【新闻周刊】Africa: Fights Off the Flu

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Africa: Fights Off the Flu
http://blog.newsweek.com/blogs/internationalist/archive/2009/06/20/africa-fights-off-the-flu.aspx

Posted Saturday, June 20, 2009 11:52 AM By Andrew Bast

The World Health Organization recently declared swine flu a global pandemic, but to the bafflement of epidemiologists, the H1N1 virus has left an entire continent almost completely untouched. Of the world’s 35,000 confirmed cases, fewer than three dozen have occurred in Africa, which is home to more than a billion people. Global-health experts speculate the best reason for Africa’s relative good luck may be transportation patterns. So far the virus has seemed to hitch rides on international flights: transport hubs like New York and Sydney—which handle 100 million and 32 million airline passengers a year, respectively—are among the worst hit. Meanwhile, African capitals like Dakar and Abuja—which each see about 2 million passengers a year—have avoided exposure. Other scientists blame Africa’s subpar health system. There simply may be too few health officials to spot the influenza cases that do exist there, or doctors could be misdiagnosing swine-flu cases as more familiar maladies, like malaria. Yet even African countries with highly developed health systems, such as Botswana and Senegal, show no signs of the contagion.

One thing health experts know for certain: Africa shouldn’t let its guard down. The virus is mutating rapidly, with a new strain surfacing just last week in Brazil. That’s a sign of things to come, says Raul Rabadan, a biologist who has isolated 300 variants of swine flu so far. “That’s the nature of the virus,” he says. “It’s like any other living system. It is always evolving.” Even more worrying, the history of flu outbreaks suggests that the worst may still be ahead. The three major flu epidemics of the 20th century—1918, 1957 and 1968—all started with an initial assault that quickly subsided, only for the disease to later resurge in a more virulent and deadly form. If swine flu follows the same pattern, Africa—the place least prepared to deal with an epidemic—may bear the brunt of the second wave. While flu season in the north has ended, in the sub-Sahara it’ll reach its peak come July. The majority of countries there, unlike Botswana and Senegal, lack good public-health systems and may miss early warning signs of the germ’s arrival. And most of the population lives without day-to-day comforts—like air conditioning—that could stem the virus’s march. Up to this point, the WHO has performed admirably. But H1N1 hasn’t yet presented a real challenge for the global watchdog. In Africa, that test could well be on its way.