California has plan

State Formula Determines Who Gets Shots During Bird Flu Pandemic
AP

SAN FRANCISCO, September 9, 2006 - California health officials have settled on a formula for resolving a wrenching question that would arise if a bird flu pandemic strikes the state: who gets doses of scarce vaccine?


The complex process for picking who would receive bird flu shots is contained in the state's Pandemic Emergency Preparedness and Response Plan. State officials completed a new version of the plan last week, and a copy was obtained late Friday by The Associated Press.

The state did not draw up a hierarchy of Californians who would most need inoculation, though it hints at groups most vulnerable. "Very young persons, elderly adults, and persons with underlying disease are at high risk of complications during interpandemic influenza outbreaks," it states.

Instead of setting out a list of likely candidates, the state developed a scoring system that the report says "produces a rank-ordered list of target groups prioritized for influenza vaccination." The formula is designed to be flexible enough to accommodate variables in a pandemic.
Click Me!

The system considers:

* The goals of a vaccination program, such as minimizing illness, social disruption and economic losses.
* Rationing strategies, such as emphasizing people who perform essential emergency-services roles or who are especially vulnerable to disease.
* Precise criteria for determining who qualifies as a member of those critical or vulnerable groups.

The state's formula represents a new attempt to grapple with the subject of a fierce debate over who should be inoculated in a worst-case scenario.

Vaccine factory employees and front-line health workers head the Bush administration's own list, but there is no consensus on who would get vaccinated next. Should it be school-age children who are flu's prime spreaders? The frail elderly who may be at highest risk of death? Police, firefighters, utility workers who would have to keep order and essential services running?

Congress allocated $3.8 billion last year with the goal of being able to distribute vaccine to every American within six months of a pandemic striking. The Bush administration leaves it up to states to determine how to distribute the vaccines.

While several pharmaceutical companies are conducting clinical trials, no vaccine currently exists. It would take time for researchers to develop a highly effective vaccine after they identified a lethal bird flu strain.

"It becomes a high-stakes process to the extent there's a shortage of vaccine, and early on, that's certainly likely to be the case," said Dr. Mark Horton, the state public health officer and chief deputy director in the California Department of Health Services.

The state plan envisions beginning vaccinations when a pandemic reaches the World Health Organization's "Phase 6" - the most severe stage in a pandemic. At that stage, "sustained" human-to-human spread of the disease is occurring.

Currently, the virus has not mutated into a form easily spread among people. But the deadly Asian strain of bird flu has ravaged poultry and killed at least 141 people worldwide.

The state released a draft bird-flu response plan in January. For nearly nine months, it worked on improvements. But the version released this month contained only "relatively minor, technical" changes, Horton said.

However, it is sure to evolve in the coming months and years. For instance, Horton said, it currently has no specific guidance on another potentially grisly issue - what to do with a large number of dead bodies.

California, the nation's most populous state, is uniquely vulnerable the virus arriving via birds or people. In addition to having a citizenry with ties to Asia, where the disease has hit hardest, California has a $2.5 billion poultry industry, and millions of birds migrate along its flyways.

State Fish and Game authorities have spent the past few weeks trying to catch some of those migrating birds, with limited success. They have been focusing especially on pintails, a type of duck with an exceptionally wide range of migration, said agency spokesman Patrick Foy.

Pintails fly all the way to Alaska and Siberia, where their flyways can intersect with those of birds that have traveled through Asia, Foy said.

Copyright © 2006 KABC-TV and the Associated Press. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

Egypt has more birds with avian flu

AVIAN INFLUENZA (193) - EGYPT (SOHAG, DAMIETTA)
*************************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases


Date: 8 Sep 2006
From: Joe Dudley
Source: IOL [South Africa-based news website; edited]



Egypt uncovered new cases of bird flu in domestic fowl, the health
ministry said on Thursday. Birds tested positive for the lethal H5N1
strain in locations in the southern province of Sohag and the
Mediterranean coastal province of Damietta, the ministry said.

"Teams were culling the infected birds in both locations," it said in
a statement on the state news agency MENA. The ministry on Tuesday
announced Egypt's 1st discovery of infected birds in months, raising
concerns over a return of the virus with the start of the migration
season.

Since the disease broke out in the country in early March 2006, 6
people died of bird flu in Egypt. sparking a massive cull of poultry
across the country.

--
Joseph P. Dudley, Ph.D.
Chief Scientist,
EAI Corporation
Arlington, VA 22203


[It is unclear from this article whether there are new cases in Sohag
or the culling there is due to the infection found on 3 Sept - see
Avian influenza (190) - Egypt (Sohag) 20060903.2510.

It is clear however, that in a very different part of the country,
another infection has been identified in Damietta. For locations of
these two outbreaks, see
in the south and
some 200 kilometers
north of Cairo.

It is ironic but certainly not unprecedented that the ministry had
just declared Egypt free of Avian Influenza a few days ago. - Mod.PC]

Countries cooperating may be key to prevent spread of bird flu

Thailand to train Egypt on bird flu

Thailand's Public Health Ministry will provide training for the control of bird flu and producing anti-viral medicines to combat the deadly disease for Egyptian medical doctors and related specialists, starting late this year, according to Prat Boonyawongvirot, Permanent Secretary for Public Health.

Dr Prat has just returned from a two-day visit and talks, which began Thursday, with Egyptian Public Health and Population Minister Hatem el-Gabali and his Egyptian counterpart on cooperation and exchanging knowledge on the disease.

The two countries have experienced the outbreak of the disease this year, in which the UN World Health Organisation (WHO) has confirmed that 14 patients in Egypt have contracted the disease, and six have died.

Under the cooperation plan, Thailand will organise a short-term training program for Egyptian medical personnel and send doctors and nurses to provide medical check-up to more than 2,000 Thai students and workers now staying in that country, said Dr Prat. (TNA)

PETA calls for humane culling

PETA calls for humane 'bird flu' killing

By David Irvin
Montgomery Advertiser


If bird flu gets loose in Alabama's chicken population, lots of birds will be killed off as the government tries to prevent a wider outbreak.

How these birds die is of great concern to People for the Ethical Treatment of Animals. The animal rights group sent a letter Thursday to Ron Sparks, Alabama's commissioner of agriculture and industries, urging a humane approach to killing birds if avian flu comes to this state.

The PETA letter pointed out that other countries have resorted to burning and burying chickens alive when faced with the epidemic, a practice that wouldn't occur here, state officials said. Because of the large number of chickens in question -- Alabama raises more than a billion each year -- PETA wants to make sure it doesn't.

"We just want to make sure we deal with it with as little suffering for the animals as possible," said Matt Prescott, a campaign manager at PETA.

PETA's proposed method for destroying infected birds is called controlled atmosphere killing (CAK). Basically, the chicken house is sealed and quantities of nitrogen and argon are pumped in with deadly carbon dioxide. The birds fall asleep and eventually die.

This method is preferable to other possible methods, PETA said, which include bludgeoning, bleeding and poisoning.

In Alabama, state officials typically would use straight carbon dioxide gas to "depopulate" a chicken farm, which PETA said is painful for the birds and should be avoided. Sparks disagreed, calling the method "very humane."

"We certainly are not opposed to a more ethical treatment of animals," Sparks said. "We would be more than glad to have our scientists sit down with their scientists" to discuss the CAK process of killing birds.

Officials with the animal-protection group admit they would like to see the CAK method used throughout the chicken industry at all times and are using this campaign to get their message across. In the letter, the group offered its services to the state free of charge to plan for an outbreak and help deal with any aftermath.

