No immunity to the Avian Influenza H5N1 virus: Bird Flu - WHO

WORLD Health Organisation (WHO) in a document released on Avian Flue Pandemic threat at the recently held WHO SEARO officials meeting in Colombo states: Virus H5N1 - The Avian Flu virus (H5N1) is highly unstable and may lead to emergence of a new pandemic virus to which the population has no immunity.

The virus which was mainly a disease of animals and humans rarely infected is presently found to be infecting both poultry and the human populations.

Human cases, 57 deaths

So far (from Dec. 2003 - Aug. 2005) in the SEARO region 112 cases of Avian Flu have been reported from four countries of which 57 have died.

The countries are:

            Cases   Deaths

Thailand     17    12

Vietnam     90    40

Cambodia    4     4

Indonesia     1    1

Evolving situation - Poultry Migratory Birds

The current outbreak among poultry is highly unprecedented. The virus is becoming increasingly pathogenic to the poultry. A wide range of animals becoming infected.

Jumping the human barrier

Migratory birds carrying the virus to long distances, and the virus jumping the species barrier and becoming highly virulent among the humans.

Migratory bird flyways are: Mississippi American Flyway, Pacific American Flyway, Atlantic American Flyway, East Atlantic Flyway, East Africa West Asia Flyway, Central Asia Flyway (covers India Sri Lanka etc.) and East Asia Australian Flyway.

Pre-requisites for a pandemic

Two met one to go

Among the three pre-requisites for a pandemic the Avian Flu Virus (H5N1) has already met two.

(1) Emergence of a novel virus to which all are susceptible.

(2) New virus being able to replicate in humans and cause disease, and the one yet to go being.

(3) The virus transmitting efficiently from human to human.

Next pandemic is now over due

From 1883 up to 1963 there had been influenza pandemics in almost 10 to 20 years intervals, but from 1973 up to now for the last 37 years there have been no pandemics.

Massive social, political and economic collapse globally

Among the possible consequences of a pandemic are:

(1) Health consequences, up to 25 per cent of global population becoming ill, with 2-7 million deaths.

(2) Health and other services being not able to cope, as 28 million could be hospitalised, and

(3) Massive social, political and economic collapse globally.

Influenza vaccines issues

Avian influenza vaccine - presently under development.

SEAR countries may have limited access to pandemic vaccines and they need to explore regional production.

Issues and challenges at country level

* Not all countries have a national pandemic plan.

* Weak public health infrastructure.

* Lack of adequate national resources.

What member countries can do

* Formulate national pandemic preparedness plans.

* Establish programme management structure.

* Strengthen multisectoral collaboration.

* Facilitate inter-country and inter-regional collaboration.

Pandemic preparedness in SEAR

Bangladesh: Draft prepared and WHO reviewing the draft.

Bhutan: None, and WHO mission planned from September 18.

DPR Korea: None, and WHO mission planned.

India: Draft prepared and under review.

Indonesia: Draft prepared and WHO mission completed.

Maldives: None, and WHO assistance ongoing.

Myanmar: Draft ready and WHO initial mission completed.

Nepal: Under preparation and WHO mission in the country.

Sri Lanka: None, and WHO support offered.

Thailand: Final document ready and on the web.

Timor-Leste: WHO reviewing draft plan.

Flu pandemics in the 20th century

1918: Spanish flu - 20-40 million deaths.

1957: Asian Flue - 1-4 million deaths.

1968: Hong Kong Flu - 1-4 million deaths.

Lessons from previous pandemics

* Pandemics are highly unpredictable.

* They have caused enormous mortality and economic devastation.

* Most originated in Asia.

* Public health interventions eg. quarantine and travel restrictions delayed but could not prevent its spread.

* Vaccine can have a great impact but manufacturing capacity still very limited.

London Guy's Hospital Paediatric heart team on heart surgery mission here

NEXT week thirty deserving child heart patients selected from several districts in the country will undergo their heart operations at the Karapitiya Teaching Hospital Galle by a well-known paediatric heart surgical team from the Guy's Hospital London headed by Consultant Cardiac Surgeon Dr. Conal Austin FRCS, Dr. John Simpson (BSc MBChp MRCP MD). The team of doctors will be leaving the country on October 3 after completing the mission.

Jai Lameer Co-ordinator of the Guy's Surgery Mercy Mission to Sri Lanka, now an approved charity in UK, who is already here busy making the necessary arrangements to carry out the heart surgery mission, told the HealthWatch, that this is the 'third mission' of the team to Sri Lanka.

In the earlier two missions carried out in the years 2002 and 2003 twenty deserving child heart patients who had been waiting for long in the operation list for their turn had been successfully operated, and they were living healthily now. The team is expecting to meet most of them this time.

Mr. Lameer said that all the cases they had done, and they were going to do this time are difficult in economically. The parents are too poor to afford surgery abroad.

According to him the estimated cost of the mission this time is Sterling Pounds 20,000 all met with donations. Several generous persons and organisations here have come forward to meet most of the missions' local expenses here.

The mission was grateful to them and to mention a few, Asha Hospital Trust Fund, FTZ security printing firm De La Rue, Sampath, Chartered and Hatton National Banks, Drs. Krishata Fernando, Mohan Jayatilleke, Drs. Neville Fernando and Githanjan Mendis, JFI Printers, Stafford Motors.

