Preparing for the next epidemic

The human race is under threat from possible disease epidemic deadlier than the Ebola Virus Disease (EVD). An epidemic is a widespread occurrence of an infectious disease in a community at a particular time while a pandemic is the worldwide spread of a new disease.

The recent epidemic of Monkeypox that has spread from Bayelsa to six other states, the ongoing cholera and hepatitis E epidemics in north-east Nigeria, the reemergence of measles even in Europe have provided more reasons why the country must be prepared for worst case scenario in terms of disease epidemics.

According to critics, including the Time Magazine, the world is not ready for the next pandemic.Across China, the virus that could spark the next pandemic is already circulating. It is a bird flu called H7N9, and true to its name, it mostly infects poultry. Lately, however, it has started jumping from chickens to humans more readily–bad news, because the virus is a killer. During a recent spike, 88 per cent of people infected got pneumonia, three-quarters ended up in intensive care with severe respiratory problems, and 41 per cent died.

What H7N9 can not do–yet–is spread easily from person to person, but experts know that could change. The longer the virus spends in humans, the better the chance that it might mutate to become more contagious–and once that happens, it is only a matter of time before it hops a plane out of China and onto foreign soil, where it could spread through the air like wildfire.

Indeed, from Ebola in West Africa to Zika in South America to Middle East respiratory syndrome coronavirus (MERS-CoV) in the Middle East, dangerous outbreaks are on the rise around the world. The number of new diseases per decade has increased nearly fourfold over the past 60 years, and since 1980, the number of outbreaks per year has more than tripled.

The United States (U.S.) Centers for Disease Control and Prevention (CDC) ranks H7N9 as the flu strain with the greatest potential to cause a pandemic. If a more contagious H7N9 were to be anywhere near as deadly as it is now, the death toll could be in the tens of millions.How prepared is Nigeria for imminent deadly disease epidemic following recent global events?

Consultant Epidemiologist and Chief Executive Officer (CEO) of Nigeria Centre for Disease Control (NCDC), Dr. Chikwe Ihekweazu, told The Guardian: “Nigeria is prepared to respond to outbreaks in conflict areas in the country, working with our partners in support of the relevant State Governments. This is demonstrated in our recent response to cholera and hepatitis E outbreaks in Borno State.

“Recently, the NCDC sent teams to support Borno State in responding to a cholera outbreak. In less than two weeks after the outbreak was confirmed, a vaccination campaign using the Oral Cholera Vaccine (OCV) was initiated and successfully implemented. NCDC monitors infectious disease incidents across the country. Regarding the Hepatitis E outbreak, NCDC supported the state in tracking and managing cases and its laboratory also supported in sample collection and testing. Daily situation reports and updates on hepatitis E were produced and sent to all stakeholders.”

Meanwhile, an ambitious new strategy to reduce deaths from cholera by 90 per cent by 2030 was launched, last week, October 4, by the Global Task Force on Cholera Control (GTFCC), a diverse network of more than 50 United Nation (UN) and international agencies, academic institutions, and Non Governmental Organisations (NGOs) that supports countries affected by the disease.

According to the World Health Organisation (WHO), cholera kills an estimated 95 000 people and affects 2.9 million more every year. Urgent action is needed to protect communities, prevent transmission and control outbreaks.The GTFCC’s new plan, Ending Cholera: A Global Roadmap to 2030, recognizes that cholera spreads in endemic “hotspots” where predictable outbreaks of the disease occur year after year. The Global Roadmap aims to align resources, share best practice and strengthen partnerships between affected countries, donors and international agencies. It underscores the need for a coordinated approach to cholera control with country-level planning for early detection and response to outbreaks. By implementing the Roadmap, up to 20 affected countries could eliminate cholera by 2030.

On re-emergence of measles in Europe, Ihekweazu, said: “Unfortunately, measles has remained a global challenge despite the availability of an effective vaccine for many years. While the primary challenge is how to get the vaccines administered to children, the reason for missing children is different in Europe and Africa.”

The epidemiologist said while in Europe, there is a population of people refusing vaccination due to misplaced anxiety over side effects, in Nigeria, the challenge is more around creating effective systems to deliver vaccines to our children.He, however, said the National Primary Health Care Development Agency (NPHCDA) is working hard to reinvigorate routine immunization in Nigeria and the NCDC has just concluded a national measles surveillance evaluation project, to assess the gaps in measles surveillance in Nigeria. These two actions, Ihekweazu said, show that there is concerted action by various government agencies to ensure that children do not suffer from a completely preventable disease such as measles.

