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Africa and Avian Influenza Outbreak: Epidemiology and Containment preparedness

Datelinehealth-Africa News Service
Published: November 6 2005
Posted: November 6 2005
Posted: November 6 2005
By Solomon K. Sackitey, DLHA Subeditor for West Africa and United Nations Online Volunteer

Introduction

As the world prepares to face the threat of pandemics of the Highly Pathogenic Avian Influenza virus subtype H5N1, it is pertinent to ask “How is Africa preparing for this concern?”

The World Health Organization (WHO) states that “Avian influenza or “bird flu”, is a contagious disease of animals caused by viruses that normally infect only birds and less commonly pigs. Avian influenza viruses are highly species-specific, but have on rare occasions, crossed the species barrier to infect humans (1)”.

Symptoms of bird flu are similar to those of the common flu and are characterized by fever, cough and muscle aches. Aside from these, bird flu patients endure sore throat, viral pneumonia, multiple organ failure, especially in the lungs and kidneys, and other severe and life-threatening complications in a matter of days (2).

Avian influenza transmissions from animals to humans have been documented since 1997 (3, 4). Three worldwide avian influenza pandemics recorded during the 20th Century are The "Spanish flu” of 1918-19 in which an estimated 50 million people died worldwide, the "Asian flu" of 1957-58, where about 70,000 deaths were reported in the United States of America and the " Hong Kong flu," of 1968-69 which resulted in about 34,000 deaths in the United States of America (5).

The US Centers for Disease Control and Prevention (CDC) reported that the infections during the Asian flu and the Hong Kong flu pandemics were caused by viruses containing a combination of genes from a human influenza virus and an avian influenza virus.The 1918-19 pandemic virus appeared to have an avian origin (4). The morphology and genetics of the Avian influenza virus (H5N1) have been reported by Padhi et. al. (6).

Photo: Highly Pathogenic Avian Influenza virus subtype 5HN1.Courtesy of Pandhi et al.

The goals of this report are to create increased awareness of the “avian flu” as a potential public health problem of significance to Africa and provide information regarding approved Avian influenza medical products (7). Besides, attention is directed to where in Africa one could go for help in preparation for the threat of pandemic bird flu (8, 9, 10). Finally, one major focus of this report is to caution public health managers, consumers, manufacturers and vendors alike about future treatment and vaccination programs regarding the use of counterfeit and adulterated Avian influenza medical products. The counterfeit drugs business is a multibillion dollar industry which is posing immense health and regulatory problems not only in the industrialized world but in the poor countries of the developing world including Africa (11 - 15).

Epidemiology

As at date, the Asian bird flu which had its origin in Asia (Cambodia, China, Indonesia, Japan, Laos, South Korea, Thailand and Vietnam) in the latter part of 2003 and going into early 2004 (16), has migrated to Europe (Britain, Romania and Turkey, in particular).

These European countries are within close proximity of countries in the Middle East, North, West, Central and East Africa regions.

To date, no human cases of Asian bird flu has been reported in any African country. It is worth noting also that no cases of the Asian bird flu (H5N1) have been reported in birds in any African country.

Although cases of highly pathogenic avian influenza (HPAI) subtype H5N2 have been confirmed in ostriches in South Africa in August 2004 (17), this is different from the H5N1 HPAI subtype that is causing a global panic since its detection in Asia.

Notwithstanding, there is good cause for major concern for the Avian flu in Africa. Once the bird flu makes its way from any European country to a Euro-proximate region of Africa, chances are very high that this could spread rapidly to the rest of Africa in view of the fact that there are ample open market poultry vendors. This concern has been highlighted by the United Nations Food and Agriculture Organization (FAO) (18).

If not safeguarded aggressively, the bird flu could cause a major devastating blow to Africa’s economy which is already being threatened by the AIDS epidemic. It is estimated, for example, that the Common Market for Eastern and Southern Africa (COMESA) alone has a total Gross Domestic Product (GDP) of over US$203 billion (19).

