thanks for the contribution, JPD!
http://newpaper.asia1.com.sg/top/story/0,4136,84354,00.html
The New Paper - 11 Mar 2005
On the verge of another killer disease?
By Ng Wan Ching
wanching@sph.com.sg
LIKE the pieces of a jigsaw puzzle, the elements needed for a deadly flu pandemic are beginning to fall in place and some experts are worried.
For a flu pandemic to start, three elements must be present:
a virus that can affect human beings;
effective human-to-human transmission; and
a susceptible group of people.
And two of the elements are already there.
Associate Professor Leo Yee Sin, clinical director of the Communicable Disease Centre, told The New Paper:
MISSING ELEMENT
'The current situation is that we have a new virus and a very susceptible population worldwide as people have no immunity against that virus.
'This is because the virus H5N1 is something new to the human species. What is missing now is effective human-to-human transmission.'
But that missing element could show up too. The signs are already there.
Said Prof Leo: 'What is happening right now, with the latest medical publications from Thailand and Vietnam, is that they are suggesting that there have been cases of human-to-human transmission for H5.'
It has been reported that in Vietnam, two brothers had contracted the virus and one died.
The younger brother, who is recovering, was known to have provided bedside care for his sibling who has died.
NO CONTACT
Evidence also suggested an 11-year-old Thai girl transmitted the disease to her mother and aunt last year.
The girl probably acquired the virus from exposure to infected poultry.
But her mother, a garment factory worker who travelled from another province to care for her daughter, had no contact with birds.
'Even though there is no conclusive evidence, it is still very worrying. We already have two out of three criteria needed for a pandemic,' said Prof Leo.
'The third factor is just sitting on the fence, so you could say we are at 2 1/2 criteria now,' she added.
Prof Leo said the virus that has swept through bird populations in Asia could evolve into a deadly pathogen for humans.
It could become as deadly as the ones that killed millions during three influenza pandemics of the 20th century.
But she does not want to create any panic.
Said Prof Leo: 'We realise that it is beyond humans to predict when the next big one is going to come and in what form it will come.'
Although cases of human-to-human transmission have been rare, 'our assessment is that this is a very high threat' based on the known history of the flu virus, she said.
She is not the only one warning about the next pandemic.
According to AP, Dr Shigeru Omi, World Health Organisation's head in Asia, said at a bird-flu conference in Vietnam last month that the world is perilously close to a deadly pandemic stemming from bird flu.
Top health officials like him are saying that governments need to start drafting emergency plans for the disease.
Dr Omi said: 'If the virus becomes highly contagious among humans, the health impact in terms of deaths and sickness will be enormous, and certainly much greater than Sars.'
The death rate is very high - about 72 per cent of identified patients.
The avian flu now spreading in Asia is part of what is called the H1 family of flu viruses. It is a pathogen that is notorious in human history.
In 1918, H1 appeared and millions died worldwide.
In 1957, the Asian flu was an H2, and the Hong Kong flu in 1968 was an H3.
There had been small appearances of the H1-type of avian viruses in other years, but nothing like the H5 now affecting birds in Asia.
NO IMMUNITY
Said Dr Leo: 'We are seeing a highly pathogenic strain of influenza virus and may see the emergence of a new strain to which the human population has no immunity.
'But it is very difficult to predict when it will happen. If you look at H5N1, it has been around since 1997 till now.
'The virus has been in circulation for some time, but it hasn't been evolving to affect humans in a big way. We don't know why and whether this H5 will be the one.'
She feels the issue of the flu pandemic should be addressed at the national, regional and international levels.
'Regionally and internationally, conference after conference, including the Asean ministers' meeting, are all talking about how to curb the threat of bird flu.
That is widely recognised as a threat to human beings. There are many things in discussion.
WANT TO LESSEN IMPACT
'The next flu pandemic could wipe out a significant proportion of the human species and we want to see that the impact is lessened,' said Prof Leo who had just attended the bird flu conference in Vietnam last month. What should people do?
'We know we have to prepare for the pandemic judging from past history. The national preparedness effort should be at ministry level,' she said.
But it is also important that people are educated on what exactly is influenza.
'The clinical symptoms can be overlapping with things like the cold and other respiratory tract infections and confusing to the public,' said Prof Leo.
Copyright © 2005 Singapore Press Holdings Ltd. All rights reserved.