A Canadian infection-control expert has recommended that drugs to help protect against the spread of pandemic flu should be purchased for healthcare workers in Ireland.
Speaking at the inaugural Flu Forum in Trinity College Dublin at the weekend, Dr Michael Gardam, director of infection prevention and control at Toronto General Hospital, told healthcare professionals that although it is not known when another pandemic flu will occur, its emergence is inevitable and countries need to be prepared.
Pandemic influenza is a large-scale, worldwide flu outbreak, which occurs when new viruses cross over from animals to humans. Because the human immune system has not encountered the virus before, it has no defence and so illness spreads quickly, and could travel around the world in three months.
Seasonal influenza can be treated with a vaccine as well as with antiviral drugs, however, a vaccine against pandemic flu would not be developed until four to six months after the condition emerges.
Anti-viral drugs work on the flu virus by blocking an enzyme that helps it propagate.
The Irish pandemic influenza expert group has estimated that in a worst-case scenario the next pandemic could result in two million people in Ireland becoming infected, 78,000 people being hospitalised and around 53,000 deaths.
Dr Gardam said that over 50 hospitals in Canada had already purchased enough antiviral drugs to give to all of their healthcare workers in the event of a pandemic outbreak. The drugs would be administered to the workers as soon as the first case was detected in Canada, he said.
"Most pandemic plans lean on having infection control procedures, social distance and masks," he said. "But we don't have the evidence to support their effectiveness. The only good evidence we have, bar vaccines, is the use of antiviral drugs for prophylaxis."
He said that if healthcare workers are part of a plan to tackle pandemic flu, they must be protected.
Toronto General Hospital decided to purchase the antiviral drugs after their experience with Sars in 2003. Almost 500 cases of the deadly respiratory illness were detected in Canada.
"We had 37 cases, almost exclusively healthcare workers who caught it on the job," Dr Gardam said.
He said the annual cost of the drugs, which have a five-year shelf life, is less than what the hospital pays for fire insurance.
"No one would say fire insurance was a waste of money at the end of the year if there was no fire," he said.
But, he admitted, the hospital's choice has been controversial and is not national health policy in Canada.
Gavin Maguire, assistant national director of emergency planning with the Health Service Executive, said the Irish expert group is keeping all antiviral drug strategies under review, but is not currently considering stockpiling the drug to pre-treat healthcare workers.
"This is not government policy anywhere in the world," he said. "It is impossible to know where you draw the line with who to treat and you very quickly get into astronomical numbers."
Speaking at the same conference, Prof Graeme Laver, head of biochemistry and molecular biology at the Australian National University, warned that a preoccupation with pandemic illness could be blinding people to the dangers of seasonal influenzas.
He said that in Sydney, almost 1,000 people died from seasonal flu in just 35 days this year.
"I don't think many people would realise that 1,000 Irish people could die in the space of a month this winter and it would be regarded as a simple case of seasonal flu, but that's the fact," he said.
