Wed, May 01, 2013 - Page 8 News List

WHO insight key to fighting H7N9

By Wang Jen-hsien 王任賢

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.

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