Sunday, February 1, 2004

Health threats leave
isles better prepared

But officials warn that there
are always new challenges

Recent public health threats such as dengue fever and severe acute respiratory syndrome have made Hawaii better prepared to deal with infectious diseases, public health officials said yesterday.

However, the dengue fever outbreak and guarding against SARS, bioterrorism and influenza should be considered "a warning shot," said Dr. Paul Effler, state epidemiologist.

"It gave us a chance to prepare," he said, noting "dramatic improvement" of the public health system to respond to emergencies. But, he said, "it's an ongoing process" with constant new challenges.

Effler commented on Hawaii's readiness to deal with overseas threats such as West Nile virus, avian flu and SARS in an interview yesterday during a conference on infectious diseases sponsored by the Department of Medicine, University of Hawaii John A. Burns School of Medicine.

Dr. Alan Tice, UH infectious disease specialist who spearheaded the meetings at The Queen's Conference Center, said every time the state is faced with a public health threat, the response system gets better.

"If it hadn't been for bioterrorism, we would be way behind," Tice said.

Avian flu, which has been confirmed in at least eight human deaths across Asia, "may be a worst pandemic (worldwide) infection than SARS," said Dr. Lawrence Eron, infectious disease specialist at Kaiser Medical Center.

"Sure as shootin', it's going to spread," he said, pointing out it is transmitted to humans from birds and it's likely to combine with a highly contagious regular flu virus. If this happens, he said, the World Health Organization says "it will make SARS look like child's play."

Dr. Daniel Jernigan, chief of the Epidemiology Section, National Center for Infectious Diseases, U.S. Centers for Disease Control and Prevention, said it was puzzling that the United States had only eight laboratory-confirmed SARS cases last year when so many people travel. Hawaii had no cases.

"Ultimately, we got lucky," Jernigan said.

Effler agreed Hawaii was lucky with SARS and, so far this year, the flu season hasn't been severe. The state mobilized a strong vaccination campaign and doctors report that flulike cases are declining, he said.

However, West Nile virus potentially is a serious threat to the islands if California is hit hard with it this year, he said.

Dr. Joseph John Jr., chief of Medical Specialty Service at the Veterans Administration Medical Center in Charleston, S.C., also warned doctors they will see a big increase in drug-resistant Staphylococcus aureus infections -- already a serious problem in Hawaii.

Even the common cold "is not so simple," Eron said, describing many different viruses as possible causes. Some may not need prescription drugs, he said, noting "tremendous interest in alternative medicine, not only in Hawaii, but nationally."

One of the best, according to one study, is "Grandma's" homemade chicken soup, he said. "It worked better than commercial products."

Jernigan stressed that frontline doctors often are the first to encounter emerging infections and have a vital role in trying to prevent and control diseases.

After listening to the talks, Dr. Robert Martin, emergency physician at St. Francis Medical Centers and City-County Emergency Medical System director, said he believes emergency medics should wear masks.

"We don't have time to see if a person has a fever," he said. "We're already in their face and exposed by the time we find out."

He added, "Since 9/11, we know we're on the front lines to treat and diagnostic terroristic things." If they are infected as first responders, they can't care for others and they could transmit diseases, he said.

Dr. Susan Rehm, infectious disease specialist at the Cleveland Clinic in Ohio and chairwoman of the Board of the National Foundation for Infectious Diseases, said many people under age 40 have no knowledge of vaccine-preventable diseases, such as mumps, measles, polio and diphtheria. "This affects their willingness to have their children immunized."

She said half of U.S. adults are not protected against diphtheria and tetanus, which result in serious illness and death, and up to 10 percent of young adults are susceptible to rubella.

Tice presented an award to McDonald's Restaurants for international efforts and policies to prevent use of antibiotics to promote growth in animals. The Hawaii Medical Service Association and the state Health Department also were commended for leadership in appropriate use of antibiotics.


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