Category: Health Care

The World Health Organization says authorities in Mozambique have declared an outbreak of wild poliovirus type 1 after confirming that a child in the country’s northeastern Tete province has contracted the disease. It becomes the second case of wild poliovirus confirmed in southern Africa this year, following a case in Malawi in mid-February.

In a statement, Dr. Matshidiso Moeti, WHO regional director for Africa, called the outbreak of poliovirus in Mozambique “greatly concerning.”

She added that efforts were underway to help strengthen disease surveillance in Malawi, Mozambique, Tanzania, Zambia and Zimbabwe, with plans to reach 23 million children ages five and below with the polio vaccine in the coming weeks.\

Dr. Ndoutabe Modjirom, the interim polio program coordinator for the WHO Africa Region, said that the first step is to carry out a quality vaccination campaign.

“The second measure is to reinforce the surveillance in all our countries so that they will be able to detect very, very quickly all poliovirus circulating in our region,” he said. “We have to extend to all other countries the measure of surveillance. So that measure we have to take very, very quickly to address this situation.”

Dr. Norman Matara, head of the Zimbabwe Association for Doctors for Human Rights, said the outbreaks of diseases may have resulted from the lockdowns that countries around the world instituted while fighting COVID-19.

“You know with the pandemic, the lockdowns and clinics shutting down, there is a probability some infants and children might have missed their immunizations schedule and thus we now have these emergency outbreaks; measles in Zimbabwe and polio in Mozambique,” he said. “So, we really urge the government that as they fight COVID-19, we should intensify immunization of children especially in those neglected areas so that every child gets immunized. We also urge the government to implement strong surveillance systems.”

Last week, Zimbabwe declared an outbreak of measles in a province on the border with Mozambique. President Emmerson Mnangagwa’s government said it was working with the WHO to immunize children in the whole country.

Source: Voice of America

In Numbers

85,788 cumulative and 811 active cases of COVID-19 in Malawi (30 April 2022)

USD 1 million six-month (May – October 2022) net funding requirements

USD 29.4 million funding required for flood response under the flash appeal

Strategic Outcome 1

• Floods Response: Under tropical storm Ana flood response, WFP completed distribution of cash-based transfers to 32,000 households in Chikwawa District. WFP confirmed a contribution from the Government of Switzerland towards cash assistance and emergency school feeding in flood-affected schools. This contribution and other resources will be used to reach 27,500 households in two additional districts (Nsanje and Phalombe) in May.

• Refugees: In parallel to the ongoing cash operation targeting over 11,000 households in Dzaleka refugee camp, WFP is also promoting income generating activities, so refugees and host communities boost their self-reliance. A wide range of interventions are promoted, from soya and mushroom farming, eggs production, soap making and tailoring.

Strategic Outcome 2

• School feeding: WFP joined a joint monitoring technical team with representation from the European Union, Government ministries and members of the AFIKEPO programme to document lessons on programme implementation in Mulanje, Nsanje, Phalombe and Zomba. The mission included visits to seven schools under WFP supported school feeding of which four schools supported by the European Union TSOLATA school feeding intervention. A total of 137 schools were proposed for scale up of home-grown school feeding under WFP.

• Social protection: In collaboration with the Government and partners, an after-action review of the lean season response will be conducted in May. The review will include the use of the social protection system jointly supported by UNICEF and WFP for targeting and delivery of lean season assistance.

Strategic Outcome 3

• Malnutrition prevention: With the support of the Government of Ireland, the Neno Nutrition Investment Project (NNIP) has strengthened overall governance structures at district and community levels, it also delivered an integrated nutrition-focused multisectoral package in Neno District. This serves as a pilot to inform multi-year and nation-wide scale up of the approach across other districts.

Source: World Food Programme

Floods – Humanitarian Situation in numbers, 28 April 2022

79 Cholera cases with 4 deaths

More than 995,000 people affected by floods including 130,000 under-five children need humanitarian assistance

Over 190,000 people displaced by floods

1 case of Polio

Highlights

• 63,006 children (32,763 girls 30,243 boys) have undergone nutrition screening bringing the total reach to 132,822 children (68,536 male 64,286 female).

