Do they appreciate it?

U.S. offers more bird flu funding

JAKARTA: The U.S. pledged Friday to provide an additional US$3.2 million to help fight bird flu in Indonesia, which has recorded 49 deaths, the world's highest number.

Building on a $14.65 million bird flu prevention and control program, USAID will provide the $3.2 million for enhanced surveillance, response and prevention, the U.S. embassy said.

Of that amount, $2.2 million will be supplied in the form of personal protective gear and disinfection kits.

After meeting with Coordinating Minister for the People's Welfare Aburizal Bakrie,, USAID Avian Influenza director Dennis Caroll said that the U.S. was pleased with the Indonesian government's redefined bird flu priorities. -- JP

Fairfax, Virginia weighs in with bird flu possibilities

FAIRFAX, Va. A new report says a severe outbreak of bird flu would infect nearly a third of Fairfax County's population, killing almost 700 people.
Emergency management officials say Fairfax is the Washington area's first local government to issue a comprehensive report on pandemic flu preparations.

According to the 112-page report, as much as 40 percent of the county's work force would be out of commission. And hospitals, nursing homes and other makeshift medical centers would have to set up temporary morgues and stockpile body bags to handle the deaths.

In response to an outbreak, the Fairfax County would track individual infections through reporting by local doctors and hospitals. Sites also would be set up across the county to distribute a potential vaccine or medicine, and sick people could be forced into quarantine.

___

Information from, The Washington Post: http://www.washingtonpost.com

5 ways to get bird flu

Azerbaijan might face bird flu danger in autumn and winter

[ 16 Sen. 2006 14:43 ]

Azerbaijan might face bird flu danger again in autumn and winter months. An individual must be very careful if he has fever over 38, coughs and feels flu symptoms in October-November, he should see a doctor.

The Republic Anti-Plague Station deputy director Faig Mammadzadeh warned today, APA reports.
He said a doctor should take into account five factors while suspecting of bird flu. The first is detection of avian flu virus in the area or the patient’s coming into contact with infected bird. The second is the patient’s coming into contact with suspected dead birds and infected wild bird. The fourth is the patient’s having half-cooked fowl or egg. And the fifth factor is the patient’s working in a virus-study lab./APA/

Hawaii to check migrating birds

art
CRAIG T. KOJIMA / CKOJIMA@STARBULLETIN.COM
Wildlife biologists Jenny Hoskins and Jeff Burgett, from the U.S. Fish and Wildlife Service, obtained a sample from a duck yesterday at Campbell Wildlife Refuge to test for avian flu.

Isle birds to be tested for flu
State and federal teams searching for the deadly virus will catch up to 3,000 birds
By Diana Leone
dleone@starbulletin.com

The search for bird flu in Hawaii moves to a new front next week as wildlife technicians begin catching and testing wild birds for the virus.

Got dead birds? Call 211
Operators at the Aloha United Way 211 information line have a list of questions to help determine whether a dead bird or birds is a candidate for avian flu or West Nile virus testing, and can provide instructions on what to do if so.

The mission is to catch and test up to 3,000 birds across the state by Dec. 31, said Megan Laut, a field coordinator for the state Department of Land and Natural Resources and a team member.

The team does expect to find some bird flu virus because there are multiple strains of it, said U.S. Fish and Wildlife Service spokesman Ken Foote.

But most of the bird flu viruses do not make wild birds sick - let alone humans.

What they are looking for is the highly pathogenic H5N1 virus. That is the strain that has infected at least 250 people worldwide since 2003 and killed 130, according to a fact sheet jointly issued by state and federal health and wildlife agencies.

The deadliness of the virus has spurred health officials worldwide to unprecedented actions to track it and to prepare for a possible pandemic if it mutates and becomes passable from human to human.

So far, people who have been diagnosed with bird flu have gotten sick through close contact with infected domestic birds like chickens.

Since November, Hawaii's Health Department has been testing travelers at Honolulu Airport who have a respiratory illness and have been in countries with reports of bird flu. There have been no human positives for the H5N1 virus through that testing, said Dr. Sarah Park, Health Department deputy chief of the Disease Outbreak Control Division.

The state lab recently has been equipped and workers trained to receive samples from wild birds and from Hawaii poultry farms, said Christian Whelen, administrator of the Health Department Laboratories Division. None of the 21 tests conducted on Hawaii bird samples so far have found any positives for bird flu, he said.

"There's no evidence that H5N1 is in Pacific wild birds and no reason to believe that it's a health risk," Foote said, "but it's our responsibility to be on the lookout."

The U.S. West Coast, Hawaii and U.S.-affiliated Pacific islands - Guam, the Northern Mariana Islands, American Samoa, Palau and the Marshall Islands - begin cooperative bird flu testing in wild birds this fall.

Priority will be on migrating birds most likely to interact with Asian birds or North American birds, such as kolea (Pacific golden plover), ruddy turnstones, sanderlings, sharptailed sandpipers, northern shovelers, bristle-thighed curlews and wandering tattlers.

The birds will be caught in specially designed nets, called mist nets, that are set up like a finely webbed, 10-foot-deep volleyball net, Foote explained.

When a bird flies into the net and is caught, the workers gently remove it, hold it to obtain a swab sample from its lower intestines and release it.

The testing is not expected to harm the birds, Foote said.

Yale makes plans for bird flu

Campus plans for potential flu outbreak
Daniel Katz
Staff Reporter

Yale is currently developing an emergency response plan in case of an outbreak of avian flu, University officials said Wednesday.

The Office of the Secretary, which manages the University's emergency operations, has been working on the plan since this summer, Deputy Secretary Martha Highsmith said. The office has convened meetings with Yale dining, facilities and security officials as well as campus, city and state health experts to formulate its details.

Since a worldwide avian flu outbreak might affect many people both on and off campus, it is important that the University be prepared, Highsmith said.

"There are lots of different scenarios about how bad an avian flu outbreak could be," she said. "The cases that have appeared, mostly in parts of Asia, have been very serious. We want to be prepared if we want to face anything like that."

In drafting their proposal, University officials have studied the 1918 flu pandemic, since it is the only scenario available, Highsmith said. But a flu outbreak today would be different from that of 1918, mainly because the disease would travel faster and there are more effective ways to treat it, she said.

University Health Services Director Paul Genecin said UHS has formulated a hypothetical planning model similar to that of the Centers for Disease Control and Prevention. The model assumes that approximately 25 percent of people would become ill to different degrees, Genecin said.

