Sunday, November 11, 2007

article from 2004

I wrote this article for the newspaper scmp in 2004. Things have changed a bit since then. The first outbreak of bird flu (H5N1) took place in HK 1997, 10 years ago. There were 18 cases and 6 of which were found to be fatal. Between 2003 - present, there have been 334 cases and 204 deaths. 10 yrs ago, bird flu was fatal in 1/3 of it's cases, and now it's 2/3's. It has spread from China to Western Europe and Africa via migratory bird routes and legal or illegal poultry trade. Although people feel a sense of over-saturation with bird flu news, it is still persisting and spreading across the continents. In the next post I will cover the history of pandemic flu and why it's such a big deal.


Friday, October 15, 2004
The best antidote to disease

SHANTHI JAYAWARDENA

While we fear, and take precautions against, a bio-terrorist attack, nature seems to be taking a stand. Time and again, with its indiscriminate propagation of disease, nature has re-established the hierarchy and demonstrated the extent to which we are at its mercy.

In many Asian nations, the image of the mass slaughter of poultry has become an all too familiar sight. Last year, the world watched anxiously as Hong Kong, mainland China and Canada battled Sars. The disease left nations economically devastated and in a state of widespread panic. With commercial airlines crossing continents every hour, Sars spread across the globe in a matter of days.

It takes only one "good" virus to cause a pandemic. In the same vein, if one country cannot effectively contain and eradicate a disease, the rest of the world will be affected. The technology to control disease exists, but there is a lack of a consensual system of prevention. Outbreaks of bird flu, Japanese encephalitis and dengue fever continue. To take a lesson from Sars, a robust surveillance system, which includes standardised detection methods, can prevent or minimise an outbreak. With the looming threat of the H5N1 bird flu, there is a need to handle the virus before it becomes a pandemic.

The highly pathogenic strain has been found in nine countries, and has claimed 31 lives. At present, humans are not very susceptible. However, as the virus mutates, there is a risk of easy transmission to and between humans. Since its discovery in 1997, the strain has become more indiscriminate, manifesting its lethality in ducks, pigs, dogs and cats. Outbreaks of the H5N1 strain in Thailand last winter led to the culling of millions of fowl to prevent the potential risk to humans.

These outbreaks could be better controlled if we had systematic molecular diagnostics for disease in the veterinary sector. A more efficient system that sources the problem before it escalates is imperative. In Asia, a significant obstacle lies in the varied public health systems, infrastructure and resources. International conventions that standardise every aspect of disease detection are the only way to make a credible effort to reconcile the present discrepancies.

The UN Food and Agriculture Organisation and the World Organisation for Animal Health, meeting in Bangkok, concluded that bird flu is a crisis of global importance. They said that major investments are needed for surveillance, early warning, detection and reporting. They have published recommended tests for the detection of diseases such as influenza, and are promoting standardised diagnostic testing. The challenge is how to execute control programmes. These two bodies should take the lead in implementing the standardisation of molecular tests, beginning by evaluating and validating the system. Diagnostic methods that demonstrate speed, simplicity, accuracy and cost effectiveness can enhance the global surveillance of infectious diseases. In fact, such methods do exist. The limitations of developing nations should be taken into account; benefits such as trade advantages can encourage the use of standardised methods and, in the case of avian flu and the poultry industry, improve a country's reputation as a top food exporter.

The most recent victim of bird flu was Kanda Srileung-On, a nine-year-old girl from Thailand. She was diagnosed with the H5N1 virus only hours before her death. There have also been suspected cases of human-to-human transmission, and these took more than a week to confirm. There needs to be a greater sense of urgency on the surveillance front. Technology makes it possible to diagnose and confirm bird flu within 24 hours. In a crisis of global importance, there is a dire need to improve international surveillance and prevent a catastrophic outbreak.

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