Blood donation in post-Ebola West Africa

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Copyright: James Meiring. Winner HIFA Photography award 2016

What do wellington boots drying in the African sun have to do with blood donation in the post-Ebola era? Tell you later.

But first, as its World Blood Donor Day on June 14th, lets consider the differences between the blood transfusion services in a high income country like the UK with those in Nigeria or Sierra Leone? How has the Ebola epidemic impacted on these services?  

Blood transfusion services in the UK

I think we in the UK probably take our well-established national blood service(s) somewhat for granted and only really give it a second thought when either we need to call on its use or something drastic goes wrong.

Established in 1946, the Blood Transfusion Service (BTS) in England and Wales employs over 6000 people to collect & process the blood alone. All sorts of rules and practices surround the preparation and distribution and use of that blood. We are very fortunate that over 3% of people in the UK donate that blood (1% being the figure recommended as a minimum by the W.H.O. to meet a populations needs) but even then we get regular appeals for more blood and we still suffer shortages for particular blood groups and platelets.

But, have you ever asked yourself why we need continuing fresh donations of blood and who are the usual recipients of that blood?

In 2014, in England & Wales, the 3 major “consumers” of blood were:

  • 67%, to treat medical conditions including anaemia, cancer and blood disorders
  • 27%, in surgery, including cardiac surgery and emergency surgery
  • 6%,   to treat blood loss after childbirth

The most frequently transfused patient group is over 65 years of age.

100% of the blood donated is voluntary. This is important, as the W.H.O. has declared that the foundation of a safe blood supply is 100% voluntary donation. Blood obtained this way has lower rates of infections and so reduces chances of disease transmission via blood or blood products.

How does this compare with a blood transfusion service in West Africa ?

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Finding a balance between equality and safety in blood donation: the 12 month ban for MSM donors

 Blood-732297_1280 image: Give Blood.
creative commons CCO

Our guest blogger this month is Harpur Schwartz, an economics/global health student from Connecticut College, USA.  Harpur is interning with Cabi’s Global Health team, learning how information resources can support public health education programmes.

World Blood Donor Day 2016 [June 14th] is quickly approaching, and this year’s theme will be “Blood connects us all”. The goal is to motivate regular blood donors to continue to give blood while motivating new blood donors to start by showing how patients and donors are connected. With the current blood donation crisis, the worry is people do not understand that they qualify to donate. To clear up any blood donation confusion, many countries like the UK have provided specific guidelines [blood donation rules] for who can give blood. Donors have to wait only four months after getting a tattoo or piercing to give blood and a mother only must wait six months after giving birth. Gay and bisexual men [men who have sex with men] who used to face a lifetime ban in the UK, can donate blood if they have not had sex with another man for at least 12 months. This 12 month rule came into force in 2011 in the UK but has only recently done so in the USA (December 21st 2015, FDA revises donor deferral guidelines). It is the reason why many people in Orlando USA, anxious to donate blood to help their injured friends, are not able to do so (Gay Blood Donation Ban Under Fire in Wake of Orlando Shooting).

I have always been interested in how society is responsible for defining disease, and how once a person is labeled as having a certain disease, it frames their very being. In one of my university classes, we discussed how ‘Disease as framed’ is the way in which a person’s image changes as a result of disease. The example we discussed was AIDS and gay men. With the current blood donation policy, my question is if gay men are still being discriminated against because of their association with HIV and AIDS, or if the policy is based on sound evidence?

There has always been a stigma attached to the gay population in regards to HIV and AIDS, mainly because this was where the disease was first identified. [The story of the discovery of the AIDS epidemic is chronicled in the 1993 film “And the Band Played On”. Attitudes began to change in the USA when Mary Fisher delivered her speech, “A Whisper of AIDS”, at the Republican National Convention that took place in Houston in 1992. As a white female, and mother of two, Mary became a new face for HIV and AIDS. She was not a haemophiliac, she was not gay, she did not inject drugs, and yet she still tested HIV positive. Fisher explained to the world how “…HIV asks only one thing of those it attacks. Are you human?”

The gay and bisexual community are still unhappy with being treated differently. A 12 month ban does not take into account if they practiced safe sex, or have been in a committed relationship for 10 years with the same man. However, the 12 month ban policy is based on research evidence and is supported by numerous countries including the UK, the US, and Australia.

 

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Five more bird species that can spread Lyme disease identified in USA

By Miroslav Djuric, DVM, CAB International, Wallingford, UK.

