Richard Bruton (Dublin North Central, Fine Gael)
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Question 69: To ask the Tánaiste and Minister for Health and Children if she has assessed the reports of the risk of a serious outbreak of flu affecting this country; her appraisal of the risk; the measures she is taking to minimise the risk to people here; and if her Department has procured sufficient supplies of antibiotics and vaccines to pre-empt a possible outbreak. [8805/05]

Mary Harney (Dublin Mid West, Progressive Democrats)
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I presume the Deputy is referring to the threat of an influenza pandemic. An influenza pandemic would have very serious effects in terms of mortality and morbidity. Services such as acute hospitals and general practice would experience greatly increased workloads, well in excess of those seen during more regular outbreaks of influenza.

The World Health Organisation published an assessment of the pandemic threat in January 2005. This concluded that: the avian influenza, H5N1, virus has demonstrated considerable pandemic potential; the world has moved closer to a pandemic than at any time since 1968; the ecology of the virus has changed in ways that increase opportunities for a pandemic virus to emerge; and based on the recurring patterns of past pandemics, the next one is overdue.

Influenza experts therefore consider that another influenza pandemic will occur; however, it is impossible to predict when it will occur. The ongoing outbreaks of avian influenza in Asia highlight the need for vigilance and preparedness.

Avian influenza, or bird flu, is an infectious disease of animals caused by viruses that normally affect only birds. While all bird species are thought to be susceptible to infection with avian influenza, domestic poultry flocks are especially vulnerable to infections that can rapidly reach epidemic proportions. There have been a number of outbreaks in poultry in Asia since late 2003. In 1997, avian influenza A, H5N1, was responsible for 18 cases of severe respiratory disease and six deaths in humans in Hong Kong. Prior to this outbreak, H5N1 was not known to infect humans. It is now recognised that highly pathogenic avian influenza outbreaks pose a significant threat to human health, with H5N1 infections in humans causing severe illness and having a high case fatality rate.

In January 2004, Thailand and Vietnam reported their first human cases of H5N1 avian influenza infection. According to the World Health Organisation, there were 69 laboratory confirmed cases in Thailand, Vietnam and Cambodia between 28 January 2004 and 11 March 2005. Some 46 of these cases were fatal.

Recent media reports have indicated that two Vietnamese nurses had contracted avian flu from a patient. However, the Vietnam Health Ministry is reported in local media on 12 March as stating that all people infected with the H5NI virus in Vietnam have had contact with infected birds. The World Health Organisation is closely monitoring the situation and there is as yet no evidence of efficient and sustained human to human transmission.

The greatest concern for human health is that the avian influenza, H5N1, virus will remain endemic in Asia and that continued transmission of the virus to humans and other animals will provide opportunities for human and avian viruses to exchange genes — re-assortment — to produce a virus that can replicate in humans, is highly pathogenic and is easily transmissible between humans. In a human population with no pre-existing immunity, such a virus could trigger a global influenza pandemic.

The Health Protection Surveillance Centre, HPSC, plays a key role in relation to the prevention and management of infectious diseases, including influenza, in this country. The Irish approach to infectious diseases outbreaks is based on sound internationally accepted principles such as: preventative measures; early identification of cases; effective clinical care including good hospital infection control; appropriate surveillance; contact tracing and management of contacts.

The HPSC monitors the avian influenza situation in Asia on an ongoing basis through the World Health Organisation. There are no restrictions on travel to any country currently experiencing outbreaks of H5N1 avian infection in poultry flocks, including countries which have also reported cases in humans. However, in line with advice from WHO, it is recommended that Irish travellers to areas experiencing outbreaks of H5N1 avian influenza infection should avoid contact with live animal markets and poultry farms. In addition, the following actions have been undertaken: interim Irish guidelines on the investigation and management of suspected human cases of highly pathogenic avian influenza, influenza A/H5, have been circulated to all health care professionals and are also posted on the HPSC website; guidance in the form of a SARS and avian influenza clinical management algorithm has been circulated to hospitals and clinicians on the appropriate management of travellers with an influenza-like illness who have returned from east or south east Asia, that is, areas where avian influenza outbreaks are occurring. This will assist in early detection of any influenza A/H5 cases.

The overall aims of pandemic influenza preparedness planning are to reduce morbidity and mortality, and to minimise the resulting disruption to society. However, the consequences of a global pandemic are still likely to be serious. Pandemic planning can only mitigate the effects.

The influenza pandemic expert group is reviewing and updating Ireland's 2002 influenza pandemic preparedness plan. Once finalised the updated plan will be published. The 2002 plan was based on the World Health Organisation, WHO, blueprint for an influenza pandemic plan published in 1999. It addresses a range of issues including prevention strategies, scientific and medical issues, and communications. The WHO plan is currently being updated to incorporate new scientific data and experience obtained during recent outbreaks. Our pandemic plan will be modified in line with these recommendations once they are agreed and published by the World Health Organisation.

Vaccination is the principal measure for preventing influenza and reducing the impact of epidemics. It will be the primary public health intervention in the event of an influenza pandemic. However, the production of a vaccine tailored to a pandemic influenza strain could take six to nine months. Developments are underway at international level seeking to expedite this process.

Pending the availability of virus specific vaccines, antiviral drugs will be the only influenza specific medical intervention available for use in a pandemic. Antivirals can be used for prophylaxis — prevention — and for treatment. The Government has decided that antiviral drugs should be stockpiled. The expert group reviewed recommendations for the use of antivirals in line with international guidance at its meeting on 24 February 2005. Following consideration of the expert group's advice, I have directed that 1 million treatment packs of oseltamivir — Tamiflu — should be stockpiled. This quantity is sufficient to treat 25% of the population and is in line with international trends. The Health Service Executive has been so advised and procurement arrangements have been put in train. I am confident that 600,000 packs will have been delivered by the end of this year. This is sufficient to treat 15% of the population. The remaining 400,000 packs will be delivered in 2006.

A national antiviral stockpile would be used to treat priority groups. Prioritisation is essential if both morbidity and mortality are to be reduced, and essential services are to be maintained thereby minimising as far as possible the disruption to society which might result from a pandemic. The priority groups include, for example, individuals who are hospitalised with influenza, people who may be more vulnerable to the virus, and key workers in essential services.

It should be noted, however, that pandemic planning is a dynamic process and the definition of risk is likely to change over time. This means that the recommendations for use of antivirals must be kept under review. In particular, the expert group will need to review the epidemiological data before final recommendations are decided in the setting of an imminent pandemic. The decision making process will be guided at all times by relevant expert advice from the European Commission and the World Health Organisation.