Madagascar
Malagasy killer influenza was "normal strain"

afrol News, 30 August - Investigations into the "killer influenza" still ravaging in Madagascar conclude that one could not detect "an especially virulent influenza strain." The almost 700 deaths were therefore mostly attributed to "the lack of access to health care and to very poor nutrition in the affected districts."

According to the World Health Organisation (WHO), a new study has mapped the Malagasy "killer influenza". An international team from the Global Outbreak Alert and Response Network had been assisting Madagascar's Ministry of Health in providing a preliminary report of their findings and recommendations yesterday. 

The results showed that the influenza epidemic could be attributed to so-called influenza A/Panama/2007/97–like (H3N2) viruses - a type of influenza that normally doesn't cause great concern. Actually, this was "the same strain that was associated with influenza epidemics worldwide during 2001-02," the report says.

Further preliminary results concluded that "the observed increase in excess mortality compared to previous years appeared to be due to widespread transmission and not an especially virulent influenza strain." Most deaths had occurred "outside of health facilities and disproportionately affected young children," the report says. 

The results more than indicate that the almost 700 deaths could be attributed to a particularly low resistance among parts of the population. This again must be seen in the light of the political chaos on the island earlier this year, and especially the roadblocks set up by followers of ex-President Didier Ratsiraka, preventing food, medicines and fuel to reach the interior of the island.

According to the report, the parts of the country suffering the greatest impact of the "killer influenza" were those suffering from the blockade. This particularly includes the highlands region of Fianarantsoa Province.

Meanwhile, the outbreak, since starting at the beginning of August, has extended to 5 out of 6 provinces in Madagascar, the exception being Antsiranana province in the north-east of the country. 

According to the latest update from the Malagasy Ministry of Health, the total number of reported cases had on 22 August reached 22,646. This included 671 deaths. The most affected province remained inland Fianarantsoa, with 18,808 cases and 556 deaths. 

The government and humanitarian organisations are responding to the epidemic on the ground that it is caused by a lack of access to health care and by "very poor nutrition in the affected districts." Along with the Ministry of Health, the WHO country office therefore has been working with UNICEF and the UN World Food Programme to provide protein-enriched foods as soon as possible and to establish nutritional education centres.

The report by the Global Outbreak Alert and Response Network additionally recommended that the government should expand its influenza sentinel surveillance system. The government was also advised to provide health education activities to inform the public about influenza and the need for those at high risk (young children, the elderly and those with chronic illness) to seek medical care if experiencing acute respiratory illness.

Even if the "killer influenza" had been an extreme epidemic, the government was well advised to invest in basic health education. "Seasonal epidemics of influenza that have been documented in Antananarivo most likely also affect the highlands region of Fianarantsoa Province each winter, resulting in morbidity and mortality," the report notes. 

Sources: Based on WHO, press reports and afrol archives 

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