Living in a Post-SARS World: What happens when another outbreak occurs?

In this day and age of global travel, you can get anywhere in the world during the incubation period of a new pathogen.  In the case of SARS, it took 61 days for a global pandemic.

Timothy Brewer of McGill University in Canada, speaking on the panel: “One Health: Detection and Control of Emerging and Endemic  Zoonotic Pathogens” noted that in the Guandong Province in China, people were walking around with masks, hospitals were shut down, and people were buying white vinegar to disinfect their homes long before most of the world knew what was happening.  He said the outbreak became widely known in November 2002, but it wasn’t until March 2003 that the Chinese government acknowledged it.

In 2005, WHO passed the Revised International Health Regulations, which requires mandatory reporting of outbreaks on international concern. The regulations went into effect June 15, 2007, and although there is no police force backing the regulations, Brewer said it adds more pressure to countries to come forward.

So has outbreak recognition improved over time?

In an analysis of the 398 reported outbreaks by WHO between 1996-2009, Brewer said there has been a slow improvement in outbreak discovery and reporting.

“SARS was the real impetus for outbreak discovery,” he said.

Panelist Jonna Mazet of University of California, Davis, an expert on surveillance, said researchers now have a cell phone network in place in many communities with an application to notify people when people see a sick animal.

But the gaps in zoonotic surveillance are still pretty big.

“Detecting a new respiratory pathogen is tricky unless you get lucky,” Brewer said.  Many of the new pathogens like H1N1 look like other  infections, so unless a pathogen creates unusual symptoms, he said it will be hard to detect especially with a lack of lab capacity.

“Even in 2010, you cannot access the WHO database unless you are with the Ministry of Health,” he said.

Panelist Hector Garcia with the Universidad Peruana Cayetano Heredia Institute of Neurological Sciences in Lima and an expert on cysticercosis (a disease from pigs) and Mazet of University of California, Davis,  said capacity building is a huge need.

Garcia said capacity building needs to happen with organizations and among collaborations. And Mazet said there is a huge need to fix the brain drain and to create a proactive approach. Her experience has been that when hunters in the Congo died of hemorraghic fever and the lab determined the pathogen wasn’t ebola, no one was interested in doing more investigation.

All three of these panelists also discussed the political pressure to keep outbreaks quiet because of the enormous economic consequences. 

For example, Garcia said during a continent-wide cholera outbreak in Peru in 1991 when many people got sick after eating fish, the health minister announced it was unsafe to eat ceviche but Peruvian President Fujimori, fearing a huge impact to the seafood industry, went to the media and said it was OK to eat ceviche.

Prepared by Bobbi Nodell,  Communications Specialist, University of Washington

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