Iran and H5N1 (finally admitting it?)

TEHRAN, Aug. 12 (Xinhua) -- An Iranian medical university raised warning status for regional bird flu contamination in northern Iran, the Fars news agency reported on Saturday.

People should refrain from selling and buying living birds, Gilan Medical Sciences University said in a statement, urging the public to observe rules of hygiene and take necessary precautions.

The statement asked the public to avoid direct contact with domestic and wild birds and inform health authorities of any suspicious cases.

The first case of bird flu was reported in Iran in February, when tests confirmed 135 swans died of the virus in marshes near Bandar Anzali in northwestern Iran. Enditem

Cambodias new outbreak of H5N1

PHNOM PENH, Aug. 12 (Xinhua) -- Cambodia has a new breakout of bird flu in poultry in southeast Prey Veng province, official in Ministry of Agriculture confirmed to Xinhua Saturday.

"There is bird flu outbreak in a village in Prey Veng province, about 20 km from Cambodia-Vietnamese border. More than 1,000 ducks got sick last week and died soon," Yim Venthan, secretary of state of Ministry of Agriculture said.

"Samples taken from the dead ducks were sent to Pasteur Institute in Phnom Penh for testing and they were confirmed positive for avian influenza virus on Friday," he added.

Kao Phal, director of the ministry's animal health department, said the outbreak was the virulent H5N1 type.

However, Yim Venthan called on people not to be panic.

"The authorities have taken measures, and no such virus have been found in other place in the country and no person has been found infected in bird flu so far," he said.

The H5N1 virus has killed at least 138 people since 2003, including six in Cambodia, according to the World Health Organization (WHO). Enditem

Indonesia youth struck with H5N1

Indonesian teenager tests positive for bird flu

JAKARTA (AP): A teenager being treated at a hospital in West Java province has tested positive for the H5N1 strain of bird flu, Health Ministry said Saturday.

The 17-year-old boy identified only as Umar, from the West Java regency of Garut, was hospitalized after developing a fever and breathing problem, said Haris, an official from the ministry's special task force for bird flu.

"We just received the laboratories' reports today that the teenager has tested positive for bird flu," said Haris.

The tests were conducted at the ministry's laboratory and a U.S. Naval Medical Research Unit, he said.

Haris did not know where the boy was hospitalized.

The deaths of two teenagers this week pushed Indonesia's human toll from the virus to 44, making it the country worst-hit by the disease. Most of the deaths have occurred this year. (***)

What is to be done about Indonesia? Help needed.

Bird flu fears focus on Indonesia

By Kate McGeown BBC News

Many people still do not understand the risks of living close to birds

The news that Indonesia is now the country worst affected by bird flu will come as little surprise to many analysts.

While other parts of Asia - such as Hong Kong, mainland China and Vietnam - have been able to tackle the disease, the death toll in Indonesia continues to rise.

Infected poultry flocks have now been found in 27 of the country's 33 provinces, and even the 44 recorded human fatalities have been spread right across the country.

"We're doing our best to try to stop this disease, but it seems that our best just isn't good enough," said Bayu Krishnamurti, secretary of a national committee set up by the government to fight bird flu.

The reason this failure matters was highlighted earlier this year when seven members of the same family all died of the disease - one of the few suspected human-to-human cases to have been recorded so far.

On this occasion, the lethal H5N1 virus appears not to have mutated into a form more easily transmissible between people - a step which could lead to a global human pandemic.

But the incident raised fears that such a mutation could one day take place, and brought the spotlight on Indonesia as the place where it could happen.

Lack of co-ordination

Despite a plethora of negative headlines, the Indonesian authorities are slowly gaining some ground in their battle against bird flu.

Until the animal situation is under control, we'll continue to see human cases Dick Thompson, WHO

According to Bayu Krishnamurti, the situation was once so bad that four million birds were dying every month, but now fewer than 200,000 are succumbing to the virus.

