I hate to pick on Indonesia, but...

Cities in Indonesia are falling like dominos to bird flu: Garut in West Java, then Kendari in Southeast Sulawesi, then Dairi, Serang, and finally Simalungun in North Sumatra.

Surabaya, Indonesia's second largest city, is still unaffected, but the cause of the recent deaths of 40 chickens there has yet to be determined. Other areas have not yet reported outbreaks but it may just be a matter of time before they too fall to bird flu.

In Garut, the virus first appeared in the villages of Cikelet and Cigadog, but it has since spread to other villages. The number of suspected bird flu victims continues to rise each day.

Health Ministry officials who hope to check the spread of the virus in the area are monitoring seven villages in Garut. Officials have also gone to each village looking for people who show signs of infection and sending them to the nearest hospital. Hendra, 21, and Gilang, 9, were the latest victims to test positive for the bird flu virus. They received medical treatment at Dr. Slamet Hospital in Garut. Four others are under observation in their homes by Health Ministry teams. If their conditions worsen, the teams will bring them to the hospital.

In response to a rising number of bird flu victims in West Java, the government there has designated 10 hospitals as virus treatment centers. Each of those hospitals will have isolated rooms and a dedicated nursery for handling bird flu patients.

In Kendari, Southeast Sulawesi, more than 1,300 chickens in seven sub districts were slaughtered after testing positive for the bird flu virus. It will be difficult to check the spread of the virus in this province because it is a major poultry farming area.

Two young children suffering from high fever, hard coughs, and shortness of breath were reportedly sent to the hospital in Kendari. Blood samples have been sent to Jakarta.

In North Sumatra, as the bird flu flare-up in Tanah Karo subsided, Simalungun was hit this week. More than 15,000 chickens were culled, although the people were reluctant initially to hand over their poultry, fearing that they would not be compensated.

Serang also reported the bird flu virus last week after about 300 chickens suddenly died. Officials there seemed to be moving too slowly to stop the spread of the virus.

One of the greatest impediments to stopping the spread of the virus is lack of awareness. Veterinary officials cannot be everywhere at once. Because the symptoms of the virus are similar to those of common chicken ailments, villagers often attribute the death of their chickens to something besides bird flu. It is only after someone in the community becomes sick or dies that the truth becomes known.

Even then, the symptoms of the virus are similar to common human ailments. Sometimes they do not seek medical treatment assuming that they have only a cold or sore throat.

Vietnam has troubles too

Mekong Delta provinces yet to take bird flu threat seriously

Local authorities acknowledged they have not completely restricted poultry raising in residential areas at a conference on preventing bird flu outbreaks Wednesday.

Representatives from Can Tho city said many households in the area continued to raise and hatch chicks regardless of warnings of the potential for bird flu outbreaks. Meanwhile, Dinh Cong Than, head of the Kien Giang Animal Health Department announced a further one million ducks are free ranging, but local authorities have yet to take any measures. In Dong Thap, local authorities have failed to monitor and cull newborn ducks, said Vo Be Hien, head of Dong Thap Animal Health Department. Source: Tuoi Tre – Translated by Tuong Nhi

Gene sequence sharing and Indonesia

Jakarta (ANTARA News) - The World Health Organization on Wednesday confirmed the 60th case of human infection with the H5N1 strain of bird flu after a 6-year-old girl was tested positive of having the virus.

In a statement, the WHO said the girl from Bekasi in West Java Province
developed symptoms on Aug. 6 and was hospitalized on Aug. 11.

''She remains hospitalized but is recovering. The source of her infection is currently under investigation,'' the statement said as reported by Kyodo.

Of the 60 cases confirmed to date in Indonesia, 46 have been fatal.

The critics say Indonesia has not done enough to control the spread of the H5N1 strain of the bird flu virus and infections among hundreds of millions of backyard poultry.

In another statement, the WHO encouraged countries with avian influenza
activities to share H5 virus sequence information, saying it is a crucial step for improving the international response to the avian and pandemic influenza threat.

