How to Effectively Contain Bird Flu
By Frank Konings
In response to the outbreak of H5N1 avian influenza among birds in Korea three months ago, the Ministry for Food, Agriculture, Forestry and Fisheries announced last week that it will start regular monitoring of the country's poultry farms and bird habitats and establish an avian influenza crisis management system.
This is good news. But let's not forget about the promise of doubling the antivirals stockpile. H5N1 avian influenza claimed its first human victim in Hong Kong almost 10 years ago.
In the meantime, the virus has continued to spread, with a death toll of 243 people to date. The majority of cases have been identified in Asia, mainly in Vietnam and Indonesia. There have so far been no human cases or deaths in Korea.
Avian influenza, also known as bird flu, infects domestic and wild birds. This is the virus that spread through Korea's bird population three months ago. To contain the outbreak, 8.5 million chickens and ducks needed to be culled.
In an attempt to avoid taking such drastic measures in the future, the government announced stricter monitoring of wild and domestic bird populations.
This is an important measure because avian influenza occasionally jumps from birds to humans. This is not easy but also not impossible for the virus. We need to be extra alert to the H5N1 strain because it is very common among birds and, hence, chances are higher for its transmission to humans.
Transmission from one person to another is even harder. However, it is possible that the virus' genetic code will change to overcome this hurdle. Once avian influenza evolves to spread easily among humans, we are at risk for another influenza pandemic.
It will not be the first influenza virus that goes global. Three influenza pandemics have occurred in the last century: the Spanish flu (1918-1920), the Asian flu (1957-1958) and, most recently, the Hong Kong flu (1968-1969).
The Spanish flu was the most severe and killed an estimated 40 million people. The Asian and Hong Kong flu killed approximately 1 to 1.5 million people.
We can learn a lesson in ``pandemics'' from other well-known viruses too. Take for example severe acute respiratory syndrome (SARS), which put the world on high alert just a few years ago. The West Nile Virus scared New Yorkers in 1999 when it suddenly appeared in their city. Fortunately, these outbreaks were quickly contained.
Of course, it is difficult to forecast the onset and extent of future influenza pandemics based on outbreaks of other viruses. Nevertheless, they reinforce how suddenly and rapidly a pandemic can spread in today's society. The numbers of previous influenza pandemics say enough about its possible extent.
Antiviral drugs and non-pharmaceutical interventions will play important roles when an influenza pandemic arrives in Korea. With regard to drugs, we rely mainly on two antivirals, oseltamivir and zanamivir or Tamiflu and Relenza by their brand names.
These are active against seasonal influenza and also have activity against H5N1 influenza. Vaccines against H5N1 have been developed but large-scale production is not possible until we know exactly what virus has become pandemic.
In the event of a pandemic, Korea obviously does not have the capacity to produce enough antivirals to treat its 49 million people fast enough to contain the disease. Building a stockpile provides a buffer to start immediate treatment of patients and preventive treatment of those surrounding them early on in the pandemic.
This will buy time for the production of more antivirals. To build the necessary buffer, it is important that Korea sticks to its promise of doubling its current antiviral reserve from 1.25 to 2.5 million treatment courses by the end of this year.
Additionally, Korea and the international community should focus on assisting countries where pandemic influenza is most likely to originate, such as Vietnam and Indonesia, to stockpile antivirals.
This may help prevent pandemic influenza from spreading beyond their borders and contain the outbreak early on. Antivirals play an important role in containing an influenza pandemic and are an essential part of a pandemic influenza preparedness plan.
Having antivirals readily available here in Korea and abroad, especially in high-risk countries, makes us better prepared for the next pandemic.
Dr. Frank Konings holds a Ph.D. in microbiology from New York University. He studied malaria in Africa and worked as an epidemiologist at the New York State Department of Health. He currently resides in Seoul and can be reached at fkonings@gmail.com.