Right Steps & Poui Trees


1 Comment

Births Fall in Jamaica in 2016…Because of #Zika Warning?

RJR birth decline in 2016 report - 4-5-17I heard the tail end of a report on RJR’s 5pm newscast yesterday (May 4, 2017), which said that there had been a significant decline in births in Jamaica last year. This seemed interesting in the context of the warning to delay pregnancy issued by the Ministry of Health (MOH) in January 2016, in advance of the country’s first confirmed case of the zika virus.

 

MOH warning to pregnant women 1-2016

During his Sectoral Debate presentation on May 3, 2017, Minister of Health Christopher Tufton tabled the first edition of Vitals, a new quarterly report published by his Ministry, which contains the following information:MOH reduced births 2016 chart

MOH reduced births 2016 text

(p.12, Vitals: Quarterly Report of the Ministry of Health – April 2017)

 

This 28% decline in the 4th Quarter of 2016 – nine to twelve months after the zika warning was issued – does on the face of it seem related to the warning. It certainly invites further study to understand how women and their partners responded to the warning and what part various factors, such as discussions and planning, increased use of contraceptives, access to abortion, for example, played in the subsequent decrease in births. It would also be interesting to compare this decrease in Jamaica with other countries which issued similar warnings. I also wonder whether there has been another recent year in which Jamaica has seen an annual decrease in births as large as 7.4%. (The RJR report mistakenly stated that the 28% decline was for the entire 2016, rather than only the 4th Quarter.)

Zika Update

The issue of Vitals also gives an update on the situation with zika in Jamaica up to the first week of April 2017:MOH zika update - Vitals 4-2017

It also reported on the cases of pregnant women with zika infections and the babies with suspected or probable cases of Congenital Syndrome Associated with Zika Virus (CSAZ).

There were 827 cases of notified Zika virus infection in pregnant women reported as at 10th April, 2017; 698 have been classified as suspected Zika based on the case definition. Of the 698 suspected cases, seventy-eight (78) have had positive PCR results confirming Zika virus infection. There were 170 notifications received regarding babies suspected as Congenital Syndrome Associated with Zika Virus Infection (CSAZ), 50 were classified as suspected cases of CSAZ (46 Microcephaly – 35 non-severe, 11 severe; 4 other congenital abnormalities). Three infants based on Pan American Health Organization/World Health Organization were classified as probable cases of CSAZ.

(p. 17, Vitals: Quarterly Report of the Ministry of Health – April 2017)

There is obviously more to be said about the cases of babies suspected to have been affected by the zika virus, including why the numbers were fewer than initially feared, how the cases of microcephaly compare to previous years in number and severity and how the programmes to support the babies, their mothers and families are proceeding.MOH Vitals 4-2017

Vitals – A New Publication by the Ministry of Health

 

When he introduced the new publication during his Sectoral Debate presentation, Minister Tufton said that he hoped it would be a source of information and a tool for accountability.Tufton sectoral debate presentation 3-5-17 Vitals

I welcome this new quarterly report and think that it can indeed be a useful source of information about a variety of topics that are part of the remit of the Ministry of Health. I hope, however, that it will be easily and widely available. I found the link to it on Minister Tufton’s Twitter account. Up to the time of publishing this blog post, it wasn’t available on the MOH website or via the Jamaica Information Service website. I hope it soon will be.

 

 

 


Ministry of Health Jamaica: 6 weeks of #zika numbers

On July 5, the Ministry of Health (MOH) in Jamaica began posting updates on its website regarding the number of zika cases. The first update was for data as of June 25, 2016 and since then the MOH has posted a further 6 updates, the most recent of which was posted on August 8 and contained the numbers up to August 5, 2016. All 7 updates are currently available on the MOH website, but for easy review I have included the chart below:

MOH zika updates June 25 - August 5 2016

One of the questions which remains for me is why there have been so few confirmed cases, given the steadily increasing numbers of reported and suspected cases. It would be useful for the MOH to publish data regarding the number of samples submitted for testing, the number of tests completed and the outcomes of these tests.

