Leadership and early strategic response to the SARS-CoV-2 pandemic at a COVID-19 designated hospital in South Africa

While many countries are preparing to face the COVID-19 pandemic, the reported cases in Africa remain low. With a high burden of both communicable and non-communicable disease and a resource-constrained public healthcare system, sub-Saharan Africa is preparing for the coming crisis as best it can. We describe our early response as a designated COVID-19 provincial hospital in Cape Town, South Africa (SA).While the first cases reported were related to international travel, at the time of writing there was evidence of early community spread. The SA government announced a countrywide lockdown from midnight 26 March 2020 to midnight 30 April 2020 to stem the pandemic and save lives. However, many questions remain on how the COVID-19 threat will unfold in SA, given the significant informal sector overcrowding and poverty in our communities. There is no doubt that leadership and teamwork at all levels is critical in influencing outcomes

Common Opportunistic Infections in HIV Infected Infants and Children : Part 2 Non-Respiratory Infections

Increased susceptibility to infections is the major cause of disease; end organ damage and death in human immunodeficiency virus (HIV)-infected children. This article will focus on prevention; diagnosis and management of the most common and less common severe infections that are specifically associated with HIV-related immune compromise; as well as some aspects relating to immune reconstitution inflammatory syndrome (IRIS)

Pertussis An update for general practice

Although there has been a global decline in the incidence of pertussis in the past four decades; the incidence has increased in developed countries; particularly in preteens; adolescents and adults. These groups provide a major reservoir of the disease for vulnerable unimmunised or incompletely immunised infants. This trend has not yet been documented in South Africa. In young infants; the diagnosis is made on the basis of clinical features. Older age groups do not usually show the typical clinical picture; leading to misdiagnosis and underreporting. The culture of Bordetella pertussis from the posterior nasopharynx remains the gold standard for diagnosis but laboratory diagnosis is complex and unavailable in most settings. Erythromycin; instituted early in the course of illness; remains the treatment of choice although there is now good evidence for the use of other macrolides; particularly in the neonate. Immunisation of young infants remains the best preventative methodagainst the disease. Due to the re-emergence of the disease in older age groups; developed countries are recommending booster vaccines in adolescents

Maintaining infants and children on highly active antiretroviral therapy

It needs to be emphasized that human immuno-deficiency virus (HIV) infection is not a curable disease and therefore highly active antiretroviral therapy (HAART) requires a life long commitment. This is why it is of paramount importance to ensure adequate preparation before HAART is initiated and to continue supporting the child and the caregiver/family throughout. Strict and non-wavering adherence is more important in the treatment of HIV than in any other infectious or chronic disease. This is clearly demonstrated by the fact that at least 95adherence is required to ensure an optimal virologic response in the majority of children. (Table 1) Achieving an optimal virologic response (undetectable viral load) is vital; as the development of drug resistance is far more rapid if this is not attained. Due to the rapidity with which resistance may develop; treatment failure is always a concern and careful follow-up is required to ensure treatment