Lengthy, but good article on bird flu

Health
Bird flu: A threat to humanity
By Mehdi Pervez
Sat, 23 Sep 2006, 10:07:00



Over centuries natural calamities have hit this earth in many shapes. Sometimes in the form of floods sometimes in the form of volcanic eruptions and sometimes in the form of epidemic of deadly diseases. Every instance has caused the lives of hundreds and thousands of human lives. Even at the prime time of medical science an old disease is re-emerging with its deadliest threats. We are thinking about none other than bird flu. Bird flu is nothing new or uncommon. It first pandemically occurred in 1918 immediately after World War I and killed more than 40 million people. The later outbreaks were in 1957 and 1968. All of the attacks from bird flu killed about 100 million people around the world. Though this is not actually a human disease but its scourge of killing 10 crore people in only 87 years is a fearful matter. For more than a century, bird flu has circulated among birds, particularly domesticated fowl, but recent attention has been called to avian influenza since some strains infected humans. No longer is bird flu relegated to pigs and birds, as the virus has strengthened and mutated, resulting in a contagion that can move from bird to human. Human cases of bird flu have caused infections and death across the globe as scientists struggle to identify the dangerous strains and prevent a fatal pandemic.

Now let us discuss some of the microbiological aspects of Flu Virus. "Flu" is short for "influenza". The name goes back hundreds of years when the disease was thought to be caused by supernatural "influences". Many describe any nasty lung infection as flu, but only specific lab tests can give a proper diagnosis. There are several different viruses (and bacteria) which may infect the lung, but true flu is caused by orthomyxoviruses, of which there are three types, designated A, B, and C. An influenza virion has about 500 "spikes" sticking out from its lipid envelope. About 80% of the spikes are a glycoprotein peplomers-rod shaped viral protein called hemagglutinin (or simply, HA) which are homotrimers of class I membrane glycoprotein's. This was first identified by its ability to cause red blood cells, which carry a molecule called "heme", to agglutinate (stick together). We now know that HA is influenza's receptor-binding protein. It plays the critical role of attaching the virus to the host cell. The other 20% of the spikes are a mushroom shaped viral protein called neuraminidase (NA), which is tetramer of a class II membrane protein. This protein is an enzyme that destroys a host cell molecule called neuraminic (or sialic) acid. NA might play a part in getting the virus into the cell, but its most important function is that it helps the newly made influenza virions to easily escape from the host cell so they can infect others[1]. The virulent avian influenza H5N1 strains differ from other avian strains in that, there lies a link between HA cleavage and degree of virulence. In virulent strains the HAs contain multiple basic amino acids at the cleavage site, which are cleaved intracellularly by endogenous proteases. In contrast, in case of avirulent avian strains as well as non-avian influenza A viruses, the HAs lack the basic amino acid residues, hence not subjected to cleavage by such proteases. Moreover, all types of influenza A viruses are antigenically labile, well adapted to evade host defenses and lack mechanisms for "proof reading"; hence constant, permanent and small changes in antigenic composition are very common, which is known as antigenic drift. Another important characteristic of great public health concern is antigenic shift which results from reassortment of genetic material from different species resulting in variability of HA spikes, keeping the basic structure of the virus constant [2].

Influenza viruses that infect birds are called avian influenza viruses. Only influenza A viruses infect birds, and all known subtypes of influenza A viruses can infect birds. However, there are substantial genetic differences between the subtypes that typically infect both people and birds. Within subtypes of avian influenza A viruses there also are different strains. 13 different kinds of HA and 9 different kinds of NA genes in type A influenza is known[3].

They evolve! Molecular evolution (the evolution of molecules) is a fascinating area of evolution and of prime concern to any scientist wanting to understand viruses and how they spread. All genetic material can mutate, that is change its nucleic acids. The mutations are random, but their selection is not. "Selection" is another word for how well they survive and reproduce. Selection ensures that the mutations that increase a virus' ability to survive and reproduce will be represented in even greater numbers in the next generation. Mutations are the "fuel" for evolution because they provide the genetic variation on which selection acts. This is simply Darwin's old theory of evolution by means of natural selection, but on a microscopic scale.

