Minister of Health on Zika Virus & Typhoid Fever preparedness and response

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Health

09 March 2016
Chairperson: Ms M Dunjwa (ANC)
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Meeting Summary

The Minister of Health briefed the Committee on the Zika virus in South Africa. It was transmitted to humans through a mosquito vector, Aedes. There was no evidence of human to human transmission. Over 34 countries had been affected mostly in South America and of key concern was the risk posed to pregnant women. The National Institute for Communicable Diseases (NICD) confirmed the first case of Zika virus disease in South Africa a traveller from Colombia who arrived in Johannesburg in February. Secondary spread of the virus into South Africa was unlikely because the local mosquito species had a different behavioural pattern. A media statement was issued and an emergency meeting held about the virus. A national action plan for Epidemic Preparedness and Response (EPR) had been developed and there was enhanced surveillance at ports of entry and health facilities. Risk communication had been initiated to raise public awareness, there were controls at airports, appropriate disinfection of aircrafts, elimination of mosquito breeding sites and environmental studies to learn more about the virus

Members were pleased with the efforts of the Department, requested the inspection of consignments of second hand tyres, and expressed fears about the malaria virus and control measures to reduce the spread. They asked for clear advice to pregnant women travelling outside South, questioned how fears about the virus could be eradicated, how long the virus could remain in the human body undetected and if children born with microcephaly (without full development of the brain) in South Africa were connected with the virus. They asked if surveillance was enhanced in all points of entries and if there were implications for future pregnancies after an initial bout with the virus.

The Minister also briefed the Committee on plans to ensure typhoid fever did not spread. The cases of rates and death had declined over the last 20 years. Risk factors included poor food hygiene, inadequate water and sanitation infrastructure. Gauteng and Western Cape had the highest number of Salmonella Typhi cases because most travellers went there. A total of 33 cases including two deaths were reported in five provinces. Typhoid fever was endemic in South Africa but had a very low incidence rate. The recently reported cases did not constitute an outbreak. Risk factors included contaminated water supply, food from street vendors, population density, temperature and proximity to water sources. Rapid and timely follow-up of cases, with  detailed history of patients, ensured no further spread of typhoid fever. The national, active laboratory-based surveillance system at the National Institute for Communicable Diseases (NICD) health would be strengthened.

Members asked if the Department was on top of controls of infections and monitoring food production, measures to prevent water borne diseases and standards of food sold on the streets, areas where typhoid fever was prevalent and if there were deliberate actions by external powers to bring organisms into the country.
 

Meeting report

Minister of Health on Zika virus
Minister Aaron Motsoaledi said the Zika virus was transmitted to humans through a mosquito vector, Aedes that also transmitted dengue, yellow fever and chikungunya viruses. There was no evidence of human to human transmission other than the two cases of sexual transmission recently reported in USA. As of February 2016, over 34 countries had been affected mostly in South America. A key concern was the risk posed to pregnant women travelling to affected countries. On 20 February 2016, the National Institute for Communicable Diseases (NICD) confirmed the first case of Zika virus disease in a traveller from Colombia who arrived in Johannesburg on 10 February. He was managed symptomatically and he was well by 16 February. Secondary spread of Zika virus into South Africa on account of this case was unlikely. He said in South Africa the local mosquito species was unlikely to act as vectors to transmit the Zika virus due to having a different behavioural pattern compared to those in South America. A media statement was issued by the National Department of Health and NICD and an emergency meeting held in the Chief Directorate. An Epidemic Preparedness and Response (EPR) had been developed and there was enhanced surveillance at ports of entry and health facilities. Risk communication had been initiated to raise public awareness about the symptoms of Zika virus disease. There was vector control at airports and communities to ensure appropriate disinfection of aircraft and elimination of mosquito breeding sites. There were environmental studies to learn more about the nature of the disease.

Discussion
Dr W James (DA) said one of the reasons the Ebola virus had spread very quickly was because citizens of many of the countries affected did not believe their government. He was pleased about what the National Department of Health was doing. He asked what extra efforts the Department had put in place for the inspection of ships involved in the second hand tyre markets as mosquitoes breed rapidly in such places.