In May, Sparks and other state officials outlined their plans for dealing with the disease, which included killing all the birds in infected areas.

Counties prepare, one at a time.

State says it's ready for a bird flu pandemic in Wisconsin

Pandemic Preparations

Updated: 5:52 PM Sep 8, 2006

Governor Doyle accepted the preparedness plan today.

Local, state and federal agencies worked together to create the strategy.

This year we have concentrated on implementing the national incident management system, which is a standardized, nationwide approach for federal, state and local governments to coordinate efforts to prepare for, respond to and recover from a disaster.

A major part of the project was creating mass evacuation plans for the entire state.

It includes primary and secondary routes for residents to use in an event of an emergency.

The frightening part is in red print

Family regrets late bird flu results

Andi Hajramurni, The Jakarta Post, Makassar

The South Sulawesi governor and the family of the latest confirmed bird flu victim expressed regret Friday that the Health Ministry did not immediately disclose the cause of the 14-year-old's death.

Health Minister Siti Fadilah Supari said Thursday the government had confirmed the girl, who passed away almost three months ago, was the 48th fatality from the virus.

"Why was the announcement made almost three months later? If we had known earlier, we could have taken the necessary steps immediately," Governor Amin Syam said in Makassar on Friday.

The victim's brother, Alimin, said his family had been shocked to learn the girl died of bird flu.

"It has really shaken us, to hear such news just as we were coming to terms with her death."

Alimin said the family knew that bird flu in humans caused symptoms like the girl's, including a high fever, chest pains and shortness of breath. However, her doctor had diagnosed dengue fever.

"But our suspicion caused us to free all our chickens and pet birds and destroy the coop amd cages immediately after her funeral."

The victim was the 48th person to have died of bird flu in the country, but it was the first case to occur in South Sulawesi.

Laboratory tests conducted by the Health Ministry on fluid samples taken from the victim concluded she died of the H5N1 bird flu virus strain.

The samples were sent by the provincial health office to Jakarta on June 23, the day before the girl died. However, the test results were only announced Thursday.

Runizar Roesin from the National Bird Flu Center said the delay between the discovery of the case and the announcement of the test results was because the samples were not specifically taken from the patient on suspicion of bird flu.

Siti said they would soon carry out poultry culls in the area where the case was found.

The girl's mother and elder sister, both of whom exhibited bird flu symptoms, died before her. After her death, her father, two other siblings, an in-law and a cousin were in turns taken to the hospital with high fevers, but soon recovered.

Alidin said the family had suspected the three died of bird flu but could not confirm the matter since they were all diagnosed as suffering from dengue fever.

The head of the South Sulawesi Health Office, Andi Muhadir, said it was unwise to make assumptions but blood samples would be taken from the victim's 11 family members and her closest neighbors.

The governor has called on related offices to apply standard procedures in dealing with bird flu and asked residents to hand over their poultry to be destroyed.

"I hope people are willing to give up their poultry to be destroyed so there will be no more cases of bird flu in humans," he said.

A plan for Vietnam

Vietnam prepared for bird flu return

Chicken meats are on sale at a market in Hanoi (Photo: AP) Vietnam’s Health Ministry has drafted a national action plan to prevent a relapse of human bird flu infection.

The epidemic still threatened Vietnam and its neighboring countries and humans were highly susceptible to the type-A flu virus especially in winter, the ministry warned. Under the plan the Vietnamese government has earmarked VND1 trillion (over US$62 million) for facilities to prevent and control the epidemic. Besides equipping local health centers, the ministry has also assigned 14 hospitals in the national disease control and prevention system to keep continuous watch to tackle probable outbreaks. If the epidemic broke out on a large scale, more provincial hospitals will be co-opted to treat H5N1-infected patients. Bird flu has so far killed at least 141 people in 10 countries since December 2003. Vietnam has registered 42 fatalities, second only after Indonesia where 47 have been killed. Source: Sai Gon Giai Phong – Translated by Tuong Nhi

Updating the numbers in Indonesia

Human bird flu death toll in Indonesia rises to 48: WHO

Jakarta, Sept. 9(AP): The World Health Organization has recognized two more cases of bird flu in Indonesia, one of them fatal, bringing the country's confirmed death toll from the virus to 48.

The cases, which occurred last year, were added to the WHO tally because of a recent change in the testing standards that the body sets for cases of the H5N1 virus. They were already included in Indonesia's Health Ministry tally.

``WHO is adding two cases in Indonesia, dating back ... to 2005,'' the WHO said in a statement received Saturday. ``The retrospectively confirmed cases bring the total in Indonesia to 63. Of these cases, 48 have been fatal.''

Indonesia has tallied the most deaths from bird flu in the world.

The retrospectively confirmed fatal case was an 8-year-old female who died on 14 July 2005 on the outskirts of Jakarta. She was part of a cluster of deaths in one family that made up Indonesia's first reported cases of the virus, the WHO statement said.

In the second case, a 45-year-old male from central Java province was sickened but recovered, the WHO said.

The H5N1 strain of bird flu has ravaged poultry stocks, mainly in Asia, since late 2003. It also has killed at least 143 people worldwide, according to the WHO. Most human deaths have been traced to contact with sick birds, the virus does not spread easily from person to person.

Experts fear that the virus could mutate into a more transmissible form, potentially causing a deadly global pandemic.

Oh, so that's why...

China blames American lab for causing delay in bird flu sample sharing
The Associated Press

Published: September 8, 2006
BEIJING China is blaming the U.S. Centers for Disease Control and Prevention for causing a delay in its attempt to share bird flu virus samples needed for drug research and development, a state-run newspaper said Friday.

China's National Avian Influenza Reference Laboratory, its main research and testing facility, has already prepared 20 samples required by a CDC lab designated by the World Health Organization, the China Daily said.

"But the U.S. lab has not yet completed import procedures, causing an indefinite delay in the shipment of the virus," the newspaper said, citing an unnamed Agriculture Ministry spokesman.

The allegation mark the latest sniping in the often bumpy cooperation between China and global health experts. International health experts have repeatedly complained about Chinese foot-dragging in cooperating in investigating emerging diseases like bird flu and the SARS pneumonia.

Virus samples are needed to produce diagnostic tools and vaccines. So the lack of cooperation, experts say, could slow efforts to track diseases and develop vaccines and other strategies to deal with them.

Julie Hall, an infectious disease expert at the WHO's Beijing office, questioned the assertion that the U.S. lab was to blame. She said China's Health Ministry has so far shared six samples with the CDC using the same import procedures without any delay.

"Where there's a will there's a way," Hall said in a telephone interview. "We've bent over backwards to try to accommodate their concerns ... but they have not yet shared."

Calls to the CDC in Atlanta, Georgia, were not answered. The Agriculture Ministry did not respond to telephone and fax requests for comment.

While the Health Ministry has improved its cooperation with foreign health experts in recent years, foreign scientists have criticized the Agriculture Ministry for refusing to turn over virus samples since 2004.

The reason for the ministry's reluctance isn't known, although some countries are slow to share genetic information or samples of viruses collected within their borders for fear they will be pushed aside in the global race to produce a lucrative vaccine.

In February, the WHO and the ministry reached an agreement under which China would share the samples by transferring them from the ministry's lab to WHO-linked labs, the China Daily said.

But, the China Daily cited the Agriculture Ministry spokesman as saying that the U.S. government only allows import of undiagnosed samples, while the Chinese samples are diagnosed and must undergo strict screening before they are allowed in.

