H5 HPAI Poultry Quarantine In Parts Of Washington State

 

# 9549

 

While poultry producers in Europe, Asia, and Canada have had to deal with the disruptions and economic losses brought on by numerous outbreaks of highly pathogenic of avian influenza over the dozen years, the United States has gotten off pretty lucky.

 

There was a pretty good scare in Texas in 2004, when – for the first time in 20 years -  an outbreak of HPAI (H5N2)  affected a flock of about 7,000 chickens in south-central Texas.  

 

But that outbreak was quickly contained, and no humans were infected.

 

Until a little over a month ago the Eurasian lineage of H5 avian flu virus had never been reported in North America, but after an outbreak of HPAI H5N2 was detected in British Columbia, we’ve seen reports of HPAI H5N2 and H5N8 among birds in the Pacific Northwest (see Avian Flu Suspected In 2nd Washington State Backyard Flock).

 

Because of repeated detections of HPAI H5 in local wild and migratory birds, the Washington State Department of Agriculture has imposed a temporary quarantine on poultry sales and movement in parts of Benton and Franklin County.

 

For immediate release:
Jan. 7, 2015
Contact: Hector Castro
(360) 902-1815
WASHINGTON STATE DEPARTMENT OF AGRICULTURE
P.O. Box 42560, Olympia, Washington 98504-2560
This news release is also available as a PDF.

---

WSDA sets quarantine to control poultry movement in Tri-Cities area

OLYMPIA — The Washington State Department of Agriculture (WSDA) today adopted an emergency rule to establish a quarantine zone for avian influenza that includes parts of Benton and Franklin counties, covering an area of roughly 20 miles around two locations where avian influenza has been identified in flocks of mixed poultry and other birds.

The quarantine area restricts the movement of eggs, poultry or poultry products out of the identified zone. Exemptions will be made for operations that obtain special permits and meet specific criteria. Visit www.agr.wa.gov/lawsrules/rulemaking for the complete rule and a detailed map.

On Jan. 2, WSDA activated a multi-agency response plan following the confirmation of highly pathogenic H5N2 avian influenza in domestic birds in a Benton County flock. Later, a second infected flock was identified in the area. Work was completed Jan. 6 at both locations to control the spread of the virus. The joint team of WSDA and U.S. Department of Agriculture officials will now work to clean and disinfect the two sites.

USDA plans to increase the amount of testing of poultry and other domestic birds within an area identified as 10 kilometers around the two flocks.

WSDA has not identified any new cases of avian influenza. The virus has not been found in commercial poultry anywhere in Washington or the United States. Washington’s commercial poultry industry has a robust avian influenza testing program and WSDA conducts weekly surveillance testing and health inspections at live bird markets in the state.

The biggest risk continues to be the presence of two highly pathogenic strains of avian influenza (H5N2 and H5N8) in migratory wild waterfowl populations. WSDA is encouraging bird owners to protect their domestic birds from contact with wild waterfowl and remain vigilant in their biosecurity measures.

There is no immediate public health concern due to the avian influenza virus detected. Avian influenza does not affect poultry meat or egg products, which remain safe to eat. As always, both wild and domestic poultry should be properly cooked.

Deaths or illness among domestic birds should be reported to the WSDA Avian Health Program at 1-800-606-3056. For wild birds, contact the Washington State Department of Fish and Wildlife at 1-800-606-8768.

# # #

 

While neither of these recently detected HPAI H5 subtypes are currently believed to pose a serious risk to human health, these HPAI outbreaks can cost the poultry industry – and the local economy – tens of millions of dollars. 

 

Some excerpts from the declaration from WSDA.

 

The establishment of HPAI would be costly to the poultry industry, consumers and taxpayers. Eradication of an HPAI outbreak in the northeastern states in the mid-1980s resulted in the destruction of 17 million birds at a cost of nearly $65 million. The disease can spread rapidly from flock to flock. In some instances, strains of HPAI can be infectious to people.

The USDA, APHIS works to keep NAI from becoming established in the United States. The director of agriculture, pursuant to authorities in chapter 16.36 RCW, has determined that the containment and eradication of NAI is necessary to protect the commercial poultry industry, small poultry farms and poultry fanciers of the state of Washington. Birds species that are potential hosts for NAI include chickens, turkeys, ratites, waterfowl, pigeons, doves and other domestic fowl as well as game birds including pheasants, partridge, chukars, quail, and grouse. Migratory waterfowl have proved to be the natural reservoir for this disease.

WAC 16-51-300 Prohibition on moving poultry, eggs, and poultry products, and specified
farm products within or from the quarantine zone established for NAI.

(1) Movement of living or dead poultry, eggs, or poultry products within or from the quarantine zone for NAI is prohibited, unless a permit has been issued by the department pursuant to WAC 16-51-800. Poultry may be moved within property that is one premises under the control of one person so long as that movement does not cross the boundary of a quarantine zone established by this chapter. Dead poultry or other dead birds can be transported to an approved landfill or an incinerator for disposal when secured within two plastic bags in compliance with WAC 16-51- 700. (2) Poultry shows or sales may not be held within the quarantine zone unless permissible per WAC 16-51-200 or by a special permit issued under WAC 16-51-800.

 

Pentagon Announces 21 Day `Controlled Monitoring’ Of Personnel Returning From Ebola Affected Regions

# 9263

 

As the contentious debate over the quarantining travelers coming from Ebola affected regions continues to embroil public health authorities, politicians, and the public – the Pentagon today announced their intent to place all personnel returning from those same nations under `controlled monitoring’ .

 

While not well defined, `controlled monitoring’ has been described in various press reports as a `quarantine-like’ protocol.  

 

The word `quarantine’ however, is noticeably absent from today’s statement. Details, according to today’s Pentagon statement, are to be worked out over the next two weeks.

 

Although the administration – and many public health officials – have repeatedly stated that a 21-day quarantine was unnecessary (and possibly counter-productive)  for non symptomatic travelers – polling from both CBS News and ABC News (see WaPo article Poll: 80 percent want Ebola quarantines) shows that the majority of Americans remain unconvinced.

This press release from Defense.gov.

 

 

IMMEDIATE RELEASE
Release No: NR-547-14
October 29, 2014

Statement from Pentagon Press Secretary Rear Admiral John Kirby on Controlled Monitoring for Personnel Returning from Operation United Assistance

This morning, Secretary Hagel signed an order that validated a recommendation from the Joint Chiefs of Staff to place all U.S. military service members returning from Ebola response efforts in West Africa into a 21-day controlled monitoring regimen. This order will apply to all military services that are contributing personnel to the fight against Ebola at its source.

