Fighting the good fight
No phones are ringing and the bulletin boards are empty in the “war room”, the new emergency operations centre set up to combat outbreaks in South Africa of diseases such as Ebola or Zika.“We will respond to major public health emergencies and infectious diseases outbreaks,” said Nevashan Govender, manager of the centre at the National Health Laboratory Service campus, in Sandringham, Johannesburg.“If an emergency is declared it will be manned by disease experts at this control centre,” he said. Africa’s only biosafety level 4 lab is in the building next door.
In the P4 lab potentially lethal viral pathogens can be studied by scientists wearing full-body impermeable hazmat suits and breathing air pumped into them.“The P4 lab is always ready to go, it is never switched off,” said Dr Jacqueline Meyer, a scientist at the Centre for Emerging and Zoonotic Diseases, who has worked in the lab.
Dr Kerrigan McCarthy is the head of the outbreak response unit at the National Institute for Communicable Diseases, the hub for diagnosing infectious diseases in South Africa.“Our role is to anticipate outbreaks and put in motion steps to prevent and safeguard against them,” she said. The outbreak unit takes 300 to 400 calls from labs and clinicians every six months, but not direct calls from the public.McCarthy said: “We manage the early diagnosis of diseases and cases, contact tracing, infection prevention, support lab diagnostics, provide logistical support for vaccinations, give national and provincial authorities technical advice and support and do communications.”
They advise medical evacuation companies who want to bring in ill citizens of other nationalities and South Africans who get ill abroad and want to return home.“People are terrified of outbreaks and get alarmed. “We need to verify rumours like the water in Johannesburg has typhoid [not true] and keep them calm,” McCarthy said.But they also make people aware of risks, for example, that a rat was found with antibodies for the bubonic plague in Tembisa, east of Johannesburg, and rotting garbage is a health hazard. To prepare for outbreaks, emergency personnel are trained to respond to scenarios that mimic real life, without knowing they are exercises.“We need to make drills as real as possible to find the gaps and keep improving our response,” Govender said.
- In March this year one rat tested positive to plague antibodies (one of 13 rodents tested from Tembisa). This rat was the only seropositive case and there appears to be no outbreak among rodents.
- No Zika cases have originated in South Africa. But in February a businessman returning from Colombia to South Africa was diagnosed with Zika and recovered, and twins visiting from Barbados tested positive for the antibodies. South Africa is at low risk for Zika since the type of mosquito which spreads it tends not to bite humans here.
- Typhoid fever levels have remained roughly the same in South Africa for 10 years. Cases peak every year in January (41 this year) when travellers return from holidays and by February they drop. The latest strain in Johannesburg is related to a strain found in Harare and cases have been detected in the Eastern Cape and Limpopo. The water in South Africa is not contaminated.
- Three cases of leptospirosis were diagnosed from Pollsmoor Prison in September 2015 and an i n m at e died. A rat infestation, overcrowding and poor hygiene required that prisoners be evacuated and the buildings revamped to prevent disease spreading.
- Fifteen diphtheria cases were picked up from March to July 2015, four resulting in death. This bacteria causes throat infections ( with “bull neck”) and can lead to heart failure. Babies get vaccinated against it at six, 10 and 14 weeks and boosters are needed at 18 months, six and 12 years old. The outbreak prompted many thousands of catch-up vaccinations in KwaZulu- Natal.
- In 2012 there was a measles outbreak — defined as more than two cases in the same district in the same month. There is an outbreak in the DRC at present. The vaccination (at nine months and 18 months) is safe and without it the risks of harm are high, including death.