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Canada's 'flu hunters' track a wily new virus Add to ...

PUBLIC HEALTH REPORTER

apicard@globeandmail.com

Canada's response to the potential swine flu pandemic of 2009 began, fittingly enough, with the late-night buzz of a BlackBerry.

Frank Plummer, scientific director of the National Microbiology Laboratory, was relaxing in his Winnipeg home, half-watching a hockey game, when an e-mail arrived from Celia Alpuche Aranda, head of the Mexican national microbiology lab. She was concerned about an ever-worsening outbreak of atypical pneumonia that scientists there were unable to identify.

Earlier that day - Friday, April 17 - the U.S. Centers for Disease Control and Prevention had alerted the World Health Organization to a seemingly unconnected occurrence: two unrelated children diagnosed with swine flu in California.

Dr. Aranda packed up samples from 51 seriously ill people in Mexico and shipped them to Winnipeg. She sent a similar package to the CDC in Atlanta.

Meanwhile, the flu hunters - the nickname given the epidemiologists and laboratory scientists who obsessively track the permutations of wily influenza viruses - were already at work.

While they usually toil invisibly, doing everything from mucking about farms in China wringing the necks of ducks to pulling all-nighters with genetic sequencers, their most powerful tool remains the gathering of information, pieced together like a puzzle.

Epidemiological information-gathering has become much easier with instant communication tools like e-mail. But cyberspace also poses the greatest challenge, because information - and fear - spreads a lot more quickly than a virus ever could, even one with pandemic potential.

Before Dr. Aranda's samples arrived in Winnipeg, the blogosphere was aflame.

On April 21, ProMed-mail, the blog of choice for flu hunters, posted a long item about swine influenza A H1N1, the virus identified in the California children, ominously noting the "possibility that human transmission of this new influenza virus has occurred."

Public health officials were also watching, with increased concern, an outbreak of flu in Mexico, a favourite vacation destination of Canadians. The Global Public Health Intelligence Network, an initiative of the Public Health Agency of Canada, sent out its first dispatch about an acute respiratory syndrome in Veracruz, Mexico, on April 10 and within days it was abuzz.

While there was no increase in flu activity in Canada, both the Ontario Agency for Health Protection and Promotion and the B.C. Centre for Disease Control sent alerts to public health units on April 21 telling them to watch for respiratory symptoms in Canadian travellers returning from Mexico.

Journalistic antennae went up too. Helen Branswell, the medical reporter at The Canadian Press, posted one of the first stories. "U.S. public health authorities are investigating two cases of swine flu in unrelated children in California, a development that has officials in Canada and elsewhere on alert," she wrote presciently.

On April 22, the CDC announced three more swine flu cases in the United States, and the Canadian Public Health Agency began investigating reports of Canadians returning from Mexico with a strange respiratory ailment. The initial fear was that SARS had returned.

But on the morning of April 23, Dr. Plummer, whose team had worked around the clock to analyze the samples it had received the day before, held a conference call with top Mexican health officials to reveal his findings: 17 of the 51 samples contained a completely new type of virus, one that had originated in pigs - swine influenza A H1N1.

In Canada, provincial health officials sent out a far more detailed alert, this time to physicians, about travellers returning from Mexico.

The arrival of a new flu virus, one that had eerie similarities to the killer Spanish flu of 90 years ago, told David Butler-Jones, Canada's Chief Public Health Officer, that it was time to activate the Canadian Pandemic Influenza Plan.

The World Health Organization also kicked it up a notch. A mere 22 minutes after receiving the results of the Canadian testing, the WHO opened its emergency operations centre. It also made the first explicit connection between the "influenza-like illness in the U.S. and Mexico" and convened a panel of international experts to determine the threat that swine influenza A H1N1 posed.

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