Date: Wed 13 Jun 2018
Source: WHO, Regional Office for Africa [edited]

The World Health Organization (WHO) today [Wed 13 Jun 2018] congratulated Ghana for having eliminated trachoma as a public health problem, 2 decades after the World Health Assembly resolved to tackle the leading infectious cause of blindness. The announcement comes the day after a commitment from Pfizer, the manufacturer of Zithromax (azithromycin) to extend their donation programme for the antibiotic until 2025, if required, to finish the task of global trachoma elimination.

"It's been 20 years since the global health community committed to eliminating trachoma worldwide" said WHO Director-General, Dr. Tedros Adhanom Ghebreyesus. "Although there's more work to do elsewhere, the validation of elimination in Ghana allows another previously heavily-endemic country to celebrate significant success."

Ghana is the 1st country in WHO's African Region to achieve this milestone.

"This success is a result of a tremendous amount of hard work by thousands of health, education and development workers to improve the lives of individuals with trachoma and their families", said Mr. Kwaku Agyemang-Manu, Ghana's Minister of Health. "The Government of Ghana is enormously grateful to its staff and to the many partners that have joined forces with us to eliminate trachoma and the cycle of poverty it triggers."

The global trachoma community learnt a lot from Ghana's experience. Innovations pioneered there include the use of height-based dosing for azithromycin; systematic active case-searches for trichiasis involving door-to-door, community-by-community fieldwork; and, intensive counseling of patients found to have trichiasis with an offer of immediate surgery, which produced considerable improvement in surgical uptake.

"Success in Ghana is a result of the strong leadership at all levels, implementation of the full SAFE strategy right from the outset, strong collaboration between Ghana Health Service and its many partners, and integration at lower levels of programme delivery, including community ownership," said Dr. Matshidiso Moeti, WHO Regional Director for Africa. "Hearty congratulations are deserved for this achievement."

Trachoma: Ghana's story
Trachoma was identified in the 1950s as the most important cause of blindness in Ghana. By the 1990s, the disease was known to persist as a significant public health problem in the Northern and Upper West Regions. There were about 2.8 million people at risk of trachomatous blindness nationally, with an estimated 13 000 people suffering from trichiasis. In 2000, the Ministry of Health and Ghana Health Service set up a national Trachoma Elimination Programme.

Ghana's Trachoma Elimination Programme implemented the WHO-recommended elimination strategy, SAFE, which comprises Surgery for trichiasis, Antibiotics to clear infection, Facial cleanliness, and Environmental improvement to reduce transmission.

Trichiasis surgery was provided at no cost, a critical Ghana Health Service decision reflecting the socioeconomic disadvantage of people with trichiasis and the impact of the condition on future earning potential.

Azithromycin, donated by Pfizer through the International Trachoma Initiative, was distributed with support from FHI 360 (using funds from the United States Agency for International Development), The Carter Center, Sightsavers and other organizations.

Facial cleanliness was promoted through community events, dramas, the school health education programme, radio messages and radio clubs. Environmental improvement was coordinated by Ghana's Community Water and Sanitation Agency.

The disease
Trachoma, a devastating eye disease caused by infection with the bacterium _Chlamydia trachomatis_, is spread through contact with infective eye or nose discharges, either directly from person to person, or mediated by flies. Active (inflammatory) trachoma occurs as a result of infection, and is common among preschool-aged children. Women are blinded up to 4 times as often as men, mainly due to their close contact with infected children. Transmission is associated with poor sanitation and hygiene, which increase the availability of eye discharges and encourage the breeding of flies.

In 1996, WHO launched the WHO Alliance for the Global Elimination of Trachoma by the year 2020 (GET2020). With other partners in the Alliance, WHO supports country implementation of the SAFE strategy and strengthening of national capacity through epidemiological assessment, monitoring, surveillance, project evaluation and resource mobilization. Elimination of trachoma is inexpensive, simple and extremely cost effective, yielding a high rate of net economic return.
Communicated by:
Dr. Anthony Solomon MBBS, DTM&H, PhD, PGCAP, FHEA, FRCP
Medical Officer, Neglected Tropical Diseases
Department of Control of Neglected Tropical Diseases
World Health Organization
[ProMED-mail thanks Dr. Anthony Solomon for this submission. Dr. Solomon comments: "I'm delighted to share news of the validation of elimination of trachoma in Ghana - the 1st country in WHO's African Region to reach this mark."

