December 9, 2005

Campus eyes avian flu issue

By Dave Jones

While UC Davis scientists stand guard for avian flu in poultry and wild birds, other university regiments are preparing to deal with the potentially fatal virus in people.

Medical professionals at the Student Health Center, Employee Health Services and Medical Center are focused on identifying any kind of flu and treating it quickly.

Emergency response planning committees, which already meet regularly on the main campus and at the medical center in Sacramento, are reviewing and updating procedures for dealing with outbreaks of communicable diseases.

"I don't want anybody to think this is a new effort, just because of avian flu," said Jill Blackwelder, associate vice chancellor for safety services on the main campus. "This is a continuous process. … Our focus is to be prepared to handle any emergency."

The medical center is prepared to fight avian flu on two fronts, said Dan Stratman, security and emergency preparedness administrator: "You've got to take care of the staff so they can take care of the population."

On the main campus, Blackwelder said, the avian flu response is emerging from a plan that officials developed when severe acute respiratory syndrome, or SARS, threatened the world. The plan deals with everything from closing the campus to alternative methods of delivering people's paychecks.

The United States by and large escaped SARS, with only 27 cases on file with the Centers for Disease Control and Prevention during the 2003 outbreak. In every U.S. case, the person had been infected while traveling abroad. Similarly, fears of a global pandemic of avian flu are based on the ease of transmission via worldwide travel — and that makes universities especially vulnerable.

"The campus is an international portal, with visitors and faculty going and coming," said Tom Ferguson, medical director of the UC Davis Student Health Clinic.

Many students travel the world, too; Ferguson noted that the university requires a strict regimen of vaccinations, including flu shots, for students going abroad. Employee Health Services runs a clinic for staff traveling abroad.

Students often bring the flu with them when they return from Thanksgiving with their families around the United States, Ferguson said. As of late last week, though, he said he had not seen a spike in cases.

Ferguson said he regularly talks with Student Health Center physicians, nurses and nurse practitioners to be on the lookout for flu. "Once you've seen influenza, it's got a certain flavor to it," he said.

Ferguson listed the typical symptoms:

• High fever.
• Tachycardia, when the heart rate goes up to 110 or 120 beats a minute.
• Myalgia, or muscle aches.

The Student Health Center is one of about 1,000 sentinel sites for avian flu surveillance in the United States. Each week, the sites report the number of patients seen and the number of those patients with influenzalike illness by age group, according to the U.S. Centers for Disease Control and Prevention.

For this surveillance system, the CDC defines influenzalike illness like this: fever with cough or sore throat.

To test for influenza, Ferguson said, medical professionals at the Student Health Center take a nasal pharyngeal swab. In other words, they insert a cotton swab into the nose, and push the swab to the back of the throat.

"The nasopharyngeal collection technique is the highest yield for isolating influenza," Ferguson said.

He said the Student Health Center lab can process a swab in 15 minutes, to determine if a patient has the flu. If so, the center can send patients on their way with antiviral medicine — Tamiflu, for example.

The rapid test cannot tell if a particular flu is avian flu, but the test can indicate if the flu is from the A or B strains.

At the request of the California Department of Health Services, the UC Davis Student Health Center also is sending specimens to a state lab in Richmond.

"Having parallel testing done at state health provides epidemiological information from the 'front line' surveillance clinics," Ferguson said.

And, he noted, the state's more specialized testing "could, in theory, tell if a specimen is avian flu."

Based on past tests, Ferguson said, results from the state lab should take about two weeks to come in. During that time, he said, patients will not necessarily be hospitalized, and treatment will continue with the antiviral medication given to them upon their initial visits to the clinic.

"It's not realistic at this point to set up an isolation center," he said.

Ferguson, who serves as Yolo County deputy public health officer, said the university would work in concert with county, state and federal authorities to try to stem or control an outbreak.

"I have confidence in the public health system," he said.

He described a strategy of concentric circles: Each avian flu case is plotted at the center of a circle, with containment efforts expanding outward, also in circles.

"We will very much take direction from county and state medical authorities," Ferguson said.

Global context

As of Tuesday, the World Health Organization had tallied 134 cases of laboratory-confirmed avian flu in people, with 69 deaths, in five countries: Cambodia, China, Indonesia, Thailand and Vietnam. The data show Vietnam as the worst hit: 93 cases and 42 deaths.

In the United States this week, Health and Human Services Secretary Michael Leavitt announced a series of pandemic planning summits, one in every state, with the first set for Dec. 14 in Minneapolis.