The Minister replied that the second hand tyre market could be a breeding ground for mosquitoes. The last time South Africa had an outbreak of a deadly fever was in 1929 and it was brought in through second hand tyre market. The Department would watch out for consignments as mosquitoes laid eggs in such places

Dr H Chewane (EFF) said he agreed with the Minister that the nation should not be concerned about the transmission of the Zika virus. What was the incidence and the prevalence rate of cases where there were infections? He expressed concerns about the Malaria virus and questioned how it would be curtailed.

Minister Motsoaledi replied that incidence meant the number of new infections and prevalence rate was those who were already infected. He had no knowledge of the incidence rate as it was a new infection and the health authorities were still working on that. Malaria was not a problem in the whole of South Africa but only in four districts. The Department of Health sprayed 80% of the households in those districts twice every year to reduce the incidence of malaria and ultimately wipe it out. The Malaria infection in South Africa was that which was imported from the neighbouring countries and it was prevalent in hot districts.

Mr H Volmink (DA) asked for clear advice to pregnant women travelling outside South Africa and how long the travel restrictions would continue.

The Minister replied that a ban could not be imposed on people travelling as economic, social, cultural and religious factors guided human beings. The advice to people travelling was – avoid being bitten by mosquitoes, wear long-sleeved clothes, use air conditioners, fans and mosquito repellers to keep the insects away and avoid travelling to affected countries unless it was a matter of life and death. His clear message was people should avoid travelling to places where there were reports of infections. He had no idea how long the travel restrictions would continue. His advice to the World Health Organisation was to strengthen the health care programme because no one had an idea of what new disease would come in tomorrow. Three factors contributed to a surge in new diseases: First was climate change. Secondly because of growing problems, human beings were encroaching on nature by cutting corners. He said using monkeys for food gave birth to the Ebola virus and cutting down trees in South America brought about the Zika virus. Thirdly, antibiotics were beginning to be resisted and it was scary.

Ms L James (DA) said there was a sense of relief after hearing the interventions taken by the Government. What information could be given to the communities so that the people would be assured that there was no need to fear.

Minister Motsoaledi replied that communication should be in line with an activity that made it easy for the population to understand. If intense communication was brought into South Africa, as was happening in South America, it would be scary and the people would be confused.

Mr A Shaik Emam (NFP) asked how long the Zika virus could remain in the human body undetected. Had it been ascertained if Zika virus was associated with those cases of South African children born without full development of the brain? Had there been efforts to find the persons who came into contact with the Colombian man that had been infected with the Zika virus?

The Minister replied that there were children in South Africa with under developed brain (microcephaly) which was not caused by the Zika virus but other factors. There was no follow up of people who came in contact with the Colombian because it was not necessary since mosquitoes must be involved before there could be transmission from one human to another.

Mr A Mahlalela (ANC) said it was good to know that there was safety and an enhanced surveillance. Were the focuses only limited to the big or all points of entry? It was necessary to communicate from time so that the people could use the information that was at their disposal. He expressed concerns about the Malaria virus and what could be done to deal with the issue. Were there systems put in place at the points of entries to prevent the spread from those who might have acquired it when they travelled outside South Africa.

 The Minister replied that the Department could not follow up every person crossing the border to verify if such persons had the Malaria virus? It would be an impossible and an extra ordinarily difficult task. Human beings could not be given special attention. All the Department could do was to check temperatures at the Airports and other points of entries. Airplanes, Ships and boots of cars were sprayed before leaving or entering South Africa.

Dr P Maesela (ANC) asked what the Department was doing to minimize the spread of Malaria from people coming from places like Mozambique.

The Minister replied that malaria was endemic in all the South African Development Community (SADC) countries except Lesotho and Mauritius because they were cold regions. It would be unfair for such countries to conclude that it was only being infected with malaria by others. All that could be done was to control the vector inside the houses as human beings were not carriers of malaria. People were encouraged to sleep under nets which were impregnated with insecticides. The use of such nets was banned in 1996 and between then and year 2000, the cases of malaria infection went up by 600%.DVT was brutally efficient in controlling malaria. Mosquitoes were not able to enter a house with DVT. If the mosquitoes could not enter, they could not bite the human beings, and therefore could not lay eggs. The emphasis of the Department was on the mosquitoes as it was the root cause of malaria and not the human beings who could be treated once the disease was detected.