"We have developed a plan, and we continue to develop it for providing a considerable amount of medical care to people on campus in a kind of clinical facility that we would be able to commission quickly using one of the athletic facilities as a space," Genecin said.

The facility would be able to accommodate about 150 people, and the level of treatment would be less than intensive care, he said. The model assumes a limited capacity of Yale-New Haven Hospital to expand care since the hospital is normally stretched to its limits, Genecin said.

Yale is also considering other issues that might arise if an avian flu outbreak occurs, including whether students would be sent home or sporting events would be cancelled, Highsmith said. University officers will discuss the plan in the coming weeks, she said.

Dining Services Executive Director Don McQuarrie said the department would provide support services in the event of an outbreak.

"We will provide food services to the various groups that remain on campus and provide support to the triage centers that Health Services would set up in remote locations," McQuarrie said.

Dining Services would also be responsible for feeding the regular medical centers, he said. The meals would be produced in Commons and delivered at specific times, McQuarrie said.

Christopher Cox, spokesperson for the Centers for Disease Control and Prevention, said that although the H5N1 avian influenza virus - a subtype of the influenza A virus - currently does not have the capacity to spread easily from person to person, preparations by universities for a potential pandemic are logical.

"It's impossible to predict whether the current avian influenza virus will ever mutate into a form that could cause a pandemic," Cox said in an e-mail. "However, most experts agree that there will likely be another pandemic at some point. It makes sense that colleges, communities, hospitals and the general public take steps now so that we can be as prepared as possible when the next pandemic comes."

Human to Human H5N1 transmission

Human-to-human transmission possible in Indonesia's 65th avian flu case

Sep 14, 2006 (CIDRAP News) – The World Health Organization (WHO) today recognized two cases of H5N1 avian influenza in Indonesia, including one from March that was first reported yesterday by a WHO official and one from May involving a man who may have become infected after exposure to an ill family member.

In both instances, the WHO has retroactively confirmed the cases on the basis of its new criteria for laboratory confirmation. The boy's case put Indonesia's count at 64 cases with 49 deaths, and the man, who recovered, represents the country's 65th officially confirmed case.

The 5-year-old boy from East Bekasi in West Java province became ill on Mar 4, was hospitalized 2 days later, and died on Mar 19. The WHO said test results using two different assays revealed high antibody titer for H5N1 on serum samples taken on days 11 and 15 of his illness. Field investigators had determined that the boy had been exposed to sick poultry near his home, where some birds had tested positive for the H5 virus subtype.

Investigators identified the second case, in a 27-year-old man from Solok in West Sumatra province, when they traced contacts of the man's 15-year-old sister who had a confirmed H5N1 infection in May. Her brother spent 6 days caring for her during her hospitalization. On May 28 he experienced mild cough and abdominal discomfort but no fever. His symptoms improved and he recovered in a few days.

Despite his mild and atypical symptoms, the brother was tested as part of the health ministry's contract tracing and management program. He was given a 5-day course of oseltamivir beginning Jun 1 and was placed in voluntary isolation during his recovery.

Initial samples were negative for H5N1 infection; however, in August, follow-up testing of paired-serum samples found a fourfold rise in neutralization antibody titer for H5N1, a result that meets WHO's new criteria for laboratory confirmation.

The man reported no contact with diseased or dead poultry before he became ill. Investigators determined that human-to-human transmission resulting from exposure to his sister could not be ruled out.

The WHO issued a report confirming his sister's H5N1 infection on May 29. It said she remained hospitalized, but no details were available on the outcome of her illness.

In other developments in Indonesia, the director of the country's main treatment center for avian flu told participants attending a scientific conference in Jakarta yesterday that avian flu will continue to circulate among the country's poultry flocks because of shortfalls in vaccination and biosecurity measures, according to an article today in The Jakarta Post.

Santoso Soeroso, director of Sulianti Saroso Hospital, said improper vaccination of ducks and chickens may be contributing to the spread of the H5N1 virus. He said authorities are using substandard vaccines and are unable to evaluate the effectiveness of the programs because they lack an unvaccinated control group.

Soeroso said recent research in Bali province revealed a vaccine failure rate of 39% and that 60% of the area's ducks had avian flu.

Indonesian agriculture minister Bagoes Poermadjaja told the group that only 60% of the country's 300 million chickens and ducks had been vaccinated. He said the country lacked resources of early detection and is not adequately compensating citizens for slaughtered birds.

He said biosecurity measures are also deficient, and he noted that most cases of avian flu in humans had occurred in provinces where transport of poultry is constant. Poermadjaja also said weak coordination between central government and regional administration hinders the coordination of avian flu prevention and management.

Prisons potential breeding grounds for H5N1

Description
One of the most potentially dangerous breeding grounds of disease is woefully ill-prepared for a bird flu crisis, according to a new study being presented today by researchers at Saint Louis University.

Newswise — As the fear of an impending avian flu pandemic is compelling hospitals, businesses and cities to develop preparedness plans, one of the most potentially dangerous breeding grounds of disease is woefully ill-prepared for a crisis, according to a new study being presented today by researchers at Saint Louis University.

“There’s a real failure to recognize how important the health status of inmates is to the public health of all of us,” says Rachel Schwartz, Ph.D., a researcher at the Institute for Biosecurity at Saint Louis University School of Public Health. “Nearly 85 percent of those in jails and prisons will be released within a year. So even if we as a society don’t think protecting them from disease is a priority, prisoners released into the general population pose a real threat to society.”

The research is being presented today at the Correctional Medicine Institute’s 2006 Conference in Baltimore.

There are more than two million prisoners in the United States, making up what Schwartz calls “a highly vulnerable population.”

“There’s a much higher level of disease among prisoners – people with HIV, drug-resistant tuberculosis, hepatitis C and other diseases,” she says.

She adds that 80 percent of inmates come to prison with some sort of illness.
“And once they’re incarcerated, they’re more likely to get other diseases. It makes correctional facilities into ticking time bombs. Many people crowded together, often suffering from diseases that weaken their immune systems, form a potential breeding ground and reservoir for diseases.”

Schwartz and fellow researchers studied research and protocols from the Centers for Disease Control, the World Health Organization and other governments to identify what plans were in place for prisons should an infectious disease break out.

Many of the correctional facilities that Schwartz and colleagues studied have acknowledged they don’t have an adequate plan to deal with a pandemic or similar health crisis. Schwartz says there’s reluctance among government leaders to provide prisoners with medical care, such as flu vaccines.

