Tag: South Africa

Nelson Mandela Bay Area Hit by Rabies Outbreak

Source: Pexels CC0

An outbreak of rabies has hit the Nelson Mandela Bay metro, with a nine-year-old Gqeberha boy being its first victim so far.

The Nelson Mandela Bay Metropolitan Municipality (NMBMM) issued a warning calling on residents to be vigilant and to take their domestic pets for rabies vaccinations, following the death of a boy last weekend who was bitten by a dog. Health-e News received confirmation from NMBMM that the nine-year-old boy died at the Dora Nginza Hospital on Friday last week.

“We have learnt with sadness of the passing of the boy from Motherwell, who died due to rabies. We have the family in our prayers,” said Acting Mayor Luxolo Namette.

The municipality’s health services directorate deputy director Dr Patrick Nodwele said vaccinating domestic pets can be the most effective way of preventing rabies transmission to humans.

“The boy passed at Dora Nginza Hospital where it was established that he had been bitten by a dog. Our health officials, together with the Department of Agrarian Reform, have been busy these last couple months vaccinating dogs and cats in an effort to curb the virus as we know that rabies is a vaccine-preventable disease and post-bite vaccinations save lives,” Dr Nodwele told Health-e News.

Rabies causes viral encephalitis which kills up to 70 000 people a year around the world. Infected animal saliva transmits viral encephalitis to humans. Rabies is one of the oldest known diseases in history with cases dating back to 4000 years ago. For most of human history, a bite from a rabid animal was uniformly fatal. In the past, people were so scared of rabies that after being bitten by a potentially rabid animal, many would commit suicide. 

Rabies cases rose significantly over August and September, he added, which is why they are calling on residents to take their domestic pets for vaccinations. The outbreak is spread throughout the entire Nelson Mandela metro region and Nodwele said that 61 rabies specimens submitted for testing all came back positive.

So far 5254 dogs and 438 cats have been vaccinated across the metro. The municipality from time to time issues a domestic pets vaccination schedule, and is calling on residents to observe the schedule so that they bring their animals for vaccination. A vaccination and community education programme is also being run.

Dr Nodwele said the incubation period of rabies is two to three months, though with factors such as bite location and viral load, it can also vary from one week to a year.

“Initial symptoms include a fever and pain, and unusual or unexplained tingling, pricking or burning sensations at the wound site. As the virus spreads through the body to the central nervous system, progressive and fatal inflammation of the brain and spinal cord develops,” Dr Nodwele explained.

Source: Health-e News

COVID Hit South Africa Harder Than Expected Despite Preparedness

Image by Quicknews

New research finds African countries, assessed as being least vulnerable to an epidemic were the worst affected by COVID, particularly South Africa.

A team of researchers from the NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA) worked with the World Health Organization (WHO) African Region to identify factors affecting mortality rates during Africa’s first two COVID waves and the timing of the first reported cases. The study, published in the journal Nature Medicine, found that countries with greater urban populations and strong international travel links were worst affected by the pandemic. Mortality rates and levels of restrictions, such as lockdowns and travel bans, were found to be lowest in countries previously thought to be at greatest risk from COVID.

Professor Mark Woolhouse, TIBA Director, who co-led the study, said, “Our study shows very clearly that multiple factors influence the extent to which African countries are affected by COVID. These findings challenge our understanding of vulnerability to pandemics.

“Our results show that we should not equate high levels of preparedness and resilience with low vulnerability.

“That seemingly well-prepared, resilient countries have fared worst during the pandemic is not only true in Africa; the result is consistent with a global trend that more developed countries have often been particularly hard hit by COVID.”

Among 44 countries of the WHO African Region with available data, South Africa had the highest mortality rate during the first wave between May and August 2020, at 33.3 deaths recorded per 100k population. Cape Verde and Eswatini had the next highest rates at 17.5 and 8.6 deaths per 100k, respectively. At 0.26 deaths recorded per 100,000, the lowest mortality rate was in Uganda.

