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GLOBAL: No A (H1N1) cases - reality or poor lab facilities?
08 May 2009 13:19:00 GMT
Source: IRIN
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DAKAR, 8 May 2009 (IRIN) - No Influenza A (H1N1) cases have yet been confirmed in Africa, causing medical experts to question whether this is due to good luck or the continent's lack of fully-equipped influenza testing facilities.

A (H1N1) cases have been confirmed in North and South America, Asia and Europe, but not yet Australasia or Africa, according to the World Health Organization (WHO).

"I'm very surprised there are no reported cases here yet – a lack of diagnosis capacity is one clear reason," said Kariuki Njenga, head of the Centers for Disease Control (CDC)-funded Kenya Medical Research Institute (KEMRI) laboratory in the capital Nairobi. "The risk we face from this is misreporting [of cases] and late detection of the infection…By the time we have discovered the disease has spread, it could be too late."

Suspected A (H1N1) cases were reported in Benin, Kenya and South Africa but when tested, all came out negative, according to the WHO.

As of 8 May, 2371 cases have been reported in 24 countries, according to WHO. The infection "may soon" spread to the African continent, the international health agency stated in a communiqué.

But WHO's Dr. Wenquing Zhang, a scientist with the Global Influenza Program, told IRIN he is not surprised at the lack of reported cases in Africa. "There are lots of countries with no reported cases – it is very difficult to say if cases are going under-reported in Africa or not."

"Diagnostic laboratory capacity in Africa is generally weak because until now, countries, partners and donors have not been serious enough about putting in place national laboratory policies and implementation plans," Giorgio Roscigno, head of diagnostic research non-profit Foundation for Innovative New Diagnostics (FIND), "This is set to change if health ministries tap into the funding that is out there."

The CDC Global AIDS Program and US President's Emergency Plan for AIDS Relief (PEPFAR) fund laboratory diagnostics as part of their global support to fight HIV, malaria and tuberculosis.

Diagnosis capacity

The UN has listed 11 laboratories in Africa with A (H1N1) diagnostic capacity, though doctors say there may be more. Countries include Algeria, Cameroon, Central African Republic, Côte d'Ivoire, Kenya, Madagascar, Nigeria, Rwanda, Senegal, South Africa and Uganda.

But Kenya's Njenga told IRIN his laboratory in Nairobi has not yet received the agent required to diagnose A (H1N1). As far as he knows, he said no other laboratories in Kenya have A (H1N1) testing capacity.

Identifying A (H1N1) involves carrying out a polymerase chain reaction or 'PCR' test on a throat swab, which enlarges DNA to help technicians identify a virus. The process requires a 'primer' to start DNA replication.

The WHO National Influenza Laboratory in Madagascar has not yet received testing materials from the US-funded Centers for Disease Control (CDC) because of cold-chain shipping problems, said a manager there.

But other reference laboratories in the capitals of Senegal, Côte d'Ivoire, and Nigeria are ready to test.

Delays in receiving testing materials are to be expected, said Njenga, given A (H1N1) is an emerging pathogen and current outbreak areas have been given priority to receive limited testing materials.

Poor testing facilities may mean more infections, said Njenga. In Mexico the first A (H1N1) case was misdiagnosed as Severe Acute Respiratory Syndrome (SARS) because the lab did not recognise the infection strain, he told IRIN. It was only reported correctly four weeks later once it had been tested in the United States - after the virus had already spread to the United States and Canada.

"In four weeks the virus can travel far and wide," Njenga warned.

WHO confident

Still, the WHO's Zhang said despite poor molecular diagnostic capacity, an A (H1N1) infection outbreak in Africa could be detected given international support to regional laboratories.

WHO supports laboratories in Senegal, Madagascar, Nigeria, Central African Republic, South Africa and Algeria through staff training and equipment.

"I am confident we will able to do reliable diagnostics of A (H1N1) in Africa. If infection broke out in a country with no testing capacity, it could be shipped out for testing, free of charge on WHO's bill," Zhang told IRIN.

Most African countries have signed the Maputo Declaration pledging to develop and implement national laboratory policies, build laboratory capacity as part of their primary healthcare strategy and set up integrated laboratory networks at the community, district, regional and national levels for quality assurance training and sending samples from one laboratory to the next, said FIND's Roscigno.

"If each of these levels is seen on its own it does not solve the problem, it has to be integrated across laboratories and across diseases ," said Roscigno. Ethiopia, Lesotho, Kenya and Uganda have come far with their policies already, he told IRIN.

Now African countries have a "powerful incentive" to expand existing molecular diagnostics capacity for HIV to cover emerging pathogens such as A (H1N1), Roscigno said. GAP and PEPFAR, with other donors, have strengthened diagnostics in 2000 African laboratories so far.

"HIV molecular diagnostic capacity is already there in many laboratories, so they can now build on this. The situation [for diagnostics] has never potentially been as good as it is now," said Roscigno.


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