Dick Thompson, a spokesman for the World Health Organization, added that Indonesia had become adept at diagnosing human cases.

But he said that however good the provision for humans was, the disease remained primarily an avian one, and people would continue to contract bird flu as long as it was endemic in poultry.

"Until the animal situation is under control, we'll continue to see human cases," Mr Thompson said.

But that is exactly where the problem lies. How do you ensure that a population of 220 million people, living on 18,000 islands, gets adequate information about prevention measures, and then implements it?

Despite awareness campaigns in the media and even door-to-door visits in some areas, many Indonesians remain oblivious to the dangers of being in contact with diseased birds, and aware of the need to inform the authorities and implement a cull.

"Some of the people who come here still know nothing about how they contracted bird flu," said Santoso Suroso, the director of the Sulianti Suroso Infectious Diseases Hospital in Jakarta, where many patients are taken.

People across this vast archipelago still continue to live in close quarters with birds, he said. Many have chickens in their backyards, and keep caged birds as pets.

QUICK GUIDE Bird flu

"We're trying to advise them to change, of course, but it's not easy to change a cultural practice. It takes a long time," said Mr Suroso.

As well as getting the message across, Indonesia also struggles with making that message a co-ordinated one.

Due to its many different separatist struggles and culturally distinct populations, the country has devolved a lot of power away from the central government to the provinces. While this might be the best solution politically, it makes the job of mounting a country-wide disease control programme extremely difficult.

In late July, Vice-President Jusuf Kalla acknowledged that culling orders sent from Jakarta were sometimes simply ignored by the local authorities, who were trying to avoid paying compensation. "This is dangerous to all of us," Mr Kalla said.

"We have a situation where each province - in fact each district - has its own veterinary service. That's been one of our biggest concerns," added Peter Roeder, a disease control expert with the UN Food and Agriculture Organization (FAO).

Worldwide concern

Indonesia has been criticised internationally for not taking enough concerted action in the fight against bird flu.

Indonesian deaths are rising despite government efforts

Unlike Thailand and Vietnam, which initiated aggressive culling programmes, at least in the initial stages of the outbreak, Indonesia has been reluctant to kill huge swathes of birds.

But Mr Roeder, who is part of an FAO team working with the Jakarta government to combat bird flu, believes that a lot of this blame is unfair.

"Widespread culling is not the right approach. It would alienate the communities you're trying to help, and the cost is prohibitive. It's better to cull infected birds and those in the immediate vicinity, then concentrate on vaccination," he said.

"It's having a systematic method that's key - you need to implement it across the board."

Mr Roeder estimates that $50m is needed over the next three years to develop such a programme. "Clearing this up will take a long time," he said.

But the international community has been slow to come up with the funds, and Indonesian officials readily admit they need more outside help.

"We've faced many other disasters recently, like the tsunami and the earthquake in Yogyakarta. We're already being squeezed in terms of resources," said Bayu Krishnamurti.

While the world may criticise Indonesia for its handling of bird flu, the fact remains that unless the funds are available to tackle this disease head-on, it could well spread beyond the country's borders.

As Mr Krishnamurti succinctly put it: "Actually, this is not just Indonesia's problem."

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Southeast ASIA problems with bird flu

Bird Flu Scare Resurfaces in Southeast Asia
By Margie Mason/AP Writer/Hanoi
August 09, 2006

New bird flu flare-ups in Thailand and Laos and the steady march of the disease in Indonesia have raised concerns in other Asian countries that they too may see the deadly virus rise again.

Thailand last month confirmed its first human case in seven months when the H5N1 strain of the virus killed a 16-year-old boy. A second death was reported in Thailand on Saturday, prompting Vietnam's prime minister to call for heightened vigilance.

Vietnam, where bird flu has killed 42 people since it began ravaging poultry stocks about three years ago, has not logged any human cases in eight months or observed disease in birds this year. A poultry outbreak last month in neighboring Laos—coupled with the Thai cases—has left officials on edge, however.