“The thinking is that there won’t be enough for the general public, and that they should get the shots first,” she says. “We tend to think of all inmates as being violent offenders, but the average length of incarceration is only 48 hours. Many are not convicted criminals, but rather people merely accused of crimes and awaiting trial.

“We know that illness among prisoners will eventually spread and cause illness in society, so we must address this now.”

The solution, says Schwartz, is to spend more energy and money on preparedness. She and fellow researchers developed a plan to educate the judicial and prison systems on ways to prevent the spread of disease, from meticulous hand-washing to appropriate use of quarantine and isolation in prison and jail settings.

The pandemic plans are designed to provide useful information for many kinds of crisis situations, Schwartz says.

“Ideally, they will help authorities prepare and respond to anything from a bird flu breakout to a biological attack. The information is also critical for existing illnesses within prisons, like HIV, not just emerging infections.”

Saint Louis University School of Public Health is one of only 37 fully accredited schools of public health in the United States and the nation’s only School of Public Health sponsored by a Jesuit university. It offers masters degrees (MPH, MHA and MS) and doctoral programs (Ph.D.) in six public health disciplines and joint degrees with the Doisy College of Health Sciences, and schools of Business, Law, Medicine and Social Service. It is home to seven nationally recognized research centers and laboratories with funding sources that include the National Institutes of Health, the Centers for Disease Control and Prevention, the Health Resources and Services Administration, the American Cancer Society, the Robert Wood Johnson Foundation and the World Health Organization.

The Saint Louis University Institute for Biosecurity was established in 2000 to provide public health and emergency response professionals with the education needed for preparedness, response, recovery and mitigation of emerging public health threats. Faculty and staff at the Institute conduct research that contributes to the development of national policies to address these threats.

South Korea update

South Korea's disease control agency confirmed Friday that five people have developed antibodies to the lethal H5N1 strain of bird flu after taking part in the slaughtering and disposal of infected chickens and ducks.

The five people tested positive for bird flu antibodies, but none of them have shown symptoms of the disease as defined by the World Health Organization (WHO), the Korea Center for Disease Control and Prevention (KCDC) said.

There is no chance they could spread the disease to others, it said, adding the workers were probably exposed to the bird flu virus in late 2003 through March 2004. The announcement raises the number of South Koreans that developed antibodies to the H5N1 strain to nine.

The state-run agency confirmed four cases in February. "There are no public health risks and no need for people to not consume poultry or eggs," a KCDC spokesman said. The affected people were given the antiviral drug Tamiflu beforehand to guard against infection. People close to the five have also been checked and none have been found to be infected, he added.


South Korea remains a bird flu clean zone and people were free to eat chickens, ducks and eggs, the spokesman said.

In 2003-2004, South Korea had to dispose of a large number of chickens and ducks when the H5N1 strain swept through the country.

The South Korean government destroyed 5.3 million birds in the outbreak at a cost of about 1 trillion (US$1.04 billion) won to prevent the spread of the disease.

The latest discovery was made as it cross-examined blood serum from about 2,109 people who took part in the cleanup operations.

Of these, 142 people who ran the most risk were tested in 2004, while 318 who were less likely to have been infected were screened in 2005.

No South Koreas have fallen sick or died from the H5N1 strain of the virus so far, but the flu has killed people in such countries as Cambodia, China, Indonesia, Thailand and Vietnam.

Seoul, Sept. 15 (Yonhap News)

New material for poultry workers uniforms

Tokyo, Sept 14, 2006 (JCN) - Shikibo Ltd. and the National Institute of Animal Health have jointly developed a fabric called 'Flutect' that has been proven to block the spread of bird influenza by 99.9%, even after 50 washings, stopping the spread of the virus within 10 minutes of exposure.

Flutect will be available in 2007 in the form of uniforms for poultry house workers, masks, filters, down jackets, lab-coats and so forth.

By Sarah Hall, JCN Staff Writer

Los Angeles schools prepare for flu

School Officials Roll Out Bird Flu Guidelines

POSTED: 5:24 pm PDT September 13, 2006
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LOS ANGELES -- The bird flu has not arrived in North America.

However, state school officials are rolling out new guidelines to be ready just in case.

Schools are hotbeds for germs and flu transmission.

In the case of a widespread flu pandemic this can become a serious problem. That's why school and health officials are trying to prepare for the worst-case scenario.

Wednesday the state schools chief made a checklist available to all schools to help them better prepare and respond to pandemic flu.

The list includes steps such as:

# Prepare for the possibility of schools functioning with only 30 percent of staff people present

# Account for what students with medical conditions will need in case of emergency

# Develop a communication plan about schedule changes and possible school closures

Schools are encouraging students to stop the spread of infections in low-tech ways like washing their hands, covering their mouths when they sneeze and cough and staying home if they are sick.

Web sites:

CDC Cover Your Cough
CDC Materials
Pandemic Flu Individuals and Families Planning Pandemic Flu Planning Checklist

Hand cream kills bird flu

Firm has bird-flu killer in its grasp

Sep 12 2006

By Graeme King, The Journal


A new hand cream to tackle bird flu could be worth millions to Newcastle company Dermasalve Sciences.

The team from Dermasalve have been working with partner Drug Delivery Solutions to launch the product on to the market - and have now seen the cream pass tests carried out by an independent company to prove its bug-killing properties.

Leading European contract virology company Retroscreen Virology has provided confirmatory test documentation to show that the cream does kill the H5N1 bird flu virus.

The tests confirmed 99.99% kill activity within 30 seconds of a single application of the cream, and that remains active for at least 30 minutes after a single application of the gel.

Dermasalve Sciences manufactures and distributes a range of skin healthcare products specifically for people who suffer from dry and sensitive skin.

New website for information on bird flu

Affiliated Physicians' Avian Flu Education Site (Graphic: Business Wire)
9/12/2006 9:00:00 AM EST

BIOWIRE

Affiliated Physicians, a corporate medical practice group that provides medical services to corporations and government agencies, launches an online education site (www.APFluWatch.com) today for its clients, their employees and the public to research and better understand the avian flu, its symptoms and how it is transmitted.

As of August 2006, 234 cases of Avian flu were reported worldwide, resulting in 136 deaths, a 56 percent fatality rate. "One of our main goals at Affiliated Physicians is to restore, preserve and enhance the health of our clients by providing a full range of preventative and diagnostic health services," said Ari Cukier, vice president of program development at Affiliated Physicians. "Because of that goal, we feel it is critical that we increase awareness among our clients of the threat posed by a potential avian flu pandemic."

