Monday, September 10, 2018

CDC investigates flu-like symptoms on American flights: Lessons to be learnt

The Centers for Disease Control and Prevention (CDC) is investigating two American Airlines flights after passengers on board complained of flu-like symptoms, as reported in USA Today on Thursday. Twelve passengers on two different American Airlines flights between Europe and Philadelphia reported flu-like symptoms when they arrived in the US. All 250 passengers from both flights were held at the airport for medical review as a precaution. The 12 sick travelers had sore throat and cough but no fever. The remaining travelers were then allowed to continue with their journey.

This incident came close on the heels of a similar incident when 11 passengers on an Emirates flight from Dubai to New York were taken to a New York City hospital with flu-like symptoms - fever, cough and vomiting - on Wednesday. All the passengers including the crew were screened by officials from the CDC. Health officials were at the airport, when the flight landed. The plane was quarantined and the 11 suspected cases were taken to the hospital and tested for flu and other respiratory viruses. They were retested when testing for additional viruses Wednesday proved inconclusive.

Following these incidents, the CDC was quick to issue guidance to all travelers, which said people who “get sick with flu symptoms – fever, cough, sore throat, runny/stuff nose, body aches, headaches, chills, fatigue, and sometimes diarrhea and vomiting – should stay home, don’t travel, and avoid contact with other people except to get medical care. And, everyone six months and older get a seasonal flu vaccine, preferably by the end of October”.

This is the level of preparedness, the level of response needed to contain a probable outbreak and prevent it from becoming an epidemic or even a pandemic.

The number of dengue cases in India increased from 99913 in 2015 to 157996 in 2017. Similarly, the number of clinically suspected Chikungunya cases reported in the country increased from 27553 in 2015 to 63679 in 2017 (PIB, March 27, 2018). These are entirely preventable diseases, yet they claim hundreds of lives every year. Outbreaks of Japanese encephalitis (JE) and acute encephalitis syndrome (AES) have been occurring every year in JE endemic states for decades, as they did this year too and take a heavy toll of life, especially of children. Three cases of Zika virus infection have also been reported in India.

The Nipah virus outbreak in Kerala this year with 12 deaths is the third outbreak reported in India, with previous ones having occurred in 2001 (45 deaths) and 2007 (5 deaths). Swine flu and Avian flu are becoming common.

India is a huge and the second most populous country in the world, where infectious diseases can spread quickly. Travelers can now introduce diseases in new places outside of the endemic zone. Air travel, in particular, facilitates rapid dissemination of pathogens. Densely populated urban areas are also risk factor for disease to spread.

Many zoonotic diseases are emerging and re-emerging in the country. They are becoming endemic in the country, and rear up ever year and create panic among the public, especially without timely advisories and awareness campaigns from the concerned authorities.

As a result, India continues to suffer recurring outbreaks of infectious diseases with no lessons learnt from the previous ones. We seem to be caught “unaware” and come across as underprepared every year.

Several factors account for this: Lack of a robust surveillance and monitoring system even when there is no outbreak, lack of diagnostic labs, shortage of required medications, lack of awareness about the diseases amongst the general public, ill-prepared health care providers, poor communication.

We need to invest more in preparedness to be able to respond promptly and adequately to such threats. Being prepared saves lives.

Active case finding and contact tracing and their timely treatment are extremely important.

Will we ever be able to achieve this level of preparedness?

Dr KK Aggarwal
Padma Shri Awardee
Vice President CMAAO
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA

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