Region: Health and Food Security Issues


Dr Deborah Johnson

Outbreaks of the SARS-associated coronavirus in February 2003 (with four recent cases in China since December 2003); of Mad Cow disease (Bovine Spongiform Encephalopathy, BSE), and its human variant, Creutzfeld-Jakob disease, vCJD; first discovered in Britain in November 1986 and later in Europe; with recent individual cases reported in the USA in December 2003, in Canada in May 2003 and in Japan - 10th case reported in February 2004); of the Nipah Virus in Malaysia (Sept 1998-April 1999; as of 26 February 2004, the WHO had received reports of 22 cases, including 17 deaths, attributed to a Nipah-like virus infection in Bangladesh – with an additional 51 cases under investigation); and now the most recent outbreak of bird (avian) flu (reported in South Korea in December 2003, but possibly present in Vietnam from October 2003; peaking in January/February 2004) have underlined the vulnerability of human populations around the world to the possibility of the spread of disease across species barriers and subsequently to human populations. The possible disastrous consequences in today’s increasingly urbanised and globalised world underline the need for vigilance in the areas of not only disease control, but also of food production and animal husbandry practices.

Migratory waterfowl are the natural hosts of the bird flu virus (known for more than 100 years but first isolated from birds in South Africa in 1961), to which domestic poultry are particularly vulnerable. However, the first documented bird-to-human transmission was in Hong Kong in 1997, when some 18 people were diagnosed with severe respiratory illness of whom six died. Hong Kong’s entire chicken population was slaughtered in three days, thus preventing its spread. In the latest outbreak at least 10 countries in Asia and North America have been affected resulting in the slaughter of some 100 million birds. The viral strains found in Taiwan (H5N2 and Exotic Newcastle disease (END) or paramyxovirus, PMV-1) Pakistan (H7 virus) and the USA (H7 virus), though lethal for poultry, are less dangerous to humans. However, in South Korea, Japan, China, Indonesia, Cambodia and Laos the presence of the deadly H5N1 has been detected. In the worst hit countries of Thailand (the world’s fourth largest poultry exporter with a US$1 billion trade) and Vietnam, the disease has not only decimated poultry stocks, but has also transited into the human population through direct contact with diseased birds. Although the numbers have not been as high as for the 2003 SARS outbreak (8,098 people sick in some two dozen countries with 774 fatalities), the H5N1 virus has had a high (70 per cent) fatality rate in humans. So far, according to WHO statistics, there have been a total of 33 confirmed cases (10 in Thailand and 23 in Vietnam) and of these 7 have died in Thailand and 15 in Vietnam. No human-to-human transfer has been detected, although the disease has also been found in some exotic (zoo) and domestic cats, which have eaten diseased chickens.

Health authorities around the world have been on high alert because of fears that this influenza type A virus may mutate (possibly within a pig or a human ‘mixing vessel’) to produce a new virus to which the human population has no immunity. Thus, the world would be exposed to a pandemic possibly more devastating than the ‘Spanish flu’ of 1918-19 which killed between 20 and 40 million people, which is more than died in World War I and more than died in four years of the Black Death Bubonic Plague from 1347 to 1351. (By comparison, as of the end of 2003, an estimated 40 million people worldwide were living with HIV/AIDS; as of January 2002 vCJD had affected 119 people, mostly in the UK but with 5 cases in France; the Nipah virus infected 265 people causing 105 deaths in Malaysia; 11 with 1 death in Singapore.)

As human populations increase, the need for mass farming often in close proximity to human populations also increases. This includes aquaculture production of fish and shrimp, etc., over which there has been increasing public health concern in Southeast Asia and Latin America. Food-borne trematodes can cause acute liver disease and may lead to liver cancer. An estimated 40 million people world wide are thought to be affected, due in part due to a combination of increased aquaculture production, often under unsanitary conditions, and of consumption of raw and lightly processed fresh water fish and fishery products. Thus, there is a need to closely scrutinise and monitor farming and animal husbandry practices, including feeding, inoculation and other veterinary drug use and waste disposal practices. Selectively bred animals living in close quarters with each other are far more vulnerable to disease necessitating administration of various kinds of antibiotics (raising concerns about the transfer of antibiotic resistance to human pathogens) and other drugs to ensure healthy populations and profits. Similarly, the use of growth hormones and supplementary feed items (such as the ruminant bone and meat meal which appears to have played a role in the emergence of BSE) as well as biotechnology-derived foods (for humans and animals) need to be closely scrutinised.

Whilst manufactured products are required in most countries to show very specific content information, the same does not apply to so-called fresh produce. Despite the costs and the problems this would cause for producers and distributors, perhaps there is need for some greater transparency, public education and food labeling. Ongoing scrutiny of farming and animal husbandry practices, of regulatory and inspection regimes, of general codes of practice are vital. Admittedly, the farm is just part of a chain of processes involved in bringing food to the table, each affecting food security. These include slaughter, handling, processing, preservation, food additives, packaging, storage, distribution and final cooking and presentation. As Shinpachiro Tamura of the Agriculture, Forestry and Fisheries Corporation of Japan once wrote, ‘I am of the opinion that food has never been totally safe’. Almost all foods contain natural or artificial agents that could be harmful if ingested in large amounts; and even organically grown vegetables have the possibility of containing bacteria or viruses.

Individual nation states remain key players despite the existence of international bodies such as the World Health Organisation (WHO), the Global Outbreak Alert and Response Network (GOARN), the Food and Agriculture Organisation (FAO) and the World Organisation of Animal Health (OIE). National authorities are obliged to notify international regulatory bodies of a disease outbreak as soon as possible and to act in a transparent manner in attacking the problem. As a WHO document indicates, ‘the food production chain has become more complex … Many outbreaks of food-borne diseases that were once contained within a small community may now take on global dimensions.

WATCHPOINT: Despite the eagerness of governments to declare the bird flu outbreak over, the WHO has asserted that it could be at least a year before this can be affirmed.


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