A “low-pathogenicITY” avian influenza (LPAI) H5N2 virus strain hit Taiwan for the first time at the end of 2003. Then, in August last year, a citizen reporter made a documentary exposing the epidemic in Taiwan. It has been almost eight years from the first occurrence of LPAI until officials admitted the existence of a “highly” pathogenic avian influenza (HPAI) H5N2 virus strain.
In 1983, Philadelphia experienced an outbreak of LPAI H5N2, as did Mexico in 1993. In both cases, after long-lasting epidemics in these areas, the LPAI H5N2 virus strains turned into HPAI H5N2 strains. This is why Taiwanese government officials took special caution when facing the challenges of the LPAI H5N2 outbreak from 2003 to 2004.
In Taiwan, former Centers for Disease Control (CDC) director Su I-jen (蘇益仁) not only started to work with National Taiwan University in monitoring anti-H5 antibodies in poultry slaughterers, but researchers even traveled to Kinmen to obtain serum samples from local disease control personnel who had been exposed to smuggled red-face ducks from China that were infected with the HPAI H5N1 strain. Luckily, all tests conducted for H5 antibodies were seronegative and nobody was infected with the H5 virus at that time.
It is very likely that HPAI viruses are zoonotic pathogens, that is, transmissible from animals to humans. These H5 viruses are still in the process of viral adaptation to human beings. This means that in future, more effort should be put into safeguarding against this H5 virus cross-spreading to other host species.
Infectious diseases among domestic fowl have huge effects on the economy. The head-in-the-sand approach is very common during the initial phase of an epidemic — when avian influenza viruses first start to spread — with the result that the potential threat to public health is ignored and action is only taken when the epidemic is already out of control.
The etiological agent, the LPAI H5N2 virus strain, responsible for the epidemic in Taiwan from 2003 to 2004, had a unique viral gene constellation that was detected only in this country. The two envelope proteins of H5N2 are hemagglutinin, which is responsible for viral entry into the host, and neuraminidase, which spreads out from the host and infects neighboring cells. Both of these derived from the H5N2 virus of the Americas. However, its six internal gene segments came from the H6N1 virus that has existed in Taiwan for a long time. Thus, we cannot just say that because H5N2 in other countries does not infect people that it will not infect people in Taiwan.
Final conclusions must be based on scientific data. Unfortunately, as a result of novel influenza A (H1N1) threatening the globe in 2009, hardly any government departments had the foresight to support research into H5N2. It would now seem that microevolutions in the virus are continuing, which is something academics have been worried about for quite some time. This is an issue that will definitely present some very tough challenges sooner or later.
Since Taiwan now has the huge responsibility of having to stop a pandemic influenza, the following blind spots and shortcomings should be taken care of as soon as possible:
First, laws clearly stipulate that when conferences involving experts on animal epidemics are held, at least one-third of of the participants must be experts on human influenza viruses or communicable disease epidemiology. This is so any possible chance of an avian influenza virus being transmitted to humans, or of human-to-human transmission, can be monitored and minimized. This is a law that needs to be followed.
Second, the new head of the Bureau of Animal and Plant Health Inspection and Quarantine must establish a syndromic surveillance system for animals within two weeks and set up a surveillance network for all avian species in Taiwan. Such a surveillance system has to be upgraded from passive to active surveillance and should be integrated with virological and serological surveillance systems to minimize any losses poultry farmers may incur in the future.
Third, bird owners and poultry farmers have to be stopped from giving their birds unauthorized vaccines or vaccines with poor quality-control if Taiwan is to avoid making the same mistakes Vietnam did.
Fourth, those taking part in avian influenza epidemic prevention, poultry slaughtering and any work related to animals on poultry farms that have experienced outbreaks of avian influenza H5N2 must all be tested to see whether they have anti-H5 antibodies so as to fully understand the possibility and magnitude of Taiwan’s unique H5N2 virus being passed on to humans. This is an area in which Taiwan must be especially vigilant.
Fifth, all health departments need to immediately start educating bird farmers and workers at live-bird markets on how to protect themselves to prevent any possibility of the H5N2 virus from adapting to the human population.
Sixth, the National Science Council should fully support research projects related to animal influenza viruses to help boost the number of self-equipped research capabilities in this field.
After the outbreak of HPAI H5N1 in 1997, Hong Kong’s academic community committed itself to scientific research and has thus become a major research center on animal influenza in Asia.
A government with a long-term vision, broadmindedness, commitment and power of execution is needed to quickly turn this crisis around and turn the situation into one where significant contributions to pandemic preparedness and prevention are made.
King Chwan-Chuen is a professor in the Institute of Epidemiology and Preventive Medicine at National Taiwan University’s College of Public Health and a consultant for the Taiwan Association for Promoting Public Health.
Translated by Drew Cameron
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