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LETTERS: Robert Kahn and John Godfrey Government proposals conflict BMJ 2007; 334: 1071-b-1072-b [Full text]

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Prevention of pandemic influenza

Jeanne A Pawitan   (30 May 2007)

Prevention of pandemic influenza 30 May 2007
Jeanne A Pawitan, Professor Department of Histology, Faculty of Medicine, University of Indonesia, Jakarta10430, Indonesia Send response to journal: Re: Prevention of pandemic influenza	To the editor: I would like to comment on the letters (1,2) titled: Preparedness for pandemic flu: Government proposals conflict, by Robert Kahn, John Godfrey, in BMJ 2007; 334:1071-1072 (26 May), doi:10.1136/bmj.39220.429727.3A, and Global triage of global resources needed, by Daniel J Barnett, Saad B Omer, David P Fidler, Ran D Balicer, James G Hodge, in BMJ 2007; 334:1071 (26 May), doi:10.1136/bmj.39220.443889.3A The two letters were commenting on plans in facing the so called coming pandemic, but what is more crucial is to prevent the pandemic, by helping the countries that may serve as the source of pandemic, such as Indonesia (3) that has both the highest number and fatal cases of avian (H5N1) influenza (97 human cases among whom 77 died). (4) In Indonesia, the surveillance for avian influenza does not work properly. Indonesia has centers for the detection of H5N1 virus, but transportations from certain remote areas to the centers are poor, and there were problems in isolating the cases and suspects. More over, in almost all Indonesian provinces, the poultries are affected by H5N1 virus, and there were problems in stamping out the infected poultry, due to problems in the payment of compensation.(3) The Government has made a regulation to separate poultry farms from human residence, but there are problems in eradicating the backyard poultry, and some people like to have caged birds as pets that are now certified to be free from bird flu (today the birds are healthy, but who knows tomorrow?).(5) The more, the presence of wet market selling living poultries is still a habit in some areas in Indonesia. Besides the poultry, other domestic animals can also be infected by avian influenza, and therefore, restriction should also be made. In addition, there is uncontrolled use of vaccines in poultry. The farmers imported many kinds of vaccines them selves from China that might not be suitable for the strains found in Indonesia,(6) due to lack of poultry vaccine supply.(7) There are 11 brands of avian flu vaccine available in Indonesia, containing either H5N1, or H5N2, or H5N9 vaccine.(6) Therefore, there might be ineffective use of vaccines, causing mild and non fatal illness in poultry while they were shedding virus continuously to the environment. This in turn will cause continuous human infections, with the last case becoming ill at the 24th of May 2007.(8) Another problem was WHO rules regulating the transfer of avian influenza specimens to WHO centers that were unfavorable for poor countries. This lead to the discontinuation of specimen transfer to WHO centers by Indonesian Government, that will continue until new and more favorable rules are made.(9) This condition is unfavorable for research and might hamper vaccine development. Though Indonesian Government has cooperated with a vaccine company to develop H5N1 vaccine from Indonesian strain,(9) if the more centers can get access to the strain, the faster and the more the needed vaccine can be developed. Facing the many problems, other rich and well developed countries should help the poor countries, by collaboration in the surveillance, and donation to get the appropriate poultry vaccines and the reimbursement of the stamped out poultries. Prevention is always better, therefore cooperation of the whole world is needed, and material transfer agreement should not be disadvantageous for poor countries, so that researches can flourish. Otherwise, we should be prepared for a pandemic. References 1. Kahn R, Godfrey J. Preparedness for pandemic flu: Government proposals conflict. BMJ 2007; 334:1071-2, doi:10.1136/bmj.39220.429727.3A . 2. Barnett DJ, Omer SB, Fidler DP, Balicer RD, Hodge JG. Preparedness for pandemic flu: Global triage of global resources needed. BMJ 2007; 334:1071, doi:10.1136/bmj.39220.443889.3A 3. Pawitan JA. Averting avian influenza pandemic: SOS from a developing country. Lancet Infect Dis 2006;6:756-7. 4. WHO. Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO, 24 May 2007. URL: www. who.int/csr/disease/avian_influenza/country/cases_table_2007_05_24/en/index.html (Accessed: May 29th, 2007). 5. Ishaq M. Jakarta province poultry regulation is not effective (in Indonesian). Kompas, May 4, 2007, p.1, col. 1. 6. Anon. Fujian bird flu: avoid uncontrolled use of vaccine (in Indonesian). Kompas, November 4th, 2006, p.1, col.2-6. 7. Anon. Bird flu due to ineffective epidemic handling in animal (in Indonesian). Kompas, May 18, 2007, p.13, col. 1-4. 8. WHO. Avian influenza – situation in Indonesia – update 7, 24 May 2007 . URL: www. who.int/csr/don/2007_05_24/en/index.html. (Accessed: May 29th, 2007) 9. Rachmawaty E. Avian flu: dispute around avian flu virus Indonesian strain (in Indonesian). Kompas, February 23rd, 2007, p.42, col. 5-7. Competing interests: None declared