Diagnostic testing methods

Avian influenza testing methods recommended by the CDC have been published in February 2004 and in August 2004. Three identification procedures routinely used in the laboratory involve culturing or growing the clinical specimens under Biosafety Level 3 (BSL 3) conditions, the Polymerase Chain Reaction (PCR) and the Commercial Antigen Method. The BSL 3 conditions are laboratory conditions which are optimized to contain the causal organisms without escaping into the environment. PCR methods result in the exponential amplification of genes while Commercial Antigen testings involve the detection of the gene products or proteins (20, 21).

Approved Avian Influenza Medicines

Medical products approved by the US Food and Drug Administration (FDA) for the treatment and/or prevention of influenza A viruses (7) are amantadine (trade name: Symmetrel), rimantadine (trade name: Flumadine), oseltamivir (trade name:Tamiflu), and zanamivir (trade name: Relenza). Tamiflu and Relenza are approved for the treatment of acute uncomplicated illness due to influenza A and B. Tamiflu has been approved also for preventive use while Relenza is approved only for treatment. Symmetrel and Flumadine are approved for treatment and prevention of influenza A. A precautionary note to consumers is that “the drugs may not always work because influenza virus strains can become resistant to one or more of these medications. For example, the influenza A (H5N1) viruses identified in human in Asia in 2004 and 2005 have been resistant to amantadine and rimantadine”, the FDA reported. At the moment, there is no H5N1 (bird flu) vaccine (22) despite the fact that aggressive research efforts are under way.

Structures and Strategies needed to combat Avian flu in Africa

1. Personnel, Monitoring and Control

A consortium of African Health Ministers, Regulatory Affairs and Veterinary Services personnel would need to immediately come up with strategies for monitoring the flight of birds from Europe into the Middle East and the north-eastern quadrant of Africa. Besides, this consortium would need to undertake surveillance measures on wild and domestic birds and ban the importation of birds into African countries. A strategy for eliminating the influx of counterfeit avian flu vaccines into the continent will be worthwhile.

2. Training and Communications

African Health Ministers and Regulatory Affairs personnel need to be active participants at international conferences such as “Preparation of the Joint WHO/OIE/FAO/World Bank Conference to Mobilize Resources for Control of Avian Influenza in Animals and for Prevention of Pandemic Influenza in Humans” to be held in Geneva, Switzerland (23).

Additionally, awareness needs to be constantly raised about recommended strategies for combating the global threat of Avian Influenza virus (H5N1) (24) and for the Progressive Control of Highly Pathogenic Avian Influenza (HPAI) (25).

Alert messages including high mortality rates among birds and epidemiological events should be posted regularly on websites for Regional, National Health and Regulatory Affairs bodies (26, 27).

Other notifications should include quarantine and movement control inside the various countries in Africa.

3. Current state of preparedness

A few African countries including Ghana, Tanzania, Congo, Sudan, Senegal, Uganda, Kenya and South Africa (28, 29) have already embarked on various measures in an effort to curb this disease, should it become a health problem. These measures primarily involve banning the importation of poultry and poultry products from known areas of bird flu cases. However, banning imports is not enough. More efforts are needed. Such efforts would include random testing of birds from various farms and uncontrolled (open market) vendors in various locales. Moreover, aggressive efforts need to be embarked upon to see if the bird flu is already on the continent.

4. Learning from South Africa and Senegal

South Africa’s Minister of Agriculture and Land Affairs, Ms. Thoko Didiza, has announced the slaughtering of nearly 6,000 ostriches to contain an outbreak of the bird flu. On 13 September 2005, the Minister also declared that the country is now free of the disease . The steps this country has taken to free itself from notifiable Avian Influenza under the guidelines of the International Organization for Animal Health (OIE) (8) has recently been reported by the Minister (30). These steps include monitoring of migrating shore birds, testing of birds to be imported at sites of origin, quarantined and retested in South Africa and the inactivation of the virus prior to the importation of other poultry products. Other birds included in these strategies are turkey, ducks and chicken.

