Cases of fatal atypical pneumonia have recently appeared in neighboring countries, and now the disease seems to have surfaced in Taiwan as well. This is a matter about which the public should be vigilant. "Atypical pneumonia" is an all-encompassing term for many different types of pneumo-nia. It stems from the era when microbiology was still in its infancy and people knew only that typical bacteria like diplococcus, streptococcus and staphylococcus could cause pneumonia. Other cases of pneumonia with no obvious cause were sweepingly referred to as atypical pneumonia.
We now know that atypical pneumonia results from many different causes, including mycoplasmosis, chlamydia, legionnaires' disease, influenza virus, parainfluenza virus and adenvirus. Research indicates that 30 to 40 percent of children's atypical pneumonia is caused by mycoplasmosis while 10 to 20 percent of such cases are caused by chlamydia.
The majority of remaining cases are caused by viral infections. These infections are all quite benign. Although the symptoms are more serious than a typical cold, they rarely result in death.
The media reports on cases of fatal atypical pneumonia are quite unusual because the mycoplasmosis and chlamydia we are familiar with are rarely fatal, and while legionnaires' disease may lead to serious pneumonia in the elderly and those with compromised immune systems. The news from abroad indicates people in their prime have also been severely affected. The evidence thus implies that the current epidemic is not caused by any of the above-mentioned pathogens.
If this indeed is not one of the commonly seen "atypical" pneumonias, then there are two possibilities. First, it may be a previously unknown bacteria or virus. Second, an influenza virus may have mutated radically and become a new kind of virus. The probability of a new type of bacteria or virus suddenly appearing is very low. Moreover, in Hong Kong a new strain of H5N1 influenza virus recently appeared, so we must pay extra attention to the possibility of a new form of influenza virus.
In general, H5N1 influenza virus infects only birds, so there is no need to worry about it spreading to humans. But prior experience shows human influenza virus will occasionally mutate radically and cause a pandemic. These mutations that cause pandemics are all related to avian influenza. The most commonly seen phenomenon is that a portion of the avian influenza virus genes recombine with those of human influenza, creating a new virus capable of infecting humans of all ages and resulting in many deaths.
The most serious such pandemic occurred between 1918 and 1919. It is estimated that at least 21 million people around the world were killed by virulent influenza in that period.
Most of those who get avian influenza have close contact with infected poultry, resulting in their being infected by too much of the virus and becoming sick. In the 1997 epidemic of H5N1 avian influenza in Hong Kong, for example, there were a total of 18 confirmed cases, of whom six died. Research showed that the majority of cases were people in close contact with poultry, and in general, cases were not clustered in families.
Recently in Hong Kong it was also H5N1 avian influenza that appeared, but this time infection has been clustered in families. Even medical personnel have been infected, so we must pay attention to whether this kind of avian influenza virus can be spread between people. In other words, the question is whether or not it has already mutated into a kind of human influenza virus.
In the face of this wave of atypical pneumonia, the first priority should be to pinpoint the cause of the disease. If it is confirmed that patients are infected with mycoplasmosis, chlamydia, or legionnaires' disease, antibiotics like Zithromax will cure them. If it is adenvirus or a parainfluenza viral infection, then patients can fully recover by receiving general supportive treatment.
If medical authorities suspect a new form of influenza virus, especially one that tends to infect multiple members of a family and even infects medical personnel, they should use the anti-influenza medicines Amantadine and Oseltamivir as soon as possible.
In the meantime, people should avoid going to areas like China, Vietnam and Hong Kong where reports of an epidemic have emerged. If cases are confirmed to have appeared in this country as well, then regardless of what is causing the atypical pneumonia, it is certainly being transmitted though the air. Prevention measures are the same as for the common cold -- avoid crowded places, maintain healthy living habits, wash hands frequently and improve personal hygiene.
It is particularly important to note that airborne pathogens can also be spread by direct contact, especially if one rubs one's nose after one's hands have come in contact with the virus on a sick person's body.
In response to the current epidemic, health authorities must mobilize immediately. Ideally, they should establish a crisis-response group. Apart from strengthening their monitoring of the epidemic at home and abroad, key response measures must include formulation of a strategy to deal with a potential epidemic. If the pathogen is something that has never been seen before, it will be necessary to formulate a strategy for monitoring the situation as well as principles to quarantine and treat patients.
If the pathogen is found to be a new form of influenza virus, then apart from the above strategies, health officials must be dispatched abroad immediately to bring back the vaccine-production technology because as soon as a vaccine is developed, each nation with such technology will give priority to the inoculation of its own citizens. Taiwan would be unable to obtain vaccine immediately. In addition, plans for stockpiling and usage of anti-viral medicines should be carefully mapped out and principles of treatment should be instituted.
Lee Ping-ing is an associate professor in the department of pediatrics at National Taiwan University Hospital.
Translated by Ethan Harkness
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