For a discussion of trachoma, please see my moderator comments in a prior ProMED-mail post Trachoma - Nepal: WHO, eliminated as a public health problem

HealthMap/ProMED-mail map of Ghana can be seen at
<>. - ProMED Mod.ML]
Date: Tue, 15 May 2018 12:48:37 +0200
By Stacey KNOTT

Obuasi, Ghana, May 15, 2018 (AFP) - Bismark Owusu moves food and bowls from a bedroom and covers clothes and furniture with a large sheet before mixing a mosquito-killing chemical with water in his spray pack.   He then puts on head-to-toe safety gear, straps the pack to his back and methodically sprays the walls, windows and corners of the room.   Owusu's visit to Domeabra, a small community in the Obuasi area of the Ashanti region in central Ghana, is his latest stop in the country's fight against malaria.

The death of two of his friends from the disease spurs him on. "Why wouldn't I help if others are dying? I am here today helping to eradicate this deadly malaria," he told AFP.   Malaria, which is spread to people through the bites of infected female mosquitoes, is one of the world's deadliest diseases.   According to the World Health Organization, there were 216 million cases of malaria in 91 countries across the world in 2016 and 445,000 deaths.   Most of those cases and deaths  -- about 90 percent -- were in sub-Saharan Africa.

In Ghana, which is home to some 28 million people, there were 4.8 million cases and 599 deaths last year, a marked drop from the 2,200 who died in 2011.   But with global concern that the fight against malaria has reached a plateau, African governments and development agencies are looking at new ways to step up the fight.   That includes preventative measures such as distribution of insecticide-treated mosquito nets and developing a vaccine against the disease but also indoor spraying.   Ghana is the first on the continent to introduce the large-scale use of a new "third generation insecticide" against mosquitoes, which have developed a resistance to other chemicals.

- 'Intelligent insects' -
As Ghana's rainy season approaches, when malaria cases increase, Owusu and his colleagues at the non-profit organisation AGALMal are working flat out.   The organisation grew out of a social initiative by global mining firm AngloGold Ashanti and has a laboratory in the grounds of an old mining site in Obuasi.   There, tiny mosquito pupae dart around in water in a white plastic container in a lab. 

Soon they will transform into mosquitoes and be studied by scientists. Technologist Paul Osei-Bonsu said chemical resistance was a major issue for the spraying programme.   If a population of mosquitoes is sprayed and just one survives and reproduces, the resistance will be passed on, he explained.   "If you use the same spray over time you will have 90 percent of the population not dying," he added.

Programme director Samuel Asiedu says mosquitoes are "intelligent insects", so the new chemical -- SumiShield 50WG -- should be more effective when rotated with others.   In 2006, after the first two years of the indoor spraying, the hospital in Obuasi saw a 75-percent decrease in malaria cases.    That led to the programme being expanded with additional support from global health initiative Unitaid and the Global Fund partnership.

Currently, the indoor spraying programme targets the homes of 1.2 million people.   "We are anticipating other chemicals to come on board by the end of the year so we can be rotating the use of chemicals to prevent resistance development," said Asiedu.   Unitaid project director David McGuire said he hoped the scheme "will convince donors and national governments to increase their investment in this life-saving intervention".

- 'Peace of mind' -
Keziah Malm, who manages the national malaria control programme at the Ghana Health Service, says the new WHO-approved spray is considered safe and has been tested internationally and locally.   It will be used in Obuasi and Ghana's far north -- all of the Upper West region and three districts in the Upper East -- which are high-risk zones for malaria.