''In its coordinating role, WHO seeks to facilitate the timely release of
sequence data to the public domain?,'' it said

''Formal procedures exist by which the WHO reference laboratory initially
informs the originating laboratory of sequence results and simultaneously
requests permission to place these results in the public domain,'' it added.

''In the event of a negative reply or no reply, the WHO directly approaches the Ministry of Health in the originating country, requesting authorization to release sequence data.''

International researchers had protested to the Indonesian government, accusing Jakarta of refusing to reveal human genome sequences data.

Following the protests, Indonesia agreed early this month to make available the sequences for viruses from the country's bird flu patients.

Since then, the Centers for Disease Control and Prevention in Atlanta, which has been actively working with the WHO to encourage sharing of viruses from countries with avian flu activity, placed total genome sequences for over 40 H5N1 viruses into a public-access database.

Indonesia always sends samples of bird flu patients to the CDC, which is one among eight WHO reference laboratories in the world.

''Information on the gene sequences of H5N1 viruses is important for vaccine development, the preparation of reagents used for diagnostic purposes, and monitoring for drug-resistant strains,'' the WHO said.

''Sequence information on viruses collected over time and from different
geographical areas can help track evolutionary changes in the virus and
identify mutations,'' it added.

''Epidemiological findings remain the most important alert to changes in the virus that indicate improved transmissibility among humans.''

Bird flu has killed at least 141 people in 10 countries since December 2003, according to WHO statistics, and Indonesia has the highest fatality cases, followed by Vietnam. The other eight countries are Azerbaijan, Cambodia, China, Djibouti, Egypt, Iraq, Thailand and Turkey. (*)