The secretary has also directed that the Joint Chiefs develop, for his review within 15 days, a detailed implementation plan for how this controlled monitoring will be applied across the force that takes into account the size and scope of the logistics required for this effort.

In addition, the secretary directed that the Joint Chiefs conduct a review of this new regimen within 45 days from now. This review will offer a recommendation on whether or not such controlled monitoring should continue based on what we learn and observe from the initial waves of personnel returning from Operation United Assistance.

The secretary believes these initial steps are prudent given the large number of military personnel transiting from their home base and West Africa and the unique logistical demands and impact this deployment has on the force. The secretary's highest priority is the safety and security of our men and women in uniform and their families.

 

Ohio Announces Stricter Ebola Quarantine Protocols

 

 

# 9205

Given the expanding epidemiological investigations into contacts of those who were potentially exposed to Ebola in Dallas, the State of Ohio has released a new set of stringent quarantine protocols for anyone who may have had contact with an Ebola infected individual.

 

These guidelines are far stricter than those released last August by the CDC (see Interim Guidance for Monitoring and Movement of Persons with Ebola Virus Disease Exposure), where asymptomatic household contacts or other close contacts with an EVD patient would only be subject to conditional release and controlled movement until 21 days after last known potential exposure.

 

For the state of Ohio, for  any direct physical contact with the index case (including brief contact such as a handshake without personal protective equipment), ODH recommends quarantine for 21 days.

 

FOR IMMEDIATE RELEASE October 16, 2014
Contact: State Joint Information Center (614) 799-6480

Ohio Issues Enhanced Ebola Quarantine Protocols

COLUMBUS – Today the Ohio Department of Health (ODH) issued new, stronger recommended quarantine protocols for local health departments responding to suspected or confirmed Ebola cases in Ohio. The ODH guidelines were developed in consultation with Ohio infectious disease experts and build on guidelines of the U.S. Centers for Disease Control and Prevention.

ODH issued the new guidelines to Ohio's local health departments and health care providers via its Ohio Public Health Communications System.

“The ODH guidelines are being recommended out of an abundance of caution to take strong measures to protect Ohio residents,” said Dr. Mary DiOrio, state epidemiologist and interim chief of the ODH Bureau of Prevention and Health Promotion. “It has become clear that we cannot be too careful in efforts to contain the spread of this deadly disease.”

Here are the ODH guidelines for local health departments:

• For individuals with any direct physical contact with the index case (including brief contact such as a handshake without personal protective equipment), ODH recommends quarantine for 21 days after the last contact in conjunction with public health officials.
• For individuals without direct contact, but within a three foot radius of the index case (such as adjacent passengers in an airplane or car) for a prolonged period of time, ODH recommends twice-daily temperature-taking and symptom check (one observed by a public health official) for 21 days after the last contact with the index case.
• For individuals without direct contact but in the vicinity of the index case as indicated by a public health official, notification and self-monitoring is recommended.

Individuals in any of the above categories who have an oral temperature of 100.4 degrees or greater, or develop symptoms including muscle aches, weakness, vomiting, diarrhea or bruising/bleeding, should seek medical evaluation and testing.

Ohio public health officials were alerted by the CDC Wednesday morning that a Dallas nurse who tested positive for Ebola was in Ohio Oct. 10-13.

ODH has activated a 24-hour-a-day call center to answer questions about Ebola and Ohio’s response. The telephone number is 1-866-800-1404. Information about Ebola is also available on the ODH website at www.odh.ohio.gov  and the CDC website at www.cdc.gov.

###

CHRONOLOGY

• Oct. 16: ODH in consultation with infectious disease experts across the state issues enhanced Ebola quarantine protocols for individuals in proximity of index cases.
• Oct. 15: CDC responds to Gov. John R. Kasich’s request by agreeing to send staff to Ohio to help support Ohio’s state and local Ebola response efforts.
• ODH deploys state epidemiologist Dr. Mary DiOrio and other staff to Summit County to assist with its efforts; participates in Summit County Public Health’s news conference.
• Gov. Kasich talks with US Secretary of Health and Human Services Sylvia Burwell, as well as CDC Director Dr. Tom Frieden. Kasich requests CDC staff to be deployed to Ohio to assist with patient contact work.
• ODH notified by CDC that Dallas nurse who tested positive for Ebola was in Summit County Oct. 10-13.
• Oct. 14: Ohio conducts a tabletop exercise and preparedness seminar with health care partners representing hospitals, physicians, nurses, EMS responders and local health departments.
• July-Pres.: ODH shares Ebola preparedness guidance with health care providers and local health departments.

Texas: Statement On Home Quarantine Of Ebola Patient’s Family

# 9138

 

Without providing details as to why they felt compelled to issue a written order, the State of Texas last night delivered orders to the family of America’s first imported Ebola case to remain home, and not accept unapproved visitors, while being monitored for possible symptoms until October 19th. 

First the statement, then I’ll be back with a bit more on the issues of isolation vs. quarantine.

 

 

Texas Department of State Health Services
NEWS RELEASE 
Oct. 2, 2014

Texas Orders Family of Ebola Patient to Stay Home

Out of an abundance of caution, Texas and Dallas County health officials have ordered four close family members of the Dallas Ebola patient to stay home and not have any visitors to prevent the potential spread of disease.

 
“We have tried and true protocols to protect the public and stop the spread of this disease,” said Dr. David Lakey, Texas health commissioner. “This order gives us the ability to monitor the situation in the most meticulous way.”

The local health department had previously instructed the family to stay home, but a strict public health control order is needed to ensure compliance. Ebola is not contagious until symptoms appear. The family members do not have symptoms at this time.

The orders were hand delivered to the family members Wednesday evening by local health officials. The orders legally require the family to stay at home and not have any visitors without approval from the local or state health department until at least Oct. 19. The order is in place until the incubation period has passed and the family is no longer at risk of having the disease.

The order requires the family to be available to provide blood samples and agree to any testing required by public health officials and to immediately report any symptoms to Dallas County Health and Human Services. Symptoms include fever above 100.5 degrees, headache, nausea, diarrhea or abdominal pain. 

Texas law allows the state health department and the local health authority to issue control measures to a person who is ill with, has been exposed to, or is the carrier of a communicable disease. (Health and Safety Code §81.083). Control measures by law can include isolation, quarantine and preventive therapy. If a person does not follow these orders, they can be enforced by the courts, and the person can face criminal charges.

 

 

Contrary to Hollywood’s draconian portrayal, quarantine usually consists of  having an exposed person stay home, and report to a healthcare worker by phone each day, during a disease’s incubation period. 

