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Monday, November 09, 2009
The following is a statement by the Minister of Health, Senator the Honourable Jerry Narace on Monday, November 9th, 2009:
"I wish to apprise the national community of the latest developments relating to Influenza A / H1N1.
A. Status Update
Trinidad and Tobago finds itself amidst what is described by WHO/PAHO as the second wave of the H1N1 2009 pandemic. The most recent epidemiological reports in our country indicate 215 H1N1 laboratory confirmed cases and five H1N1 deaths. Thus far males and females seem to be equally affected, while most of the cases fall within the 0-19 and the 20-49 age groups.
It is important to note that the persons who passed away presented with respiratory distress when admitted at the hospital and had serious underlying risk factors. Apart from these deaths, the rest of the H1N1 cases treated in our country were relatively mild and the persons returned to their normal activities within seven to ten days. This is consistent with worldwide trends indicating that 95% of H1N1 cases are mild and treated at home.
Generally, the groups which are at greatest risk of severe or fatal illness are pregnant women, children younger than 2 years of age and persons with chronic lung disease, including asthma, and other chronic diseases affecting the immune system. The obese are also among those at high risk.
We are continuing to appeal to high risk groups with flu like symptoms to seek medical attention and follow closely their doctor’s advice.
B. Vaccines
Lately one area of concern worldwide and also in Trinidad and Tobago is the availability, administration and safety of the H1N1 vaccines.
I wish to inform the national community that Trinidad and Tobago will be receiving the first batch of the H1N1 vaccines, comprising 50,000 doses, next week; to be precise, on November 16, 2009, following special negotiations with PAHO.
And I would like to extend our most sincere appreciation to PAHO/WHO for their cooperation and the support they have provided to us since the early days of the pandemic, and also in general, whenever their assistance was needed.
We have said before and I wish to reiterate now that vaccine administration will be conducted in a strategic manner. Therefore, the H1N1 vaccine delivery programme will follow WHO/PAHO recommendations, based on priority groups, comprising health care workers, pregnant women, children and high risk groups.
This first batch will be administered to health care workers, security officers and front line personnel at ports of entry. A second batch of 20,000 doses, which has been purchased directly from a private manufacturer in Europe by the Government of Trinidad and Tobago, will be delivered on the 17th of November. We also expect delivery of the rest 210,000 vaccines in the following weeks. A strategic plan towards their administration to population will be followed for all batches.
The Ministry of Health is confident of the efficiency of its immunization mechanisms, given that they have not only been strengthened, but also a clear implementation schedule has been set in terms of immunization. I will ask the Chief Medical Officer, Dr. Anton Cumberbatch, to speak to our immunization plans and explain the process.
A question dominating international media is whether the pandemic vaccines are safe. The World Health Organization has informed us that outcomes of studies completed to date suggest that pandemic vaccines are as safe as seasonal influenza vaccines. Side effects seen so far are similar to those observed with seasonal influenza vaccines. We should all recognize that any vaccine might have side effects, as any other pharmaceutical intervention. However, at all times, we need to weigh the risks against the benefits of each intervention. For the priority groups we have described above and based on all the scientific evidence that we have available today, it seems that the benefits of getting the vaccine far outweigh the risk of not being immunized.
I will kindly ask the Ag. Representative of PAHO/WHO, Dr. Gebre, to speak in more detail about the vaccines that we shall be receiving, their safety and efficacy, their side effects, testing and adverse events. The Chief Medical Officer will also comment on the vaccines’ licensing in Trinidad and Tobago.
C. H1N1 biosecurity
Ladies and gentlemen, the Ministry of Health, along with the Ministry of Agriculture, has also been investigating the incidence of H1N1 in food producing animals.
To date, thirty-seven outbreaks of pandemic influenza A H1N1 in food-producing animals, following exposure to infected people, have been reported to the World Organization for Animal Health; 34 in pigs and three in turkeys. Additionally, six pigs have tested positive for pandemic influenza A H1N1 at a state fair in the United States of America; further investigations are ongoing.