This mission is an annual event. Last year 2004 it was not possible to undertake it owing to the tsunami.

Local contributions to the mission are most welcome and could be sent to the Secretary, Asha Central Hospital. Mr. Lameer could be contacted for details on 0779548580 till October 3.

HealthWatch Medical Crossword Draw No. 15

The draw will be done by the Guy's Hospital (London) Paediatric Cardiac Medical Team at Trans Asia Hotel Colombo on October 2.

Basic guidelines for a mental health plan for Sri Lanka

Dr. A. A. W. Amarasinghe MD Associate Clinical Professor of Psychiatry in an article on "A Blue Print for a Mentally Health Sri Lanka", writes: Basic guidelines for a plan

There are various systems of mental health around the world.

Each has its own individuality.

Although what is aimed is the alleviation of human mental suffering, there are overt similarities and differences in these systems.

The basis on which each mental health system is build consists of the three pillars of research, education and caring.

In the formulation of the basic pillars for a national mental health system in Sri Lanka discussions, debates, discourses etc. by interested persons or groups are most welcome.

I foresee a multitude of questions begging clarifications in this process. Elucidation of such will be most fruitful and enriching.

Affordability is a valid concern that has to be met squarely, quantitative diversion of the national resources should not hurt or strain the very society which is intended to be the beneficiary.

Initial treading of a pragmatic middle path jettisoning grandiosity certainly will augur well for the future. Components of the proposed mental health plan

1. Creation of a National Institute of Mental Health

2. Establishment of islandwide mental health services to cover the entire population

3. Expansion of the academic parameters in psychological disciplines in the seats of higher learning

4. Development of a cadre of mental health professionals (e.g.; psychiatrists, nurses, psychologists, counsellors, sociologists, social workers)

5. Creation of a postgraduate institute of psychiatry and psychology.

Healthy Heart Awareness and Promotion Clinic

THE Sri Lanka Heart Association in collaboration with the Colombo Municipal Council will conduct a full day 'Healthy Heart Awareness and Promotion Clinic' to mark the World Heart Day falling on Sunday, September 25.

The Clinic will be conducted at the Sahassapura Municipal Community Centre on Baseline Avenue in the morning from 8.30.

Cardiologists and paramedical staff from the Cardiology Unit of the National Hospital, Colombo along with other institutes such as Asiri Hospital and Asha Central Hospital will lend their support to the conduct of the Clinic.

The main objective of the Clinic is to screen those persons at risk and advise them accordingly, while disseminating information on preventing heart disease.

Sri Lanka Heart Association anticipates a wide cross-section of people benefiting from this Clinic which is being conducted in one of the most populace areas of Colombo.

It will also be of educational value to rectify several misconceptions and beliefs regarding Heart disease.

We also hope that this would be an incentive for similar activities to be conducted in other parts of the country.

New test can predict breast cancer's spread

WASHINGTON: A new test that looks at immune cells in the lymph nodes may be the best way to predict whether breast cancer has spread and will be likely to recur, doctors said recently.

Currently, the best way to predict whether breast cancer is likely to come back is to search for tumour cells in the lymph nodes near the breast.

But Dr. Peter Lee and colleagues at the Stanford University School of Medicine say that perhaps examining the immune cells in those lymph nodes might be a better way to predict the cancer's spread.

Patients whose tests suggest an aggressive cancer could receive extra treatment to try to kill any stray tumour cells.

"Immune changes in the lymph node almost perfectly predict clinical outcome, much better than any other prognostic factor that is available today," Lee said in a statement.

Writing in the journal Public Library of Science-Medicine, Lee and colleagues said they tested lymph node tissue samples from 77 breast cancer patients taken more than five years ago. All of these patients had had cancer that had spread out of the breast.

Within five years, 33 of the 77 patients had their cancer return.

Immune cells are known to sometimes destroy cancer cells -- they keep cancer constantly under control in most normal healthy people. But Lee was tying to find out what goes wrong when the immune system fails to control cancer.

Lee's team looked for tumour cells and for three major types of immune cells: cytotoxic T cells, helper T cells and dendritic cells.

Lymph nodes that had been invaded by tumour cells showed dramatic decreases in helper T cells and dendritic cells. They also had fewer cytotoxic T cells, Lee found.

"Then we found something more interesting and puzzling," Lee said. Even in some lymph nodes that had only a few tumour cells, or no tumour cells, the immune cell balance was off.

For the most part, this imbalance in immune cells was seen in the 33 women whose breast cancer came back before five years, Lee's team found.

"It was a surprise to find immune changes in lymph nodes with no detectable tumour cells," said Lee.

Perhaps tumour cells secrete some substance that prepares the lymph node for invasion, he said.

"Even before it actually invades the node, it actually causes the node to change," he added.

The women whose lymph nodes had a normal immune cell balance had an 85 to 90 per cent chance of being disease-free after five years. The group with an "unfavourable" immune profile had less than a 15 per cent chance, Lee's team reported.

Lee hopes to develop a simple test that could help determine which women could benefit from more aggressive therapy, and which could be spared undergoing costly and toxic treatments unnecessarily.