities.
-------------------------------------------
How to get ready
- Establish a strong surveillance and early warning system
- Register qualified health workers who will be deployed as soon as the first case is reported
- Establish a receiving facility to which people who get symptoms can report and be quarantined
- Set mechanisms to stop all social places and gatherings that may help the spread of the epidemic
- Establish a two way communication system with the public so as to harness their participation in the response
- Stock enough drugs for as a big a portion of the population as possible
- Communicate preventive measures to the public now
From April 14 when swine flu was confirmed to have crossed Mexican borders, at least 28,000 travellers entered Uganda without screening. Uganda receives an average of 2000 visitors daily through Entebbe alone according John Nuwagira, the immigration assistant commissioner in charge of the airport. Of those that came in unscreened, eight were Mexicans, 1,237 US citizens and 315 Canadians, the three countries where the virus was first confirmed. It is, however, not known if these individuals had been to their countries before coming to Uganda. The Ministry of Health only started screening travellers at immigration entry points on April 29.
World wide, other countries started their surveillance earlier. By April 27, Russia, Hong Kong and Taiwan had begun identifying all travellers from affected areas, and were promising to isolate those with fevers. Singapore, Thailand, Japan, Indonesia and the Philippines were using thermal scanners to check for signs of fever among passengers from North America. In Spain, passengers from Mexico were told to fill out forms detailing where they had been in the country and whether they had felt any flu-like symptoms.
Many other countries had also stepped up airports checks for people from affected countries. Argentina and Cuba simply banned travel to Mexico in order to lock out the influenza virus that has compelled the World Health Organisation to raise its international health alert to the second highest level.
While it is not known whether or not the virus has already come into Uganda, late response to epidemic reports has in the past cost Uganda dearly. When surveillance is delayed, the disease spreads to more people before it is detected and everything in the response process is delayed. During the 2000 Ebola epidemic in Gulu, active surveillance began in second week after the initial reports of the outbreak according to a report by CDC. This contributed to the 53% death toll in that outbreak.
In a meeting last year on the 2007-2008 Ebola outbreak in Bundibugyo, health officials decried the lack of emergency response planning, noting that even after the outbreak had been reported, they had trouble deploying doctors and got tied up in negotiations with doctors over small issues like per diem and transport. As a result, precious time and lives were lost.
Drawing from his experience with last year’s ebola outbreak, Bundibugyo district health officer, Dr Sikyewunda, advised that emergency response preparedness be a permanent feature on the national health budget.
Other epidemiologists said the country needs a register for rapid response health workers and argued that issues like remuneration and facilitation should be agreed upon in advance.
In addition to delayed screening of travellers, Uganda has only 500 doses of antiviral drugs to treat the virus should the epidemic get here. In contrast, the US is currently distributing drugs and test kits enough for 11 million people in each of its 50 states, the UK has enough drug to treat 50% of its population, WHO has a stockpile of three million doses in Dubai to be distributed to the middle east should there be an outbreak, France has 30 million doses and Italy has ten million but has powder enough for 30 million more doses.
Limited amounts of Tamiflu are available in a few Kampala pharmacies and a dose is sh80,000 which is too high for the ordinary Ugandan.
Dr. Sam Zaramba, the director for clinical services in the Ministry of Health, says Uganda’s supply is adequate. “Even in Mexico, where the outbreak started, they have only recorded 1,500 (2,000 by press time -ed) cases. There is no need to worry,†he says.
But what seems adequate today could seem far less than enough if the epidemic spreads as much as some health experts fear. WHO has warned that poor countries like Uganda will not find it easy to access drugs once if this epidemic becomes global. Richer countries and drug makers are likely to enter into deals that will divert most of the drugs to richer countries’ citizens.
What does being ready mean?
It may seem that countries like Uganda are so overwhelmed with already existing epidemics that they cannot afford to plan for potential ones but epidemiologists warn that it is crucial for developing countries to prepare now as they are likely to suffer the biggest harm in any future pandemic.
One 2006 study published in the Lancet medical journal estimates the 96% of the deaths from such an epidemic will be in the developing world. The U.S. Centres for Disease Control and Prevention (CDC) in June last year published a paper on what developing countries can do to prepare themselves for the next flu pandemic.
Recognising that developing countries face unique limitations, the paper recommends that countries like Uganda should improve their planning process by including a list of strategies that do not depend on drugs.
“Since the availability of pharmaceutical interventions in developing countries is less likely, non pharmaceutical interventions such as social distancing and personal hygiene may be the only available interventions,†the paper, Pandemic Preparedness argues.
Perhaps more significantly, the paper suggested that the best defense against an outbreak may be better routine care – and the time to start providing that is now.
“The health consequences of a pandemic, including deaths, can be substantially reduced by providing better medical care,†the CDC writes.
“Essential medical supplies such as masks, gloves and antimicrobial agents should be available in hospitals and clinics. The stockpiles of these basic supplies can be more cost-effective in developing countries than the stockpiles of more expensive antiviral agents.â€
The paper also calls on international health bodies like WHO to ensure that developing countries get more access to antiviral drugs. Donors are also called on to increase health funding for pandemic preparedness activities.
-------------------------------------------
How to get ready
- Establish a strong surveillance and early warning system
- Register qualified health workers who will be deployed as soon as the first case is reported
- Establish a receiving facility to which people who get symptoms can report and be quarantined
- Set mechanisms to stop all social places and gatherings that may help the spread of the epidemic
- Establish a two way communication system with the public so as to harness their participation in the response
- Stock enough drugs for as a big a portion of the population as possible
- Communicate preventive measures to the public now