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Swine flu jab…the new visa weapon

By Clarkson Eberu
07 August 2009   |   10:00 am
NIGERIAN travellers are about to feel the impact and politics of the emerging worldwide new health threat, the swine flu. The Saudi Arabia authorities have decreed that without a vaccination certificate against the disease, entry even for pilgrimage would be denied. BEN UKWUOMA and CHUKWUMA MUANYA write on why and how Nigerians would be affected.

IT is an issue if not resolved in time will certainly disrupt the journey to the Holy Land.

Saudi authorities, concerned about swine flu, also known as HINI, and the potential for transmission in the crowded setting of the Umra and the Hajj in the Holy cities of Saudi Arabia, have threatened to shut their doors on Moslem pilgrims without a certificate of vaccination to the emerging public health disease.

They had insisted that Moslems would need the certificate before they can apply for visa, while those in high risk groups including pregnant women and the elderly should not come in at all.

Good as the intention may seem but the unavailability of vaccines has sent tongues wagging in many countries of the world especially Nigeria.

“These are major concerns,” lamented Minister for Health, Prof. Babatunde Osotimehin. “There is no vaccine yet in Africa and no vaccine had been administered all over the world so far, and there is no likelihood that the vaccine would be administered before the hajj,” he said.

While Saudi Arabia has reported 600 cases of the disease, Nigeria is yet to report any. Worldwide death toll increased by 625 last week from 2,185 published in previous week’s update from the World Health Organisation (WHO).

In Africa, the WHO last month reported 3,872 laboratory confirmed human cases of H1N1 virus including 11 deaths in 21 countries.

Some of the confirmed cases and deaths in Africa are: South Africa, 3,485; Kenya, 85; Mauritus, 69; Tanzania, 53; Cape Verde, 37; Namibia, 34; and Algeria, 33. Ghana with eight cases and Cameroun, four; are the only countries in the West coast with reported cases.

These concerns have led the Federal Ministry of Health to have meetings with the National Hajj Commission of Nigeria and the Embassy of the Royal Kingdom of Saudi Arabia and the WHO in Geneva with a view to finding solutions and measures that can reduce the chance of the spread of the disease by Nigerian pilgrims during the Hajj’s Umra.

Osotimehin, who sounded optimistic of a positive intervention from WHO said: “No Nigerian pilgrim would be embarrassed or picked on during the pilgrimage due to non-vaccination, because dialogues had been going on with the Saudi Arabian embassy and the hajj commission and there was due intervention by WHO.

“The Federal Ministry of Health will procure H1N1 vaccines once they are available globally,” he added.

Current estimates suggest that between 45 million and 52 million doses of vaccine will be ready by mid-October, with another 195 million by the end of the year.

Researchers reported September 10 in Science Journal that since the H1N1 flu outbreak does not peak until November/December, it could be curtailed with a staggered vaccination programme that begins with children and ultimately targets 70 per cent of the population.

Preliminary results based on three weeks of data from several vaccine trials suggest that one dose of the vaccine elicits a good antibody response in healthy young and middle-aged adults.

The findings are “welcome and reassuring,” states an editorial by Kathleen Neuzil in the September 10 New England Journal of Medicine along with the preliminary studies.

Experts thought two doses of the H1N1 vaccine might be necessary, which halves the number of people that can be vaccinated with a fixed amount of vaccine.

Drug makers look set to sell all the swine flu vaccine they can make in 2009, despite growing evidence that just one shot is needed to protect most people against the virus.

GlaxoSmithKline, for instance, has become the fifth manufacturer to report success with a single dose of the vaccine last Monday, further easing supply fears as the northern hemisphere heads into winter and a possible new wave of the disease.

Rival vaccines from Sanofi-Aventis, Novartis, CSL, and Sinovac have also been found to protect people with a single dose.

For governments, the clinical trial results are excellent news, since one-shot programmes will be cheaper and quicker.

Britain and France received their first batches of the vaccine last week. Australia on Friday said a massive swine flu vaccination programme would start in October and Turkey hopes the first supplies of the vaccine will come by that time.

Swine flu vaccines promise a sales and profit windfall for many firms from October 2009.

Glaxo, for example, said last month it had orders for 291 million vaccine doses and the group was reported last week to be close to selling another 35 million to Japan.

Although Osotimehein insisted that the country has no known case of the disease, he said that his ministry “has put in place mechanism to adequately screen all pilgrims with flu-like symptoms upon their return from the lesser Hajj (Umra).

