Another view of Bird Flu

Have we got it right about bird flu?

Disease/Infection News

Published: Thursday, 8-Jun-2006

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Health officials in Indonesia must have breathed a sigh of relief at the the World Health Organisation's (WHO) news that bird flu has been ruled out in the cases of four Indonesian nurses who fell sick after caring for people infected with H5N1 virus. Indonesian health authorities and the WHO had closely monitored the influenza-like illnesses of the four nurses; two of whom worked in Bandung, West Java and two in Medan, North Sumatra. The two nurses from Sumatra were a particular worry as they had been involved in caring for members of an extended family, seven of whom died last month from the virus. The cluster of infections caused alarm that the virus was mutating and becoming better at infecting people. But the WHO says laboratory tests showed no significant change in the virus, a result that was further confirmed by the nurses' negative diagnosis. The WHO has confirmed an additional case of the H5N1 avian influenza virus in Indonesia in a 15-year-old boy from West Java who died on May 30. To date of the 49 confirmed cases in Indonesia, 37 have been fatal. According to the WHO the virus has killed 128 people and infected 225 others since 2003 and 200 million birds have died or been culled. The H5N1 virus remains mainly a disease of birds, but experts fear it could change into a form easily transmitted from person to person triggering a pandemic with the potential to kill millions within a short period of time. All human cases have so far been traced to direct or indirect contact with infected birds. Many experts believe wild birds are spreading the deadly H5N1 virus but others suggest the spread of the disease is more likely to be down to the poultry industry. Media coverage of officials in poor, rural third world countries slaughtering flocks of poultry and birds adds to the panic and possibly endorses the view that the wild bird population is the culprit in spreading the virus. Various reputable organisations, the WHO included, have released a plethora of advice, information and strategies supporting the wild bird and backyard poultry theory, yet the scientific consensus on the origins of avian flu is assumed. Over the last year an ever increasing number of non-governmental organisations, bird experts and veterinarians have voiced suspicion over the global intensive poultry industry. The international environmental organisation Grain has directly challenged the official view in a new report and declares that H5N1 is essentially a problem of industrial poultry practices, the epicentre of which is the factory farms of China and south-east Asia. The report says that the UN agencies at the forefront of the international response to the virus, the WHO and FAO, are pursuing top-down strategies for wiping out bird flu that in turn are wiping out the foundations for long term, pro-poor solutions in the process. The report highlights how the FAO has turned its back on family poultry farming and contrasts the WHO's lack of concern for the impact of its bird flu measures on small farmers and says the global approach to control bird flu co-ordinated by the UN agencies excludes local communities from decision-making and does not consider the dynamics of the disease in local contexts. The report maintains that the solution being proposed - a complete shift to factory farming - merely brings us back to the source of the current bird flu crisis. Although wild birds can carry the disease, at least for short distances, the main infection route is the highly self-regulated transnational poultry industry, which sends its products and wastes around the world through a multitude of channels. Grain's theory for the emergence of H5N1 has been supported by an editorial in the prestigious medical journal The Lancet which points out that bird flu has coexisted peacefully with wild birds, small-scale poultry farming and live markets for centuries without evolving into a more dangerous form of the disease. The low-density of outdoor poultry flocks offers plenty of genetic diversity in breeding stock, whereas hi-tech, intensive poultry farms, where as many as 40,000 birds can be kept in one shed and reared entirely indoors produces the perfect environment for spreading the disease and for encouraging the rapid mutation of a mild virus into a more pathogenic and highly transmissible strain, such as H5N1. Grain says H5N1 is a poultry virus killing wild birds, not the other way around. This view is supported by the charity BirdLife International, which plots the migratory routes of wild birds and says, with few exceptions, there is a limited correlation between the pattern and timing of the spread of bird flu among domestic birds and wild bird migrations. The charity also believes that most of the bird flu outbreaks in south-east Asian countries can be linked to the movements of poultry and poultry products. Intensive poultry farms are notorious for rapidly spreading and amplifying diseases and bugs such as salmonella, campylobacter and Newcastle disease which are already endemic among factory-farmed poultry. Experts say such birds are genetically similar but their immune systems are compromised by living in conditions of impacted litter and faeces, in close proximity to one another, and sharing the same warm air space, which creates a hothouse for bugs to develop. Many still suspect the initial source of the virus was in China where intensive poultry farms were using, with government approval, a human anti-viral drug called Amantadine. This misuse could well have caused the avian flu virus to evolve into the drug-resistant H5N1 strain. In the event experts say that Amantadine has become useless in protecting people in case of a worldwide bird flu epidemic. A suspected source could very well be a mass outbreak last year among geese at Qinghai lake in northern China. Migratory birds were blamed for carrying the virus westwards to Russia and Turkey, but BirdLife International says no species migrates from Qinghai west to eastern Europe and the most likely explanation might be found in the intensive poultry farms whose "poultry manure", a euphemism for what is scraped off the floor of factory farms - bird faeces, feathers and soiled litter - is used as feed and fertiliser in fish farms and fields around Qinghai. The WHO says that bird flu can survive in bird faeces for up to 35 days and it could be that the virus was passed from intensively reared birds to wild ones via chicken faeces, rather than the other way around. An outbreak of bird flu in a remote village in eastern Turkey in January was also initially blamed on migratory birds but it later emerged that the birds were intimately connected with a large factory farm nearby. The Food and Agriculture Organisation (FAO) has now acknowledged that the poultry trade was responsible for the spread of H5N1 in Turkey, going as far as to single out the common practice of intensive poultry farms sending out huge truckloads of low-value, possibly sick birds, to poor farmers. Despite this when bird flu hit a factory farm in Nigeria in February, the FAO still blamed wild birds even when Nigerian authorities blamed the poultry industry and it was later found that the eggs used by the farm in question were not from registered hatcheries, and may have come from a bird flu-infected country, such as Turkey. The explosion of intensive poultry production across the world appears to be in line with an increase in outbreaks of avian flu. In the south-east Asian countries such as Thailand, Indonesia and Vietnam poultry production has expanded to eight times what it was years ago. Whereas in Laos, H5N1 has been restricted mainly to the country's few factory farms and authorities there have successfully eradicated bird flu by closing it's borders to poultry from Thailand and culling chickens in commercial operations. Laos has abundant free-ranging chickens mixing with ducks, quail, turkeys and wild birds but almost no contact between its small-scale poultry farms which produce nearly all of its domestic supply. Despite all the evidence now emerging that wild birds may not be the prime carrier of H5N1, governments are still panicking and in Europe many countries have issued bans or restrictions on the keeping of outdoor poultry. Environmental organisations insist that this would be an enormous mistake to place all birds indoors and fails to address the root cause of disease. They say governments should support farming that encourages animal health, so that livestock have naturally robust immune systems developed by contact with, rather than exclusion from, all disease challenge.