COPYRIGHT © 2006 ANTARA

Another good overview of avian flu

FREQUENTLY ASKED QUESTIONS ABOUT BIRD FLU

Written by Administrator

Wednesday, 23 August 2006

Q) What is bird flu? A) Avian influenza, also called bird flu, is a disease of birds that is found primarily in wild waterfowl such as ducks, geese and swans. Sometimes, this disease can also spread from wild birds into domestic poultry. There are many strains or types of bird flu. Right now there is a type of bird flu called Highly Pathogenic Avian Influenza (HPAI) type H5Nl (also called H5Nl bird flu) that has made many birds and a few people sick elsewhere in the world. Q) Is the highly pathogenic avian influenza, H5Nl bird flu present in the United States? A) No, this type of bird flu has not been found in the United States. Other strains of bird flu are commonly found in wild waterfowl in the United States, but usually affect small numbers of birds and generally do not cause obvious illness. These other types of bird flu are not considered a human health risk. The H5NI bird flu is now circulating in Asia, Europe and Africa. Q) Can pets get bird flu? A) Yes. In some places where H5Nl bird flu has occurred, cats and other mammals have gotten sick and died after eating infected birds. Q) Can my pets get vaccinated against bird flu? A) No. But there are things you can do to protect your pet. Q) What can I do to protect my pets from bird flu? A) If you are worried about your pets, do not let them roam outside where they could be exposed to, or eat the remains of sick or dead wildlife. Many diseases can cause wild birds and other animals to get sick and die, and some diseases could be spread to pets that run free. Q) My pet has been exposed to a dead bird, Can my pet be tested? A) Routine testing of pets for bird flu is not necessary and currently unavailable. If you have concerns about your pet's health, it is best to contact a veterinarian. Q) Can my pet give me bird flu? A) There have been no confirmed cases of bird flu transmission between humans and pets. IfH5Nl bird flu occurs in our country, it will be important to protect pets from possible exposure to sick birds and wildlife so that they will not get infected. Q) How do I know that animals from a pet store don't have bird flu? A) It's always best to make sure your pet has been checked by a veterinarian prior to purchase. There have been no confirmed cases of bird flu being transmitted from pets to humans. Q) Are you going to test dead wild birds for bird flu? A) Currently, certain wild birds are being tested so that ifH5Nl bird flu occurs in the United States we will recognize it right away. State and Federal agriculture and wildlife agencies have a list of birds that are of most concern and have begun testing these birds. Most birds do not need to be tested. Q) What birds are being tested? A) Waterfowl, such as ducks and geese, are a top priority to be tested. The vast majority of backyard birds-robins, sparrows, pigeons, cardinals, etc.-do not need to be reported or tested. Avian influenza usually involves migratory waterfowl, not backyard birds. If you are concerned about dead waterfowl in your area, contact your regional Department of Environmental Conservation office. Q) If most birds are not being tested for disease, why am I still being asked to report dead crows? A) Dead crow reports help us to know whether West Nile virus is present in an area. Just knowing where crows are dying tells us a lot. Dead crow reports are still important to help us track West Nile virus, but most crows will not be picked up or tested. Q) I found a dead bird in my yard-what should I do? A) First, there is no need to report a dead bird unless it is a crow. Dead crow reports help us to track West Nile virus, so please call1-866-537-BIRD if you see a dead crow. Other types of birds do not have to be reported unless there are many dead birds in the same area. Call our re ional Department of Environmental Conservation EC office if you see a lot of dead birds in the same place. You may also visit the State DEC web site at: www.dec.state.nv.us for contact information for regional offices. DEC will decide if testing is needed. To dispose of a dead bird, use a shovel and wear gloves to double-bag the dead bird and throw it in the trash, or bury it at least three feet deep, away from a stream or other water source. Always wash hands after disposing of a dead bird in this way. Q) Should we stop feeding birds and not have bird feeders? A) There is no need to change your normal practices for feeding backyard birds at this time. If the H5Nl bird flu does occur in our country, experts may have different advice, depending on what has been learned about the role of wild birds in spreading bird flu to humans. Q) Should I feed ducks, geese and other waterfowl? A) Unlike backyard birds, waterfowl are more likely to be infected when bird flu is present. But there are many other reasons that you should not feed ducks and geese. It increases the chance of spreading many diseases that are common among waterfowl. It makes them tame, and causes them to become a nuisance. They lose their natural behaviors. It is best to enjoy your local wildlife from a distance! Q) Should I stop hunting waterfowl? A) No. However, waterfowl hunters should always take simple precautions to protect themselves from exposure to disease, including: - Do not handle obviously sick birds or birds found dead. - Keep your game birds cool, clean and dry. - Do not eat, drink or smoke while cleaning harvested waterfowl. - Wear rubber gloves when cleaning waterfowl. - Wash your hands with soap and water after cleaning waterfowl. - Clean up tools and surfaces immediately with hot, soapy water and disinfect with a mixture of 10 percent household chlorine bleach in water. - Thoroughly cook harvested waterfowl (165° Fahrenheit). Q) Can I get bird flu from my neighbor's birds and animals? A) No, you don't have to be concerned that neighbor's poultry and animals will expose you to bird flu at this time. IfH5Nl bird flu does occur in our country, additional guidance from experts will be developed. Bird flu is primarily a disease among birds and rarely spreads to other animals and humans. Most people who got sick with bird flu had come into contact with infected chickens or domestic ducks and touched them with their bare hands. Q) With the concern over bird flu, is it safe for my child to take part in projects that involve hatching eggs and raising chicks? A) Yes. Chickens that get infected with bird flu become ill and often stop laying eggs so there is little risk of bird flu. However, chicks can carry other diseases such as salmonella. Projects involving hatching eggs and raising chicks should minimize hand contact and require thorough hand washing if contact does occur. Q) With the concern over bird flu, is it safe to eat poultry and eggs? A) Yes. There is no evidence that properly cooked poultry or eggs can be a source of infection from bird flu. Because other common diseases such as salmonella infection can be spread by eating undercooked poultry or eggs, always cook them thoroughly. Wash your hands with soap and hot water after touching any raw meat. Make sure to clean cutting boards and counters used for food preparation immediately after use to prevent cross contamination with other foods. Q) Can I get bird flu from Canada goose droppings in parks, ballparks, reservoirs and other public places? A) No. Right now, the H5Nl bird flu is not present in the United States. If and when it does occur in our country, we hope to have learned more about the role of wild birds in spreading bird flu to humans. Because many different bacteria, viruses and parasites can be present in bird droppings, it is best to avoid exposure to them at all times. The following precautions should be taken: · Teach children to always wash their hands after playing outside. · If you pick up droppings, use a shovel, "pooper scooper," or gloves-never your bare hands. · If you are worried about exposure during swimming, swim at a regulated beach, where regular tests are conducted to make sure the water is not polluted from human, animal or farm waste.

