Business and bird flu

BUSINESS

FLU FEARS: Big companies prepare for pandemic, but not everyone is ready

By JULIE JETTE
The Patriot Ledger

First, it was Y2K. Then it was potential for terrorist attacks in the wake of Sept. 11. Last fall, in many parts of the country, there was the threat of devastating hurricanes. Now, it’s a pandemic flu.

Businesses have always needed to plan for disasters. But if ever they were looking for incentive, the last several years have provided plenty of them.

But the challenges faced by businesses in the course of a pandemic flu could be substantially different than those posed by previously forecasted catastrophes.

The good news: There would likely be little damage to physical assets like buildings and infrastructure. The bad news: Public health officials are urging businesses to consider how they will operate - or how to conduct an orderly shut-down or curtailment of business - should 40 percent of their workforce be absent, potentially for weeks at a time.

Unlike weather-related events or all but the most cataclysmic terrorist attacks, most disasters tend to be localized and limited in time. If a flu pandemic strikes, it may well be regional, national or worldwide.

‘‘It’s being described as a global blizzard that could be 12 to 18 months, and that is not something business continuity planners (generally) plan for,’’ said Ann Beauchesne, a spokeswoman for the U.S. Chamber of Commerce in Washington. ‘‘Wherever ground zero is, it’s going to spread.’’

Beauchesne said the chamber believes most large, multi-national companies are well-prepared for a flu pandemic, in part because many have long had extensive disaster recovery and business continuity plans.

However, she said, it is less clear whether small- and mid-sized companies are adequately prepared.

‘‘The larger multinationals get it and have been doing (pandemic planning),’’ she said. ‘‘The small- to mid-sized companies need more information.’’

As part of its pandemic education effort, the U.S. Chamber - along with the Centers for Disease Control, the New England Council and several health plans - is hosting a half-day seminar on pandemic planning at the Landmark Center in Boston on Monday. The seminar is the first of a number of regional seminars the Chamber will hold with the CDC.

While larger companies may be more prepared for the pandemic, most aren’t sharing details about their strategies, saying they don’t want to reveal too much, given the sensitive nature of disaster planning.

‘‘Our specific plans are proprietary,’’ said Robert Keane, a spokesman for Quincy-based Stop & Shop Supermarket Co.

He did say the company’s primary goals are to get information quickly to customers and employees, and ‘‘also to keep our shelves stocked, especially with items our customers might need in any kind of pandemic.’’

He said the company is also meeting with the state Department of Public Health to prepare for various scenarios.

Boston-based State Street Corp., one of the South Shore’s largest employers, said it is prepared to shift work to other locations in its worldwide network of offices if one is particularly hard-hit by the flu.

The company also has information on the flu, how to avoid getting it, and explanations of health terms on its internal employee web site. It will also link that site to any travel restrictions that are announced by public health authorities.

Anne Marie McCaughey, head of business continuity planning for State Street, said the company is working on policies to address when and how infected employees will return to work, how to handle the absences of employees who may need to care for loved ones, and other absenteeism issues.

She said the company is also setting up systems to track absentee patterns closely. Officials hope they can perhaps get an early warning of a problem, or at know exactly what areas are being hit the hardest.

‘‘We’d like to at least be prepared and also to track how exactly this is affecting our business,’’ she said.

Like planning for any disaster, part of the challenge of planning for a pandemic is the fact that much of what may happen is difficult to predict.

Epidemiologists are confident there will be another flu pandemic. Flu pandemics have surfaced every 30 to 50 years for much of recorded history. They occur when a new strain of influenza virus to which humans have no natural immunity makes the evolutionary leap from animals to humans.

For starters, no one knows when or how the next pandemic flu will surface. Planning and worrying about the next pandemic has intensified, however, since the H5N1 virus began killing birds and poultry workers in Asia over the past two years. It’s possible that virus may never make the jump to one that is easily transmissible among humans, and that the next pandemic will be triggered by an entirely different virus.

Stephen Aldrich, CEO of Bio Economic Research Associates in Cambridge, a consulting firm that is helping clients plan for a pandemic, says the potential impact on industry of the H5N1 virus will be localized if it doesn’t evolve into a human-to-human flu. The poultry industry would be the first, and potentially hardest hit.

‘‘For most European countries, when the virus arrived and there was disease in birds, poultry demand dropped off significantly,’’ Aldrich said, adding that the estimated worldwide hit to the poultry industry is already $15 billion. He said the travel industry could also be affected if that strain of bird flu appears in a certain region of the country.

‘‘Certainly we can expect the media to advertise loudly the arrival of that particular strain of influenza in North America, and heightened fears could lead to local and relatively contained economic impact,’’ he said.

Considering that poultry-handling practices in the U.S. are far different than those in Asia, Aldrich said it is possible there won’t be any human cases here resulting from an H5N1 virus in poultry.

Effects of a human-to-human virus on the economy would be far more widespread, he said. But Aldrich said the approach individual businesses are taking to prepare for such an event varies broadly.

‘‘There’s a sort of ‘act of God’ mentality in some businesses,’’ he said. ‘‘And in other businesses, that’s not the idea at all (and) there’s a very proactive idea that this is something we can have an influence on and we should figure it out rationally.’’

BUSINESS CHECKLIST

The CDC has a checklist for businesses trying to prepare for a pandemic flu. Among the federal agency recommendations:

—Identify a pandemic coordinator or team with defined roles and responsibilities for preparedness and response planning. The planning process should include input from labor representatives.

—Develop and plan for scenarios likely to result in an increase or decrease in demand for your products or services during a pandemic.

—Establish policies for employee compensation and sick-leave absences unique to a pandemic, including policies on when a person who is no longer infectious can return to work.

—Develop and disseminate programs and materials covering signs of the flu, personal and family protection, and response strategies.

—Collaborate with federal, state, and local public health agencies and emergency responders to participate in their planning processes, share your pandemic plans, and understand their capabilities and plans.

The checklist can be found at pandemicflu.gov.

Julie Jette may be reached at jjette@ledger.com .

Copyright 2006 The Patriot Ledger
Transmitted Saturday, June 24, 2006

Is it safe to swim in the lakes?

Risk To Bathers From H5N1 Bird Flu Is Close To Zero
Main Category: Bird Flu / Avian Flu News
Article Date: 22 Jun 2006 - 1:00am (PDT)


An assessment issued today by the European Centre for Disease Prevention and Control (ECDC) concludes that the risk of catching H5N1 avian influenza from bathing in Europe's lakes, rivers and seas this summer is close to zero. After reviewing what is known about H5N1, including evidence from east Asia where H5N1 has been widespread in the bird population since 2003, and after reviewing current knowledge about other zoonoses (animal diseases capable of infecting humans) ECDC scientists concluded that the possible presence of birds infected with H5N1 near bodies of water where people bathe presents little or no risk to human health. H5N1 avian influenza is a bird virus, poorly adapted to humans. Once it is diluted in large volumes of water the risk of a person catching the virus becomes close to zero. Nonetheless, the risk assessment states the general health risks from zoonoses and human microbes in bathing water should not be underestimated, and highlights the need for the safety standards in the EU's Bathing Water Directive to be met.

Zsuzsanna Jakab, Director of ECDC said:

“H5N1 avian influenza is an animal virus that does not pass easily to humans. You have to be exposed to a large amount of this virus in order to be at risk of catching it. If an infected bird leaves droppings in a lake or river, the virus in those droppings will be too diluted to pose a health risk to humans. The only time I would be concerned is if a large number of infected birds are found near a small pond, though even here we have no evidence of risk.”

