SYMPOSIUM 2: COMMUNICABLE DISEASES

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Cornelia Porter
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1 Oyewale SCIENTIFIC CONFERENCE- PROMOTING HEALTH SYMPOSIUM 2: COMMUNICABLE DISEASES Models for infectious disease control and prevention: from mosquito nets to vaccines

A little over 50 years ago - By the end of the Second World War it was possible to say that almost all of the major practical problems of dealing with infectious disease had been solved. 1962- M.

2 A little over 50 years ago - By the end of the Second World War it was possible to say that almost all of the major practical problems of dealing with infectious disease had been solved M. Burnet..we can look forward with confidence to a considerable degree degree of freedom from infectious diseases Indeed, within some measurable time, all the major infections would have disappeared. 1963, T. Cockburn we could close the book on infectious disease." 1969, William Stewart US Surgeon General

3 An emerging disease recognized for the first time in the human population, or present in one location and now appearing in another and new location; A re-emerging disease has been controlled or eliminated and now occurring with increased incidence.

4 ERGING INFECTIOUS DISEASE EVENTS EID EVENTS BY DECADES* ~40 diseases emerged or re-emerged * LF (1969), EVD (1976), LD (1976), HIV/AIDS(1981), AI (1996) Hep. C (1988), Nipah virus (1998), SARS (2002), MERS_CoV (2012). *Jones et al (2008), Morens et al. (2008)

6 MODELS FOR DISEASE PREVENTION AND CONTROL Multiple factors, with dynamic interplay Humans Pathogens - Environment Human demographics and behavior Dynamics of human-animal contact, Nature of the pathogen, Mode of disease transmission

7 MODELS FOR DISEASE PREVENTION AND CONTROL Multiple factors, with dynamic interplay Alteration of the environment, including Effects of climate change.

8 The Microbial Agent The Human Host The Human Environment Genetic adaptation and change Polymicrobial diseases Human susceptibility to infection Human demographics and behavior Climate and weather Changing ecosystems International trade and travel Intent to harm (bioterrorism) Occupational exposures Inappropriate use of antibiotics Economic development/land use Technology and industry Occupational exposures Poverty and social inequality Lack of public health services Animal populations & Animal production methods War and famine Lack of political will

9 MODELS FOR DISEASE PREVENTION AND CONTROL Resources & Infrastructure Availability of sustainable health infrastructure Effective & reliable disease surveillance system Rapid and efficient laboratory diagnosis Availability and access to efficacious drugs Reliable and potent vaccines

10 MODELS FOR DISEASE PREVENTION AND CONTROL Actions and Interventions building toilets to reduce open defecation and limit the spread of diseases transmitted through the feco-oral route - cholera. polio providing access to potent vaccines for all ages, - polio, measles, YF, Rotavirus diarrhea, other vaccine preventable diseases using mosquito nets to prevent bites of mosquitoes transmitting malaria and virus infections, malaria,

11 MODELS FOR DISEASE PREVENTION AND CONTROL Actions and Interventions improving environmental sanitation to reduce humananimal contact, Nipah, Lassa and human vector contact malaria, dengue, WN, Zika, Yellow fever changing social and cultural practices, (such as safe burial to reduce human to human transmission), Lassa EVD

12 YELLOW FEVER TRANSMISSION IN AFRICA Source CDC -

13 YELLOW FEVER IN NIGERIA

14 No. YF cases reported YF VACCINATIONS WITH FRENCH NEUROTROPIC VACCINE AND REPORTED CASES OF YF IN AFRICA, '34 '35 '36 '37 '38 '39 '40 '41 '42 '43 '44 '45 '46 '47 '48 '49 '50 '51 '52 '53 0

15 YELLOW FEVER ANNUALLY : 840, M CASES 84, ,000 DEATHS MASS VACCINATION IN WEST AFRICA PREVENTED 29,000-60,000 DEATHS

Geographic Expansion of the outbreak +++ Local transmission documented in 3 new provinces Clustered cases Lunda Norte ( DRC), Cunene, Namibia) Malanje Highly probable Cabinda ( DRC and the Congo)

16 Geographic Expansion of the outbreak +++ Local transmission documented in 3 new provinces Clustered cases Lunda Norte ( DRC), Cunene, Namibia) Malanje Highly probable Cabinda ( DRC and the Congo) Under investigation : Kwanza Norte, Continuous transmission in Luanda From 5 December 2015 to 31 May 2016, a total of : new suspect cases, 24 new deaths and 41 new confirmed cases 30 districts in 10 provinces have reported local transmission 2,893 suspect cases incl 325 deaths (CFR: 12%). 788 laboratory confirmed cases ANGOLA

55 YF cases in total 52 related to Angola Kongo central, Kinshasa and Kwango) : 52 confirmed +3 probable cases 2 autochthonous + 48 imported+2 sylvatic New province : Kwango (in former Bandundu) 3

17 55 YF cases in total 52 related to Angola Kongo central, Kinshasa and Kwango) : 52 confirmed +3 probable cases 2 autochthonous + 48 imported+2 sylvatic New province : Kwango (in former Bandundu) 3 confirmed cases Imported from Angola /Lunda Norte Total 22 suspect High mortality reported in Congolese in Lunda Norte RDC Vaccination campaign Started on 26 May 11 Health zones Kinshasa + Kongo central Target: 2 M preliminary coverage 36 % (30 May).