 

While usually voluntary, if there are reasons to suspect non-compliance and the threat to the public is considered great enough, then state and local health departments have legal recourse to enforce home (or other) confinement.

 

Just so we are all on the same page, here is how the CDC differentiates between Quarantine and Isolation:

The CDC applies the term "quarantine" to more than just people. It also refers to any situation in which a building, conveyance, cargo, or animal might be thought to have been exposed to a dangerous contagious disease agent and is closed off or kept apart from others to prevent disease spread.

The Centers for Disease Control and Prevention (CDC) is the U.S. government agency responsible for identifying, tracking, and controlling the spread of disease. With the help of the CDC, state and local health departments have created emergency preparedness and response plans. In addition to early detection, rapid diagnosis, and treatment with antibiotics or antivirals, these plans use two main traditional strategies—quarantine and isolation—to contain the spread of illness. These are common health care practices to control the spread of a contagious disease by limiting people's exposure to it.

The difference between quarantine and isolation can be summed up like this:

• Isolation applies to persons who are known to be ill with a contagious disease.
• Quarantine applies to those who have been exposed to a contagious disease but who may or may not become ill.

 

Two months ago, in A Revision In the List Of Quarantinable Communicable Diseases, we looked at a recent executive order that expanded slightly the types of diseases that could be quarantined.  

 

Ebola, and other hemorrhagic viruses, were already part of that short list.

 

Twenty months ago, in EID Journal: A Brief History Of Quarantine, we looked at the long and successful use of quarantine in the United States, and around the world, to contain highly infectious diseases. The ultimate containment of SARS in 2003 was due, in large part, to the use of home quarantines around the globe.

 

While never likely to be popular - particularly among those caught up in one – quarantines are an important public health tool, and can often spell the difference between containing a disease, and seeing it spread further.

CDC Quarantine Stations: Not What You May Think

 

 

# 8939

 

There’s a scaremongering meme running on the Internet – usually accompanied by the above map – suggesting that the CDC has set up massive quarantine `centers’ around the country ready to forcibly house people who may have been exposed to Ebola, MERS, or Avian Flu. 

 

These stories are often accompanied by unattributed pictures of barbed wire enclosed facilities, and dire warnings about the recent Revision In the List Of Quarantinable Communicable Diseases signed on August 1st by President Obama.

 

Contrary to popular fiction, and many of these websites, the CDC’s quarantine stations are not massive holding pens for those unfortunate enough to be tagged as having being `exposed’ to a listed infectious disease – in fact, they are merely offices located at 20 busy ports of entry where CDC quarantine officers work.

 

Yes, if you are entering the country and  are visibly ill, and suspected of being infected by a handful of particularly nasty and contagious diseases, you could be placed in isolation – usually at the nearest appropriate hospital – while tests are conducted.  

 

But as far as `quarantine’ is concerned – we are talking those who may have been exposed, but are not ill – the most common course of action is to ask those people to stay home and report any symptoms to the health department during the incubation period.

 

U.S. Quarantine Stations

U.S. Quarantine Stations are part of a comprehensive system that serves to limit the introduction and spread of contagious diseases in the United States. U.S. Quarantine Stations are located at 20 ports of entry and land-border crossings where international travelers arrive,

They are staffed with medical and public health officers from the Centers for Disease Control and Prevention (CDC) and managed by CDC’s Division of Global Migration and Quarantine. These health officers decide whether ill persons can enter the United States and what measures should be taken to prevent the spread of contagious diseases.

Authority and Scope

CDC has the legal authority to detain any person who may have an infectious disease that is specified by Executive Order to be quarantinable. If necessary, CDC can deny ill persons with these diseases entry to the United States. CDC also can have them admitted to a hospital or confined to a home for a certain amount of time to prevent the spread of disease.

Daily Activities

Medical and public health officers at U.S. Quarantine Stations perform these activities:

Response

• Respond to reports of illnesses on airplanes, maritime vessels, and at land-border crossings
• Distribute immunobiologics and investigational drugs
• Plan and prepare for emergency response

Quarantinable Diseases by Executive Order

• Cholera
• Diphtheria
• Infectious tuberculosis
• Plague
• Smallpox
• Yellow fever
• Viral hemorrhagic fevers
• Severe acute respiratory syndromes
• New types of flu (influenza) that could cause a pandemic

Migration

• Monitor health and collect any medical information of new immigrants, refugees, asylees, and parolees
• Alert local health departments in the areas where refugees and immigrants resettle about any health issues that need follow up
• Provide travelers with essential health information
• Respond to mass migration emergencies

Inspection

• Inspect animals, animal products, and human remains that pose a potential threat to human health
• Screen cargo and hand-carried items for potential vectors of human infectious diseases

 (Continue . . . )

 

While conspiratorialists are sputtering `Yes, but . .  yes, but . . .’  - it is true that the CDC has the legal authority to isolate or quarantine someone against their will.  As do practically every state and local health department in the country, I might add  (see CDC Legal Authorities for Isolation and Quarantine).

        Enforcement

If a quarantinable disease is suspected or identified, CDC may issue a federal isolation or quarantine order.

Public health authorities at the federal, state, local, and tribal levels may sometimes seek help from police or other law enforcement officers to enforce a public health order. 

U.S. Customs and Border Protection and U.S. Coast Guard officers are authorized to help enforce federal quarantine orders.

Breaking a federal quarantine order is punishable by fines and imprisonment.

Federal law allows the conditional release of persons from quarantine if they comply with medical monitoring and surveillance.

Federal Quarantine Rarely used

Large-scale isolation and quarantine was last enforced during the influenza (“Spanish Flu”) pandemic in 1918–1919. In recent history, only a few public health events have prompted federal isolation or quarantine orders.

 

As I’ve said before,  quarantines are politically messy, logistically difficult to administer, and would lose their value quickly in an outbreak. Once a communicable disease is `in the community’, there is rarely a good  reason to pursue them.

 

But implemented early in an outbreak – as was done with SARS in 2003 – they can literally turn the tide against an emerging epidemic.

 

Quite frankly, the biggest reason why Ebola is unlikely to spread significantly here in the western world is because we have the laws, infrastructure, and good sense to isolate those who are likely sick, and to ask those who may have been exposed to stay home.

A Revision In the List Of Quarantinable Communicable Diseases

Photo Credit CDC PHIL

 

# 8902

 

Eighteen months ago, in EID Journal: A Brief History Of Quarantine, we looked at the long and successful use of quarantine in the United States, and around the world, to contain highly infectious diseases. 

 

Contrary to Hollywood’s draconian portrayal, quarantine usually consists of  having an exposed person stay home, and report to a healthcare worker by phone each day, during a disease’s incubation period.