With its new online learning Web site, Affiliated Physicians is working not just to educate people about the avian flu but to help its clients develop specific medical response contingency plans in order to mitigate the impact of the threat on employees.

The tool, which features quizzes for learners to test their knowledge, provides users with background information and a series of prudent steps that should be taken prior to the threat materializing, during alerts and periods of high risk and during an actual, confirmed outbreak of the avian flu.

"Affiliated Physicians' choice to leverage online education to reach its customers and their employees is very forward thinking and is evidence of the proactive approach they take to preventative health maintenance," said Charlie Gillette, president and CEO of Knowledge Anywhere, the company that developed the course. "By making the site available to the general public, they are making it possible for each of us to learn more and put a plan in place as individuals and communities."

In the same vein of being proactive, Affiliated Physicians is offering a medical interview to each of its corporate employees in addition to a prescription for Tamiflu, a product made by Roche that is thought to be effective in combating a pandemic virus.

Affiliated Physicians has created a robust program to assist companies and their employees in preparation for a possible flu pandemic. The program, designed to augment companies' existing business continuity plans, includes: Education (onsite and remote), onsite vaccination programs, anti-viral dissemination programs, and corporate medical consultation.

The site can be accessed at: www.APFluWatch.com.

About Avian Flu

The avian flu virus (H5N1) is a specific strain of the influenza virus that has been found in worldwide populations of birds and has recently been known to also infect some humans.

Experts believe that this strain has a very good chance of mutating to a form that is easily transmittable from human-to-human. Because this strain is deadly and a mutated strain is likely to be very different from flu strains of the past, people have almost no immunity to it which could result in a worldwide pandemic.

About Affiliated Physicians

Based in New York City, Affiliated Physicians is a Corporate Medical Practice providing high quality corporate medical services to corporations and government agencies in the New York/Metropolitan area and Nationwide since 1982. Additionally, AP has over 400 contracted medical facilities nationally.

Pleasant and efficient handling of patients and meeting the special and varied needs of the corporations and agencies it serves has earned AP the reputation for providing quality, courteous and personalized medical care.

For more information about Affiliated Physicians, please visit www.affiliatedphysicians.net.

About Knowledge Anywhere, Inc.

Knowledge Anywhere provides technology-based learning and performance support solutions to corporations around the globe. Founded in 1998, the company deploys products and services to train large numbers of employees, customers and partners in an efficient and engaging manner that both maximizes the training dollar and the experience for the individual learner. Knowledge Anywhere's talented team of developers, designers, engineers and project managers work diligently with each client to customize their solution and see each project through.

Knowledge Anywhere's valued customers represent a variety of industries including the medical, telecommunication, technology, manufacturing, distribution and finance.

Its customers include Compuware, Microsoft, Hewlett-Packard, Lawson Products, Captaris, Starbucks, and E. & J. Gallo. Customers turn to Knowledge Anywhere when looking for products and services to help implement solutions ranging from Web-based learning solutions to applications running on handheld devices, to context sensitive help systems on state-of-the-art instruments.

For more information about Knowledge Anywhere, please visit www.knowledgeanywhere.com.

CONTACT:

Communique PR Jennifer Gehrt, 206-282-0696 Jennifer@communiquepr.com

Reseach on travels impact on flu season

In 2001-02, reduced air travel delayed flu season

Sep 12, 2006 (CIDRAP News) – Researchers reported today that reduced air travel in the wake of the Sep 11, 2001, terrorist attacks delayed and prolonged that year's influenza season.

The study, published this week in the online journal Public Library of Science–Medicine, provides what the authors call the first empirical evidence for an effect of air travel on the spread of flu. As such, the findings may elevate the role of travel restrictions in pandemic planning.

Using 9 years of weekly influenza and pneumonia mortality data (1996 to 2005) from the Centers for Disease Control and Prevention (CDC), researchers from Harvard University and the Massachusetts Institute of Technology in Boston measured the rate of influenza spread across nine regions. Then they used government estimates of air travel volume to assess whether it was related to the timing of yearly flu outbreaks.

The researchers found that the national peak date for flu mortality was within 2 days of Feb 17 in the first 5 seasons they examined (1996-97 to 2000-01). But in 2001-02, the peak date was Mar 2, 13 days later than the previous average. In the ensuing 3 seasons, the peak date progressively returned to the Feb 17 baseline.

For comparison, the authors analyzed flu and travel data for France, where air travel was not restricted after the terrorist attacks. The investigators found no evidence of a delay in France's flu season that year.

The researchers also reported an overall finding that the seasonal flu spread more slowly when the number of domestic air travelers was low, particularly in November.

"Our results suggest that for a nonpandemic year, travel during the Thanksgiving holiday may be central to the yearly national spread of influenza in the United States," they write.

Also, the team found that the flu season peaked later when the number of international air travelers was lower, particularly in September.

The authors say their findings suggest that airline passenger volume explains about 60% of the year-to-year variation in the spread of flu across the country. They say other factors remain unknown; they were unable to link the timing of seasonal flu deaths to the weather.

The spread of highly pathogenic H5N1 influenza has intensified debate about whether border controls and travel restrictions can slow a pandemic, the article notes. "Our results suggest that limiting domestic airline volume may have a measurable impact on the rate of spread of an influenza pandemic, and particularly on spread across regions," the investigators write, adding that the benefits would hinge on early detection and immediate intervention.

Brownstein JS, Wolfe CJ, Mandl KD. Empirical evidence for the effect of airline

What the heck is this bird flu stuff..its disappeared from the news

Bird flu: A beginner's guide, to quell panic

Why is flu in birds suddenly such a problem? Headlines, newscasts, and documentaries flood us with news of developments. What does it all mean? Where did it come from and where is it going?

Terminology we have not seen before, like "H5N1", "clusters", "genetic drift and shift", "zoonosis", "pandemic" and others get thrown around as if plainly understood. Getting a grasp of the problem and the risks, and thus putting breaking news into context, requires some understanding of virus biology.

Without it, we are at the mercy of irrational fear and the dire consequences of panic in the face of what is likely to be a relatively minor threat.

Contributor J Kevin Baird offers a "road map" for the uninitiated to navigate through the quagmire of misunderstanding:

How a virus works

The chemical code of life is deoxyribonucleic acid (DNA). All living things possess their own unique code, expressed in the sequence of just four different chemicals.

Some evolutionary biologists view all forms of life as simply representations of a survival strategy by a particular collection of these four chemicals. This view holds, for example, that the being we see as a horse is an instrument constructed around horse DNA that allows the molecule to survive.

