20 countries in Africa have reported infections with the new H1N1 virus:
- Cape Verde
- Democratic Republic of the Congo
- Ivory Coast
- South Africa
Deaths have been reported in Egypt (1) and South Africa (4).
Egypt is of especial concern because there are ongoing outbreaks of the H5N1 outbreak in humans. Thus, there is the potential for co-infection of individuals with both viruses, possibly leading to a reassortment or recombination event that could lead to a new “hybrid” virus. Such a virus might possess dangerous combinations of the parent viruses, ie, it might spread like the new H1N1 and kill like H5N1.
There are nearly 2,000 confirmed cases of infection with the new H1N1 virus in South Africa. The four deaths include a 15 year old boy from Bloemfontein, a 23 year old pregnant woman from Durban, a 42 year old paramedic in Somerset West and a 22 year old University student from Stellenbosch. The presence of a pregnant woman and a health care worker among these four is significant. There is considerable evidence indicating that pregnant women are at increased risk for severe disease and death from the new H1N1 virus. There have been anecdotal reports of people in the health professions who have died, including a news story from Argentina indicating that 10% of the deaths there were among health care workers. South Africa’s cases of pandemic flu continue to rise.
Many Africa-watchers expect that the pandemic may be particularly harsh on this Continent for two reasons. First, many Africans have other diseases, most notably, HIV/AIDS. Although we do not know what the case fatality rate is for the new flu in individuals with HIV/AIDS, it is reasonable to predict that it may be higher than in people with normal functioning immune systems. Second, access to health care is quite limited for most Africans. There is substantial evidence that people who do not receive prompt medical care are much more likely to die of the new H1N1 virus than those who do. Most African countries are too poor to afford a sufficient supply of Tamiflu to treat their people. They are also unlikely to obtain much vaccine in a timely fashion. Thus, most Africans will face the pandemic without any of the modern tools of biomedical science.
Those who advocated unrestricted movement of the infected via airports may soon see the results of their “Let-it-Spread” philosophy on people without access to the same level of medical care that they enjoy.