States plan for avian flu

Reuters HealthWednesday, June 7, 2006

By Carey Gillam
TOPEKA, Kansas (Reuters) - Kansans are practicing using a football field-sized tent as a portable hospital. Hawaii plans to find the sick by doing nasal swabs on tourists, and Seattle is issuing instructions on how to bury the dead.
Across the United States, local and state officials are spending millions of dollars to plot strategies for dealing with a still hypothetical - but experts say inevitable - pandemic flu crisis forecast to kill upwards of 2 million Americans.
The fears are tied to the current spread of a deadly strain of avian influenza known as H5N1 that has surfaced in Asia, Europe and Africa.
"There is no cookbook for pandemic. There is no one who says this is how this works," said Tod Bunting, who leads Kansas' emergency management operations, including the state's National Guard troops, who would be on the front lines of pandemic response. "The picture is unclear but we're just going to have to plan as best we can and then go with the flow."
The H5N1 avian influenza virus has infected at least 224 people in 10 countries and killed 127 of them, according to the World Health Organization. Experts evaluating the spread of this type of avian influenza believe it will ultimately mutate into a strain that could pass easily from person to person, sparking a pandemic that could sweep the globe in weeks or months.
The United States has not yet seen a case of H5N1, either in fowl or in a human, according to the Department of Health and Human Services. But federal officials have spent the past few months criss-crossing the country, warning of the possibilities of pandemic and pushing states to come up with plans for how to handle a deadly flu outbreak if it strikes.
'OVERDUE, UNDER-PREPARED'
"We are overdue and we are under-prepared," HHS Deputy Secretary Alex Azar told a group of Kansas emergency responders at a meeting in Topeka last week. "The more and better we prepare, the more lives we will save."
Azar said the federal government won't be able to provide a safety net if a pandemic hits. States will have to rely on their own ingenuity to provide health care, keep essential services operating and distribute food and medicines.
The state efforts have been augmented with $100 million in federal money so far, including $1.2 million earmarked for Kansas. HHS will distribute another $250 million to states later this year, according to Azar.
Taking the concerns to heart, community leaders and local and state officials have a mix of plans on the drawing board.
In Hawaii, officials at the Honolulu airport are planning to have nurses take nasal swabs of airline passengers who appear ill to screen them for the flu, and a jetload of people could be quarantined if any one passenger tested positive for the H5N1 strain, according to the Hawaii State Department of Health.
In Boston, thousands of healthcare professionals are being asked to sign up as volunteers for a "Medical Reserve Corps" who could help treat flu victims.
BURY IN THE BACKYARD
In Illinois, the DuPage County Health Department, which encompasses 1 million people in suburbs west of Chicago, last month sent out a mailer to 350,000 homes warning residents of pandemic flu and offering tips on how to personally prepare, including stocking up on food and water.
The county is also planning outreach kits to businesses, churches and schools along with a series of conferences in the fall, and it is launching a bird flu Web site.
"People are concerned and are asking for information," said DuPage County Health Department spokesman Dave Hass.
In South Carolina, representatives from all state agencies are meeting monthly with American Red Cross volunteers and other volunteer organizations to develop a plan of action.
The Muhlenberg College in Allentown, Pennsylvania is readying technology and personnel to transform the college quickly into a command center capable of handling hundreds of hotline calls should pandemic hit.
And in Washington state, the King County public health department in Seattle has warned people that if body bags and refrigerated trucks are in short supply, flu victims should be buried in backyards, provided the graves are far from septic systems.
In Kansas, where state officials estimate a pandemic would claim some 2,500 lives, military units in Topeka spent last weekend practicing an emergency setup of the state's "EMEDS" (expeditionary medical support system), a portable system of tents that was deployed for use along the Gulf Coast after Hurricane Katrina. The system is designed to accommodate 25 intensive care beds, a surgical wing and a pharmacy. Another EMEDS is on order and the state anticipates it would be critical in handling waves of flu patients.
"We have never really had a public emergency of this magnitude in our lifetime," said Bunting. "But we can rally the country to win this thing. We can do this."