No living things express this minimalist concept more plainly than viruses. Viruses represent the simplest form of what can be considered a living thing. They are bundled packages of DNA or its complementary chemical partner, RNA (as with influenza).

The bundles of proteins and other biological molecules surrounding the genetic material provide the virus a means of getting into a particular kind of cell it favors, so HIV favors immune cells and hepatitis virus favors liver cells, etc.

Once inside the target cell, the genetic code of the virus inserts itself into genetic material of the cell and issues instructions to the cell to make thousands of copies of the virus. The hijacked and doomed host cell bursts, releasing new viruses to infect new cells.

Balancing act

This form of parasitism is a tricky business for the virus. If all viruses were completely successful, there would be no life left in which to continue their existence. A virus that asserts itself too powerfully will eventually kill off the beings it depends upon to live.

It must show some restraint or perish. Conversely, the virus must also deal with a host having the equipment to defend itself from such attacks. The host immune system vigorously counterattacks, and a lack of assertiveness by the virus would be its doom.

The virus must strike a working balance between successful copying and coping with a provider bent on its destruction. These forces have shaped the viruses into the agents of many diseases we recognize today.

Living evolution

Viruses, like all living things, evolved into the beings present today. Their strategies have been honed and refined by natural selection, the crucible of Darwinian evolution. Viruses that have been with us a long time have adopted various strategies of balance between the harm they cause and the infection absolutely required for their survival.

These viruses tend to be more benign. Their balancing act is a good one. But Nature experiments continuously. New viruses are constantly thrown out, testing the waters of the living world they inhabit. The newer viruses are clumsier and they tend to cause more severe disease.

Viruses are not thinking, strategizing beings. External forces drive their strategizing, where a good strategy results in more copies being made than with a poor strategy.

Think of coconut trees. On the most isolated sandy atoll in Indonesia we see coconut trees standing. How did they get there? Coconuts float. They drop into the sea and off they go, at the mercy of wind, wave and current to find a suitable sandy beach.

A very, very small fraction of them, perchance, actually do. Coconuts do not consult maps and weather forecasts. If one lands on a beautiful sandy beach in Alaska -- and some do -- it is doomed. Most others become waterlogged and sink without ever seeing a beach.

The coconut tree employs a strategy of dumping hundreds of coconuts into the sea and playing the odds that one of them will land at a hospitable site.

Viruses do much the same. They cast themselves out into the living world in their billions playing the odds some of them will find that tropical sandy beach of viruses -- access to the cell they are capable of commandeering.

The nature of bird flu This is what is going on with bird flu. The influenza virus experiments by creating copies with random errors in its genetic code. A very small fraction of those errors will, by chance, yield a virus better equipped to find its sandy tropical beach.

This is called genetic drift. Still other viruses will find themselves in the same host already infected by a related virus strain, and the two of them combine to create many thousands of hybrids with a relatively dramatically different genetic makeup compared to either of the original strains.

Rarely, one of those hybrids will successfully propagate and infect other hosts. This is called genetic shift.

Bird flu is in a group of closely related viruses known as influenza-A. Different strains inhabit the group, much like the races and myriad ethnic groups of humans. The strain designation for bird flu is H5N1, each letter referring to a convenient identity marker found in the envelope enclosing the genetic code of the virus.

Those marker types (the numbers) are specific biological molecules that vary slightly among strains. These variations provide scientists a convenient means of classifying viruses in the influenza-A group, much like we use characteristics of skin color and facial features to determine a person's group identity.

Exactly where H5N1 strain emerged from and how is unclear. It may have been produced by a genetic shift event with the mixing of influenza strains circulating in different bird species. Clearly, the new strain found traction and has been wildly successful.

Its lethality to chickens has not slowed it down, largely because it can infect other species of birds, notably domesticated ducks, and do relatively little harm. Dead chickens simply represent the collateral damage of successes enjoyed elsewhere.

Bird flu in people H5N1 happens to be able to infect people. But the human host does not entirely agree with the virus -- although able to find receptive target cells and replicate itself, the strain finds it very difficult to bridge into a new human host.

Almost all human infections have been in the wake of direct contact with infected chickens, and the few cases of documented transmission from human to human followed close and prolonged contact with an infected person.

A superior influenza-A virus needs no such thing -- it jumps from human to human with great efficiency. This is probably a product of both the infectious dose -- a relatively low number of virus particles needed to successfully seed an infection -- and the inability of the human immune system to defeat the invasion.

H5N1 as it exists today does not possess the equipment to manage this.

Fatality rate with bird flu

The term "case fatality rate" describes the percentage of people exposed to a disease who succumb to it. Scientists do not know the case fatality rate for H5N1 infection. What they do know, and what the media often present as the case fatality rate, is the fatality rate among confirmed infections.

No one knows how many people have been infected by H5N1. We only know how many people have been diagnosed as infected and what happened to them.

The difference between these numbers -- real versus observed infections -- may be very large. People who experience H5N1 infection and an unremarkable illness will not be diagnosed. The reliable diagnosis of H5N1 requires an extraordinarily high degree of technical expertise and very costly equipment and supplies.

The laboratories capable of doing this do not examine people with mild illness. There are not enough machines and money to do so. Consequently, it is very likely that the true case fatality rate for H5N1 infection is very much lower than the more than 50 percent figures often described.

The writer is an expert in tropical infectious diseases who worked formerly with the U.S. Navy as a microbiologist. He was also a section editor for the American Journal of Tropical Medicine & Hygiene. He can be reached at jkb@vhasia.com.sg

Flu monitoring in the UK

By Patricia Reaney

LONDON, Sept 13 (Reuters) - British public health experts on Wednesday unveiled one of the largest systems in Europe for collecting data about people with flu-like symptoms, aimed at improving Britain's preparedness for an influenza pandemic.

Health experts believe an influenza pandemic capable of killing millions of people is already overdue. The H5N1 strain of bird flu has killed 143 people since 2003. It is still an animal disease but scientists fear the virus could mutate to become highly infectious in humans.

The QFLU system shown at the Health Protection Agency (HPA) conference in Coventry covers nearly 3,000 general practices across the country and more than 17 million people.

QFLU will track the number of people visiting their family doctors with flu-like symptoms and respiratory problems and patients prescribed antiviral drugs. If a pandemic strain of flu emerges, the information could be vital in identifying outbreaks early, the HPA said. "It is certainly a big step forward," Dr Gillian Smith, who headed the project at the HPA, said in an interview.