All influenza viruses (all orthomyxoviruses) have RNA as their genetic material. When RNA is replicated it tends to have more errors than when DNA is replicated. These extra errors provide extra mutations upon which selection may act. That means RNA viruses (not just influenza viruses but all RNA viruses) have a high mutation rate and can evolve quickly - faster than a DNA virus or even a DNA human! Over time these mutations accumulate and eventually the virus evolves into a new strain. This progressive accumulation of individual mutations is called antigenic drift, because the shape of the antigen (the viral protein) slowly drifts into a different shape with each generation of virus. Eventually they drift so much that the original antibody can no longer bind to it.. All viruses show antigenic drift, but RNA viruses mutate faster so they drift faster. Antigenic drift is responsible for many of the localized outbreaks of different strains of influenza, especially influenza B.

Importantly, type A - but not B or C - undergo a kind of gene swapping or genetic reassortment to give it its proper name. If a cell is simultaneously infected by two different strains of type A influenza, the offspring virions may contain mixtures of each parents' genes! This really complicates things and makes it very easy for influenza A to quickly evolve new combinations of HA and NA genes. To better understand what I mean you need to learn a little bit about how we keep track of all this reassortment. We know of 13 different kinds of HA and 9 different kinds of NA genes in type A influenza. All these different kinds have evolved by antigenic drift as described earlier. Any one virion can contain only one HA and one NA. For example then an influenza A strain designated H1N1 can be produced. (We drop the "A"s at the end to make it clearer.) Along comes another virus with different kinds of HA and NA genes, let's say it is H3N7. If these two different virions infect the same cell at the same time they may produce offspring not only like themselves (H1N1 and H3N7) but also with a mixed combination (H1N7 and H3N1).

This is only a small sample of the many possible new combinations that might be made. All eight segments may take part in the reassortment. These newly created mixed genomes are very different from their parents and (probably) have never been "seen" by your immune system - or for that matter, anyone else's. This form of viral evolution is called antigenic shift, to differentiate it from antigenic drift (which occurs slowly and without a change in the gene associations). These new combinations present us with such a unique strain of virus that our immune system has to start all over to make new antibodies to combat it[1].

Since now we have seen that there are many strains of flu virus. But the strain that is mostly infecting people since 1997 is the H5N1 strain. This strain, in many ways, different and dangerous from other flu strains which we will try to explain below.

A report by a World Health Organization (WHO) committee says avian flu may have a longer incubation period and is more likely to cause diarrhea than typical flu viruses are, among other differences.

Published in the Sep 29 New England Journal of Medicine, the review was written by experts from several countries, including Vietnam, Cambodia, Thailand, the United States, the United Kingdom, Hong Kong, and Myanmar. They reviewed 71 published studies and reports, including details on 41 confirmed human cases from Vietnam, Thailand, Cambodia, and Hong Kong.

Researchers from Hong Kong report that lung cells growing in a laboratory responded much more intensely to the H5N1 virus than to an ordinary flu virus, even though the viruses reproduced at about the same rate, according to the report published online by Respiratory Research.

The H5N1 viruses were "more potent inducers" of cytokines and chemokines-chemical messengers that trigger inflammation-than H1N1 viruses were, says the report by a team led by J.S.M. Peiris of the University of Hong Kong. A flood of inflammation-triggering chemicals released by the immune systems has been referred to as a "cytokine storm."

They found that all the H5N1 viruses caused cells to secrete significantly higher levels of IP-10 (interferon-gamma-inducible protein 10), interferon beta, a type of T cell known as RANTES, and interleukin-6 than the H1N1 virus did. In addition, the 2004 versions of H5N1 caused cells to release more IP-10 at 6 hours than the 1997 version did.

"We have found that infection with H5N1 viruses led to the production of 10 times higher levels of cytokines from human cells than normal human flu viruses," said Peiris, as quoted Nov 12 in The Standard, a Chinese business newspaper.

The most alarming news about this H5N1 virus is that, Scientists reported findings which may help explain what made the 1918 pandemic influenza virus so deadly and that reveal similarities between that virus and the H5N1 avian influenza virus now circulating in Asia. The 1918 flu pandemic, regarded as the worst in history, killed as many as 100 million people

"The new studies could have an immediate impact by helping scientists focus on detecting changes in the evolving H5N1 virus that might make widespread transmission among humans more likely," the statement said[4].

Avian influenza viruses circulate among birds worldwide. Certain birds, particularly water birds, act as hosts for influenza viruses by carrying the virus in their intestines and shedding it. Infected birds shed virus in saliva, nasal secretions, and feces. Susceptible birds can become infected with avian influenza virus when they have contact with contaminated nasal, respiratory, or fecal material from infected birds. Fecal-to-oral transmission is the most common mode of spread between birds.