South Africa also recorded the highest mortality rate during the second wave between December 2020 and February 2021, at 55.4 deaths per 100,000. Eswatini and Botswana recorded rates of 39.8 and 17.7 deaths per 100,000, respectively. The lowest rate was in Mauritius, which recorded no deaths during the second wave.

“The early models which predicted how COVID would lead to a massive number of cases in Africa were largely the work of institutions not from our continent. This collaboration between researchers in Africa and Europe underlines the importance of anchoring analysis on Africa’s epidemics firmly here,” said Dr. Matshidiso Moeti, WHO Regional Director for Africa and co-author. “We can no longer focus our understanding of disease transmission purely on the characteristics of a virus—COVID operates within a social context which has a major impact on its spread.”

Countries with high rates of HIV were also more likely to have higher mortality rates. This may be because people with HIV often have other health conditions that put them at greater risk from COVID, the team suggests.

The weak association between mortality rate and the timing or severity of government-imposed social restrictions shows the varied impact and enforcement across the region, making a consistent impact pattern difficult to discern. Restrictions during peaks of infection are well documented to have interrupted transmission in the region.

The findings show that the earliest recorded cases of COVID were in countries where most people live in urban areas, with strong international travel links and greater testing capacity. Algeria was the first of 47 African countries to report a case, on 25 February 2020. Most countries had recorded cases by late March 2020, with Lesotho the last to report one, on 14 May 2020.

Higher death rates were observed during the second wave, compared with the first. The infection peak during the second wave was also higher, with 675 deaths across the continent on 18 January 2021 compared with 323 during the first wave peak on 5 August 2020. Potential under-reporting was accounted for in the analysis.

Source: University of Edinburgh

AstraZeneca Vaccine Confers COVID Protection for People with HIV

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Interim results from a phase 1B/2A clinical trial conducted by the Wits Vaccines and Infectious Diseases Analytical (VIDA) research unit showed that the AstraZeneca vaccine conferred COVID protection in people living with HIV.

The findings, published in Lancet HIV, show that the AstraZeneca COIVD vaccine is likely to work as well in people living with HIV compared with people who are HIV negative.

These interim findings are vital for informing the clinical management of people with HIV during the COVID pandemic.

In general, clinical trials which evaluate the safety and immunogenicity of COVID vaccines in people living with HIV are limited, and in Africa they are virtually non-existent. This is despite the overwhelming prevalence of HIV infection in Africa, especially South Africa .

“We searched PubMed for peer-reviewed articles published between 1 January 2019 and 29 June 2021, using the terms ‘safety’ and ‘Covid-19’ and ‘vaccine’, but we did not find any reports that evaluated safety and immunogenicity of COVID vaccines in this population,” said Shabir Madhi, Professor of Vaccinology and Director of Wits VIDA, which led the first South African trial for a COVID vaccine in June 2020.

Compared to the general population, people living with HIV have an increased risk of infectious diseases and have a greater mortality risk when hospitalised with severe COVID.

In addition, compared with HIV-negative individuals, people with HIV are at greater risk for infectious diseases, such as influenza, including during antiretroviral therapy (ART).

Risk factors for severe COVID in people with HIV include more advanced stage of HIV/AIDS, the HIV-1 infection not being virally suppressed, and CD4 counts below 500 cells per microlitre.

The study was an interim analysis of a randomised, double-blind, placebo-controlled, phase 1B/2A trial. In 2020, the trial enrolled 104 people living with HIV were enrolled in the trial, HIV-negative people. Eligibility criteria for people with HIV included being on ART for at least three months, with a plasma HIV viral load of less than 1000 copies per microlitre.

The HIV study was a unique addition to the AstraZeneca COVID vaccine clinical trial, and aimed to assess safety and immunogenicity of this vaccine in people with HIV and HIV-negative people in South Africa. The primary endpoint in all participants regardless of HIV status was the safety, tolerability, and reactogenicity profile of the AstraZeneca COVID vaccine.