 

Just so we are all on the same page, here is how the CDC differentiates between Quarantine and Isolation:

The CDC applies the term "quarantine" to more than just people. It also refers to any situation in which a building, conveyance, cargo, or animal might be thought to have been exposed to a dangerous contagious disease agent and is closed off or kept apart from others to prevent disease spread.

The Centers for Disease Control and Prevention (CDC) is the U.S. government agency responsible for identifying, tracking, and controlling the spread of disease. With the help of the CDC, state and local health departments have created emergency preparedness and response plans. In addition to early detection, rapid diagnosis, and treatment with antibiotics or antivirals, these plans use two main traditional strategies—quarantine and isolation—to contain the spread of illness. These are common health care practices to control the spread of a contagious disease by limiting people's exposure to it.

The difference between quarantine and isolation can be summed up like this:

• Isolation applies to persons who are known to be ill with a contagious disease.
• Quarantine applies to those who have been exposed to a contagious disease but who may or may not become ill.

 

During the SARS outbreak in 2003, then President George Bush via  Executive Order 13295: Revised List Of Quarantinable Communicable Diseases added SARS to the short list of quarantinable diseases.

 

(a) Cholera; Diphtheria; infectious Tuberculosis; Plague; Smallpox; Yellow Fever; and Viral Hemorrhagic Fevers (Lassa, Marburg, Ebola, Crimean-Congo, South American, and others not yet isolated or named).

(b) Severe Acute Respiratory Syndrome (SARS), which is a disease associated with fever and signs and symptoms of pneumonia or other respiratory illness, is transmitted from person to person predominantly by the aerosolized or droplet route, and, if spread in the population, would have severe public health consequences.

 

Two years later, when avian flu became a serious concern, Executive Order 13375  amended this list by adding :

 

‘‘(c) Influenza caused by novel or reemergent influenza viruses that are causing, or have the potential to cause, a pandemic.’’.

As emerging disease threats evolve, so to must the legalese enabling an adequate response.   Yesterday the White House issued the following executive order (h/t Sharon Sanders & Treyfish on FluTrackers) regarding a subtle change that broadens the scope of SARS and SARS-like diseases.

 

The White House

Office of the Press Secretary

For Immediate Release

July 31, 2014

Executive Order -- Revised List of Quarantinable Communicable Diseases

EXECUTIVE ORDER
- - - - - - -
REVISED LIST OF QUARANTINABLE COMMUNICABLE DISEASES

By the authority vested in me as President by the Constitution and the laws of the United States of America, including section 264(b) of title 42, United States Code, it is hereby ordered as follows:

Section 1.  Amendment to Executive Order 13295.  Based upon the recommendation of the Secretary of Health and Human Services, in consultation with the Acting Surgeon General, and for the purposes set forth in section 1 of Executive Order 13295 of April 4, 2003, as amended by Executive Order 13375 of April 1, 2005, section 1 of Executive Order 13295 shall be further amended by replacing subsection (b) with the following:

"(b)  Severe acute respiratory syndromes, which are diseases that are associated with fever and signs and symptoms of pneumonia or other respiratory illness, are capable of being transmitted from person to person, and that either are causing, or have the potential to cause, a pandemic, or, upon infection, are highly likely to cause mortality or serious morbidity if not properly controlled.  This subsection does not apply to influenza."

Sec. 2.  General Provisions.  (a)  Nothing in this order shall be construed to impair or otherwise affect:
(i) the authority granted by law to an executive department, agency, or the head thereof; or
(ii) the functions of the Director of the Office of Management and Budget relating to budgetary, administrative, or legislative proposals.

(b)  This order is not intended to, and does not, create any right or benefit, substantive or procedural, enforceable at law or in equity by any party against the United States, its departments, agencies, or entities, its officers, employees, or agents, or any other person.

BARACK OBAMA

 

The major change here is the removal of the requirement that the disease be transmitted  `predominantly by the aerosolized or droplet route’.   While not specifying why this change was needed, one could speculate that since we don’t have absolute answers regarding how MERS is transmitted, it falls outside of the older SARS definition. 

Quarantines are politically messy, difficult to administer, and lose their value quickly in an outbreak. Once a communicable disease is `in the community’, there is rarely a good  reason to pursue them. 

 

But implemented early in an outbreak – as was done with SARS in 2003 – they can literally turn the tide against an emerging epidemic.

 

During the 2003 SARS epidemic, Isolation was used in the United States for patients who were ill, but since transmission of the virus was very limited here, quarantine was not recommended for those exposed (cite).

 

In other countries, where transmission risks were greater, quarantines were used – quite successfully – in order to contain the virus. 

• Singapore was one of the first countries to mandate quarantines when more than 800 family members of SARS patients were ordered to stay in their homes. 
• Hong Kong sealed part of the Amoy Gardens Apartment complex after scores of cases erupted there, and later moved all remaining residents to two holiday camps where they were quarantined.
• And Toronto, Canada closed schools and quarantined thousands in their bid to contain the virus (see The SARS Experience In Ontario, Canada).

The graph below shows two distinct phases of disease transmission in Canada, both apparently dampened by the implementation of quarantines.

 

While unlikely to be popular (particularly among those caught up in one) – quarantines are a necessary and often highly effective tool for public health – and likely stopped SARS from becoming a global pandemic in 2003.  

Xinhua News: Plague Quarantine Lifted In NW China

Credit CDC

 

 

# 8861

 

 

Last Friday, while writing about the Colorado DPH Statement On 4 Cases Of Plague, I also mentioned the report of a single case of pneumonic plague in Gansu Province in North Central China (see CHP notified by NHFPC of plague case in Gansu ).

 

Yesterday it was widely reported that parts of one (or more) cities were `sealed off’ or under quarantine (see Reuters Parts of Chinese city in quarantine after plague death: Xinhua). 

 

While they make great copy, reports such as these out of China are difficult to verify. In researching this report, I found several conflicting stories in the Chinese press going back 5 or 6 days.  

 

Today Xinhua News is reporting that – after 9 days – that quarantine has been lifted, while appearing to downplay (or omit) the size of the quarantine action. 

 

Plague quarantine lifted in NW China

English.news.cn   2014-07-24 11:53:15

LANZHOU, July 24 (Xinhua) -- Yumen City in northwest China's Gansu Province on Thursday lifted a nine-day quarantine on an area in which plague caused one death.

A total of 151 people who had close contact with the infected man had been put in quarantine and under medical observation. None of them has reported symptoms of the disease, according to a report submitted by the local authorities and approved by the provincial government.