International experts say they're less concerned about Thailand and Vietnam, which have shown they can control the virus, than Indonesia, which does not have the same record of success.

Indonesia has tallied 44 deaths in the past year and became the world's hardest-hit country this week after two more teenagers died on the outskirts of Jakarta.

"Indonesia takes a lot of sleep away from me," said Juan Lubroth, an animal health expert at the UN Food and Agriculture Organization in Rome. "If we are not able to keep a lid on the problem, it could be a source for future outbreaks and an extension of the outbreaks to other parts of the world."

The re-emergence in Thailand and Laos, along with continuing outbreaks in China, is a reminder of just how difficult it is to rid a country of the virus.

WHO spokesman Dick Thompson in Geneva said the human cases and outbreaks in Thailand were unexpected and "certainly disappointing."

"There is always the possibility that (avian influenza) will return and continued vigilance is necessary at all levels throughout a country," he said in an e-mail.

Cambodia experienced human cases and poultry outbreaks in April, and Dr. Sirenda Vong, head of the Pasteur Institute's epidemiology and public health unit in Phnom Penh, said he's always on the lookout for new flare-ups.

Bird flu has killed at least 137 people worldwide since it began ravaging Asian poultry in late 2003. Most human cases have been traced to contact with infected birds, but experts fear the virus could mutate into a form that passes easily among people, potentially sparking a pandemic.

Dutch poultry banned

AMSTERDAM, Aug 9 (Reuters) - Five countries have banned imports of Dutch poultry and poultry products after the Netherlands found a low-pathogenic H7 bird flu strain at a farm last week, the Dutch agriculture ministry said on Wednesday. The countries are Russia, the Philippines, Singapore, Taiwan and Hong Kong, a ministry spokeswoman said. The Netherlands is one of the world's biggest poultry exporting country in the world and Europe's second biggest producer after France.

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CIDRAP update

(CIDRAP News) - A World Health Organisation (WHO) reference laboratory confirmed today that a 27-year-old man who died on Aug 3 in central Thailand's Uthai Thani province had H5N1 avian influenza.

The WHO said investigators found that the man had contact with household chickens, which started dying about 1 week before the patient began having influenza symptoms.

The man had symptoms beginning Jul 24 and was hospitalized Jul 30. The Bangkok Post reported today that the man developed flulike symptoms shortly after burying dead chickens in his backyard with his bare hands.

The WHO announcement brings Thailand's official avian flu toll to 24 cases, with 16 deaths. The man's death marks Thailand's second avian flu death in 2 weeks.

The Post also reported six suspected cases in Uthai Thani province where the man died, which is about 137 miles north of Bangkok: the man's wife and five of his neighbors. Thai agriculture minister Sudarat Keyuraphan told the Post that 200 fowl died on a poultry farm in the province yesterday, which prompted an order to cull nearly 20,000 chickens on the farm. She told The Nation, a Thai newspaper, that the culling would be postponed until laboratory tests confirmed an outbreak in the province's poultry.

The WHO notes that avian influenza outbreaks have been officially recorded in the northern provinces of Phichit and Nakhon Phanom. Thailand's only confirmed human avian flu case so far this year was in a 17-year-old boy who died of the disease Jul 24 in Phichit province. Thai news outlets, however, have reported poultry outbreaks in several northern and central provinces, and on Jul 31 all of Thailand's provinces were put on avian flu alert.

As of today, the Thai Health Ministry has reported that 122 patients from 16 provinces are under surveillance for possible avian flu.

Thailand launched a week-long campaign today to check every house in 29 provinces to help slow a resurgence of bird flu in the country, Reuters reported today. Volunteers will inspect backyard farms for sick or dead birds and will educate residents about the H5N1 virus. Until last week, the country had reported no avian flu since 2005.