Hall said the CDC receives thousands of viruses each year — about 400 from China alone — all without problem.

"The procedures are all there," Hall said. "In terms of logistics, it's fairly routine."

Bird flu, or H5N1, ravaged poultry in Asia in late 2003. It also jumped to humans and has killed at least 141 people worldwide. Most human deaths have been traced to contact with sick birds.

Experts have warned that if poultry outbreaks are not controlled, the virus may mutate into a form more easily passed between people, potentially resulting in millions of deaths worldwide.

Two distinct "clades," or genetic families, of H5N1 have been identified. The Vietnam 2004 strain belongs to the first clade. In mid-2005, a second clade emerged, which has since caused bird flu cases in China, Indonesia, the Middle East, Europe, and Africa.

Earlier this week, the medical journal Lancet said that Chinese researchers may have found a way to create a potential H5N1 vaccine that would maximize production in the event of an influenza pandemic. It was made using the clade one virus, Hall said.

She said it was necessary to get samples from China — where many mutations of the second clade have appeared — so that vaccines for them can be developed.

China has been criticized in the past for covering up its 2002-03 outbreak of severe acute respiratory syndrome.

Its campaign against bird flu, by comparison, has appeared public and aggressive, with health officials touting their efforts to foreign media.

Last month, Chinese researchers said a soldier died of the H5N1 bird flu strain in 2003, two years before the government publicly acknowledged its first human infection.


BEIJING China is blaming the U.S. Centers for Disease Control and Prevention for causing a delay in its attempt to share bird flu virus samples needed for drug research and development, a state-run newspaper said Friday.

China's National Avian Influenza Reference Laboratory, its main research and testing facility, has already prepared 20 samples required by a CDC lab designated by the World Health Organization, the China Daily said.

"But the U.S. lab has not yet completed import procedures, causing an indefinite delay in the shipment of the virus," the newspaper said, citing an unnamed Agriculture Ministry spokesman.

The allegation mark the latest sniping in the often bumpy cooperation between China and global health experts. International health experts have repeatedly complained about Chinese foot-dragging in cooperating in investigating emerging diseases like bird flu and the SARS pneumonia.

Virus samples are needed to produce diagnostic tools and vaccines. So the lack of cooperation, experts say, could slow efforts to track diseases and develop vaccines and other strategies to deal with them.

Julie Hall, an infectious disease expert at the WHO's Beijing office, questioned the assertion that the U.S. lab was to blame. She said China's Health Ministry has so far shared six samples with the CDC using the same import procedures without any delay.

"Where there's a will there's a way," Hall said in a telephone interview. "We've bent over backwards to try to accommodate their concerns ... but they have not yet shared."

Calls to the CDC in Atlanta, Georgia, were not answered. The Agriculture Ministry did not respond to telephone and fax requests for comment.

While the Health Ministry has improved its cooperation with foreign health experts in recent years, foreign scientists have criticized the Agriculture Ministry for refusing to turn over virus samples since 2004.

The reason for the ministry's reluctance isn't known, although some countries are slow to share genetic information or samples of viruses collected within their borders for fear they will be pushed aside in the global race to produce a lucrative vaccine.

In February, the WHO and the ministry reached an agreement under which China would share the samples by transferring them from the ministry's lab to WHO-linked labs, the China Daily said.

But, the China Daily cited the Agriculture Ministry spokesman as saying that the U.S. government only allows import of undiagnosed samples, while the Chinese samples are diagnosed and must undergo strict screening before they are allowed in.

Hall said the CDC receives thousands of viruses each year — about 400 from China alone — all without problem.

"The procedures are all there," Hall said. "In terms of logistics, it's fairly routine."

Bird flu, or H5N1, ravaged poultry in Asia in late 2003. It also jumped to humans and has killed at least 141 people worldwide. Most human deaths have been traced to contact with sick birds.

Experts have warned that if poultry outbreaks are not controlled, the virus may mutate into a form more easily passed between people, potentially resulting in millions of deaths worldwide.

Two distinct "clades," or genetic families, of H5N1 have been identified. The Vietnam 2004 strain belongs to the first clade. In mid-2005, a second clade emerged, which has since caused bird flu cases in China, Indonesia, the Middle East, Europe, and Africa.

Earlier this week, the medical journal Lancet said that Chinese researchers may have found a way to create a potential H5N1 vaccine that would maximize production in the event of an influenza pandemic. It was made using the clade one virus, Hall said.

She said it was necessary to get samples from China — where many mutations of the second clade have appeared — so that vaccines for them can be developed.

China has been criticized in the past for covering up its 2002-03 outbreak of severe acute respiratory syndrome.

Its campaign against bird flu, by comparison, has appeared public and aggressive, with health officials touting their efforts to foreign media.

Last month, Chinese researchers said a soldier died of the H5N1 bird flu strain in 2003, two years before the government publicly acknowledged its first human infection.

Illegal bird trade risky business for Barbados

Smuggling 'open door to bird flu'
Published on: 9/7/06.

SMUGGLING EXOTIC PETS and fighting birds into Barbados could simply offer the deadly avian influenza (AI), "bird flu", a way into Barbados.

Minister of Agriculture and Rural Development, Senator Erskine Griffith, issued this warning yesterday during a workshop to determine activities and the timetable for an emergency aid plan related to the early detection of AI in the Caribbean region.

"The trade in smuggled exotic pets and fighting birds and hatching eggs through our points of entry continues to present a challenge for us . . . ," Griffith told the gathering that included representatives of the Food and Agriculture Organisation (FAO), the Pan American Health Organisation/ World Health Organisation, the Inter-American Institute for Co-operation on Agriculture (IICA) and the Barbados Poultry Association.

"We recognise that this will create yet another route for the entry of the highly infectious disease of avian influenza," Griffith said.

He admitted that "a Herculean effort" was needed to keep bird flu "out of this and other islands of the region".

The PAHO/WHO's Caribbean Programme Co-ordinator, Veta Brown, also told the high-level regional meeting organised by the FAO that smuggling of birds posed a major problem to the fight to keep avian influenza at bay.

"The challenges to the implementation of a successful animal disease management programme are even greater when we consider that our borders are truly wide open," she asserted.

Griffith stated that the medium-term strategies for the poultry industry "must include the establishment of new and enhanced regulations to prevent the importation of exotic birds into the island and thus minimise the transmission of diseases like the Newcastle Disease and the Highly Pathogenic Avian Influenza (HPAI)".

While indicating that there had been increased surveillance at ports of entry in order to minimise the introduction of the disease into Barbados, Griffith reported that since the year 2000, Barbados had been confronted with "no fewer than 15 plant and animal pests and diseases of quarantine significance".

He declared that none was "more debilitating than the HPAI".

In the case of Barbados, he said steps had been taken to remodel the agencies and institutions responsible for the development of the sector, and to rationalise programmes in response to the changing environment.

He added that discussions were ongoing with the poultry industry in relation to the establishment of an insurance scheme to compensate farmers for any losses suffered from bird flu as well as to facilitate a speedy recovery from such a disaster. (TY)

Jakarta announces another death from bird flu

Jakarta - Indonesia confirmed another person had died of bird flu as the nation hardest-hit by H5N1 continues to battle a disease that experts fear could one day spark a global pandemic.

Indonesia's 47th fatality from the virus was a woman called Akira from South Sulawesi province, said Health Minister Siti Fadillah Supari, adding that infected birds had been found dead in the same area.

