Category Archives: Measles

African Children and COVID-19

Until recently it was thought that the novel coronavirus, COVID-19, was less severe in children. Now as more cases can be studied, that prognosis is less likely to be true. The number of cases overall in Africa is still lower than the rest of the world, with 36,857 cases reported by the Africa CDC as of 29 April 2020, compared to over 3 million globally. One assumes out of this that the number of child cases would also be lower, but there is worry about other indirect effects of the pandemic on children.

Initial beliefs that the young would be less impacted by COVID-19 may have led to complacency. For example, the Atlantic reports that, “Africa will enjoy the advantage of youth. COVID-19 kills mostly the old, and Africans are relatively young, with a median age of 18.9. (The median age in the United States and China is 38.) That means, in effect, that about half of Africans who get COVID-19 will have a low risk of death.” The reality is turning out much different.

First from the medical standpoint, VOA reports that, “Doctors in Britain, Italy, Portugal and Spain are exploring a possible link between a severe inflammatory disease in children and the coronavirus. A growing number of children of various ages in several European countries have been admitted to hospitals with high fever and heart issues. Some also have suffered from gastrointestinal problems, such as vomiting and diarrhea.” There is not enough information disaggregated by age to tell us how coronavirus is affecting children in Africa.

Secondly, UNICEF tells us that, “in any crisis, the young and the most vulnerable suffer disproportionately,” as children suffer from “collateral damage.” Lockdowns reduce access to essential services such as routine immunization, nutritional supplementation and malaria treatment and prevention programs and thus increase morbidity and mortality among children.

Nature published on 7th April that measles has currently, “killed more than 6,500 children in the Democratic Republic of the Congo (DRC) and is still spreading through the country.” Unfortunately “23 countries have suspended measles vaccination campaigns as they cope with SARS-CoV-2.”

There are groups of children that are especially vulnerable. In Kenya. “Street children are having a rough time during the curfew. Food and water are a real problem as hotels and eating places where they would normally get food have closed down. Movement is restricted,” according to the Guardian. The article goes further to share the concern that, “the virus could drive homeless children back to families where they are at risk of abuse.” Abuse of children during stressful times goes affects many confined to homes with out-of-work parents, not just street children.

We cannot afford to lose more children to direct and collateral mortality from the COVID-19 pandemic as it spreads in Africa. We need to begin with better data to tell us about infection and effects on children. Nigeria has done some reporting on age.  We need to ensure that all countries collect data on children and COVID-19 and also maintain routine child survival services.

The Weekly Tropical Health News Update 2019-06-22

For almost 20 years we have been maintaining an email list where current news and articles have been shared with those interested in tropical health and malaria. The listserve host we have been using is changing to a paid model. While there are still some free listserve options, these are cumbersome to produce. Since we are already maintaining this blog, we thought it best to provide a weekly summary of key news events through this medium.

Mapping Plasmodium Vivax

The Malaria Atlas Project has published in The Lancet a global burden of Plasmodium Vivax mapping study. The authors describe the contribution of this study as: “Our study highlights important spatial and temporal patterns in the clinical burden and prevalence of P vivax. Amid substantial progress worldwide, plateauing gains and areas of increased burden signal the potential for challenges that are greater than expected on the road to malaria elimination. These results support global monitoring systems and can inform the optimisation of diagnosis and treatment where P vivax has most impact.”

Ebola Spread from DRC to Uganda

Since the major ongoing outbreak of Ebola Virus Disease in North Kivu and Ituri Provinces of the Democratic Republic of Congo (DRC) started nearly a year ago, there has been concern that the disease might spread to neighboring countries like Uganda, Rwanda, South Sudan and the Central African Republic. This fear same true recently when a family affected by Ebola crossed from DRC into Uganda to connect with relatives in Kasese District Uganda. Uganda has had many years’ experience dealing with Ebola and was able to contain the situation.

A press release this week noted that, “As of today (21 June 2019), Uganda has not registered any new confirmed Ebola Virus Disease (EVD) case in Kasese District or any other part of Uganda since the last registered case one week ago. There are no new suspect cases under admission. Currently, 110 contacts to the confirmed Ebola cases in Kagando and Bwera are being followed up daily. A total of 456 individuals have been vaccinated against EVD using the Ebola-rVSV vaccine in Kasese District, Western Uganda.”

Although many people expected that the meeting of the “International Health Regulations (2005) Emergency Committee} for Ebola virus disease in the Democratic Republic of the Congo would finally declare the current outbreak a Public Health Emergency of International Concern (PHEIC) because it crossed a border, the result was noting that the challenge was still an emergency only for DRC. WHO did note that there were serious funding gaps and support from other countries for the DRC’s predicament. Ironically, such gaps make it more likely that Ebola can spread more widely.

As of 21 June 2019, the DRC reported a total of 2,211 cases since the start of the epidemic last year, of which 2,117 have been confirmed and 94 are probable. There have been 1,489 deaths. To date 139,027 persons have been vaccine with the Merck rVSV-ZEBOV vaccine.

Progress toward Eliminating Malaria – the E-2020 Countries

The process of eliminating malaria from the world needs to start in a step-by-step fashion. WHO explained that, “Creating a malaria-free world is a bold and important public health and sustainable development goal. It is also the vision of the Global technical strategy for malaria 2016-2030, which calls for the elimination of malaria in at least 10 countries by the year 2020.”

Actually, WHO identified 21 countries, spanning 5 regions, that could defeat malaria by 2020. The progress report charts the effort. During the recent World Health Assembly two countries received recognition for being certified malaria-free, Argentina and Algeria. This week WHO also announced that 5 more countries have not had malaria cases in the past year. There was also release of a downloadable report on progress toward the 2020 target for selected countries.

Reconsidering Yaws Eradication

In the 1950s and 1960s the world focused on the possibility of eradicating Yaws through screening and treatment interventions. Like the early malaria eradication programs from the same period, the Yaws effort slowed, stopped and experienced a resurgence. The Telegraph reported that, “Between 1952 and 1964, Unicef and the WHO screened some 300 million people for the illness, in a coordinated programme which treated more than 50 million cases. Yaws was on the brink of being wiped out and reports of the disease dropped by 95 per cent.” WHO continues to work on treatment strategies with azithromycin and for resistant cases, benzathine benzylpenicillin injection.

WHO noted that there were 80,472 cases reported in 2018, although this figure is likely to be much higher in actuality. The challenge of case detection exists but may be overcome, according to the Telegraph with a new molecular rapid diagnostic test which detects yaws within 30 minutes, and thus could allow on-the-spot diagnosis in remote regions.

Measles Cases Continue to Increase

The problem of measles in the DRC may not be receiving much attention because of the Ebola epidemic. Ironically, Outbreak News Today reports that, “In a follow-up on the measles outbreak in the Democratic Republic of the Congo (DRC), UN health officials report an additional 7500 suspect cases in the past 2 weeks, bringing the total cases since the beginning of the year to 106,870. The death toll due to the measles outbreak has reached 1815 deaths (case fatality ratio 1.7%).”

Vaccine coverage challenges in the DRC result from health systems weaknesses. Unfortunately, a global study has shown that increasing cases in the Global North are not due to weak systems, but ‘vaccine hesitancy.’ The Guardian reports that a global survey has revealed the scale of the crisis of confidence in vaccines in Europe, “showing that only 59% of people in western Europe and 50% in the east think vaccines are safe, compared with 79% worldwide.” The Guardian observes that, “In spite of good healthcare and education systems, in parts of Europe there is low trust in vaccines. France has the highest levels of distrust, at 33%.”

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