Most often, the wild birds that are host to the virus do not get sick, but they can spread influenza to other birds. Infection with certain avian influenza A viruses (for example, some H5 and H7 strains) can cause widespread disease and death among some species of domesticated birds[3].

Domesticated birds may become infected with avian influenza virus through direct contact with infected waterfowl or other infected poultry, or through contact with surfaces (such as dirt or cages) or materials (such as water or feed) that have been contaminated with virus[3]. Avian influenza A viruses may be transmitted from animals to humans in two main ways:

Ø Directly from birds or from avian virus-contaminated environments to people. Almost all these casualties were directly exposed to infected fowl, making contact with the virus through the birds' saliva, nasal secretions and feces, which become dry, pulverized and are then inhaled.

Ø Through an intermediate host, such as a pig[3].

A new study indicates that H5N1 avian influenza viruses are becoming less deadly to ducks, permitting them to carry the viruses for days or weeks and spread them to more susceptible birds and potentially to humans.

The findings "suggest that the duck has become the 'Trojan horse' of Asian H5N1 influenza viruses," says the report by an international team led by researchers from St. Jude Children's Research Hospital in Memphis. "The ducks that are unaffected by infection with these viruses continue to circulate these viruses, presenting a pandemic threat."

The researchers experimentally infected ducks with various H5N1 viruses, most of them dating to 2003 and 2004. About half of the infected ducks survived while shedding the virus for as long as 17 days, according to the report, published online today by the Proceedings of the National Academy of Sciences[4].

Avian influenza virus lacks the ability to 'hop' easily between people, which have probably helped to contain the problem. However, in the future, it is possible that the process of genetic reassortment could occur in a human who is co-infected with avian influenza A virus and a human strain of influenza A virus. The genetic information in these viruses could reassort to create a new virus with a hemagglutinin from the avian virus and other genes from the human virus. Theoretically, influenza A viruses with a hemagglutinin against which humans have little or no immunity that have reassorted with a human influenza virus are more likely to result in sustained human-to-human transmission and pandemic influenza. Therefore, careful evaluation of influenza viruses recovered from humans who are infected with avian influenza is very important to identify reassortment if it occurs[3].

Symptoms of Avian Influenza

Infected bird will get fever with rigor; diarrhea, paralysis then the bird will be unable to stand and keep the head up and ultimately die in 1-2 days[5].

The reported symptoms of avian influenza in humans have ranged from typical influenza-like symptoms:

1. fever (usually high)

2. headache

3. extreme tiredness

4. dry cough

5. sore throat

6. runny or stuffy nose

7. muscle aches

8. Stomach symptoms, such as nausea, vomiting, and diarrhea, also can occur but are more common in children than adults

9. Conjunctivitis is seen in some patients

Life threatening complications like viral pneumonia, respiratory distress syndrome, worsening of chronic medical conditions, such as congestive heart failure, asthma, or diabetes and multi organ failure may result in the death of the patient[3].

Laboratory Testing Procedures

Rapid antigen detection by immunofluorescence assay and enzyme immunoassay, virus isolation by culture in HeP-2, RD cells or MDCK cell lines and identification by immunofluorescence assay using specific monoclonal antibody and haemagglutination inhibition assay have been used for diagnosis. Detection of influenza- specific RNA by reverse transcriptase-polymerase chain reaction, by using primer sets specific for HA sequence of influenza A/H5 and of N1 are some of the other tests that have been developed. Serological identification by measuring the specific antibodies by haemagglutination inhibition test, enzyme immuno assay and the virus neutralisation test, more specifically the micro neutralisation test, have also been developed. Following kits are presently available:

1. Immunoflourescence assay- WHO influenza reagent kit for the identification of Influenza A/H5 virus (1997-1998, 2003 or 2004 version) which includes influenza type A/H5- specific monoclonal antibody pool along with influenza B, A/H1 and A/H3 subtype specific monoclonal antibodies.

2. Virus culture - Madin-Darby Canine Kidney cells (MDCK). ATCC CCL34.

· Inactivated virus, goat serum to A/Term/South Africa/61/H5, and chicken pooled serum to A/Goose/Hong Kong/437-4/99.

· WHO influenza reagent kit: reference antigens and reference antisera.

· Receptor destroying enzyme (RDE)[3].