Plague is categorized as a Class A infectious disease, the most serious under China's Law on the Prevention and Treatment of Infectious Diseases.

A 38-year-old man in Yumen died of plague on July 16. He had been in contact with a dead marmot, a member of the squirrel family.

During the quarantine, local authorities aided with disease prevention, and control specialists sent by the National Health and Family Planning Commission carried out disinfection and rat extermination and educated locals on how to guard against plague.

The experts said plague is currently in a communicable, "active" phase among the local rat population.

 

 

As the Chinese press often indulges in euphemisms, so `disinfection, rat extermination & educating locals’ could entail a litany of strong, proactive steps by local public health authorities. 

 

Whatever the truth of the matter, for now this event appears to be under control.

HK: H7N9 Contact Tracing, Testing, Isolation & Quarantine

 

# 8035

 

Now that Hong Kong’s first (imported) case of H7N9 has been identified, the job of contacting and testing all of her close contacts over the past two weeks becomes paramount for public health officials. Since she is in critical condition, and on an ECMO (Extracorporeal Membrane Oxygenation) machine since November 30th, getting detailed information about her contacts has proven difficult.

 

So far, 200 people have been contacted, and 17 close contacts have been tested (all negative for now).  Those with negative results will be moved from hospital isolation and quarantined at a holiday resort while they are kept under observation.  This from RTHK.

 

Bird flu contacts test negative for H7N9

03-12-2013

The government says 17 people who had close contact with the first Hong Kong person to come down with H7N9 bird flu have all tested negative for the virus.

This includes an Indonesian friend who travelled to Shenzhen with the women, who remains in a critical condition in hospital.

All 10 members of a family whom the sick Indonesian domestic helper worked for and six people who shared the same ward with her in Tuen Mun Hospital have also tested negative.

The Health Secretary, Ko Wing-man says these people have been moved out of hospital isolation wards and will be sent to the Lady McLehose Holiday Village for continued observation.

 

Although they are often used interchangeably in the press, here is how the CDC defines Quarantine and Isolation:

 

The CDC applies the term "quarantine" to more than just people. It also refers to any situation in which a building, conveyance, cargo, or animal might be thought to have been exposed to a dangerous contagious disease agent and is closed off or kept apart from others to prevent disease spread.

The Centers for Disease Control and Prevention (CDC) is the U.S. government agency responsible for identifying, tracking, and controlling the spread of disease. With the help of the CDC, state and local health departments have created emergency preparedness and response plans. In addition to early detection, rapid diagnosis, and treatment with antibiotics or antivirals, these plans use two main traditional strategies—quarantine and isolation—to contain the spread of illness. These are common health care practices to control the spread of a contagious disease by limiting people's exposure to it.

The difference between quarantine and isolation can be summed up like this:

• Isolation applies to persons who are known to be ill with a contagious disease.
• Quarantine applies to those who have been exposed to a contagious disease but who may or may not become ill.

 

Hong Kong has a good deal of experience with both isolation and quarantine procedures, as they were employed extensively more than a decade ago for the SARS epidemic.   During that outbreak, 1,750 Hong Kong residents were infected, 286 died, and thousands were quarantined to prevent its spread (see SARS and Remembrance).

Since a negative quick test is no guarantee that someone who has been exposed isn’t infected (this patient tested negative twice while hospitalized before testing positive on Dec 2nd), it is prudent to try to quarantine those who have been exposed until infection can be ruled out.  Since hospital isolation is overkill for asymptomatic (and likely uninfected) individuals, other arrangements that are reasonably palatable to those quarantined are desirable.

 

To that end, Hong Kong’s CHP has reserved cabins at the Lady McLehose Holiday Village to house those under observation.  The facility is described on Gov HK website as:

 

Located within Sai Kung Country Parks at Pak Tam, Sai Kung, the Lady MacLehose Holiday Village has an air of tranquility and presents a charming view of the woody hillsides. Each bungalow, which can accommodate 3 to 15 persons, is self-contained with a sitting room, bedroom(s) and a toilet with shower facilities. The Camp has a capacity of 280 campers. Hirers please note that Camp facilities, such as bungalows, recreational facilities, canteen, etc., are located on different spots of a slope and connected by pavements.

 

This arrangement is similar to what we’ve seen elsewhere, including Singapore (see MERS: Singapore MOH Puts Quarantine Chalets On Standby).  Earlier this year, in EID Journal: A Brief History Of Quarantine, I wrote about the use of quarantine and isolation with the 2003 SARS outbreak:

 

During the 2003 SARS epidemic, Isolation was used in the United States for patients who were ill, but since transmission of the virus was very limited here, quarantine was not recommended for those exposed (cite).

In other countries, where transmission risks were greater, quarantines were used – quite successfully – in order to contain the virus.

• Singapore was one of the first countries to mandate quarantines when more than 800 family members of SARS patients were ordered to stay in their homes. 
• Hong Kong sealed part of the Amoy Gardens Apartment complex after scores of cases erupted there, and later moved all remaining residents to two holiday camps where they were quarantined.
• And Toronto, Canada closed schools and quarantined thousands in their bid to contain the virus (see The SARS Experience In Ontario, Canada).

 

While we don’t know how many mild or asymptomatic cases of H7N9 may have occurred, so far the number of severe cases detected by Chinese public health authorities suggests the virus hasn’t yet gained the ability to spread easily and efficiently among humans.

 

We have seen evidence of a few small clusters, and research over the summer suggests that the virus may not have that far to evolve to pose a pandemic threat (see Nature: Receptor Binding Of H7N9).

 

So public health interventions – such as quarantining those with likely exposure until infection can be ruled out – is a prudent and necessary step.

MERS: Singapore MOH Puts Quarantine Chalets On Standby

 

 

 

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Singapore, which already issued warnings to travelers planning to visit the Middle East last month (see MERS-CoV: Singapore Issues Umrah Health Advisory) has set aside eight chalets at a local resort to be used as quarantine housing for anyone suspected of being exposed to the MERS coronavirus.

 

Singapore was one of those areas very hard hit by SARS ten years ago, and they were among the first countries to implement quarantine measures.

 

First a statement by Singapore’s Ministry of Health, then I’ll be back with some background on how quarantine was used (successfully) with SARS a decade ago to contain the virus.

 

STRENGTHENING PREPAREDNESS FOR EMERGING INFECTIOUS DISEASES

Strengthening preparedness for emerging infectious diseases

As at 7 Jun 2013, the World Health Organisation (WHO) has reported a total of 55 confirmed cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) worldwide, since the disease was first reported in September 2012.