• 40,000 cholera patients will benefit from 3 types of health kits which UNICEF has provided to four flood-affected districts (Nsanje, Chikwawa, Mulanje and Phalombe). Each kit contains a range of prepacked supplies including medicines like albendazole and oral rehydration salts and infection prevention and protective equipment.

• 5,366 people were reached with emergency sanitation interventions in displacement sites across affected districts.

• 1,812 households have been reached with key messages and counselling on WASH, Nutrition, Vitamin A, Exclusive Breastfeeding, Complementary Feeding, COVID-19 prevention, anti-natal care and benefits of iron and Folic Acid to pregnant women and adolescent girls.

Situation Overview

A series of flooding events including Tropical Storms Ana and Gombe and sporadic flooding occurrences that hit the country over the period of January to March 2022 led to over 190,000 people displaced and left seeking shelter in displacement sites. These people have now started moving back to their places of origin while others are planning to resettle in newly identified areas that they consider to be less prone to flooding. The Government facilitated discussions on a harmonised return package to be provided by humanitarian actors to the affected people as a starter pack to rebuild their lives. Humanitarian actors are mobilizing resources to provide the much-needed return package to the people as they go through the transition.

Since the declaration of a Cholera outbreak in Malawi on 3 March 2022, a total of 79 cases and four deaths have been registered as of 25 April 2022 representing a case fatality rate of five per cent. COVID-19 cases and deaths continue to drop. This reporting period has seen a drop in new infections by 46 per cent, and hospital admissions reduced by 76 per cent from the previous reporting period. The positivity rate lingers at around one per cent. As of 26 April, three cases were hospitalized. Since the beginning of the pandemic, 85,752 cases and 2,633 deaths have been registered. COVID vaccination status presently stands at 1,107,875 fully immunized people from 908,688 reported in the previous report. This is about 10 per cent of the targeted reach. In addition, close to 277,000 AstraZeneca vaccines that were to expire in May 2022 have all been used. The success was attributed to the strong collaboration between the Ministry of Health and partners, during the “finish-a-vial” campaign to scale up coverage.

No additional Wild Polio Virus (WPV) case has been registered since the index was reported in February 2022. The second of four planned rounds of vaccination campaigns against wild poliovirus Type-1 started on 25 April 2022. More than 11 million doses are being administered to more than 2.9 million children under 5 years in the four-round vaccination drive in Malawi after the country declared an outbreak on 17 February 2022 – the first such case in the country in 30 years, and the first in Africa since the region was certified free of indigenous wild poliovirus in 2020. This second phase of the campaign targets children under 5 in Malawi, as well as neighbouring Mozambique, Tanzania and Zambia. Two subsequent rounds are set for June and July, with the first having already taken place in April. Cumulatively, the target is to reach over 23 million children with more than 80 million doses of the bivalent Oral Polio Vaccine recommended by the World Health Organization (WHO) for wild poliovirus (type 1). So far in 2022, 92 Acute cases of Flaccid Paralysis (AFP) have been reported in Malawi compared to 25 cases by the same time last year. The high number of AFP reports could be attributed to good surveillance and increased reporting as a result of the ongoing OPV campaigns.

The number of children admitted for severe acute malnutrition (SAM) treatment increased mainly in Chikwawa by 60 per cent from 599 in March 2021 to 959 in March 2022. Overall, there is a 49 per cent increase in SAM admissions from 3,953 in March 2021 to 5,904 in March 2022. Data for April 2022 is being compiled but indications from field observations are that the situation is continuing to deteriorate.

Source: UN Children’s Fund

Outbreak at a glance

The Ministry of Health declared a cholera outbreak in Malawi on 3 March 2022, following laboratory confirmation of a case in in the country. A second case was detected in on 7 March. As of 26 April, 78 cholera cases and four deaths have been reported, of which 97% (76 cases) have been reported from Nsanje district. Several response measures have been implemented including delivery of cholera kits, mapping of hotspot districts.

