WHO’s six-step proposaloffers greater clarity infight against flu infection
Weekend • June 21, 2008
Tan Hui Leng in Kuala Lumpur
THE World Health Organisation (WHO) has released details of a new flu pandemic alert system to replace its existing one, which has been criticised for lacking clarity.
Currently, the world is in phase 3 of the alert system, which is defined as “no or very limited human-to-human transmission”. The six-step, three-layer alert system is a ladder going from “low risk of human cases” in phase 1 to “efficient and sustained human-to-human transmission” in phase 6, the pandemic phase.
Last year, a cluster of eight Indonesian family members who were infected through human-to-human H5N1 transmission sparked confusion over WHO’s flu alert level, with some calling for it to be raised to phase 4; that is, “evidence of increased human-to-human transmission”.
WHO’s new system addresses such issues of interpretation with three layers. The first comprises phases 1 to 3 and is defined as “predominantly animal infections; limited transmissibility among people”.
Phase 4 would be “sustained human-to-human transmission of animal or hybrid animal-human influenza virus, able to cause sustained community-level outbreaksthat have been verified” — this is when health authorities can consider issues such as rapid containment, discussion of phase changes, and switching to a pandemicvaccine.
Phases 5 and 6 would comprise the “geographical spread” of flu. There is also a post-pandemic phase.
Dr Nahoko Shindo, the medical officer at WHO’s Epidemic and Pandemic Alert and Response department, said the final version of the phases would be available by year’s end. She announced this on Friday during the 13th Congress of Infectious Diseases in Kuala Lumpur.
Infectious disease experts at the conference also warned that although the worst of the bird flu threat is over, the fight to eliminate the disease from poultry is weak.
The head of the United Nations’ Food and Agricultural Organization, Dr Juan Lubroth, said that “drawbacks and weaknesses” remain in the battle to eliminate the H5N1 strain from the poultry sector. The virus is now active in 10 countries and is endemic in the poultry population of some.
Infectious diseases experts fear that H5N1 could mutate into a form that spreads easily among humans and trigger a deadly flu pandemic.
He said the death of poultry especially affects the poor, 80 per cent of whom own livestock for their livelihood. As poultry is an important, inexpensive protein source, Dr Lubroth warned that failure to protect their food sources could worsen the global food crisis.
Veterinary services around the world need to be strengthened and more experts trained, while reporting must be more transparent, he said, adding that countries have to use more surveillance and implement policies to deal with the disease.
“We fail to see that political commitment,” he said.
This is of concern especially as H5N1 in humans exhibits a high fatality rate and unlike seasonal human flu, H5N1 spreads to the various organs.
On Thursday, Indonesia reported another two human avian flu cases, bringing the total number of infected humans worldwide to 385 since 2003. Of these, 243 have died.
Source: http://www.todayonline.com/articles/260862print.asp 
