For almost five years now, scientists, researchers and health experts around the world have been telling nations to be ready for an influenza pandemic. This warning was repeated again at the International Congress on Infectious Diseases last week, writes ANNIE FREEDA CRUEZ

Dr Julie Louise Gerberding says bird flu remain a serious threat.

Dr Timothy F. Brewer says the main concern is the influenza pandemic

THE pesky bird flu (H5N1) isn't just going away. Early this week, Pakistan reported a new outbreak at a farm in the Swabi district. No deaths were reported and the outbreak was confined to a small area in a remote part of Pakistan.

It is hardly cause for worry. Or is it?

The continuing spread of bird flu (H5N1) virus to domestic poultry in many countries and the emergence of bird flu cases in humans is cause for worry.

"It still remains a serious human health threat," said Dr Julie Louise Gerberding, the director of the America's Centres for Disease Control (CDC) and Prevention at the 13th International Congress on Infectious Diseases (ICID) in Kuala Lumpur last week. "What worries us is that the virus may mutate into a form that could spread easily between people."
Some 3,500 physicians, scientists, microbiologists, veterinarians and public health experts from 100 countries attended the congress.

New infections of the H5N1 virus still occur in China, Vietnam, and Indonesia, while Thailand has also seen recurrence of the virus in areas it thought were disease-free. Poultry stocks in impoverished Cambodia and Laos also appear to have been seriously affected.

In Vietnam and Thailand, the only countries to have reported human bird flu cases, 22 people of the 32 reported cases infected with the virus have died.

Dr Gerberding said severe acute respiratory syndrome (SARS) had been a wake-up call and avian flu outbreak has now put nations on high alert for the influenza pandemic.

The World Health Organisation's worst fear is that the virus will mutate into a form that can pass quickly from person to person, creating a major pandemic. While there is no evidence so far that that has happened, nations cannot take warnings by health experts lightly.

Infectious diseases transcend national boundaries and global solutions are necessary to address problems such as avian influenza, the HIV/AIDS epidemic and SARS.

For over 20 years, the ICID has been a leading forum for infectious disease experts worldwide to come together for answers to the challenges posed by infectious diseases.

Dr Timothy F. Brewer, programme director for ISID, said scientists, researchers and public health experts are concerned over countries, especially in the Western Pacific region, not having effective surveillance systems to monitor the outbreak of infectious diseases.

He said there were probably small outbreaks around the world and in countries in the Western Pacific region which were not taken seriously and reported to authorities.

Dr Brewer said what was worrying was the fact that some new organisms and new diseases could have emerged in these small outbreaks which would then propagate to the larger population, especially with the world being so interconnected.

"Our main concern is the influenza pandemic which might break out, we believe, from the Western Pacific region. Although we really hope not to have a pandemic, we have to be prepared with the assumption that it will, and can, occur and take every step to prevent it."

Dr Brewer said the SARS and Avian flu emerged in the Western Pacific region and it caused a tremendous social and economic disruption, although the number of people affected was small.

Some 8,000 people were infected with SARS and about 800 died which was relatively small compared to the 30,000 people dying of influenza every year in USA.

The estimated cost of the 2003 SARS epidemic in Asian countries was US$20 billion (RM65 billion) in gross domestic product or a more dramatic US$60 billion in terms of gross expenditure and business losses.

If the influenza pandemic were to persist for over a year, the long term consequences in terms of job losses and bankruptcy would continue to produce hardship for many more years.

The longer the pandemic remained active, the greater the damage in terms of loss of productivity, along with hospitalisation and other health-care expenditures

Dr Brewer said there were various factors leading to emerging diseases in Western Pacific region. One factor was the high concentration of people and the close proximity between people and animals which facilitate transmission of viruses, that is from animals or birds to people.

"We suspect that most of the emerging diseases, some 60 to 70 per cent, start as zoonotic infection (infections from animals and birds transmitted to people).

Dr Brewster said ISID was working with WHO and six countries in the Western Pacific region -- Cambodia, Laos, Myanmar, Thailand, China and Vietnam -- to improve the surveillance system to identify infectious diseases and share the information with other countries.

Another important global focus is the emergence of antimicrobial resistance which is now being seen in many infections, ranging from antibiotic resistance and community- acquired infections to resistance to anti-tuberculous drugs.

Containment of anti-microbial resistance, as well as the development of new therapeutic agents, have now become one of the major emphasis of the medical and pharmaceutical industry.

Deputy Health Minister Datuk Dr Abd Latiff Ahmad said the spectrum of infectious diseases was evolving rapidly in tandem with the dramatic changes in our society and environment.

"Worldwide, there is an explosive population growth associated with poverty, current escalating food crisis, global economic slowdown and increased urban migration.

"All these, augmented by increasing international travel, have affected and increased the risk of development and exposure to newer infectious agents, particularly viruses with which we share our environment."

As a result, Dr Abd Latiff added, infectious diseases increasingly continue to threaten public health, and due to rapid globalisation and lifestyle changes, the tampered environmental landscape has altered the way pathogens evolve or spread and resulting in the expansion of the spectrum of infectious diseases.