In Indonesia, The Associated Press reported today that a 16-year-old boy died after testing positive for H5N1 virus. The boy was admitted to the hospital 2 days ago. Reuters reported earlier today that the boy lived on the outskirts of Jakarta and was being treated at a human bird flu facility at a local hospital.

An Indonesian health ministry official told Reuters that the boy had been in contact with sick chickens. He said samples from the boy had been sent to the US Centers for Disease Control and Prevention in Atlanta.

If the results confirm the findings of the local test, Indonesia will surpass Vietnam as the country with the most avian flu deaths. Confirmation will mean the boy becomes Indonesia's 55th human case and its 42nd death, according to a WHO tally. In July, Indonesia recorded its 42nd death, which ties it with Vietnam. All of Indonesia's deaths have occurred in 2005 and 2006.

China's mystery revealed: it was H5N1 in 2003

China confirms bird flu death in 2003 (Xinhua) Updated: 2006-08-08 12:39 The Chinese Ministry of Health confirmed Tuesday that the country's first human case of H5N1 bird flu occurred two years earlier than previously thought, in November 2003. Chicken vendors sleeping near their chickens at a fowl market in Shanghai, China, in this Friday Oct. 21, 2005 file photo. China on Tuesday, Aug. 8, 2006 confirmed that a man died of bird flu in 2003, two years before the country reported its first human case of the disease. [AP] A letter published by eight Chinese scientists on June 22 in the New England Journal of Medicine said that the bird flu virus had been isolated in a 24-year-old man who died in Beijing in 2003. The man, surnamed Shi, became ill with pneumonia and respiratory disease in November 2003 and died four days after being hospitalized. China was then in the aftermath of severe acute respiratory syndrome (SARS), and the case was initially thought to be a SARS case. However, lab tests for SARS proved negative. Parallel laboratory tests, carried out in collaboration with the World Health Organization (WHO), later confirmed that it was a human case of bird flu. "This is the first human case confirmed on the Chinese mainland and the first human infection confirmed in the world in the current H5N1 virus cycle," said Roy Wadia, WHO Beijing office spokesman. Before the case was revealed, China's first official human case of bird flu was thought to have occurred in Nov 2005. Nineteen human cases have been confirmed since then, including 12 deaths. "Although this mainland case occurred two years earlier than other cases, there is no reason to think that China had an outbreak of bird flu in 2003," said Mao Qun'an, spokesman for the Ministry of Health. "People shouldn't panic," he told Xinhua in an interview. "The country's bird flu surveillance capability is much stronger now than it was two years ago." Mao said the Ministry was treating the case as a result of individual scientific research, and had no plans to probe more cases from that period. But Wadia said it was "highly possible" that other cases of bird flu may have occurred during SARS and that they were misdiagnosed as pneumonia or treated as cases with unknown causes. "There was no outbreak in poultry when this case appeared, which again highlights the importance of strengthening surveillance in the animal sector," Wadia said. The first human cases of H5N1 bird flu occurred in Hong Kong in 1997. Eighteen cases including six deaths were reported at that time. The current cycle of the virus began in late 2003 and felled its first victim in Vietnam in January 2004. Globally, there have so far been 233 confirmed human cases of bird flu. By August 7, 135 of the people had died, according to WHO figures.

Deaths climb in Indonesia

08/08/2006 - 11:39:07 AM

Indonesia records 43rd death from bird flu

A 16-year-old Indonesian boy has died from bird flu, according to local test results that, if confirmed, would bring Indonesia’s death toll to 43 and make it the world’s hardest-hit country.

Normally reliable tests performed at a local laboratory showed that the boy who died late yesterday had the H5N1 virus, said Dr. Santoso Suroso, the director of the capital’s infectious diseases hospital, where he was treated for three days.

Grieving relatives buried Megi Saputra early today at a family plot shaded by jackfruit trees close to his home in Bekasi, just east of Jakarta. A short distance away from the cemetery, villagers were rearing chickens in coops.