Local communities still need to be convinced about the benefits of having their homes sprayed. But Asiedu says only a handful of people refuse.   Sprayers themselves also speak to households about the work and the risks to health from the disease, which can lead to severe illness and death if not treated within 24 hours.   "If I go to the whole house and someone does not want it I have to sit the person and let them know the importance of the spraying because malaria kills," said Owusu.    "It's very important we all understand that malaria is a killer. We have to eradicate it and kick it out of Obuasi and the nation as a whole."

During the course of his work, he's found everyone has a story about the disease.   "I sprayed a full house and the owner was telling me her son died some years go from malaria. He would be 18 years today. She was crying bitterly," he added.   Children under five and pregnant women are considered most vulnerable to malaria.   Seamstress Victoria Awuah lives in an eight-room house some 30 minutes from the lab.   She is seven months pregnant and doesn't need much persuasion to have her room sprayed.   "The spraying really helps. It helps us so that we don't get sick, give us peace of mind and rid this area of all these insects," she added.
Date: Thu 1 Mar 2018
Source: Graphic Online [edited]

The Ghana Health Service (GHS) has confirmed the 1st recorded case of Lassa fever in the country at Tema General Hospital. Dr Anthony Nsiah-Asare, the director-general of the Ghana Health Service, who was speaking to the media in Accra on Thursday [1 Mar 2018], said one person has been confirmed dead from Lassa fever.

Lassa fever is transmitted to humans via contact with food or household items contaminated with the urine, saliva faeces, and blood of infected rodents.

The confirmation, Dr Nsiah-Asare said, followed a test conducted by the Noguchi Memorial Institute for Medical Research. He said that, currently, all the frontline staff at the hospital that handled the patient before he died were being screened, while further investigations to trace the background and all contacts of the deceased were being pursued to prevent the spread of the virus. He called on the public to be extremely cautious of rodents and maintain good hygiene. He also urged the public to report any suspected case of the disease.

The GHS in February 2018 issued an alert of the likelihood of an outbreak of Lassa fever in the country. The disease is said to have already affected several countries in West Africa with, over 300 cases and 31 deaths in Nigeria.

The GHS recommended the following to all health workers and institutions:

1. Surveillance on Lassa fever, and acute hemorrhagic fevers in general (using case definitions), should be enhanced.
2. Suspected cases of Lassa fever should be managed in specific isolation conditions.
3. Health workers should adhere to regular infection prevention and control (IPC) measures to prevent and protect against possible nosocomial transmission.
4. Blood samples from suspected case(s) should be taken and safely packaged and sent to Noguchi Memorial Institute for Medical Research (NMIMR) for laboratory investigations.
5. All levels (national, regional, districts and facilities) are requested to update their preparedness and response plans for Lassa fever and VHF in general, sensitize the respective staff, and create necessary public awareness.

Lassa fever [LF] is an acute viral haemorrhagic fever illness which is endemic in West Africa. The incubation period is 6-21 days. The onset of LF illness is often gradual, with non-specific signs and symptoms and commonly presents with fever, general weakness, and malaise at the early onset. After a few days, headache, sore throat, muscle pain, chest pain, vomiting, diarrhoea and abdominal pain may follow. Severe cases may progress to show facial swelling, and bleeding tendencies (from mouth, nose, vagina or gastrointestinal tract), and low blood pressure. Shock, seizures, disorientation, and coma may be seen in the late stages. Complications include: deafness, transient hair loss, and gait disturbance may occur during recovery. About 80 per cent of Lassa fever infections are mild or asymptomatic.