"This we know from the results of the (tests by the) Health Ministry's Research and Development Board last night (Wednesday)," Supari told journalists.

"We did not send (the samples) to the WHO (World Health Organisation) because our positive results are usually positive results at the WHO," she added.

Up until now, Indonesia has always sent blood and tissue samples from suspected human bird flu cases to a WHO laboratory in Hong Kong for confirmation.

Sari Setiogi, the WHO spokesperson in Indonesia, said that under a new arrangement Jakarta could confirm infections after two local tests showed the person to have contracted H5N1.

Supari gave no further details other than that the latest bird flu case had been first discovered on June 24.

Indonesia, the world's fourth most populous nation, is grappling with ongoing outbreaks of H5N1, which has infected 61 people to date, 47 of them with fatal consequences.

The minister said that they would soon carry out poultry culling in the area where the case was found.

"We will soon do "stamping out", because they found dead birds in the area," Supari said.

While the virus does not spread easily among people, the chance of a mutation occurring which will allow it to do so is heightened as more humans catch it from infected birds.

Scientists fear that if this occurs, a global flu pandemic with a massive death toll could result.

Indonesia has been criticised for its slowness in stamping out the virus at its source - among poultry. But the government has said that it was facing difficulties in funds to conduct cullings and pay compensation to poultry owners.

It said last month that approximately 30 million homes keep chickens in their backyards and in some instances, many refused to turn in their birds despite offers of compensation. - Sapa-AFP

Editorial on preparedness

We Need to Do a Better Job of Preparing for the Next Big Disaster

Posted 08/25/2006

Margaret A. Clark, RN, RRT-NPS, MS

Since Hurricane Katrina, numerous reports and recommendations have been developed to incorporate lessons learned, and assess our readiness to respond to the next big disaster. While well intentioned, many of these reports are of little use. They tell us what we should do, but give little guidance on implementing the recommendations -- let alone funding them.

For example, some reports confirm that the nation's hospitals would not have enough mechanical ventilators should a pandemic flu or mass casualty situation occur.^[1,2] An estimated 105,000 ICU ventilators are currently available.^[3] According to the National Preparedness Plan issued by President Bush in November of 2005, we would need over 700,000 in the event of an influenza pandemic.^[4]

It's been estimated that the Strategic National Stockpile, created in 1999 by the federal government for just such emergencies, has only 4000-5000 ventilators.^[5] With the cost of a typical ICU ventilator around $30,000, stockpiling enough ventilators for a pandemic would seem cost-prohibitive at an $18 billion price tag.^[3]

September is National Preparedness Month. The Federal Government through the Department of Homeland Security is encouraging individuals, business, and especially state and local healthcare authorities and hospitals to review and update their plans. This year we should inject a heavy dose of practical reality into that review rather than following some meaningless pro forma checklist.

That's my opinion. I'm Margaret Clark, Editorial Director, Pulmonary Medicine, Medscape.

Almost time for flu shots

CDC expects 100 million doses of flu vaccine this season

Robert Roos News Editor

Sep 6, 2006 (CIDRAP News) – Influenza vaccine manufacturers expect to make and distribute more than 100 million doses in the next few months, millions more than in any previous flu season, the Centers for Disease Control and Prevention (CDC) said today.

The predicted total is about 17 million more than the current record for doses distributed—83.1 million in 2003, the CDC said. Last year about 81.2 million doses were distributed.

Although the flow of vaccine is always hard to predict, CDC Director Dr. Julie Gerberding said in a news release, "If the manufacturers' estimates hold, more people than ever before will be able to protect themselves and their loved ones from influenza this year."

Manufacturers expect that about 75 million doses will be distributed by the end of October, followed by most of the rest in November, the CDC said. Remaining doses should reach clinics by early January. Last year about 60 million doses were distributed by the end of October, officials said.

Producers and major distributors intend to "provide some influenza vaccine by the end of October to all providers who ordered it," the statement said.

"We expect that some healthcare providers and clinics may get or have more influenza vaccine than others in the first month or so, but people will have plenty of opportunities to be vaccinated during October and November, as well as December or later," Dr. Lance Rodewald, director of the CDC's Immunization Services Division, said in the news release.

CDC officials told CIDRAP News the US vaccine supply could reach as high as 115 million doses this season if a vaccine made by the Canadian firm ID Biomedical, now part of GlaxoSmithKline, wins Food and Drug Administration (FDA) approval soon.

"We're hoping it'll be licensed in September, but we don't know," said Rodewald.

Curtis Allen, spokesman for the CDC's National Immunization Program, said ID Biomedical might contribute 10 million to 15 million doses to the US supply if the vaccine is licensed. Some of those doses wouldn't be available until after December, he said.

Last week Bloomberg News reported that a slow-growing strain of virus used in this year's vaccine could delay delivery of some of the doses destined for Americans by up to 3 weeks. The report said the three biggest suppliers to the US market—Novartis, GlaxoSmithKline, and Sanofi Pasteur—have had trouble growing the influenza A(H3N2) strain in this year's vaccine.

But Rodewald told CIDRAP News he does not expect that problem to affect the US supply this season.

"I think some of the European manufacturers were using a different strain, but all the vaccine made for the American market used a strain that was not the slow grower, so we haven't seen problems with the slow-growing strain here in the US," he said.

The CDC recommends getting flu shots in October or November, before the flu season usually begins, but says vaccination is still worthwhile in December or later, because the season typically doesn't peak until February.

This year the agency recommended for the first time that 2-, 3-, and 4-year-olds and their household contacts and caregivers receive flu shots. The recommendation added an estimated 16 million people to the population for whom the shots are advised. Children between 6 and 23 months and their close contacts were included in the flu immunization recommendations 2 years ago.

Other groups advised to get flu shots, according to the CDC, include:

• Children and adolescents (6 months through 18 years) on long-term aspirin therapy
• Women who will be pregnant during the flu season
• Adults and children who have asthma, other chronic respiratory or cardiovascular conditions, or any condition that can impair respiratory function
• Adults and children under treatment for chronic metabolic disorders, kidney problems, hemoglobinopathies, or immunodeficiency
• Residents of nursing homes and other chronic-care facilities
• People age 50 and older
• Healthcare workers
• Close contacts of people at high risk for severe flu complications.

See also:

Irish Health speaks about bird flu

Flu pandemic threat–it hasn't gone away

By Niall Hunter-Editor

Public concern about health threats and scandals tends to wax and wane according to their popularity in the media. One week it may be infected beef and vCJD, another week nursing home charges, another week organ retention controversies or another week A&E trolley problems.

While public focus and debate on bird flu and the threat of a pandemic has waned a little in recent months, it remains a very real threat. So what can be done and is being done about the threat of bird flu in humans coming to Ireland, or worse still, the virus mutating into a strain trhat would cause a pandemic, leading perhaps to thousands of deaths?

An clinical expert on infections diseases working in Dublin says that the Government could do more to communicate information to the public and [rimary care doctors on how we will deal with an Irish outbreakof human bird flu or a flu pandemic.

Dr Jack Lambert, infectious diseases specialist at Dublin's Mater and Rotunda Hospitals, said that while the Government had done a good job in terms of making preparations for a pandemic and in terms of stockpiling antiviral drugs, there is a gap in terms of communications.

"There is a gap in terms of information provided by the Government to the general public and primary care doctors, who would be in the firing line, and it would be helpful to improve that."