CDC bird flu healthcare update

CDC updates advice on avian flu testing, lab work

Jun 8, 2006 (CIDRAP News) – The US Centers for Disease Control and Prevention (CDC) yesterday released updated guidelines that provide more details on when to test a patient for the H5N1 avian influenza virus, as well as substantially more specifics on laboratory testing.

In the revised guidelines, the CDC also recommends that H5N1 avian flu surveillance in the United States remain the same, saying the epidemiology of human cases has not changed significantly since the agency issued recommendations on surveillance in February 2004. The guidelines are titled "Updated Interim Guidance for Laboratory Testing of Persons with Suspected Infection with Avian Influenza A (H5N1) Virus in the United States" (see link below).

The new guidelines recommend lab testing for a patient whose illness is associated with all of the following: (1) hospitalization or death; (2) a fever of 38°C (100.4°F) or higher; (3) radiographically confirmed pneumonia, acute respiratory distress syndrome, or other severe respiratory illness; and (4) potential exposure within 10 days of symptom onset.

The CDC lists potential exposure as any of the following:

• History of travel to a country with documented H5N1 in poultry, wild birds, or people and, during travel, at least one potential exposure (eg, contact with sick or dead domestic poultry, consumption of incompletely cooked poultry, or close contact with a person who was hospitalized with a severe, unexplained respiratory illness)
• Close contact (within about 3 feet) of a sick person who was confirmed or suspected to have H5N1
• Working with live influenza H5N1 in a laboratory

In addition, the new guidelines recommend considering testing for a patient with: (1) mild or atypical disease (eg, respiratory illness and fever that does not require hospitalization, or significant neurologic or gastrointestinal symptoms in the absence of respiratory disease) and one of the exposures in the bulleted list above, or (2) severe or fatal respiratory disease whose epidemiologic information is uncertain, unavailable, or otherwise suspicious.

The new guidelines expand substantially on previous CDC guidelines, which called for testing for patients who have the radiographically confirmed severe respiratory illnesses listed above as well as a history of travel to a country where H5N1 infection has been documented. The previous guidelines called for considering testing for patients who have the same degree of fever listed above, as well as a cough, sore throat, or shortness of breath, and a history of contact with poultry or a known or suspected human case of H5N1 in an H5N1-affected country within 10 days of symptom onset.

The CDC update issued yesterday also provides greatly expanded recommendations for specimen collection and testing. They are condensed here:

• Oropharyngeal swab specimens and lower respiratory tract specimens (eg, bronchoalveolar lavage or tracheal aspirates) are preferred over nasal or nasopharyngeal swab specimens.
• Detection of H5N1 is more likely from specimens collected within 3 days of illness onset.
• Bronchoalveolar lavage is a high-risk, aerosol-generating procedure that requires infection-control precautions such as gloves, gown, goggles, and fit-tested respirator.
• Swabs used to collect specimens should have a Dacron tip and an aluminum or plastic shaft.
• Influenza H5N1-specific reverse-transcriptase polymerase chain reaction (RT-PCR) testing conducted under biosafety level 2 conditions is the preferred diagnostic method.
• For RT-PCR analysis, nucleic acid extraction lysis buffer can be added, after which specimens can be stored and shipped at 4°C (40°F) or properly deep frozen and shipped on dry ice.
• Viral culture should not be attempted unless conducted under biosafety level 3 conditions.
• Commercial rapid influenza antigen testing should be interpreted with caution for H5N1.
• Serologic testing for influenza H5N1-specific antibody can be considered if other H5N1 diagnostic testing methods are unsuccessful.

The CDC update also reiterates that the public need not avoid travel to countries affected by H5N1. However, its advice remains that travelers to these countries should avoid poultry farms, bird markets, and other places where poultry is kept.

The agency also says that no evidence of reassortment between avian and human flu viruses has been found. However, the update states, "It is expected that human infections resulting from direct contact with infected poultry will continue to occur in affected countries." It adds, "This expanding epizootic continues to pose an important and growing public health threat."

See also:

Jun 7 CDC Health Update
http://www.phppo.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00246

good prepper example

2 months of food: $1,200; Emergency-ready pantry: Priceless
By KEVIN DARST
KevinDarst@coloradoan.com

LOVELAND - In a cool, dry basement room, shelves full of canned food and hulking bags of flour and other staples act as Suzy Price's insurance policy.

It's a policy against a blizzard, flood, pandemic flu, even job loss.

"A couple of times a year, I'll come down and evaluate it and see what we've used," said Price, who is Mormon.

The Church of Latter-day Saints advocates what it calls "provident living," or self-reliance, to protect against disaster.

As federal, state and local health officials urge America to stockpile two weeks' to two months' worth of food, medical supplies and emergency items in case of a flu pandemic, perhaps one caused by the H5N1 strain of bird flu, experts say the public can learn from people like Price.