Highly pathogenic avian influenza A (H5N1) is classified as a select agent, and culturing of clinical specimens for influenza A (H5N1) virus must be conducted under laboratory conditions that meet the requirements for Biosafety Level (BSL) 3 with enhancements. These enhancements include controlled access double-door entry with change room and shower, use of respirators, decontamination of all wastes, and showering out of all personnel. Laboratories working on these viruses must be certified by the U.S. Department of Agriculture. 4 recommends that virus isolation studies be conducted on respiratory specimens from patients who meet the above criteria only if requirements for BSL 3 with enhancements can be met[3].

3. Polymerase chain reaction - Gene primers from Hong Kong, Government Virus Unit.

All laboratory results for influenza A/H5N1 should be confirmed by a WHO collaborating center for influenza or by another WHO- recommended reference laboratory. The WHO reference laboratories are as below:

1. Queen Mary Hospital, University of Hong Kong.

2. National Influenza Center, Kowloon, Hong Kong.

3. National Institute of Infectious disease, Tokyo, Japan.

4. National Institute of Medical Research, UK.

5. Department of Infectious disease, Memphis, USA.

6. Centers for Disease Control and Prevention, Atlanta, USA[2].

Clinical specimens from suspect influenza A (H5N1) cases may be tested by PCR assays under standard BSL 2 conditions in a Class II biological safety cabinet. In addition, commercial antigen detection testing can be conducted under standard BSL 2 conditions used to test for influenza[3].

The range of antiviral drugs is small, but especially so when it comes to bird flu. Four different influenza antiviral drugs (amantadine, rimantadine, oseltamivir, and zanamivir) are approved by the U.S. Food and Drug Administration (FDA) for the treatment of influenza; three are approved for prophylaxis. All four have activity against influenza A viruses. (4). Two of them, amantadine and rimantadine, are ineffective against H5N1. The other two are zanamavir (commercialized as Relenza) and the widely-stockpiled oseltamivir, commercialized as Tamiflu. These medications are called neuraminidase inhibitors, which block the virus from replicating. If taken within a couple of days of the onset of illness, they can ease the severity of some symptoms and reduce the duration of sickness[6].

No definitive vaccine against the viral threat is available, because no-one knows the precise shape that it will take after mutating to the feared highly contagious form. Several prototypes are being explored, but the risk is that they could be only partially effective or even useless because the virus' genetic shape will have changed and will not be recognized by antibodies. If a pandemic does occur, one worry is about manufacturing capacity and distribution: making enough of the vaccine and getting it on time and to the right people, without causing panic or a black market or leaving poor countries helpless[6].

H5N1 virus in Montana birds, but not the bad one!?

Mild H5 flu virus found in Montana ducks

Sep 22, 2006 (CIDRAP News) – Wild ducks in Montana were found to be carrying what may be an H5N1 avian influenza virus, but not the lethal Asian strain of H5N1, US officials announced yesterday.

Viruses containing H5 and N1 surface proteins (hemagglutinin and neuraminidase) were found in samples from healthy northern pintail ducks in west-central Montana's Cascade County, the US Department of Agriculture (USDA) and the Department of the Interior said in a news release.

"Initial tests confirm that these samples do not contain the highly pathogenic H5N1 strain that has spread through birds in Asia, Europe and Africa," the statement said.

A Colorado State University laboratory tested 66 samples taken from the ducks and sent 16 samples on to the USDA's national laboratory in Ames, Iowa, for further testing. One of 16 samples tested positive for both H5 and N1, but that doesn't necessarily mean an H5N1 virus is present, officials said. It could point to two different viruses, one containing H5 and other containing N1.

Confirmatory testing in Ames will identify the virus subtypes and their level of pathogenicity, the agencies said. The testing should be completed in 2 to 3 weeks.

Montana wildlife officials said the samples were collected Sep 15 at Benton Lake, near Great Falls, during routine research on the movements of migratory birds, according to an Associated Press report.

Low-pathogenic flu viruses are common in wild birds and typically cause only minor illness or none. Federal officials reported finding the mild "North American strain" of H5N1 in some Maryland ducks and Michigan swans in August.

Northern pintail ducks are among hunted species, but there is known health risk to hungers or hunting dogs from contact with low-pathogenic avian flu viruses, federal officials said.

In other avian flu news, the World Bank today announced a $13 million grant to minimize the threat to humans from avian flu in the West Bank and Gaza strip. The disease struck poultry at eight sites in Gaza last April.