Reactogenicity refers to a subset of reactions that occur soon after vaccination, and are a physical manifestation of the inflammatory response to vaccination. Such symptoms include pain, redness, swelling or induration for injected vaccines, and systemic symptoms, such as fever, myalgia, headache, or rash. In clinical trials, information on expected signs and symptoms after vaccination is actively sought.

The interim findings show that the AstraZeneca COVID vaccine was well tolerated and showed favourable safety and immunogenicity in people with HIV, including heightened immunogenicity in SARS-CoV-2 baseline-seropositive participants.

Source: University of the Witwatersrand

Rare Diseases in South Africa: A Neglected Topic

Source: Pixabay/CC0

An article in Spotlight examines the challenges faced by South Africans with rare diseases.

A rare disease is a health condition affecting a small number of people compared with other diseases commonly identified in the population. According to the World Health Organization (WHO), there are between 5000 and 8000 known rare diseases worldwide, affecting an estimated 400 million people.

According to the advocacy group Rare Disease South Africa (RDSA), about 3.6 million people in SA have a rare disease. In South Africa, the ability to diagnose a rare disease is hindered by a lack of capacity and resources, according to research, putting the time to diagnosis for rare diseases in general higher than the estimated 5.5 to 7.5 years in high-income countries.
“There is still low recognition of genetic disorders among specialists. And when they are recognised, testing remains expensive and requires sophisticated levels of training which are relatively limited,” says Prof Karen Fieggen, a medical geneticist at the University of Cape Town (UCT).

According to her, costs, skills, training, and human resource factors are all barriers to effective testing and diagnosis. But she says the rationale to build an effective system is solid.

“We have capable people and expertise to build this system, but until you invest in it, it won’t be big enough to be self-sustaining,” she says.

Prof Fieggen acknowledges that resources are stretched in the public sector, where specialists who carry out genetic testing for rare diseases must meet the needs of a larger part of the population. However, she notes, “there’s no guarantee you’re better off in the private sector”.

“There are very few genetic referral options, and none of the medical geneticists are kept in work full time,” she says. In Cape Town, for example, she says that all patients seeking genetic testing had to come to the private sector until recently. “We have the capacity to train seven specialists a year, but posts aren’t available for them to take,” she says.

At one per 4.5 million population, available medical geneticists in the public healthcare sector fall far short of the 21 per 2 million recommended by the WHO. These services are also spread unevenly through the country. The country’s heavy burden of HIV and TB is partly responsible for this lack of coverage.

While healthcare training must focus on these public health needs, Prof Fieggen says rare diseases need a sensible approach. “It doesn’t help to throw huge resources at something that will have minimal management impact,” she says. “But the way in which rare diseases have been relatively ignored isn’t constructive.”

Helping the recognition of rare diseases and referral pathways in physician training may make a difference. “One thing that could be instilled in training is to recognise that if things are atypical in their presentation, there should be a discussion with a referral centre,” says Associate Professor Ian Ross, a senior consultant endocrinologist at UCT and Groote Schuur Hospital.

Only 2.5-5% of rare diseases have approved treatments, some of which are prohibitively expensive.

The most expensive drug in the world is Zolgensma (generic name onasemnogene abeparvovec), a once-off treatment costing a mind-blowing USD $2.1 million (R 30m). Used to treat inherited spinal muscular atrophy, where infants with the condition are unlikely to see their second birthday. However, even this is available through the UK’s National Health Service, which struck a deal to bring prices down.

Du Plessis says these drugs are not on the essential medicines list because of the small group of patients they would serve. “The essential medicines list is dedicated to treatments that are procured in large numbers. Rare diseases will never be mass-market drugs.”

Such drugs can be purchased by hospital pharmacists so they can be available at a certain hospital, making for a haphazard situation.
To help address this inequality, RDSA held a Rare Disease Symposium on 25 August, inviting feedback on a draft policy framework from various medical sector and political stakeholders.

