National Institute for Communicable Diseases (NICD)

2012-11-19

The fresh team ready ready to take the step for a day of 

learning at the NICD

We met Lucille Blumberg and Pieter de Jager at the NICD at 1 Modderfontein Rd in Sandringham, Johannesburg.  A typical government facility with many different buildings all spread out over a large leafy area.  Lucille gave us a very interesting lecture on Malaria and the South African Malaria Control Programme.  It gave us as Capetonians interested in public health a much better understanding of the extent of the malaria problem and it’s complexity.  It was clear that specialists from different sectors all had to work together to tackle the continuous threat to health in the North Eastern region of our country.  Problems include the ruralness of the part of the country with malaria occurs, the type of houses, rains, marches and puddles, mosquito nets, pesticides used and its potential effects on the environment, residual spraying, types of mosquitoes and their feeding patterns, mosquito resistance to poison, malaria parasite resistance to treatment, access to health facilities, rapid testing, responsiveness of health workers once there has not been malaria in an area for a while, travellers and so on.  

Lucille Blumberg sharing her malaria wisdom

The John Frean gave us an interesting presentation on malaria immunizations and the progress, obstacles and limitations we are currently facing before a malaria immunization will make a significant impact on health and mortality in Africa.

Then we headed up to the Vector Control Reference Unit and met Lizette Koekemoer.  We had a brief discussion on what her job entails and then we went to the entomology / mosquito breeding area.  It’s a building with strict environmental control - temperature, humidity and even the day-night cycle to allow scientists employed here to study a mosquitoes’ day and night behavioural patterns all in their workday.  They test mosquitoes collected in the field for their susceptibility to commonly used malaria programme Pesticides.  They also breed mosquitoes with known pesticide susceptibility that can be used in the field to estimate whether residual spraying in households is effective.

The field trip team entering the insectary...

Lizette Koekemoer explaining the mosquito breeding
and pesticide sensitivity testing.

Muthei Dombo investigating the mosquito specimens

Malaria incidence in South Africa from 1972 to 2008.
The colourful squares indicate different pesticide and chemotherapy milestones

Megan Saffer, Mandla Mavimbela and Neil Cameron

 We visited the unit where polyvalent snake antivenin is produced for the most common poisonous snakes in South Africa and met Mandla Mavimbela Megan Saffer.  70 horses are kept at the facility and some have been used to produce the antivenin for 25 years.  Antivenin have a rack life of 3 years and are sold to health facilities and Zoo’s worldwide.

Jackie Weyers from the Centre for Emergency and Zoonotic Pathogens discussed outbreak responses for haemorrhagic fevers like CrimCongo, Marburg and Ebola.  We asked her questions about control, barriers contact tracing.  They have a P4 bio hazardous diagnostic laboratory and we had a look at the personal protective suits and laminar flow laboratory boxes.  The NICD lab is the only of its kind in the whole of Africa.  We also asked about the media interaction and the consternation that goes with the detection of haemorrhagic fevers as well as the personal stress of having to work with viruses in which the infected have an 80% mortality.

Lucille Blumberg, Barry Schoub, Neil Cameron

Barry Schoub gave us a capturing lecture on ‘The Polio end-game’ – the South African and international strategy to eradicate new polio infections.  He also highlighted the effectiveness of a good quality public health intervention like immunisations has on the devastating effect of infectious diseases on a population.

After the magnificent gourmet lunch we watched the documentary film; Kuru:  The science and the sorcery.  This is a fascinating and scary portrayal of the discovery and initial investigation into the strange disease that was first discovered in Papua New Guinea in the 1950’s. Michael Alfreds, a young Australian doctor, was so intrigued by the neurological disease that he decided to relocate to this extremely rural tropical jungle area to investigate the relationships and possible causative factors.  This lead to the discovery that it is transferrable to Chimpanzees, the entity later coined as prions and the links to the transmission of Kuru via cannibalism!  This is a must watch and could be quite disturbing for sensitive viewers.

Outbreaks investigations and responses are the core functions of NICD and therefore Juno Thomas spent 2 hours teaching us on the basics.  We had ample time for questions and they were answered from a point of great knowledge and experience.  A bunch of examples were used to bring home the point of the importance of an organized and well-planned response.

We moved outside for the late afternoons session and all placed our chairs on the grass outside the NICD main building.  Lucille Blumberg discussed reasons for surveillance and strategies with us before we had to give feedback on some potential public health exam questions that were given to us in the morning.  More rich and stimulating discussion venturing through all theoretical avenues, but always returning to the current reality in South Africa.

Fidele Mukinda, Gina Bernhardt, Julius Ayuk,
Shabir Madhi, Rosamund Southgate, Robin Dyers
and Ziyaad Essop at the social after the lecture.

We were privileged enough to be able to attend the James Gear Memorial Lecture that started at 18:00 in the James Gear lecture theatre.  Shabir Madhi gave us an fact filled hour-long lecture on the effectiveness of immunizations – the crux of his talk being that immunizing a pregnant woman can reduce the infant mortality rate by protecting the baby from influenza, viral pneumonia and subsequent secondary bacterial infection.  This could have a major impact on South Africa’s ability to get closer to reach the MDG’s.

What struck me about the NICD was the absolute essential role they can and have to play in an health care system.  Organizations like the NICD is a ship carrying an freight that a country like South Africa can not go without and I was very proud to know that there is a group of sailors and captains that in the last decade kept the ship afloat through some very heavy storms.  With the changes thats currently on the horizon and a new minister of health the NICD is bound to get closer to the role it should play in monitoring and preventing disease in our country.