The ECDC risk assessment on bathing water has been issued on an interim basis and will be kept under review, particularly if any evidence emerges of the H5N1 virus changing and becoming more easily transmissible to humans. This is especially important for an influenza virus since these viruses are liable to change. The new risk assessment supplements opinions and advice already issued concerning the risk to human health from avian influenza. ECDC's advice that people should not touch dead or sick birds continues to be valid, as does advice to wash your hands after any contact with birds or their droppings. (see ecdc.eu.int/avian_influenza/Health_Advice.php)

Bathing in lakes, rivers, the sea and other untreated water continues to carry a small risk of becoming infected with microbes usually from other bathers, human sewage or some of the zoonoses that are more infectious to humans, such as campylobacter or salmonella. This is why there are Europe-wide standards on the purity of bathing water set out in the EU's Bathing Water Directive. In places where the EU standards are complied with, bathing can be considered as safe.

The ECDC guidance has been considered by experts from national public health institutes across Europe who sit on ECDC's Advisory Forum and draws on work done by a panel of independent scientists (the ECDC Panel on Influenza) created earlier this year.

Full text of risk assessment (PDF)

http://www.ecdc.eu.int

Statins and bird flu??

Heart drugs might provide bird flu weapon: expert

The world's top-selling drugs, cholesterol-lowering statins, might provide a way to treat feared bird flu, according to a doctor and retired drug company executive who is trying to get the researchers to study the possibility.
Antivirals that affect the influenza virus are in short supply, and it will be years before vaccine makers can ramp up capacity enough to immunize the world's population against a pandemic flu.
But what if there was a cheap and widely available drug that helped treat the flu's worst symptoms and possibly save lives?
Evidence suggests that statin drugs, designed to lower cholesterol, might help turn a potentially deadly infection into a milder disease, according to Dr. David Fedson, who thinks world health authorities ought to take a harder look at the possibility.
"Generic statins are available in virtually every country," said Fedson, a retired U.S. physician living in France.
"You'll be able to take five days of statins in India for less than a dollar," Fedson, who was also director of medical affairs at Aventis Pasteur (now French drug company Sanofi Aventis), said in a telephone interview.
"We have something that conceivably could save tens of thousands of lives. This research is so important that we cannot afford not to take it."
Fedson, an expert on vaccination, cites several recent studies that show that statins reduce inflammation. Designed to lower cholesterol, the drugs work on several biological processes and may reduce the risk of Alzheimer's disease, some cancers, and multiple sclerosis.
In January, researchers in Canada reported that statins act against sepsis, a dangerous blood infection and a 2005 study published in the journal Respiratory Research found the death rate was 64 percent lower in pneumonia patients who had been taking statins.
IMMUNE STORM
Fedson cites yet other studies that suggest strongly that people who are infected with avian influenza have an immune system overreaction known as a cytokine storm.
Their immune system signals chemicals rush to fight off the alien virus, causing an inflammation of the lungs and other organs that may be what kills them.
"It's an idea, just an idea and it needs to be substantiated with both cellular-based and animal-based studies," Fedson said. "We need to do it and we need to do it fast."
He is getting some attention.
Fedson presented his idea last week to the Congress of Infectious Diseases in Lisbon, Portugal, and is to speak to a bird flu conference next week at the Institut Pasteur in Paris. He also has a paper in next month's issue of the journal Clinical Infectious Diseases.
Statins -- which include Pfizer Inc.'s $10 billion-a-year Lipitor, Bristol-Myers Squibb Co.'s Pravachol and Merck and Co. Inc.'s Zocor -- are the world's best-selling drugs, taken by millions to reduce the risk of heart attack.
Experts say a pandemic of some sort of influenza is inevitable.
The H5N1 avian influenza sweeping countries in Asia and also affecting Europe and Africa is considered the most likely candidate. So far it has rarely infected people, but has killed 130 out of 228 infected and just a few mutations would turn it into a form that could be passed easily from one person to another.
If this happens in the next few years, the World Health Organization and other experts agree the world is very poorly prepared and that millions could die.
A WHO spokesman said the agency had no immediate comment on Fedson's work, and spokespeople for companies that make statins said they had not looked into the possibility of testing the drugs in influenza patients.


Disclaimer: The text presented on these pages contained within Heart Smart Advice is for your information only. It is not a substitute for professional medical advice. It may not represent your true individual medical situation. Do not use this information to diagnose or treat a health problem or disease without consulting a qualified healthcare provider. Please consult your healthcare provider if you have any questions or concerns.

posted by HeartSmart at 8:15 AM

China mystery deepens re first case avian flu

Mystery thickens around report of early Chinese bird flu case
16:14:27 EDT Jun 23, 2006
HELEN BRANSWELL

(CP) - The mystery surrounding a report by Chinese researchers that contradicts Beijing's official line on how long China has been having human cases of H5N1 avian flu took a twist Friday that suggests someone may have tried to block the report's publication in a prestigious medical journal.

Hours before the official release of this week's issue of New England Journal of Medicine, editors at the journal received a series of e-mails from someone purporting to be Dr. Wu-Chun Cao, one of the authors of the report which had been submitted by eight Chinese scientists.

But on Friday, editors at the journal spoke by phone with someone they believe to be Cao. He categorically denied having sent the e-mails and told the journal he and his co-authors stand behind their report.

Cao, of the State Key Laboratory of Pathogens and Biosecurity, later faxed the journal a letter reaffirming those claims.

"He has not requested withdrawal of the report, and so it stands as published in the issue of June 22," Dr. Jeffrey Drazen, editor-in-chief, said in a statement.

"We are continuing to investigate."

The eight researchers reported on the molecular characteristics of an H5N1 virus isolated from a Chinese man who died in November 2003.

The report has stirred up intense interest in the scientific world because that was two full years before Beijing first reported a human H5N1 case to the World Health Organization, in November 2005.

The authors made no reference to the discrepancy between their report and China's official H5N1 timeline. Nor did they indicate whether the testing that discovered H5N1 virus in the dead man's lung was actually done around the time of death or more recently.

When the report was published the WHO's China office formally requested that the Chinese Ministry of Health explain the discrepancy and provide information about the case.

On Friday, a WHO spokesperson in Geneva declined to comment on the latest development.

Influenza experts outside China have long believed the country has hidden or missed human cases of H5N1, but they hadn't anticipated seeing proof in the pages of one of the world's most prestigious medical journals. China has officially reported 19 cases and 12 deaths.

A spokesperson for the New England Journal of Medicine said the journal had received "multiple" e-mails asking to withdraw the report. From the e-mail addresses, some seemed to be from Cao; others claimed to be from all eight authors.

"It seemed very clear that they were coming from Dr. Cao and/or that institution," Karen Pedersen said from Boston. Copies of the e-mails were also faxed to the journal.

But editors could not immediately reach Cao to explore why he wanted the report pulled and to explain it was too late - the journal had been printed and mailed to subscribers days earlier.

On Friday someone identifying himself as Cao called the journal and said he hadn't made the request and didn't want to withdraw the report. Pedersen said the journal editors believe that call was legitimate.

The editors asked Cao to submit a letter reaffirming that the report should stand, and they received that letter. Pedersen said the journal was in the process Friday of getting the remaining seven researchers to sign similar letters.

