INTERVIEW: NHRI director calls for more flu preparations

Saying it may be impossible to keep H7N9 avian influenza out of Taiwan due to frequent cross-strait contact, Su Ih-jen, director of the National Health Research Institutes’ National Institute of Infectious Diseases and Vaccinology, warned in an interview earlier this month with the ‘Liberty Times’ (the ‘Taipei Times’ sister newspaper) staff reporter Jennifer Huang that a bigger outbreak may occur later this year if the strain spreads via migratory birds flying south for winter

Mon, Apr 22, 2013 - Page 3

Liberty Times (LT): This year marks the 10th anniversary of the outbreak of SARS in 2003 that resulted in more than 700 deaths worldwide. Now this year, we are seeing outbreaks of the H7N9 avian influenza virus in China. Experts have warned that there may be further developments of the virus affecting both animals and humans. What are your views on the current outbreak ?

Su Ih-jen (蘇益仁): The transmission of an avian influenza virus usually proceeds from migratory birds, to water fowls (ducks), to domesticated poultry (chickens) and then to domesticated animals (pigs) or humans. For example, the SARS virus in 2003 started in bats, before moving from civet cats to humans.

The outbreak of the H5N1 virus in 2005 also started with poultry. The global scare about the spread of the H1N1 virus in 2008 was caused by a virus that had its primary infection host in pigs (swine flu). This time the H7N9 virus came from migratory birds, spread to poultry and then went on to infect humans.

This virus type, capable of infecting both animals and humans, seems able to spread quickly and affect larger areas in Asia. This is because cohabitation between humans and animals is more common in Asia. Also, Asians eat almost all species of poultry and wild fowl, so there is a greater likelihood of an infection spreading from animals to humans.

LT: The nation’s health authorities have officially listed H7N9 avian influenza as a category five notifiable communicable disease, enforced inspection and monitoring measures at national borders and have prepared medical systems in preparation. Are these measures enough?

Su: Migratory birds are the origins of the infection and they are migrating north at this time. Therefore, China should monitor if the infection is spreading from its southern regions northward.

For Taiwan, we must pay attention to migratory birds when they fly south for the winter. It is feared that there may be an even bigger outbreak during winter this year and early next year. Therefore, our epidemic prevention measures and warning systems must expanded by then. With SARS, it was relatively easy to monitor infected individuals as all cases showed signs of fever.

However, for the H7N9 virus, individuals may only develop a fever one or two days after infection. The latency period is longer and the virus may be spread via saliva and mucous of the respiratory tract even before a fever is noticeable.

Therefore, we will not be able to completely block virus carriers by monitoring and surveillance at border control points. We all must be prepared that H7N9 infections may arrive in Taiwan at anytime.

The main function of activating monitoring and surveillance at border controls is to delay the virus from entering the country and allow us more time to prepare to fight an outbreak.

When we launch monitoring and surveillance at border controls, contingency plans and preventative measures ought be instituted.

LT: The SARS outbreak spread worldwide because China initially covered up news about infected patients. China also delayed reporting the H7N9 virus. Could Taiwan and Hong Kong succumb to the outbreak, despite having launched preventative measures? Are there other infectious disease to watch out for?

Su: Seven of the past 10 large-scale influenza outbreaks in the world originated in China. Although in 2008 the reported cases of the H1N1 virus first came from Hong Kong and Vietnam, the patients were infected in China.

Taiwan has lots of contact with China, much more frequent than 10 years ago. Just look at the tourism sector, there are more than 7 million Chinese visitors coming to Taiwan yearly. More worrying is the active cross-strait agricultural trade and poultry smuggling.

Therefore, to prevent a large-scale outbreak of H7N9, basic preventive measures, such as screening people at airports are not enough. We must also monitor the ‘small three links’ and cargo shipments, and be particularly on guard against the smuggling of poultry and agriculture products.

Also, whenever a major disease outbreak occurs in China, many China-based Taiwanese return to Taiwan in panic mode. As such, they could become another possible conduit for the latent transmission of the H7N9 virus. Therefore, the government is advised to prepare medicine for travelers who have to pass through infection regions in China. This would help ease worries and avoid panicked population movement between China and Taiwan.

LT: During the SARS outbreak, you took on the responsibility of heading the Department of Health’s Centers for Disease Control [CDC] and were in charge of combating the outbreak. Do you think the standard operating procedures set up in the past is still effective against this new virus outbreak?

Su: When I was at CDC in 2004, I prepared a plan to enable the development of our own vaccines against possible avian influenza outbreaks. The goal was for Taiwan to produce vaccines, so that we would not have to rely on imports.

The H1N1 influenza outbreak of 2008 marked the first time mankind won a battle against an unknown new strain of influenza virus. The WHO mobilized countries to combat the epidemic and coordinated with pharmaceutical companies to produce Tamiflu and vaccines.

That was also the first time that Taiwan developed our own vaccines, working with Adimmune Corp and other private sector companies to establish a government-certified development program for producing vaccines against the virus.

Looking at the H7N9 virus strain, Adimmune could expand human trial testing of avian influenza vaccines and could be able to convert human influenza vaccines into avian influenza vaccines.

LT: Do you think Taiwan’s prevention and control measures need to be upgraded? Any suggestions?

Su: Not only do we have to confront infections from abroad, we also have to deal with our own indigenous avian diseases. For example, in 2004, the low-pathogenic H5N2 avian influenza virus caused the deaths of a large number of chickens at poultry farms in central and southern Taiwan. The National Health Research Institutes (NHRI) has developed the world’s first human vaccine against the H5N2 avian influenza virus. It is to undergo clinical trials soon. This would provide Taiwan with the capability and experience to develop vaccines that could be expanded to counter all types of avian influenza virus.

With the H7N9 virus, once the WHO is able to verify and announce the virus strain, the NHRI can start developing a vaccine and then pass it on to Adimmune for mass production.

For Taiwan, we have the professional know-how to respond to the situation, from monitoring and medical treatment to the development of vaccines.

However, the biggest question centers on the country’s decisionmakers and whether they can efficiently implement preventatives mechanisms and mobilize resources.

Translation by Staff Writer Jason Pan