- Lassa fever virus is transmitted to humans via contact with food or household items contaminated with the urine, saliva faeces, and blood of the rodent (Multi-mammate rat).
- Person-to-person infections and laboratory transmission can also occur, particularly in hospitals lacking adequate infection prevent and control measures.
- The disease is endemic in the rodent population in parts of West Africa, and the multi-mammate rat serves as reservoir for the virus.
- Lassa fever is known to be endemic in Benin, Guinea, Liberia, Mali, Sierra Leone and parts of Nigeria, but probably exists in other West African countries as well.
- Ghana recorded the 1st confirmed case(s) in 2011 in 2 districts, one each in Ashanti and Eastern regions, then confirmed outbreaks of Lassa fever (see Lassa fever - Ghana: (AH, EP) susp.
- Early use of [Ribavirin] (within 7 days of disease onset), supportive care with re-hydration, and symptomatic treatment improve survival.
- There is no effective vaccine for the disease at the moment.  [byline: Seth J Bokpe]
[Lassa fever has been active in several West African countries this year [2018], including Nigeria, Liberia ex Guinea, and Benin ex Nigeria, so it is not surprising that a case has been diagnosed in Ghana. Interestingly, this was predicted previously. In commenting on the 2011 cases in Ghana, the late Mod.CP commented that Lassa virus infection had not been recorded previously in Ghana, but the lesser prevalence of Lassa fever in Ghana was predicted by a spatial-climatic analysis of Lassa fever data from human cases and infected rodent hosts in West Africa during the period 1965-2007 (See Risk maps of Lassa fever in West Africa. PLoS Negl Trop Dis. 2009;3(3):e388) <;jsessionid=A18CA8161C084054F4225595CF9E71CB> and also the ProMED-mail archived report: Lassa fever, predictive maps - West Africa

Halting the acquisition of Lassa fever virus infection at its source -- at the village level -- is not easy. As noted previously, getting local people to understand that virus transmission to humans occurs when people are in contact with the reservoir rodent host, the multimammate mouse (in the genus _Mastomys_) or its excreta can be difficult. Preventing this contact requires understanding that leads to action. Rodent control and prevention of contact with rodent excreta have to be undertaken at the village level with individual households. This requires an extensive and continuous public education effort. Transmission of the virus also occurs in health facilities when personal protective equipment is not employed and barrier-nursing practices are not adequate to protect staff from blood and secretions of infected patients. Although no vaccine is available, Ribavirin has been used to successfully treat patients and is most effective if patients are treated early in the course of infection.

Images of the mastomys mouse, the rodent reservoir of Lassa fever virus, can be seen at
<>. - ProMED Mod.TY]

[HealthMap/ProMED-mail map of Ghana:
Date: Sat 9 Dec 2017
Source: WHO, Weekly Bulletin on Outbreaks and Other Emergencies. Week 49: 2-9 Dec 2017 [edited]

New events: Influenza A H1N1 - Ghana
Event description: Ghana: 77 cases, 4 deaths. 5.2 percent case fatality rate

On 6 Dec 2017, the Ghana Ministry of Health notified WHO of a focal outbreak of influenza A H1N1 in a school in Kumasi city, Ashanti region. The event was detected on 30 Nov 2017 when a cluster of 13 cases of severe acute respiratory illness was reported from Kumasi Academy Senior High School. The initial cases developed illness on 29 Nov 2017 and 3 deaths were reported by 1 Dec 2017.

The case-patients presented with fever, cough, headache, joint and body pains, and abnormal chest auscultation. As of 9 Dec 2017, 77 cases with 4 deaths (case fatality rate 5.2 percent) have been the reported. The majority of the cases, 66 percent, were males and over 95 percent of the cases are teenagers. Thus far, the disease is still localized in the school as no cases have been reported among community members.

Laboratory specimens, including blood, cerebrospinal fluid, and throat swabs were collected from the case-patients and sent to Noguchi Memorial Institute for Medical Research (NMIMR), Kumasi Centre for Collaborative Research (KCCR), and other public health laboratories. Test results from NMIMR (a national influenza centre) released on 6 Dec 2017 indicated that 12 out of 19 throat swabs were positive for influenza A H1N1 2009 pandemic strain using polymerase chain reaction.

Corroborative test results from KCCR released on 7 Dec 2017 showed that seven out of 25 nasal and throat swabs were positive for influenza type A using quantitative real time polymerase chain reaction (rt-PCR).