© The Canadian Press, 2006

Mutation in Indonesian Bird Flu Virus

Human transmission of bird flu confirmed
By Elisabeth Rosenthal International Herald Tribune

Published: June 23, 2006
An Indonesian man who died after catching the H5N1 bird flu virus from his 10-year-old son represents the first laboratory confirmed case of human- to-human transmission of the disease, a World Health Organization investigation of an unusual family cluster has concluded, the agency said Friday.

The WHO investigators also discovered that the virus had mutated slightly when the son had the disease, although not in any way that would allow it to pass more readily among people. Flu viruses like H5N1 mutate constantly, although most of the mutations are insignificant biologically, as appears to have been the case in the Indonesian cluster.

"Yes, it is slightly altered, but in a way that viruses commonly mutate," said Dick Thompson, a spokesman for the WHO in Geneva, describing the findings of the report, which was not publicly released. "But that didn't make it more transmissible or cause more severe disease."

The greater importance of the slightly modified virus is that it allowed researchers from the WHO and the U.S. Centers for Disease Control and Prevention to document for the first time that the virus almost certainly was passed from person to person.

In previous cases where human-to- human transmission was suspected, researchers could not test samples from the patients, or the virus in the patients was the same as that in poultry in the area.

Scientists have long said that the H5N1 virus, which has killed hundreds of millions of birds worldwide, does not spread easily to humans or among them. But they have worried that it might acquire that ability though normal biological processes that involve genetic rearrangement. That could potentially set off a devastating human pandemic.

More than 200 people have contracted bird flu worldwide, almost all of them after very close contact with infected birds.

International health officials have been in Indonesia for much of the past month, investigating a family outbreak that affected seven relatives in a remote region of Sumatra. Six of the seven died.

Although Indonesia has been struggling all year to control bird flu outbreaks among poultry, the family on Sumatra had no known direct contact with sick birds, although the first death was a woman who sold vegetables in a market that also sold birds.

But scientists have long suspected that H5N1, though an avian virus, could also spread between people in rare cases, if there was prolonged close contact.

The family members in the cluster had a banquet in late April when the vegetable merchant was already ill and coughing heavily. Some spent the night in the same small room with her. Some members also cared for their relatives when they were sick.

In hospitals, doctors and nurses generally wear masks when treating potential bird flu victims.

The first five family members to fall ill had identical strains of H5N1, one that is common in animals in Indonesia. But that virus had mutated slightly in the sixth victim, a child, and he apparently passed the mutated virus to his father - which allowed the lab to confirm the transmission.

Still, Thompson said there was no evidence that the mutated virus was better adapted to human infection. To the contrary, the WHO has been following 54 neighbors and family members who lived near the family in the village for a month and none have contracted the virus. "So we know it is not more easily transmitted," he said.


An Indonesian man who died after catching the H5N1 bird flu virus from his 10-year-old son represents the first laboratory confirmed case of human- to-human transmission of the disease, a World Health Organization investigation of an unusual family cluster has concluded, the agency said Friday.

The WHO investigators also discovered that the virus had mutated slightly when the son had the disease, although not in any way that would allow it to pass more readily among people. Flu viruses like H5N1 mutate constantly, although most of the mutations are insignificant biologically, as appears to have been the case in the Indonesian cluster.

"Yes, it is slightly altered, but in a way that viruses commonly mutate," said Dick Thompson, a spokesman for the WHO in Geneva, describing the findings of the report, which was not publicly released. "But that didn't make it more transmissible or cause more severe disease."

The greater importance of the slightly modified virus is that it allowed researchers from the WHO and the U.S. Centers for Disease Control and Prevention to document for the first time that the virus almost certainly was passed from person to person.

In previous cases where human-to- human transmission was suspected, researchers could not test samples from the patients, or the virus in the patients was the same as that in poultry in the area.

Scientists have long said that the H5N1 virus, which has killed hundreds of millions of birds worldwide, does not spread easily to humans or among them. But they have worried that it might acquire that ability though normal biological processes that involve genetic rearrangement. That could potentially set off a devastating human pandemic.

More than 200 people have contracted bird flu worldwide, almost all of them after very close contact with infected birds.

International health officials have been in Indonesia for much of the past month, investigating a family outbreak that affected seven relatives in a remote region of Sumatra. Six of the seven died.

Although Indonesia has been struggling all year to control bird flu outbreaks among poultry, the family on Sumatra had no known direct contact with sick birds, although the first death was a woman who sold vegetables in a market that also sold birds.

But scientists have long suspected that H5N1, though an avian virus, could also spread between people in rare cases, if there was prolonged close contact.

The family members in the cluster had a banquet in late April when the vegetable merchant was already ill and coughing heavily. Some spent the night in the same small room with her. Some members also cared for their relatives when they were sick.

In hospitals, doctors and nurses generally wear masks when treating potential bird flu victims.

The first five family members to fall ill had identical strains of H5N1, one that is common in animals in Indonesia. But that virus had mutated slightly in the sixth victim, a child, and he apparently passed the mutated virus to his father - which allowed the lab to confirm the transmission.

Still, Thompson said there was no evidence that the mutated virus was better adapted to human infection. To the contrary, the WHO has been following 54 neighbors and family members who lived near the family in the village for a month and none have contracted the virus. "So we know it is not more easily transmitted," he said.

Zambia birds did not die of bird flu...

Tests rule out bird flu in Livingstone of Zambia style="font-weight: bold;"> <

The Zambian government has said test results from samples of some dead wild birds in Livingstone, capital of Southern province, are avian influenza negative, The Post newspaper reported Friday.

Christina Chisembele, epidemiologist with the Ministry of Agriculture, was quoted as saying here Thursday that the test results indicate that the birds do not die of bird flu.

However, Chisembele could not give more details and said the permanent secretary of the ministry will issue a statement on the issue.

Chisembele reiterated the government appeal to people to remain calm.

More than 40 wild birds were found dead early this week in Livingstone near the famous Victoria Falls shared by Zambia and Zimbabwe.

Four birds were found dead in Lusaka Thursday triggering off new fear of possible bird flu outbreak in the southern African country.

Source: Xinhua

WHO investigates dead birds in Zambia

Lusaka - The World Health Organization (WHO) on Thursday appealed for calm in Zambia as laboratory tests on possible presence of the avian influenza were carried out on scores of wild birds that died in unknown circumstances in the Southern province.

Provincial health authorities, meanwhile issued an appeal to people who ate the dead birds to immediately report to health centers for medical examinations.

Southern Province chief health officer Gardener Siakantu said there was urgent need for such people to be examined and monitored even before the laboratory tests were concluded.

WHO country representative Stella Anyangwe said it would be premature to speculate that the birds died of the feared H5N1 flu virus.

'Birds die all the time, and mostly of viral infections, so there is need to wait for test results being conducted,' she said.

Ananygwe however, called on health and agriculture authorities for quick action if it was found that the birds died of the virus that can be transmitted to humans.

On Monday, district veterinary officials said they had found and collected over 40 dead wild birds near the port offices of the Zambia Revenue Authority in the tourist capital of Livingstone, some 470 kilometers south of Lusaka.

Tests were ordered on samples of the birds to determine the cause of death.

In the wake of an outbreak of the flu in West Africa, Zambian authorities in March this year, banned the import of all poultry products and the movement of live birds in a bid to cut the risk of a similar outbreak.