 

There are currently no cases of MERS-CoV in Singapore. The risk of an outbreak in Singapore remains low.  However, given today’s globalised travel patterns, the Government remains vigilant and is stepping up its operational readiness in the event of an imported case.

 

As a precautionary measure, the Government will put on standby the Home Team NS (HTNS) Pasir Ris Chalets as possible quarantine housing from 17 June 2013 (Monday) at 1.00pm. This is to ensure that quarantine facilities can be deployed at short notice to safeguard public health, if the need arises.

 

Options Available to Members to Minimise Inconvenience

HTNS members who have made prior bookings at the chalets may continue with their holiday plans at the HTNS Pasir Ris Chalets or opt to cancel their bookings. Instead of outright cancellation of bookings, these voluntary options minimise inconveniences. The public can continue with their holiday plans at the chalet until the time comes for the chalets to be activated as quarantine facilities

 

When the facility is activated to house the persons served with the Quarantine Order – Persons Under Quarantine (PUQ), chalet occupiers will be requested to check-out of the chalets within 3 hours upon receiving the notice, which will be served between 8.30am to 6.00pm. They will be given a full refund of their booking fee and vouchers worth $100, as a gesture of goodwill.

 

For HTNS members who prefer to make alternative holiday plans, they may  opt to cancel their bookings for chalets booked on or after 17 June 2013. They will be similarly given a full refund of the booking fee and a $100 voucher, as a gesture of goodwill.

 

HTNS will contact all affected members. We seek the understanding of families who have made prior bookings at the HTNS Pasir Ris chalets.

 

Capacity at the HTNS Pasir Ris Chalets

 

Should HTNS Pasir Ris Chalets be activated as a Government Quarantine Facility (GQF), seven of the eight units will serve as quarantine housing with the remaining unit functioning as the operations centre. 21 persons can be quarantined under this arrangement.

 

The Government will continue to monitor developments and stands ready to respond to any evolving situation to safeguard the public health of all people in Singapore.

 

For more information, please visit the webpage www.e101.gov.sg/mers-cov.

 

 

Although the terms are often used interchangeably by the public, the CDC sums up the difference between quarantine and isolation this way:

 

• Isolation applies to persons who are known to be ill with a contagious disease.
• Quarantine applies to those who have been exposed to a contagious disease but who may or may not become ill.

So presumably, these chalets would be used for people who have been exposed to a MERS infected person, but are not yet symptomatic (or only mildly so).

 

Earlier this year, in EID Journal: A Brief History Of Quarantine, I wrote about the use of quarantine and isolation with the 2003 SARS outbreak:

 

During the 2003 SARS epidemic, Isolation was used in the United States for patients who were ill, but since transmission of the virus was very limited here, quarantine was not recommended for those exposed (cite).

 

In other countries, where transmission risks were greater, quarantines were used – quite successfully – in order to contain the virus.

 

• Singapore was one of the first countries to mandate quarantines when more than 800 family members of SARS patients were ordered to stay in their homes. 
• Hong Kong sealed part of the Amoy Gardens Apartment complex after scores of cases erupted there, and later moved all remaining residents to two holiday camps where they were quarantined.
• And Toronto, Canada closed schools and quarantined thousands in their bid to contain the virus (see The SARS Experience In Ontario, Canada).

The graph below shows two distinct phases of disease transmission in Canada, both apparently dampened by the implementation of quarantines.

While the aggressiveness of quarantine measures taken in Toronto have been criticized by some (see Severe acute respiratory syndrome: Did quarantine help?), many experts have stated that quarantining those exposed (usually in their own homes) helped to halt the epidemic.

 

A 2003 MMWR report from China’s CDC, called Efficiency of quarantine during an epidemic of severe acute respiratory syndrome--Beijing, China, 2003 found:

The use of quarantine, in combination with enhanced surveillance, isolation of SARS patients, and comprehensive use of PPE by health-care workers, appears to have been effective in controlling the recent epidemic of SARS in Beijing.

 

Limiting quarantine to persons who have contact with an actively ill SARS patient will likely improve the efficiency of quarantine and allow for better focus of resources in future outbreaks.

 

While unlikely to be popular among those caught up in one - particularly early in an outbreak - quarantines may be one of the most effective tools that public health officials have in their arsenal.

 

That said, the value of quarantines tends to diminish quickly as the number of cases, and geographic spread of a disease, increases.

EID Journal: A Brief History Of Quarantine

 

Photo Credit CDC PHIL

 

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Although controversial, and often misunderstood, quarantines have a long and successful history of helping to curb the spread of disease transmission during epidemics.

With the emergence of SARS early in the last decade, the use of quarantines made headlines once again around the world, eliciting both praise and concern.

 

Just so we are all on the same page, here is how the CDC defines Quarantine and Isolation:

 

The CDC applies the term "quarantine" to more than just people. It also refers to any situation in which a building, conveyance, cargo, or animal might be thought to have been exposed to a dangerous contagious disease agent and is closed off or kept apart from others to prevent disease spread.

The Centers for Disease Control and Prevention (CDC) is the U.S. government agency responsible for identifying, tracking, and controlling the spread of disease. With the help of the CDC, state and local health departments have created emergency preparedness and response plans. In addition to early detection, rapid diagnosis, and treatment with antibiotics or antivirals, these plans use two main traditional strategies—quarantine and isolation—to contain the spread of illness. These are common health care practices to control the spread of a contagious disease by limiting people's exposure to it.

The difference between quarantine and isolation can be summed up like this:

• Isolation applies to persons who are known to be ill with a contagious disease.
• Quarantine applies to those who have been exposed to a contagious disease but who may or may not become ill.

 

During the 2003 SARS epidemic, Isolation was used in the United States for patients who were ill, but since transmission of the virus was very limited here, quarantine was not recommended for those exposed (cite).

 

In other countries, where transmission risks were greater, quarantines were used – quite successfully – in order to contain the virus. 

• Singapore was one of the first countries to mandate quarantines when more than 800 family members of SARS patients were ordered to stay in their homes. 
• Hong Kong sealed part of the Amoy Gardens Apartment complex after scores of cases erupted there, and later moved all remaining residents to two holiday camps where they were quarantined.
• And Toronto, Canada closed schools and quarantined thousands in their bid to contain the virus (see The SARS Experience In Ontario, Canada).

 

The graph below shows two distinct phases of disease transmission in Canada, both apparently dampened by the implementation of quarantines.

 

 

While the aggressiveness of quarantine measures taken in Toronto have been criticized by some (see Severe acute respiratory syndrome: Did quarantine help?), many experts have stated that quarantining those exposed (usually in their own homes) helped to halt the epidemic.