Senegal’s strategies include not only banning the importation of birds but also measures such as the immediate inspection of all poultry stocks by the veterinarian and the containment and inspection of any dead bird (29).

5. A Call for Emergency Meetings

This is urgently needed to formulate strategies aimed at combating the Avian flu in Africa from the African perspectives. Among the justification for this meeting is the fact that Africans are more conversant with the infrastructure of Africa especially when it comes to efforts to disseminate information into the remote areas of various African countries. Such meetings would be better served within the context of The Common Market for Eastern and Southern Africa, The African Union, West African Health Organization and the Southern African Development Community (26, 27), among others.

The justification for the proposed emergency meeting stated above should not be misinterpreted to mean that Africa’s problems should only be solved by Africans. Africa is not in isolation in the community of nations, so it must be a major player in developing strategies for curbing this global health threat in the continent.

6. Funding

An emergency funding and strategic planning for tackling the Avian flu in Africa should engage the participation of The African Development Bank (ADB), The African Union (AU), The World Bank, The World Health Organization (WHO), The Food and Agriculture Organization of the United Nations (FAO), The World Organisation for Animal Health (OIE), The United States of America (31) and other international organizations.

7. Treatment/Vaccination control

In order to ensure that counterfeit or adulterated Avian Influenza drugs and vaccines are not prevalent on the African markets, African National and Regional Regulatory bodies (32), in addition to the WHO and the OIE, among others, need to be vigilant. This vigilance would include ways and means of setting up mobile laboratories (33) and standard laboratories capable of testing drugs and vaccines coming into the various countries.

Conclusions

For Africa’s preparedness to combat the threat of Avian influenza, the following are recommended:

Increased funding, awareness, training and technology opportunities within Africa and in collaboration with foreign counterparts.

Formation of Cooperative of African Harmonization Union of Health Regulators drawn from Academia, Government Agencies, Non-governmental agencies, the Food and Agriculture sector and the Traditional and Herbal Medicines groups to serve as clearing house for policy resources and action. Such a Union should have very close interactions with various organizations such as the Human and Veterinary International Conference of Harmonizations (ICH and VICH) respectively as well as other established harmonizations such as the European Medicines Agency (EMEA), The US Food and Drugs Administration (FDA), The Pan American Health Organization (PAHO), the Pan American Network for the Drug Regulatory Harmonization (PANDRH), the Therapeutic Goods Administration (TGA), the US Department of Agriculture (USDA) and the International Federation of Pharmaceutical Manufactures Association (IFPMA) (34).

In the Global Economy, every country is a major player irrespective of size or location. For this reason and for a health concern of the magnitude feared, an international collaborative effort is strongly recommended.

Emerging markets in Africa and the rest of the developing world are needed for the prosperity of industrialized countries. At the same time, the development of these markets has to be influenced by the industrialized countries.

In order to adequately prepare to fight off any pandemic threat, strategies for minimizing the influx of counterfeit drugs and vaccines on the global market must be given serious consideration.

Resources:

(1) What is Avian influenza virus?

(2) Avian influenza symptoms

(3) Avian influenza Infection in humans

(4) Transmission of influenza A viruses between animals and people

(5) Influenza pandemics during the 20th century

(6) Morphology of influenza A (H5N1)

(7) Approved avian flu drugs

(8) Guidelines of the International Organization for Animal Health (OIE)

(9) WHO National Influenza Centers In Africa:

Algeria - Algiers
Dr Belabbes Hadj
Institut Pasteur d Algérie
Annexe de Sidi Fredj
Rue Docteur Laveran
Hamma Arger
Algiers
Algeria
Tel: +213 (21) 376850
Fax: +213 (21) 390257
Email: hbelabbes@sante.dz

Central African Republic - Bangui
Dr Antoine Talarmin
Institute Pasteur de Bangui
BP 923
Bangui
Central African Republic
Tel: +236 (61) 2837
Fax: +236 (61) 01 09
Email: talarmin@intnet.cf