"These grants will assist the PA [Palestinian Authority] to improve their readiness and protect their citizens from a potentially devastating outbreak as the [bird] migration season is around the corner," Arif Zulfiqar of the World Bank said in a news release.

The money includes $3 million from the World Bank's Avian and Human Influenza Facility, a multidonor financing mechanism, and $10 million from the bank's own resources, officials said.

In other developments, the European Union (EU) and the United Nations Food and Agriculture Organization (FAO) have launched a study of avian flu in Nigeria, according to an Agence France-Presse report yesterday.

In cooperation with the Nigerian agriculture ministry, the FAO will study the incidence, spread, and impact of H5N1 avian flu in the hope of eradicating it in Nigeria, according to the report.

Avian flu first cropped up in Nigeria last February and has since been found in about 13 states and the capital city, the story said. The FAO study will cost $667,000 and will be funded by the EU.

Also yesterday, Randall L. Tobias, head of the US Agency for International Development (USAID), said the US has provided a total of $191 million in foreign aid to combat avian flu.

USAID has sent 93,000 personal protective equipment kits to 66 countries this year and is building a stockpile of 1.5 million protective kits, 100 lab kits, and $15,000 decontamination kits for use by surveillance and outbreak-response workers, Tobias said.

He said the United States also is training first responders in how to use protective equipment, collect and ship samples, detect disease, and provide emergency response.

Indiana preparation for smallest victims of bird flu

IndyStar.com Metro & State
September 22, 2006
Official: Kids most at risk for bird flu in Indiana
Though no U.S. cases are known, children would be vulnerable in outbreak


Powered by Topix.net
By Richard D. Walton
richard.walton@indystar.com
Hoosier children could be the hardest hit if the bird flu strikes Indiana, the director of the Marion County Health Department said Thursday.
ABOUT THE VIRUS
Avian influenza viruses are very contagious in birds, but the risk of transmission to humans is low -- the bird flu would have to mutate into a new strain. As of Sept. 19, the World Health Organization had reported 247 human cases of Avian Influenza A (H5N1) and 144 deaths in 10 countries in Asia, the Middle East and Turkey.

Dr. Virginia Caine said statistics suggest an infection rate as high as 40 percent for youngsters exposed to the virus -- far higher than the rate for adults.
Immature immune systems and poor hygiene habits account for the increased vulnerability of children, she said. While there have been no confirmed cases of avian flu in the U.S., Caine said an outbreak among children "could very well be the first sign that something is going on in a community."
Caine spoke at a summit of more than 200 public health and school nurses Thursday at a Westside hotel.
She said health officials are concerned that if the virus reaches this country, there could be a shortage of breathing machines required to deal with the resulting respiratory distress.
"We'll have to make some very tough ethical decisions about who should be eligible for a respirator," she said.
Bird flu began ravaging Asian poultry stocks in late 2003 and spread with migrating birds to Europe, Africa and the Middle East. The disease has killed more than 140 people.
The virus is spread through the saliva, nasal secretions and feces of infected birds. It has proved difficult to transmit, but officials fear it could mutate and devastate populations.
Caine said the best protection against influenza is to practice good hygiene, especially washing your hands and covering your mouth when you sneeze. She also said Hoosiers should be prepared for shutdowns of groceries and public transportation if there is a major outbreak, as officials will want to limit large public gatherings.

Call Star reporter Richard D. Walton at (317) 444-6289.

WHO fights bird flu

WHO takes bird flu as top health danger


Avian influenza remains the No. 1 danger for global public health, said Richard Nesbit, World Health Organization's Acting Regional Director for the Western Pacific, on Friday.

He made the remarks at the conclusion of WHO's Western Pacific Region meeting held in Auckland, New Zealand.

The WHO (World Health Organization) 57th annual meeting calls on its member countries to step up their defenses against emerging diseases, including bird flu, and to devote more resources to counter the growing threat from noncommunicable diseases.

Earlier this week, Nesbit urged member country delegates to do more to prepare for an outbreak of bird flu, saying no nation would be immune.

He said WHO lacked about half of the funds needed to help countries prepare for and fight bird flu.

WHO spokesman Peter Cordingley said many countries did not have the money or resources to implement full emergency plans.

The five-day meeting on Sept. 18-22 also endorsed a regional strategy designed to stem the exodus of health care workers from poorer countries in the region to more affluent nations.

