After SARS and bird flu, Asia wary of new virus

After SARS and bird flu, Asia wary of new virus
Mon Apr 27, 2009 7:16am EDT

By Tan Ee Lyn

HONG KONG (Reuters) - Asia battled SARS and H5N1 bird flu in 2003 and has improved its health infrastructure but there is a wide gulf in how prepared countries in the region are to fight swine flu.

Countries around the world have moved to contain the spread of a possible pandemic after a new swine flu outbreak killed 103 people in Mexico. Twenty cases have been identified in the United States and six in Canada, with no deaths reported.

Possible cases are being checked as far afield as New Zealand.

"With SARS and H5N1, there was a lot of impetus to improve preparedness in many countries in Asia, but there is still a huge variation in preparedness," said Malik Peiris, a virologist and professor at the University of Hong Kong.

Densely populated cities in developing countries such as China or India would encounter major problems, said Guan Yi, a Chinese virologist at the University of Hong Kong who helped fight SARS and bird flu and trace their sources in the past.

"If it goes to China or India, where populations are very dense and infrastructure is not enough, there will be many problems," Guan said. "We are counting down to a pandemic."

Health experts are also worried about impoverished countries such as Laos, Cambodia and Myanmar, which have rudimentary public health systems, meaning a delay in reporting cases and risking the spread of outbreaks.

Since SARS and H5N1 swept through Asia in 2003, governments around the region have beefed up disease surveillance systems, built hospital isolation units and maintained stockpiles of Tamiflu, a drug that appears effective against the new virus.

However there are still big discrepancies between countries.

While many dead birds found in Hong Kong are routinely tested for diseases like H5N1, that would be hardly be possible in sprawling countries like China or India.

NEW LABS

Sophisticated laboratories have been set up in Hong Kong and even Indonesia, which has four such facilities. In Thailand, there are flu monitoring systems in place in the countryside, a legacy from battling H5N1.

However, experts are jittery because such facilities are scarce and there are many questions surrounding the new virus.

"Indonesia has prepared a system in case of a flu pandemic. But there is something I am not certain of, the early warning, reporting and action system," said I Gusti Ngurah Mahardika, a virologist at Udayana University in Indonesia.

"The laboratories and government research institute are of course ready, but the question is, do the rest (in the country) have the early diagnostic (systems) already?"

"I am trying to find out about the H1N1 that spread in Mexico and California, why is it new? How is it connected to swine?"

Thailand strengthened its pandemic preparedness after an initial slow response to bird flu in 2003, and health experts say it now has a "robust" surveillance system, improved laboratory facilities and better training.

Health Minister Witthaya Kaewparadai said 14 medical centers were capable of tackling an outbreak of swine flu. Another six mobile units were on standby to handle remote outbreaks.

"It will take us four hours to verify suspected cases," Witthaya said, adding Thailand had enough Tamiflu stockpiled in the country to treat 300,000 patients, and the government drug maker can produce more if necessary.

(Additional reporting by Olivia Rondonuwu and Telly Nathalia in Jakarta, Darren Schuettler in Bangkok; Editing by Nick Macfie and Dean Yates)


Thomson Reuters 2009 All rights reserved

Fourteen people in Auckland are now being treated as having swine flu with another 31 suspected cases nationwide.

At a press conference in Wellington this morning, health officials said there were now 12 people from Rangitoto College who had tested positive for Influenza A - one more than last night. They believed all 12 had swine flu.

It also emerged this morning that two Auckland travellers, who had returned to New Zealand on US flights, were also being treated for swine flu after testing positive for Influenza A.

Officials said while World Health Organisation swine flu tests in Melbourne had only been completed on three swabs sent from the Rangitoto College party – all three had come back positive. Therefore they believed the rest of the group, plus the two Auckland travellers, also had swine flu.

"We are assuming from the results of Melbourne that everyone in that group... were positive for swine flu,” said Auckland Regional Public Health Service (ARPHS) clinical director Dr Julia Peters.

