H5N1 avian – influenza virus Source: Promega Connections
Chijioke Iremeka
The recent emergence of the H5N1 avian influenza virus in wild birds, which is causing outbreaks in poultry and U.S. dairy cows with one recent human case occuring, is raising global concerns.
This has made consultant epidemiologists and public health physicians harp on the urgent need for the Federal Government and its agencies to consistently scale up epidemic preparedness, response strategies, and execution.
This proactive approach, they said, is crucial to mitigate the potential impact of another pandemic on the country and prevent being caught in the web, should there be any shortly.
The specialists highlighted that amid ongoing discussions concerning the H5N1 Flu and the looming threat of the next pandemic, there remains considerable room for improvement in Nigeria’s pandemic preparedness.
While acknowledging some past achievements by the government, the experts stressed the need for further enhancements to ensure the nation is adequately equipped to respond effectively to future pandemics.
They underlined that the lessons gleaned from the COVID-19 pandemic underscore the stark reality that no country can claim complete preparedness, saying that even nations with seemingly robust infrastructure and advanced facilities faced significant challenges.
Therefore, the physicians added, there is a critical imperative for Nigeria to fortify its defences comprehensively to guard against the potential outbreak of H5N1 or any other disease within its borders.
Clarifying misconceptions surrounding the possibility of the H5N1 virus adapting to human-to-human transmission, the World Health Organisation said there is no evidence to support such claims.
WHO
The Director General of the WHO, Dr Tedros Ghebreyesus said, “So far, the virus does not show signs of having adapted to spread among humans, but more surveillance is needed,”
He noted that while the virus has been found in raw milk in the US, adding, “preliminary tests indicate that pasteurisation effectively eliminates the virus”, and emphasised the WHO’s standard recommendation for the consumption of pasteurised milk.
According to a peer-reviewed journal, ScienceDirect, pasteurisation is a mild heat treatment where food (including milk) is heated below 100 °C to minimise health hazards from pathogenic micro-organisms in low-acid foods and to extend the shelf-life of acidic foods for weeks by destroying spoilage micro-organisms or enzyme inactivation.
Ghebreyesus added that many more people have been exposed to the infected animals, and it is important that all those exposed are tested or monitored and made to receive care if needed.
He noted that at least, 220 people are being monitored and 30 have been tested for the flu.
The WHO DG revealed that the outbreak in the U.S. has infected 36 dairy herds in nine states and one herder.
Ghebreyesus assured that the WHO has a system for monitoring influenza globally through a network of centres in 130 countries, seven collaborating centres, and 12 reference laboratories with the capacities and biosafety requirements to deal with H5 viruses.
“We also have the Pandemic Influenza Preparedness Framework to support the rapid development and equitable distribution of vaccines in case of an influenza pandemic,” he added.
PUNCH Healthwise reports that in recent years, H5N1 has spread widely among wild birds, poultry, land, marine mammals, and now among dairy cattle.
Since 2021, there have been 28 reported cases in humans, although no human-to-human transmission has been documented.
Speaking on the need for Nigeria to be pandemic prepared, physicians in different interviews with PUNCH Healthwise said since the next pandemic is not known in terms of the causative agent and time, Nigeria as a country needs to be ever prepared and join others in the global effort against the next pandemic.
A Consultant Public Health Physician at the University of Ilorin Teaching Hospital, Kwara State, Professor Tanimola Akande said that Nigeria as the “Giant of Africa” needs to continuously scale up its epidemic preparedness, response policies, and implementation to prevent being caught unawares.
The don, who was at various times Head of Department, Epidemiology and Community Health, University of Ilorin, Kwara State, said Nigeria’s pandemic preparedness is encouraging.
He noted that a lot has been done by various stakeholders in the last few years towards ensuring pandemic preparedness, insisting that the Joint External Evaluation for International Health Capacities carried out in 2023, showed an improvement in Nigeria’s pandemic preparedness and response capacity
“There is a lot of improvement in disease surveillance in Nigeria. The experience from Ebola and COVID-19 epidemics has built so much capacity and strengthened the healthcare system to prepare for future epidemics and pandemics,” he added.
On the effectiveness of Nigeria’s testing laboratories and their capacity to act promptly during emergency responses, he said, “A lot of capacity was built during the COVID-19 pandemic with more laboratory equipment and trained health workers.”
Akande, who is a member of the Expert Review Committee on Poliomyelitis Eradication Initiative and Routine Immunisation in Nigeria, said despite these gains, at the sub-national level, a lot more still needs to be done.
“It is important to continuously increase general awareness of the populace on the possibility of pandemics and what roles individuals, communities, and each level of government should play.
“Attention should be paid to making funds available and building capacities at all levels. More so, the clamour for the pandemic treaty being championed by the World Health Organisation is a step in the right direction.
“Also, the H5N1 flu pandemic treaty will be towards ensuring international agreement aimed at coordinating efforts in the areas of surveillance, early detection, containment measures, vaccine development, and international cooperation to mitigate the spread and impact of the virus,” Akande added.
Corroborating Akande’s position, a Consultant Epidemiologist and Public Health Physician at the Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Professor Aisha Abubakar, said there are so many things to prepare for and that the Nigeria Centre for Disease Control and Prevention is already working on them.
He noted that there are different types of pandemic preparedness plans and that the International Health Regulation system determines how countries can respond to health emergencies that have the possibility of an epidemic outbreak.
According to Abubakar, a researcher specialising in Infectious Disease Epidemiology and Public Health Surveillance, the IHR creates rights and obligations for countries, including the requirement to report public health events.
She said, “The preparedness level of a country usually depends on what epidemic a particular country is prone to. It could be diseases like cholera or cerebrospinal meningitis.
“Also, there is an alert and action threshold, which shows that something is happening, and when you have more cases than expected, then, you know that you are headed for the epidemic.
“And that is when you go for mass vaccination against such disease and increase your risk communications and campaign.
“Then, you can activate the Intensive Care Unit and the like. We have structures but nobody can be 100 per cent prepared. One major lesson we got from COVID-19 is that nobody is prepared. We are a low-and-middle-income and less research country, but we saw what happened to other countries with well-established health systems.
“The point is that we have to keep on improving; we have to look at how we responded to previous pandemics and outbreaks. Was there room for improvement? Do we need more diagnostic centres?
“Do we have the capacity to diagnose because we need to know what is happening? You have to know how to diagnose a particular disease or epidemic. You need to have the capacity to know that this is what you are dealing with and not something similar.
“Do we have the manpower? We need trained manpower depending on the type of infection. Are they trained to use personal protective equipment? Do we have the isolation centres and equipment?
“If we are talking about respiratory disease, do we have ventilators, doctors, and nurses to use these ventilators? Do we need new ICUs and the like? These are the questions we need to ask ourselves and then, we look at the public, are they adequately informed about the risk of getting infected?”
The epidemiologist recalled that the first time Nigeria had H5N1, farmers reported that they incurred huge losses but were not compensated, saying that the next one that happened, people started hiding and selling off their flocks.
She noted that in risk communication, there has to be a balance between the risks and economic losses, saying that the insurance system should be able to help in a time like this.
On preparedness, she said there is always room for improvement, adding, “We have structures on the ground but there are things we can do better. Early detection is something that we can improve on. Improving our surveillance system is what we can improve on,” Abubakar added.
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