The framework has a definition for rare disease in SA, namely a condition affecting one in 2000 people or fewer. It also recommends including rare diseases in the NHI benefit package. The NHI bill also includes a Benefits Advisory Committee, which will determine what diseases get coverage,

However, Dr Nicolas Crisp, Acting Director General for Health, said that the NHI would not ring-fence funding. As medical insurance will be done away with, it will be crucial to secure funding for those extremely expensive drugs unaffordable to the private sector.

Source: Spotlight

C.1.2 Variant Slows in SA; Colombian Variant Named Mu

Computer image of SARS-CoV-2. From CDC at Pexels
Source: CDC on Pexels

The Network for Genomic Surveillance in South Africa (NGS-SA) has reported that the C.1.2 variant is spreading less slowly than in July, from 2.2% of all sequenced COVID cases to 1.5% in August, and is therefore unlikely to become a dominant variant.

Meanwhile, B.1.621,  another variant that first emerged in Colombia in January has been recently classified by the World Health Organization (WHO) as a variant of interest (VOI), receiving the Greek letter “Mu”. Since its first detection, it has spread across North America, South America and Europe, and has also been detected in Asia. The majority of the Mu sequences (5123) have been detected in North America (55%, n=2841) followed by South America (23%, n=1328), Europe (18%, n=948) and Asia (0.1%, n=6). As of 3 September 2021, Mu has not been detected in Africa. Thus far, it makes up less than 1% of the globally circulating viruses with Delta accounting for 88%.

NGS-SA, which includes the National Institute for Communicable Diseases (NICD), continuously and rigorously monitors SARS-CoV-2 sequences circulating in South Africa. This work is crucial in the early detection of SARS-CoV-2 variants, including Mu.

Many of the mutations within the spike protein which define the Mu variant (T95I, E484K, N501Y, D614G, P681H and D950) have been seen before in other VOIs or variants of concern (VOCs) including Beta and Delta. Some of these mutations have previously been associated with decreased antibody responses and increased transmissibility. Therefore it is likely that Mu will have similar properties to other variants with increased transmissibility and reduced sensitivity to antibodies in vaccines and those who have recovered from COVID.

The NICD advises that both COVID vaccines being used in South Africa have high levels of protection against severe disease requiring hospitalisation and death even against VOI/VOCs such as Beta and Delta and therefore will likely also protect against Mu. 

Source: NICD

Europe to Return Millions of Locally-filled J&J Vaccines

The European Union has agreed to return millions of COVID vaccines doses partially produced in South Africa back to the African continent.

South Africa’s Aspen Pharmacare operates the plant that is partially producing Johnson & Johnson vaccines, where vaccine substance from Europe is sent to be bottled and shipped.

The plant is supposed to produce 400 million doses for the AU’s African Vaccine Acquisition Trust through 2022, to be purchased by African nations using World Bank financing. Shipments started in August, with 6.4 million doses delivered to countries, but they have been limited due to the manufacturing plant’s production capacity.

The announcement came as Africa struggles to immunise its population against COVID, partly due to a lack of supply resulting from wealthier countries buying up most vaccines, and also from widespread vaccine hesitancy. 

“All the vaccines produced at Aspen will stay in Africa and be distributed to Africa,” said Strive Masiyiwa, special African Union envoy. “This issue has been corrected and corrected in a very positive way.”

The announcement came after a meeting in Berlin between South African President Cyril Ramaphosa and European Commission President Ursula Von der Leyen, he said, adding that the first supplies were expected this month.

“In addition, the Europeans committed to give us 200 million doses before the end of December,” Masiyiwa said at the briefing by the Africa Centres for Disease Control and Prevention.

About 2.93% of people who have been fully immunised against COVID, said Africa CDC director John Nkengasong. The World Health Organization meanwhile warned that eight out of 10 African countries were likely to fall short of the “crucial” goal of vaccinating the most vulnerable 10% of their populations against COVID by the end of the month.

Source: Eyewitness News

New Antiviral Drug for COVID to Be Trialled in SA

Source: CDC

Codivir, a new antiviral drug with promising effects against COVID, will be trialled in South Africa.

