Moderated by Tom Sabulis
The Atlanta-based Centers for Disease Control and Prevention has begun researching the new strain of bird flu recently discovered in China, where people get the virus from infected poultry, and where it’s spreading to other cities. More than a dozen people have died. Today, CDC Director Tom Frieden talks about how this flu is different and how the CDC is working on it. In our second column, an expert from the Georgia Department of Public Health addresses says disease-fighting on a local level.
Commenting is open below.
By Tom Sabulis
CDC Director Thomas Frieden talked recently about the latest Avian flu health scare to hit China. The big fear with bird flu virus is that it develops the ability to go from person-to-person and trigger a pandemic.
The scarier aspects of this virus (H7N9): “The first is the severity of illness. A significant proportion of the people who have been diagnosed had severe illness or have died. We expect that more mild cases will be found. The genetic sequence itself… seems to have some characteristics that suggest that it’s a little bit adapted to a mammalian host — to people, pigs. So it has the risk of mutating into something that would go person-to-person. And it doesn’t cause severe illness in birds. This again is paradoxical: We don’t have the clue of sick flocks, so we’re not able to cull flocks. If that persists as the pattern, the likelihood is that it could become widespread in birds in China and even neighboring countries. Even if it doesn’t develop the ability to spread person-to-person, it would still increase the risk of infections for people who work with poultry.”
Reassuring signs: “We have not seen sustained person-to-person spread. China has assessed hundreds of close contacts of (infected) cases and has not identified secondary cases; that’s really encouraging, because in regular influenza, you would expect 20 or 30 percent of contacts to be infected. There has been excellent global collaboration. We’re building on a decade of preparedness. We’re better prepared than ever to deal with a pandemic.”
China’s reaction to the outbreak: “From the moment the (cases) were reported, the collaboration that we’ve had with China has been exemplary. We’re receiving the virus samples. They posted on the Internet the full genetic sequence of the viruses. We’ve had regular communication with them.”
H7N9 samples at the CDC: “We’re doing several key things with it. The first is to understand it well. We’ll re-sequence the genome so we know every DNA molecule in it. The most urgent tasks are to come up with the best way of diagnosing the infection. Our laboratory is working on that. We will provide that to China so they can improve the quality of their diagnosis there. The second is to work on seed strains for a vaccine. We don’t know that this will spread person-to-person, but we want to be prepared, and that means making a vaccine. If you look at (the) 1918-1919 (flu pandemic), more than 50 million people died. Of all the threats to health, there’s none that has as much potential to do harm as influenza.”
Why bird flu often hits China: We have generally anticipated influenza coming from Southeast Asia, not just China. There’s a very intense animal-human interface. Lots of people, lots of chickens, lots of pigs and all kind of mixed up together in close quarters. About 75 percent of emerging infections come from an animal source. China is what about a fifth of the world’s population, so even on an average you expect it to account for a significant portion of the new infections. But you can’t let down your guard anywhere. In fact, H1N1 came out of Mexico, and we didn’t expect that, so one of the things we try to do in public health always is to expect the unexpected.
What CDC can do that China can’t do: CDC laboratories are, in practice, the reference laboratories for the world. We have the top scientists in so many areas, including in influenza. We’ve already sent to the Chinese some materials that will help them do blood tests to see if people have been exposed to or infected with this strain of flu. When they’re safer, we’re safer. We have the ability to create a test that’s a little more accurate.
CDC’s new Advanced Molecular Detection (AMD) Initiative: It’s the single most important thing that we can do to improve our ability to protect Americans from infectious disease threats. With AMD , we’ll be able to find outbreaks that we missed before, find them sooner than before, stop them quicker and figure out how they’re spreading so we can prevent them more effectively.
AMD funding: It’s a proposal in the president’s budget for FY 2014. $40 million. I’m optimistic. I think there’s broad bipartisan support for protecting Americans from infectious disease threats. We need to do this. The microbes are evolving all the time and unless we keep pace with them we will lose the arms race with drug resistance, with new strains, with globalization of travel.
By Tom Sabulis
Along with the CDC on the federal level, local health departments are keeping close watch on the new avian flu outbreak in China. Dr. Cherie Drenzek, State Epidemiologist at the Georgia Department of Public Health, answered a few questions this week:
Q: Should we be concerned with bird flu in China here in the U.S.?
A: Yes, the fact that there’s a novel influenza virus infecting humans anywhere in the world is of global concern. Any time there is a brand new flu virus it raises the potential that the virus could become pandemic and spread to other areas of the world rapidly. So far the evidence in China has shown that this particular flu virus has not been able to be transmitted from person to person in a sustained or rapid way, which is the good news.
Q: What does public health department do when you hear of a new outbreak?
A: We actually conduct influenza surveillance through a variety of mechanisms year round. We conduct surveillance for the actual flu viruses, for outpatient illness, for influenza hospitalizations, for influenza deaths. This is how we gain situational awareness about flu anywhere in the world. With something like (the new avian flu), we enhance the surveillance systems. We are on the lookout for individuals who now may have an appropriate travel history to areas of the world where this novel virus is circulating so we can rapidly detect and contain it here. The foundation of any disease containment strategy is really disease surveillance, finding out what’s going on, where the virus is located, how it’s spreading. In this situation certainly it’s imperative to keep an eye out for ill travelers.
Q: You monitor people traveling from China?
A: The CDC is responsible for a lot of that, from the federal level, and has worked very closely with the airline industries and sent out travel alerts to the airlines and put notices in airports. We have a very close relationship with the federal CDC quarantine station at Hartsfield-Jackson International Airport. We deal with ill individuals on planes a lot in trying to assess whether they represent a risk of a communicable disease being transmitted or not.
Q: Are we well-prepared locally to address a pandemic?
A: Influenza pandemic preparedness has been ongoing for many years here in Georgia and across the nation. We gained a lot of practical information experience from the 2009 H1N1 pandemic. You learn as you go (but) as much as we prepare it all can change based on the epidemiology of the virus itself. Is it infecting the young? Is it infecting the old? We really have to rely on the surveillance to guide a lot of our mitigation decisions. These are new viruses. They essentially have to build and manufacture vaccines on the fly while the outbreak is ongoing. Very often the vaccine is not available for months at a time and when it becomes available at first there may not be enough for everyone at risk. So it’s really important to use the disease surveillance and the epidemiology to guide prioritization of vaccines.