Epidemic researchers
see central role for Hawaii

Two renowned researchers in the University of Hawaii's John A. Burns School of Medicine are working to make Hawaii a key player in fighting the global threat of infectious diseases.

"We want Hawaii to be the center of the universe for infectious diseases in the Pacific," said Dr. Duane Gubler, director of the Asia-Pacific Institute for Tropical Medicine and Infectious Diseases. "We're hoping the CDC (Centers for Disease Control) will recognize this and help us develop a program."

Gubler said he is working with Dr. Richard Yanagihara to pull together all the expertise at UH to expand research on diseases of the Pacific and Asia.

Yanagihara, a professor of pediatrics, public health sciences, epidemiology and tropical medicine and medical microbiology, said there is an urgent need for Hawaii to protect not only the health of its people from infectious diseases, but also its fragile ecosystem.

"What we're really worried about are the unknowns," Gubler said. "It's hard to put your finger on any one because we don't know what they are."

The best protection, he said, is to develop infrastructure for good surveillance and to create a program to reduce the chances of invading infectious agents.

The two discussed their efforts to bolster investigations of infectious diseases after appearing on a panel yesterday with CDC Director Julie Gerberding at the Hawaii Bioscience Conference sponsored by the medical school at the Hawai'i Convention Center.

They described the re-emergence of old infectious diseases such as hemorrhagic dengue fever, and new viruses in recent years such as SARS (severe acute respiratory syndrome).

Gerberding, also CDC administrator for toxic substances and disease registry, said the agency has accelerated communications and linked resources nationally and internationally to deal swiftly with emerging infectious diseases and terrorism.

"We all, in the Pacific Rim, are sitting on a potential health catastrophe, as well as an economic and security catastrophe, in the form of avian flu," she said.

She emphasized the need to understand how avian flu occurs in communities where it has emerged, and links with bird species and migrations to learn how to stop transmission.

"Unintentional introductions have a devastating impact," Yanagihara said, describing Hawaii's experiences over the years with dengue, bubonic plague and murine typhus.

Gubler said many infectious diseases were controlled effectively by 1970, but some have dramatically re-emerged globally.

Many are pathogens or agents that exist silently in animal species and are not detected until something causes them to move out of their normal cycle and affect humans, he said.

Also of concern, he said, is increased epidemic activity of previously controlled diseases. West Nile virus is an old disease, like dengue, that has emerged as a major public health problem worldwide only in the past 10 years for reasons not fully known, Gubler said. No cases have been detected in Hawaii.

Yellow fever, which Hawaii had in the late 1700s, has caused epidemics in Africa and is "waiting in the wings for an opportunity to get on an airplane and fly to Asia and the Pacific," he said.

A major concern for the 21st century is that such exotic agents are hitching rides daily on modern transportation, Gubler said.

"We should be able to develop more effective early warning," he said. With the world shrinking, he said, the development of a local, national and international network is critical to the ability to develop prevention programs.