The movement of poultry and frozen poultry products within the country was also restricted to the permission of health and veterinary authorities.

This was Zambia first case of mass deaths of birds in unclear circumstances. Reports of the dead birds and suspicion of Avian Flu have triggered panic among poultry farmers and consumer watchdogs, and resort owners in the tourist province.

© 2006 dpa - Deutsche Presse-Agentur

Treasury Dept. running financial avian flu prep test

Treasury to Sponsor First Pandemic Flu Response Exercise
Focused on Financial Sector
Florida Coalition to Host Program

The Treasury Department in cooperation with the FloridaFIRST regional financial coalition will sponsor the first U.S. pandemic flu response exercise focused on the financial sector Thursday, June 22 in Miami, Fl.

Treasury Deputy Assistant Secretary for Critical Infrastructure Protection and Compliance Policy Scott Parsons and will join 70 participants from Florida financial services firms and health, police and fire officials from local, state and federal agencies to test the local industry's preparedness for such a crisis.

FloridaFIRST is a regional coalition formed by financial institutions based in Miami with the goal of enhancing the resilience of the financial sector in South Florida to handle threats from terrorism and natural disasters. FloridaFIRST is a collective effort to protect the homeland through public and private partnerships. Treasury helped to facilitate the partnership's creation in October 2005. For more information on the coalition, please visit: http://www.treas.gov/press/releases/js2970.htm.

DRUDGE reports

Not clear to me why this is a new story. Maybe just confirmation of what was already suspected to be true, that H5N1 has been H2H.

WHO: Bird flu likely spread among family members in Indonesian cluster
Thu Jun 22 2006 02:29:02 ET

The World Health Organization concluded that human-to-human transmission likely occurred among seven relatives who died from bird flu on Indonesia's Sumatra Island, while an animal health expert said the disease was more widespread in poultry than previously thought.

In a report obtained by The Associated Press, WHO experts said the cluster's first case was probably infected by sick birds and spread the disease to six family members living in a remote village. One of those cases, a boy, then likely infected his father, it said.

The U.N. agency stressed the virus had not mutated in any major way and that no cases were detected beyond members of the family, who died last month.

"Six confirmed H5N1 cases likely acquired (the) H5N1 virus through human-to-human transmission from the index case ... during close prolonged contact with her during the late stages of her illness," the report said.

Developing...

Counting cases of avian flu

China Had Human Bird Flu Infection Two Years Earlier Than Stated

Main Category: Bird Flu / Avian Flu News
Article Date: 22 Jun 2006 - 5:00am (PDT)
China had its first case of human bird flu infection in 2003, not 2005 when the first case was officially reported to the World Health Organization, according to eight Chinese scientists who wrote to the New England Journal of Medicine.

The patient was a 24-year-old man in November, 2003. It had been thought he had died of SARS. The letter does not mention whether samples were analyzed. This means human bird flu infection hit China before Vietnam, which reported its first case in December, 2003. During the SARS outbreak in 2003 the UN criticised China for its slow response.

The authors of the letter to the New England Journal of Medicine have requested that it be withdrawn. However, as the journal's issue has already been printed this is not possible.

The WHO says it is vital to clarify this as it puts into question exactly how accurate the total number of confirmed cases really is. Confirmed cases of human bird flu infection have reached 228, of which 130 have been fatal. Does this figure really reflect the true numbers or does it only represent the minimum?

Tracking human infection is crucial in our fight against the mutation of H5N1. The more people who get infected the greater the virus' chances of mutating. If we do not know about all the human infections our efforts are seriously undermined. If H5N1 mutates we could be facing a serious flu pandemic.

Chinese authorities are much more forthcoming now. International agencies are working much better with Chinese agencies and experts compared to a few years ago. Parts of southern China, where population density is high, require precise monitoring.

Written by: Christian Nordqvist
Editor: Medical News Today

Canada tries to recruit nurses for H5N1

Nurses mobilized for bird flu
67,000 active Quebec to call on private sector, retirees, students in the event of a pandemic


KATE LUNAU, The Gazette
Published: Wednesday, June 21, 2006

Quebec's Health Department is mobilizing nurses across the province in case of an avian flu pandemic, The Gazette has learned.

Nurses working outside the public sector, retirees and even nursing students will be called on in the event of a bird flu outbreak in the province.

Nurses would staff public hospitals, private clinics and even non-traditional sites like arenas and gymnasiums to care for the public and provide mass vaccinations.

"In the case of a pandemic, nurses themselves may get sick," said Louise Cantin, secretary-general of the Quebec Order of Nurses, a professional association. "Replacements would be needed not only to take their spots but to handle increased demand from the public."

For planning purposes, the Health Department hypothesizes an avian flu pandemic could affect 35 per cent of Quebec's population in its first eight weeks. If that scenario plays out, 2.6 million people would be infected within that period, and 8,500 could die.

At the request of Health and Social Services Minister Philippe Couillard, the Quebec Order of Nurses contacted 18,000 nurses employed outside the public sector to determine which ones would be willing to work for the province in case of a pandemic.

Those include nurses employed by private clinics, insurance agencies, laboratories and nursing schools.

Nurses who have been retired for less than five years were also contacted. After a refresher course, they could be reinstated as full nurses.

The pay and benefits would be identical to part-time public sector nurses, Cantin said.

There now are about 67,000 active nurses in Quebec in both the public and private sectors.

The people contacted were asked where in Quebec they would be willing to work, because the province's less inhabited areas could face a shortage of health-care workers.

"The Health Department would cover displacement costs," Cantin said.

As of yesterday, the Order had received replies from about 2,000 nurses willing to help.

In the fall, when classes resume, nursing students who have completed two of their three years of study will also be contacted. There are about 5,400 such students in the province.

"After the second year of study, nursing students are eligible to do some hospital work, like providing vaccinations and first aid," Cantin said.

"In case of a flu pandemic, schools may close," Cantin said. "Nursing students would be free to help fight the outbreak."

The Health Department will use the information to compile a database of nurses employed outside the public sector, to be drawn on in case of a pandemic.

The database would be refreshed every year.

This is the first time the Health Department has asked for such help from the Quebec Order of Nurses, Cantin said.

"As those outside the public sector are not the department's employees, the minister could not reach them," she said.

For more information on influenza prevention in Quebec, visit www.pandemicquebec.ca

klunau@thegazette.canwest.com

Wash those hands...

Ignorance a key factor in H5N1 infections-experts
21 Jun 2006 12:58:29 GMT
Source: Reuters

By Fitri Wulandari

JAKARTA, June 21 (Reuters) - Many people who contracted the H5N1 bird flu virus in Indonesia were ignorant and never warned about the disease and children are the ones most vulnerable, medical experts said on Wednesday.

"Children may be off to play with sick chickens ... an activity that adults do less of," Thomas Grein, a leading epidemiologist at the World Health Organisation, told Reuters on the sidelines of an experts meeting on bird flu.

"Other high risk exercises are slaughtering of sick birds, de-feathering and preparing food. But if you wash your hands, it can reduce that risk very dramatically," he said. "But again, this is less often done by the younger person than adult."

The H5N1 virus has infected 51 people and killed 39 of them in Indonesia since 2005 and is now endemic in poultry in nearly all of the country's 33 provinces.

It is common in the far-flung country of 17,000 islands for households to keep chickens for food and extra income - which means that everyone, and not just poultry workers, is at risk.