 

A 2003 MMWR report from China’s CDC, called Efficiency of quarantine during an epidemic of severe acute respiratory syndrome--Beijing, China, 2003 found:

 

The use of quarantine, in combination with enhanced surveillance, isolation of SARS patients, and comprehensive use of PPE by health-care workers, appears to have been effective in controlling the recent epidemic of SARS in Beijing.

 

Limiting quarantine to persons who have contact with an actively ill SARS patient will likely improve the efficiency of quarantine and allow for better focus of resources in future outbreaks.

 

Disease transmission dynamics are different with different pathogens, so the lessons from SARS may not be applicable to the next pandemic.  

 

All of which serves as prelude to an interesting look at the history of quarantine through the ages that appears today in the CDC’s EID Journal.

 

Historical Review

Lessons from the History of Quarantine, from Plague to Influenza A

Eugenia Tognotti

Abstract

In the new millennium, the centuries-old strategy of quarantine is becoming a powerful component of the public health response to emerging and reemerging infectious diseases. During the 2003 pandemic of severe acute respiratory syndrome, the use of quarantine, border controls, contact tracing, and surveillance proved effective in containing the global threat in just over 3 months. For centuries, these practices have been the cornerstone of organized responses to infectious disease outbreaks.

 

However, the use of quarantine and other measures for controlling epidemic diseases has always been controversial because such strategies raise political, ethical, and socioeconomic issues and require a careful balance between public interest and individual rights.

 

In a globalized world that is becoming ever more vulnerable to communicable diseases, a historical perspective can help clarify the use and implications of a still-valid public health strategy.

(Continue . . . )

 

 

While unlikely ever to be popular (particularly among those caught up in one) – with novel emerging infectious diseases like SARS  - particularly early in an outbreak, quarantines may be the only effective tool that public health officials have in their arsenal.

 

That said, the value of quarantines tends to diminish quickly as the number of cases, and geographic spread of a disease, increases.

Queensland: A Hendra Watch & A New Vaccine

Nipah/Hendra Virus & Fruit Bat Home Range – WHO

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Although long known to carry rabies, over the past two decades bats have increasingly been linked to emerging infectious diseases.

 

The SARS-CoV (coronavirus) outbreak of 2002-2003 – which infected roughly 8,000 people and killed nearly 800 – is undoubtedly the best known of these diseases, but is by no means the only one to emerge.

 

Genetic analysis of two recent novel coronavirus infections in the Middle East suggest (but fall short of proving) that bats may be the primary host for this virus as well (see Coronavirus `Closely Related’ To HK Bat Strains).

 

And the natural reservoir for the Ebola viruses (including Marburg) are believed to be fruit bats of the Pteropodidae family.

 

Prior to the SARS outbreak - during the 1990s – two new bat-borne viruses made headlines; Nipah and Hendra, both henipaviruses of the family Paramyxoviridae.

 

Of the two, Nipah has been the deadliest, causing outbreaks primarily in India and Bangladesh. But the virus was first discovered in April of 1999 when an outbreak occurred at a pig farm in Malaysia. 

 

During this initial outbreak, the virus jumped to local swine herds from bats, and infected more than 250 people, killing more than 100. The virus was then exported via live pigs to Singapore, where 11 more people died (see MMWR Update: Outbreak of Nipah Virus -- Malaysia and Singapore, 1999)

 

Over the past decade, Nipah has sparked a hand full of smaller outbreaks across Southern Asia with the greatest activity centered around Northern India and Bangladesh. Fruit bats (Pteropodidae) are considered the natural host of Nipah virus.

 

Perhaps most concerning has been evidence of limited nosocomial, or human-to-human transmission, of the Nipah virus (see Bangladesh: Updating The Nipah Outbreak).

 

The Nipah virus, like it’s close cousin the Hendra virus, is classified as a biosecurity level 4 (BSL-4) agent.

 

While not associated with as many human fatalities, the Hendra virus was first identified after the deaths of 13 horses and a trainer in Hendra, a suburb of Brisbane, Australia in 1994. A stable hand, who also cared for the horses, was hospitalized, but survived.

 

Another outbreak was later identified as having taken place in MacKay, 1000 km to the north of Brisbane, the previous month. Two horses died, and the owner was hospitalized several weeks later with meningitis. He recovered, but developed neurological symptoms and died 14 months later.

 

Over the past 18 years 40 outbreaks of Hendra virus – all involving horses – have been reported in Australia. Four human fatalities have been linked to the virus as well.

 

Subsequent studies have showed a high prevalence of the newly identified Hendra virus in Pteropid fruit bats (flying foxes) in the region.

 

Unlike Nipah, to date no human-to-human transmission of Hendra has been documented.

All of which brings us to the latest outbreak news, and hope for a new vaccine for horses that just became available. First stop, an update from the QLD Department of Agriculture, Fisheries, and Forestry.

 

November 2012

---

Hendra virus communique no.10-5 November 2012

Hendra virus incident Ingham

Biosecurity Queensland is managing a Hendra virus incident in Ingham after a positive test result was received on Friday 2 November 2012.

 

A mare was first noticed unwell on Wednesday 31 October 2012 by her owner. She was not interested in food, had a slight nasal discharge, rapid, laboured breathing, elevated heart rate, lowered head and was unsteady on her feet.

 

A private veterinarian visited the horse and collected samples for Hendra virus testing. The horse deteriorated and went down and was euthanased on Thursday 1 November 2012.

Movement restrictions

Biosecurity Queensland has quarantined the property and undertaken tracing and risk assessments to determine susceptible animals that may have had exposure to the virus.

 

There are eight horses remaining on the property as well as dogs and cats. Several rounds of testing will be conducted on animals assessed to be at risk of being exposed to Hendra virus before the quarantine can be lifted.

 

Restrictions will apply to moving horses and horse materials on and off the infected property, and the property will be quarantined for at least one month. There are no other movement restrictions for the general Queensland horse population because of Hendra virus.

Hendra virus vaccine

A commercial pharmaceutical company has released a Hendra virus vaccine for use in horses under a Minor Use Permit. Under permit conditions, only accredited veterinarians can administer the vaccine.

 

The vaccine provides another option for the horse industry to reduce the risk of Hendra virus infection; however it is important to remember no vaccine is 100% effective and people in contact with horses need to continue to practice good biosecurity and hygiene measures even if horses are vaccinated.

 

Horse owners should discuss with their veterinarian whether vaccinating their horse is appropriate.

 

From CSIRO (Commonwealth Scientific and Industrial Research Organisation) we get more details on this newly available vaccine, via a 9 minute audio podcast & transcript.