Ms D Senokoanyane (ANC) asked if the Zika virus affected the carrier of the pregnancy and if there were any effect on future pregnancies

The Minister replied that there were no implications on future pregnancies and the woman was not in danger but the unborn baby. The infection was on for a short window period of seven days. The person who remained with the problem was the baby.

Minister of Health on Typhoid cases in South Africa and Gauteng Province
Minister Aaron said typhoid fever was endemic in South Africa but with a very low incidence rate. The number of cases and death rate had declined over the last 20 years. Cases declined from about 6000 in 1985 to about 200 in 2002. Risk factors included poor food hygiene, inadequate water and sanitation infrastructure. Gauteng and Western Cape had the highest number of Salmonella Typhi cases between 2013 and 2015 because most travellers went there. As of February 2016, a total of 33 cases including two deaths had been reported in five provinces (Gauteng 17, Western Cape 12, KZN 2, Limpopo 1, and Mpumalanga 1). The recently reported cases of typhoid fever were within the expected range and did not constitute an outbreak. Recognised risk factors included contaminated water supply and food bought from street vendors. Community level risks factors included population density, temperature and proximity to water sources. It was imperative that each case be appropriately investigated and managed. Rapid and timely follow-up of cases and the obtaining of a detailed history from patients had ensured no further spread of typhoid fever in South Africa. The national, active laboratory-based surveillance system for Salmonella Typhi at the National Institute for Communicable Diseases (NICD) health would also be strengthened.

Discussion
Dr James remarked that typhoid fever was caused by a bacterial infection and not a virus as was the case in Vika. Was the Department happy with its ability to stay on top of controls of infections and the quality of monitoring food production?

The Minister replied that it was a very good observation. Viruses had no treatment and bacteria were treated by and large with antibiotics except the bacteria had become resistant to some antibiotics. South Africa was a part of an organisation that had standards about how food was prepared.

Mr Volmink asked what measures were in place to prevent and reduce water borne diseases and if there were standards on how food sold on the streets was prepared.

Minister Motsoaledi replied that water borne diseases like typhoid and cholera that depended on sanitation were usually prevalent in places where there was drought. The National Department of Health was working with the Department of Water and Sanitation to prevent this in view of the looming drought situation. The ones that happened in South Africa recently were from people who travelled outside the country. It was imperative for the National Department of Health to find a way to bring back health inspectors. This was the biggest area of weakness and the country was naked because when the Constitution was adopted in 1996, the Ministry of Health had off loaded the health inspectors and had assumed that municipalities would employ them as a municipal competence but the municipalities never did. The Department was looking for ways to bring the health inspectors back because a serious function had been lost because of constitutional imperatives.

Mr Shaik Emam asked from which areas of the country were the victims of typhoid fever. Were there deliberate actions by external powers to bring such organisms into the country?

The Minister replied that any disease that depended on sanitation will flourish among poor people. The rate of such diseases had decreased since sanitary conditions even among the poor had improved over the years. He said to imply that there was a deliberate action to introduce organisms into South Africa’s waters was mere suspicion, fear-mongering and innuendo. There was an erroneous belief that scientists were homogenous group of people. There were as diverse as any group of people on the planet Earth. He was sceptical about the idea of scientists conspiring to do evil to the society. The National Institute for Communicable Diseases (NICD) in Johannesburg was the highest level scientific laboratory where the biggest killer diseases could be dealt with. He did not encourage the belief that scientists would decide to kill everyone. The United Nations had rules about biological welfare. There were theoretical possibilities but were mostly myths. Such myths in the apartheid era were as a result of mistrust. He did not believe that scientists could produce organisms that would kill one race and leave another. He argued that there should be a belief that people still had a bit of humanity in them.

The Chairperson concluded that the Committee was confident as its questions had been answered and the country was empowered to handle these diseases. The Minister announced that the Department would launch a programme on Friday 11 March 2016 on what could be done for sex workers to reduce the spread of HIV/AIDS. He invited the Committee to attend the launch. The Chairperson welcomed the invitation and replied that Members of the Committee would be there.

The meeting was adjourned
 

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