It would also be useful for the MOH to make public any reports on any problems being experienced with the testing that has been and is being done. I had asked some time ago, for example, about a doctor’s comment on having heard from two sources that a lack of a reagent had been hampering the testing of samples.

Sloper on FB

Dr Tufton had said via Twitter that he would check on that report. I haven’t heard an update from Dr Tufton on that reported lack of reagent, but it is entirely possible that I missed his update.

I heard CMO Dr De La Haye saying on a radio programme this morning (Nationwide News Network) that routine testing of all pregnant women could cost as much as J$100 million. If such an expenditure is being contemplated, it would be good to have an assurance that the process would be reliable.

The zika outbreak and its impacts continue to unfold, and the provision of information continues to be an important aspect of the government response.

 


Jamaica: Increased #Zika Numbers & Some Questions

I wrote about zika on Tuesday (July 5) and here I am writing about it again, primarily because I heard Minister of Health Christopher Tufton talking with journalist Cliff Hughes on his programme on Power106FM yesterday, and there was some updated information that caught my attention.

Minister Tufton MOH photo

Minister Tufton

Cliff Hughes NNN photo

Cliff Hughes

Additionally, some other questions and concerns have been milling around in my head for a while, and I thought I would transfer them from brain to blog.

 

Ministry of Health Zika Update, as of July 1, 2016

At the beginning of the interview, Minister Tufton shared that his son now has zika, with mild symptoms so far, and he reiterated that the World Health Organization (WHO) projection is that approximately 70% of the population will get zika. He also noted that the majority of zika cases have mild symptoms, with approximately 1% being severe.

The updated figures for zika that he gave stood out for me, particularly the number of pregnant women with suspected zika infection, which was significantly higher than the figure he had given at the Ministry of Health (MOH) press briefing two days before. This sent me to the MOH website, but I didn’t seriously think I would find the new data there. O ye of little faith! The website had been updated today, and there was a document entitled Zika Update as at July 01, 2016. (Is a trend in posting regular updates now underway? That would be good.)

The following  changes are reflected between the June 25 & July 1 reports:

  • Number of notifications                      – from 2825 to 3088
  • Number of suspected cases                – from 2135 to 2183
  • Number of confirmed cases               – from 24 to 26
  • Number of suspected cases in pregnant women    – from 88 to 142
  • Number of notifications for GBS      – from 42 to 53

The most striking change was the reported number of suspected cases of zika infection in pregnant women, which had gone from 88 to 142.

MOH zika in pregnant women 1-7-16

Minister Tufton said it is expected that there will be cases of zika-related microcephaly in babies born later this year. With the first confirmed case of zika in Jamaica being in late January, it is thought that such cases may affect some babies born in September and beyond. He reminded that not all babies born to mothers who have had zika are affected by microcephaly, though he gave a possible figure of 10%. He said that the hospital system was being prepared for this eventuality and that counselling was being and would be provided to pregnant women.

MOH GBS 1-7-16

Speaking about the cases of Guillain-Barre Syndrome (GBS), the Minister told Cliff Hughes that not all cases of GBS require treatment in Intensive Care Units (ICU), but that there have been some severe cases requiring ICU care. He said that during a visit he made to Kingston Public Hospital (KPH) this week, there had been 2 or 3 patients with GBS in ICU there.

Some Questions for the Minister

 

 

 

In speaking with Mr Hughes, Minister Tufton indicated that he and others at the MOH were committed to handling the zika outbreak with transparency, having learned lessons from the handling of the chikungunya epidemic in 2014. He said:

Jamaicans need to know what they are confronting, what the risk factors are and what they need to do in preventing and, if they can’t prevent, how they need to follow up…We shouldn’t hide anything from the public; we should go out of our way to explain to the public the issues at hand. – Minister Tufton (transcribed from recording of interview with Cliff Hughes on Power106FM, July 7, 2016)

The MOH has been providing more information about zika than it did for ChikV and the Minister certainly seems to be committed to providing such information. With that in mind, I ask the following questions:

Blog questions 1

blog question zika

blog questions 2

(Click for copy of MOH Zika-update-of-as-at-July-1-2016)

 

 


3 Comments

Jamaica: #Zika Update…On the Ministry of Health Website, No Less!