"We just have to accept as if it is [swine flu]. We can't get all the results, we just have to prioritise," she added.

All those that have tested positive for Influenza A will be tested for swine flu. Tests are still being conducted in Melbourne, but it is likely swine flu testing will shift to ESR labs in Wellington in the coming days.

Health Ministry deputy director general Dr Fran McGrath said a new case definition had also been introduced, which reduced the time someone was considered susceptible after visiting Mexico or North America from two weeks to one.

Meanwhile, Dr Peters hit back at reports the Rangitoto party was to blame for bringing swine flu into the country.

"They should not be blamed for that. We should be thanking them and their families for co-operating..."

She said some of the infected Rangitoto College pupils - who had completed 72 hours of Tamiflu treatment - would be allowed out of isolation as they were no longer infectious.

"When they are released from quarantine, [we need to] accept that they are not infectious, they are cured. We need them to go back to school without questions being asked."

There were no other probable cases outside Auckland as yet but 31 people around the country had been tested for Influenza A and were suspected of possibly having the illness. They include 10 people in Nelson, eight in Christchurch, four in Hutt Valley, two in Taranaki, five in Waikato and another five in Auckland. At least 179 people are in isolation nationwide.

Meanwhile, two women with suspected flu symptoms were detained by health officials after arriving at Auckland Airport this morning.

An Auckland Regional Public Health Service official said the two arrived on a Qantas flight from Los Angeles early this morning.

They have been taken to Middlemore Hospital and will be tested for swine flu.

Thousands of New Zealanders may have been exposed to the deadly swine flu virus because of a three-day delay in alerting health boards to potentially infected people.

The swine flu virus has killed close to 150 people in Mexico and infected dozens in the United States, Canada and Europe. Spain's health minister has confirmed a second case of swine flu, while Israel also confirmed one case.

As confirmation of the outbreak emerged, the Government faced criticism for its response to the crisis.

Officials have admitted they did not send swabs taken from the 11 pupils for testing till Monday night, missing a flight to Melbourne because of delays in packaging the samples.

The Government has now moved from trying to contain the outbreak to attempting to minimise it.

Another member of the school group tested positive for influenza A yesterday.

Rangitoto College principal David Hodge said most of the school party, which visited Mexico on a three week trip, had recovered with only one student, who already suffered from asthma, still unwell.

He said he was shocked at the test results, "even though it was a possibility''.

But Auckland Regional Public Health officials said the families of the swine flu-infected had taken the news well.

Officials did not plan to update New Zealand's health alert code from "yellow" to "red" following the positive results. The result merely confirmed that it had been "sensible for us to have been cautious", Public Health Director Mark Jacobs said.

Dr Jacobs said the general public did not need to worry as officials were working to contain the spread and those with confirmed swine flu had so far experienced mild symptoms.

"There is no indication it is any more or less contagious than any other form of influenza,'' he said.

It was most contagious a day before symptoms appeared and up to seven days after. The greatest risk was in the early days.

All but 18 of the 356 people on board flight NZ1 have now been contacted, offered Tamiflu and been asked to stay in voluntary home isolation.

Auckland doctor Jim McVeagh, who works at a private accident and medical clinic, said everyone should have been contacted immediately it became apparent passengers had symptoms of the deadly swine flu.

Dr McVeagh treated a patient on Monday from the same flight as the infected pupils. She had rung Health Line and been told to visit her doctor "one of the most spectacularly bad pieces of advice" he had heard.

"I am hoping this isn't a big deal, because we've probably already missed the boat with containment. I think the Health Ministry has been a bit tardy, a bit relaxed."

Reports of the outbreak began emerging from Mexico on Thursday. But there were no plans to screen passengers arriving from North America till the Rangitoto pupils showed symptoms.

Auckland Regional Public Health clinical leader Julia Peters defended the response time, saying health authorities could not act till they knew what they were dealing with.