School-age children and children less than 10 years of age make up over 40 percent of Indonesia's H5N1 human infections. People are not used to the idea that sick birds could be dangerous and children play with chickens and are sent to clean up after them.

"It shows that the risk profile is much broader than we expected. It's not only poultry workers. This is because the virus is found so widely in backyard chicken," said Steven Bjorge, WHO's medical officer of communicable diseases.

"There were other diseases in birds but they did not cross over to humans in the past. That's the situation that they are not familiar with," he said.

"People need to understand that dead chickens are a high risk factor. If there is dead chicken, they need to call the authority to clean them properly and should not let children touch them."

NOT JUST INDONESIA

In Hong Kong, where the virus made its first documented jump to humans in 1997, nine of the 18 human infections involved children who were six years old or younger.

The first victim was a three-year-old boy who died 12 days after he developed fever, a sore throat and a cough in May, 1997. While experts never confirmed how he came to be infected, he attended a nursery which kept chicks and ducklings in a pet zoo.

At least two other children attended a school that was next to a wholesale market and often played in an area used to store chicken cages that were unwashed and splattered with faeces.

H5N1 infected birds shed plenty of virus in their faeces and experts say stool particles are a main vehicle of transmission. Kept moist and cool, the virus can survive for days on faeces.

"If chickens infected with H5N1 are shedding the virus in their faeces on the floor of houses where people live, then they are more likely to be exposed to H5N1 infection," said Julian Tang, a microbiologist at Chinese University in Hong Kong.

"The virus may survive for some time in the chicken faeces, then when dry, can be inhaled as dust. This may occur if the faeces on the floor is disturbed by walking, playing. You can breathe or have direct contact with it, when you are just present in the area, whether sleeping or doing other things."

"Children are probably more vulnerable because they tend to play on the floor, more often, where the risk of contact with such infected material is higher. If they are sent to clean up dead chickens, well, you have your answer," Tang said.

Ignorance is also believed to have played a role in the deaths of four young Azerbaijanis in February and March, who de-feathered dead swans to make pillows before they fell sick.

Feathers too may infected an 18-year-old Indonesian shuttlecock maker, who died last month. While officials have not said how he got infected, he sorted feathers for a living.

"Infected birds preen their feathers which could be contaminated with beak excretions. The virus would then be transferred to the person by hand or breathing in feather dust contaminated with virus," said John Oxford, virology professor at the Royal London Hospital. (Additional reporting Tan Ee Lyn in Hong Kong)

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Bird flu burials at VA cemeteries

The VA buries more than 250 veterans and eligible family members a day _ about 93,000 a year. It operates cemeteries in 39 states and Puerto Rico.

Those burials could stop or be put on hold during a pandemic, presumably even as the tally of dead surges, according to a VA plan that lays out how it will cope with an influenza outbreak. The government is preparing for a worst-case scenario of nearly 2 million deaths in the United States in a pandemic.

The VA would continue treating veterans at its 150-plus hospitals and hundreds of smaller clinics. It also would provide back-up care to active duty military, as well as non-veterans if necessary, according to the plan posted on the department's Web site.

As for the dead, the VA said it may have to store bodies in refrigerated warehouses or trucks outfitted as temporary morgues.

If forced to close cemeteries because of staffing shortages or other reasons, the plan calls for VA employees to reroute phones and contact funeral homes and the next-of-kin to "reschedule" burials.

As much as 40 percent of the national work force could be off the job in a pandemic, according to federal estimates.

"They're raising a common concern: Where are the workers going to come from?" said Robert Fells, external chief operating officer and general counsel for the International Cemetery and Funeral Association.

During the 1918 Spanish flu pandemic, the dead were sometimes buried in trenches, Fells said. Should another pandemic strike, it could take days to bury the dead, and perhaps only then in mass or temporary graves, he added.

"Will that be necessary? It may be and we have to be prepared if things get that bad," Fells said.

The VA acknowledges cemeteries will have to plan ways of allocating staff and plots for "significant numbers of burials if closure and rescheduling is not an adequate response," according to the plan.

Thai research about chicken farming and H5N1

Letter
Avian Influenza Risk Communication, Thailand

Masami T. Takeuchi*1Comments
*Food and Agriculture Organization of the United Nations, Rome, Italy



To the Editor: Twenty-two human cases of H5N1 highly pathogenic avian influenza (HPAI) have been reported in Thailand since 2003, with 14 deaths (1). From July to December 2005, I investigated Thai consumers' food safety practices by conducting an oral survey prepared in the Thai language. Interviews were conducted in 3 areas that have not had cases of H5N1 avian influenza, Bangkok (urban, n = 126), Rangsit (suburban, n = 125), and Phetchabun (rural, n = 50). Of the 301 Thai consumers surveyed, 92% thought that Thailand has >1 food safety problems, such as pesticide residues (62%), poor personal hygiene of food vendors (39%), and microbiologic/viral contamination of food (26%). Although the Thai Ministry of Public Health has conducted an aggressive public education campaign regarding HPAI (2), only 6% named bird flu as their primary concern. Most participants had some knowledge of avian influenza; 88% of participants knew the name of the disease, and of those, all knew that infections can be deadly, and 97% knew that interacting with and slaughtering infected birds are the most risky activities.

In the rural area, 72% of participants had backyard chickens (almost no one had them in urban and suburban areas). Of those, only 6% were aware of the symptoms of HPAI in poultry. Most villagers knew that minimizing contact with birds could reduce their risk for infection; however, they were not sure how they could minimize contact. None of the owners of backyard chickens had tested them for HPAI. The reporting system for HPAI was not easily accessible for home poultry producers.

The findings of this study are similar to those of Olsen et al., who reported that widespread knowledge of avian influenza had not resulted in behavior change (2). Behavior change is a complex process; both motivators and barriers contribute to change. One participant said that the household chickens were a very important economic source, not only for the household but also for her entire village. Eggs were usually consumed within the household or sold at the local market. This villager also said that government educators told villagers not to directly interact with or slaughter chickens at home. Although she was well aware of the danger of HPAI, she thought the recommendations would be impossible to follow since feeding and egg collection involve direct interaction with chickens. When a chicken is no longer able to produce eggs, the participant slaughters the hen and either eats or sells the meat. No facility that could safely slaughter chickens is available in the village, so she does it at home.

The pattern of the villagers' risk perception was interesting. They were very aware of the risk backyard chickens present in the mid-northern area of Thailand, where many HPAI infected poultry have been reported, but they simply thought it would not happen to their chickens. The villagers' lack of concern is compatible with Slovik's theory of risk perception, whereby familiar, naturally occurring risks elicit much less concern than unfamiliar, human-made risks (3). The complacency among these villagers indicates that behavior changes will not occur unless villagers are provided with practical recommendations.

Many organizations, such as the Food and Agricultural Organization of the United Nations, the World Health Organization, and the Centers for Disease Control and Prevention, have determined that risk communication is one of the most important strategies to respond to an influenza pandemic. The Thai Ministry of Public Health is conducting a national public awareness campaign to stop the spread of HPAI. Thailand has a rapidly developing metropolitan area and many traditional village areas, and the campaign targets people in all areas. The campaign must provide highly practical recommendations for persons who own backyard chickens.

Three practical items should be included in the campaign: 1) a list of detailed symptoms of HPAI in poultry and humans; 2) guidelines on raising and slaughtering home-raised poultry, with a list of protective equipment such as boots, masks, and goggles, as well as cleaning materials; 3) instructions on how to report sick birds or persons to the Thai Ministry of Health.