Christopher-Tufton-WebListening to the news at midday today, I heard a report of an update given by Minister of Health Christopher Tufton about the current situation with the zika virus here in Jamaica. As the news report was read, I madly tried to scribble down the figures being given…number of reported, suspected and confirmed cases, etc. I was particularly interested in the number of pregnant women reported with suspected cases of zika. I thought I heard 88, and began to comb the news sites online and on social media to see if I could track down the figure. No luck. I was about to send Minister Tufton a tweet or to call Power 106 to see if I could speak with someone in their news room.

And then I decided to check the Ministry of Health website, though I had little hope of finding any current figures there, based on past experience.

Eureka! Look what I found! A downloadable, written document entitled “Zika update as at June 25, 2016“, posted on the website today, July 5, 2016! Hallelujah!MOH zika update 25-6-16

 

Seriously though, this is a significant development in keeping the public informed, that on the same day the Minister gives an update to the media, a document containing the figures is posted on the MOH website. I sincerely hope that this is the beginning of a trend.

The full document (3 pages long) is available on the website and I have included it here: MOH Zika-update-of-as-at-June-25

Of particular note are the general update regarding number of cases, with 24 confirmed cases as of June 25, 2016:

MOH zika cases 25-6-16

and the number of pregnant women with suspected cases of zika:

MOH zika and pregnancy 24-6-16

Providing reliable, easily accessible official information to the public on a regular basis is essential during a public health situation such as this.

 

 

 


Jamaica: #Zika, Guillain-Barre Syndrome & Information

NNN GBS news report 21-6-16On Tuesday evening (June 21), Nationwide News Network carried a report of a speech given that day by Minister of Health Christopher Tufton, in which  he gave current figures for cases of Guillain-Barre Syndrome (GBS) in Jamaica.  Minister Tufton stated that 30 confirmed cases of GBS have now been identified in Jamaica (this year?) and that the majority of the current cases are Zika-related. (Nationwide’s report is available online & contains audio clips of the Minister.)

This is a significant increase in the number of cases of GBS over the figures given by Minister Tufton during his press conference 3 weeks ago, at which time he also said that none of the GBS cases identified had yet been linked to zika infection. (In an earlier blog post, I dealt with that press conference: Jamaica: Ministry of Health #Zika Virus Update – June 2, 2016.)

Minister Tufton also referred to the cost of treating GBS and the pressure being put on the public health system by the increasing number of cases of GBS.

“A confirmed case of Guillain-Barre costs or is costing in the public health system to treat 1.5 million Jamaican dollars. If we have had 30 cases confirmed to date – do the math – 1.5 million…you are talking about 45 million or so.” – Minister Tufton

I checked the Ministry of Health (MOH) website to see if anything has been posted there about these increased numbers or a copy of the Minister’s speech, but unsurprisingly there is nothing (yet). JIS re AgroGrace products - 6-16And Jamaica Information Service’s (JIS) article about the speech focuses entirely on the launch of the Agro-Grace products (which look interesting), saying nothing about the increased numbers of GBS.

 

So I am grateful to Nationwide for covering the story.

 

Nationwide News’ GBS Discussion

In their discussion about GBS that evening, Nationwide had two guests – Mr Reid Buckley and Dr Karen Webster. Mr Buckley shared his experience with GBS, which he developed in October 2014, following bouts of flu and chikungunya. He detailed being hospitalized with what was initially thought to be a stroke, but because the paralysis affected both sides of his body, the doctor treating him suspected GBS, did an MRI and, with the symptoms getting progressively worse, transferred Mr Buckley to the University Hospital, where he was admitted to the Intensive Care Unit (ICU). Mr Buckley said that the immunoglobulin needed for his treatment was not readily available in the island at the time and when tracked down at one supplier,  his family was faced with the cost of J$1.6 million for 5 days of treatment.

