A chain of events that began in a microbiology laboratory in a Vancouver hospital may have helped avert a global pandemic when it was discovered last month that a potentially deadly flu strain had been shipped to 4,000 labs worldwide.
The alert has led to laboratories around the world rapidly destroying stocks of deadly H2N2 flu strain, which killed four million people during a flu pandemic in 1957.
But the problem only came to light when the Vancouver laboratory, which has not been identified, sent a patient specimen to the National Microbiology Laboratory in Winnipeg.
The Winnipeg lab did extensive tests and relayed the results to the Vancouver facility, which alerted health authorities in this country and in the U.S. that a deadly strain had been accidentally shipped to about 4,000 laboratories in 18 countries for practise-only purposes.
Ironically, however, it was a mistake made in the Vancouver lab that eventually led to the discovery.
Dr. Perry Kendall, B.C.'s top public health official, said the chain of events originated in March when the Vancouver hospital sent a sample from a female patient to the national lab for further testing to determine what subtype of influenza A she had. It turned out the sample had been cross-contaminated with H2N2.
The sample took three weeks to culture and subtype; results finally came back on the Easter weekend.
Thousands of other labs around the world were also unwittingly in possession of the H2N2 virus because none had bothered to do the kind of detailed subtyping that was done in this case.
Kendall said the sample was sent for further testing to Winnipeg because "influenza didn't fit with the patient's clinical symptoms.
"There was no history of her getting anything that looked like influenza."
He said when the national lab revealed the results "we were really concerned that we had discovered a new strain of influenza in our population, but then we realized this patient had not travelled, had no contacts with any potential sources of H2N2.
"So upon further discussion, we decided that her sample was probably contaminated. Then the detective work figured out that on the same day that her specimen had been prepared for shipping to the lab in Winnipeg, the lab had also been conducting proficiency testing," said Kendall, referring to the tests lab workers conduct to know how to identify and characterize viral strains.
Kendall said the lab is conducting a review to find out precisely how the cross-contamination occurred.
"It's a problem the lab is addressing. It's always a problem which laboratories can have, because it takes just minute traces for this to happen.
"In a perfect world, cross-contamination would not occur and it is indeed very rare," Dr. Danuta Skowronski, physician-epidemiologist at the B.C. Centre for Disease Control, added. "But obviously, humans are fallible. Those who work in laboratories are taught to assume that every agent is potentially infectious, whether they know what it is or not," she said.
Kendall said he was refusing to disclose the identity of the hospital lab "because there is nothing to be gained, from a public health [point of view by] disclosing it."
Skowronski said health officials act on a "need to know basis and if there is no threat to public health, there is no need to disclose" the hospital identity.
B.C. public health officials said Wednesday it is not believed any laboratory workers or other citizens in the province -- or indeed anywhere in the world -- have contracted the H2N2 influenza strain, which was contained in vials shipped to labs from the United States. The vials containing live virus were produced by a Cincinnati-based test-kit maker and shipped by the College of American Pathologists in February so that lab workers could gain proficiency at typing viral strains for accreditation purposes.
The H2N2 strain hasn't circulated in the world since 1968, so anyone born after that time would have no immunity to it, raising the spectre that if people suddenly did become exposed to it, a pandemic could result. H2N2 is considered one of five candidates for an influenza pandemic.
Dr. Perry Kendall, B.C.'s top public health official, said when the vials were shipped, they were improperly labelled as A/Shanghai, related to the influenza strain that has been circulating in North America this past winter. Kendall said it was "neither sensible nor wise" to send the H2N2 subtype and it was also "unacceptable to mislabel the vials."
The U.S. government is investigating. The WHO has alerted labs which received the virus to destroy it.
Samples of a potentially lethal flu strain sent to Lebanon and Mexico did not reach the respective laboratories, the World Health Organization says.
The WHO said it was trying to trace the samples, which were sent by a US testing organisation.
The samples are of Asian flu, which killed between one and four million people in 1957 but disappeared by 1968.
More than 3,700 laboratories in 18 countries received the testing kits and have been racing to destroy the virus.