Other issues examined included universal access to HIV/AIDS treatment, prevention and control of tuberculosis, and program updates on measles elimination, hepatitis B control and polio eradication, as well as tobacco control, mental health and environmental health.

The 58th session of the Regional Committee for the Western Pacific will take place in South Korea, in 2007.

Source: Xinhua

Indonesia report from ProMed Mail

An 11-year-old boy who died this week has been confirmed as
Indonesia's 50th human bird flu fatality. The boy died on Mon [18 Sep
2006] and test results from 2 laboratories confirmed he was infected
with the H5N1 virus, [according to] Nadirin, a doctor at the National
Avian Influenza Information Centre. Tests from 2 laboratories are
required for the World Health Organisation to count the fatality in its toll.

Nadirin said that the latest death brought the number of confirmed
deaths to 50, the highest reported anywhere in the world.

The boy, identified only by the initial A., came from Karanggentong
in densely-populated East Java and had come into contact with sick
poultry, the usual method of transmission of the virus, the doctor
said on Fri 22 Sep 2006. He had developed a fever, cough and
breathing difficulties 2 days before he died, the doctor added.

Indonesia's death toll from bird flu has been steadily rising as the
virus has marched across the archipelago nation, spreading to 29 of
its 33 provinces. While the virus does not spread easily among
people, the chance of a mutation that would allow it to do so is
heightened as more humans catch it from infected birds.

--

Flu prevention tips to teachers

Fending off a flu outbreak
Salinas: Workshop teaches educators how to stop transmissions
By CLARISSA ALJENTERA
Herald Staff Writer

Weeks before the flu could hit Monterey County, educators were preparing for a worst-case outbreak Wednesday in a workshop in Salinas.

While nobody is predicting a pandemic this winter, teachers and administrators gathered to learn how to keep the flu from spreading beyond the classroom. Educators ranging from preschool teachers to college professors met at Sherwood Hall for the seminar.

"You are the conduit to parents and students," said Hugh Stallworth, Monterey County health officer.

A number of tips were presented to help stop the spread of germs, including covering your mouth and nose when you sneeze or cough, washing your hands and using gel sanitizers or alcohol-based hand wipes.

An official at the Immunization Branch of the state Department of Health Services said the ability to spread germs is much greater in school because children are in such close proximity for much of the day.

Most important, Stallworth said, is that people who are starting to develop flu-like symptoms should not come to work or school.

Stallworth said the county Health Department will schedule a summit for business owners in October.

He outlined how pandemics start, giving a history of avian flu -- the current focus of pandemic fears -- and how it can spread.

In the past 90 years, three flu pandemics have been reported, the latest in 1968. The possibility of another pandemic is real, Stallworth said.

The state Department of Education circulated a checklist to schools regarding pandemic flu Sept. 13, and state Superintendent of Public Instruction Jack O'Connell urged schools to be ready.

"While we hope a pandemic never occurs, schools must be prepared to help protect the health and safety of staff and students," O'Connell said in a written release. "These planning checklists will help to protect our children by minimizing the impact to their education should a pandemic force school closures for any length of time. It is vitally important that our education systems and health services agencies work together to protect lives in the future should a pandemic occur."

A pandemic flu would start when a new flu virus develops and begins to spread worldwide. Avian flu has the potential to change and become dangerous for human-to-human contact, which might lead to a pandemic.

For information, visit www.cde.ca.gov/ls/he/hn/fluinfo.asp.

China needs to come clean on bird flu

21 September, 2006
CHINA
Bird flu: Beijing must designate a focal point to immediately inform the WHO
New body would be required to communicate any health emergency within 24 hours so as to allow immediate action. Mainland China has so failed to do so and Hong Kong demands to be able to act on its own.

Beijing (AsiaNews/SCMP) – China has not yet organised itself in order to immediately report public health emergencies like a pandemic flu to the World Health Organisation (WHO) as 12 countries in the western Pacific area have done, this according to a conference in Auckland (New Zealand) on Asia-Pacific Strategy for Emerging Diseases.

Under international health regulations adopted last year, countries were urged to designate a national “focal point” to communicate with the WHO to ensure a more rapid global response to public health emergencies. The regulations will be enforced from next June, making the guidelines legally binding on all member states.

About 150 health ministers and officials from 37 WHO member states and areas in the western Pacific attending the Auckland conference were urged on Tuesday to submit names of national contact points.

