Hong Kong must always be on the highest alert to prevent outbreaks of infectious diseases. We learned the lesson for complacency with Sars five years ago; the experience was costly to the community and our reputation. Yet, as the case of teacher Clare Lennon proves, in the absence of a specific threat, we can lower our guard to serious levels. Lennon was admitted to St Paul's private hospital on April 10 after three weeks of coughing. The following day, tests were taken and sent to Queen Mary Hospital. On April 17, the results were not yet back when she checked herself out and, with her parents, boarded a plane for her native England. She had flown halfway around the world when the hospital told her that she had tuberculosis. On April 24, she died. Hundreds of people have been exposed to tuberculosis because of inefficiencies in determining she had the disease. Tests could have been more prompt and the attending doctor should have been told of the findings immediately they became available. A matter other governments are grappling with - whether people with or suspected of having an infectious disease should have their movement restricted - should already have been considered. Given our record, the situation is one over which alarm bells should be ringing. Hong Kong is particularly vulnerable to infectious diseases. Our reliance on the mainland for food and water leaves us open to diseases through the movement of goods. Cross-border and international travel increase the risk. Overcrowded living conditions make for higher risk of infection. These factors, combined with a subtropical climate, make preparedness essential. There is no shortage of diseases to which we have fallen prey. Sars is gone, but the bird flu virus H5N1 is ever-lurking. In the past two decades, other new and old infectious diseases have also emerged, chief among them HIV/Aids, dengue fever and tuberculosis. The latter has long been endemic and causes more infections and deaths than any other disease. Tuberculosis was at its peak in 1952 when the government instituted a programme of immunising newborns. The approach has been effective; rates of infection are considerably lower here than elsewhere in the region. But the disease has been making a comeback globally and more cases are being reported here. The problems highlighted by Lennon's case must not reoccur. Although she was put in isolation after being admitted to the hospital, it is clear that the possibility of her having an infectious disease was not followed as astutely as it should have been. If this had been the case, the doctor involved would have known about the test results sooner through prompt notification and phone alerts rather than an office in-tray. The woman could have been advised against travel. Patients can check themselves out of hospital whenever they like. Confidentiality rules in the absence of a positive test result means that the Department of Health does not have to be alerted; the person involved can freely board a plane. The government has been looking into this for the past year. A Taiwanese couple with TB passed through Hong Kong while on the way to the mainland, while an American lawyer sparked international concern after he travelled to France and then Canada. Immigration officers are not doctors; they rely on the honesty of travellers and observation to prevent diseases from crossing borders. Hong Kong's experience in dealing with infectious diseases leaves us better placed than many other cities when it comes to detection, isolation and treatment. Our system is robust, but the manner in which Lennon's illness was dealt with shows that it is only as strong as the alertness of medical staff. Public and private hospitals clearly need to review procedures and regularly check that staff are enacting them properly. Authorities would also do well to quickly determine the best steps to take to prevent infectious diseases from spreading.