07 | April | 2013 | Otterman speaks...

As a co-ordinator of several undergraduate modules and an organiser of a variety of events including the International Coastal Cleanup Singapore, I routinely keep track of local and international health news through twitter (notably @healthmap), international and local news and health agencies, and alerts by savvy friends on twitter.

In the event of a threat of an epidemic, most large organisations including educational institutions like the National University of Singapore will initiate measures to reduce risk and ensure operational continuity as far as possible.

In NUS, this will include e-learning to replace lectures, reduction of cross-faculty travel and non-critical events, contact tracing after lab classes, strategies to reduce contact during field trips, new site parameters in the risk assessment, temperature checks, exam management, etc.

A recent epidemic which has moved a notch up on everyone’s radar soon after its discovery in China is the Avian Influenza A (H7N9) virus.

The Chinese CDC report of 31 Mar 2013 states:

“The three confirmed cases presented all with acute pneumonia whose symptoms include acute fever onset, high fever, cough and respiratory tract infection symptoms at the early stage of the disease. Five to seven days of disease onset, the patients developed severe pneumonia i.e. breathing difficulties and some progressed rapidly into acute respiratory distress syndrome and death.”

A stream of detection reports from China have been helpfully mapped by the South China Morning Post:

The cluster on the map is Shanghai, which has closed three markets and banned all live poultry from other parts of China from entering the city.

Thankfully, China is sharing reports quickly this time, but this virus does not kill chickens. This makes detection more difficult and the disease may be more widespread than reported. John Oxford, a professor of virology at Queen Mary, University of London, says he is “cautiously worried“.

As of now, the CDC (US) states,

“This is a “novel” (non-human) virus and therefore has the potential to cause a pandemic if it were to change to become easily and sustainably spread from person-to-person. So far, this virus has not been determined to have that capability. However, influenza viruses constantly change and it’s possible this virus could gain that ability. “

Well, yes, the virus could mutate and before we know it, appear at our doorstep in Singapore, seeing how air travel from China (and other countries at risk) is voluminous and common.

Clinicians (probably everywhere now) are advised to be on the look out for respiratory illness and appropriate travel history. So if you are coming from China with any of the symptoms, be prepared for scrutiny.

China’s closest neighbour, Taiwan, is certainly aware and vigilant. Earlier this evening, the Taiwanese CDC just cleared all their eight suspected cases of H7N9. They seem confident about being able to contain the disease if that time comes:

“We are also now practicing strict infection control and surveillance measures, raising vigilance in three major areas: ports of entry, families and communities and hospitals,” he [CDC Deputy Director-General Chou Jih-haw] said.

The Ministry of Health in Singapore too has been alert, and are already roused by action to preempt the recent SARS-like coronavirus. Health Minister Gan Kim Yong commented, at the recent SARS commemorative ceremony on 20th March 2013 that

“The ever-present threat of infectious diseases remains a concern worldwide … surely it will come one day.”

“In our highly globalised world, where cities are well connected by air travel, the transmission of infectious diseases has become much harder to control.

There is a real risk of epidemics or outbreak of a new infectious disease spreading to Singapore, given our global connectivity.”

We’ve all been served notice.

Update: MOH’s media release, 06 Apr 2013: “Ministry of Health closely monitoring the influenza A (H7N9) situation” [link].

Do read the overview articles below which include some basics about the biology of the virus, and update yourself from now on. Let’s hope this fizzles out!

Links

Articles providing an overview

“The New Virus on the Block: H7N9 Case Counts, Explanations and Updates,” by Anna Tomasulo. The Disease Daily, 05 Apr 2013 [link].
“The New Bird Flu: How Dangerous Is Avian Flu H7N9?” By Melanie Haiken. Forbes, 06 Apr 2013 [link].
“Health leaders lay out their concerns about the new bird flu,” by Helen Branswell. The Canadian Press, 04 April 2013 [link] (with biological detail)
“Novel bird flu kills two in China,” by Declan Butler. Nature News, 02 April 2013. Scientists are racing to assess the pandemic potential of H7N9 flu virus. (more biological detail) [link]
“The New Bird Flu, and How to Read the News About It,” by Maryn McKenna. Wired, 05 Apr 2013 [link].
“How to Stop the Spread of a Pandemic Flu Virus.” WikiHow, date unknown [link] Nicely illustrated simple hygiene guide.

News reports

“Shanghai bans entry of live poultry.” Xinhua, 06 Apr 2013 [link].
Suspected H7N9 flu cases cleared of infection: CDC,” by Alison Hsiao and Lee I-Chia. Taipei Times, 06 Apr 2013 [link].
“Expert ‘cautiously worried’ over China’s H7N9 bird flu strain.” AFP, 05 Apr 2013 [link]; with comments by Prof John Oxford.
“China Escalates Its Response to Outbreak of Avian Flu” by Andrew Jacobs. The New York Times, 05 Apr 2013. [link]; with comments by Prof John Oxford

Singapore’s preparedness

“Threat of epidemic is ever-present, Gan warns,” by Tan Weizhen. Today, 21 Mar 2013 [link]
“World is ‘not well-prepared’ for next outbreak,” by Tan Weizhen. Today, 21 Mar 2013 [link] (Phone interview with Dr Isabelle Nuttall, Director of the Global Capacities Alert and Response department at WHO)

Health agency (source) announcements

World Health Organisation (WHO) FAQ: “Frequently Asked Questions on human infection with influenza A(H7N9) virus, China.” WHO, 05 April 2013 [link]
“Questions and Answers about human infection withA(H7N9) avian influenza virus.” Chinese Centre for Disease Control and Prevention, 31 Mar 2013 [link].
CDC Health Advisory: “Human Infections with Novel Influenza A (H7N9) Viruses.” CDC Health Alert Network, 05 Apr 2013 [link].