“I knew about bird flu from the TV and radio, but when my son got sick I had no clue it was bird flu,” Megi’s mother Sadiah said after the funeral. “I had no idea he was going to leave me.”

She said Megi was initially diagnosed with typhoid and told to go home.

It was only four days after symptoms appeared that bird flu was suspected, and by then it was too late, said Sadiah, wiping away her tears.

Health officials said Megi was suspected of coming into contact with sick chickens near his home, where he lived with his parents and seven brothers and sisters.

Neighbour Hasan Basri said Megi kept racing pigeons, which had probably been infected by sick chickens in a nearby coop.

Another neighbour, 40-year-old Romlah who uses a single name, said she had seen posters warning about bird flu, but that the government “should intensify its campaign to prevent more deaths.” Door-to-door visits are needed to get the message to everyone, she said.

Health Ministry official Nyoman Kandun said Megi’s swab and blood samples have been sent to the United States for further testing.

Indonesia again

JAKARTA (Reuters) - A 16-year-old Indonesian youth has tested positive for bird flu according to results from a local laboratory.

The youth, from Bekasi on the outskirts of Jakarta, is being treated at the designated bird flu centre at the city's Sulianti Saroso Hospital, said Runizar Ruesin, head of the bird flu information centre at Indonesia's health ministry.

Ruesin said the patient had been in contact with sick chickens, the usual mode of transmission of the disease that is endemic in poultry in nearly all the country's provinces.

"The symptoms are a high, white blood cell count, high body temperature and breathlessness. He's now using a ventilator to help him breathe," said Ruesin.

Nasal samples from the patient have been sent to the U.S. Centres for Disease Control and Prevention in Atlanta. Local tests are not considered definitive.

Human cases of bird flu have been rising steadily in Indonesia since its first known outbreak in poultry in late 2003.

Indonesia has recorded 42 confirmed deaths from bird flu, equalling Vietnam, although no one has died of the disease there this year.

Indonesia drew international attention in May when the virus killed as many as seven members of a single family in a north Sumatra village.

Last week, seven Indonesians from the same village in North Sumatra were tested for the virus, but preliminary tests cleared them of suspected bird flu.

Indonesia has been criticised for not doing enough to stamp out H5N1. The virus remains essentially an animal disease, but experts fear it could spark a pandemic if it mutates into a form that can pass easily among people.

The government has so far shied away from mass culling of poultry, citing lack of funds and impracticality in a country with millions of backyard fowl.

© Reuters 2006. All Rights Reserved.

Avian flu basics

Avian flu could be a real killer; here’s what you need to know and do

By Miela Gruber, 2006 graduate, ND candidate and Jennifer Johnson, ND, Clinical Faculty UB

Avian flu (avian influenza strain H5N1), more commonly known as “bird flu,” is quickly becoming a common household term. Because of ongoing reports of infected humans, there is a push for worldwide awareness and preparedness.

In response, the United States government recently issued a report stating that an outbreak of bird flu could lead to quarantines, travel restrictions, and create an economic downturn with damage comparable to that caused by war. Ultimately, the report estimates, a serious outbreak could take the lives of two million people.

Preparedness involves common sense precautions to reduce the likelihood of infection from not only avian flu but other flu strains as well. Good hygiene — especially hand washing, proper nutrition and a healthy lifestyle — can promote immunity and assist in a quick return to health in the case of flu.

The avian flu was first discovered in Vietnam nine years ago. Since then, according to the World Health Organization, only 208 cases worldwide have been confirmed by laboratory analysis.

Risk to humans

Humans contract bird flu when they are infected by a virus that lives in sick poultry. All of the documented human cases occurred in people who have had direct and very close contact with infected birds or surfaces exposed to either infected poultry mucous or excrement. The virus has not spread from human to human or beyond the person infected. It does not yet have this ability.

