2005-11-10-Preparing for the worstUnderstanding Avian Influenza
2005-11-10-Preparing for the worst
The Ministry of Health, Labor and Welfare this month is expected to finish formulating its first national action program in preparation for the possible outbreak of a new strain of influenza. The ministry will decide specifically on measures to prevent the spread of contagion and on medical arrangements in response to the scale of the outbreak.
The ministry estimates that if the highly pathogenic H5N1 avian-flu virus mutates and becomes a new type of influenza that is contagious among humans, and if the new virus causes a pandemic, there would be up to 25 million patients in Japan and up to 167,000 deaths.
To minimize the damage in case of such an outbreak, it is essential to respond calmly and not to panic. For this purpose, it is important for people to have advance knowledge of specific scenarios so that they can act. Prefectural governments also are scheduled to formulate their own action programs by the beginning of next year. It is hoped that they come up with well-crafted programs that take local conditions into account.
The H5N1 bird-flu strain has been confirmed among poultry in various Asian countries since the end of 2003, including Cambodia, China, Indonesia, Japan, South Korea, Thailand and Vietnam. Since the beginning of October this year, infection has spread to yet more countries such as Turkey and Croatia. Originally the bird-flu virus was not transmitted to humans, but cases of human infection have occurred in regions where people live in close contact with poultry. The World Health Organization has confirmed that more than 60 people have died in Vietnam, Thailand, Indonesia and Cambodia.
If this virus mutates into a strain that is easily passed from person to person, there could be a major pandemic like Spanish flu, which caused more than 40 million deaths around the world in the 1910s.
The health ministry's national action program will be divided into six phases. The first concerns infections that are limited to birds; the last deals with a worldwide pandemic. At present, we are in the third stage: Infection from birds to humans has been confirmed in some areas, with experts saying the mutation of the virus could occur anytime.
As countermeasures against a new type of influenza, attention is being focused on the stockpiling of the antiviral medicine Tamiflu. It should be noted that Tamiflu is not a cure for everything. In Japan, about 15 million doses of Tamiflu are in circulation every year, and the central government and prefectures plan to stockpile an additional 5 million doses.
However, even in the case of ordinary influenza, Tamiflu only has the effect of easing symptoms. In fact, even medical experts do not know how effective it would be in fighting a new type of influenza. At the same time, however, they believe that Tamiflu will be effective in one way or another in fighting such an unprecedented type of influenza.
The problem is that Tamiflu is still unavailable to many people in developing countries. The manufacturer has offered, free of charge, 3 million doses of this medicine to the World Health Organization for use in developing nations. But the figure is too small to meet the need in those countries, according to the WTO.
In the end, the key to controlling the damage caused by a new type of influenza will lie in how much we can contain it at the starting line. First of all, we must take measures to monitor the state of avian-flu infection among birds and prevent its spread. If a new type of influenza that infects humans does appear, it is important to detect it quickly and have an international network in place to concentrate medical resources. Infectious diseases do not stop at national borders. In particular, Japan is expected to play a leading role in Asia in such endeavors.
If the outbreak of a new type of influenza is not limited to a few small areas but occurs in Japan as well, we will face a situation that we have never experienced before. Various measures will have to be taken to prevent the further spread of the disease, such as self-imposed controls on travel and assemblies attended by large numbers of people, the closure of schools and leisure facilities, the screening of transport, and compulsory hospitalization. An order of priority will be necessary in medical treatment, too, with medical personnel, for example, being given preventive vaccinations first.
The action programs, both of the central and prefectural governments, must be as concrete as possible so that people understand exactly what they will have to do under various situations. In particular, it is important to establish a system for conveying clear information to elderly people and other vulnerable members of society.