Mr Buckley spoke about losing his ability to speak, stand, sit, swallow or eat and described the pain he experienced as severe. He said that he immediately began to feel better once the treatment started, but that it took a long time to recover, and that he needed a lot of physiotherapy during that time. He says that he is now 99% recovered, but still occasionally feels some tingling in his toe.

Dr Karen Webster, National Epidemiologist at MOH, said that there is a spectrum of GBS and Mr Buckley seems to have had a severe form of this rare condition. She said that many viral infections can have GBS as a complication; it wasn’t particularly described as being associated with chikungunya, but it has been so described for zika. She noted that with the current outbreak of zika, it is estimated that Jamaica may eventually have between 350- 400 zika-related cases of GBS.

Because of this association, from 2015 the MOH has acted to procure adequate supplies of immunoglobulin needed for treatment of GBS and to increase the numbers of functioning ventilators, which are needed when GBS affects breathing. Dr Webster said that there are adequate supplies of immunoglobulin and the aim is to have 80 treatments in stock at any one time; more would not be kept, as the immunoglobulin has a short shelf life. She said that it is expected that there would be no more than 5 cases of GBS in the peak week of the outbreak. She also said that most of the people who have had GBS this year have responded very well to the immunoglobulin treatment and have recovered quickly. In response to host Cliff Hughes’ question about cost, and whether people who couldn’t afford the expensive treatment would simply have to die, she indicated that the treatment can be accessed without cost, once GBS has been diagnosed.

Concerns have been expressed since the beginning of the year about the capacity of our health facilities to deal with any significant increase in the number of GBS cases that might result from the zika outbreak. As recently as last week, I heard such concerns being expressed again.

GBS tweet Prof Holness 23-6-16

Weekly Epidemiology Bulletin Posted on MOH Website

When I was trying to find out if  the information about the increase in GBS cases was posted on the MOH website, I noticed that the Weekly Epidemiology Bulletin produced by the Epidemiology Unit of the MOH is again being posted on the website. MOH Bulletin linkOn June 16, most of the bulletins for 2016 were posted; none for May or June had been posted as of today. The posting of such material as this, already being produced by the MOH, makes a great deal of sense, and I hope to see more of this kind of routine proactive posting of information.

It was interesting to note that the first two bulletins for 2016 acknowledged the likely outbreak of Zika in Jamaica, with the first bulletin highlighting microcephaly and the second highlighting GBS.

MOH Epidemiology Bulletin EW2 2016

I remain concerned that it is not easy to access some types of information about public health situations on a real time basis  in some central online space. I know that there are problems associated with doing this, but every effort must be made to provide such information in a timely, permanent, accessible format. Access to Information Act timelines are not sufficient in a time of an active outbreak or other developing public health situation. Provision of data 30, 60 or 90 days later may have an impact on people’s ability to make fully informed decisions for themselves, their families or communities.

I again acknowledge the availability of MOH representatives to the media and their willingness to share the up-to-date information they have. Public health information is also being communicated via broadcasts and publication in the press. However, continuing efforts must be made to deal with the gaps where they exist.

More Information About GBS


1 Comment

Jamaica: Ministry of Health #Zika Virus Update – June 2, 2016

Last week Thursday morning (June 2, 2016), the Ministry of Health (MOH) held a press briefing to give an update on the current situation regarding the zika virus outbreak in Jamaica. Minister of Health, Dr Christopher Tufton, made an initial statement and was supported during the question and answer session  by MOH Permanent Secretary, Dr Kevin Harvey & Chief Medical Officer, Dr Winston De La Haye. Also participating in the briefing was Dr Noreen Jack, PAHO/WHO representative in Jamaica.

moh 2-6-16

L to R: Dr De La Haye, Minister Tufton, Dr Harvey

Dr Tufton first gave his statement, the text of which can be seen on the MOH website, but he and others gave additional information during the briefing. He has also posted the link to his Periscope video of the briefing on his Facebook page. (The video does not contain the entire briefing; however, it contains a substantial amount.) Below is some of the information given during the briefing.

