Ignorance is not bliss
Developed countries will embark on national swine flu vaccination campaigns in October—but South Africa may not be able to access the vaccine until April next year.
In the wake of South Africa’s first swine flu death—of a Stellenbosch University student—Neil Cameron of the university’s Centre for Infectious Diseases said there is limited manufacturing capacity in the world “and the countries that are first in line are those who make [it], like the US and Europe”.
Wolfgang Preiser, Stellenbosch’s medical virology head, does not expect medication to reach the country before the second quarter of next year. An exact price has not been confirmed, but the UK’s Daily Mail has reported that it costs about R80 a jab. Each person will need at least two jabs.
Mara Kardas-Nelson spoke to Tony Lancaster in this week’s M&G podcast about how soon the swine flu vaccine will reach South Africa in light of the country’s first swine flu death. Click here to listen to the interview
Edward Rybicki of the University of Cape Town’s virology department said South Africa’s technology is insufficient for mass domestic production.
Following the death of 22-year-old Stellenbosch student Ruan Muller a 44-year-old Durban pastor, Rajan Archary, reportedly died after travelling to Swaziland a month before falling ill. Like Muller, he was diagnosed with seasonal influenza, was not treated for swine flu, and developed severe pneumonia.
The authorities said 600 people in South Africa have been confirmed to be infected with the virus.
That Muller was not tested for swine flu raises concerns about the ability of both the university and the Health Department to cope with the epidemic. A swine flu test costs about R600 in the public sector.
On the university website parents have asked if more should not have been done to prevent Muller’s death and halt further infection. But Cameron said Muller had been sick for only a week and had received “quite appropriate treatment”.
A health department spokesperson said that given the many South Africans with flu-like symptoms, not everyone can be tested and anti-viral medication works only if administered within 48 hours of infection.
In addition most medical aids will not pay for the test and charge it to patients’ savings plans.
Health department guidelines call for only the most vulnerable to infection, including pregnant women and patients with compromised immune systems, and those with severe symptoms to be tested.
Senior health department official Frew Benson said: “More than 99% of cases will be mild; patients will recover and need to be treated as if it is regular flu. Testing them and knowing they have swine flu does no good.”
Cameron said that given the testing and treatment available, “the best that we can do is slow down the spread of infection and make sure people are exposed less”.
National Institute for Communicable Diseases head Lucille Blumberg pointed out that swine flu is “not like avian flu, where 60% of people died, which we first thought would happen”.
However, experts also warn that Muller’s death serves as a warning of possible fatalities, even among the young and healthy.
The majority of the 1 154 global deaths so far have been “typical” flu victims—very old, very young or immune-compromised—but many were healthy young adults.
While swine flu and seasonal flu are nearly identical in symptoms, the US Centre for Disease Control said that the virus H1N1 has a genetic characteristic that allows it to infect the lower lungs, while seasonal flu tends to infect the upper respiratory tract. Cameron said most swine flu victims have, like Muller, died of complications following severe pneumonia.
Doctors are concerned about the virus’s impact on the over-burdened public health system. “We don’t know what we will do in our HIV population; we can’t say it won’t be a problem; we don’t know,” said Blumberg.
Meanwhile, the Stellenbosch community is in panic mode. “People are afraid because they don’t really know what it is; they think it’s deadly,” said Evan Williams, a first-year student who knows eight others on the campus who have been diagnosed with swine flu. “A lot of kids are going to the doctor. Some are staying home.”
The university has increased the number of doctors at the campus clinic and circulated emails and SMSes to students with information on preventing flu infection, but is adamant that classes remain in session.
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