Dr Lambert said more information material needs to be made readily available by the HSE on influenza and avian flu. "While there is excellent work being done there is a need for better and more communication."

Dr Lambert this week is addressing a conference organised by the IBM corporation in Ireland on the preparedness of business for a flu pandemic. IBM has recently published a contingency plan assessment in preparation for a possible pandemic.

He said that as regards the Government preparing for a pandemic, one can never do enough. He said our Government would rank highly among EU countries in terms of the amount of the antiviral drugs it has ordered.

"However, it has to be asked whether you can just leave all of this in the hands of the Government. Others need to become part of the solution, including large corporations, the hospital system, the army etc. Corporations with large workforces need to come on board and say we have a plan."

Dr Lambert said large companies who do not want to have a large amount of their workforce out of work would have to have strategic plans in the event of a flu pandemic.

"While the Government here has done a good job there is a need for a public/private partnership."

Dr Lambert said that while he could not put an exact figure on it, there would be significant illness and mortality from a flu pandemic in Ireland.

He said the antiviral Tamiflu would be effective in shortening the duration of viral infections and in reducing complications in a pandemic, but the major issue would be getting it to the people most at risk and delivering it quickly.

An effective vaccine against pandemic flu cannot be developed immediately, and it would take six to 12 months after an outbreak to develop an effective vaccine, Dr Lambert said.

He said he believed that a flu pandemic would occur.

Dr Lambert said the danger was that the current avian flu virus could combine with the human flu virus and cause a similar catastrophe to the previous flu pandemic of 1918, when up to 40 million people died worldwide.

The 1918 pandemic, he said, was probably caused by a bird flu virus mixing with a human flu virus.

So what is the current situation as regards the avian flu threat?

The avian influenza H5NI strain was first described in animals in Hong Kong in 1997. More recently, it crossed the species barrier to infect some humans who have come into contact with sick or dead infected birds.

To date, the disease has killed around 140 people, mostly in Asia, with some cases in Africa, and there has been a total of just over 240 human cases reported. To date in Ireland, there have been no reported cases of avian flu in birds nor have there been any cases of the bird flu virus in humans.

Most experts agree that the dreaded mutation of the virus will occur, thereby causing a probable pandemic, but it cannot be predicted when this will happen.

According to the World Health Organisation (WHO), there have been more human cases of H5N1 recorded in 2006 than in any previous year, since the first cases were recorded in 2003.

Health authorities here have in place a plan to deal with a possible flu pandemic, with preparations being made at national level by the National Pandemic Expert Advisory Group.

According to Dr Anna Beug, of the Expert Group, and Dr Derval Igoe of the Health Protection Surveillance Centre (HPSC), the Government has ordered a stockpile of the antiviral agent Tamiflu, sufficient to treat 25% of the population. A stockpile of another drug, Relenza, is also being ordered. This will supply additional doses to supply a further 20% of the population. Both of these drugs need to be taken within 48 hours to be effective.

The HSE plans to set up flu clinics to dispense the drugs to the majority of patients, leaving GPs to treat patients who require medical assessment due to pre-existing conditions, severe illness, etc, the doctors state in a recent article in the GP magazine Forum.

It is planned that people will be asked to ring a specific pandemic flu helpline directing them to the most appropriate place for treatment.

While a pandemic vaccine will take some time to develop after the outbreak first occurs, it will initially be prioritised to groups most severely affected by the disease, including healthcare staff, providers of essential services, the elderly, and those at high medical risk.

The public is likely to be advised through media campaigns to limit the risk of infection by staying at home if ill, to limit contact with others when ill and to use a mask or tissue to cover their nose and mouth when coughing out in the open.

Frequent handwashing will be recommended.

The WHO is likely to introduce travel restrictions.

There will, according to the experts, be widespread disruptions to usual work patterns, with many companies already planning for remote working by their staff.

There is likely to be increased absenteeism in the workplace.

Drs Beug and Igoe say health planners are using a planning model based on information from previous pandemics to predict the impact of a pandemic on Ireland.

In this model, with a 25% clinical attack rate, there would be around 970,000 clinical cases of pandemic flu in Ireland in the course of a 15-week pandemic.

It is estimated that there will be 5,386 influenza-related hospitalisations and a minimum of 3,600 deaths related to flu will occur.

Nothing like a good hoax

Notice Concerning Avian Flu a Hoax

An official-looking notice announcing cancellation of Florida’s 2006 turkey hunting seasons is a hoax.

According to the bogus notice, delivered to the Florida Fish and Wildlife Conservation Commission (FWC) via fax, several cases of avian influenza in Northwest Florida wild turkeys prompted closure of this year’s turkey hunting seasons, and possibly subsequent years’ through 2009, as well. It says the action is necessary to prevent the disease from spreading through other wild bird populations.

The FWC and other agencies across the continent are monitoring bird populations for signs of the disease. To date, they have discovered no cases of the highly dangerous form of the disease. As part of the FWC’s avian influenza surveillance, scientists investigate reports of bird deaths and ask that anyone who finds dead birds note the details online at MyFWC.com/bird or contact the local FWC office. Further information about avian influenza is available at MyFWC.com/bird/avianinfluenza.htm.

Florida’s fall turkey hunting season is Nov. 23-26 and Dec. 9 – Jan. 14 in the Northwest Hunting Zone, and Nov. 11 – Jan. 7 in the Central and South zones. Spring turkey hunting season is March 17 – April 22 in the Northwest and Central zones, and March 3 – April 8 in the South Zone. Hunters also may take turkeys during archery, crossbow and muzzleloading gun seasons before the fall season begins.

Holmes County has no fall harvest of turkeys, and the spring harvest there is limited to March 17-19 to enable the county’s depleted turkey population to rebuild.

Wyoming releases results

Tests come back negative for bird flu

By The Associated Press

LARAMIE - Test results for the first birds sampled in Wyoming for highly pathogenic avian influenza have come back negative.

Several government agencies began testing wild and domestic bird populations in Wyoming for the disease. It has not been found in North America.

The first test results come from 50 Canada geese that were tested during a banding operation June 19-21 at Eden and Big Sandy Reservoirs north of Farson.

The birds were tested for the H5N1 strain of the disease, which has caused some human fatalities in Eastern Europe and Asia. Experts believe that if the disease enters North America, it will most likely come in through Alaska.The Wyoming Department of Game and Fish plans to collect about 500 more samples from birds this fall from species that could have migrated from Alaska. The department will test 400 migratory game birds and 100 shorebirds.

The samples will come from field checks of pintails, geese, teal and sandhill cranes killed by hunters.

The shorebirds will include long-billed dowitchers and pectoral and buff-breasted sandpipers. The shorebirds will be netted and released with the help of the Casper chapter of the Audubon Society.

Dr. Cynthia Tate, assistant veterinarian at the Wyoming Department of Game and Fish, said the department will not accept birds that the general public might want to drop off for testing. But Tate requested that if anyone finds five or more dead birds of the targeted species in the field that they contact the game department.

Tate urged the public to take precautions when handling dead birds.

"Minimize direct contact with wild dead birds," Tate said. "Wear rubber or latex gloves, or invert a plastic bag over your hand."

Copyright © 2006 Associated Press

Calm. No flap.