For bird flu to cause a pandemic, the virus needs to acquire a genetic mutation allowing it to be transferred from person to person. This type of mutation has not occurred in H5N1 and infectious disease specialists are working to prevent this. To keep us safe at home, the United States has an embargo on all poultry from countries affected by the avian influenza virus.

Precautions to take

The Centers for Disease Control (CDC) recommends the following to kill any possible avian flu virus that may be present in store-bought poultry:

First, wash hands with soap and warm water for at least 20 seconds before and after handling raw poultry.

Next, thoroughly wash cutting boards and utensils with soap and warm water to avoid contamination of other foods.

Be certain to cook poultry to a temperature of 165 degrees F.

Cook eggs until whites and yolks are firm.

Cleanliness a sound practice

General recommendations to avoid the spread of flu viruses (not exclusively avian) also include washing hands frequently, covering the mouth and nose when sneezing or coughing, and not sharing dishes, utensils, wash cloths or face towels with persons who are infected.

If you are sick with the flu, do not expose others unnecessarily. Stay home and rest. There is no reason to wear a mask, or stop eating poultry.

Good nutrition, exercise, sleep and stress management are important ways to keep your immune system strong. Excess alcohol and sugar can have a strong negative affect on your immunity, so use good judgment and moderation.

Thailand tries to inhibit bird flu

[BANGKOK (Reuters) - Thailand began a week-long campaign on Monday to check every house in 29 provinces, including Bangkok's suburbs, in a bid to halt a resurging bird flu virus that has killed two people in the last three weeks.

Hundreds of thousands of volunteers will scour backyard farms for sick or dead chickens and educate villagers on the H5N1 virus, which re-emerged in July after an eight-month lull.

"Starting today, we will check every house in every village for suspicious chicken deaths," senior Agriculture Ministry official Nirandorn Uangtrakulsook told Reuters.

If any suspicious bird deaths are found, all poultry within a one km (mile) radius of the suspected outbreak would be culled immediately, said Nirandorn of the Livestock Department.

More than one third of Thailand's 76 provinces have been declared bird flu risk zones, but livestock officials said they had confirmed H5N1 in poultry in only two provinces, Pichit in the north and Nakhon Phanom in the northeast.

However, health officials say a 27-year-old man who died in the central province of Uthai Thani, the country's second victim in two weeks, had caught the virus while burying sick chickens without wearing protective clothing.

H5N1, which scientists fear could mutate into a form that jumps easily between people although it shown no ability yet to do so, has killed 16 Thais since the virus swept across parts of Asia in late 2003.

The World Health Organization, which says at least 134 people died worldwide before the latest Thai death, has urged countries to be vigilant because the virus continues to circulate in poultry.

A 19-year-old Uthai Thani man taken to hospital last week with flu-like symptoms has so far tested negative for the virus.

Thawat Suntrajarn, head of the Health Ministry's Disease Control Department, said final test results were due on Tuesday.

Fewer than 10 patients, mostly in central and northern Thailand, remained under "intensified surveillance and investigation for the bird flu virus," he said.

Birds burned to prevent H5n1

26 love birds torched to avoid risk of avian flu

Published: Monday, 7 August, 2006, 11:40 AM Doha Time

By Julmunir I Jannaral
AUTHORITIES incinerated yesterday some 26 African love birds seized earlier from a businessman caught attempting to sneak them into Manila through the Ninoy Aquino International Airport (NAIA) from Bangkok, Thailand.
The Bureau of Animal Industry (BAI) burned the birds in the presence of Bureau of Customs (BoC) officials inside the animal quarantine compound located at the Nayong Pilipino "to avoid risk of bird flu," officials said.
The birds were seized a few days ago by the BoC and BAI authorities from Danilo Alano Trinidad, 44, of Sipac, Navotas, who flew in from Bangkok on board Philippine Airlines flight PR-731.
NAIA Customs District Collector Carlos So said Trinidad was nabbed by Customs authorities while carrying the birds shortly after he deplaned.