"The difference is the extent of the coverage of this and the number of people we can get data about and the localness of it," she said.

While the current scheme reports data on a weekly basis, which would be too late if a strain of pandemic flu emerged, QFLU would allow HPA experts to analyse the information daily.

QFLU is one of the biggest systems in Europe, Smith said, but the technology could be replicated in other countries where general practitioners use a similar computer system.

"QFLU has been developed to be quick, efficient and easy to use by those who will be in the frontline," she added.

QFLU was developed by surveillance experts at the HPA, which monitors infectious diseases in Britain, and scientists from the University of Nottingham and EMIS, which provides software systems for general practitioners.

Julia Hippisley-Cox, a professor at the University of Nottingham and a co-founder of QFLU, encouraged more family doctors to join the scheme.

"Pandemic flu is not an easy thing to prepare for," she said in a statement. "The information will help individual practices ... to plan resources for their patients, as well as helping the government to plan on a national scale."

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Update on deaths in Indonesia

JAKARTA, Sept 13 (Reuters) - A five-year-old Indonesian boy who died in March had bird flu, a health official said on Wednesday, raising the country's death toll from the virus to 49.

The boy died at Jakarta's Sulianti Saroso Hospital, the country's main bird flu treatment centre. He was from Bekasi on the eastern outskirts of the capital Jakarta.

The World Health Organisation (WHO) last week recognised three more cases of bird flu in Indonesia, one from June and two dating to 2005.

The boy has also been included after the WHO issued new definitions for human infections of the H5N1 avian flu virus, said Runizar Ruesin, head of the health ministry's bird flu information centre.

Prior to the recent revision of the WHO's definitions for H5N1 infection, the cases had not met the UN health agency's criteria for serologically confirmed avian influenza infection.

The Health Ministry said no one else in the boy's family was known to have been infected, although it was unclear how he caught the virus. Contact with infected poultry is the usual mode of transmission.

Indonesia has now recorded 64 cases of H5N1 infection. The national death toll is the world's highest.

Bird flu remains essentially an animal disease, but scientists fear the virus, which has killed at least 143 people since late 2003, could mutate and pass easily among humans, possibly killing millions.

Indonesia has been criticised for not doing enough to combat the disease, which is endemic in birds in most of the country's 33 provinces.

The government has so far refused to conduct mass culling of poultry, citing the expense and logistical difficulties in capturing and killing millions of backyard fowl.

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Hospitals in Vietnam get organized for influx

Vietnam prepares for potential bird flu outbreaks among humans
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Vietnam's Health Ministry has assigned 14 hospitals in major cities to closely supervise and promptly cope with any bird flu outbreaks among people, according to local newspaper Labor on Monday.

The hospitals and preventive medicine centers are to ensure the operation of disease surveillance systems around the clock, and the sufficient supply of facilities for treatment of bird flu patients.

The ministry said if the outbreaks spread, general hospitals in provinces had to form an isolation area at their infectious disease departments, and mobilize healthcare workers and equipment from first aid and pediatrics departments. Each hospital should set aside 10-20 beds for receiving bird flu patients.

The Vietnamese government has recently instructed state agencies and localities nationwide to intensify prevention of and fights against bird flu, including placing a temporary ban on import of live poultry and related products from countries hit by the disease. It has urged relevant ministries and People's Committees of localities to speed up bird flu vaccination among fowls nationwide, and maintain operation of anti-bird flu steering committees at all levels in preparation for potential outbreaks of bird flu among both fowls and humans.

Bird flu outbreaks, starting in Vietnam in December 2003, have killed and led to the forced culling of dozens of millions of fowls. The last outbreak of bird flu among poultry in the country was in December 2005, according to the Department of Animal Health under the Vietnamese Ministry of Agriculture and Rural Development.

To date, Vietnam has detected 93 bird flu patients, the country 's Health Ministry said on Monday, noting that it has seen no new human cases of infections since mid-November 2005.

Source: Xinhua

Vietnam researches bird flu

New bird flu findings announced

HO CHI MINH CITY, Vietnam, Sept. 11 (UPI) -- Vietnam scientists say they've discovered why the H5N1 strain of bird flu is much more deadly to people than are other human flu strains.

The researchers compared people infected with various strains of influenza and found the bird flu virus triggers a massive inflammatory response that often proved fatal, the BBC reported.

The team from the Oxford University Clinical Research Unit at the Hospital for Tropical Diseases in Ho Chi Minh City looked at 18 people who infected with H5N1 and eight infected with normal human flu.

The researchers found the H5N1 patients had much higher concentrations of the virus than those infected with a normal influenza virus, the BBC said. The researchers said the highest viral loads -- found in H5N1 patients who died -- caused a release of proteins called cytokines that should control a person's response to infection.

Dr. Menno de Jong and colleagues concluded, "The focus of clinical management should be on preventing this intense cytokine response, by early diagnosis and effective antiviral treatment."

The study appears in the journal Nature Medicine.

The Sudan announces a case of H5N1

Bird flu case confirmed in Juba
Monday, 11th September, 2006

By Joyce Namutebi

THERE is a confirmed outbreak of bird flu (Avian Influenza) in Juba, Southern Sudan, the Ministry of Health has announced.

The chairperson, National Task Force on Bird Flu, Dr. Sam Okware, said yesterday the outbreak was confirmed on September 6, and is affecting local chicken.

He directed the district health officers and district veterinary officers in Nebbi, Arua, Koboko, Yumbe, Moyo, Adjumani, Pader, Gulu, Kitgum, Lira. Apac, Kaabong, Kotido and Moroto districts to strengthen their task forces on bird flu to enhance surveillance and public education.

“In addition, the people at the country borders should be on high alert for any suspicious birds or poultry products being brought into the country,” Okware said in a press release yesterday.

He asked the public, especially people who have been travelling to Juba or Southern Sudan to be on ‘high alert’.

H5N1 infection explored

Bird flu triggers high and sustained virus buildup, cause of severe disease
15:13:05 EDT Sep 10, 2006
Canadian Press: HELEN BRANSWELL

(CP) - The severe disease that H5N1 avian flu provokes in people appears to be caused by the virus's ability to replicate at unusually high levels for a prolonged period - an overwhelming assault that triggers a massive and devastating immune system response, a new scientific paper suggests.

Interrupting that process before it reaches the tipping point is critical, say the authors of the article, who based their observations on detailed study of 18 H5N1 patients in Vietnam.