Handle bird flu without flapping

Sep 5 2006

Carwyn Jones, Western Mail

WHILE the risk of incursion of avian influenza into the UK is still regarded as low, poultry keepers will be aware that there is a marginal increase in risk at this time of year due to wild birds returning from northern latitudes and passing over the UK. Last year, I was very pleased with the measured response to the Cellardyke case among the industry in Wales. The media here also reacted responsibly compared with other parts of the UK. Even though avian influenza has been out of the headlines over the summer, it is likely that interest will pick up again during the migratory season. Once again, the Welsh Assembly Government is urging the industry and the public to be vigilant and report any suspicious bird deaths (three or more birds of one species or five or more birds from different species). The UK and devolved governments have updated plans to deal with any outbreak in the UK, building on last year's experience. We have improved links with overseas governments, such as Russia and Iceland, to ensure that we have early notice of any cases in other countries. Testing of live and dead birds will take place again, concentrating on areas of greatest risk, including, Anglesey, Welshpool, the Dee Estuary and Burry Port.

The Cambodian ducks have it!

New bird flu outbreak hits Cambodian ducks
September 05, 2006, 13:00

A fresh outbreak of bird flu has been confirmed in ducks in eastern Cambodia where the virus re-emerged last month, officials said today.

Tests confirmed the deadly H5N1 virus in live and dead ducks in the Bateay district of the eastern province of Kampong Cham, where 700 birds died last week, they said. "We sent our vets to cull the rest of the live ducks after the result was confirmed on Saturday," said Yim Voeunthan, a senior agriculture official.

The virus could have spread from a nearby village where a bird flu outbreak killed nearly 2 000 ducks last month, said Ku Chanthan, a veterinarian in Kampong Cham.

In early August, the virus was also found among 1 300 ducks that died in the province of Prey Veng, 70km south-east of Phnom Penh. Authorities said that infected ducks that survived the outbreak in Prey Veng may have been smuggled to Kampong Cham, where surveillance efforts against the virus have been stepped up.

No signs of mutation as yet
"We are worried that more bird flu will be found in ducks because our survey experience showed that up to 15% of live ducks carried the virus," Yim Voeunthan said.

The H5N1 bird flu virus has killed more than 140 people worldwide, including six in Cambodia, according to the World Health Organisation.

The virus has not yet shown the ability to mutate into a form that could pass easily between humans and cause a pandemic that might kill millions of people. But experts fear it might, especially in a poor country such as Cambodia, which is recovering from 30 years of civil war, and where health surveillance systems are limited. - Reuters

Must have been an oversight...

WSJA: China Acknowledges Not Giving WHO Bird Flu Samples

BEIJING (Dow Jones)--China acknowledged it hasn't given the World Health Organization any bird flu samples taken from poultry since 2004, blaming the long delay on talks over the protocol for how to hand over the virus to international labs.

"When viral strains cross international borders, special protocols are needed and we are working to finish them," vice director of the Ministry of Agriculture's veterinary department Li Jinxiang said Tuesday. International scientists say they need the bird flu samples from poultry to study the development of the H5N1 virus that causes avian flu and to help make drugs and vaccines to fight the disease.

They're also crucial to tracking any changes that could make bird flu easy to catch from human-to-human contact, a transformation that could turn it into a pandemic capable of killing millions.

Already, more than 100 people have been killed since 2003, most, if not all, from contact with infected birds. In March, China promised to hand over poultry samples to the World Health Organization.

China has shared strains of the bird flu virus found in humans, but hasn't shared any samples taken from animals since 2004, when it provided samples from five animals. "There are no real logistical reasons why the (poultry) virus can't be shared," said Julie Hall, coordinator for the WHO Epidemic Alert and Response Team in Beijing.

"The Ministry of Health regularly shares (the human) H5N1 with us. The logistics are there to transport these safely and quickly." Li said that though the Ministry of Agriculture hasn't shared samples from poultry, it has shared the results of laboratory tests, including genetic information, with international agencies. Critics say that's not enough.

They accuse the Ministry of Agriculture of dragging its feet in order to protect Chinese scientists who are working on coming up with a vaccine or cure and could lose their competitive edge if that information was made widely available.

The WHO is under fire by some scientists who say it isn't being transparent enough with information about the virus. Advocates for opening up the WHO's research database, which is now tightly restricted, say that lack of information is slowing the search for a cure.

Li said China had vaccinated nearly 5 billion poultry in the first six months of this year, and that authorities were monitoring for any signs of resistance to vaccines. He said there were some problems reaching more remote parts of China for vaccinations, as cross contamination with wild birds continues to cause outbreaks.

-By Shai Oster, The Wall Street Journal Asia; (8610) 6588 5848; shai.oster@wsj.com

Update: Indonesia cluster

AVIAN INFLUENZA, HUMAN (139): INDONESIA
*******************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Sun 3 Sep 2006
From: Mary Marshall <tropical.forestry@btinternet.com>
Source: The Mercury News online, Sun 3 Sep 2006 [edited]
<http://www.mercurynews.com/mld/mercurynews/news/world/15425359.htm>


Indonesia: Analysis of the North Sumatran Cluster
-----------------------------------------------
Dowes Ginting, the most wanted man on Sumatra island, lay dying. He
had abandoned the hospital where he had seen his relatives succumb
one after another, and he had fled deep into the mountains, trying to
outrun the black magic he feared had marked him next. For 4 nights,
witnesses recalled, a medicine man hovered over him in a small
clapboard home, resisting the evil spell.

Ginting, a wiry 32-year-old, had watched disease burn through his
family over the previous 2 weeks, killing 6 and sickening 2 others,
including himself. International health experts grew increasingly
concerned when laboratory tests confirmed they were sickened by bird
flu, the largest cluster of the disease ever recorded. But Dowes
feared medical treatment more than he did the avian influenza. And so
he ran, potentially exposing villagers across the province to the
highly lethal virus.

In the end, the outbreak in May 2006 did not presage the start of a
worldwide epidemic. But the enormous difficulties that Indonesian and
international disease specialists confronted in investigating the
outbreak and protecting against its spread raised fundamental
questions about whether bird flu could be contained if it mutated
into a form more easily spread among people. "If this were a strain
with sustainable transmission from human to human, I can't imagine
how many people would have died, how many lives would have been
lost," said Surya Dharma, chief of communicable disease control in
North Sumatra province.

Officials from the World Health Organization (WHO), drawing on
sophisticated computer modeling of a theoretical bird flu outbreak in
Southeast Asia, have suggested that a pandemic could be thwarted
through a rapid containment effort in the affected area, including
the right mix of drugs, quarantines and other social controls. To
succeed, the anti-viral drug Tamiflu would have to be distributed to
90 percent of the targeted population, roughly defined as those
within at least a 3-mile radius of each case. The drug would have to
be administered within 21 days from the "timely detection" of the
initial case of an epidemic strain. Residents would have to stay
home, limit contact with others and take the medicine as prescribed.
In the case of the North Sumatra cluster, almost none of this
happened, according to extensive interviews with health officers,
family members and villagers. The underlying problem was that most
family members and villagers were convinced that magic, not flu, was
to blame. "How can you ever get people to cooperate if they don't
even believe you," Dharma said.

Health investigators have concluded that the 8-person cluster in
Sumatra began with Ginting's older sister, who fell ill in late April
[2006]. They suspect she was infected with bird flu from live
chickens sold in a market where she peddled oranges, limes and chili
peppers or from contaminated poultry droppings in manure used in her
garden. She died and was buried before any samples were taken to
confirm bird flu. Several days after she became sick, the extended
family had gathered in the village of Kubu Sembilang for a feast of
roast pig and chicken curry to celebrate the annual harvest festival.
That night, many of the relatives slept in the same small room with
the sister, who had developed a serious cough. By the time she died,
a sister, a brother, 2 sons, a niece and a nephew had become ill. Flu
specialists said the final victim, her brother Dowes Ginting, in turn
probably caught the virus from his infected son. Health experts have
concluded this was the 1st time the bird flu virus had been passed
from one person to another and then on to a 3rd person.