Ministry of Health Zika statistics as of May 29, 2016

  • 1969 notifications
  • 1387 notifications fit the case definition for suspected zika
  • 465 suspected cases in Kingston & St Andrew
  • 405 suspected cases in St Catherine
  • 787 samples tested
  • 403 test results received
  • 16 positives for zika, with lab test confirmation
  • 6 additional preliminary positives now being retested
  • 2 pregnant women have tested positive
  • all 16 positive cases have fully recovered

Dr Tufton said that 16 confirmed cases doesn’t reflect the reality on the ground, which is why the MOH is also giving the numbers of suspected cases at this time.

MOH zika briefing 2-6-16 Tufton ab

The MOH is also investigating clusters of people with rash that is suspected to be zika; these reports are coming primarily from the parishes of Kingston, St Catherine, Westmoreland and Clarendon.

Microcephaly & Guillain-Barre Syndrome (GBS)

At the briefing, an update was given on the two main complications of zika infection which have been of concern to the MOH, as they have been to the global community – microcephaly and GBS.  So far there have been no confirmed cases of microcephaly or GBS linked to zika virus in Jamaica.

Microcephaly

  • 1 case of microcephaly reported; on investigation  found to be negative for zika. Woman would have become pregnant before zika reported in island.
  • Dr Harvey noted that there is no baseline data for microcephaly in Jamaica, as it is not a reportable condition.
  • MOH is now going back and doing docket searches to establish a baseline.
  • The head circumference of all babies born in medical facilities is now being measured.
  • MOH will be monitoring carefully, particularly from September onwards, which will be 9 months since first confirmed case of zika.

GBS

  • 7 cases of GBS are currently being managed; 3 at Spanish Town Hospital, 3 at Kingston Public Hospital (KPH) & 1 at University Hospital of the West Indies (UHWI).
  • Results as at June 1, 2016 showed that the patient at UHWI and 2 of the patients at Spanish Town Hospital are zika negative.
  • Since start of 2016, MOH has been actively searching for cases of GBS. So far 13 investigated, 6 of which also tested negative for zika.
  • Dr Tufton cautioned that a negative zika test does not absolutely rule out zika association, due to the short window of 3 to 5 days for testing.

Going Forward: The 2nd Phase of the Outbreak

During the second phase of its activities, the Minister indicated that there will be more focus on pregnant women and their partners, as well as those who develop severe complications such as GBS. The MOH will continue “to engage the population and stress the importance of taking personal responsibility.”

Among the activities listed were the following:

  • Employing 1000 temporary workers to support the public health team in engaging in island-wide community vector control and public education activities.
  • Hosting island-wide education sessions working through agencies such as the Social Development Commission, Neighbourhood Watch and the police to get to communities.
  • Continuing the monitoring of pregnant women at the community level throughout their pregnancies including providing them with educational support.
  • Providing 20,000 bed nets over six months to all pregnant women who visit antenatal clinics; these nets have been obtained with the help of Food for the Poor.
  • Carrying out Vector Control activities through ‘fogging’ and larvicidal activities.
  • Conducting heightened House to House Surveillance in sections of the population where the infection has been notified and/or confirmed.
  • Working with the international partners such as PAHO/WHO/CARPHA/CDC to ensure that MOH actions are aligned with international standards and best practices.

moh ps harvey 2-6-16Dr Harvey noted that reporting of zika cases is currently a manual process, but that the MOH is working on a web-based form, which it intends to roll out in a couple of weeks. moh dlh 2-6-16Dr De La Haye indicated that some doctors have said that they find the form long & that a review is underway. He also reiterated that the MOH doesn’t wait for confirmation of zika cases before it takes action, but acts on reports of suspected cases. He said that some doctors have indicated that they are seeing as many as 20-25 cases of zika per day.