Last Updated ( Wednesday, 23 August 2006 )

Case numbers rise in ?cluster in Indonesia

Indonesia confirms its 60th H5N1 case

Aug 23, 2006 (CIDRAP News) – Indonesia has confirmed its 60th human case of H5N1 avian influenza, this one in a 6-year-old girl who is recovering, the World Health Organization (WHO) said today.

The girl is from Bekasi, a city southeast of Jakarta in West Java, not part of the Cikelet subdistrict, where several recent cases and suspected cases sparked concern about possible human-to-human transmission.

The girl became ill Aug 6 and was hospitalized Aug 11 but is improving, the WHO said. Bloomberg News reported today that she was in Sulianti Saroso Hospital in Jakarta.

The Bloomberg story said dead chickens had been seen in the girl's neighborhood, but the WHO said only that the source of her infection is under investigation.

Forty-six of the 60 H5N1 cases in Indonesia have been fatal, for a 77% case-fatality rate. The WHO's global H5N1 case count is 241 cases with 141 deaths, for a case-fatality rate of 59%.

Test results are awaited in another suspected H5N1 case in Indonesia, involving a 35-year-old woman from Simalungun regency in North Sumatra province, according to Bloomberg. The health minister said the woman fell ill Aug 21.

In other news, a World Bank official said Indonesia needs an estimated $120 million a year to vaccinate chickens and compensate farmers for culling, but its vaccine budget covers only 10% of that amount, according to the Bloomberg report. The official, Louise F. Scura, made the statements at a meeting between the Indonesian government and donor countries.

India's past no measure of the future

Bird flu danger

Business Standard / New Delhi August 23, 2006

The government may have pronounced India to be free from the bird flu virus but the threat of its reappearance is far from over. The declaration is indeed based on the fact that no fresh case of the highly pathogenic avian influenza (HPAI), caused by the deadly H5N1 virus, has been detected anywhere in the country since the effective control and containment of the last outbreak in February-March in the Navapur-Jalgaon region of Maharashtra. However, past record cannot be deemed as a guarantee for the non-emergence of the dreaded disease in future. This is especially so because this virus still exists in India’s neighbourhood and the role of the migratory birds in their transport to other areas has, by now, been well-established. What is more, even the United Nations Food and Agriculture Organisation (FAO) has issued a fresh warning about the menace, pointing out that the new strains of the virus have also been detected at some places. The heightening of the risk is borne out also by unabated outbursts of the dreaded affliction in China and its recurrence in Cambodia, Laos and Thailand. Local poultry experts, too, fear that the fresh influx of migratory birds in the ensuing winter may pose a real danger of resurgence of the infection in India.

What needs to be realised is that, unlike the earlier bird flu epidemic of 2003, which was confined to the East Asia-Australia flyway of the migratory birds, the present concentration of the pathogen is in countries that lie on the East Africa-West Asia flyway, which passes through India as well. The lurking menace needs to be viewed all the more seriously since the birds’ flyways converge in the northern hemisphere, where they return from various destinations, and intermingle with each other, passing on the infection. Besides, since the virus has begun to mutate, as reflected in several cases of human deaths, the chances of a pandemic outbreak are increasing with time. And, should this happen in a populous country like India, its containment will be extremely difficult, if not impossible.