But experts unrelated to the research wonder whether the current anti-flu arsenal - mainly neuraminidase inhibitors such as Tamiflu - is equipped to do that job.

"The question I worry about is whether treating patients now with neuraminidase inhibitors may be very much like shutting the barn door after the horse is already out," said Dr. Michael Osterholm, director of the Center for Infectious Diseases Research and Policy at the University of Minnesota.

"I don't know that. But we've got to find that out."

The World Health Organization is in the process of setting up a research network across countries afflicted with H5N1, in the hopes that joint studies will answer questions like the one Osterholm poses.

Dr. Frederick Hayden, an antiviral expert who heads the effort, said the first task will be to investigate whether different dosing regimes for Tamiflu might achieve better results.

As well, the group hopes to look at whether a flu drug that could be administered intravenously would be more effective at combating H5N1 infection. Injectable forms of two drugs - peramivir and zanamivir - are in development.

"A potent parenteral (injectable) agent ... is really needed and will give us the ability, I hope, to more rapidly control replication in patients with these kinds of severe infections," Hayden said.

The paper, to be published Monday in the journal Nature Medicine, is the first detailed record of the disease process or pathogenesis of H5N1 in humans. The observations are based on 18 H5N1 patients who were treated in Vietnam during 2004 and 2005. Thirteen of them died.

The researchers charted the way H5N1 replicated in those cases and how their immune systems responded. The massive amounts of virus generated triggered production of excessive levels of some chemokines and cytokines, chemicals used to attract white blood cells - the body's cleanup crew - to the site of infection.

This hyperactive immune response - called a cytokine storm - actually does more damage than it sets out to fix. And scientists aren't clear on how to suppress the damaging parts of that process without disabling the immune system's ability to fight the virus.

Lead author Dr. Menno de Jong suggested the key is early treatment with antivirals, perhaps combined with drugs that modify the immune response.

"The paradigm 'Hit hard and hit early' which has been used for treatment of HIV-AIDS in the past may well be very true for the treatment of avian flu," said de Jong, a physician and virologist with Oxford University's Clinical Research Unit at the Hospital for Tropical Diseases in Ho Chi Minh City.

"Considering the likely role of the immune response in causing damage during the later stages of infection, it obviously makes sense to think about the use of anti-inflammatory or immune-modulatory treatment," he said in an e-mail interview.

"However, we still know relatively little about which part of the immunological cascade is best targeted and how to target this."

The director of the U.S. National Institutes of Allergy and Infectious Diseases said more needs to be known about the way the virus interacts with a human host. That could shed light on when antiviral drugs would have maximum impact on replication and the cytokine storm phenomenon, Dr. Anthony Fauci said in an interview.

But finding that optimal point may not be easy, he suggested, because influenza replication typically peaks as people are becoming symptomatic and the immune response is already kicking into gear.

"To me that's almost a catch-22," Fauci said.

"Because if you know the person is infected and has virus replication only when they become symptomatic, then depending on how long that peak lasts, will you or will you not be able to have a substantial impact on it by (administering) antivirals?"

Osterholm for one is pessimistic on that count, suggesting neuraminidase inhibitors like Tamiflu may be better suited to preventing H5N1 infection rather than treating the ensuing disease once it's apparent someone is infected.

If that's true, he advocates stockpiling the drugs to protect health-care workers and keep hospitals operational during a pandemic rather than using the drugs for treatment, as the pandemic plans of many countries - including Canada - currently stress.

De Jong's paper also clearly underscores the differences between the disease provoked by H5N1 and that caused by human flu strains.

It notes, for instance, that swabbing the pharynx to look for virus is a more effective way to diagnose H5N1 than taking a nasal swab. With human flu strains, the reverse is true.

The researchers also found traces of the virus in the blood and rectum of critically ill patients. While that could be a hint the virus replicates in organs outside the respiratory tract and the lungs, it isn't proof positive, de Jong said.

Autopsies of H5N1 patients would needed to determine that, he and others said. But because of cultural objections, autopsies have been performed on fewer than a handful of the 143 people known to have died of H5N1 so far.

Bird flu details revealed

Study adds new details on bird flu in humans
The Associated Press

Published: September 10, 2006
WASHINGTON When bird flu infects people, the virus is more concentrated in the throat than the nose, the opposite of human flu, according to a new study. This finding may help doctors more quickly diagnose the bird flu in people.

The disease has been linked to the deaths of more than 140 people worldwide, mostly among Asian farm families who live in close contact to birds.

Health officials have monitored the disease as it moves through poultry and other animals. The fear is it could mutate into a form that spreads easily from person to person, a development that officials say could lead to a global pandemic.

Researchers are studying the disease in an effort to find a way to prevent or block it and to treat victims.

Menno de Jong of the Oxford University Clinical Research Unit at the Hospital for Tropical Diseases in Ho Chi Minh City, Vietnam, reports in Monday's issue of Nature Medicine that people with bird flu had much higher levels of the virus in their throat than in their nose.

That is important in showing doctors a better way to diagnose the disease, he said. It is also important that physicians can detect the virus in diarrhea and other rectal secretions. This is one more way the disease can spread and shows the need for infection-control measures, de Jong said in an interview via e-mail.

"Our observations suggest that early recognition and early treatment may provide the best benefit. Early recognition and diagnosis will pose a challenge for clinicians," he said.

De Jong and his co-authors studied 18 people infected with bird flu, which is known as H5N1, and compared them with eight people who had common human flu viruses.

"Our observations suggest that H5N1 virus replicates to very high levels — higher than common human flu — in the respiratory system and that these high levels of virus ignite an overwhelming intense inflammatory response," he said.

In inflammation, the body's immune system causes blood vessels to allow chemicals and blood cells to leak into an infected area, designed to attack the infection, but an over-response can cause harm.

"Extensive damage to the lungs and possibly other organs are likely caused by both the direct effects of the virus as well as by the intense inflammatory response to the virus by the infected individual," de Jong said.

He said the researchers could detect the bird flu virus in the blood of people who died of the disease, but not in the blood of these who survived an infection.

"The virus in the bloodstream most likely is picked up during passage of the blood through the lungs where most virus replication occurs," he said.

"The presence of virus in the bloodstream may be a direct consequence of high levels of virus in the most important site of infection (lungs) and reflect an overall high 'bodyburden' of virus in fatal cases," he said.

Dr. Wilbur H. Chen of the University of Maryland School of Medicine in Baltimore said that researchers are clamoring for more details on how the bird flu affects humans, and in particular better ways to quickly diagnose the illness.