She didn't outfit herself and her family in a day or a week or a month. She amassed what she estimates to be at least a year and a half of food supply over the course of years, buying 10 cans of cream of mushroom soup when it was on sale or a couple extra jars of peanut butter when the price was too good to pass up.

She buys only items her family eats anyway - tuna, peanut butter, canned peaches, cereal - and uses the oldest ones before they go bad, then replaces those with fresher products.

The government's http://pandemicflu.gov Web site urges families to stock two weeks of emergency items. Others, including Larimer County’s chief health official, suggest two months of supplies.

Some say supply lines could be cut or slowed during a pandemic as workers and truckers get sick; others say grocery stores could remain stocked during a flu pandemic, but people might not want to risk going out.

But pinning down how much food a two-week or two-month supply really is can be tough. It can also be an expensive stockpile to create in one trip to the store, not to mention an improbable one if hordes of others are trying to do the same.

For a better idea of how much food a family would need for two weeks or two months and how much it would cost, the Coloradoan built a day’s worth of meals using only nonperishable food that could be prepared without water or heat. The result was a 1,800-calorie-per-day diet that includes snacks of peanut butter and Powerbars to generate enough calories.

The canned food and drinks in the Coloradoan’s diet would cost about $20 per day for a family of four, assuming an average of 1,800 calories per person.

That’s about $280 for two weeks, or $1,200 for two months, of canned or other food that needs no preparation.

That’s more than many families can afford, which is why experts recommend a little-by-little approach.

Dr. Adrienne LeBailly, director of the Larimer County Department of Health and Environment, suggested families buy what they can, when they can. She compared the cost of stocking up to that of a family insurance policy.

“How much insurance do you want to buy for yourself and for your family?” she said.

Preparedness companies, including the Utah-based Nitro-Pak, offer emergency packs with enough food to last anywhere from three days to a year.

Nitro-Pak’s Ultimate-Pak Food Reserve, which the company says is enough food for four people for three months or one person for a year, costs about $4,000.

The company says there’s a three- to five-week delay on food orders because of bird flu worries.

Local officials say little help will come from federal or state agencies during a pandemic.

“Family preparedness, individual preparedness are the foundation for community preparation,” said Stephen Blois, director of Fort Collins Emergency Management.

“You don’t have to dump out the $1,200 to do it all at once. It’s like savings. You put a little in the bank and it adds up.”

With the thousands of dollars of canned food in Price’s basement, her most important investment might be in the one item the government also suggests not to get caught without — a can opener.

“I have five,” Price said.

Originally published June 9, 2006

HELP TO PAKISTAN FOR BIRD FLU TESTING

The U.S. will provide Pakistan with equipment that will reduce the time needed to identify avian flu virus down to six hours. In the past, it took up to seventy-two hours to identify the virus. Greatly speeding up the process will eliminate unnecessary killing of birds and reduce the risk of the disease spreading to humans. Pakistan has had twenty-eight small-scale poultry farms with confirmed cases of avian flu, resulting in the killing of more than one-hundred-twenty-thousand birds.

In addition to the new equipment to speed up the detection process, the U.S. has already provided two-thousand sets of personal protective equipment to those working to combat avian flu in Pakistan. As part of a long-term plan to contain the virus, the U.S. will also help Pakistan’s Ministry of Health upgrade its ability to investigate and control the outbreak of communicable diseases.

In 2005, the U.S. initiated the International Partnership for Avian and Pandemic Influenza, which now involves more than ninety nations. The U.S. has pledged more than three-hundred-thirty million dollars to control avian flu. The goal is to prevent a new human influenza pandemic.

Medical experts say the bird flu could mutate into a form that could be transmitted from person to person. Since people would have no immunity to this new flu virus, such an outbreak could lead to a worldwide epidemic, causing widespread illness and death.

U.S. Under Secretary of State Paula Dobriansky said that if avian flu developed into a human pandemic, it “could cripple economies, bring international trade and travel to a standstill, and also jeopardize political stability.” President George W. Bush says, “No nation can afford to ignore this threat, and every nation has responsibilities to detect and stop its spread.”

The preceding was an editorial reflecting the views of the United States Government.
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Economic concerns of bird flu

(CNN) -- South Asia is a high-risk region for bird flu and a consequent economic recession because of the large role that poultry plays in the lives of many people there, the World Bank has warned.

It says a severe outbreak could cut South Asia's output by almost 5 percent, creating a major recession in the region and disrupting trade and transport.

There have been no reports yet of human cases of bird flu in South Asia, though poultry in India, Pakistan and Afghanistan have been affected.

Since February, hundreds of thousands of chickens have been culled and poultry farms shut in those three countries.

The bank's Director of Human Development in South Asia, Julian Schweitzer, said this week: "When you have humans and chickens living in close proximity, the threat of human H5N1 infection is that much larger."

He said the economic consequences of avian flu mutating into a form allowing human-to-human transmission would be "gigantic."

"There would be huge economic disruption in trade, goods, food and transport of all types."

Schweitzer said high population density, illiteracy and weak health infrastructure added to the challenges facing parts of South Asia.