The WHO regional adviser for communicable disease surveillance and response, Takeshi Kasai, yesterday said that Beijing has not yet done so.

China is one of the worse hit countries by the bird flu pandemic and has been repeatedly chastised by the WHO for delays and providing partial information as well as for not allowing WHO experts to intervene immediately. But the head of the Chinese delegation, Vice-Minister of Health Jiang Zuojun, told the meeting the mainland needed guidance on procedures and criteria for notification and response under the new international health regulations.

The WHO's director for combating communicable diseases in the western Pacific, Tee Ah Sian, said she reminded delegates that without focal points to facilitate action the WHO cannot intervene right away. Under the regulations, the time frame for reporting was 24 hours.

Some analysts believe that China prefers to manage such emergencies on its own before communicating with the WHO and allowing the latter’s experts into the country.

Hong Kong Director of Health Lam Ping-yan said Hong Kong would like to have direct contact with the WHO even though it was not a member state, hoping to “have the understanding of the Chinese government”. (PB)

Nigeria preparing for outbreak of deadly bird flu

Nigeria: EU Launches Surveillance On Bird Flu


Daily Champion (Lagos)

September 21, 2006
Posted to the web September 21, 2006

Malachy Uzendu
Abuja

ONCERTED efforts to combat the deadly strain of HSN Avian Influenza, otherwise known as 'bird flu' will be stepped up today with the launch of a surveillance programme aimed at bridging the gap associated with the disease.

United Nations Childrens' Fund (UNICEF) in a statement issued in Abuja yesterday, said the primary aim of the surveillance programme is to "bridge the huge gap in federal and state reporting on the bird flu."

The statement cited an unnamed laboratory study which indicated that as at today, "40 local government areas in 15 states and the Federal Capital Territory (FCT), Abuja have confirmed the presence of the influenza.

"Although no deaths have been reported in Nigeria, the global figure for death arising from the influenza as at September is 144 deaths from 247 AI human infections."

Based on this information, UNICEF will today launch the surveillance at the United Nations office, Abuja, where the Agriculture minister and UN Resident Co-ordinator will address the press.

Bangladesh prepares to fight bird flu

Business
Bangladesh takes bird flu outbreak seriously
By UNB, Dhaka
Thu, 21 Sep 2006, 10:40:00


A two-day workshop here on Avian and Human Influenza has developed the framework for a National Communication Strategy and Action Plan for prevention of the disease in Bangladesh.

"The government takes the threat of 'bird flu' outbreak very seriously as it has been detected in India and Myanmar. Bangladesh remains free of the disease and this is how we would like to keep it," said Kamrul Islam, the Secretary-in-Charge of the Ministry of Fisheries and Livestock, in his opening remarks at the workshop that concluded Tuesday.

He said, "An effective communication strategy will help us prevent an outbreak and allow us to prepare in case there is one. Bangladesh has proven its competency in combating natural disasters because of its improved preparedness."

The Avian, Human and Pandemic Influenza communication efforts in Bangladesh are supported by the government of Japan through UNICEF.

This is part of the Japanese government's global support to Avian Influenza (AI) and HI prevention and control efforts in Asia in particular.

Kirsty McIvor, Chief of Communication and Information, UNICEF, and chair of the Technical Working Group summarised the outcome of the workshop and the main focus of the National Risk Communication Strategy on Avian and Human Influenza.

The main areas of the strategy include research, implementation of public awareness and campaign for behaviour change, coordination of efforts, monitoring and evaluation and capacity building.

Technical Working Group of UNICEF, representatives from the Department of Health Services (DGHS), Institute of Epidemiology and Disease Control and Response (IEDCR), Institute of Public Health and Nutrition (IPHN) under the Ministry of Health and Family Welfare, Ministry of Environment, Forest Department and Bangladesh Medical Association took part in the workshop.

At the inaugural ceremony, UNICEF Bangladesh Representative Louis-Georges Arsenault said, "So far no confirmed bird flu cases have been found in Bangladesh."

"We'll however have to be prepared because of the outbreak that took place in the region and with the migratory bird season starts in a few weeks. The strategy coming out of this workshop will chart the way forward for our preparedness, he said."

The workshop was also represented by BCCP, UNICEF, WHO and BRAC.

© Copyright 2003 by The New Nation

Death toll rising from avian flu

Worldwide Bird Flu Death Toll is Rising
The avian influenza death toll is rising. Some countries have been able to slow the diseases progress and reduce risk to their population. However, the battle to prevent a catastrophic worldwide pandemic continues and the outcome is far from settled.