“The Federal Ministry of Health will also give the country’s Hajj medical team adequate amounts of antiviral drugs and supplies for immediate H1N1 influenza treatment and management of pilgrims while in the Holy land,” he stressed.

According to him over 250,000 doses of the antiviral drugs have been procured and distributed to all tertiary healthcare facilities in the country.

The WHO has issued guidelines for antiviral treatment for novel influenza A (H1N1) and other influenza.

The purpose of the new recommendations, which were posted online August 20, is to provide a basis for advice to clinicians regarding the use of the currently available antivirals for patients presenting with illness caused by influenza virus infection, as well as considerations regarding potential use of these antiviral medications for chemoprophylaxis.

On the basis of a review of data collected with previously circulating strains, and treatment of human H5N1 influenza virus infections, the new guidelines expand on recommendations published in May 2009, titled: “Clinical management of human infection with new influenza A (H1N1) virus: Initial guidance.”

Management of patients with H1N1 2009 virus infection is the primary focus of the statement, although it also includes guidance regarding the use of the antivirals for treatment of other seasonal influenza virus strains.

The new recommendations highlight the use of oseltamivir and zanamivir, and amantadine and rimantadine. Suggestions are also provided regarding the use of some other potential pharmacological treatments such as ribavirin, interferons, immunoglobulins, and corticosteroids.

The guidelines urge country and local public health authorities to issue local recommendations for clinicians periodically, based on epidemiological and antiviral susceptibility data on the locally circulating influenza strains.

For patients with confirmed or strongly suspected infection with influenza pandemic H1N1 2009, when antiviral medications for influenza are available, specific recommendations regarding use of antivirals for treatment of pandemic H1N1 2009 influenza virus infection are as follows:

Oseltamivir should be prescribed and treatment started as soon as possible for patients with severe or progressive clinical illness.

Depending on clinical response, higher doses of up to 150mg twice daily and longer duration of treatment may be indicated. This recommendation is intended for all patient groups, including pregnant women, neonates, and children younger than five years.

Zanamivir is indicated for patients with severe or progressive clinical illness when oseltamivir is not available or not possible to use, or when the virus is resistant to oseltamivir but known or likely to be susceptible to zanamivir.

However, antiviral treatment is not required in patients not at risk who have uncomplicated illness caused by confirmed or strongly suspected influenza virus infection.

Oseltamivir or zanamivir treatment should be started as soon as possible after the onset of illness in patients at risk who have uncomplicated illness caused by influenza virus infection.

Roche Pharmaceuticals, represented in Nigeria by Worldwide Commercial Ventures Ltd has pledged to make Tamiflu(r) (oseltamivir) available in the country in preparation for any possible outbreak of the swine flu.

Roche Business Development Manager (Nigeria), Taofik Olorunko-Oba said that its drug is registered in Nigeria and endorsed by both the WHO and the U.S. Centre for Disease Control for prevention and treatment.

Taofik stated: “We have been discussing with the government and responsible corporate bodies about areas in which we can offer support in preparing for the swine flu pandemic in Nigeria”.

“Swine flu spreads four times faster than other viruses and 40 per cent of the fatalities are young adults in good health,” WHO Director General Margaret Chan told France’s Le Monde daily.

“This virus travels at an unbelievable, almost unheard of speed.

“In six weeks it travels the same distance that other viruses take six months to cover,” Chan said.

“Sixty per cent of the deaths cover those who have underlying health problems,” Chan added. “This means that 40 per cent of the fatalities concern young adults – in good health – who die of a viral fever in five to seven days”, she said.

The emergence of the Influenza A H1N1 2009 pandemic puts an additional pressure on health systems of African countries already stretched with other competing public health priorities, said Dr. Luis Gomes Sambo, the WHO’s Regional Director for Africa.

In April 2009, the first case of Influenza A H1N1 was reported in Mexico. Since then the virus has spread to other parts of the world affecting over 166 countries with confirmed cases in excess of 174,913 and 1,411 deaths.

“There is no sense that the virus has mutated or changed in any sense,” WHO spokesman Gregory Hartl said in Geneva.

As H1N1 ebbs and flows in various parts of the world, experts advise countries to stockpile antiviral drugs and employ them for therapeutic and preventive purposes as the world waits for the availability of vaccines.

“As H1N1 ebbs and flows in various parts of the world, experts advise countries to stockpile antiviral drugs and employ them for therapeutic and preventive purposes as the world waits for the availability of vaccines”