The region has almost a quarter of the world's population, with India alone having more than 1.1 billion people.

According to the World Health Organization, there have been 225 cases of the bird flu virus in humans, with 128 deaths since the outbreaks began in Southeast Asia in 2003.

Vietnam, Indonesia
The most deaths have occurred in Vietnam, with 42 deaths from 93 confirmed cases, and Indonesia, with 37 deaths from 49 cases. Thailand has had 14 deaths and China 12. The most recent death was in Indonesia on May 30.

Schweitzer said India in particular had been affected by outbreaks in poultry this year, but had responded quickly to cull large numbers of birds in the districts of Nandurbar and Jalgaon in Maharashtra state.

Culling raised the question of compensation to affected farmers, he said.

"It is absolutely critical to compensate farmers to avoid the risk of having farmers not report cases of the virus," he said.

The bank is stepping up its capacity to deal with the economic impact of a human epidemic. This includes helping to strengthen the diagnostic capability so outbreaks can be detected quickly; helping farmers manage their poultry; and improving the response of health systems.

India has been on a high-growth track in recent years, so any regional recession would be a significant setback to its economic ambitions.

The bird flu outbreaks which began in Southeast Asia in 2003 have since spread to parts of Europe and Africa.

Public health experts and other officials are meeting in Vienna this week to follow up on pledges of financial support made at a donors conference held in Beijing in January.

LYSOL website helpful hints for bird flu

The germ experts at LYSOL® believe that preparing, not panicking, about the Avian Flu is the best thing you can do for your family. Read through this five page article to learn how to prepare at home, school and work. You will find general preparedness information as well as links to your state government's plans. As a reference, click here to print our Avian Flu checklist—a short guide to prepare your family for a possible outbreak.

Based upon the latest estimates by wildlife experts and the USDA it is believed that the Avian Flu (H5N1) will be identified on the North American continent sometime during the summer bird migration of 2006. Should a human pandemic from this ultimately develop, it is estimated that up to 30% of the population may become ill. With our current healthcare infrastructure already stretched thin and distribution channels of goods possibly shut down, it will be our own responsibility to take care of ourselves.

At this time the H5N1 Avian Flu virus is a bird to bird transmission strain. Experts have stated that with continued earth travel and exposure to alternate species, including other wild animals, pets and farm animals, the chances of the virus possibly mutating into a human strain may increase. This is not meant to scare, but rather impress the importance of the need to be prepared.



Flyway map demonstrates how migratory birds blanket North America. [Credit: USFWS]






Confirmed Human Cases by Country [Note: Numbers are confirmed by World Health Organization and may not reflect news or country reports.]



GET INFORMED

Knowing the facts is the best preparation. Identify sources you can count on for reliable information. If a pandemic occurs, having accurate and reliable information will be critical.
Reliable, accurate, and timely information is available at www.pandemicflu.gov.

Another source for information on pandemic influenza is the Centers for Disease Control and Prevention (CDC) Hotline at: 1-800-CDC-INFO (1-800-232-4636). This line is available in English and Spanish, 24 hours a day, 7 days a week. TTY: 1-888-232-6348. Questions can be e-mailed to cdcinfo@cdc.gov.

Look for information on your local and state government Web sites. Links are available to each state department of public health at www.cdc.gov/other.htm#states.

Listen to local and national radio, watch news reports on television, and read your newspaper and other sources of printed and Web-based information.

Talk to your local health care providers and public health officials.Planning for any type of emergency is in your best interest. Listed below are examples of how to prepare your family for an emergency. For more information go to www.mypyramid.gov or www.cdc.gov

Items to have on hand for an extended stay at home:


Examples of food and non-perishables
Ready-to-eat canned meats, fruits, vegetables, and soups
Protein or fruit bars
Dry cereal or granola
Peanut butter or nuts
Dried fruit
Crackers
Canned juices
Bottled water
Canned or jarred baby food and formula
Pet food



Examples of medical, health, and emergency supplies

Prescribed medical supplies such as glucose and blood-pressure monitoring equipment
Soap and water, or alcohol-based hand wash
Medicines for fever, such as acetaminophen or ibuprofen
Thermometer
Anti-diarrheal medication
Vitamins
Fluids with electrolytes
Cleansing agent/soap
Flashlight Batteries
Portable radio
Manual can opener
Garbage bags
Tissues, toilet paper, diapers and feminine hygiene supplies
Plastic garbage or trash bags with twist ties
Disinfectant Spray
Disinfectant/Sanitizing Wipes
Disposable Baby Wipes


(Adapted from www.pandemicflu.gov)
To keep your family busy, comfortable and connected, have portable flashlights, radios, TVs, electronic games and personal MP3 players with complete charges on hand. Portable DVD players and board games can help entertain the entire family. Keep chargeable items like cell phones fully charged. Assemble school learning supplies to keep the mind healthy, too. Free Children’s Learning and Activity Books can be ordered by dialing 1-800-99-LYSOL. Portable outdoor grills are always helpful should the power be interrupted.

If possible keep all vehicle gas tanks full. Additionally, homes with wells should maintain a supply of water for manual toilet flushing should power loss render the pump useless. 1.5 gallons of water poured directly into the bowl will flush it completely.