In view of all this, it will be nothing short of a folly if the self-proclamation of a disease-free status lulls the government to inaction on this front. Timely preventive and precautionary measures are a must to ward off the hazard. The Poultry Federation of India has, in fact, been sounding out the government on this issue for a long time. It has suggested that poultry birds in the radius of about 20 km of all water bodies situated on the route of the migratory birds should be compulsorily vaccinated before the onset of the winter, when the fresh influx of migratory birds will begin. Of course, the poultry industry, too, needs to be vigilant and take the bio-safety measures required. But that alone will not suffice as the visiting birds get in touch with the wild birds and the back-yard poultry as well. The fear that the vaccination move may send wrong signals to importers of poultry products from India should not deter action on this front. For, exports account for less than 1 per cent of the country’s total poultry production. The gains from these exports, thus, are too meagre to justify putting the whole poultry production in jeopardy or, even more importantly, endangering human lives.

China's bird flu spreads

China protests over UN's bird flu `slur'

AFP , BEIJING
Monday, Aug 21, 2006,Page 1

China has blasted as "groundless and irresponsible" a UN report that recent bird flu outbreaks in Thailand and Laos were caused by a virus strain originating in China, state media said yesterday.

"This is groundless and irresponsible," the agriculture ministry said, according to a report on the People's Daily Web site.

The UN Food and Agriculture Organization said on Thursday that outbreaks in the Thai province of Nakhon Phanom and near the Laotian capital Vientiane were caused by a strain that originated in China and had not been seen in that region before.

The ministry said the country has not exported any poultry products to Thailand or Laos since 2004 when China first reported a H5N1 outbreak in its poultry.

"Nakhon Phanom ... and ...Vientiane, where the virus strain was detected, are both very far from the Chinese border," the ministry said.

It emphasized that as the prevention and control abilities of different countries varied, most reports were inconclusive and could not safely be used to detect new trends. Also complicating the case is the fact that the virus can be transmitted by wild birds, the ministry said.

"So it is irresponsible to decide that the strain of virus detected in Thailand was from a certain country before having sufficient evidence," the ministry said.
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whats worse than bird flu

21 Aug 2006
MRSA, Scarier than SARS or Bird Flu

Methicillin-Resistant Staphylococcus Aureus, or MRSA, a type of bacteria resistant to treatment, is becoming a potential threat to public health; it spreads through direct contact and can spark off skin infections in normal healthy people.

This infection is thought to be dormant in nearly 2.3 million Americans with no apparent signs of sickness, which makes it all the more crucial to identify the carriers of the illness and treat them effectively to contain the spread of the disease.

MRSA can spread with a simple skin-to-skin contact, even sharing of personal items. MRSA is also resistant to the commonly used antibiotics. Those who have healthy immune systems can throw out the bacteria from their system without much medical assistance, but it can take a severe turn for those whose immunity is weak, which could result in blood poisoning, pneumonia, and even death. The US Centers for Disease Control and Prevention has estimated that MRSA is the cause of nearly 90,000 serious infections and death of 17,000 people annually.

Cambodian ducks dying

21 Aug 2006 Page 1
Cambodia hit by two new bird flu outbreaks

Bird flu outbreaks have been detected in two more districts in Cambodia's eastern province Kampong Cham. According to officials, around 3000 ducks have died in the last week.

"We have discovered two more outbreaks of bird flu, but it has not infected the people yet," Kao Phal, the director of animal health at the agriculture ministry, told AFP on Friday.

"The result of tests on dead duck samples taken from the two districts has shown that the ducks died of H5N1 virus," Yim Venthan, secretary of state of the Ministry of Agriculture said. Kampong Cham Province is around 100 kms east of the capital Phnom Penh.

