Avian influenza – H5N1
WHO chief warns region to prepare for flu pandemic

The World Health Organisation (WHO) has issued a stern warning to all countries to prepare in advance for an epidemic of the highly pathogenic H5N1 virus.

“In view of the immediacy of the threat, WHO recommends that all countries undertake urgent action to prepare for a pandemic,” the WHO says in its recently released document Responding to the avian influenza pandemic threat: recommended strategic actions (available online at www.who.org) Dr Lee Jong-wook, director-general WHO, speaking at the 52nd session of the Regional Committee of the Eastern Mediterranean in Cairo late September, stressed “the absolute necessity to be alert and prepared against the destabilising and destructive effects of uncontrolled epidemics”.

He warned health ministers of the Eastern Mediterranean Region: “You have been successful and innovative in protecting your peoples against polio. But problems you are experiencing in controlling HIV are indicative of gaps in your preparedness for other pandemics. “Every government, everywhere, should be certain that it has done all it can to protect itself and its peoples,” he said.

“The crucial and deadly development of the next human influenza epidemic is likely to occur in one of the countries that has avian flu infection in its bird populations. Highly pathogenic H5N1 virus is now entrenched in several parts of Asia, and is moving further afield.” Media reports in October said the virus had spread west as far as Turkey, Croatia and Romania where it had been found in domestic bird populations. Both countries had culled the infected bird populations to prevent the spread of the virus. Officials believe the virus was carried from Asia by migratory birds.

Dr Lee said this was a critical moment for health ministers in the Eastern Mediterranean Region (EMR) to interact decisively with their counterparts in agriculture, finance, education and industry, to share information and plan strategically.

“We need external early warning systems. We must have systems capable of detecting clusters of cases, closely related in time and place, so as to identify human-to-human transmission at the earliest stage possible. “Antiviral medication will help to limit spread if we can quickly get it to source. Quarantine measures will help stop further transmission if we can rapidly isolate cases and contacts before they infect a wider population. “No government or Head of State can afford to be caught off guard,”

Dr Lee warned. “I cannot emphasise this enough. Failure to take this threat seriously will have catastrophic consequences.” He called on all countries to establish a national pandemic control plan. “Every country must also have a communications strategy and be ready and able to inform the public about what is happening and what to do.”

He said the recently announced International Partnership on Avian and Pandemic Influenza recognised the importance of international co-operation. “Massive international collaboration is needed now on the advance preparation of global antiviral stockpiles and pandemic vaccine development. Dr Lee pointed out that several countries in the EMR were in post-conflict or emergency situations and “face problems in providing even the most basic healthcare.

Many countries have inadequate survey data.” For example distribution of antiretroviral therapy was very low, at about 5%. “All of these areas would be critical weaknesses in the event of a flu pandemic. Data gathering, communications, and distribution of medical aid will be central features of a successful response,” Dr Lee said.

“We must rapidly evolve the levels of communication and co-ordination that we will need, and ensure equity of access to lifesaving vaccines or medicines.” Dr Hussein Gezairy, WHO EMR Office regional director, said: “The regional office has cosigned a memorandum of understanding with six strategically located countries and the US Naval Medical Research Unit 3 in Egypt to ensure national influenza centres received supplies and technical assistance.”

He said the regional office would support countries in developing national plans and stockpiles in collaboration with partners and a regional meeting would be held in the last week of November to boost preparedness activities in the region. Contamination The 13 October WHO - Weekly Epidemiological Record states: “Large amounts of the virus are known to be excreted in the droppings from infected birds. Populations in affected countries are advised to avoid contact with dead migratory birds or wild birds showing signs of disease.

“Direct contact with infected poultry, or surfaces and objects contaminated by their droppings, is considered the main route of human infection. Exposure risk is considered highest during slaughter, defeathering, butchering and preparation of poultry for cooking. There is no evidence that properly cooked poultry or poultry products can be a source of infection. “Countries located along migratory routes need to be vigilant for signs of disease in wild and domestic birds. Recent events make it likely that some migratory birds are now implicated in the direct spread of the H5N1 virus in its highly pathogenic form.”

For the latest information on avian influenza and WHO’s “Recommended Strategic Actions” visit: www.who.int/csr/disease/avian_influenza

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