Belize Health Workers prepare for possible flu Pandemic
The Island Newspaper, Ambergris Caye, Belize
January 29, 2009

In Belize, like the rest of the world, health workers, including doctors, nurses, pharmacist and other health care providers are being educated on the pandemic influenza. The World Health Organization (WHO) and the Belize Health Department are conducting a series of countrywide training workshops to strengthen the capacity of the health care system in order to detect and respond to outbreaks of Severe Acute Respiratory Infection, (SARI) cases with the emphasis on human influenza.

According to Doctor Javier Zuniga, the Director of the San Pedro PolyClinic, the successful control and containment of a pandemic will be dependent on early recognition of the first instance of human-to-human transmission with timely detection and rapid response. In preparing for another influenza pandemic that scientist believe is eminent, the WHO has established six phases of increasing risks for public health workers to follow. The global plan provides guidelines for preparation that health workers in Belize are following.

Doctor Zuniga stated that, ?we don?t want the pandemic to come, but we are preparing in the event that it presents itself,? adding that ?if we look at the WHO phases that we are guided by, we are currently at phase three.?

So, how far are we in preparation? According to Doctor Zuniga, besides being prepared with the tools necessary to diagnose patients, the Belize Health Department is in the process of establishing two surveillances; Sentinel Surveillance (strategic selected healthcare facilities) and National Wide Enhanced Surveillance (all public and private healthcare facilities). In addition the Government of Belize, through the Health Department, is moving swiftly to establish a Central Medical Laboratory in an effort to make early detection of Severe Acute Respiratory Infection cases. Patients who demonstrate symptoms of SARI must be tested within the first 72 hours of onset in order to assure proper treatment of the patient.

?We are not looking for just any case of flu, we will be looking for Severe Acute Respiratory Infection, especially in healthy people because then it will send a signal to us in the health system,? stated Doctor Zuniga.

But if and when it happens, how will the Health Department deal with such cases? Doctor Zuniga says that tests will be run to find out what the causes are, and whether it is a case of influenza pandemic. If that is the case, Doctor Zuniga explained that they will have to find out if there is a human-to-human (cluster), transmission. If it plays out that there is a human-to-to-human transmission, the government will have to issue quarantine and isolate the patient.

?Containment is crucial, so we will have to isolate the patient from the rest of the population,? stated Doctor Zuniga adding that, ?currently we are working at putting up a central referral medical facility and more than likely it will be at Karl Huesner Medical Hospital (KHMH), but eventually when KHMH cannot deal with the pandemic, out district medical facilities will have to simply depend on what we have to deal with the pandemic.?

However, because Belize medical providers are looking for SARI cases, after adequate tests are conducted, they will be able to determine whether a case is unusual or unexpected, if it is a cluster outbreak and whether it has characteristics suggesting infection with avian influenza.

As cold as it sounds, if there is an outbreak of influenza pandemic, Belize is currently not prepared to deal with such conditions. Patients will need to depend on ventilators, especially in severe cases. Unfortunately, due to the cost, Belize only counts with eight ventilators countrywide, meaning that the mass population will be left to the mercy of nature. Time is crucial for the first detention of an influenza pandemic, and scientists believe that it will take six to eight months after the first case before they can produce a vaccine to combat the virus.

In the meantime, in an effort to minimize diversion in detection, the Belize Health Department is advising that the population take flu shots against the common flu. Of recent, the Health Department implemented the anti flu vaccine for children between six to twenty three months of age for free. In addition, the vaccine is also free for adults above 65 years and for those suffering from chronic diseases and the vaccine is available at all public medical facilities in the country.

Doctors and scientists from the WHO are justifiably concerned. They believe we are due for another flu pandemic like the one that killed 40-50 million people worldwide in 1918-1919. Scientists believe that it is also likely to start, in Asia, where the flu pandemics in 1957 and 1968 started but are not disregarding other possibilities. The worst known strain swept the world in the Fall of 1918, infecting 500-1000 million and killing 40-100 million, about 2-5% of the world population. The possibility exists that another flu pandemic will sweep the world like the one in 1918. So far, an H5N1 influenza virus has killed millions of birds and at least 30 people in Southeast Asia. So far this virus strain has not evolved the ability to pass directly from human-to-human referred to as cluster outbreaks, but that possibility becomes more likely as the bird pandemic continues and humans remain in contact with chickens, ducks, and other birds. The virus has been fatal to two-thirds of people reported to be infected.

Looking at the WHO phases that we are guided by, we are currently at phase three.