Chen, who was not part of de Jong's research team, said it sounds like the researchers found some useful information.

De Jong's work was funded by the Wellcome Trust.

___

On the Net:

Nature Medicine: http://www.nature.com/naturemedicine


WASHINGTON When bird flu infects people, the virus is more concentrated in the throat than the nose, the opposite of human flu, according to a new study. This finding may help doctors more quickly diagnose the bird flu in people.

The disease has been linked to the deaths of more than 140 people worldwide, mostly among Asian farm families who live in close contact to birds.

Health officials have monitored the disease as it moves through poultry and other animals. The fear is it could mutate into a form that spreads easily from person to person, a development that officials say could lead to a global pandemic.

Researchers are studying the disease in an effort to find a way to prevent or block it and to treat victims.

Menno de Jong of the Oxford University Clinical Research Unit at the Hospital for Tropical Diseases in Ho Chi Minh City, Vietnam, reports in Monday's issue of Nature Medicine that people with bird flu had much higher levels of the virus in their throat than in their nose.

That is important in showing doctors a better way to diagnose the disease, he said. It is also important that physicians can detect the virus in diarrhea and other rectal secretions. This is one more way the disease can spread and shows the need for infection-control measures, de Jong said in an interview via e-mail.

"Our observations suggest that early recognition and early treatment may provide the best benefit. Early recognition and diagnosis will pose a challenge for clinicians," he said.

De Jong and his co-authors studied 18 people infected with bird flu, which is known as H5N1, and compared them with eight people who had common human flu viruses.

"Our observations suggest that H5N1 virus replicates to very high levels — higher than common human flu — in the respiratory system and that these high levels of virus ignite an overwhelming intense inflammatory response," he said.

In inflammation, the body's immune system causes blood vessels to allow chemicals and blood cells to leak into an infected area, designed to attack the infection, but an over-response can cause harm.

"Extensive damage to the lungs and possibly other organs are likely caused by both the direct effects of the virus as well as by the intense inflammatory response to the virus by the infected individual," de Jong said.

He said the researchers could detect the bird flu virus in the blood of people who died of the disease, but not in the blood of these who survived an infection.

"The virus in the bloodstream most likely is picked up during passage of the blood through the lungs where most virus replication occurs," he said.

"The presence of virus in the bloodstream may be a direct consequence of high levels of virus in the most important site of infection (lungs) and reflect an overall high 'bodyburden' of virus in fatal cases," he said.

Dr. Wilbur H. Chen of the University of Maryland School of Medicine in Baltimore said that researchers are clamoring for more details on how the bird flu affects humans, and in particular better ways to quickly diagnose the illness.

Chen, who was not part of de Jong's research team, said it sounds like the researchers found some useful information.

De Jong's work was funded by the Wellcome Trust.

Tennessee preps

Experts see conditions exist to foster flu pandemic

Published 09/10/2006 By J.H. OSBORNE

Second in a series

KINGSPORT - To become a pandemic influenza threat to humans, the avian (or bird) flu that has been making headlines around the world the last couple of years would have to mutate to a strain easily passed from one person to another.

It hasn't done that - yet - pandemic experts told local health officials last week.

"Human-to-human transmission with efficiency hasn't happened yet," said Dr. David Henderson, a Bethesda Md.-based epidemiologist.

He was among several pandemic experts who spoke Friday at a preparedness summit hosted by the Sullivan County Regional Health Department.

To date, there have been no confirmed cases of avian flu, in birds or people, in the United States, Henderson said.

But two major factors have federal, state and local health officials concerned and making preparedness plans: history tells us the world is about due for an influenza pandemic; and past pandemics had their roots in bird flu.

"That's how we got pandemics in the past," Henderson said. "Everything has happened except the efficient transmission from human to human."

Henderson said there has also been an increase in the incidence of bird-to-human transmission, most notably in countries in Asia.

Earlier this year, health officials reported human-to-human transmission of the bird flu among several members of a family in Indonesia, Henderson said.

That cluster of seven cases comprises the bulk of only nine, or maybe 10 at the highest, cases of human-to-human transmission of the virus on record, Henderson said.

That helps explain the World Health Organization's (WHO) current pandemic alert level of "phase 3," which signifies "little to no" reports of human-to-human transmission.‘MIXING VESSELS'

According to the Tennessee Department of Agriculture:

•Avian influenza viruses mutate rapidly. A mutation can cause an outbreak to shift from causing only mild illness in birds to causing rapid high mortality rates. A viral mutation during the course of an epidemic may also alter which species can be infected by the virus. Avian influenza is currently of concern because more than 100 people have been infected with the H5N1 virus over the past 2 years, resulting in 60 human deaths. However, avian influenza will not become widespread in people unless the virus gains the ability to be transmitted from person to person easily. When human or swine populations are infected by more than one strain of influenza virus at the same time, these non-avian species can serve as a "mixing vessel" for the mutation and spread of a strain that can be transmitted easily between humans.FLU TERMS DEFINED

According to the U.S. Department of Health and Human Services, on the Web site www.pandemicflu.gov:

•Seasonal (or common) flu is a respiratory illness that can be transmitted person to person. Most people have some immunity, and a vaccine is available.

•Avian (or bird) flu is caused by influenza viruses that occur naturally among wild birds. The H5N1 variant is deadly to domestic fowl and can be transmitted from birds to humans. There is no human immunity and no vaccine is available.

•Pandemic flu is virulent human flu that causes a global outbreak, or pandemic, of serious illness. Because there is little natural immunity, the disease can spread easily from person to person. Currently, there is no pandemic flu.

President Bush issued the National Strategy for Pandemic Influenza in late 2005.

Its stated intent is "stopping, slowing or otherwise limiting the spread of a pandemic to the United States; limiting the domestic spread of a pandemic, and mitigating disease, suffering and death; and sustaining infrastructure and mitigating impact to the economy and the functioning of society."

It gives the U.S. Department of Health & Human Services (HHS) the leading role in federal pandemic preparedness.

Earlier this year, Bush released an implementation plan for the strategy, outlining more than 300 actions for Federal departments and agencies and setting expectations for state and local governments.

In April, Gov. Phil Bredesen signed a planning resolution detailing HHS' and Tennessee's shared and independent responsibilities for pandemic planning.

Tennessee received nearly $2 million in federal funding for phase one for pandemic planning activities, and the state is scheduled to receive another $4.4 million.

Tennessee's state pandemic preparedness plan is