Health officials ready for swine flu

Health officials examine incoming passengers with an infrared heat scanner at Abu Dhabi International Airport.

Health officials have sought to reassure the public about the UAE's readiness to tackle a swine flu outbreak, as the number of confirmed cases of H1N1 virus in the country jumped from one to five last week. "We don't want [people] to panic and we want them to be aware that medication is available. People can be treated and they are fine. They can go back to work and continue with their life normally," said Dr Khodr Awad, a health education consultant with the Ministry of Health (MoH).

There are ample supplies of the anti-viral drugs Tamiflu and Relenza in the UAE to handle an emergency, according to the ministry. Sources from inside the MoH have estimated that there are supplies for 50,000 cases. By September there would be enough drugs in the country to treat the entire population, according to the Minister of Health, Dr Hani Hassan Ali. But most important, say officials at the World Health Organisation (WHO), an outbreak of the virus in the country would be impossible to avoid.

"We can delay the outbreak in a country, but we cannot stop it," said Dr Mamunur Malik, an epidemiologist in the WHO's Regional Office for the Eastern Mediterranean. But he said countries could take steps to delay an outbreak of H1N1 inside their borders and to minimise the number of people affected. "Most cases are travel-related, so what we need to do is limit the in-country transmission to as much as possible."

Swine flu has reached pandemic levels, according to the WHO, but the disease itself is generally mild. This strain is unlike other forms of flu in that it tends to infect younger people, aged between 30 and 50. "It is pandemic phase six; the transmission is happening in most places around the world, but it is not a killer disease. The mortality rate is very low," said Dr Malik. All five confirmed cases in the UAE caught the virus abroad.

At the end of May the first case was confirmed in a Pakistani man who travelled to Abu Dhabi from Canada. Although previous cases involved people with the virus passing through the country, this was the first instance of the disease attacking someone who lived in the UAE. The patient was an associate professor at the UAE University faculty of medicine and health sciences in Al Ain and he was quarantined for more than a week, until he recovered. The ministry said his relatives had also been quarantined, but released when they tested negative.

The second case was confirmed on June 16. The man was only identified as an Emirati who had flown in from the United States. Five days earlier, the WHO had declared the H1N1 outbreak to be pandemic. Only two days later the MoH confirmed two new cases, both Emiratis travelling from abroad. Both are undergoing treatment and are in stable condition. The next day, Friday, the ministry confirmed the fifth case in the UAE.

The fifth patient, a woman, has only been identified as a UAE resident who arrived in the country on Friday. She is receiving treatment but the ministry would not disclose which hospital she is in or where she had arrived from. Although there have been four cases in the last week, the MoH would not comment on whether this was a growing trend or a statistical anomaly. But the WHO said extreme measures would not contain the virus.

"We do not recommend closing the border or travel restrictions because the disease has already made its geographic spread - the virus has already spread. There is no point taking any containment measures at the point of entry." In May the ministry announced that entry points to the country would be equipped with thermal scanners. These check the temperatures of people crossing the border to determine whether they have a fever, and are potentially infected with the virus.

The MoH, in conjunction with local health authorities, is also launching a campaign to inform people about the disease. The state news agency, WAM, reported that Emirates Mobile Hospital, which began operating last month, has launched the first website to educate the public about the prevention, diagnosis and treatment of H1N1, in co-ordination with the UAE's National Crisis and Emergency Management Authority (NCEMA) under the supervision of the MoH and other agencies.

The website, in Arabic only at www.uaehealthawareness.org, includes detailed information on treatment and prevention. People with chronic disease are most at risk. Clinical evaluations of the disease indicate that people with diseases such as diabetes, or suffering from hypertension, and women who are pregnant, are more likely to suffer complications. More than one in four adults in the UAE suffer from diabetes and about one in three have hypertension.

"This does not mean that all diabetic patients who contract the disease will die. The majority of the deaths have taken place in people who have chronic underlying diseases - lung disease, heart disease and pregnancy is a risk factor as well." More than 85 countries have reported the disease. Although there have been 44,287 confirmed cases, there have been only 810 deaths. It is not known how the virus will progress, but it is clear that it will be an ongoing public health issue.

The director general of the WHO has indicated that is is likely to be around for months or even years. Dr Malik said: "The virus is unpredictable and we are not sure how it will be behaving in the coming weeks, coming months and coming years." [e-mail]