One of the outbreaks started when a farmer smuggled 2,000 ducks from the area, where bird flu was detected on Aug.12 and authorities were slaughtering birds to prevent the disease from spreading, Phal said.

Those ducks were brought into the Tbong Khmum district, 125 kilometers (80 miles) northeast of the capital. Most of them had died there by Friday, he said. The rest were slaughtered by the health officials. The official who was responsible for prevention of movement of the birds was dismissed.

Another outbreak was found in close by Batheay district. Here the ducks had begun to fall ill on Aug.12. According to Phal, 600 birds in that district had died or been killed.

Update on Indonesia cluster {?}

Indonesia: Avian Influenza Situation - WHO Update 28
-----------------------------------------------
As of Mon 21 Aug 2006, the Ministry of Health in Indonesia has
confirmed the country's 59th case of human infection with H5N1 avian
influenza virus. The case occurred in a 35-year-old woman from the
remote sub-district of Cikelet, West Java Province. She was
hospitalized with severe respiratory disease on 17 Aug 2006 and died
shortly after admission. She is the 3rd confirmed case from this
sub-district to be reported in the past week.

Preliminary findings from the Cikelet investigation
-----------------------------------------------
A team of experts is presently in the Cikelet sub-district
investigating the outbreak and monitoring for further cases. Three
hamlets are the focus of investigation.

The Cikelet sub-district consists of around 20 isolated hamlets, each
with a population of around 200 to 400 persons, many living in large
extended families. The hamlets sit in a basin surrounded by steep
mountains with rocky winding paths best accessed by foot or
horseback. In this area, mortality from endemic diseases, especially
malaria, is common, access to health care is poor, and medical
records of deaths are scanty or non-existent.

Prior to late June 2006, no mass die-offs of poultry are known to
have occurred in the area. At that time, live chickens were purchased
from an outside market in preparation for a religious feast and were
integrated into local flocks. Shortly thereafter, chickens began
dying in large numbers in an outbreak that continued throughout July
2006 and the 1st week of August 2006, gradually spreading from one
hamlet to another.

As the population had no experience with this disease, high-risk
behaviors commonly occurred during the disposal of carcasses or the
preparation of sick or dead birds for consumption. These exposures
are, at present, thought to be the source of infection for most
confirmed or suspected cases.

Deaths from respiratory illness are known to have occurred in late
July and early August 2006, but no samples were taken, and medical
records are generally poor. Though some of these undiagnosed deaths
occurred in family members of confirmed cases, the investigation has
found no evidence of human-to-human transmission and no evidence that
the virus is spreading more easily from birds to humans.

The cooperation of residents is good, house-to-house surveillance for
febrile illness is continuing, and specimens have been taken from
symptomatic persons and sent for testing. The team is well-supplied
with antiviral drugs, and these are being administered
prophylactically to close contacts of cases and therapeutically to
persons showing symptoms of influenza-like illness.

--
ProMED-mail
<promed@promedmail.org>

Case numbers rising

Human Bird Flu Cases Found This Year Equal 2005 Level (Update2)

By Jason Gale and Karima Anjani

Aug. 21 (Bloomberg) -- Bird flu killed a 35-year-old woman in Indonesia, raising the number of cases worldwide this year to 95, the same number reported in the whole of 2005, as health authorities study whether the virus is spreading between humans.

Tests on the woman were positive for the H5N1 strain of avian influenza, I Nyoman Kandun, a director general at the Ministry of Health, said late yesterday. Indonesia, with the most H5N1 deaths, confirmed two other cases from the village where the woman lived. No signs of human-to-human transmission have been found, health officials said today.

``The cases have occurred in a remote, mountainous area where there are a lot of other diseases,'' Georg Petersen, the World Health Organization's Indonesia representative, said in a telephone interview today. ``It's important to identify illnesses caused by bird flu and illnesses caused by the other diseases.''