Description of the outbreak

On 3 March 2022, the Ministry of Health Malawi declared a cholera outbreak in the country, following confirmation of a case in a 57-year-old male, from Machinga district, in Southern Malawi. On 28 February, the case developed watery diarrhoea and visited Machinga hospital where cholera was confirmed on 2 March. Samples from the patient tested positive by culture and Vibrio cholerae O1, serotype Inaba was isolated. The case had a history of travel to two cities – Blantyre and Machinga — prior to being admitted to the district hospital. Although an epidemiological investigation was carried out, the source of the infection was not identified.

On 7 March 2022, a second case was identified in a 11-year-old boy at a local health centre from Nsanje district, Malawi. The case was displaced to Mozambique following floods caused by the tropical storm Ana and cyclone Gombe and returned to Malawi while symptomatic.

As of 26 April 2022, a total of 78 cholera cases with four deaths (case fatality ratio: 5.1%) have been reported from Nsanje (76 cases; four deaths) and Machinga (2 cases) districts (Figures 1 and 2). Of the 78 cases, 13 have been confirmed by culture, and 20 tested positive by rapid diagnostic test (RDT). The age of the cases range between 2 and 57 years, with the 5 to 14 years age group being the most affected.

The Southern region of Malawi was severely affected by the tropical storm Ana and cyclone Gombe that caused torrential rains and floods between late January and February 2022. The displaced populations remained with no access to safe drinking water and sanitation facilities and thus, at risk of widespread disease outbreaks including cholera.

Epidemiology of cholera

Cholera is an acute enteric infection caused by ingesting the bacteria Vibrio cholerae present in contaminated water or food. It is mainly linked to insufficient access to safe drinking water and inadequate sanitation. It is an extremely virulent disease that can cause severe acute watery diarrhoea resulting in high morbidity and mortality, and can spread rapidly, depending on the frequency of exposure, the exposed population and the setting. Cholera affects both children and adults and can be fatal if untreated.

The incubation period is between 12 hours and 5 days after ingestion of contaminated food or water. Most people infected with V. cholerae do not develop any symptoms, although the bacteria are present in their faeces for 1-10 days after infection and are shed back into the environment, potentially infecting other people. Among people who develop symptoms, the majority have mild or moderate symptoms, while a minority develop acute watery diarrhoea with severe dehydration. Cholera is an easily treatable disease. Most people can be treated successfully through prompt administration of oral rehydration solution (ORS).

Cholera can be endemic or epidemic. A cholera-endemic area is an area where confirmed cholera cases were detected during the last 3 years with evidence of local transmission (cases are not imported from elsewhere). A cholera epidemic can occur in both endemic countries and in non-endemic countries.

The consequences of a humanitarian crisis – such as disruption of water and sanitation systems, or the displacement of populations to inadequate and overcrowded camps – can increase the risk of cholera transmission, should the bacteria be present or introduced. Uninfected dead bodies have never been reported as the source of epidemics.

A multifaceted approach including a combination of surveillance, water, sanitation and hygiene, social mobilization, treatment, and oral cholera vaccines is essential to control cholera outbreaks and to reduce deaths.

Public health response

WHO, in coordination with partners, is supporting the implementation of the National Cholera Response Plan in Malawi.

Other specific actions undertaken include:

• National and district level emergency operation centres (EOCs) were activated and currently coordinating the response in collaboration with other health sectors and partners.

• Initial mapping of the high risk/ hotspot districts was conducted in late February 2022, after the landfall of tropical storm, and an update was conducted on 25 March 2022.

• The Ministry of Health and WHO jointly completed field supervision including risk and needs assessments. A comprehensive report is being prepared.

• Four data managers and three public health officers were engaged and deployed to the affected districts for data management.

• Cholera preparedness training was conducted from 21 to 22 April 2022 in Nsanje district.