"As soon as we got a provisional diagnosis we swung into action and began contacting people ..."

She said test samples were not sent to a specialist lab in Melbourne before Monday because they required special preparation and packaging.

The Health Ministry's emergency planning co-ordinator, Steve Brazier, said initially Auckland authorities were doing all the contact tracing. "However, when the size of the task was appreciated on Monday a decision was made to refer potential cases from Flight NZ1 to regional public health units around the country to follow up in their area."

The Government has upgraded it travel advisory warning to Mexico, warning of a high risk to health and advising against all non-essential travel.

Health Minister Tony Ryall dismissed criticism yesterday, saying the initial response had been rapid, thorough and appropriate for the level of risk at the time.

"This is a threat New Zealand has planned for. Many of the best people in the health service are working night and day to protect the health of New Zealanders."

The World Health Organisation has raised its pandemic alert level to phase 4, indicating significant increased risk of a pandemic a global outbreak of a serious disease.

-By ANNA CHALMERS, MICHAEL FIELD, KERRY WILLIAMSON, and RUTH HILL

Eerlijk gejat van Stuff NZ!

groetjes Om Kesas

BREAKING NEWS
World Health Organisation raises swine flu pandemic alert to 5 ... wine flu pandemic alert rises
Last updated 08:32 30/04/2009


LATEST The World Health Organisation has raised the pandemic threat level from swine flu to phase 5 as the virus spread and killed the first person outside Mexico, a toddler in Texas.

WHO Director-General Margaret Chan made the decision to raise the alert level from phase 4 - signifying transmission in only one country - after reviewing the latest scientific evidence on the outbreak.

"Things are moving fast," a WHO source said.

Nearly a week after the H1N1 virus, or swine flu, first emerged in California and Texas and was found to have caused deaths in Mexico, Spain reported the first case in Europe of swine flu in a person who had not been to Mexico, illustrating the danger of person-to-person transmission.

Phase 5 is the WHO's second highest level of warning that a pandemic, or global outbreak of a serious new illness, is imminent. Phase 6 means a pandemic has begun.

"It is clear that the virus is spreading and we don't see evidence of it slowing down at this point," Dr Keiji Fukuda, WHO acting assistant director-general, told a news briefing.

In Mexico, where up to 159 people have died from the virus and around 1,300 more are being tested for infection, people struggled with an emergency that has brought normal life virtually to a standstill.

Germany and Austria reported cases, bringing the number of affected countries to 9. US officials said a 22-month-old boy had died in Texas – the first confirmed US swine flu death – while on a family visit from Mexico.

NZ AUTHORITIES STEP UP MEASURES

Meanwhile, here in New Zealand the Ministry of Health says it is unlikely to get a result from the fourth flu sample sent to the WHO laboratory in Melbourne.

Genetic material in the sample was not of sufficient quality to obtain a meaningful result, the ministry said.

Four influenza A samples from Rangitoto College students who returned from Mexico last Saturday were sent to Melbourne, with three testing positive for swine flu.

That meant all those in the group were deemed to have contracted swine flu, which has been blamed for more than 150 deaths in Mexico.

The Government yesterday took steps that make swine flu a notifiable disease.

Following an update overnight, the number of swine flu cases here – all in the Auckland area – had reduced from 14 to 13.

One passenger who arrived in Auckland recently with flu symptoms had done so from Samoa, as opposed to Los Angeles as first advised.

There were now 96 suspected cases of swine flu, which included those who had returned from Mexico within the last seven days and developed symptoms.

They have all been tested for influenza A and will be tested for swine flu if those tests are positive. They are also being treated and have either recovered or are on the mend.

The Health Ministry said at least 10,000 people arrived here from North America each week and all were subject to screening.

Eleven people on a flight that stopped off in Auckland yesterday en route to Australia were taken to hospital, suspected of having the virus.

Five of those were in transit.

