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Brace For Severe Flu Season and Outbreaks, Health Experts Warn

WITH load shedding a permanent feature and as temperatures plummet in winter, health experts are warning ​South Africans to brace for a severe cold and flu season, as well as several potential disease outbreaks.

“Colds and flu are more common in the winter,” said National Institute for Communicable Diseases (NICD) Professor Cheryl Cohen. “The influenza season has not started yet but we are seeing an increase in influenza circulation currently and we expect it to start soon.”

These sentiments were shared by Nicole Jennings from Pharma Dynamics who added that the colds and flu season typically starts in May, but varies in timing, severity and duration from one season to the next.

“It’s difficult to estimate when exactly it will end, but the average duration of the colds and flu season over the past 30+ years has been 12 weeks.”

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​The NICD said it was still too early to determine how severe this year’s influenza season would be.

“To date this year influenza A(H1N1)pdm09 has been most commonly detected but we have also seen cases of influenza A(H3N2) and influenza B,” Cohen said.

But health experts have warned that this year’s seasonal flu might be more severe than in the previous two to three years when the Covid-19 pandemic restricted human contact, which resulted in fewer cases of the flu.

According to the United States’ Centres for Disease Control and Prevention, between October 1, 2022, and April 30, 2023, Americans recorded 27-54 million flu illnesses and between 19,000 and 58,000 flu deaths.

SA’s NICD Weekly Respiratory Pathogens Surveillance report for week 19 of 2023, which is data collected up to May 11, 2023, shows there have been 179 influenza cases detected this year so far.

The NICD said the majority of cases were reported from Gauteng, followed by the Western Cape, KwaZulu-Natal, the Eastern Cape, the North West and Mpumalanga.

During the same time period of collected NICD data, 196 Covid-19 cases were detected from all surveillance programmes in 2023 to date.

Jennings also warned there were more than 100 viruses that could cause what a sick person would term a cold, which made it very difficult to monitor.

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“It’s interesting to note that only about 10% of those will show up again next year, which makes the development of a vaccine for the common cold extremely difficult.”

But Jenning said it was easier to track flu strains because there were only about three strains circulating each season.

Wits professor of vaccinology Shabir Madhi ​c​onfirmed there had been a slight increase in Covid-19 cases in South Africa.

“Much of the increase in respiratory illness over the past few weeks have been due to other pathogens​,”​ said Madhi.

“Currently, this includes an increase in flu (influenza) and pertussis (also known as whooping cough).​ ​What is required is for people, especially with underlying medical conditions and those older than 60 years, to ensure they get the flu vaccine immediately. Also, children should be up to date with their vaccines, which includes vaccination against whooping cough.”

Madhi ​added that the sole focus should be on people older than 60 years.

“It is particularly important if they have underlying medical conditions to get another dose if the previous dose was more than 12 months ago, or were not previously vaccinated.”

“There is limited value of otherwise healthy people to be vaccinated now that there is widespread infection and vaccine induced immunity.”

​Meanwhile, ​the immunisation gap during the global pandemic is also seeing a rise in diseases which have been dormant for decades. The World Health Organization and the NICD warned this week that outbreaks of other diseases besides Covid-19, even polio, was a risk.

Cholera and diphtheria have already caused deaths in the country in just over a month​ and cases of ​mumps have been recorded.

Doctors Simangele Mthethwa and Joseph Wamala of the WHO Emergency Preparedness Response Team (EPR) said this was the time to be concerned because any disease could become an outbreak.

“We should be worried about all vaccine preventable diseases against which our children have not been vaccinated because all have a potential of spiralling into outbreaks,” the team said.

“There is a potential for diphtheria cases to increase because of the immunisation gap, therefore we should be worried.

“During the Covid-19 pandemic, the uptake of vaccines significantly declined, and this exposed our population to these diseases which were controlled because of high vaccine coverage,” they stated.

“There is still an opportunity to close the low immunisation gap by bringing children for catch-up immunisation for the antigens missed and thus reducing the risk of outbreaks.”

This week, Minister of Health, Joe Phaala called for vigilance after the detection of diphtheria cases, stating there was a shortage of vaccines.

Phaala said diphtheria was uncommon, but vaccine preventable and is a serious infection caused by a toxin-producing bacterium called Corynebacterium diphtheria.

The toxin may lead to difficulty in breathing, heart rhythm problems and even death.

The bacteria spreads from person to person, usually through respiratory droplets from coughing or sneezing.

The symptoms of diphtheria include sore throat (with the formation of a membrane on the tonsil and throat), and swollen glands in the front of the neck. Close contacts of known cases are at increased risk of infection.

“The vaccine should be given to all children as part of the routine vaccines in the first year,” he said.

Dr Linda Erasmus of the NICD ​said the lack of human contact showed a decrease in diseases but that had now changed.

“Disruptions to health services during the Covid pandemic contributed to lower vaccination coverage rates resulting in immunity gaps,” said Erasmus. “There are systems in place to monitor these diseases and provide warning of any unusual increase in cases.”

​Commenting on the vaccines, Madhi said many children were not receiving their vaccines.

“All children are meant to get at least four doses of diphtheria-toxoid-containing vaccine in the first two years of life and a further booster dose at school entry.​ ​Unfortunately, only about 80% of children receive all their vaccines in the first two years, and less than 20% receive the booster dose at school entry.​ ​Mumps occurs each year in SA, usually during spring.​ ​The outbreak this year is unseasonal and has more cases than usual.​ ​This is likely due to there being an immunity gap which has transpired during Covid-19.”

Source: DFA