Health Minister shares insights on H1N1

He was joined by the Health Department’€™s Chief Director of Communicable Diseases, Dr Frew Benson and the National Institute for Communicable Diseases’€™ Dr Lucille Blumberg.  

QUESTION: With the latest statistics showing that H1N1 is an additional burden on maternal health, are there any plans to test pregnant women generally like you would test them for hypertension and other things?

DR AARON MOTSOALEDI: The best way to deal with this disease is to classify it into three categories ‘€“ mild, moderate and severe. Those who fall within the moderate and severe are the ones who must be given extensive treatment like Tamiflu, etc. But then, we said of the mild category, if they fall within the four groups ‘€“ pregnant mothers, people living with HIV/AIDS, people with diabetes mellitus, people with vascular or pulmonary diseases – then they must be dealt with as we do with the moderate and severe (categories). Subsequent to that it became clear that in that particular group there is one group that we are losing a lot, and as we’€™ve said, more than half of these deaths, is that group of pregnant mothers.  

 But some of them are also having the other factors like cardiovascular disease, HIV/AIDS (and) diabetes. You are aware that some mothers develop diabetes because of pregnancy,   others develop cardiovascular disease also because of pregnancy. But, quite a number of pregnant mothers are also HIV-positive. So, quite a number of them have all four factors put in one person. For that reason we said they must be put on Tamiflu immediately even before you do any testing or you get results. If you already see that this person has got mild symptoms and is pregnant why wait for results? We are asking healthcare centres to try their best and put them immediately on Tamiflu.

We have been working around the clock with the Director-General (DG) to buy 30 million rand worth of Tamiflu, because we’€™ve got a problem here that most of the Tamiflu might go to the northern hemisphere now that their winters are starting. Because they’€™ve got facilities, they might be hoarding a lot of it before we get our hands on it. Fortunately, the DG has already spoken to Roche (a pharmaceutical company) and I’€™m hoping we are making progress.                      

QUESTION: You were saying if any pregnant woman should display flu-like symptoms they should take Tamilfu even without being tested. Is this dangerous for the baby at all?

DR AARON MOTSOALEDI: Because some of these things are new, doctors are still doing research on the effects of Tamiflu on babies.

When I was attending the international conference in China (on H1N1), the experts there said probably the gains of giving Tamiflu to a pregnant mother far outweigh any risks. They said there is a probability that Tamiflu might be dangerous to the baby. But, if you are going to be saving the mother, you are going to weigh (options) and say, ‘€˜which one do I choose’€™? Most often in medicine we do that, and our conclusion is that putting pregnant mothers on Tamiflu, far outweighs whatever adverse effects that might happen to them. That’€™s why we gave this instruction.

DR LUCILE BLUMBERG: Everybody is concerned about the severe illnesses and the deaths in pregnant women. But, a particular problem is the third term of pregnancy, much less so in the first two parts of pregnancy. Seasonal influenza is a higher risk for complications in pregnancy normally, and H1N1 seems to be a particular risk. It’€™s from the foetus pushing up the lungs and squashing them, and there’€™s some physical effect and probably from some immune effect. But I think absolutely, I agree with what the minister has said. We need to make sure that health professionals recognise influenza like illnesses in pregnancy, particularly in the third trimester, and make sure that patients access Tamiflu early, and I think we will prevent deaths. In terms of the effect on the foetus, I think in the third trimester there would be less effect. I think in the first trimester, if it was a mild illness we would watch the patients and make a risk-benefit decision.

QUESTION: Private school students are returning to school.   What measures has the department put in place to contain the spread of the disease?

DR AARON MOTSOALEDI: We are busy sending letters to 29 000 schools in the country and we’€™ve already issued letters to all rectors of universities and FET (Further Education and Training) colleges, trying to give them guidance on what to do. We are hoping that might help to mitigate some of the effects.

QUESTION: The hotline number that was introduced: is there a proposal, perhaps, to have more agents working there, since on the first day it was busy?

DR FREW BENSON: In the first couple of hours that it operated, we received 240 calls. Now what happened is that within those hours, it came out that we had to have a call waiting facility. So, to a large extent we had to increase the number of operators in those first couple of hours, from two to six operators. I’€™ve been with the minister to China and I did not get a full report, thereafter. But the hotline is operating on a 24-hour basis and we are inundated with the number of calls from the public.    

QUESTION: What are you doing as the department to create awareness about the dangers of other forms of flu?

DR AARON MOTSOALEDI: Indeed you are aware that ordinary flu – seasonal influenza – kills between 250  000 and 500  000 people (globally). With H1N1, you are aware that we are still at about 180  000. But because it’€™s a new disease, people start panicking.

