By Alice Keesing

It could be said that disease investigators lead rather strange lives. On the front lines of the State’s fight against infectious diseases, they live in a world swarming with all the little yuksome things that make us sick.

Their suspects are the harmful organisms that are hitchhiking in our food, or fired off in a sneeze, or carried in the bite of a mosquito. For the state Department of Health disease investigation team, the job never stops; 24/7 they’re on call, sifting through reams of data looking for signs of an outbreak, tracking down the source, then acting fast to stamp it out before it spreads and claims more victims.

One day they might be flying off to Kona to protect a church congregation from an outbreak of meningococcal meningitis. The next night they might be doing the same work in a Honolulu strip bar. They might be fielding calls on a preschool uku infestation. Or planning for the dreaded arrival of the avian flu.

“Our job is so interesting,” says Augustina Manuzak, an epidemiological specialist who has been on the team for two years.

Every day the disease investigation team receives reports from the state’s doctors, hospitals, clinical labs and the public. Already this year, it has responded to 1,500 cases on Oahu alone. And sometimes the situations are as dramatic as any of the medical-based television shows.

Like the time they traced a case of cholera to a stash of smuggled clams. A nurse looking for a second income had illegally imported 70 pounds of the contaminated clams from the Philippines in her suitcase for sale at the open markets.

Or the time they traced a simmering hotbed of measles to a group of pregnant teenage girls brought to Hawaii from the Pacific Islands to deliver their babies for adoption.

Measles. Cholera. Leptospirosis. West Nile virus. Dengue fever. They are among the 60-plus infectious diseases that are on the state’s watch list. But the biggest baddie of all these days is avian influenza. In the last two years, the bird flu virus has wiped out huge numbers of birds in Asia. It has jumped to humans and killed at least 65 people. And experts are concerned the virus will mutate into a form that spreads easily among humans creating a global flu pandemic.

“It is a constant worry because the avian flu does seem to be spreading,” says Dr. Sarah Park, deputy chief of the disease outbreak control division. “People feel that it is only a matter of time.”

Right now Hawaii has a small measure of protection because of its geographic isolation and because it is not on the migratory flight path of any of the affected bird populations. But if it reaches the point where the virus can transmit between humans, then “Hawaii is as safe as anywhere else,” Park says.

While the seasonal flu attacks the weakest — the young, elderly and ailing — a new flu strain like this would hit everyone, says Joe Elm, supervisor of the field investigation team.

The big post-war pandemic of 1918 may have killed as many as 50 million people worldwide; later pandemics in 1958 and 1969 killed tens of thousands in the United States. And based on historical patterns, the world is overdue for a major flu pandemic, Park says.

“We’ve started to prepare,” she says. “It’s only prudent to do so. You can just look at non-infectious emergencies like Hurricane Katrina and know that you need to be prepared to some extent. … You can’t predict every single detail, but you can try to make sure you know who your partners are, what their functions are in an emergency, what their capabilities are, what your capabilities are and who you can utilize for what we call surge capacity.”

Within the next few weeks, the disease investigation team will also begin responding to Honolulu airport whenever an airline pilot reports an incoming passenger with a fever. This new measure is aimed specifically at the threat of the bird flu, and the department does have the authority to quarantine, if necessary.

The Hawaii health department already has earned kudos as one of the first in the country to use an electronic reporting system, which automatically notifies the disease investigation branch if there is a positive lab test for a reportable disease.

This means a faster response, which is crucial because early identification can mean the difference between nipping something in the bud or having it spread into the wider community.

The case of the pregnant teens and the measles is a good example. When the investigation team heard there was a pregnant woman hospitalized with the measles — and that she was living with a group of other pregnant women — they knew they had to act quickly.

“Measles is very, very contagious,” says disease investigation branch chief Michele Nakata. “We’ve had outbreaks in the past where a case had gone to a hospital to be treated and wasn’t properly isolated, and walked down the hallway coughing, and they’ve had patients that have walked through the hallway either at the same time or a couple of minutes later … and that’s their only exposure and they’ve come down with it.”

While most people are vaccinated against the disease, there are those who are not, including young babies and many immigrants. Measles in pregnant women also can cause terrible harm to the unborn child.

Once the disease investigation team reached the apartment where the pregnant teens were living, they found that only two in the group had immunity. They also discovered that the virus had started spreading in the Pacific Island community through shared baby-sitters and church groups, Elm says.

“There was a scramble, as it seemed to seed out in the community, to find those spots and stop it there before it could move further out,” he says.

Working the job does give the 30-odd members on the disease investigation team a slightly different view of the world we live in.

They joke that there’s nowhere they can go out and eat anymore because they hear all the complaints about food poisoning. Nakata laughs and says that when she looks at a plate of oysters she sees Hepatitis A and vibrio cholera rather than a tasty treat.

And their office kitchen is testimony to their intimate knowledge of the unseen threats we live with — there are three choices of handwashing soaps, someone is always throwing away the dirty sponge and food is never left sitting out for long.

Asked if there’s any message they’d like to send to the public, they all chorus without hesitation: “Wash your hands!”

10.13.05