August 2008 Email from Dr Roger Breeze - re
BBC article Hope over 'quick' bird flu test
I am always intrigued at the prospect of a better mouse trap and so the recent announcement that the EU is to fund a £ 2.3 million effort to find a way to detect avian influenza virus in places like Indonesia in 2 hours using a briefcase sized device perks my interest, if only because it tells me something that I did not know - that EU briefcases are apparently much smaller than briefcases in the rest of the world (probably a Brussels Directive I missed).
Those who would like to know how the avian influenza mice are currently being trapped in Indonesia should consult the website of the US Department of Defense Global Emerging Infections Surveillance System (GEISS) at http://www.geis.fhp.osd.mil/GEIS/Training/namru-2asp.asp. GEISS and the Indonesian government have been the main players for the past several years in monitoring, detecting and responding to avian influenza H5N1 in Indonesia. GEISS uses PCR devices in labs and also the Idaho Technology RAPID PCR device (www.idahotechnology.com) for portable field detection. It has been possible and practical to use the RAPID device to detect avian influenza virus on farm and in the field since 2000. The RAPID is sold in a small suitcase that I have until now called a briefcase in my ignorance of the mandated specifications for EU briefcases.
I am not sure how small the EU briefcase is, but Smiths Detection has been selling a portable device for on farm detection of foot and mouth disease and avian influenza that until today I would have sworn under oath was briefcase sized - see http://www.smithsdetection.com/eng/veterinary_diagnostics.php. The Smiths technology (sample to result in about 90 minutes on farm) is very well suited to avian influenza because it differentiates avian influenza viruses likely to be found in birds from Newcastle disease virus, which can cause a very similar set of clinical signs, and it simultaneously determines the virulence of the avian influenza virus type present in the sample.
Just recently I found myself on the front lines of the global battle against avian influenza H5N1 when I visited the laboratory at Kamphaeng Phet, in northwest Thailand, operated by the Royal Thai Army and the US Defense Department. This lab is staffed entirely by Thai nationals who demonstrated mastery of avian influenza in their region: they told me that avian influenza H5N1 had been present in the region for a few years but had been minimized almost entirely by public information and education programs. All the chickens and ducks in this region are owned by villagers and wander the streets and waterways freely, where they can contact wild birds.
The lab is closely linked with public health authorities, schools, hospitals, law enforcement and emergency responders, and political entities in the region. I visited a primary school where the children were all well versed in the dangers of approaching sick chickens at home (all children in Thailand learn English as their second language from the primary level and this school had a computer lab where all the children were working via Internet on a graphics presentation in English), a public health department that was actively engaged in adult education and avian influenza awareness in the villages, and the local hospital that was fully prepared to receive and treat avian influenza patients.
At the entrance to this very busy regional hospital was a colorful statue of a rooster along with a notice telling patients with respiratory illness who had been in contact with sick chickens to enter the hospital by a separate entrance. This entrance led to an isolated reception and examination area. Patients thought to have avian influenza were admitted to an isolation ward with HEPA-filtered air and biological safety precautions that isolated the patient from others in the hospital. Medical personnel wore special protective clothing when attending to these patients.
Patients were diagnosed with avian influenza as the result of a PCR test on a sample collected at this hospital and tested at the lab within 2 hours. When a positive case was found, a mobile team turned out to examine and test other people in the same village who had respiratory infections. The PCR tests were performed on site in the village. I asked the lab director if the results of PCR tests performed in the village were regarded by public health authorities with the same validity as those conducted in the lab itself. She replied,
"Of course. It is the same people performing the test in both places using the same controls, test reagents and equipment. Why would we not treat them identically?"As I ponder this frontline region that has mastered real outbreaks in people and birds and current threats of avian influenza H5N1 occurring under very low resource conditions, I can only wonder how different things might have been had Thailand had a Chief Scientific Advisor to the Government of the stature demanded in UK, or a resource like Imperial College, or even the benefits of the research just funded by the EU.
Regards and best wishes,