The death toll from H5N1 has tripled this year as the virus spread in wild birds and domestic poultry to at least 38 countries. It may kill millions of people should it change into a pandemic form and spread easily among people.

An average of three new human cases a week have been reported this year as the virus became entrenched in Indonesia and China, and infected people for the first time in Turkey, Iraq, Azerbaijan, Egypt and Djibouti. It claimed more lives in Thailand and Cambodia, where fresh outbreaks killed fowl in the past month.

Death Tally

Since 2003, H5N1 is known to have infected 240 people in 10 countries, killing 141 of them, the WHO said today. The virus has killed 64 people this year, compared with 22 in the first eight months of 2005.

The spread of the virus is slowing worldwide as efforts to contain the illness partially succeed, the Food and Agriculture Organization of the United Nations said. Among the areas where migratory birds and poultry remain at risk are Asia, including Indonesia where 46 people have died; some African countries such as the Ivory Coast; and the southern Balkan and Caucasus regions in Europe, the organization said.

Almost all human H5N1 cases have been linked to close contact with sick or dead birds, such as children playing with them or adults butchering them, according to the WHO.

Doctors from the Geneva-based health agency joined a team of local medical and veterinary officials last week to identify the cause of the cases in West Java's Garut district, where the 35- year-old woman lived. Deaths from established infectious diseases are common in the area and public-health resources are minimal, the WHO said today.

Human-To-Human Transmission

While deaths from respiratory disease are known to have occurred there in late July and early August, no samples were taken, the United Nations health agency said on its Web site.

``Though some of these undiagnosed deaths occurred in family members of confirmed cases, the investigation has found no evidence of human-to-human transmission and no evidence that the virus is spreading more easily from birds to humans,'' the agency said in the statement.

Large numbers of poultry began dying in Garut after live chickens were purchased from outside the area in late June and integrated into local flocks, WHO said. Many chicken carcasses were eaten without proper preparation or were incorrectly disposed of, the agency said.

``These exposures are, at present, thought to be the source of infection for most confirmed or suspected cases,'' the agency said.

Testing

Samples have been sent for testing and some patients and their close contacts are taking antiviral drugs. Residents are cooperating with the investigation and treatment efforts, the WHO said.

At least 16 other people are undergoing testing for the virus, Agence France-Presse reported yesterday. Clusters of cases may signal the virus is becoming more adept at infecting humans, not just birds.

A pandemic can start when a novel influenza A-type virus, to which almost no one has natural immunity, emerges and begins spreading. Experts believe that a pandemic in 1918, which may have killed as many as 50 million people, began when an avian flu virus jumped to people from birds.

A flu outbreak killing 70 million people worldwide may cause global economic losses of as much as $2 trillion, Milan Brahmbhatt, a World Bank lead adviser in the East Asia region, said in June.

Indonesia, the world's fourth-most-populous country, attracted international attention in May when seven members of a family from the island of Sumatra contracted H5N1, six of them fatally. The cases represented the largest reported cluster of infections and the first laboratory-proven instance of human-to- human transmission.

To contact the reporters on this story: Jason Gale in Singapore at j.gale@bloomberg.net ; Karima Anjani in Jakarta at kanjani@bloomberg.net

Last Updated: August 21, 2006 14:18 EDT

growth of avian flu

Rome - The deadly H5N1 strain of bird flu continues to spread throughout Asia, Africa and Europe, threatening people, animals and economies, the United Nations Food and Agriculture Organisation (FAO) warned on Monday.

The spread of the virulent virus had slowed, the FAO noted, but it was still continuing its advance across the globe with 55 countries now having reported infections, up from 45 in April.

The Rome-based organisation said veterinary controls must be strengthened, particularly in developing countries, in a bid to limit the spread of H5N1 among domestic birds.

"We don't expect to eradicate the H5N1 virus from possible wild bird reservoirs but we can contain and control it fully in the poultry sector," FAO's chief veterinary officer Joseph Domenech said.

