Lucille Blumberg

Global perspectives for prevention of infectious diseases associated with mass gatherings

We assess risks of communicable diseases that are associated with mass gatherings (MGs), outline approaches to risk assessment and mitigation, and draw attention to some key challenges encountered by organisers and participants. Crowding and lack of sanitation at MGs can lead to the emergence of infectious diseases, and rapid population movement can spread them across the world. Many infections pose huge challenges to planners of MGs; however, these events also provide an opportunity to engage in public health action that will benefit host communities and the countries from which participants originate.

Nosocomial Outbreak of Novel Arenavirus Infection, Southern Africa

This case reinforces the need for strict screening of internationally transferred patients.

Fatal human infection with rabies-related Duvenhage virus, South Africa.

Duvenhage virus was isolated from a patient who died of a rabieslike disease after being scratched by a bat early in 2006. This occurred ≈80 km from the site where the only other known human infection with the virus had occurred 36 years earlier.

Elevated Influenza-Related Excess Mortality in South African Elderly Individuals, 1998–2005

BACKGROUND Although essential to guide control measures, published estimates of influenza-related seasonal mortality for low- and middle-income countries are few. We aimed to compare influenza-related mortality among individuals aged ≥65 years in South Africa and the United States. METHODS We estimated influenza-related excess mortality due to all causes, pneumonia and influenza, and other influenza-associated diagnoses from monthly age-specific mortality data for 1998-2005 using a Serfling regression model. We controlled for between-country differences in population age structure and nondemographic factors (baseline mortality and coding practices) by generating age-standardized estimates and by estimating the percentage excess mortality attributable to influenza. RESULTS Age-standardized excess mortality rates were higher in South Africa than in the United States: 545 versus 133 deaths per 100,000 population for all causes (P<.001) and 63 vs 21 deaths per 100,000 population for pneumonia and influenza (P=.03). Standardization for nondemographic factors decreased but did not eliminate between-country differences; for example, the mean percentage of winter deaths attributable to influenza was 16% in South Africa and 6% in the United States (P<.001). For all respiratory causes, cerebrovascular disease, and diabetes, age-standardized excess death rates were 4-8-fold greater in South Africa than in the United States, and the percentage increase in winter deaths attributable to influenza was 2-4-fold higher. CONCLUSIONS These data suggest that the impact of seasonal influenza on mortality among elderly individuals may be substantially higher in an African setting, compared with in the United States, and highlight the potential for influenza vaccination programs to decrease mortality.

DDT and urogenital malformations in newborn boys in a malarial area

Study Type – Symptom prevalence (retrospective cohort)
Level of Evidence 2b

A Comparison of Outbreak- and Nonoutbreak-Related Multidrug-Resistant Tuberculosis Among Human Immunodeficiency Virus-Infected Patients in a South African Hospital

Nosocomial multidrug-resistant tuberculosis (MDR-TB) in human immunodeficiency virus (HIV)-infected people is recognized in Europe and America. We report the first such outbreak in South Africa. Six hospitalized women, identified by DNA fingerprinting, were infected with an outbreak strain of MDR-TB while receiving treatment for drug-susceptible tuberculosis. The putative source case was identified as an HIV-positive woman who underwent prolonged hospitalization for chronic cavitary tuberculosis. Compared with other HIV-positive patients in the hospital, outbreak patients were more immunocompromised, had fewer cavitary lung changes, and were less likely to have been treated before. They had high fevers, infiltrative patterns on chest radiographs, and a mean survival of 43 days. When individual isolation is not possible, separating highly immunocompromised patients with first-time tuberculosis from previously treated patients with cavitary lesions and from those with established drug resistance may reduce nosocomial transmission.

Outbreak of Rift Valley fever affecting veterinarians and farmers in South Africa, 2008

BACKGROUND During 2008, Rift Valley fever (RVF) virus re-emerged in South Africa as focal outbreaks in several provinces. AIMS To investigate an outbreak affecting cattle farmers and farm workers, and the staff and students of a veterinary school, assess the prevalence of infection during the outbreak, document the clinical presentation of cases, and identify potential risk factors. METHODS We conducted a cross-sectional serological survey of exposed veterinarians and farmers, who were examined to determine the presence of current or recent illness. Blood specimens were collected for virus isolation, nucleic acid detection and serology. A subset was interviewed using a standardised questionnaire to obtain data on recent exposures and risk factors for infection. RESULTS Of 53 participants potentially exposed to infected domestic ruminants, 15% had evidence of recent infection and 4% evidence of past exposure to the RVF virus. The prevalence of acute infection was 21% in veterinarians compared with 9% in farmers and farm workers. After a mean incubation period of 4.3 days, the most frequent symptoms experienced included myalgia (100%), headache (88%) and malaise (75%). No asymptomatic cases were identified. Transmission, by direct contact with infected animals was the major risk factor in these professional groups. Performing animal autopsies was significantly associated with acute infection (risk ratio 16.3, 95% confidence interval 2.3 - 114.2). CONCLUSIONS Increased risks associated with veterinary practices highlight a need for the use of personal protective equipment, and identify veterinarians as a primary target group for future vaccination.

Epidemiology and Molecular Virus Characterization of Reemerging Rabies, South Africa

Late identification of an outbreak of human rabies in Limpopo Province led

Twenty-five Years of Outpatient Influenza Surveillance in South Africa, 1984–2008

INTRODUCTION Understanding the seasonality of influenza can help inform prevention and clinical treatment strategies. The aim of this manuscript is to describe the trends and epidemiology of outpatient influenza in South Africa prior to the influenza A(H1N1) pandemic. METHODS Throughout each year, participating healthcare practitioners sent throat swabs from patients with influenza-like illness (ILI) to the National Institute for Communicable Diseases for influenza testing by immunofluorescence and viral culture through the Viral Watch influenza surveillance program. RESULTS From 1984 to 2004, participating sites were restricted to 1 province and the annual number of specimens ranged from 91 to 534. In 2005 the program was expanded. By 2008 the program included all 9 provinces; 1276 specimens were submitted that year. The mean week of onset was the first week of June and the mean peak was the first week of July. The duration of the season ranged from 6 to 18 weeks with a mean of 10 weeks. The mean annual influenza detection rate was 28% (range, 23%-41%). Influenza A(H3N2) predominated in 14 (56%) of the 25 years, seasonal influenza A(H1N1) in 7 (28%), and influenza B in 2 (8%), and in 2 years multiple types cocirculated. CONCLUSIONS The program has provided valuable data on the timing of the influenza season each year that can be useful to direct the timing of vaccination and assist clinicians in deciding whether to prescribe empirical antiviral therapy.

malaria control in South Africa - challenges and successes

Control measures have substantially reduced the historical distribution of malaria in South Africa; the countrys population currently at risk for contracting malaria is approximately 4.3 million, predominantly in the northern and eastern border areas. The major strategies for malaria control are vector control through indoor residual spraying, case management, disease surveillance, epidemic preparedness and response, and public awareness. There has been a significant and sustained decrease in malaria case notifications since 2000, as a result of intensive indoor residual spraying including the use of DDT to combat insecticide-resistant Anopheles funestus; the introduction of artemisinin combination therapy; and the Lebombo Spatial Initiative, a cross-border collaboration targeting malaria in eastern Swaziland, southern Mozambique and northern KwaZulu-Natal (KZN). Rapid malaria antigen detection tests are widely used for diagnosis at primary health care level. HIV-malaria co-infected patients who are malaria non-immune are at risk for severe malaria. Renal failure has been identified as a particular complication in this group of patients. Despite successes in malaria control in South Africa, many challenges remain.