Egypt - Cairo
Dr Mostafa Orkhan
Egyptian Organisation for Biological Products and Vaccines
51, Wezarat El Zeraa
Agouza, Dokki
Cairo
Egypt
Tel: +20 (2) 7611111 - ext. 3394
Fax: +20 (2) 761 8497
Email: morkhanh@link.net

Kenya - Nairobi
Dr F. Okoth
Center for Virus Research
P.O. 54628
Nairobi
Kenya
Tel: +254 (2) 722 541
Fax: +254 (2) 726 115
Email: kemriub@ken.wuthnet.org

Madagascar - Antananarivo
Dr Dominique Rousset
WHO National Centre for Influenza
Unité de Virologie - Institut Pasteur de Madagascar
BP 1274, Antananarivo 101
Madagascar
Tel: +261 (20) 224 1272
Fax: +261 (20) 224 1534
Email: drousset@pasteur.mg

Morocco - Rabat
Dr Rajae Aouad
Labourtore d
Immunologie - Virologie
27 Avenue ibn Batouta
B.P. 769
Rabat
Morocco
Tel: +212 (37) 771 930
Fax: +212 (37) 772 067
Email: RELAOUAD@sante.go.ma

Nigeria - Ibadan
Dr D. Olaleye
College of Medicine
University of Ibadan
U.C.H.
Ibadan
Nigeria
Tel: +234 (02) 241 00 88 ext. 2796 / 2662
Fax: +234 (02) 241 1768 (college) 241 3545 (UCH)
Email: library@odeku.med.ui.edu.ng

Senegal - Dakar
Dr Mbayame Niang
Department of Virology, Pasteur Institute
BP 220 Dakar
Senegal
Tel: +221 (839) 9222
Fax: +221 (839) 9210
Email: niang@pasteur.sn

South Africa - Sandringham
Dr Terry Besselaar
National Institute for Communicable Diseases
Private Bag X4
Sandringham 2131
South Africa
Tel: 27 11 386 6354
Fax: +27 (11) 386 6455
Email: terryb@nicd.ac.za
Website

South Africa - Capetown
Dr Girish Kotwal
University of Cape Town Medical School Observatory
Medical Microbiology
Capetown
South Africa
Tel: +27 (21) 406 6128
Fax: +27 (21) 448 4110
Email: gkotwal@curie.uct.ac.za

Sudan - Khartoum
Dr A.R. Salim
University of Khartoum
Department of Microbiology and Parasitology
P.O. Box 102
Khartoum
Sudan

Tunisia - Tunis
Dr Amine Slim
Laboratoire de Microbiologie
c/o M. le Directeur
Hôpital Charles Nicolle
Bvd 9 avril
Tunis
Tunisia
Tel: +216 (71) 578186
Fax: +216 (71) 56 87 44
Email: amislim@yahoo.com

Uganda - Entebbe
Dr S.D.K. Sempala
Uganda Virus Research Institute
P.O. Box 49
Entebbe
Uganda

(10) Selected African countries that are OIE Member states and cfficial delegates:

ETHIOPIA
Dr Sileshi Zewdie
Head of Veterinary Services
Ministry of Agriculture, Animal and
Fisheries Resources
Development and Regulatory Department
PO Box 62347
Addis Ababa

GHANA
Dr Mensah Agyen-Frempong
Acting Director
Veterinary Services Department
Ministry of Food and Agriculture
PO Box M 161
Accra

KENYA
Dr Truphosa A. Otindo
Director Ag. of Veterinary Services
Department of Veterinary Services
Ministry of Agriculture and Rural Development
Veterinary Research Laboratory
P.O. Kabete, Nairobi

NIGERIA
Dr Foluso Emman Fasanmi
Director
Dept. of Livestock and Pest Control Services
Federal Ministry of Agriculture and
Rural Development
New Secretariat, Area 11
P.M.B. No. 135
Garki, Abuja, FCT