Following on from the phase I study’s successful completion, Code Pharma, a Dutch pharmaceutical company developing Codiviir, is starting phase II double-blind controlled study in Spain, Brazil, South Africa and Israel.

Codivir is a short synthetic 16 amino-acid peptide, originally derived from HIV peptides. Code Pharma discovered the peptide’s direct antiviral effect against SARS-CoV-2 after in vitro studies at the British virology research laboratory, Virology Research Services in London.

Codivir was tested in a phase I trial in São Paulo, Brazil, where researchers found that Codivir had a high safety profile while significantly suppressing viral replication in most of the fully assessed patients. All treated patients recovered quickly and no side effects often associated with COVID infections were seen. The results also indicated that Codivir might have a similar beneficial effect on other RNA viruses such as influenza.

Lead researchers from the Department of Medicine at Hadassah Medical Center, Dr Yotam Kolben and Dr Asa Kesler said the antiviral drug had potential for improving the current therapies for COVID.

“The pre-clinical data and the results of the clinical trial support the safety of Codivir administration in humans and suggest its significant anti-COVID effect,” the researchers said.

Professor Shlomo Maayan, director of the Infectious Disease division at the Barzilai Medical Center, said Codivir had a very good safety profile and an impressive antiviral effect, both in the lab and in the phase I clinical trials.

“We eagerly await the results of the double-blind studies using Codivir. It may be a breakthrough in the field of antiviral therapy for COVID patients,” said Prof Maayan.

Source: Biospace

Suspensions of Top Health Officials are Imminent

Photo by Bill Oxford on Unsplash

An article by the Daily Maverick reveals that a wave of suspensions in the Department of Health are impending as a result of the investigation into the Digital Vibes contract, which prompted the resignation of Dr Zweli Mkhize.

Minister of Health Dr Joe Phaahla said that he received a letter from the Special Investigations Unit (SIU) which he would have to act on. 

Dr Phaahla said that “in the next few days and weeks there will unfortunately be some action and that will have some impact also on our capacity as a department”, adding that “when wrong things have happened and investigations have led to findings, then people have to be held answerable”.

However, Dr Phaahla said it was regrettable since “it will have an impact on our capacity, because from what I have seen, a number of people will have to be on suspension, pending charges.” He said it would be difficult for the vaccination programme as management staff were already stretched thin, but “it’s a consequence which must follow”. 

Drs Buthelezi and Pillay denied any knowledge of suspension, though the Daily Maverick has found out that referral for disciplinary action have been sent to the presidency.

The details of the SIU’s investigation have not been made public yet, although the Daily Maverick was able to tease out some details from an affidavit to set aside the Digital Vibes contract and to seeks to reclaim up to R150 million that was paid for the contract.

The affidavit further reveals that Dr Mkhize allegedly pressured the previous Director-General, Precious Matsoso, to employ Tahera Mather to be contracted for communication.

Precious Matsotso was replaced after an unblemished ten years by Dr Anban Pillay, who had been Deputy DG. Dr Pillay then became the active facilitator for the Digital Vibes contract, the affidavit suggests — a matter in which the DIU has also referred to the National Prosecuting Authority.

The current DG, Dr Sandile Buthelezi, who replaced Dr Pillay, is also noted as approving payments to Digital Vibes, though the DIU states it is not seeking any relief against him other than setting aside of relevant agreements.

The situation still has a way to run, with disciplinary inquiries, the Special Tribunal hearing and NPA investigations all ongoing. 

However, the Daily Maverick warns that it is clear that this critical government department is in “freefall” and will not have the capacity to deal with South Africa’s health challenges in the months and years to come.

Source: Daily Maverick

What is The C.1.2 Variant?

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A preliminary study recently uploaded on the medRxiv preprint server, researchers detail the detection and characteristics of the C.1.2 variant of SARS-CoV-2, which has not yet been assigned a variant of interest (VOI) status, but which could potentially have increased transmission and immune escape potential.