The WHO says the virus could "easily cause an influenza epidemic" if not handled properly.
All but five of the countries outside US that received the kits say they have now destroyed them.
The WHO has not said how much had been destroyed in US labs, which received the vast majority of the samples.WHERE THE VIRUS WENT:
Europe: Belgium, France, Germany, Italy
Americas: Bermuda, Brazil, Canada, Chile, Mexico, the US,
Asia: Hong Kong, Japan, Singapore, South Korea, Taiwan
Middle East: Israel, Lebanon, Saudi Arabia
The College of American Pathologists (Cap) said the kits had been sent to the following countries including the US: Bermuda, Belgium, Brazil, Canada, Chile, France, Germany, Hong Kong, Israel, Italy, Japan, Lebanon, Mexico, Saudi Arabia, Singapore, South Korea, Taiwan.
But the man who co-ordinates the WHO global influenza programme, Klaus Stohr, told the BBC News website that the one laboratory in Lebanon that was supposed to have been sent the kits had not received any. And one out of four laboratories in Mexico had not had any consignment either.
Mr Stohr said the WHO and Cap were trying to find out what happened to the samples sent by prestigious international carriers.
He said it was possible that the laboratories had not gone to collect the kits. However, he said the WHO was not concerned at this stage.
"There are simpler ways of interfering with the samples" if one so wished, Mr Stohr said.
No immunity
Because the virus has not been in circulation since 1968, people born after that do not have antibodies against it - and current vaccines do not guard against it.
The Cap sent out kits between October 2004 and February of this year.
On 8 April, the US government asked the body to write to the laboratories affected - of which 61 are outside the US and Canada - telling them to destroy the samples.
Given the concerns that the virus could be used in bio-terrorism, letters were sent to the laboratories before the mistake was made public. The virus - technically known as H2N2 - was classified as Biological Safety Level 2, meaning that it was not considered particularly dangerous.
But the US government agency responsible for classifying viruses, the Centers for Disease Control and Prevention, says it was in the process of deciding whether to change the strain's classification when it found out it had been widely circulated.
The WHO says there is no guarantee that every sample of the virus can be traced and destroyed because some of the laboratories may have sent derivatives of the sample elsewhere.
But there have been no reports of anyone becoming ill from handling the virus.
It is only a matter of time before a major outbreak of potentially deadly flu, according to scientists. Could the world cope?
There have been three flu pandemics during the past 100 years.
The 1918 Spanish flu is estimated to have killed up to 50m people worldwide.
The Asian flu of 1957 was caught much earlier but still claimed one million lives. The Hong Kong flu of 1968 was responsible for a similar number of deaths.
It has been 37 years since the last major outbreak and scientists, health professionals and some governments are getting twitchy.
'Inevitable outbreak'
Most scientists agree that another flu pandemic is inevitable. Many say it is overdue.
"It really is inevitable," says Dr Alan Hay, director of the World Influenza Centre in London. "We don't know when it will arrive but we are anticipating it."
Some experts believe the next killer flu may already have arrived.
"Avian flu might yet be the next pandemic virus," says John Oxford, professor of virology at St Bartholomew's and the Royal London School of Medicine.
The latest outbreak of bird flu in Asia has killed about 50 people. Millions of chickens have been slaughtered.
There has been no confirmed case yet of this particular strain of the virus being passed from human to human.
However, scientists are worried that the virus could mutate and could pass from one person to another, triggering a possible pandemic.
Those fears are not groundless. Dutch scientists say three people who caught bird flu when a different strain hit the Netherlands in 2003 may have caught it from people and not animals.
The World Health Organization has been urging the international community for years to prepare for the next flu pandemic.
It estimates a future outbreak could kill as many as 650,000 people in industrialised countries. The figure would be significantly higher in the developing world.
Recent outbreaks of bird flu and Sars have spurred some countries into action. However, others are lagging behind.
"The WHO has been desperately trying to get countries to take this seriously," Professor Oxford says. "It has 192 members but only 12 have done anything about it.
"People really need to think about what happens when this virus arrives - who is going to do what; what vaccines are available; who is going to distribute them and who is going to bury people when they die."