Lyme disease or Lyme borreliosis is the most prevalent arthropod-borne disease of animals and humans in the temperate regions of the northern hemisphere1. Risk of infection in humans is primarily associated with occupation (e.g. forestry work) or outdoor recreational activities.

BIRDS-LYME

Recent surveys show that the overall prevalence of Lyme disease may be stabilizing, but its geographical distribution is increasing. There are foci of Lyme borreliosis in forested areas of Asia, north-western, central and eastern Europe, and the USA. According to the CDC, Lyme disease is the most commonly reported vector borne disease in the United States. It is most commonly diagnosed in the northeast and upper Midwest, especially Wisconsin and Minnesota. However, Lyme disease is spreading geographically, especially into Virginia and the southeastern United States. The CDC estimates that about 300,000 Americans are diagnosed with Lyme disease each year, afflicting sufferers with flu-like symptoms. If not treated with antibiotics, the infection can cause inflammation of the joints and it can affect the heart and nervous system.

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Accurate and timely communication is key to stopping transmission of Ebola

Ebola on TDB
Ebolavirus: coverpage for CABI's print journal Tropical Diseases Bulletin

Ebola brings out the worst and the best in mankind.

Global coverage of the Ebola outbreak in West Africa began with (the best) courageous foreign health care workers (HCWs) being flown home by their governments in a desperate attempt to save their lives, and rapidly moved on to the sheer panic amongst the local populations experiencing the outbreak: riots, health care workers and government officials abandoning their posts (the worst). Somewhere imbetween mention was made, usually by the foreign HCWS, of their local colleagues left behind who struggled on without resources and personal protection (the best).

Medicin Sans Frontiers highlighted the slow response of the international community.

Misinformation, public panic and stigma

Ebola haemorrhagic fever (caused by different ebola virus strains) has been around since 1976, with regular self-limiting outbreaks, usually in remote areas of one country. Index cases always involve some contact with animal reservoirs (bushmeat (wild animal meat), bats, rodents, monkeys), and its then spread by person-to-person transmission through contact with bodily secretions or with objects contaminated with secretions. It’s infamous for its high case-fatality rate and the ease with which it spreads among contacts of the diseased.

What makes this time different is the Zaire strain has now reached West Africa: there  it has spread from remote regions into highly populated urban areas, and it has crossed borders so that there are escalating outbreaks in 3 adjacent countries (Guinea, Sierra Leone and Liberia), with no end in sight. The epidemic (for that is what it is now), has resulted from sustained person-to-person transmission.

Cases have also been reported in Nigeria and Senegal but these countries seem to have contained the transmission of the virus. DR Congo  has an outbreak.   An up-to-date Ebola Healthmap can be found here.

Ignorance and fear, drivers of disease

Misinformation among health workers and the public fuelled panic and contributed to the spread of Ebola-zaire over the last 6 months.  HCWs abandoned their posts or were the source of rumours that created riots, government officials got out whilst they could. [The index case for Nigeria, was an official who left Liberia, who knowingly had had contact with an Ebola victim].

Fear has not just caused civil breakdown.  It is masking the magnitude of the outbreak, especially in Liberia and Sierra Leone. Families fear stigma so hide sick relatives or consider the hospitals as death sentences (breaking relatives out!) or indeed consider them the cause of the illness in the first place. Cases being cared for outside hospitals do not enter the statistics.   

Unlike the “Black Death” in medieval Europe, it’s not lack of real clinical knowledge that’s the problem but:

  1. Weak health systems, lacking skilled HCWs and resources
  2. Lack of knowledge amongst the general public
  3. Lack of community involvement & mistrust of government
  4. Misinformation among health workers, ministries of health and the public
  5. Lack of effective drugs and vaccines…supportive therapy only is current medical response.

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Handwashing: harnessing the yuck factor to improve public health

The recent E. coli O104:H4 outbreak has set us thinking about handwashing again. (We've tackled it before in  Now wash your hands)

It’s very difficult to change people’s behaviour  and to prove my point,  just watch this video
Do Shocking Images Change Hygiene Behavior”.  The video refers to a study from University of Denver "Using a relevant threat, EPPM and interpersonal communication to change hand-washing behaviours on campus" which found that making you feel awful about what might be on your hands works better than appealing to the conscience.

But as well as “yuck” factor signs which seem to work on the Denver students,  I wondered what else could be done..

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