How about the threat of MERS-CoV in United Arab Emirates?According to the WHO, Since 2012, when the virus was first identified in Saudi Arabia, there have been 2081 laboratory-confirmed cases of MERS-CoV infection reported to WHO from 27 countries, with at least 722 deaths – a fatality rate of 35 per cent. While progress has been made in research and surveillance, significant gaps remain in understanding the virus, including how it circulates in dromedary camels, the natural reservoir host, or how it spills over into the human population.

The NCDC boss said the Middle East respiratory syndrome coronavirus has slowly been spreading in the Middle East, thankfully Nigeria has been spared so far. He, however, said that at NCDC they continuously prepare for new infectious disease threats.Ihekweazu said NCDC scientists recently participated in a training programme on bio-preparedness by United States (US) Defense Ministry and the training covered included the detection and response to emerging threats such as MERS-CoV.

The epidemiologist cautioned that one population at risk of introducing MERS-CoV into Nigeria are returning Hajj pilgrims but the surveillance unit in NCDC supports the Port Health Department of the Federal Ministry of Health in screening pilgrims on their return from Saudi Arabia.

On the threat human infection with avian influenza A(H7N9) virus from China, Ihekweazu said influenza is a major threat to global health security. He, however, said one of NCDCD’s oldest and strongest programmes is the influenza surveillance and response programme. Ihekweazu said together with colleagues in four sentinel clinical sites, specimens are continuously collected from patients presenting with symptoms of influenza to test for new strains. “Their work is coordinated by a National Avian Influenza Technical Working Group, which also includes colleagues from the Federal Ministry of Agriculture. NCDC also responds to outbreaks in farms and conducts surveys with handlers of poultry and birds as the need arises,” he said.

Meanwhile, the scientific and international communities have begun to take the threat of pandemics more seriously. But global health experts–including Bill Gates, World Health Organization director Dr. Margaret Chan and former CDC director Dr. Tom Frieden, to name just a few–warn that nowhere near enough is being done to prepare. That is because the system for responding to infectious disease is broken. So broken that it recently prompted Gates and his wife Melinda to put their weight behind a major public-private initiative called the Coalition for Epidemic Preparedness Innovations (CEPI). The Gates Foundation alone will devote $100 million over the next five years to CEPI, which will help speed the development of vaccines against known diseases, like MERS, while also investing in next-generation technologies that can counter future threats.

Meanwhile, advances in the provision of water sanitation and hygiene (WASH) services have made Europe and North America cholera-free for several decades. Today, although access to WASH is recognized as a basic human right by the United Nations, over two billion people worldwide still lack access to safe water and are potentially at risk of cholera. Weak health systems and low early detection capacity further contribute to the rapid spread of outbreaks.

According to the WHO, cholera disproportionally impacts communities already burdened by conflict, lack of infrastructure, poor health systems, and malnutrition. Protecting these communities before cholera strikes is significantly more cost-effective than continually responding to outbreaks.The introduction of the oral cholera vaccine has been a game-changer in the battle to control cholera, bridging the gap between emergency response and longer-term control. Two WHO-approved oral cholera vaccines are now available and individuals can be fully vaccinated for just US$6 per person, protecting them from the disease for up to three years.

The Global Roadmap provides an effective mechanism to synchronize the efforts of countries, donors, and technical partners. It underscores the need for a multi-sectoral approach to cholera control with country-level planning for early detection and response to outbreaks.According to the WHO, By strengthening WASH in endemic “hotspots”, cholera outbreaks can be prevented. By detecting cholera outbreaks early, and responding immediately, large-scale uncontrolled outbreaks like the one observed in Yemen can be avoided – even in crisis situations.

Meanwhile, Ihekweazu said measures that can be taken to prevent infection with Monkeypox virus include avoiding contact with the animals listed above, especially animals that are sick or found dead in areas where Monkeypox occurs.He advised the public is advised to always wash hands with soap and water after contact with animals or when caring for sick relatives humans or soiled beddings.

Ihekweazu advised Nigerians to remain calm and supportive of public health authorities, avoid self- medication and report to the nearest health facility if feeling unwell or notice any of the above symptoms in anyone around them.“Health care workers are strongly advised to practice universal precautions while handling patients and/or body fluids at all times. They are also urged to be alert, be familiar with the symptoms and maintain a high index of suspicion,” he said. The NCDC boss said all suspected cases should be reported to the Local Government Area or State Disease Surveillance and Notification Officers.Ihekweazu, however, advised that health workers must continue to manage their patients without fear. “As long as universal infection prevention and control practices are strictly adhered to by all clinical staff, the chances of transmission are minimal,” he said.