Monday, July 16 2018


Border first line of defence against bird flu

Update: May, 06/2013 - 09:34

Vietnamese authorities are still dealing with two old types of flu, H5N1 and H1N1, while having to address the threat of a new type, H7N9, spreading from China. Viet Nam News spoke to stakeholders about Viet Nam's responses.

Nguyen Thanh Long

Deputy Minister of Health Nguyen Thanh Long, speaking at a press briefing on Saturday

As of now, Viet Nam has no recorded cases of H7N9 infection in humans or poultry.

The threat is high if drastic measures are not taken. The virus might be introduced across the border by people and through the smuggling of tonnes of frozen poultry from China. What makes it so difficult to respond to the H7N9 threat is that we still do not know of the source of infection, mode of transmission or the treatment.

Meanwhile, there is no immunity against it since there has been no vaccine available. And given what is happening in China now - 128 infected cases and 27 deaths in just a month - there is a fear that if H7N9 turns out to be a human virus, it will trigger a pandemic. We will be in a very serious situation so we'd better get prepared.

As soon as we receive information from China, we quickly activate our surveillance and diagnosis systems to prepare ourselves against H7N9. Although the symptoms of H7N9 in the early stage is the same as other types of influenza, we can detect the differences with molecular tests. These tests can be run at the National Institute of Hygiene and Epidemiology and other institutions. We also strengthen surveillance at border gates by giving people temperature checks to make sure they are not importing the disease.

While staying on the high alert at the threat of H7N9, my ministry is also closely watching for other types of influenza. There is a sign that H1N1 is making a comeback and the number of cases is increasing in Viet Nam, which raises concerns of a pandemic. However, the general public should not be too worried because it is a seasonal influenza, has mild severity. The important thing is that existing vaccines and drugs work.

H5N1 is among flu viruses that cause severe respiratory syndromes. The mortality rate among infected people is about 60 to 70 per cent. Poultry are the source of this type of flu, so if we make sure the birds do not get infected, we protect humans.

Currently, there is no vaccine for H5N1 in Viet Nam, but we plan to distribute one by the end of this year after seven years of research. The vaccination will go to highly vulnerable groups, such as poultry farmers.

As poultry is a source of infection for H5N1 and also the likely source for H7N9, to touch on the root causes of the problem is to minimise infections among poultry. We have asked the Ministry of Industry and Trade and Ministry of Agriculture and Rural Development to tackle the issue of smuggling poultry which is rampant along Viet Nam-China long border.

Dr Takeshi Kasai, WHO representative, Viet Nam

Dr Takeshi Kasai

We have still not confirmed how the new bird-flu virus, H7N9, is caught by humans in China. Of particular concern is that it is starting to spread much more quickly than what we experienced with other strains of bird flu. That is why the World Health Organisation (WHO) is paying serious attention to the situation across the border. As of Thursday, Chinese health authorities reported there had been 28 deaths from a total of 128 cases.

China is responding in a massive way. When its authorities confirm a case, they check a huge number of contacts to make sure there are no secondary infections. At present, we are unsure if there are any human-to-human transmissions. Although the ailment has been reported in four family clusters, we still do not know whether they infected from each other or if they were exposed to the same source.

The old bird flu strains, such as H5N1, are strong viruses and kill birds. That is why if sick or dead birds are found, it indicates that there is something wrong. Unfortunately, the new strain doesn't have such characteristics. WHO laboratories have analysed the H7N9 virus and found that all the virus genes come from birds. However, we have still not been able to identify how people were infected, even though poultry are the most probable source.

We do not know what the best treatment is either, but in laboratories, we have already confirmed that typical anti-influenza drugs work. If Tamiflu is given to the right patients from the beginning, it should work. While there are many things still unknown, what is important from a response perspective is that as of now, the virus remains a bird virus. It is only causing rare and sporadic cases.

Although the speed of increase is sharp, if you think about the population in affected areas, cases are rare and none seem connected. This situation will completely change once the virus becomes a human virus. No human has yet developed immunity against it.

We are working closely with the Vietnamese Government and it is taking a series of actions to prepare against the threat. We at WHO national and regional offices are very impressed. For example, the Government has issued a precautional decree asking all hospitals and laboratories to intensify their surveillance system and all health-care facilities to make sure they have basic infection-control kits stockpiles. It has also instructed the two national laboratories to set up diagnosis systems.

WHO also monitors H5N1 infection closely in Viet Nam. Again, it is rare and sporadically occurs. Where there is H5N1 circulating, most of human victims have had direct or indirect exposure with the virus in their poultry. It is a norm that H5N1 exists in Southeast-Asia, including Viet Nam. Unfortunately, we can't completely control it.

The good news is if we take simple precaution measures, we can minimise the risk to a large extent. Those measures are: do not to touch sick poultry; report all found sick or dead poultry to authorities; wash hands thoroughly after touching infected birds. You do not have to be worried what to eat, but the important thing is to cook it well to kill the virus.

We also hear that another variety of flu, H1N1, is circulating these days. H1N1 is a different category because it is a human virus which means it can be transmitted from one person to another. Luckily for us, it is a very mild virus and can be controlled by existing drugs.

International co-operation is crucial to control influenza in particular and infectious diseases in general. The huge volume of people on the move means that the virus, bacteria or whatever can easily cross borders.

After SARS, WHO and its member states had a serious discussion. In 2005, we adopted International Health Regulations to control all the events that might pose a threat to the international community. This is a right but also an obligation. Countries have to report all outbreaks of such events.

That is why China quickly reported H7N9 and keeps updating the international community. In retrospective, SARS took them six months to report, but this time, it took just one day after the first case was confirmed.

Another important obligation under this framework is to develop the core capacity to detect, report and control. WHO has a mandate to help Viet Nam to develop this capacity. Like many other developing countries, Viet Nam has not achieved the minimum standards. But the level has significantly increased and every year, we see Viet Nam is moving forward.

Ly Kim Soi, director of Lang Son Province's Centre for International Health Quarantine

At the Huu Nghi International Border Gate, on average there are 1,000 entries into Viet Nam a day, many of them from the H7N9-affected area in China.

Well-aware of the risk, we have intensified the health quarantine activities, particularly temperature checks on people. My centre has plenty of medical equipment, including remote temperature scanners, specialised equipment and temporary isolation rooms.

We also have beefed up the monitoring of vehicles arriving from China - and use chemicals to disinfect them at border gates.

My colleagues at animal quarantine are also very active. Since we heard about H7N9, they have posted staff on duty 24/7 to monitor the flow of poultry from China. — VNS

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