• WHO has provided cholera kits and other supplies to the affected districts.

• A request for an oral cholera vaccine (OCV) submitted to the International Coordination Group (ICG) for 3.9 million doses of vaccines targeting eight high risk districts was approved. The country has received more than 1.9 million doses of OCV for the first round of the campaign planned for early May 2022.

• Supplies for case management and laboratory confirmation of cholera are pre-positioned in health facilities and the district laboratory. Case management has been strengthened through the establishment of treatment structures and the provision of equipment. Two cholera treatment centres have been established in Nsanje district.

• The collection and analysis of stool samples for confirmation at the district public health laboratory continues. A total of 13 samples were confirmed by laboratory analysis (culture) as of 26 April 2022.

• Efforts to collaborate with the Mozambique team are underway through the regional coordination in the East, Central and South Africa.

WHO risk assessment

Cholera is endemic in Malawi with seasonal outbreaks being reported from 1998 to 2020. The Southern region, which shares border with Mozambique, remains the hotspot of the recurrent cholera outbreaks. The detection of cholera cases is concerning as Malawi has low population immunity in the districts reporting confirmed cases.

The main factors attributed to the initiation and ongoing spread of the cholera epidemics in the two affected districts include:

• Tropical storm and floods

• Inadequate hygiene and sanitation

• Limited access to safe drinking water and personal hygiene practices

• Open defecation

• Delay in seeking care

Other identified challenges from Nsanje and neighbouring at-risk districts (Balaka and Chikwawa) include poor capacity for sample collection, transportation, and diagnosis in the affected areas mainly due to the difficult access following floods.

Additionally, Malawi shares international borders with Mozambique, and there is frequent and substantial cross-border population movement, including people displaced following the floods caused by the tropical cyclone. This poses a risk of cross-border transmission of cholera.

Close monitoring of the situation with active cross-border coordination and information sharing remains crucial.

WHO advice

Prevention and control: WHO recommends improving access to clean water and sanitation, good waste management, food safety practices and hygienic practices to prevent the transmission of cholera. OCV should be used in combination with improvements in water and sanitation to control cholera outbreaks and for prevention in areas known to be at-high risk for cholera.

Surveillance: Strengthening surveillance, particularly at the community level, is advised. There is a need to ensure that countries are ready to quickly detect and respond to this cholera outbreak to reduce the risk of spread to new areas. As the outbreak is occurring in border areas where there is significant cross border movement, WHO encourages the respective countries to ensure cooperation and regular information sharing.

Case management: Appropriate case management, including improving access to care, should be implemented in outbreak-affected areas to reduce mortality.

International travel and Trade: WHO does not recommend any restrictions on travel and trade to and from Malawi.

Source: World Health Organization

**Lilongwe – **Malawi launches the second of four rounds of vaccination campaigns against wild poliovirus type 1 today. More than eleven (11) million doses will be administered to more than 2.9 million children under 5 years in the four-round vaccination drive in Malawi after the country declared an outbreak on 17 February—the first such case in the country in 30 years, and the first in Africa since the region was certified free of indigenous wild poliovirus in 2020.

The second phase of the campaign, which begins this week, targets children under 5 in Malawi, as well as its neighbors, Mozambique, Tanzania and Zambia. Two subsequent rounds are set for June and July, with the first having already taken place in April. Cumulatively, these aim to reach over 23 million children with more than 80 million doses of the bivalent Oral Polio Vaccine recommended by World Health Organization (WHO) for wild poliovirus (type 1).

Mass vaccinations, or supplementary vaccinations, aim to interrupt the circulation of poliovirus by immunizing every child under 5 years with oral polio vaccine regardless of previous immunization status. The objective is to reach children who are either not immunized, or only partially protected, and to boost immunity in those who have been immunized. Supplementary immunization is intended to complement—not replace—routine immunization.

“It’s a nationwide campaign,” said Janet Kayita, WHO Country Representative for Malawi. “It’s targeting all under-5s in Malawi and it’s really a race to get ahead of the polio outbreak and this is really important for Malawi but also important for the region.”

