Wed, May 01, 2013 page8

• WHO insight key to fighting H7N9

  • By Wang Jen-hsien 王任賢
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  Taiwan and China are so close, and there is so much interaction between them, that the Taiwan Strait cannot alone prevent infectious diseases that appear in China from entering Taiwan.

  It therefore comes as no surprise that a human case of H7N9 avian influenza has now appeared in Taiwan, or that the infected person is a businessman who had recently returned to Taiwan from China.

  The patient is now being treated in the intensive care ward of a medical center.

  The patient went to a hospital after developing a fever a week after arriving in Taiwan.

  In view of his symptoms and travel history, the hospital notified the authorities, resulting in the patient being screened for the H7N9 virus, for which he tested positive.

  What this incident tells us is that immigration, customs and quarantine services are these days limited in their ability to screen and detect infectious diseases, and that, to a large extent, hospitals now play the role that immigration and customs once did.

  That is not to say that immigration and customs staff are not doing all they can.

  Modern air travel takes people from one place to another in less than a day and people may not display symptoms until well after they have passed through immigration, so how can airport staff possibly prevent diseases from entering a country?

  At the same time, we should applaud the efforts of hospital staff, whose vigilance safeguards the nation’s future.

  There is no evidence that the H7N9 virus can pass from one person to another yet.

  Among the thousands of people in China who have had contact with H7N9 patients, only two have exhibited flu-like symptoms, and tests showed that those people were not infected with the H7N9 virus.

  This data from China is very significant because in China, those listed as having been in contact with infected patients are defined solely as people who have visited the homes of patients and had contact with them there.

  Nobody who has had such close contact has been infected, never mind anybody else.

  However, in Taiwan, 139 people have been listed as having had contact with this one patient.

  Dealing with such a large number of people places a heavy burden on public health services and hospitals, so the nation’s approach to handling such matters needs adjustment.

  Although this illness cannot yet spread from person to person, we should still exercise caution regarding the possibility of infections taking place within hospitals.

  The WHO defines respiratory tract interventions, such as intubation, surgery, bronchoscopy, open sputum suction, first aid and autopsies as risky medical procedures, so hospitals must be on their guard.

  However, with regard to general medical care, the WHO believes, based on its research into H1N1 influenza, that wearing surgical masks provides sufficient protection.

  In other words, the WHO recommends that hospital staff handle people with influenza in the same way they would any other patient.

  So hospitals can be fairly relaxed when caring for people with mild symptoms. However, cases involving severe symptoms should not be taken lightly.

  If hospitals act accordingly, their burden will be somewhat lighter.

  It would be a good thing if the Centers for Disease Control could revise their guidelines for hospitals and infection control points based on the WHO’s most recent recommendations.

  It would not be wise to arbitrarily apply all the measures that were adopted to deal with the 2003 SARS outbreak, because doing so could spread needless fear among the public.

  Among the cases of humans infected by H7N9 in China, many do not seem to have had histories of close contact with poultry or other birds.

  There have been many cases in the provinces of Jiangsu and Zhejiang, but few in the north of China. These figures correlate closely with the fact that there have been more positive samples of H7N9 detected in poultry and the environment in Jiangsu and Zhejiang than in China’s northern provinces.

  This suggests that the possibility of the virus infecting humans from the environment cannot be ruled out.

  If indigenous cases of the H7N9 infection occur in Taiwan, it will be necessary to inspect and disinfect the areas in question, something Taiwan does not have a very good track record of doing.

  The type of environmental disinfection that may be necessary in this case may be a bit different from the kind of disinfection that has been done in response to previous outbreaks of contagious diseases among poultry, because while birds have not died, people are still living in the environment.

  A key point for the government to consider is how to choose disinfectants that are non-toxic, while still being effective.

  Like swallows in spring, when new cases of illness appear, they offer us new information and ideas.

  That does not mean that we should put old wine in a new bottle by doing exactly as we have in the past.

  We need to take the WHO’s most recent recommendations as the blueprint for drawing up a comprehensive plan.

  Let us bear in mind that Hong Kong handled its 2009 outbreak of A(H1N1) novel influenza entirely in accordance with the WHO’s recommendations.

  Wang Jen-hsien is president of the Taiwan Counter Contagious Diseases Society.

  Translated by Julian Clegg
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