| The transmission of an avian influenza H5N1 virus to a child
in Hong Kong in May 1997 followed by the occurrence of 17 other human cases
with a high case fatality rate (6/18, 33%) (1) suggested that an influenza
pandemic could be imminent and led many European countries to take preventive
measures.
In this context, Directorate General V (DGV) of the European Commission
called for a meeting of the ad hoc group on communicable diseases on 14
January 1998 to review the epidemiological and virological situation and
the measures taken by member states, and to discuss the coordination of
surveillance and action needed in Europe. Two representatives of health
ministries and/or institutes responsible for national surveillance in
each European Union (EU) member state participated in this meeting as
well as representatives from DG III ( Industry), VI (Agriculture),
XII (Research), XXIV (Consumers), and the World Health Organization (WHO)
(Emerging diseases).
After an assessment of the epidemiological and virological situation
regarding the transmission of the H5N1 virus in Hong Kong (1),
each country presented its surveillance system and the measures taken
nationally to cope with the potential risk of spread of H5N1 infection.
The two commonest measures were firstly to activate plans for the control
of an influenza pandemic, or in countries without such plans the constitution
of an ad hoc working group, and secondly, the circulation of information
for health professionals recommending that national reference centres
for influenza should test people who had recently returned from Hong Kong
and who presented with influenza-like symptoms for influenza virus. Information
about potential risks for travellers from Hong Kong (posters in airports,
information sheets given to travellers) was provided in only one European
country. More generally, this alert made each country more conscious of
the need to plan against influenza (2). Countries with pre-existing plans
were able to evaluate the preliminary stages and adapt them. Countries
without plans had an opportunity to create a working group with the aim
of preparing such plans.
The discussion noted that if there was room for improvement in European
surveillance (3), the current international system was adapted, subject
to adjustments, particularly with regard to the speed of responding.
Member states identified two major problems about the response to the
threat: 1) in case of a pandemic, the availability of a vaccine adapted
to the pandemic strain and the definition of target groups for vaccination,
as not all European countries produce vaccines coordination would be necessary,
and 2) the availability of antiviral drugs as few or no antiviral drugs
are produced in Europe; several countries have taken measures to build
up stocks that would be reserved in case of a potential pandemic.
Technical aspects of these problems are not solved : how to act
at a European level to improve the availability and fair distribution
of vaccines and antivirals if a pandemic arose and what coordination mechanisms
could be set up (marketing authorisation procedures, protocol use, etc).
If DGV can facilitate all the procedures carried out by member states,
it cannot answer these two questions in terms of public health action
which is the prerogative of member states. The fact that officials in
public health from all the member states agreed on the analysis of the
problems should encourage further reflection. The coordination requested
at a European level is intended to face up to a threat that is not merely
theoretical, as proved by the H5N1 influenza outbreak in Hong Kong.
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