Preparation, swift response key to tackling new flu pandemics
Investment in health crisis response systems during non-pandemic periods is crucial to combating the next inevitable flu pandemic, according to a government representative.
“The general public is aware of the threat of the next flu pandemic and is concerned about it,” said Dr Norhayati Rusli, deputy director of surveillance for the Disease Control Division of the Ministry of Health (MOH). “The situation globally as well as in Malaysia is this: we see the emergence of new influenza viruses, more borderless travelling in short durations, lack of immunity against new pandemic viruses, increasing incidence of MDR (multi-drug resistance), inadequate vaccination uptake, greater population density, and limited vaccine production capabilities.”
Speaking at the 2017 Annual Congress of the Malaysian Thoracic Society (MTS), Norhayati stressed that one of the key lessons from the SARS epidemic was that while modern science helped to clarify its epidemiology and confirm cases of infection, 19th-century strategies of contact tracing, quarantine and isolation still played key roles in controlling its spread.
Norhayati added that with vaccine development cycles taking a minimum of 6 months, and logistic issues with global distribution thereof, it would be insufficient to depend on vaccines alone as a main line of defense against new strains possibly generated from zoonotic origins.
“The 2009 (H1N1) influenza spread with unprecedented speed; past pandemics of influenza viruses needed more than 6 months to spread as widely as H1N1 did in less than 6 months,” said Norhayati. She added that the “unusual cocktail of avian, swine and human viruses” had not only caused explosive outbreaks in semi-closed communities, but also higher hospitalization and mortality rates in young adults compared to those seen in previous seasonal influenzas.
In the aftermath of SARS, the World Health Organization (WHO) revised its International Health Regulations in 2005, which broadened the scope of notifiable diseases—ie, those which would require an international coordinated public health response—to include ’any event of potential international public health concern, including those of unknown causes or sources,’ thus extending the IHR’s jurisdiction beyond cholera, yellow fever and plague.
Lessons from the past
On a local scale, Norhayati discussed some of the actions of Crisis Preparedness and Response Centres (CRPCs) at national and state levels, as well as Emergency Operation Rooms (EOCs) at district levels, in mitigating human transmission during incidents of avian influenza A (H5N1) and MERS-CoV.
“CPRC prevention and control of avian H5N1 involved active case detection within 300 m of confirmed cases; intensive health education at local clinics, pamphlet distribution and small group discussions; mass health education at mosques, schools, and through mass and social media; and monitoring health and Department of Veterinary Services (DVS) staff involved in management of dead birds for at least 10 days after exposure,” said Norhayati. “No human cases (of H5N1) have been reported here to date… as for the single case of MERS-CoV reported in March 2014, the national and Johor state CPRCs were activated to sample and clear over 199 close contacts between March to April of that year.”
During non-active periods, the CPRCs conduct daily monitoring and analysis of health-related events, electronic outbreak notification (eWabak), rumour and laboratory surveillance, risk assessment and communication, stockpiling and training. These are done in collaboration with other local agencies such as the DVS, National Security Council (NSC), National Disaster Management Agency (NADMA) and the Department of Meteorology.
“Investment in strengthening our healthcare system’s capacity during peaceful times is therefore crucial,” said Norhayati, who also expressed hopes for further enhanced collaboration with regional and international agencies.