This "is the best insurance we have that it will not mutate into a virus that is easily transmissible among humans", he continued.

"We need to find the weak links in the global effort to contain H5N1 and strengthen them.

"That means building up veterinary and laboratory services in the poorer countries of the world, where public services are hampered by a general lack of funds," Domenech stressed.

According to World Health Organisation figures, 239 people have been infected with the virulent H5N1 strain of the virus since 2003 and 140 have died, mostly in Asian nations.

More than 220-million birds have died from the virus or been culled in a bid to limit contamination.

The FAO said the southern Balkan area and the Caucasus region were at high risk of infection as they were prime resting grounds for migratory wild birds and health checks and security measures in the poultry industry were still rudimentary.

It also expressed concerns about the continued H5N1 spread through Asian countries and said that Ivory Coast and Nigeria in Africa were also struggling with the virus. - Sapa-AFP

Indonesia has big troubles and so do we...

Bird flu cluster suspected in Indonesian village
Disease/Infection News
Published: Sunday, 20-Aug-2006
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A possible new bird flu cluster is being investigated in an Indonesian village following the death of a woman last week from the virus.
The 35-year-old Indonesian woman was from the West Javan village of Cikelet where a series of confirmed and suspected cases of bird flu in humans have occurred and her daughter died after showing signs of having the virus.
Indonesian officials say the woman died on Aug. 17 after being treated for symptoms of the H5N1 virus in the province's Dr. Slamet hospital.
Health Minister Siti Fadillah Supari has said they suspect there is possibly a cluster of infections as her 9-year-old daughter died last week, before her mother, of what was initially thought to be typhoid and as a result no specimens were taken for testing.
A five-year-old boy also from Cikelet was taken to hospital in West Java on Saturday, with the symptoms of bird flu, raising the official number of people suspected of having bird flu to 10 all from five hamlets in Cikelet and Cigadog villages, located some 130 kilometers south of Garut city.
Blood samples have been taken from 40 residents who had a history of contact with people confirmed as having bird flu and those suspected of having the disease.
Four other people from the village are reported to have died with symptoms of bird flu before tests could be done.
The latest death takes Indonesia's toll from the disease to 46, the highest of any country and officials are collecting samples from any others who may have been in contact with the family from the village where the H5N1 virus is said to be endemic in local poultry.
A team from the health ministry, local authorities and the World Health Organization are investigating but authorities believe the cases have been transmitted from infected poultry.
The situation is causing concern as a number of cases have occured in the general area and just last week officials appeared to be playing down the prospect of a cluster.
Experts have long feared that the virus could mutate into a form that could pass easily between humans and this fear was exacerbated in May when seven people from an extended family died of the disease in Northern Sumatra.
Scientists worry that the H5N1 virus could mutate into a strain that could spark a human pandemic.
The latest death in Indonesia is the second confirmed from bird flu in the area, made up of a number of remote hamlets about 90 km south of the provincial capital of West Java, Bandung.
A 14-year-old boy is said to be recovering at home after local tests confirmed he had the disease.
Two other children from the village who were thought to have bird flu, a six-year-old girl and an eight-year-old girl are also recovering but tests carried out have so far shown negative for the H5N1 virus.
Blood samples of a pregnant woman from the same village have also been sent for testing after she was admitted to hospital on Friday, she is said to be recovering.
Officials say the government is distributing the antiviral medicine Tamiflu but poor road access means the villages are hard to reach.
More than 4,000 birds have reportedly been culled in the area.
Indonesia has seen a steady increase in human bird flu deaths this year and the virus is endemic in poultry in nearly all of the provinces of the sprawling archipelago.
The country has been heavily criticised for not doing enough to stamp out H5N1, and has shown a reluctance to carry out the mass culling of poultry, citing the expense and the practical difficulties because of the millions of backyard poultry.
The H5N1 virus has to date killed around 140 people and millions of birds since 2003 and has spread from Asia to Europe and Africa.