Many obstacles prevent Thai consumers from following recommendations to reduce their risk for HPAI, primarily their economic status. Reporting sick birds voluntarily could lead to the destruction of their source of income unless they are compensated for depopulated flocks. To encourage persons to report or test sick birds, home poultry producers should be informed that the Thai government has initiated a system to compensate them for culled birds. Purchasing protective equipment for home slaughter may be cost-prohibitive, however. Therefore, a successful campaign must address economic considerations.

Conducting a risk communication program with consumers can be a tremendous challenge. However, considering the high literacy level of Thai consumers (98%) (4), written information is well accepted; therefore, increasing the awareness of HPAI and providing practical recommendations could be achieved in Thailand, if planned carefully.
Acknowledgments

I thank Kangsadan Boonprab, Jongjit Angkatavanich, Kaemthong Indaratna, Virginia Hillers, Raymond Jussaume, and John Gay for their assistance, comments, and support; and Suphattra Laksameebukkol for technical and language assistance.

This research project was funded by Ministry of Foreign Affairs of Japan through the Foundation for Advanced Studies on International Development.

References

1. World Health Organization (WHO). Cumulative number of confirmed human cases of avian influenza (H5N1) reported to WHO. [cited 2006 Feb 17]. Available from: http://www.who.int/csr/disease/avian_influenza/country/cases_table_2006_02_13/en/index.html
2. Olsen SJ, Laosiritaworn Y, Pattanasin S, Prapasiri P, Dowell SF. Poultry-handling practices during avian influenza outbreak, Thailand. Emerg Infect Dis. 2006;11:1601–3.
3. Slovic P. Perception of risk. Science. 1987;236:280–5.
4. United Nations Educational. Scientific and Cultural Organization (UNESCO). Adult literacy—education for all. 2004 assessment. [cited 2006 Feb17]. Available from: http://unstats.un.org/unsd/mi/mi_resultsd.asp?crID=764&fID=r5&action=print



1At the time of the research, Dr. Takeuchi was a visiting research fellow at Kasetsart University and Chulalongkorn University, Bangkok, Thailand.



Suggested citation for this article:
Takeuchi M. Avian influenza risk communication [letter]. Emerg Infect Dis [serial on the Internet]. 2006 Jul [date cited]. Available from http://www.cdc.gov/ncidod/EID/vol12no07/06-0277.htm

Canada reports not H5N1

P.E.I. bird flu case not H5N1 strain, report says

Updated Tue. Jun. 20 2006 2:15 PM ET

CTV.ca News Staff

A domestic goose that died in Prince Edward Island last week was not carrying the highly pathogenic H5N1 strain, according to an unconfirmed report.

"The news is good. The dead bird was not carrying the highly pathogenic strain of H5N1," a Canadian source told Reuters.

However, the source declined to say exactly what the dead bird had been suffering from.

The Canadian Food Inspection Agency is expected to release results of its tests at mid-afternoon on Tuesday, spokesman Marc Richard said.

The CFIA's director of animal health indicated last week there were already clues suggesting this avian flu virus isn't the highly pathogenic H5N1 virus that has decimated poultry flocks.

The dead goose -- one of four that died -- was part of a small mixed backyard flock of free-range geese, chickens and ducks.

"If this is a highly pathogenic virus -- or it was -- then it should have been causing some difficulty for the chickens,'' Dr. Jim Clark told The Canadian Press last week.

"So we're relatively confident that the virus has low pathogenicity. But we won't be able to say that definitely until the lab in Winnipeg finishes analyzing the samples."

The owner of the birds, who had purchased the geese from a local co-operative for personal consumption, told authorities he noticed four of his geese were "walking funny" on Sunday.

"Monday morning, he came out (and) the four birds that were walking funny were dead,'' Clark said.

The man disposed of three but took one for testing to the Atlantic Veterinary College in Charlottetown, where the laboratory confirmed the presence of an H5 virus.

A wild bird surveillance program conducted in Canada last fall discovered a number of birds carrying low pathogenic H5 viruses.

Analysis showed none of the viruses were of Asian H5N1 lineage and posed little or no threat to human health.

WHO UPDATE INDONESIA 06/20/06

Avian influenza – situation in Indonesia – update 20

20 June 2006

The Ministry of Health in Indonesia has confirmed the country’s 51st case of human infection with the H5N1 avian influenza virus.

The case, which was fatal, occurred in a 13-year-old boy from South Jakarta. He developed symptoms on 9 June one week after helping his grandfather slaughter diseased chickens at the family home. The boy was hospitalized on 13 June and died on 14 June.

The grandfather remains healthy. Contact tracing and monitoring are under way to ensure no further cases arise from this exposure setting.

Of the 51 cases confirmed to date in Indonesia, 39 have been fatal.

Expert consultation

WHO, FAO, and the Indonesian ministries of health and agriculture are jointly convening an expert consultation in Jakarta from 21 to 23 June. The consultation is being held, at the request of the government’s national commission on avian influenza and pandemic influenza, to assess the avian influenza situation in poultry and humans.

The consultation, which will be attended by more than 40 national and international experts, will review measures for addressing the widespread presence of the virus in poultry and offer advice on strategies for reducing the number of human cases. The experts will also examine epidemiological and virological data collected during a month-long investigation of a cluster of cases among family members in the Kubu Simbelang village of North Sumatra.

More than three weeks (two times the maximum incubation period) have passed since the last case in the cluster died on 22 May. Daily house-to-house monitoring for influenza-like illness was conducted throughout the village and in hospitals where patients were treated, and no further cases were detected. While these findings indicate no significant changes in the epidemiology of the disease, results from investigation of the cluster will be reviewed as they may yield lessons useful in the investigation and interpretation of other large clusters where human-to-human transmission is suspected.

Several viruses have been isolated from the seven confirmed cases in the cluster and these have been fully sequenced at WHO reference laboratories in Hong Kong and the USA. Experts from these laboratories will be presenting their findings for review during the consultation.

Delays in reporting bird flu

Denmark cites 2-week delay in reporting H5N1 outbreak

Jun 16, 2006 (CIDRAP News) – When avian flu struck a poultry flock in Denmark last month, the owners waited 2 weeks to notify authorities, thereby increasing the risk of human infection, according to a report in the Jun 15 Eurosurveillance Weekly.

The outbreak, which thus far is Denmark's only one in domestic birds, began in a backyard holding in Funen county on May 3 with the death of four birds out of 102 free-ranging poultry on the farm. It peaked May 5 and 6, when 30 birds died, and ended May 12, according to the report.

The outbreak killed 47 birds, all of which were in one flock of 50 birds on the backyard farm. Three other flocks in different areas of the farm were unaffected.

Veterinary authorities were alerted the evening of May 17, and avian flu was confirmed May 18.

In the meantime, according to the report, the two farm owners had close contact with the birds, including culling sick birds without wearing masks or gloves. They reported getting bird blood on their bare hands in the process.

In addition, the farm had visitors on several occasions during the outbreak, and three visitors bought eggs for home cooking during this time.

"Avian influenza A/H5N1 is currently not a very contagious virus for humans," the report says, "but there is a small and real risk of infection for people who have close contact with sick birds."

All the people who might have been exposed to avian flu virus during the outbreak took oseltamivir for postexposure prevention. Fortunately, follow-up with farm owners, visitors, and others who might have been at risk has revealed no signs of avian flu.