One question from a reporter was whether there has been a decrease in the number of pregnancies, given the MOH advice to women earlier this year to delay pregnancies. Dr Harvey responded that what is counted is births, and so any such decrease could only be noted later in the year. (Dr Tufton had indicated earlier in the briefing that there are approximately 40,000 births annually in Jamaica.)

moh who rep 2 2-6-16

The Olympic Games in Brazil

In response to a question, Dr Tufton said that the MOH did have concerns about our athletes going to the Olympics and continued to monitor the international debate regarding postponement of the games, though not a part of such discussions. He said that the MOH would be proactive in ensuring that athletes and supporters were given appropriate information and support, and that they understood the risks. On their return, people would be monitored for zika symptoms.

Dr Jack added that at this point WHO advice is not to stop the Olympics. She said that 60 countries have active zika transmission and that the risk of visiting Brazil is no greater than visiting any other country with active transmission. She said that current advice is that pregnant women not travel to countries with active zika transmission; others may travel, but are advised to take the recommended precautions to prevent being bitten by mosquitoes. It is advised that people are monitored for symptoms on return and that they abstain from sex or have safe sex for a month to prevent sexual transmission of zika.

(Last week a WHO spokesperson said that the Emergency Committee on zika will discuss concerns about zika and the Olympic Games at a meeting in June.)

Dr Tufton said that he will be giving a report on zika to Parliament on Tuesday,  June 7 and will give additional details during that report.

 

PS: Live Coverage of Media Briefing 

On the morning of the briefing, I called both the Jamaica Information Service (JIS) and the Public Broadcasting Corporation of Jamaica (PBCJ) to find out if either would be carrying live coverage of the event. I was very disappointed to find out that neither agency planned to do so.

I certainly appreciate the live coverage that did take place:

  • Minister Tufton carried the briefing live via Periscope on his Twitter account: @christufton
  • Jamaica News Network (part of the RJR Group) carried live coverage on television & online
  • Power106FM interrupted their regular programming to carry part of the briefing live.

It is not acceptable, however, that a public health briefing of this nature and importance was not carried live by either of the government broadcasting agencies.

 

 


2 Comments

350 Words Or Less: Where Are We With #Zika Outbreak in #Jamaica?

Last night I was very puzzled when I took a look at PAHO/WHO’s Zika – Epidemiological Update  for April 28, 2016. These updates are posted weekly on their website.

paho who zika alerts page with border

PAHO/WHO Epidemiological Alerts and Updates

In the section on Incidence and Trends, the April 28 Update had the following about Jamaica:

paho who update 28-4-16 jamaica border

paho who update 28-4-16 jamaica A with border

Where exactly do we stand in terms of the Zika outbreak in Jamaica? This report seems to be saying that the outbreak here began in October 2015 (EW 39), when there was one reported suspected case. The highest number of suspected cases (162) was reported in the first week of February 2016 (EW5), with decreasing numbers of suspected cases susequently. Is this pattern agreed by the Ministry of Health (MOH)? If so, what does this mean in terms of expected incidence of zika? And if not, what does the MOH say about where we are in terms of the outbreak?

The number of suspected cases I have mentioned are taken from an interactive graph on the PAHO/WHO site. Pointing to each bar in the graph  gives the number of confirmed and suspected cases reported for that week.  PAHO/WHO interactive chart of suspected & confirmed Zika cases 

 

 

paho who interactive chart 28-4-16 update with borders

Unfortunately the MOH website doesn’t provide any such data. In a situation as rapidly changing as the zika outbreak is, it isn’t acceptable that the Ministry’s website isn’t being updated regularly in respect of this and other viruses (dengue and H1N1 influenza in particular) now circulating in Jamaica.

MOH representatives, including Minister Tufton, CMO Dr De La Haye and Director of Health Promotion and Protection Dr Copeland, seem to be readily available to the media, and are often heard giving updates. They share data about samples for testing and confirmed cases, etc. But this data is not posted to the website, where it can be accessed in more permanent form. The MOH website should be the go-to source for this kind of information.

NB As of today, there are still only 8 confirmed zika cases for Jamaica. But how many suspected cases are there? You can find a news report on Irie FM, for example, but not on the MOH website.

irie fm zika 5-5-16 copeland

Enter a caption