Health Officials Focus on How To Respond to Disease Outbreak

By Charlene Porter
Washington File Staff Writer

Washington – Concern about a pandemic of avian influenza triggered a meeting of more than 100 experts in human and animal health from 14 countries in Thailand July 17-21, just as further reason for their concern was confirmed with Indonesia’s report of its 42nd death from the H5N1 avian influenza virus.

The Ministry of Health reported July 20 a human case of H5N1 involving a 44-year-old man from Jakarta province, who took ill on June 24 and died on July 12.

Confirming the case, the World Health Organization (WHO) reported that the man had contact with poultry around his home and place of employment at a market where birds are slaughtered. Tests of birds in the areas he frequented are being conducted in search of the H5N1 virus.

The highly pathogenic avian influenza virus has killed hundreds of millions of animals over the last two and a half years.

With this confirmed death, Indonesia has detected human H5N1 fatalities in numbers equal to those found in Vietnam, heretofore the nation most severely affected with human cases. Vietnam has not detected a single human case since 2005. Indonesia has detected 37 cases in 2006 alone, more than any other of the nations from Southeast Asia to the Horn of Africa that have reported cases this year.


The mounting toll of H5N1 since it began appearing widely in Southeast Asia in late 2003 has led international health officials to urge greater awareness and preparedness for the possibility of pandemic disease and widespread public health emergencies. That is why 100 experts convened in Bangkok, Thailand, to learn how to mount a rapid response to outbreaks of infectious disease.

The U.S. Centers for Disease Control and Prevention (CDC), the Thai Ministry of Health (MOPH) and the WHO are collaborating in the training in Bangkok, which provides guidance on how public health workers need to respond within the first 72 hours of the outbreak of a respiratory disease to recognize disease, identify and contain it, and begin treatment, vaccination and public information activities.

“They are epidemiologists, influenza experts or training specialists,” said Sonja J. Olsen, the acting chief of the International Emerging Infections Program, a collaborative program based in Bangkok, sponsored by CDC and Thai MOPH. “Each of these participants is charged with returning to their country, translating and adapting the material as needed, and then putting on more training courses,” said Olsen in an e-mail interview with the Washington File.

Specialists participating in the training come from Bangladesh, Burma, Cambodia, China, Egypt, Guatemala, India, Indonesia, Kenya, Laos, South Africa, Thailand, the United States and Vietnam.

Thailand was among the first countries to be stricken in the avian influenza pandemic that now has affected domestic or wild birds in more than 50 countries. Since the first appearance of the highly pathogenic avian influenza strain H5N1 in Southeast Asia in late 2003, the virus also has infected 231 humans, causing 133 deaths worldwide.

Thailand has discovered 22 of the human cases of disease resulting in 14 deaths.

In tracking the appearance of the disease in animals, Thai authorities submitted more than 80 reports to the World Organisation for Animal Health, some reporting dozens of outbreaks at either small backyard farms, or large poultry operations, requiring the destruction of tens of thousands of birds.

When disease becomes that pervasive in an environment, providing so many opportunities for the transmission of the dangerous virus between animals and humans, the chance for a serious outbreak of human disease increases.

Thai MOPH is sharing its experience in working in that environment with others at the July training session.

“Our goal is to take what we’ve learned from our responses to avian influenza and assist senior epidemiologist in building teams that can recognize and respond to outbreaks that have the potential to become pandemics,” said Dr. Tawat Suntharaja, director-general of the Department of Disease Control at Thai MOPH. “When these trainees return to their countries, they’ll be better equipped to train their colleagues in effective rapid response to any outbreak.”

Regarding the Thai experience with human and animal disease since 2003, Olsen said, “These experiences have taught us all about the importance of preparedness for new disease threats, the importance of good communication between animal and health agencies and the importance of transparency and openness so that the international health community can work together to prevent additional illness and death.”

Thailand appears to have contained effectively and controlled H5N1, having detected no further appearance of the virus since November 2005.

Though no further training sessions are scheduled in the immediate future, Olsen expects more will be organized in the months ahead.

This latest round of training is part of a wide-ranging U.S. and international strategy to support vulnerable countries in strengthening their capabilities to detect, contain and control disease as a strategy to prevent pandemic. (See fact sheet and related article.)

For ongoing coverage see Bird Flu (Avian Influenza).