"None of us thought it was bird flu. We thought it was black magic,"
said Anestia Tarigan, the wife of the youngest Ginting brother,
Jones, the only victim to survive [and not a blood-relative -
Mod.CP]. "Everyone in the family was getting sick and no one else
was. Someone had put a spell on our family. Black magic is very
common in our place."

Indonesian and WHO investigators discovered that many residents in
Kubu Sembilang were unwilling to share information or give blood
samples that could reveal how widely the virus was circulating. Many
villagers believed that claims of bird flu were a lie. Some even
threatened the investigators. When a team of officers 1st arrived
from the provincial health department, they were warned by their
local counterparts that it was too dangerous to enter the village.
Investigators were able to take samples from only 2 people in the
village, including the local midwife, said Diana Ginting, chief of
the district health department, who shares a common surname in the
region. Indonesian health officials working with an international
team returned day after day to the village and made progress. They
recruited 20 local volunteers to monitor fellow residents for fever
and set up a temporary health post on the soccer field offering free
medical care. The investigators methodically pieced together the
chronology of the outbreak. They traced those who had contact with
the victims and provided them with Tamiflu. But many of those closest
to the Gintings refused to take it. As a medicine man treated Dowes
Ginting, Indonesian and international health investigators finally
tracked him down and urged his family to take him to a hospital. They
demurred: He needed 2 more days of traditional treatment, they said.
That night, he took a turn for the worse and died.

[Byline: Alan Sipress, Washington Post]

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

[This article provides a useful resume of the investigation of the
cluster of human cases of H5N1 avian influenza virus infection which
involved 8 members of an extended family in the village of Kubu
Sembilang in the province of North Sumatra. For the 1st time, there
was clear evidence of passage of virus from one person to another and
onward transmission to a 3rd member of an extended family. It should
be emphasized, however, that no other comparable cluster of cases has
been identified in Indonesia or elsewhere. There has been no evidence
to date that the H5N1 avian virus is evolving to a form more easily
transmitted from human to human. Similarity of the genetic
constitution of close relatives still seems to be the determining
factor in susceptibility to infection. - Mod.CP]

Just the facts ma'am

Bird flu fears: How dire the threat?

A Mayo Clinic specialist discusses timely questions about bird flu and its potential to cause a human pandemic.

James Steckelberg, M.D.

---

Since 1997, bird flu has killed tens of millions of birds in several countries, and infected hundreds of humans, killing more than half of them. Most people became sick through close contact with infected birds. But in a few instances, the H5N1 strain of the virus, which is uncommonly lethal, appears to have spread from person to person. But, a recent case of suspected bird flu transmission among family members in Indonesia has health officials concerned.

Although cases of human-to-human transmission of bird flu have been rare and self-contained, some experts fear that as the virus continues to mutate, it or some other form of the influenza virus may produce a new, equally deadly strain that spreads easily among people, leading to a worldwide pandemic.

This troubling scenario has raised many questions. Here, James Steckelberg, M.D., an infectious disease specialist at Mayo Clinic, Rochester, Minn., answers some of them.

Bird flu is always making headlines. Has the threat grown more serious?

Worldwide epidemics (pandemics) of influenza aren't new; historically, they've occurred at approximately 25- to 30-year intervals and, like hurricanes and earthquakes, are natural events. Past pandemics have tended to occur when strains of influenza already present in animals adapt to human transmission.

Concern about the disease has intensified recently for several reasons. One is the appearance of several human cases of H5N1 influenza in regions previously unaffected by bird flu. Another is the news that researchers have determined that the 1918 flu pandemic, which killed 50 million people, was a bird flu that jumped to humans. And the H5N1 virus continues to spread among poultry and other birds in more and more countries, and cases of human-to-human transmission, though still relatively rare, continue to develop — such as the recent spread of the illness among Indonesian family members.

The feeling among health officials and agencies worldwide is that it would be irresponsible not to be prepared, especially since we appear to be underprepared right now.

How long might it take for the bird flu to mutate into a serious human threat?

That's the question of the hour, and the truth is, no one knows. We do know a few important things about H5N1, the bird flu subtype that is the greatest cause for concern. First, H5N1 is particularly virulent, killing close to 100 percent of susceptible birds infected with the most virulent form of the virus and more than half the people who have been infected. Second, the virus appears to be spreading, including most recently to Europe; it has now killed tens of millions of birds in a number of countries. Third, it seems to be affecting more and more species, including cats, which usually aren't susceptible to bird flu, and pigs, which traditionally have been a species that acts as a "mixing bowl" for viruses transmitted between birds and people. But whether this virus will ever make the genetic changes needed to infect humans on a mass scale, or how long that might take — there's just no way of knowing.

If the disease were to become transmissible among humans, how likely is a rapid worldwide spread?

Right now, there's no evidence of sustained, efficient, human-to-human transmission. Most cases of bird flu in humans appear to have come from contact with infected birds, not infected people. When the virus has been passed from one person to another, the illness has been confined to close family members and doesn't seem to have spread to the wider community. This indicates that at least for now, the virus hasn't discovered how to effectively move from human to human.

If the virus mutates enough so that it spreads quickly among people, the great worry — and this wasn't true in 1918 — is modern transportation. Theoretically, infected people could board a plane and unwittingly carry the virus to the other side of the world in a matter of hours.

Some public health officials foresee dire consequences — an epidemic like the flu pandemic of 1918, which killed millions of people. Is this likely?

Some of what's driving this concern is the historical perspective. An influenza pandemic occurs when a virus mutates so drastically from previous strains that people have little natural immunity, and so large numbers of people get sick or die. Flu pandemics typically occur about once every 30 years. Because the last pandemic took place in 1968, the thinking is that we're due for another one. And because there would be little natural immunity to H5N1, the effects could conceivably be devastating.

With the government's release of an official plan for pandemic flu, will a major outbreak be handled properly?

The government's plan for pandemic flu includes information for state, national and international efforts to manage a flu pandemic. Plans are in place to get and distribute vaccines and antiviral drugs. The document also suggests preparing for limited international and domestic travel, including limited use of public transportation. Those who do travel will be screened and quarantined if necessary. For individuals, the plan recommends practicing good infection control hygiene — such as keeping hands washed and staying home if you are ill. The report also recommends staying away from crowds, planning for school closings and having food and water on hand.

While this plan is an important framework for handling pandemic flu, each community, each organization and each household will also need to take responsibility for planning and implementing their own response to a pandemic.

Are effective vaccines to prevent bird flu available? If so, is there enough to treat everyone around the world?

There's no commercially available vaccine as of yet, although prototypes that may offer some protection against the H5N1 strain are being studied. Once a specific vaccine is ready to go, it could take several months or more to produce meaningful supplies.

More readily available, and the primary treatment option right now, is the flu drug oseltamivir (Tamiflu), which may help limit symptoms and reduce chances the disease will spread. But it's not clear how effective this drug will be against bird flu. In Southeast Asia, H5N1 strains seem to have become resistant to it fairly quickly, and resistance to anti-flu drugs is growing worldwide. What's more, Tamiflu has to be taken within two days of the appearance of symptoms, which might prove logistically difficult on a worldwide scale, even if there were enough of the drug to go around.