The disease in pigs was first detected in Alberta, Canada in April, and since then other outbreaks in swine have been reported in Argentina, Australia, Northern Ireland, the Republic of Ireland, Iceland, Norway, Japan and the United States of America. Approximately 10,000 pigs have been affected in these outbreaks and there have been 36 reported deaths in pigs worldwide.
To date there have been no reports of any H1N1 infections of pigs either locally or in the Caribbean.
The Ministry of Health has been monitoring food safety and wishes to emphasise that there is no food safety risk associated with H1N1.
For further advice about biosecurity and herd health, pig farmers should consult their veterinarian or the County Veterinary Officers of the Ministry of Agriculture, Land and Marine Resources.
The Ministry of Health and the Ministry of Agriculture, Land and Marine Resources will continue to monitor the situation in the swine population and will provide further updates. In fact, our collaboration is ongoing via the inter-ministerial and inter-agency committee on H1N1 response.
D. Patient confidentiality and stigmatization
Last, but certainly not least, I feel compelled to discuss with both the media and the national community the issue of patient confidentiality and stigmatization.
Oftentimes the media, in their eagerness to inform the public, report medical data of specific individuals, a practice which we have seen flourish lately in reporting alleged H1N1 deaths.
Both I personally and the Ministry at large fully respect the public’s right to be informed on important health matters. And we have made a considerable effort, especially in this pandemic, to report as early and as responsibly to the population as possible, and to provide several communication channels for the public to contact us and get information. However, we have never endorsed any practice compromising the patient’s right to confidentiality.
I would like to remind all the members of the media that a patient has the right to privacy with respect to his/her person and to information, such as is manifested in the following rights:
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The right to expect that every consultation or mention of your case is made discreetly and that there are no people present who are not directly involved in your treatment, without your consent.
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The right to have your medical file read only by those directly involved in your treatment or those who supervise its quality, and by other persons only with your prior written authorization or that of your legal representative.
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The right to expect that all communication and records pertaining to your treatment, including the provision for payment, are treated confidentially.
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The right to be provided with the isolation and protection that are considered necessary for your personal and biological safety.
The Ministry subscribes to these rights and urges the national community to also acknowledge and respect them.
When the media report on the death of a particular patient, for example, a person who has allegedly died from H1N1, which has been the case lately, there are a number of implications. Firstly, the patient’s right to confidentiality is breached. Secondly, inaccurate reports presenting persons as having died of H1N1 create unnecessary confusion and promote distrust in the population in the accuracy of reporting. Thirdly, and perhaps more importantly, they create stigmatization of the patient and/or the deceased’s family.
Not too long ago the family of a diseased complained that they were ostracized in their community due to an irrational and unfair, yet sadly very real stigma associated with H1N1. Even though we can understand the fear, this clearly shows a lack of knowledge of the dangers surrounding such circumstances. Moreover, this is not the way a compassionate, informed community should function. But most importantly, this is not consistent with the behaviour of a developed society. And so, I call on the national community to recognize that since we know that their fear is scientifically unjustified and just not right, members of all communities should desist from this kind of behaviour.
As we all strive towards preventing the spread of the disease, we should also strive towards preventing stigma. When stigmatized, people might be afraid to seek medical care if they are sick. Blaming people also takes time and energy away from important messages such as the importance of washing hands frequently; avoiding touching one’s mouth, nose, and eyes; and sharing in a workplace ethic that supports people staying home when they are sick.
All affected families deserve our compassion.
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No one’s to blame; H1N1 flu is a naturally occurring disease.
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Every one of us depends on others for support when dealing with an illness.
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The virus is entirely new, which means any of us could get sick and need community support.
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Additionally, an individual can not and will not infect anyone after the infectious period, which usually has a maximum period of transmission which can last up to 10 days.
Permit me to repeat to the national community, we need to show sound judgment and sensitivity at this time. Stigmatization of H1N1 patients is not only unscientific and unjustified, it is also insensitive, unfair and dangerous.
Thank you very much."
Senator the Honourable Jerry Narace
Minister of Health - Trinidad and Tobago
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