"At present," the report states, "it is impossible to know whether avian influenza H5N1 has become endemic in Danish wild birds, or if it has not, whether it is likely to be reintroduced later.

"It is therefore important to maintain timely surveillance, preparedness, and communication lines between relevant stakeholders."

Molbak K, Trykker H, Mellergaard S, et al. Avian influenza in Denmark, March-June 2006: public health aspects. Eurosurveill 2006 Jun 15;11(6):E060615.3 [Full text]

scientists to share viral information

Veterinary virologists to share H5N1 samples
Sharing H5N1 samples could help monitor the spread of the virus
16 June 2006
Source: Science

A consortium of veterinary virologists says it will make samples of the H5N1 bird flu virus available to researchers worldwide to process for genetic information that could help monitor the spread of the virus.

Ilaria Capua and colleagues from the scientific committee of OFFLU (the World Organization of Animal Health/UN Food and Agriculture Organization Network of Expertise on Avian Influenza) say they will do this in collaboration with the US National Institutes of Health.

The FLU-ID project — an OFFLU initiative — will make samples of H5N1 from several countries available. The full genetic sequences will then be available in a public database known as GenBank.

This kind of information, say the virologists, is of great value to researchers trying to tackle the spread of avian influenza.

In their letter to Science, they invite other veterinary researchers to join their initiative.

Cats and bird flu in Indonesia

Cat infection by bird flu detected in Indonesia


A case of cat infection by the H5N1 strain of bird flu has been detected in Indonesia, a World Health Organization medical officer in Jakarta said Monday.

"We have evidence of one cat in Indonesia that has already been infected by this virus," said Steven Bjorge, medical officer for the WHO's Communicable Disease Section.

Bjorge, speaking in a panel discussion at the Jakarta Foreign Correspondents' Club, said he thinks the cat "was infected by probably eating contaminated birds."

"This is a very rare disease. It's extremely difficult for this virus to be passed on to humans," he said, downplaying concerns about cross-species transmission of the virus.

There are no recorded cases of cat-to-human H5N1 infection anywhere in the world.

Trisatya Naipospos, the government's top adviser on H5N1 strategy, told the panel there have been unpublished studies of other cats in Indonesia being tested positive for the H5N1 strain of bird flu.

There have been a number of cases of feline infection by the dangerous H5N1 strain of avian flu outside of Indonesia, all of which appear to have been associated with outbreaks in domestic or wild birds and acquired through ingestion of raw meat from an infected bird.

In December 2003, two tigers and two leopards that were fed with fresh chicken carcasses died of H5N1 infection at a zoo in Thailand. In October 2004, 147 of 441 captive tigers in another zoo in Thailand died or were euthanized as a result of infection after being fed with fresh chicken carcasses.

Civet cats have died of bird flu in Vietnam, while earlier this year a domestic cat in Germany became the first case of a European Union mammal dying of bird flu.

There have also been cases of martens, pigs and ferrets being infected.

Naipospos genetic analysis shows the virus isolated from humans is exactly the same as that found in birds, "so we can say here now that our problem is still with birds, with poultry."

Indonesia's Health Ministry says the WHO has confirmed 52 cases of humans infected by bird flu in Indonesia, of which 39 resulted in death. But the WHO says there have been 50 cases with 38 deaths in the country.

In explaining the discrepancy, Bjorge said the WHO and the Health Ministry use a "different definition" as to what constitutes a confirmed case of bird infection. He said the organization will later revise its definition to avoid such discrepancies in the future.

Source: Kyoto

China worries about bird flu

New China case suggests H5N1 now more infectious-HK
16 Jun 2006 07:00:33 GMT
Source: Reuters
Bird flu
More HONG KONG, June 16 (Reuters) - China's latest human bird flu infection is worrying as it indicates that the H5N1 virus may have mutated and become as infectious in warm months as it is in cooler ones, Hong Kong's health minister said on Friday.

The H5N1 virus thrives in lower temperatures and is more infectious in the cooler months between October and March in the northern hemisphere.

But China's confirmation on Thursday that a 31-year-old truck driver in the southern city of Shenzhen had been infected by the disease has brought uneasiness.

"Is this because the virus has changed, so that it can be highly infectious all year round? Or, if it is happening in summer, winter would be even worse?" Health Secretary York Chow told reporters. "We will have to monitor further."

The truck driver was admitted to hospital and is critically ill. He visited a wet market where live poultry was sold and ate a chicken before he fell ill, but he is not known to have had any other close contact with poultry.

He is the 19th person in China to be infected, 12 of whom have died. But, like most of the other cases, it is a mystery how he came to be infected because there was no known outbreak of the disease in poultry in the area where he lived.

The official Xinhua news agency said on Friday that the government has not found the disease in Shenzhen poultry farms.

Experts in Hong Kong, including Chow, have highlighted the possibility that the human infections in China may have been due to contact with infected poultry which were not taken ill by the disease, which are described as "asymptomatic".

A recent study of fecal samples taken from healthy poultry in markets found that one percent were infected with the virus.

Lo Wing-lok, an infectious disease expert in Hong Kong, said China must explain how the truck driver came to be infected when it claimed there were no H5N1 outbreaks in birds in the area.

"They ought to come up with a reasonable explanation how this man came to be infected. Blanket denials don't help at all. When they deny we have to think twice about accepting," Lo said.

He recalled an incident in late January when a chicken that was smuggled into Hong Kong from Shenzhen was found with H5N1.

"It took only one tiny bird to show that the virus is there (in Shenzhen)," Lo said, adding that China should disclose how it conducts disease surveillance in poultry.

"I don't know if there is insufficient surveillance or if the data is too frightening to be disclosed," he said.

Hugh Hewitt interviews Gov. Arnold about California preparedness

Tick. Tick. Tick.
by Hugh HewittJune 16, 2006 10:00 PM PST
Now the MSM will get very interested. From the WSJ.com "Avian Flu News Tracker":




10:45 a.m.: Two journalists are suspected of having H5N1. A reporter for the Indonesian newspaper Tempo was thought to be infected with H5N1 after covering a mass cull of flu-infected poultry, Indonesian officials told the Jakarta Post. A second journalist, working for Indonesian daily publication RES, was thought to have H5N1 after attending a bird-flu victim's funeral, the state Antara news agency reported.


And from my conversation with Arnold today:




HH: All right. Let me get to one key issue. I think California is fundamentally unprepared for the Bird Flu if it gets here. I do a lot of work on that down in Orange County on our Prop. 10 Commission. I know you've held a couple of forums with Mike Leavitt, and you've got Mark Horton up there. He's doing a good job. But I mean Governor, if it gets here, we're not ready.

AS: Well, what are you doing about it?

HH: We are stockpiling Tamaflu in Orange County. We've appropriated money, run some drills. But I mean, the state's not ready. I mean, L.A., Sacramento, no one else is doing anything.

AS: Well, we are working on it. As a matter of fact, we have been working with the federal government very effectively, and we are working with local governments very effectively. I think there's a very good communication. As a matter of fact, I also put in my budget $400 million dollars to make sure that we have enough of the vaccine, and that we also have enough beds available, enough ventilators available, enough nurses, and so on. So we have really taken this seriously. As a matter of fact, there's no one that takes it more seriously than me. When I was back at the National Governor's Conference, it was actually me that brought it up, and we had a debate over it to see and find ways where all the states could work together to make sure that we are protecting the people, because it's our number one priority. And it is my top priority, also, and our responsibility to protect the people of California, and to do everything we can, if there is a problem like that with the Bird Flu, that we have enough of the medication and enough beds, and all of those things.