2 blood specimens tested negative for Ebola and Marburg virus diseases, Lassa fever, yellow fever, dengue, chikungunya, and Zika virus. Specimens analyzed in other public health and research laboratories were negative for meningitis and encephalitis. Accordingly, the Ministry of Health has declared an outbreak of influenza A H1N1 pandemic strain as further epidemiological investigations are ongoing.

Kumasi Academy High School is a mixed sex school with total population of 3010 (2814 students including 541 day students, 127 teaching staff, and 73 non-teaching staff).

Public health actions
The Minister of Health and the WHO Representative held a press briefing to inform the public and provide updates on the outbreak.  The Ministry of Health deployed a multi-disciplinary rapid response team to Kumasi to conduct the outbreak investigation and support response actions. WHO provided technical and logistical support to the investigation mission.  Active surveillance has been enhanced: a case definition was developed and active case search is being done among students and staff at the school and four healthcare facilities that treated the ill students. Suspected cases are being line listed.

Four hospitals in Kumasi have been designated as isolation and treatment centres. Doctors have been assigned to the school Sick Bay to provide high-level pre-referral care to students.  Public health education and community sensitization are ongoing. The Public Health Directorate has granted media interviews to provide updates on the outbreak and actions being taken. Simple messages on infection prevention and control have been developed for education at the school.

Situation interpretation
The influenza A H1N1 virus that caused the 2009 pandemic is now a regular human influenza virus circulating seasonally worldwide. However, seasonal influenza spreads easily, with rapid transmission in crowded areas including schools. This is the case for the event in Kumasi, Ghana. When an infected person coughs or sneezes, droplets containing viruses (infectious droplets) are dispersed into the air and are spread to persons in close proximity who breathe these droplets in. The virus can also be spread by contamination of hands with influenza viruses, which are then deposited on fomites.

Ghana has a good influenza preparedness system. The National Influenza Centre at NMIMR is part of the Global Influenza Surveillance Network (GISN), coordinated by WHO since 1996. Furthermore, the country is benefiting from the Pandemic Influenza Preparedness (PIP) Framework for determination of influenza burden of disease. The PIP Framework facilitates sharing of influenza viruses and access to vaccines and other benefits to improve global pandemic influenza preparedness and response. These capabilities enhanced the ability to detect the current outbreak in real time and initiate containment measures. Going forward, it is necessary to remain vigilant and continue active epidemiologic and laboratory surveillance for early detection of further transmission of the virus in the community.
Date: Fri 8 Dec 2017
Source: YEN [edited]

Deaths at Kumasi Academy have been linked to spread of influenza. The health minister is calling for students to still stay on campus. It has emerged that the cause of mysterious deaths at the Kumasi Academy is due to type A influenza, the strain [that] causes the deadly swine flu.

Addressing the press in an emergency briefing, the health minister, Kwaku Agyeman-Manu, revealed that out of 44 cases reported, only 4 have died, bringing a total of 11 deaths in the year alone.

Samples of students taken for intense investigation at Nuguchi [Noguchi Memorial Institute for Medical Research, Accra] revealed that out of the 19 samples collected, 12 tested positive for influenza type A.

Meanwhile, the health minister is calling for all students to be kept on campus to provide that vaccinations to control the outbreak are ensured.  A senior pathologist at KATH, Dr Osei Sampene, revealed on Nyira FM that "all bodies of students from Kumasi Academy showed signs of a strange disease, which could also be one of its kind in Ghana." Meanwhile, vaccines are currently being administered to all students to protect them against possible viral or bacterial infections.

Parliament has summoned the minister for health, Kwaku Agyemang-Manu on updates related to the deaths of persons. According to him, any attempt by parents to send their wards home poses a serious national security threat since the cause of their deaths is strangely unknown.

The current atmosphere at Kumasi Academy is that of fear and uncertainty as parents run to the school to see if their wards are doing well, as others demand to take their wards home with them. The death toll continues to rise, as the total number of persons losing [their] lives in a week alone has reached 6. [Byline: Charles Ayitey]
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