Emergency plans
In early 2004, Canada, which was hit hard by Sars, outlined its plans for dealing with a flu pandemic. The 450-page document spells out what actions authorities will take in the event of an outbreak.
Four years ago, ministers signed a deal with a local pharmaceutical company to provide a vaccine for 32m Canadians in the event of a pandemic.
Other countries have taken similar steps. In Germany, the government has drawn up plans to dispense millions of doses of the antiviral drug Tamiflu.
The UK government is taking similar action. "We are taking active steps to increase our stocks of available antivirals," says a spokesman for the Department of Health.
In a report in 2003, the WHO said countries needed to do more.
"A few member states are formulating national plans for pandemic preparedness, but only one country has completed a formal, legally sanctioned plan.
"The absence of such national plans, including projected needs for vaccines, antiviral drugs, and other essential supplies, hinders efforts to coordinate preparedness planning at the global level."
It added: "All countries need to be aware of the need to begin preparedness planning well in advance of a pandemic, as many essential activities take considerable time."
The WHO will spearhead the international response to any flu pandemic.
Some 110 national influenza reference centres in 83 countries are acting as its eyes and ears, feeding into four collaborating centres in Atlanta, London, Melbourne and Tokyo.
"There is very intense surveillance to detect any novel viruses," says Dr Alan Hay.
Vaccine search
One of the biggest challenges facing scientists if and when a powerful strain of flu emerges will be to find a vaccine to protect people against it.
Scientists around the world are already working on possible vaccines for Sars and avian flu - two of the leading contenders for the title of next pandemic virus.
"We have a sort of hierarchy of likelihood viruses that may spark a pandemic," says Dr Hay.
"We have some vaccine prepared against some of these viruses. We hope they will give us a head start."
The vaccines are in very early stages of development and are based on strains of influenza that have emerged in recent years but have not sparked major outbreaks.
The hope is they can provide the basis of an effective vaccine in the event of a pandemic.
Like all new drugs, any vaccine for flu - even one for a particularly lethal strain of the virus - will take time to develop and to be made available to the public.
"It is difficult to say how long it could take," says Dr Hay.
Some experts believe a vaccine could become available relatively quickly. Others maintain it will take a year or more after the virus hits.
However, experts are hopeful that some existing drugs could provide an important first line of defence against a future pandemic.
A study published in early 2004 by scientists in Australia suggests Relenza is effective against the strain of bird flu currently affecting Asia.
The GlaxoSmithKline drug has been available since 1999 and stops the flu virus from spreading. Tamiflu, which is manufactured by Hoffmann-La Roche, works in a similar way.
Professor Oxford believes governments around the world should be stockpiling these drugs now.
"These drugs act against every known influenza virus. There is no excuse for governments not to have them," he says.
"There will be a mad rush for these drugs if this flu arrives on the scene. It will be pretty chaotic.
"It will be a dereliction of duty not to have stockpiled these drugs."
| ||||
Your listing would include your phone number and a linked web page on this site.
For sample pages, see the advertising rates information and existing advertiser's links below.
Call JKW Media Consulting at 416-521 9634. See our advertising rates page.
| ||||
| ||||
Is your business on the Lakeshore, on Lakeshore Blvd West, on Lakeshore Blvd. East, on the Toronto waterfront, on Bloor Street, on Queen Street, on King Street, on Dundas Street, on the Queensway, on College Street, on the Kingsway, on Yonge Street, on Bay Street, on University Avenue, on St. Clair Avenue, on Eglinton Avenue, on York Mills Road, on Sheppard Avenue, on Lawrence Avenue, on Wilson Avenue, on Steeles Avenue, on Kipling Avenue, on Islington Avenue, on Royal York Road, on Jane Street, on Keele Street, on Dufferin Street, on Bathurst Street, on Bayview Avenue, on Leslie Street, on Don Mills Road, on Victoria Park Avenue, on Pharmacy Avenue, on Warden Avenue, on Birchmount Road, on Kennedy Road, on Midland Avenue, on Brimley Road, on McCowan Road, on Markham Road, or on Kingston Road?