Should an outbreak occur, two weeks of isolation should be adequate, however, the longer one can live segregated, the better. The following is a formula for maintaining a level of family comfort for a week for a family of four. For additional time simply multiply the supplies by weeks expected

Supply basics per person per day based upon the 2005 USDA food pyramid are as follows:


FOOD GROUPS 30 YR OLD MALE 30 YR OLD FEMALE 8 YR OLD MALE 8 YR OLD FEMALE TOTAL / WEEK

GRAINS 9 OZ. 6 OZ. 5 OZ. 5 OZ. 175 OZ.
VEGETABLES 3.5 CUPS 2.5 CUPS 2 CUPS 2 CUPS 70 CUPS
FRUITS 2 CUPS 2 CUPS 1.5 CUPS 1.5 CUPS 42 CUPS
MILK 3 CUPS 3 CUPS 3 CUPS 3 CUPS 84 CUPS
MEAT/BEANS 6.5 OZ. 5.5 OZ. 5 OZ. 5 OZ. 154
OIL 8 TSP 6 TSP 5 TSP 5 TSP 168 CONVRT
WATER 1 GAL. 1 GAL. 1 GAL. 1 GAL. 28 GAL.
Additional Valuable Information

The American Red Cross has always recommended emergency preparedness, not for a possible flu pandemic, but rather any emergency that may come upon us. Such emergencies may include a tornado, flood, severe winter storms, etc. A family preparedness kit can be purchased directly from the Red Cross, packaged in an easy to carry back pack. Additional information can be found by visiting www.redcross.org.

Additionally, the U.S. Centers for Disease Control and Prevention Coordinating Center for Infectious Diseases, National Center for Infectious Diseases (CDC) in partnership with Reckitt Benckiser Inc., the makers of LYSOL® Brand Products, have recently updated and re-launched a 7 Step Program called AN OUNCE OF PREVENTION—KEEPS THE GERMS AWAY. By following these seven easy and low cost steps one can stop many infectious diseases and maintain a Safer, Healthier Home. These seven steps include:

CLEAN YOUR HANDS OFTEN—Keeping your hands clean is one of the best ways to keep from getting sick and spreading illness.

ROUTINELY CLEAN AND DISINFECT SURFACES—Cleaning with soap, water and scrubbing removes dirt and most germs. However, using a disinfectant cleaner kills germs, giving even better protection.

HANDLE AND PREPARE FOOD SAFELY

Clean hands and surfaces often
Separate—don’t cross contaminate one food with another
Cook foods to proper temperatures
Chill- Refrigerate foods promptly
GET IMMUNIZED—Getting immunizations is easy, low-cost, and saves lives. Make sure you and your kids get the shots suggested by your doctor.

USE ANTIBIOTICS APPROPRIATELY—Antibiotics don’t work against viruses such as colds and flu. Unnecessary antibiotics can be harmful. Antibiotics should be taken exactly as prescribed by your doctor.

BE CAREFUL WITH PETS—Pets should be routinely cared for by a vet. Babies and children under age 5 should be watched carefully around pets and animals. Always wash hands after touching animals or animal waste.

AVOID CONTACT WITH WILD ANIMALS—Wild animals can carry deadly diseases and pass them to you and your pets. Keep your house free of wild animals by not leaving any food around. Keep garbage cans sealed.

For information about downloading these helpful materials or to order brochures and posters, please visit www.cdc.gov/ounceofprevention.
State-by-State Pandemic Information

Each state page contains information about the state pandemic plan, summit materials, formal agreements, and other pandemic information pertaining to the state.

State Pandemic Plans
Access all state pandemic plans that are currently available
by clicking on your state.




IN SUMMARY


PREPARATION NOT PANIC can help make life go on as normal while keeping your family healthy. Every family knows their habits and routines best. The above are simple guidelines to help maintain life as close to normal as possible in the event that any emergency takes place.

For additional information and other healthy messages, please feel free to visit www.lysol.com.

You many also click here to contact our team for more information or if you have questions about the Avian Flu.

WHO UPDATE INDONESIA 06/06/06

Avian influenza – situation in Indonesia – update 18

6 June 2006

The Ministry of Health in Indonesia has confirmed the country’s 49th case of human infection with the H5N1 avian influenza virus.

The case occurred in a 15-year-old boy from Tasikmalaya District, West Java Province. He developed symptoms on 24 May, was hospitalized on 26 May, and died on 30 May.

An investigation conducted by provincial health authorities found a history of contact with sick and dying chickens in the boy’s household in the week before the onset of his symptoms. Monitoring of family members and close contacts has detected no cases of influenza-like illness.

Of the 49 cases confirmed to date in Indonesia, 37 have been fatal.

The H5N1 virus is considered firmly entrenched in poultry throughout much of Indonesia. Unless this situation is urgently and comprehensively addressed, sporadic human cases will continue to occur.

The newly confirmed case is one of several where exposure occurred despite a clear signal of a high-risk situation arising from poultry deaths. Pending better control of the disease in animals, WHO and officials in the Ministry of Health see an urgent need to improve public awareness of this disease, the risk factors for infection, and the behaviours that should be avoided.

