Irish Health speaks about bird flu

Flu pandemic threat–it hasn't gone away

By Niall Hunter-Editor

Public concern about health threats and scandals tends to wax and wane according to their popularity in the media. One week it may be infected beef and vCJD, another week nursing home charges, another week organ retention controversies or another week A&E trolley problems.

While public focus and debate on bird flu and the threat of a pandemic has waned a little in recent months, it remains a very real threat. So what can be done and is being done about the threat of bird flu in humans coming to Ireland, or worse still, the virus mutating into a strain trhat would cause a pandemic, leading perhaps to thousands of deaths?

An clinical expert on infections diseases working in Dublin says that the Government could do more to communicate information to the public and [rimary care doctors on how we will deal with an Irish outbreakof human bird flu or a flu pandemic.

Dr Jack Lambert, infectious diseases specialist at Dublin's Mater and Rotunda Hospitals, said that while the Government had done a good job in terms of making preparations for a pandemic and in terms of stockpiling antiviral drugs, there is a gap in terms of communications.

"There is a gap in terms of information provided by the Government to the general public and primary care doctors, who would be in the firing line, and it would be helpful to improve that."

Dr Lambert said more information material needs to be made readily available by the HSE on influenza and avian flu. "While there is excellent work being done there is a need for better and more communication."

Dr Lambert this week is addressing a conference organised by the IBM corporation in Ireland on the preparedness of business for a flu pandemic. IBM has recently published a contingency plan assessment in preparation for a possible pandemic.

He said that as regards the Government preparing for a pandemic, one can never do enough. He said our Government would rank highly among EU countries in terms of the amount of the antiviral drugs it has ordered.

"However, it has to be asked whether you can just leave all of this in the hands of the Government. Others need to become part of the solution, including large corporations, the hospital system, the army etc. Corporations with large workforces need to come on board and say we have a plan."

Dr Lambert said large companies who do not want to have a large amount of their workforce out of work would have to have strategic plans in the event of a flu pandemic.

"While the Government here has done a good job there is a need for a public/private partnership."

Dr Lambert said that while he could not put an exact figure on it, there would be significant illness and mortality from a flu pandemic in Ireland.

He said the antiviral Tamiflu would be effective in shortening the duration of viral infections and in reducing complications in a pandemic, but the major issue would be getting it to the people most at risk and delivering it quickly.

An effective vaccine against pandemic flu cannot be developed immediately, and it would take six to 12 months after an outbreak to develop an effective vaccine, Dr Lambert said.

He said he believed that a flu pandemic would occur.

Dr Lambert said the danger was that the current avian flu virus could combine with the human flu virus and cause a similar catastrophe to the previous flu pandemic of 1918, when up to 40 million people died worldwide.

The 1918 pandemic, he said, was probably caused by a bird flu virus mixing with a human flu virus.

So what is the current situation as regards the avian flu threat?

The avian influenza H5NI strain was first described in animals in Hong Kong in 1997. More recently, it crossed the species barrier to infect some humans who have come into contact with sick or dead infected birds.

To date, the disease has killed around 140 people, mostly in Asia, with some cases in Africa, and there has been a total of just over 240 human cases reported. To date in Ireland, there have been no reported cases of avian flu in birds nor have there been any cases of the bird flu virus in humans.

Most experts agree that the dreaded mutation of the virus will occur, thereby causing a probable pandemic, but it cannot be predicted when this will happen.

According to the World Health Organisation (WHO), there have been more human cases of H5N1 recorded in 2006 than in any previous year, since the first cases were recorded in 2003.

Health authorities here have in place a plan to deal with a possible flu pandemic, with preparations being made at national level by the National Pandemic Expert Advisory Group.

According to Dr Anna Beug, of the Expert Group, and Dr Derval Igoe of the Health Protection Surveillance Centre (HPSC), the Government has ordered a stockpile of the antiviral agent Tamiflu, sufficient to treat 25% of the population. A stockpile of another drug, Relenza, is also being ordered. This will supply additional doses to supply a further 20% of the population. Both of these drugs need to be taken within 48 hours to be effective.

The HSE plans to set up flu clinics to dispense the drugs to the majority of patients, leaving GPs to treat patients who require medical assessment due to pre-existing conditions, severe illness, etc, the doctors state in a recent article in the GP magazine Forum.

It is planned that people will be asked to ring a specific pandemic flu helpline directing them to the most appropriate place for treatment.

While a pandemic vaccine will take some time to develop after the outbreak first occurs, it will initially be prioritised to groups most severely affected by the disease, including healthcare staff, providers of essential services, the elderly, and those at high medical risk.

The public is likely to be advised through media campaigns to limit the risk of infection by staying at home if ill, to limit contact with others when ill and to use a mask or tissue to cover their nose and mouth when coughing out in the open.

Frequent handwashing will be recommended.

The WHO is likely to introduce travel restrictions.

There will, according to the experts, be widespread disruptions to usual work patterns, with many companies already planning for remote working by their staff.

There is likely to be increased absenteeism in the workplace.

Drs Beug and Igoe say health planners are using a planning model based on information from previous pandemics to predict the impact of a pandemic on Ireland.

In this model, with a 25% clinical attack rate, there would be around 970,000 clinical cases of pandemic flu in Ireland in the course of a 15-week pandemic.

It is estimated that there will be 5,386 influenza-related hospitalisations and a minimum of 3,600 deaths related to flu will occur.