OTHER COUNTRIES WEST CENTRAL AFRICA Republic of Congo (As of 27 May) 88 suspect cases (no additional details available) 1st confirmed case IGM +ve DEN

to be confirmed Bouenza departement suspected to be imported from Cabinda, Angola Dates onset (jaundice +fever)and sample : March 2016 Sao Tome &

18 OTHER COUNTRIES WEST CENTRAL AFRICA Republic of Congo (As of 27 May) 88 suspect cases (no additional details available) 1st confirmed case IGM +ve DEN WNV ve (INRB/IPD) 3 year girl, vaccinated December 2015? to be confirmed Bouenza departement suspected to be imported from Cabinda, Angola Dates onset (jaundice +fever)and sample : March 2016 Sao Tome & Principe 2 IgM positive cases in Sao Tome IgM positive IPC. Confirmation pending at IPD. Both imported from Luanda/Angola, Both pregnant women; symptoms - fever and vomiting Both allegedly vaccinated (2013, and March 2016, respectively) investigation on going

OTHER COUNTRIES EAST AFRICA Ethiopia Started mid May, suspect cases (acute febrile illness + diarrhoea + haemorrhagic signs) 144 suspect cases including 5

Samples sent to KEMRI for confirmation No information on vaccination, travel history / potential link with Uganda / Angola Last YF outbreak South Omo in

19 OTHER COUNTRIES EAST AFRICA Ethiopia Started mid May, suspect cases (acute febrile illness + diarrhoea + haemorrhagic signs) 144 suspect cases including 5 deaths in (144 cases) in South Omo zone 22 samples YF IgM positive; 4 positive Salm Typhi. Samples sent to KEMRI for confirmation No information on vaccination, travel history / potential link with Uganda / Angola Last YF outbreak South Omo in 2013 Uganda : 1st June YF cases and 3 deaths reported in 7 districts 7 confirmed cases : Masaka (5), Rukungiri (1), Kalangala (1) Preliminary coverage Masaka=90% Rukungiri= 97%. Kalangala vaccination to start on 4 June

20 URBAN (OVER POPULATION) SLUMS REFUSE SANITATION CULTURE BURIAL POLITICIAN POLIO PATHOGENS (PPP)

21 Our increasing and expanding urban centers will become fertile ground for disease epidemics

22 OUR CITIES, OUR FILTH OUR REFUSE HEAPS

23 CULTURE IN EBOLA VIRUS DISEASE 25 outbreaks in Africa since WA outbreak :28,646 cases, 11, 323 deaths In Guinea, 82% of transmission occurred in the community, 72% between family members, 9% via hospital transmission, and 4% occurring at funerals.

24 OPEN DEFECATION - CHOLERA AND POLIO Recent UNICEF report : Globally, 1 billion of 5.9 billion people defecate openly, Of the 1 billion, 713 million and 123 million live in Asia and SSA respectively In SSA, diarrhea is 3 rd largest killer of children >5 years A child dies every 2.5 minutes because of unsafe drinking water, poor sanitation and hygiene.

25 OPEN DEFECATION - CHOLERA AND POLIO Experts say one gram of feces contaminating water or food could contain 10 million viruses, one million bacteria, 1,000 parasite cysts 100 parasite eggs.

26 ANNUAL WILD POLIOVIRUS CASES POLIO & ELECTIONS IN NIGERIA: HISTORY In the past, elections have distracted key leaders and led to polio resurgence 1200 National elections

27 Lessons learnt from smallpox eradication a clear definition of goals and objectives an unambiguous implementation strategy on the structure and management a strong national political commitment and international coordination including funding involvement of all participants ab initio

28 Lessons learnt from smallpox eradication a flexibility in programme implementation occasioned by operational research findings applying surveillance & containment strategy, especially in the end game of the programme, engaging in operational and laboratory research adopting and using the findings of research to improve the programme

29 TIGER WOODS TIGERS WOOD CUTTING CORNERS, WILL NEVER MAKE MEDIOCRITY EQUAL TO EXCELLENCE

30 SOME CONCLUDING REMARKS ON LEADEERSHIP AND PREVENTING /CONTROLLING EMERGENCE AND RE-EMERGENCE OF DISEASES

31 THE REAL DISEASE- THE REAL BURDEN THE REAL PATHOGEN IN MANY OF THE MOST DISEASE RIDDEN COUNTRIES THE LEADERS ARE THE BURDEN THE POLITICIANS ARE THE PATHOGENS CONTROLLING THEM IS A RAPID PATH TO PREVENTING EMERGING AND RE-EMERGING DISEASES

32 BEFORE EBOLA, EVERY AFRICAN COUNTRY HAD A LEADER SPOT THE DIFFERENCE

33 MANY NATIONAL SYSTEMS ARE UNDER SEVERE BURDEN OF LEADERSHIP

34 My time is UP, I thank the Organizers for the invitation, & all of YOU for your attention

35 Distinguished and Eminent Ladies & Gentlemen

SITUATION REPORT YELLOW FEVER 16 JUNE 2016 SUMMARY

ZIKA VIRUS SITUATION REPORT YELLOW FEVER 16 JUNE 2016 SUMMARY In Angola the total number of notified cases has increased since early 2016. As of 15 June a total of 3137 cases have been reported, of which