Preps for bird flu

Sunday June 4, 2006
NEWS

Experts say U.S. is 'overdue' for flu pandemic
Local officials make plans to limit spread of viruses

WHAT YOU CAN DO

The federal government offers the following suggestions to help families and individuals prepare for pandemic influenza.

* Store a two-week supply of water and food.

* Have nonprescription drugs and health supplies available.

* Volunteer with local groups to prepare and assist with an emergency response.

To limit the spread of the flu virus:

* Wash your hands.

* Cover your nose and mouth when you cough or sneeze.

* Avoid large groups, and stay home from work or school if you exhibit flu-like symptoms.

For more information, visit the federal Web site for pandemic influenza at www.pandemicflu.gov.

Powered by Topix.net
By Brian Liberatore
Press & Sun-Bulletin

The hospitals were filled past capacity, and entire families lay isolated in improvised wards. To keep the sickness from spreading further, the county banned all public and private assemblies, from churches and schools to theaters and lodge meetings.

It was October 1918, and the Spanish flu had hit Broome County. By some estimates, the deadly strain of influenza would claim 50 to 100 million lives worldwide,with many of those deaths in the United States.

Broome County health professionals say such an outbreak could happen again.

"I do think something's going to happen, whether it's bird flu or regular flu that mutates into something deadly," said Deborah Mack, infection control officer with United Health Services. "We are overdue for a pandemic in the United States."

In the event that the bird flu, or the H5N1 virus, were to trigger a worldwide flu epidemic, officials say Broome County will be as prepared as it can be. A lot has changed since 1918, said Broome County Public Health Director Claudia Edwards.

"Technology and communication and the ability to communicate electronically will greatly reduce the effects (of a pandemic)," Edwards said.

The advance of technology, Edwards said, would have a double edge. In one respect, advances in global transportation would allow a virus to spread very quickly. Mack said a virus could spread across the world in as few as three days. Fortunately, medical advances such as anti-viral drugs and vaccinations would help minimize the effects of the virus.

The Center for Disease Control and the World Health Organization are watching carefully the spread of avian flu among migratory and domestic birds. With a few key mutations, the virus, with a mortality rate near 60 percent, could develop the ability to transmit itself between humans, fueling another pandemic.

The bird flu, according to the CDC, has fulfilled two of the three requirements for a full-fledged pandemic. There is little human immunity to the virus and it can be deadly. The virus fails on the third criterion: It can not spread easily between humans. But with a virus reproducing its RNA coding billions of times, there are a lot of opportunities for the virus to mutate.

"That's why we're looking at getting a plan in place," Edwards said. Under the state Department of Health's authority, the Broome County Health Department would become the lead agency in the county's response. The department's priority would be to buy time, Edwards said, by curbing the spread of the virus.

"The canceling of events would probably be a reality early on," Edwards said. Businesses and schools would close and people would be discouraged or ordered to cease congregating in large numbers. The department has been working with law enforcement and schools and is planning to meet with business leaders in August to plan for such a situation.

"If you're talking about a large scale number of people getting sick and possibly dying," Edwards said, "you're going to see some chaos."

While the county and the state made efforts to stop the spread of a virus, the federal government and pharmaceutical companies would be busy pumping out medications and vaccinations. The Federal Government last year dedicated billions of dollars to beef up the infrastructure necessary to fill 300 million prescriptions.

"I think researchers have been talking about a pandemic for a long time," Edwards said. "As far back as 2001, I can remember attending sessions on pandemic planning. The bird flu has certainly increased planning for a virus."

"I think it's just a matter of when an influenza pandemic hits," Mack said.

Update Indonesian and Europe

In this update:
[1] Indonesia - Nurse no longer a suspected case
[2] ECDC Revised Risk Assessment

From Pro-Med:

Indonesia: Suspected Avian Influenza infected Nurse Tests Negative
-----------------------------------------------
Local tests have come back negative for an Indonesian nurse who fell
ill after treating 2 siblings infected with avian influenza amid a
surge in deaths from the virus. "Thank God, the result came back
negative," Hariadi Wibisono, a senior Health Ministry official said
on Sun 4 Jun 2006. He said specimens would be sent to a World Health
Organization-approved laboratory in Hong Kong for confirmation.

The 25-year-old nurse was isolated and given the antiviral drug
Tamiflu when she developed a fever and other flu-like symptoms. She
fell ill about 10 days after treating a 10-year-old girl and her
18-year-old brother from West Java province, who died hours apart
last month of bird flu. She is improving and will likely be released
this week after finishing the full course of Tamiflu, said Dr. Hadi
Jusuf of Hasan Sadikin Hospital in Bandung, where the nurse is being
treated. The nurse's case initially raised concerns that the H5N1
virus may have passed to her from the siblings, but Wibisono said it
now appears that she was instead suffering from a seasonal flu.

On Friday [2 Jun 2006], health officials said local tests found a
7-year-old girl from the outskirts of Jakarta had died from the
virus. Specimens have been sent to the WHO laboratory for
confirmation. The girl's 10-year-old brother died 3 days earlier with
similar symptoms, but no samples were taken before he was buried.

