The SARS panic in 2003 has shaken medical researchers and

officials. While many are probing to find a cure for the disease, a call for preventive measures against pandemic outbreaks has been brought in the picture.

Contagious disease prevention has topped healthcare agenda because of the outbreak of SARS, severe acute respiratory syndrome, that killed 299 people in Hong Kong five years ago.

While SARS-specific vaccines

are still not available, researchers have moved to study other possible pandemic outbreaks.

“It doesn’t mean fewer resources have been delegated to SARS researches. It’s our own perceptions that we should concentrate on diseases posing bigger threats, such as avian flu,” said Malik Peiris, chair professor of the department of microbiology at the University of Hong Kong.

Professor Peiris and his team identified one of the SARS agents during the peak of the

pandemic. In his researches, they found the coronary virus actually resided in bats. And the virus was readapted to wild animals selling in market places and finally transmitted to humans in mainland China.

Professor Peiris said even if SARS comes back there is more a likelihood to control the spreading as the behaviour of the disease is now known. He cited the second SARS outbreak in 2004 that started off in the laboratories in Beijing was successfully contained.

Relatively, the spreading of influenza pandemic may be more threatening.

“Inter-persons transmission happens in the later stage of SARS. It can be contained if the patients are diagnosed and isolated quickly. On the other hand, transmission of influenza happens in an early stage before we can isolate the people,” said Professor Peiris, who is also a bird flu expert and he is embarking on a HK$136 million joint-university project on influenza control.

The government set up a $450 million Research Fund for the Control of Infectious Diseases (RFCID) after the SARS outbreak to support local researches. SARS-related applications peaked in 2003, where 16 projects received fundings. The application number sheds gradually afterwards and only three projects were funded in 2006.

In total, RFCID funded 45 SARS individual projects from 2003 to 2006. Twenty-four of them were completed while others are ongoing. No more projects were officially closed since 2005.

Alongside, the Health, Welfare and Food Bureau has also commissioned 36 studies on SARS through the fund.

Still, no SARS-specific vaccines and medicines are available in the market. Another HKU microbiologist Dr Zheng Bojian said, whose SARS vaccine studies were subsidised by the fund, his researches could not proceed further owing to the lack of resources and new clinical cases.

Patients have only beenhave only been treated by the combination of existing drugs of Ribavarin and Kaletra, which was originally used on AIDS patients. Traditional quarantine and sanitation measures were also applied to contain the infection.

Dr Zheng said some candidate drugs and vaccines that could inactivate the virus or induce neutralising antibodies have been developed. But none of them have been approved for manufacture unless the real threat exists.

“They were found effective on animals and unharmed for human use. But we can’t test them on human as there isn’t any new SARS cases, and huge financial cost involved in doing so,” Dr Zheng said.

He said he had shifted his focus to avian flu after 2004. He claimed mortality rate of avian flu has exceeded that of SARS already.

Joseph Sung Jao-yiu, famed as the SARS hero, from Prince of Wales Hospital said, “The next outbreak may not be SARS, but avian flu or other disease. You can prepare for the war, but you never know whether you have enough soldiers or weapons till the war breaks out.”

SARS gone, infection control echoes

KEITH YU

EN

By Edward Lui and Charlotte Wat

“You can prepare for the war, but you never know whether you have enough soldiers or weapons till the war breaks out.”

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Professor Sung, who is also arofessor Sung, who is also a doctor, led a team to take care of to take care of the first batch of SARS patients, which included many of his colleagues and medical students.

As the head of therapeutics department at Chinese University, Professor Sung said they had done some researches on SARS after the pandemic but not many. “SARS does not exist anymore, at least in the past five years,” he said.

Professor Sung said they had studied how to prevent the spread of infections within hospitals, which will also be useful in the case of influenza or other chest infections.

David Hui Shu-cheong, also from Prince of Wales Hospital, echoed Professor Sung and said their studies helped improve

infection control measures within hospitals.

“One of our studies found that patients’ breath could leak through the side vents of an oxygen mask applied to them and coughing could extend the distance beyond 40 centimetres. Healthcare workers should take precautions,” said Dr Hui, also the deputy director of Stanely Ho Centre for Emerging Infectious Diseases at CUHK.

Like Professor Sung, Dr Hui also underwent the battle against the respiratory disease. He identified the potential risks existing in wards in his researches, such as poor air ventilation and closely spaced beds in wards.

“Maintaining good hygiene practices, such as washing hands frequently, could reduce the risk of diseases contracted at hospitals, especially those transmitted by droplets,” said Dr Hui.

Hong Kong’s health care system has put more emphasis on infection control after the outbreak. The Centre forThe Centre for Health Protection (CHP) was created under the Department of Health in 2004. It is a body responsible for public health, especially on the surveillance

of infectious diseases.

The Infection Control Units in public hospitals have established communicating channels to initiate close linkages with CHP for exchanging information.

“We don’t know what are going to hit us. Infection Control is not just about SARS,” said Patricia Ching Tai-yin, senior nursing officer in charge of Infection Control Unit of the Queen Mary Hospital. “If we maintain a standard precaution such as cleaning hands frequently, we are prepared for whatever comes to us.”

She said the Unit will patrol to make sure the staff keep to the required hygienic standard. And the unit is available if there is any question on treating infections.

However, to strictly follow the hygiene guidelines could be difficult for busy medical staff.

According to Ms Ching, one of their internal guidelines

highlights hand hygiene, it is estimated that a doctor or a nurse contact with patients for 20 to 40 times a day. If a doctor needs to go to a basin every time, hand washing could take up one-forth of their working hours.

Ms Ching said the compliance rate was poor. In April 2006, only 20 per cent of the staff maintains the habit accordingly. Yet, the rate reached 50 per cent after the introduction of the World Health Organisation “hand hygiene” campaign in September 2006. Queen Mary Hospital is one of the four pilot sites for the campaign.

The campaign encourages medical staff to clean hands with the alcohol hand rub formulated by the World Health Organisation (WHO) which

can be stored in a small portable bottle.

“According to WHO, there are about 1.4 million people contracted diseases in hospital worldwide

each day. The culture of precaution should be

developed urgently,” she added.

Some healthcare workers do not reckon the alcohol hand

rub helps.

Dr Lam from Queen Mary Hospital, who declined to give her full name, said she would prefer the traditional method

A WHO-inspired poster to promote hygienic practices in hospitals worldwide.

Professor Sung Jao-yiu still treasures gratitude cards from SARS patients.

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with soap because it could wash away the germs properly.

Another general service assistant named Pang Suet-fan from the same hospital said, “it is better than nothing.”

While Thomas Hung Tai-hang from Pamela Youde Nethersole Eastern Hospital said the officials might have over-reacted, yet all those hygienic practices were the basic for them.

The Controller of CHP Thomas Tsang Ho-fai said, “One“One may think we give the public and the medical workers with excessive health information. But it’s a world trend that we should look into infectious diseases closely for the sake of public health. I don’t see the point in going back.”

The CHP has hosted a symposium on emerging infectious diseases in January where international experts shared experiences. However, SARS was not highlighted in the programme.

Professor Peiris regards pandemic influenza as one of the immediate threats of Hong Kong.

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“We don’t know what are going to hit us. Infection Control is not just about SARS. ”

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