The researchers describe how they identified a new SARS-CoV-2 variant, C.1.2. The first detection of this variant was during the third wave of infections in South Africa from May 2021 onwards, and has also been detected in seven other countries around the world.

New SARS-CoV-2 variants are commonly associated with new waves of infection. Like several other variants of concern (VOCs), C.1.2 has accumulated a number of substitutions beyond what would be expected from the background SARS-CoV-2 evolutionary rate. This suggests the likelihood that these mutations arose during a period of accelerated evolution in a single individual with prolonged viral infection through virus-host co-evolution. Deletions within the N-terminal domain have been evident in cases of prolonged infection, further supporting this hypothesis.

C.1.2 contains many mutations that have been identified in all four VOCs (Alpha, Beta, Delta and Gamma) and three VOIs (Kappa, Eta and Lambda) as well as additional mutations. Many of the shared mutations have been associated with improved ACE2 binding or furin cleavage, and reduced neutralisation activity, raising concern about the transmission potential of this variant. The next step is determining the functional impact of these mutations and to find out if they give it a replication advantage over the Delta variant.

The C.1.2 lineage is continuing to grow, and as of 20 August 2021, there were 80 C.1.2 sequences in GISAID, and the variant has now been detected in Botswana and in the Northern Cape of South Africa. Note that this study is yet to have the peer review process completed.

Source: MedRxiv

A KZN Doctor’s Observations and Treatments of COVID

SARS-CoV-2 viruses (yellow) infecting a human cell. Credit: NIH

Dr Shankara Chetty, a general practitioner with a natural science background in genetics, advanced biology, microbiology and biochemistry, has been critically reviewing information that has arisen from observations of the COVID pandemic from around the world. Knowledge gained from a broad natural science background convinced him that there was a missing element in these reports. This is a summary of an article published in Issue 5 of Modern Medicine in 2020.

“A wealth of knowledge of hospital presentations, pathology and investigations has been generated, but there has been a distinct lack of information regarding initial presentation, progression and pathogenesis,” said Dr Chetty.

Type 1 hypersensitivity reaction

When COVID arrived in South Africa, Dr Chetty isolated himself so as to limit interactions with family and the public and erected a tented field clinic in his practice parking so as to be able to examine and follow up on every COVID patient without risk to his other patients. According to him he had a theoretical understanding of the possible pathogenesis but needed to verify his suspicions.

“From the examination, treatment and follow up of over 200 symptomatic COVID patients, it is my opinion that COVID illness has two aetiologies. It is initially a respiratory viral infection with typical symptoms, progression and outcomes over the initial 7 days. On around day 7, a Type 1 hypersensitivity reaction is triggered in those that are sensitive, leading to the sequelae typically seen on admission.

“This reaction causes the release of chemical mediators in the ling, resulting in inflammation, oedema, and in time, massive cell damage. The resultant cellular disruption is what triggers the ‘cytokine storm’ in an attempt to repair damaged cells and remove debris. This release of cytokine produces the variety of pathologies that are seen,” said Dr Chetty.

Rapid response to treatment
His treatment protocol included the use of hydrochloroquine, azithromycin and doxyclcline to combat the viral component and antihistamines, leukotriene receptor antagonists and steroids, amongst others, for the Type 1 hypersensitivity reaction. This protocol produced consistent outcomes, no sequelae, and rapid recovery of all patients. In all, they had no deaths, no hospitalisations and recover of all patients, regardless of age, within 14 days.

“Outcomes of identifying and treating a Type 1 hypersensitivity reaction were most telling in the more severe dyspnoiec patients, with saturations below 85% on presentation that had improvement to over 95% in 24 hours, with outpatient management on room air, negating the need for oxygen or hospitalisation,” said Dr Chetty.

According to Dr Chetty, the rapid response to these medications used to treat Type 1 hypersensitivity reactions confirmed its existence. This could have some serious implications for the future management of the COVID pandemic. Monitoring for a hypersensitivity reaction and prompt treatment would decrease morbidity and mortality significantly.

Source: Modern Medicine