New Immigration Policies Would Deal With Malaria:
By Quincy Parker -
The Ministry of Health is reviewing its policies with respect to requirements of immigrants from malaria endemic areas. That pronouncement came from Health Minister Dr. Bernard Nottage late Monday afternoon, though he did not elaborate.
Seven days have now passed since the identification of new cases of malaria. Each day with no new cases reduces the likelihood that transmission of the disease will resume, officials said.
The ministry held a press conference on Monday to announce the interruption of local transmission of "plasmodium falciparum" malaria on Exuma. "Falciparum," as the officials referred to it, is a potentially fatal strain of malaria, responsible for two million deaths a year, mostly in Africa.
However, officials said swift diagnosis and treatment would prevent serious illness. And in fact, none of the 16 identified cases grew seriously ill, and none died.
Health officials also sought to deal with the reports that tourists had contracted the disease. Press reports stated that a Canadian traveler and an American had contracted the disease. Dr. Nottage sought to clarify the information about the Canadian traveler.
"I am able to report that the person concerned is a Bahamian student who returned to Ottowa after spending a period of time in Exuma. The time he spent there corresponds with the time of the local transmission," he said.
Dr. Nottage said he spoke with the young man’s doctor, and he was apparently fine and attending classes. The other case, the American, was explained by the ministry’s Chief Medical Officer Dr. Merceline Dahl-Regis.
She said the ministry was informed that there was an individual who visited Exuma in early May, and was symptomatic when he was in Exuma. On May 24, he reportedly showed up at a US emergency room, suffering from malaria and another medical condition.
"This person has traveled, but according to the history (retrieved from the Centers for Disease Control), denied travel to any endemic areas," Dr. Dahl-Regis said.
Also, on the international publicity the cluster of malaria cases received, Dr. Nottage explained how the ministry got its message out.
"From the very beginning we have had the value of use of the Ministry of Tourism’s public relations firm, and they have been issuing information to the travel agencies," Dr. Nottage said.
"Additionally, we have been in touch with the (Centers for Disease Control) and others who have made inquiries, and we have asked the Ministry of Foreign Affairs to make the necessary contacts and make sure that the information coming from us is being widely disseminated."
Dr. Nottage explained some of the steps his team took to arrest the spread of the disease.
After identification of persons suffering from malaria on Exuma, a surveillance team made up of officials from the ministry and the Pan American Health Organization (PAHO) went door to door in a one-mile radius of where each malaria victim lives or works.
This phase of the ministry’s response to the first cluster of malaria cases in The Bahamas in at least 40 years is 90 percent complete, and Dr. Nottage reported that none of the people tested had contracted the flu-like illness.
As for how the outbreak started, PAHO’s regional malaria advisor reiterated that the Anopheles mosquito is not born with the "falciparum" parasite – it has to bite an infected human before it can infect anyone else.
"So the problem with malaria transmission is the problem of human beings infecting mosquitoes initially, and then those mosquitoes subsequently move on to (infect) persons, so we have the source being…most likely an imported case from an endemic country," Dr. Carter said.
Dr. Dahl-Regis explained the heightened surveillance efforts.
"First of all there was a review of all the log books from the clinics. Then there was inquiry from anyone who came to the clinic with a history of fever…and so we cast the net pretty wide in looking for possible cases," she said.
"In fact, to date we have interviewed or reviewed 600 possible (cases, including a review of) charts and spoken with individuals."
Dr. Nottage explained that 12 of the 16 malaria victims had recently contracted the disease – the other four were old cases. Of the 12 recent cases, nine were Bahamian, two were from Uruguay and one was from Haiti.
There is no malaria transmission in Uruguay, according to Dr. Carter. But while the disease is endemic to Haiti, Dr. Carter hastened to point out that there are 21 endemic countries in the region, with nationals who visit The Bahamas regularly.
Also, health officials were not sure that the rise in the number of cases was due to the disease spreading rapidly.
"I am not sure that we are speaking of (a rapid spreading) – we may have had a number of people infected who we had not detected," Dr. Carter explained.
"So I think what might be a fairer statement is that, having detected the first case, the Ministry of Health went ahead and started seeking cases, any possible source of infection and/or symptomatic person."
Among the ways the surveillance team sought the Anopheles mosquitoes was a technique the minister described as "human baiting" – officials from the ministry and PAHO sat out in the open, simply waiting for the mosquitoes to bite them.
"Results of these activities indicated that the Anopheles population is extremely low and non-existent in most of the surveyed locations. These findings are consistent with increased vector control activities in the form of fogging and larviciding conducted by the (Department of Environmental Health Services) after the report of the (first) case," Dr. Nottage said.
21 June 2006