Health officials worldwide are concerned about the spread of bird flu, and in Hawai'i — gateway to and from Asia — fears are particularly immediate.

If the flu mutates to a version that spreads easily among humans, air travel could quickly spread the potentially deadly disease, said Sarah Park, deputy chief of the state Health Department's disease outbreak control division.

"We're more concerned here because of our proximity to Asia, and because we are a thoroughfare to so many points," she said. "Other states — California and New York — have larger numbers of travelers coming through, but as far as the ratio of visitors to residents, we outstrip them."

So federal and state officials are making Honolulu International Airport the state's first line of defense.

The Centers for Disease Control and Prevention Quarantine Station will become a screening area for sick passengers as they arrive.

"We're talking about screening ill travelers at the airport," Park said. "This will be the first quarantine center surveillance — no one else is doing this. The CDC are looking at this as a model for what they would like to institute across the nation."

If all goes well, she said, the quarantine center will begin operating as a disease surveillance system on Oct. 31.

"We don't want to hinder traffic," Park said, "so this is going to be a somewhat passive system. It'll depend on pilots reporting to the airports when crews notice a sick passenger who needs to be assessed."

Airports will coordinate with the medical staff at the quarantine center, who will assess the person, she said.

Symptoms of a respiratory disorder alone will likely not raise concerns about bird flu, she said. Symptoms combined with reports that the passenger might have been in Southeast Asia and close to places where people or animals had been diagnosed with bird flu would be seen as more significant.

All passengers showing respiratory disorders will be tested at the airport. Tests will be sent to the state health department's lab.

SPECIMENS SHIPPED

David Horio, chief of the state laboratory, said testing to rule out or confirm avian flu is not available in Hawai'i or in other state labs. Specimens must be shipped by air to the CDC in Atlanta.

But the CDC has been preparing labs in Hawai'i and elsewhere to conduct the tests.

"We expect to have a test to deal with the actual specimen in two to four weeks," he said.

In addition to the state lab in Pearl City, two military labs — one at Tripler and an emergency medical unit with the Navy — are preparing to conduct the tests.

Scientists are still not sure avian flu will mutate to allow it to spread easily from human to human, said Duane Gubler, director of the Asia-Pacific Institute of Tropical Medicine and Infectious Diseases at the University of Hawai'i medical school.

"If there is a pandemic," he said, "it will make the SARS epidemic pale by comparison. It will be a major public health issue. It will cause social disruption and tremendous economic impact."

There is no vaccine, he said, and there are not sufficient supplies of antiviral drugs available anywhere, including Hawai'i.

"It's going to create lots of problems," he said. "Hopefully, the aloha spirit will reign."

In the spring of 2003, the respiratory virus SARS journeyed to five countries in 24 hours after emerging in rural China. Airline and tourism industries lost billions of dollars worldwide because people were afraid to travel and governments ordered flights canceled.

COMMUNICATION

Bird flu, which spreads to people through bird excretions, is most prevalent in Southeast Asia. Only two U.S. airlines fly their own planes there — United and Northwest. But officials with the CDC, airlines and other aviation organizations are keeping a close eye as the disease spreads elsewhere.

"The best thing we always do in these situations is stay in close touch with CDC and as soon as we hear something, we kick it out," said Steve van Beek, executive vice president of the Airports Council International, a trade group. By that he means letting airports know they should be prepared to make space available and tell staff and police that planes will need to be isolated and passengers quarantined.

Since the Sept. 11 terror attacks, most airports have contingency plans and crisis centers, van Beek said.

Diseases spread easily on airplanes: Passengers are confined closely together for hours, and many people may sit in the same seat between cleanings as the jet makes stops.

One way to limit the spread of disease is to force recirculated air through high-efficiency particulate filters, which trap fungi and germs. HEPA filters are used on about three-fourths of all commercial airplanes, Federal Aviation Administration spokeswoman Alison Duquette said.

"It's a standard industry practice for new aircraft," Duquette said.

Airlines also follow CDC guidelines calling for flight crew to separate a passenger with a contagious disease, if possible, and provide a surgical mask. Pilots, by law, must notify the nearest quarantine station and quarantine workers will arrange for medical assistance, notify health departments and work with the airline to make sure the disease germs are killed, according to the CDC.

"Flu is pretty easy to kill with disinfectant," said Katherine Andrus, spokeswoman for the Air Transport Association.

An Orlando, Fla., company called AeroClave has developed equipment that modifies temperature and humidity inside airplanes so the air kills smallpox, SARS and bird flu. A giant white box and hose pump heated air through an airplane's ventilation system for two hours, disinfecting parts of the plane that cleaning crews can't reach.

Company founder Dr. Ronald Brown said the FAA is in the process of certifying the system.

"When we started this 2 1/2 years ago, people looked at us cross-eyed," Brown said. "SARS was just our two-minute warning. It showed how things can spread rapidly."

Brown said he's unaware of any standard for plane cleanliness. Airline cleaners wipe off stains and spills, and maintenance workers deep clean them during heavy maintenance checks, but Brown said he doesn't know of any airlines that disinfect seat belts, tray tables and overhead bins every week.

MORE STATIONS

Since the SARS outbreak in 2003, the CDC has added nine more quarantine stations to international airports for a total of 17. CDC workers can meet airplanes from countries affected by a disease and isolate anyone who shows symptoms. They can also tell anyone possibly exposed what to watch for and how to seek help.

Flight crews were reminded that they must notify health officials if a passenger shows suspicious symptoms. United Air Lines spokeswoman Robin Urbanski said the airline has annual training for flight attendants on controlling infectious diseases and an airline doctor available around the clock.

Passengers sometimes don't show disease symptoms while traveling but are diagnosed later. In those cases, the CDC tracks people who were exposed to the infected passenger.

That turned out to be a challenge during the SARS epidemic, Andrus said.

The airlines and the CDC came up with a passenger locator card that can be read by a machine. The CDC would direct airlines to distribute the card, most likely on flights coming from the part of the world where the disease is endemic, Andrus said.

The Associated Press contributed to this report.

Reach Karen Blakeman at kblakeman@honoluluadvertiser.com.