Everybody is scared, even people who do not have any symptoms, who might be having resources, rush to centres and say, ‘€˜please test me, I want to know whether I’€™ve got it’€™.

One radio station which was interviewing me was asking me a question, because last week I had flu, he said, ‘€˜have you tested’€™? And I said, ‘€˜no, the symptoms I’€™m feeling are what I feel annually. I do get flu, annually. There’€™s no question about it. I don’€™t remember a winter in my adult life when I never got flu. It’€™s my special problem’€™.

Then, he said, ‘€˜are you not dancing with death’€™? In other words, once you feel a small symptom you must rush in (for testing). Then, I said look, ‘€˜once that happened for people all over the world that when you feel something you rush in, I can tell you there’€™s going to be absolute chaos. The people who actually need these services will never be able to get them’€™.

Then the other problem is, if we start concentrating on seasonal flu, you know what will happen? It will be that, ‘€˜you see? The department is in denial again. They are denying the fact that there is a new type of flu which is killing people, they’€™re running over to seasonal flu’€™. So, we deliberately kept quiet about seasonal flu and talk about this one which is the concern of people. The third reason might be that because seasonal flu has always been there, many people might have developed some form of immunity for it and because this one is new that’€™s why everybody feels, ‘€˜oh am I safe’€™?

QUESTION: Are you concerned as the department?

DR AARON MOTSOALEDI: We are very, very concerned. Otherwise, we wouldn’€™t even be doing the type of things we are doing. We are very, very seriously concerned. That’€™s why one of the reasons why I insisted on undertaking the trip to China was because I realised that all the ministers, especially of the countries that were badly affected, like Mexico, were there and went to share experiences. Secondly, (the fact) that the WHO (World Health Organisation) was going to be there and one of the topics was to give us an insight into the production of a vaccine and the mitigating factors, etc. So, it’€™s because we are really concerned that we are taking these matters seriously. The reason that two weeks ago there was a conference here for the Africa regional was also because of our concern.

QUESTION: How significant is the number of pregnant women overseas that died from H1N1?

Dr AARON MOTSOALEDI: In the conference in China this issue of pregnant women was at the forefront. In fact I remember the WHO and China, when they were mentioning their priority if a vaccine is produced, they put pregnant women as number one on the priority list and then healthy young people. You are aware that this virus, unlike seasonal influenza, is targeting younger people. In fact China, said they are intending to immunise, if the immunisation becomes available either in November or April, all their 67 million pregnant women. So it shows that we are not the only country with this problem.

QUESTION: Should pregnant women wear masks when they go through airports?

DR FREW BENSON: In terms of masks, it’€™s really the eastern countries that began to use them widely and they were also widely used in Mexico. But what they have learnt with the use of masks (is that) they did not stop the spread of the virus. What it in fact does is that it gives the person a false sense of protection and there are other factors. If they use it wrongly then their chances of getting it (H1N1) are higher as well. The chances of people getting the infection in the community at the moment in South Africa are higher than at the airport. It’€™s only advisable for the person that’€™s infected, that is sick. When the person needs to, say for instance, go to school, when the person needs to write a test, then it’€™s advisable for the person to wear a mask, especially when they cough and sneeze. But it’€™s not advisable for the wider community.

DR AARON MOTSOALEDI: On the issue of concern again, we also got a report at the international conference in China from the WHO about the issue of vaccines. What we do know is that the World Health Organisation has produced 13 candidate vaccines. They’€™ve distributed them all over the world to about 1  600 (pharmaceutical) companies, which are skilled in producing vaccines to start that process of testing and production, etc. We do not know which country in which part of the world will come up with it first. China did inform us at the conference that they are already starting to test 13  000 people with the vaccine that they are trying to produce. There is a belief that if we are lucky around the world, we may come up with a vaccine perhaps in November, if not perhaps in April. But the process of producing a vaccine is a lengthy one from the beginning to the end. It takes about six months and they’€™ve started this process around May. The biggest question that is confronting us is that most of the vaccines are being tested in first world countries. The question is by the time they produce it, when will we, in the developing world, get our share? I mean if China is saying, ‘€˜we want to vaccinate 67 million pregnant women’€™, they will try to do so before sending it to any other person outside China, and I suspect every other country will try do so. But we are negotiating. We’€™ll negotiate very hard that even if they haven’€™t completed (vaccinating) their population, can the whole world try to prioritise all pregnant women all over the world, regardless of whether they come from the first world or the developing world?  


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