Health Minister Tony Ryall, said the Government had made an order-in-council making non-seasonal influenza a notifiable disease.

While health officials had all the powers they needed at present, this step would mean that there was now a process for notifying health authorities of swine flu.

"Secondly, it is now on the schedule for the Epidemic Preparedness Act, so if there's any need to bring in that Act it's much more straightforward," he said.

The Canterbury District Health Board has set itself up at Christchurch International Airport to help passengers from overseas that are unwell.

The Public Health Association (PHA) praised the response of health officials to the Mexican swine flu.

They had to tread a fine line between unnecessarily isolating people and making sure infected people do not pass the flu on to others, said PHA national executive officer Dr Gay Keating.

"Authorities have got the balance right, and have moved swiftly to prevent this influenza from spreading."

Dr Keating says health bureaucrats tend to get bad press, but an influenza outbreak such of this was a perfect example of how necessary their work was.

MARKETS OVERCOME JITTERS

Despite jitters, many global markets rose as traders sought hopeful signs through the gloom of the worldwide financial crisis.

Airline shares, which had fallen on Monday and Tuesday, rallied on expectations that the outbreak may not significantly crimp travel demand and US pork futures recovered on the Chicago Mercantile Exchange as health officials hammered home the message that there was no danger posed by pigs or pork products.

"The market doesn't seem to be affected by this too much," said Cleveland Rueckert, market analyst at Birinyi Associates Inc. Stamford, Connecticut.

"Swine flu makes a good news story, but to be honest doesn't seem it's been as bad as some of the press has made it seem to be."

In some places, however, it was already bad. Mexico's central bank warned that the outbreak could push the country deeper into recession, hurting an economy that already shrank by as much as 8 percent in the first quarter.

France said it would seek a European Union ban on Thursday on flights to Mexico. Argentina and Cuba have already stopped flights from Mexico.

The EU, the United States and Canada have advised against non-essential travel to the popular tourist destination, as nearly all the cases so far, in Canada, New Zealand, Israel and Spain, have been linked to travel from Mexico.

The WHO's Fukuda said the Spanish case – involving a person who had reportedly been in contact with someone who visited Mexico but not travelled there themselves – suggests the virus is spreading more easily among people.

"There are cases which are occurring in people who have not travelled," Fukuda told a briefing.

BIGGEST RISK SINCE 2003

H1N1 swine flu poses the biggest risk of a pandemic since H5N1 avian flu re-emerged in 2003, killing 257 people of 421 infected in 15 countries. In 1968 a "Hong Kong" flu pandemic killed about 1 million people globally, and a 1957 pandemic killed about 2 million.

The new strain contains genetic material from avian, swine and human viruses and appears to have evolved the ability to pass easily from one person to another.

It cannot be caught from eating pork products but Egypt ordered all its pigs to be slaughtered and some countries, led by Russia and China, have banned US pork imports.

Obama's newly confirmed Health and Human Services Secretary Kathleen Sebelius held her first news conference on Wednesday seeking again to reassure the public

"We are determined to fight this outbreak and do everything we can to protect the health of every American," she said, adding that work also move speedily on a vaccine, although some experts said this could be tricky.

The outbreak has deeply affected life in Mexico and ravaged tourism, a key earner. Mexico City was unusually quiet, with schools closed. Many parents took their children in to work.

All Mayan and Aztec pyramid ruins, dotted through central and southern Mexico, were closed until further notice.

Tourists and foreign students were hurrying to leave the country on Wednesday, fearing they could be stranded if the flu prompts officials to cut air links.

"We didn't want to get stuck here," said Alex Grinter, who left her Mexican beach vacation early to return to Australia.

Seasonal flu kills 250,000 to 500,000 people in a normal year, including healthy children in rich countries.

Health agencies advise frequent hand-washing and covering sneezes and coughs to help stop the spread. Experts generally agree that face masks, especially the surgical masks seen on the streets of Mexico City, offer little protection.

(according to STUFF NZ)