“Polio is a highly infectious and an untreatable disease that can result in permanent paralysis. In support of Malawi and it neighbours, we are acting fast to halt this outbreak and extinguish the threat through effective vaccinations,” said Janet Kayita, WHO Country Representative for Malawi. “The African region has already defeated wild poliovirus due to a monumental effort by countries. We have the know-how and are tirelessly working to ensure that every child lives and thrives in a continent free of polio.”

The African region was declared and certified as free of indigenous wild polio in August 2020 after eliminating all forms of wild poliovirus. The region’s certification as wild polio-free remains unchanged. Laboratory analysis linked the strain detected in Malawi to the one circulating in Pakistan’s Sindh Province in 2019.

WHO has been supporting the country to reinforce response measures including disease surveillance, risk assessment and preparations for the vaccination campaigns. A surge team from WHO is working with country-based counterparts, partner organizations and the government to end the outbreak. The WHO team is part of a broader multi-partner Global Polio Eradication Initiative support to the country.

Malawi has also now set up environmental surveillance for polioviruses in 11 sites across four cities. The sites are in Lilongwe District that encompasses the capital Lilongwe where the initial, and so far, only case, was detected. Other sites are in Blantyre, Mzuzu and Zomba cities. Teams are collecting samples from the environment and sending them for analysis to laboratories while active surveillance is also underway in health facilities and in communities.

In preparation for the vaccination drives, trained surge teams of national officers have been deployed at district level to facilitate the campaign and ensure that all eligible children are vaccinated. Maintenance and repair of cold chain facilities are also ongoing.

Polio is a viral disease with no cure. It invades the nervous system and can cause total paralysis within hours, particularly among children under 5 years. The virus is transmitted from person to person mainly through contamination by faecal matter or, less frequently, through contaminated water or food, and multiplies in the intestine. While there is no cure for polio, the disease can be prevented through administration of a safe, simple and effective vaccine.

Source: World Health Organization

In advance of World Malaria Day, the World Health Organization recommends the expanded use of the first malaria vaccine, calling it a potential game changer in the fight against malaria.

Malaria is a preventable, treatable disease. Yet, every year, malaria sickens more than 200 million people and kills more than 600,000. Most of these deaths, nearly half a million, are among young children in Africa. That means every 60 seconds a child dies of malaria.

Despite this bleak news, the outlook for malaria control is promising, thanks to the development of the world’s first malaria vaccine. The World Health Organization calls the achievement a historic breakthrough for science.

A pilot program was started in 2019 in Ghana, Kenya, and Malawi. Since then, the World Health Organization reports more than a million children in the three countries have received the malaria vaccine.

Mary Hamel is Head of WHOs Malaria Vaccine Implementation Program. She said the two-year pilot program has shown the vaccine is safe, feasible to deliver and reduces deadly severe malaria.

“We saw a 30% drop in children being brought to the hospitals with deadly, severe malaria. And we also saw almost a 10% reduction in all caused child mortality. If the vaccine is widely deployed, it is estimated that it could save an additional 40 to 80,000 child lives each year,” she said.

WHO reports Gavi, the Vaccine Alliance will provide more than $155 million to support expanded introduction of the malaria vaccine for Gavi-eligible countries in sub-Saharan Africa.

The vaccine against malaria was under development before the COVID-19 vaccine was produced. Hamel said WHO has learned a lot of lessons from that effort, which could be used in the development of future malaria vaccines.

“We know there have been new platforms that came forward since the COVID vaccine, including the mRNA platform and now the developers of one of the mRNA vaccines is looking forward to developing a malaria vaccine using that same platform,” she said.

Last July, BioNTech, manufacturer of the Pfizer-BioNTech COVID-19 vaccine, announced it wants to build on that success by developing a malaria vaccine using mRNA technology. The pharmaceutical company says it aims to start clinical trials by the end of this year.

Source: Voice Of America