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Preparedness will help avert bird-flu tragedy

The H5N1 avian influenza virus first began spreading through Asia in late 2003. In light of four of its major epidemiological characteristics -- high pathogenicity, rapid spread and inter-species transmission, as well as human fatalities -- the world's infectious disease specialists and public health professionals began to focus attention on it, and predicted that it is unlikely to disappear in just one or two years.

In the face of the new challenges, vaccine production and the implementation of a pandemic influenza-preparedness plan are two important tasks.

The situation with the H5N1 bird flu virus this year brings to light a few obvious points:

First, the virus has expanded its geographic range continuously.

Second, the number of human cases and deaths have continued to rise, especially in places where the virus has not been initially recognized. These places are the most likely sites where an accelerated spread might occur.

Third, the fatality rate among reported and hospitalized bird flu patients has remained above 50 percent.

Fourth, the number of species infected by the H5N1 virus has also risen.

Most importantly, both waterfowl -- seen as the traditional reservoir of the virus -- and pigs have both become infected by a new strain of H5N1 avian influenza.

In addition, the virus' mutations are making it more complex. And if migrating waterfowl carry highly pathogenic strains of the avian influenza virus, this could easily lead to its rapid spread and an international pandemic. Under such conditions, the risk that a simple mistake could spark an even more rapid transmission among humans requires more attention.

After an outbreak in Indonesia last month spread quickly to Burma, India and Bangladesh, European health ministers became anxious. They watched as a new strain of the H5N1 avian flu virus spread north and west, from the Qinghai region in China across Mongolia and Siberia.

Sure enough, Romania reported its first outbreak on Oct. 8, followed by Turkey the next day. Asia's H5N1 virus had spread to continental Europe, bringing with it the danger of an avian flu pandemic.

Over the last few days, US President George W. Bush has made numerous public statements that his government is working hard to make sure the country is prepared for a possible bird-flu pandemic.

In Taiwan, during the outbreak of SARS in 2003, our medical and public health system took quite a battering. Therefore, after the threat had dissipated, infectious disease experts teamed up with the Center for Disease Control in July 2003 to come up with a plan to combat influenza.

The plan included stockpiling antiviral drugs, making free vaccines available to veterinarians and livestock farmers, and boosting research into vaccine development. The government also held an avian flu drill yesterday to ensure that emergency response measures are in place should there be an outbreak.

As there is a strong possibility that the virus could enter Taiwan through migrating waterfowl, illegally imported animals or infected individuals, it is important to educate the public about the issue.

First, it is important not to touch any dead wild birds and to inform local animal-health disease control authorities as soon as possible if any are discovered.

Second, if anyone you know is experiencing severe respiratory symptoms, you should advise them to immediately put on a face mask and seek medical assistance.

Lastly, people considered to be in high risk groups should be vaccinated prior to the flu season.

It is also important that government agencies cooperate and abandon the divisions of the past.

First, the Immigration Office should improve its computerized management operations system, including keeping tabs on people traveling to and from areas where avian flu has been reported.

Second, the government should tell airlines and people working in the hospitality industry how to identify bird flu, and what to do if they come into contact with it.

Third, they should increase the rewards for uncovering smuggling, and ensure that the public knows that illegally imported livestock are likely to pose a public health threat.

Fortunately, at this point transmission of the avian flu virus to humans has been limited.

If we remain on our guard, we will be able to evade a catastrophe.

King Chwan-chuen is a professor at the Institute of Epidemiology in the College of Public Health at National Taiwan University.

Translated by Eddy Chang and Paul Cooper
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