East Asia is most at risk of human flu epidemic, experts say
Michael Day
The UK Medical Research Council (MRC) is flying experts on influenza to East Asia in a bid to boost flu surveillance programmes, so scientists will be able to pick up signs if a pandemic is about to ensue.
The eastward spread of the H5N1 strain of avian flu—which has already killed 60 people—from China to Europe’s borders in just 18 months has alarmed veterinary experts and virologists. The UK government published guidance for doctors on its website on Thursday this week, after the BMJ went to press.
However, it is in China, Vietnam, and Hong Kong where most infected flocks persist and where World Health Organization experts say the bird virus is most likely to recombine with human influenza to form a pandemic strain.
The MRC’s chief executive, Colin Blakemore, announced on Monday that a team of senior scientists, including the MRC’s influenza expert John Skehel, would be visiting China, Vietnam, and Hong Kong to "extend research collaboration" between Britain and East Asian countries. The team will report back to an international meeting on flu in London in December.
Senior MRC figures said, however, that the urgent need to improve surveillance systems in East Asia before the emergence of a pandemic virus was one of the main reasons for the visit.
Alan Hay, director of the joint MRC and WHO World Influenza Centre in north London, said: "In some parts of China the surveillance networks are not so well established. We need to have good surveillance so that we’re in a better position to detect any signs that the virus is about to become a pandemic."
Two years ago the Chinese authorities were heavily criticised for doing too little to contain the emerging severe acute respiratory syndrome virus and then for seeking to conceal the extent of its spread.
However, Dr Hay admitted that if a pandemic strain emerged in Asia then even with the best surveillance systems the rest of the world would have little time to prepare for its arrival. "Once it does emerge it is likely to spread around the world in a few months," he said. In contrast he said that "many months" would be needed to produce an effective vaccine against it.
The production process could be further hampered by the private ownership in the United States of "reverse genetics technology" needed to make the vaccine. "There are a number of issues relating to this that we may well have to address," Dr Hay said.
Despite these concerns, Patricia Hewitt, the UK secretary of state for health, told the House of Commons on Tuesday that Britain was one of the "best prepared nations in the world" to deal with a flu pandemic and that the acquisition of 14 million doses of the antiviral drug oseltamivir (Tamiflu) would reduce the number of deaths in Britain.
She added that the government had ordered 2-3 million doses of vaccine against the current form of the HN51 strain and the government expected delivery of this early next year. The government would also work with WHO and the European Commission to produce a new vaccine once a pandemic influenza strain emerges.
On Sunday the chief medical officer, Liam Donaldson, said that the most recent flu pandemics of 1957 and 1968 indicated that
a new worldwide epidemic would kill 50 000 people in Britain. But he said this was unlikely to happen this winter. (See p
922.)