Last month [May 2006], 6 members of a family also died of bird flu,
and a 7th fell ill in the largest family cluster reported since the
virus began ripping through Asian poultry stocks in late 2003. An 8th
member of the family in the farming village of Kubu Simbelang in
North Sumatra province was buried before samples were collected, but
WHO considers her part of the cluster of cases. Experts have not
found any link between the relatives and infected birds, which has
led them to suspect human-to-human transmission. But no one outside
the group of blood relatives has fallen ill, and experts say the
virus has not mutated.

--
Joseph P. Dudley, Ph.D.
Chief Scientist,
Biosecurity and Bioinformatics
EAI Corporation
4301 North Fairfax Drive
Suite 200
Arlington, VA 22203
<jdudley@eaicorp.com>

[The failure to confirm avian influenza in this healthcare worker
reinforces the belief that so far "clusters" of cases of human
infections have been restricted to blood relatives. Readers are
referred to the ECDC Risk Assessment document described below for
more detailed discussion. - Mod.CP]

******
[2] ECDC Revised Risk Assessment
Date: Mon 5 Jun 2006
From: Angus Nicoll <angus.nicoll@ecdc.eu.int>
Source: Press release, European Centre for Disease Prevention and
Control (ECDC), 1 Jun 2006 [edited]
<http://www.ecdc.eu.int>


Revised ECDC Risk Assessment
-------------------------------------
[The attention of ProMED-mail readers is drawn to the Technical
Report entitled ECDC Risk Assessment, which has been recently
revised. The ECDC Technical Report is a 31-page document that can be
accessed at
<http://www.ecdc.eu.int>.
The ECDC risk Assessment provides a balanced and detailed account of
current understanding of the HPAI avian influenza outbreak in animals
and humans. The following summary intimates the release of a revision
of this document. - Mod.CP]

A revised risk assessment published today [1 Jun 2006] by the
European Centre for Disease Prevention and Control (ECDC) highlights
the need for governments to intensify preparations against a possible
influenza pandemic. While the assessment concludes that "bird flu,"
in its present form, presents only a low risk to humans, it expresses
concern about the spread of H5N1 among birds in Asia and Africa.
Developments in recent months mean that more humans than ever are
being exposed to the virus, increasing the possibilities for the
virus to adapt or mutate into a human pandemic virus.

Zsuzsanna Jakab, Director of ECDC has declared that: "The spread of
H5N1 across Africa and Asia means more people than ever are now being
exposed to it. We do not know for sure whether "bird flu" is going to
mutate into a human pandemic virus. However, we are getting nearer to
finding out. This underlines the need for Europe to move ahead with
its preparedness against a pandemic."

In May 2006, the ECDC, the European Commission and WHO Europe held a
meeting with senior public health officials from across Europe to
discuss preparedness against a possible influenza pandemic (see ECDC
press release of 17 May 2006). Today's risk assessment from ECDC
underlines the importance of reinforcing and accelerating Europe's
preparedness drive.

Details of risk assessment
--------------------------
ECDC's new risk assessment points out that, because of its occasional
presence in wild birds, Europeans may have to adapt to the fact that
H5N1 will remain one of the zoonoses (animal diseases capable of
passing to humans) present on our continent. It finds no evidence
that H5N1 has become any better adapted to humans than it was in
1997, when the virus 1st emerged. The few humans who become infected
do so only when exposed to high doses of the virus.

People who keep poultry near where they live need to be aware of the
risk from H5N1 and how to protect themselves. In addition, some
precautions need to be taken to protect people such as vets and
poultry farm workers. However, the overall level of risk to the
public in Europe from "bird flu" in its current form is lower than
for many other infections that can pass from animals to humans, for
example, salmonella, campylobacter and the zoonotic strains of
_Escherichia coli_ (EHEC). As of yet, there have been no human cases
of H5N1 in the European Union, compared with thousands of infections
each year from other zoonoses.

The major cause for concern about H5N1 "bird flu" is its potential to
mutate or adapt into a human pandemic virus. There is no way of
knowing whether or when this might happen. However, the increased
exposure of humans to H5N1 resulting from its spread across Africa
and Asia multiplies the opportunities for it to adapt or mutate, if
it has that capability.

This increased exposure raises the importance of preparing for a
pandemic. Even if a pandemic caused by "bird flu" never occurs, the
same preparations will protect against other pandemics. Three
influenza pandemics occurred in the 20th century: in 1918-1920, in
1957 and 1968. It is highly likely that another pandemic will occur
at some point in the coming years.

The full text of the revised risk assessment can be found at:
<http://www.ecdc.eu.int>.

--
Prof Angus Nicoll CBE
Influenza Coordination
European Centre for Disease Prevention and Control (ECDC)
Stockholm, SWEDEN

Analysis of trends of avian influenza

More Bird Flu Deaths Due To Human Transmission Experts Reconsider Cases But Say Virus Not Yet Pandemic

SAN FRANCISCO, Jun 5

In the wake of a cluster of avian flu cases that killed seven members of a rural Indonesian family, it appears likely that there have been many more human-to-human infections than the authorities have previously acknowledged, Monday’s online edition of the San Francisco Chronicle informed. The numbers are still relatively small, and they do not mean that the virus has mutated to pass easily between people -- a change that could touch off a worldwide epidemic. All the clusters of cases have been among relatives or in nurses who were in long, close contact with patients. © Mediafax 2004. Toate drepturile rezervate.