Posted on: Monday, March 24, 2003
Health officials track illnesses
By Robbie Dingeman
Advertiser Health Writer
When symptoms of illnesses such as the recent respiratory ailment centered in Asia surface in the Islands, Hawai'i health officials assume the role of disease detectives. They sift through symptoms and painstakingly track suspected patients to trace a path of infection.
Officials have identified a third suspected case, but say all three women who were examined have recovered and are unlikely to have contracted the new ailment.
The suspected cases include a Kaua'i woman who came down with a fever and respiratory illness after returning from a trip to China as well as two Wilcox Hospital healthcare workers who came into contact with her.
Michele Nakata, chief of the disease investigation branch of the state Health Department, said her office was on a heightened alert last month for signs of avian flu, which has been occurring in China. When she first was notified by a Kaua'i physician of a possible case, they hadn't sent out an alert about the latest illness worry: severe acute respiratory syndrome, or SARS.
The Kaua'i woman and her husband said they had visited a Hong Kong park, where they had recalled reading that a number of birds had died, alerting them to the possibility of avian flu.
The woman tested negative for influenza, but Nakata said they notified the Centers for Disease Control. After the SARS warning went out last weekend, the Health Department stepped up surveillance for that disease, calling hospitals each day to ask about possible cases with the specific symptoms: a fever of 100.4 degrees or higher, trouble breathing and recent travel to areas where the illness is suspected, such as Hong Kong or Guangdong province in China, Hanoi or Toronto.
"They were seeing a patient that had influenza-like illness symptoms and had just returned the day before from a trip to Hong Kong," she said.
Nakata instructed the Kaua'i medical staff to collect throat swab specimens for virus isolation
Later that evening, the hospital called Nakata to say it was going to admit the patient for monitoring.
When investigators close in on a possible case, their detailed work begins. They question the patient, the family, the medical facility, hoping to reach everyone who has had contact with the patient.
"We also looked at employee illness records to identify anybody who was sick from when the first person got sick until now," she said.
That process led them to the two other suspected cases at the hospital. Each time a new potential case is identified, the interview process starts again.
In this case, the first employee to turn up with symptoms had contact with very few people after getting sick.
"The first employee had not gone back to work since she had become ill," Nakata said. "The only thing we had to worry about was exposures to people while she was hospitalized."
The second employee provided a different challenge. Because her respiratory illness was mild and followed a family member's illness, she continued many of her daily activities and was never hospitalized. That meant investigators had to reach people she had been in contact with and all those who worked with her, a process continuing this weekend.
Nakata said the Wilcox staff has been helpful in providing information quickly. Some companies aren't as good, downplaying the importance of a disease investigation if they only see a case or two with relatively mild illnesses, she said.
Nakata said officials usually wait through two 10-day incubation periods before saying the risk has eased.
Though SARS is likely to be ruled out, health officials are cautious about drawing any conclusions too early.
"We always have to operate on the suspicion that the case will rule in instead of rule out," Nakata said.