SOMALIA
Dr Ahmed Mohamed Hashi
General Manager
Somali Livestock Marketing Authority (SOLMA)
Hargeisa

SOUTH AFRICA
Dr Emily Mmamakgaba Mogajane
Assistant Director General
National Regulatory Services
Department of Agriculture
Private Bag X250
Pretoria, 0001

TANZANIA
Dr Johnson O. Mollel
Acting Director of Veterinary Services
Ministry of Water and Livestock Development
Temekeveterinary
PO Box 9153
Dar Es Salaam

ZIMBABWE
Dr Stuart K. Hargreaves
Principal Director
Division of Livestock and Veterinary Services
Ministry of Agriculture and Rural Development
18 Borrowdale Road
PO Box CY66
Causeway Harare

(11) Combating counterfeit drugs: A report of the Food and Drug Administration

(12) New report says counterfeit drug sales to reach $75 billion in 2010, up 92% from 2005

(13) Criminals make killing from fake drugs

(14) Raising the alarm on rise in counterfeit drugs

(15) Sales of counterfeit drugs soar

(16) CDC: Avian Influenza (Bird flu)

(17) Highly pathogenic avian influenza, South Africa

(18) Africa may face serious bird flu risk

(19) The Common Market for Eastern and Southern Africa (COMESA)

(20) Update on Avian influenza A (H5N1)

(21) Laboratory diagnostic procedures for influenza

(22) Avian Influenza vaccines

(23) Preparation of the Joint WHO/OIE/FAO/World Bank Conference to Mobilize Resources for Control of Avian Influenza in Animals and for Prevention of Pandemic Influenza in Humans” to be held in Geneva (Switzerland), 7-9 November 2005.

(24) WHO recommended strategic actions for responding to the avian influenza pandemic threat PDF. Acrobat Reader required.

(25) Global strategy for the progressive control of Highly Pathogenic Avian Influenza (HPAI). PDF. Acrobat Reader required.

(26) Selected regional harmonizations

(27) Selected regulatory bodies in Africa

(28) African countries act on bird flu

(29) Senegal follows Kenya in poultry imports ban

(30) South Africa determined to stay bird flu free

(31) Bush outlines $7.1B flu-fghting srategy

(32) Selected National Regulatory Affairs Bodies:
Ghana:
(i) Ghana Food and Drugs Board
Phone: 233-21-660 989
Phone: 233-21-673 090 (Drugs Division)
FAX: 233-21-660-389
E-mail: fdb@ghang.com

(ii) Pharmacy Council of Ghana
Phone: 233-21-678-538
Fax: 233-21-229-573
E-mail: Pharmcon@gh.com

Nigeria:
The National Agency for Food, Drug Administration and Control

(33) Mobile Labs: The GPHF-Minilab® - Protection against counterfeited and substandard pharmaceuticals

(34) International Harmonizations:

The International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH)

European Medicines Agency (EMEA)

Pan American Health Organisation (PAHO)

Pan American Network for Drug Regulatory Harmonization (PANDRH)

Food and Drug Administration (FDA)

Therapeutic Goods Administration, Australia (TGA)

International Cooperation on Harmonization of Technical Requirements for Registration of Veterinary Products (VICH)

International Federation of Pharmaceutical Manufactirers and Associations (IFPMA)

Solomon Sackitey is also a Senior Regulatory Affairs Specialist at a Global Animal Health Corporation in the United States. He additionally has experience in HIV/AIDS Vaccines Research at a Global Pharmaceutical Company and can be reached at Email: Solosack@yahoo.com.

Disclaimer: The opinions expressed in the report are exclusively the responsibility of the author and are not necessarily shared by the organizations to which the author is associated or affiliated with. This story is neither written on behalf of any Corporation/Institution or Organization mentioned in the report nor does it imply sponsorship by them.The mere mention of Organizations/Companies and products/resources in this story by no means constitutes endorsements.

All links were checked and confirmed fucntional as at the date of publication.

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