HH: So you think the Tamiflu and the ventilators would be here before any outbreak occurred?

AS: Oh, yeah. We have put in the money into the budget that we can buy all of those things, and be ready for it.



Unfortunately, "money into the budget" and preparation are very, very different things.

Overview of avian flu

Avian flu: Frequently asked questions
By S. Heather Duncan
TELEGRAPH STAFF WRITER
QUESTION: What is avian influenza?

ANSWER: Avian influenza, or "bird flu," is a contagious disease of animals caused by viruses that normally infect only birds and, less commonly, pigs. Most strains of influenza originate in wild birds and never become deadly to birds or humans. The deadly strain of bird flu now spreading out of Asia is identified by scientists as strain H5N1.


QUESTION: What are the symptoms?

ANSWER: Reported symptoms of avian influenza in humans include fever, cough, sore throat and muscle aches; and sometimes eye infections, pneumonia, acute respiratory distress and other life-threatening complications.


QUESTION: How does it spread, and where has it spread?

ANSWER: Avian flu spreads mostly among migrating waterfowl, such as ducks and shore birds, and through domestic poultry that is not kept isolated from wild birds. The virus has infected birds in more than 50 countries spanning three continents. It has not been found in the United States or the Western Hemisphere.

Birds transmit the virus through saliva, nasal fluid and feces. Human cases of bird flu have mostly occurred after direct contact between people and infected birds.

Last month's deaths of family members in Indonesia, and a few cases of caregivers who caught the flu, seem to indicate that the virus has passed directly from person to person in isolated cases. If so, these infections did not trigger larger outbreaks of a human-spread virus. This may be because it is a deep-lung infection, unlike seasonal flu, which is easily breathed out of the upper lungs, said Dr. Susan Lance, Georgia's state epidemiologist.


QUESTION: Is it safe to eat chicken and eggs?

ANSWER: Poultry is not imported to the United States from Asia. In fact, almost all poultry sold in this country is American-bred, and the bird flu has not been found here. Even if the virus spread to U.S. poultry, there is no evidence that anyone has been infected with the deadly strain of bird flu from eating properly cooked poultry products. The U.S. Department of Agriculture indicates that cooking eggs until firm and chicken until it reaches 165 degrees will kill the virus.


QUESTION: How deadly is bird flu?

ANSWER: The H5N1 strain of avian flu has killed 57 percent of the people diagnosed with it. That's a higher death rate than the 1918 flu pandemic, said Dr. Joseph Swartwout, director of the North Central Health District, which includes Macon, Warner Robins and Milledgeville.

It is also higher than the death rate for Severe Acute Respiratory Syndrome, better known as SARS, which was regarded as a potential pandemic a few years ago with a 43 percent death rate, said district epidemiologist Dr. German Gonzalez.


QUESTION: What would have to happen for bird flu to become a pandemic?

ANSWER: The World Health Organization identifies a pandemic as a worldwide outbreak of a new disease, for which humans have no immunity, that spreads easily among people and causes serious illness. H5N1 is a new disease that causes serious illness, but it is not yet easily transmitted from one human to another, so it is not a pandemic.

It is widely believed that the virus would have to either mutate or cross with a human-flu virus in a person or animal's body, before it could become a pandemic. However, the extent of mixing needed is unclear. In January, sequencing of the genes in the 1918 "Spanish flu," the most deadly pandemic flu in modern times, showed that it contained fewer human genes than originally believed, said Lance. "It was almost entirely a bird virus," she said.


QUESTION: Aren't flu pandemics just an unlikely science-fiction scenario?

ANSWER: Flu pandemics happen regularly. Three struck during the last century: the "Spanish influenza" of 1918, "Asian influenza" in 1957 and "Hong Kong influenza" in 1968.


QUESTION: We've had several health scares in recent years: anthrax, West Nile virus and even a supposed pandemic threat from SARS. How is bird flu any different?

ANSWER: There is no guarantee that the H5N1 strain of bird flu will become a pandemic, but public health experts say the virus has characteristics that make it more threatening. West Nile virus was never as deadly, and anthrax doesn't pass from person to person.

SARS was highly transmissible and it had a long incubation period, Lance said. It was easier to identify SARS carriers before they could infect others because the disease took 10 to 15 days to develop. In contrast, bird flu takes just a couple of days and it is more deadly.

H5N1 also has unusual staying power, Lance said. Despite efforts to eradicate the virus by killing more than 200 million Asian birds, it has persisted since 1996.

"In some ways, the longer a virus like that is out there, the more time it has to make genetic changes dangerous to humans," Lance said.

Avian flu also has greater pandemic potential because there is no vaccine for it and because medical experts have a poor understanding of it, Centers for Disease Control spokesman Von Roebuck said.

However, public health officials are aware that people take disease scares less seriously over time. Karen Ebey-Tessendorf, the North Central Health District emergency preparedness coordinator, said this attitude is similar to hurricane weariness on the coast: People prepare less each time they aren't hit by the big one, but that doesn't mean the next storm won't be deadly.

"People since 9/11 and the anthrax letters (soon afterward) are more in tune with public health disasters than before," Lance said. "I think we have people's attention. Whether we've cried 'wolf' or not, I don't know."


QUESTION: Is there treatment or a vaccine?

ANSWER: There is no vaccine for H5N1. Although they are under development, vaccines are not expected to be finished any time soon. And because the virus is likely to adapt before becoming a pandemic, an effective vaccine could not be developed until months after a pandemic begins, Swartwout said.

Initial bird flu vaccines tested in healthy adults had to be administered in high doses, and it had to be given twice to be effective, said Dr. Jon Abramson, chairman of the CDC Advisory Committee on Immunization Practice. One problem with manufacturing a bird flu vaccine is that vaccines are often cultured using eggs - an obvious problem if the egg supply becomes contaminated, he said.

There are two antiviral drugs, sold commercially as Tamiflu and Relenza, that can reduce severity and duration of illness caused by many kinds of influenza. They must be administered within 48 hours of the onset of illness to be effective. They may improve survival rates for patients with H5N1, but the evidence is limited, according to the WHO.

University of Georgia researchers are working on an alternative to the antiviral drugs: a genetic process that would essentially "silence" the expression of viral genes in the body. The process has already gone through the first phase of human clinical trials, said Ralph Tripp, a UGA professor and director of the Center for Disease Intervention.

"We believe it can be used for human treatment very soon," Tripp said. "We can make enough stockpile for pandemic flu in months, whereas it would take years to make enough Tamiflu."


QUESTION: What can I do to prepare?

ANSWER: Public health organizations are recommending that families assemble "disaster kits" to help prepare for pandemic flu or natural disasters, including at least a three-day supply of water for each member of the
household (a gallon per day per person) and a three-day supply of non-perishable food.

In addition, the U.S. Department of Health and Human Services recommends keeping nonprescription drugs and other health supplies on hand, including pain relievers, stomach remedies, cough and cold medicines, fluids with electrolytes, and vitamins, as well as soap or alcohol-based hand wash, a flashlight, batteries, a portable radio, a manual can opener, garbage bags, and extra tissues, toilet paper, pet food and disposable diapers. Some disposable rubber gloves and face masks might also be useful to have ahead of time.