Nevertheless, governments are stockpiling Tamiflu, but that doesn't mean that individuals should. For one thing, the drug is in short supply, and if there were a pandemic, it would be needed to treat infected people and help control the spread of the virus.

Young children and older adults are at greatest risk of regular flu. Who is most at risk of bird flu?

The 1918 strain was most lethal in adults in the prime of life, which means that pandemic strains may behave differently from the strains of flu that normally circulate. On the other hand, children seem very susceptible to bird flu, but that may be because they are more likely to have contact with infected birds or to play on ground contaminated with droppings. So far, people of all ages have contracted and died of bird flu.

Is there anything I can do to prepare for a potential bird flu outbreak?

The best thing to do is to take reasonable precautions. For instance, continue to get annual flu shots. They won't protect you from bird flu specifically, but they will reduce the risk of simultaneous infection with human and bird flu viruses — the main way that viruses swap genes, leading to new strains that can cause pandemics. Beyond that, the best protection is to wash your hands thoroughly and often and to avoid people who are sick or to stay home if you're sick yourself.

If you're traveling to areas where bird flu is prevalent, there are additional precautions you should take: Avoid rural areas, wild birds and open-air markets, and steer clear of ice cream and any other foods that contain raw or undercooked eggs because the shells may be contaminated with droppings.

What is a good way to monitor news on bird flu? How can I separate reliable information from speculation?

Two good sources for factual information are the Web sites of the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO).

US sampling of birds for J5n1

National Avian Influenza Surveillance Information

Right click on map for full image

Surveillance News:

Test results for 12030 samples have been entered into HEDDS as of September 1, 2006 Highly pathogenic H5N1 avian influenza virus has NOT been detected in these samples.

Birds Tested by State in the 2006 Sampling Season *

Indonesia to try vaccination program

Indonesia to vaccinate 300 million poultry

Jakarta (dpa) - The Indonesian government will press ahead with plans to vaccinate some 300 million poultry from the bird flu virus despite fears by some health officials that vaccines are not effective, a local report said Tuesday.

The plan will be done in stages with 60 million doses being prepared for vaccinations beginning this month and running through December, The Jakarta Post reported.

Bird flu outbreaks have been confirmed in 29 of 33 Indonesian provinces, affecting tens of millions of birds and killing 46 people - the highest death toll in the world.

A 2-year-old boy was admitted to hospital in West Java province on Monday suffering from bird flu symptoms, including high fever and respiratory problems.

"The target of the mass vaccination is 300 million chickens," Musni Suatmodjo, director of animal health services at the Indonesian Ministry of Agriculture, was quoted as saying.

The H5N2 vaccine being used is closely related to the H5N1 virus affecting poultry and also generally covers various other forms of H5 viruses, according to health officials.

However, there is debate among health officials in Indonesia as well as abroad on whether mass culls are more preferable to vaccines to prevent and contain outbreaks.

The Jakarta government has been reluctant to do widespread culling, partially because it does not want to compensate poultry farmers. The government came under fire for its initial slow response after bird flu was first discovered in Indonesia in 2003.

Last week, the government launched a national bird flu education drive to teach the country's 230 million people, in particular rural farmers and their families, about the virus and how to avoid being infected.

On Sunday, animal quarantine officers in the Maluku Islands seized 2 tons of fertilizer made from bird droppings, which will be incinerated if it is found to be contaminated with the virus.

Bird Flu PT.1

Rap version of bird flu?

BBC says funding for H5N1 to be cut

Avian flu research 'could be cut'

Prospect said public health could be affected if research was reduced

Vital research into avian flu, environmental pollution and food safety could be reduced to save money, government scientists have claimed.

The Department of Food and Rural Affairs (Defra) has to save £200m partly due to mistakes at the Rural Payments Agency, said Farming Today.

The union Prospect told the BBC Radio 4 programme its members could be forced out of work as a result of the cuts.

Defra said ministers were still working on the budget and would not speculate.

Target for cuts

Farming Today's Anna Hill said Defra's shortfall was due in part to "costly mistakes at the Rural Payments Agency (RPA), which failed to deliver a new subsidy system to farmers on time".

The agency had been criticised for late payments of the new subsidy, which gives farmers a single sum irrespective of how much food they produce.

Some 2,000 farmers were then overpaid by £20m this summer, for which Defra apologised.

Some cheques were stopped, while the agency said it would contact other farmers about recovering the money.

Defra has to save the money in the next six months and government scientists believe they could be the target for cuts.

Prospect told Farming Today public health could be affected if research was reduced.

The union is due to launch a campaign to highlight its concerns.

Defra said until the budget was finalised, it would be premature to speculate on its potential effects.

Vietnamese ducks with flu

New bird flu outbreak suspected in Vietnam after 100 ducks die suddenly

The Associated Press Published: September 4, 2006

HANOI, Vietnam More than 100 ducks have died suddenly in southern Vietnam in a suspected new bird flu outbreak, an official said Monday. Another 400 ducks were culled and samples were sent to the Ho Chi Minh City Regional Veterinary Center for testing to determine whether the H5N1 strain of bird flu was responsible for the deaths discovered on Friday, said Tran Van Quang, deputy director of the animal health bureau in Dong Nai province. "When more than 100 ducks died suddenly, we treated it as a bird flu outbreak," Quang said. Vietnam had not reported any outbreaks in poultry this year until the virus was detected through random testing in a handful of poultry in southern Ben Tre province last month. Vietnam has not reported any human cases in nearly a year. Authorities urged farmers to vaccinate about 80,000 ducks in the province, and farmers were given until the end of October to stop raising them. All ducks discovered after the deadline will be destroyed, Quang said. Prime Minister Nguyen Tan Dung over the past month has issued a series of decrees urging local governments to step up efforts to prevent a bird flu resurgence, as flare-ups have been reported in Vietnam's neighboring countries. Bird flu ravaged poultry farms in Asia in late 2003. It also jumped to humans killing at least 141 people worldwide. Most human deaths have been traced to contact with sick birds. Experts fear the bird flu virus may mutate into a form that can easily spread among people, possibly sparking a pandemic. HANOI, Vietnam More than 100 ducks have died suddenly in southern Vietnam in a suspected new bird flu outbreak, an official said Monday. Another 400 ducks were culled and samples were sent to the Ho Chi Minh City Regional Veterinary Center for testing to determine whether the H5N1 strain of bird flu was responsible for the deaths discovered on Friday, said Tran Van Quang, deputy director of the animal health bureau in Dong Nai province. "When more than 100 ducks died suddenly, we treated it as a bird flu outbreak," Quang said. Vietnam had not reported any outbreaks in poultry this year until the virus was detected through random testing in a handful of poultry in southern Ben Tre province last month. Vietnam has not reported any human cases in nearly a year. Authorities urged farmers to vaccinate about 80,000 ducks in the province, and farmers were given until the end of October to stop raising them. All ducks discovered after the deadline will be destroyed, Quang said. Prime Minister Nguyen Tan Dung over the past month has issued a series of decrees urging local governments to step up efforts to prevent a bird flu resurgence, as flare-ups have been reported in Vietnam's neighboring countries. Bird flu ravaged poultry farms in Asia in late 2003. It also jumped to humans killing at least 141 people worldwide. Most human deaths have been traced to contact with sick birds. Experts fear the bird flu virus may mutate into a form that can easily spread among people, possibly sparking a pandemic.