 

Vaccine for killer Hendra virus launched

Australian horse owners and the equine industry have received an important boost in their fight against the deadly Hendra virus with the introduction of Equivac® HeV vaccine. (9:02)

• 1 November 2012

 

 

A final note, in the QLD notice above, it mentions that dogs and cats are quarantined, as well as horses. This comes about primarily because in 2011, we saw the first evidence of canine infection with the virus (see Australia: Dog Tests Positive For Hendra Virus).

 

The Queensland DAFF maintains a FAQ file on Hendra and dogs, where they write:

 

What animals have been shown to get Hendra virus?

Naturally occurring infection is limited to horses, flying foxes, humans and dogs. In animals, naturally occurring clinical disease is limited to horses.

 

Hendra virus is present in wild flying fox populations but does not appear to cause disease in them.

Laboratory studies have shown that other species including cats, guinea pigs, ferrets and pigs can develop disease when inoculated with Hendra virus in an experimental setting. Other species, including rabbits and dogs, have developed antibodies to Hendra virus in an experimental setting, but did not develop any signs of illness.

 

Although transmission from animals other than horses to humans has not been demonstrated, it is always a concern whenever a virus adapts to or jumps to a new host.

 

It not only gives the pathogen fresh opportunities to mutate and evolve, it provides another potential vector to spread the disease.

 

And when that host is a dog or a cat – animals with whom humans closely interact – it naturally serves to increases those concerns.

New Zealand : Airline Passengers Quarantined

 

 

 

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On an otherwise quiet Sunday afternoon here in the states, news wires are carrying reports of a Boeing 777-200 inbound from Japan that has landed at Auckland’s airport with roughly 60 passengers exhibiting flu-like symptoms.

 

While this sounds like the opening scene to a pandemic disaster movie, in all likelihood this will sorted out to be standard H3N2 influenza which is currently spreading across much of Japan. 

 

The sudden onset of so many cases during this flight has obviously set off alarm bells for local health authorities, however.

 

New Zealand has developed one of the most aggressive airport disease surveillance and interdiction systems in the world. 

 

For now, local media is reporting that all 274 passengers remain on the plane, and health authorities are setting up some sort of quarantine.

 

A couple of reports:

 

First from TVNZ

 

Health scare at Auckland Airport

breaking news

Published: 9:48AM Monday February 13, 2012

A major health response is under way after an Air New Zealand plane landed at Auckland Airport with children with flu-like symptoms on-board.

 

A group of 60 passengers arrived into Auckland off NZ90 from Narita, Tokyo, this morning with the symptoms.

 

Air New Zealand is following public health procedures and has advised the Auckland Regional Public Health Service.

(Continue . . .)

And this report from 3News New Zealand.

 

Flu-like symptoms on Air NZ Tokyo flight

By 3 News online staff

Sixty passengers arriving at Auckland International Airport this morning have reported flu-like symptoms, Air New Zealand has confirmed.

 

Flight NZ90 from Tokyo landed a short time ago and passengers remaining on the plane could be seen on the plane wearing face masks.

(Continue . . . )

 

 

While the odds favor this outbreak turning out to be something fairly mundane, I’ll keep an eye on it and update this blog if I hear more.

Japan: Quarantine At Ports Ineffective Against Pandemic Flu

 

 

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Japan, India, and China were among the nations that attempted to identify and interdict those who might be carrying the H1N1 virus when they entered their country.  

 

While their efforts may have slowed the introduction of the virus, they certainly didn’t stop it. 

 

And a study today out of Japan suggests that between asymptomatic or mild infections, and a silent incubation period of several days, there wasn’t much chance of long-term success. 

 

For every person identified, and quarantined, by port authorities  - researchers estimate 14 others infected by the virus entered undetected.

 

First a article from The Yomiuri Shimbun, followed by a link to the study which appears in Eurosurveillance.

 

 

 

Quarantine at ports found ineffective against new flu

The Yomiuri Shimbun

The number of people infected with new flu who passed undetected through airport quarantine between April last year, when the new strain of influenza began spreading, and May was about 14 times higher than the number of infected people stopped at the airports, according to a study carried out by Tokyo University.

 

The research results confirm anew that to prepare for an outbreak of new infectious diseases, such as bird flu, it is essential to take comprehensive countermeasures, such as having medical institutions prepare to treat large numbers of patients and closing schools, in addition to quarantine, from the early stage of proliferation of such a disease.

 

An official of the Health, Labor and Welfare Ministry said, "We'll use the data to work out to what extent quarantine measures [at ports] can prevent new infectious diseases from entering the nation."

 

The research results were to be published Thursday in the online version of Eurosurveillance, a European journal on infectious disease prevention.

 

Most of the infected people who passed through quarantine undetected were experiencing the incubation stage of new flu, in which fever and other noticeable symptoms do not appear.

 

(Continue . . . )

 

 

 

Eurosurveillance, Volume 15, Issue 1, 07 January 2010

Rapid communications

When should we intervene to control the 2009 influenza A(H1N1) pandemic?

H Sato , H Nakada, R Yamaguchi, S Imoto, S Miyano, M Kami

We simulated the early phase of the 2009 influenza A(H1N1) pandemic and assessed the effectiveness of public health interventions in Japan. 

We show that the detection rate of border quarantine was low and the timing of the intervention was the most important factor involved in the control of the pandemic, with the maximum reduction in daily cases obtained after interventions started on day 6 or 11.

Early interventions were not always effective.

 

 

 

Last month we looked at the failure of thermal scanners to detect those with fevers from entering Singapore in Travel-Associated H1N1 Influenza in Singapore  and last summer I wrote about ways passengers were defeating the scanners to get home in Vietnam Discovers Passengers Beating Thermal Scanners.

 

Areas that receive a small number of arrivals might be able to institute a quarantine system (see Can Island Nations Effectively Quarantine Against Pandemic Flu? ), but even then the ability to interdict infected travelers won’t be 100%.

 

The four successful quarantines during the 1918 pandemic were in American Samoa (5 days' quarantine) and Continental Australia, Tasmania, and New Caledonia (all 7 days' quarantine).

 

• The Spanish Flu did not reach American Samoa until 1920, and had apparently weakened, as no deaths were reported.

• Australia's quarantine kept the influenza away until January of 1919, a full 3 months after the flu has swept New Zealand with disastrous effects.

• Tasmania kept the flu at bay until August of 1919, and health officials believed they received an milder version, as their mortality rate was one of the lowest in the world.

• By strictly enforcing a 7-day quarantine, New Caledonia managed to avoid introduction of the virus until 1921.

Eventually, once the quarantines were lifted, the virus did make it to these isolated regions of the world.