The H5N1 version of bird flu is the deadliest flu in recent history. Indonesia has now recorded its 49th human bird flu death according to the World Health Organization (WHO). This surpasses that of neighboring Vietnam with 42 bird flu deaths.

This makes 2006 the deadliest year since the H5N1 virus started spreading rapidly amongst the world’s bird population. And it brings this year’s worldwide human death toll to 66, out of the 100 reported cases (66%). This death rate far exceeds that of the most deadly pandemic of the century, the 1918 Spanish flu, which had a death rate approximated at 2.5%. Even with this much lower death rate, the 1918 pandemic took a large toll on the worlds population with somewhere between 50-100 million deaths.

The H5N1 bird flu numbers however, are only for confirmed cases. The actual death toll and extent of illness are likely to be higher. The World Health Organization’s situation reports indicate that other likely cases have remained unconfirmed, due to the inability to collect samples prior to death and disposal of the remains.

An example of this surrounds the 44th confirmed bird flu death in Indonesia. The neighbor also fell ill with similar symptoms and then died prior to samples being obtained. Another neighbor has also died and confirmation of bird flu as cause of death is pending laboratory results.

So far most people who have become ill have had close contact with poultry. Indonesia has some 2 billion chickens and the virus is endemic in these birds in 27 of the 33 provinces.

Culling this many birds would require massive compensation to farmers and chicken owners. Indonesia has been criticized for not carrying out such an effort. Its neighbor Vietnam has carried out an aggressive culling campaign and has not had a confirmed case of the bird flu in 2006.

In July and August Thailand officials also conducted large-scale culling of chickens in an attempt to curb the spread of the disease. The aggressive action seems to have paid off with a government official declaring Thailand “bird flu free” for over a month.

This victory does not obviate the current worldwide risk. The battle ground is currently set in Asia and possibly Africa against this tiny viral enemy. Poverty and the lack of adequate healthcare feed the opportunities for the virus to mutate.

The more opportunities H5N1 has to mix with the typical human seasonal flu, the greater the likelihood it will acquire the mutations that allow it to spread easily amongst humans. Experts agree that if this happens within 6 weeks the worldwide population will be fighting a pandemic battle that will be one for the history books.

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Birdwatchers watching for bird flu

Bird flu risk low but vigilance still urged

by Nicci Martel

BIRDWATCHERS are on the lookout for signs of avian flu as migrating species fly south for the winter.

The UK Department for Environment, Food and Rural Affairs is stepping up its surveillance of certain areas where migrating birds from the Arctic or Russian tundra are likely to be seen.
But Guernsey has not been deemed a high-risk area.
‘Most migrating birds will be coming back from the north-east so will have crossed large areas of the UK before arriving here, so hopefully we are not on the front line,’ said agricultural and environmental advisor Andrew Casebow, who is a member of the Defra Wild Bird Surveillance Group.
‘But we are concerned about H5N1 bird flu coming to Guernsey as a disease of migrating birds and infecting local poultry. For this reason, we are taking part in the UK’s surveillance programme.’
Commerce and Employment has agreed with birdwatchers from La Societe Guernesiaise and the RSPB that any unusual or high death rates in migrating or resident birds will be monitored.
Waterfowl found dead in areas where poultry are present will be targeted and live-caught swans, geese, ducks, gulls and waders will be sampled where appropriate.
If any of these birds are found dead, samples could be sent to Defra for further examination. The cost of sending samples for analysis can reach almost £300, so this will be done only when the circumstances conform to Defra guidelines.
Unusual bird deaths should be reported, but people are being urged to try to distinguish between what is a natural, normal occurrence and something of greater concern.
‘In the spring we had huge numbers of reported deaths among garden birds. While this was interesting at the time, Defra is now emphasising the need for a more targeted approach,’ said Mr Casebow.
‘They are not really interested in the deaths of blackbirds, finches or starlings etc. unless they occur in very high numbers – more than 10 at one time.’
He also said that in the spring, many of the birds reported had been killed in accidents or had been partially eaten by cats.



Published 21/9/2006

University of California plans for avian flu

Campus to Form Task Force on Flu Readiness
BY Matthew Koh
Contributing Writer
Thursday, September 21, 2006


UC Berkeley established a Pandemic Flu Preparedness Task Force earlier this week to assess campus preparedness for a pandemic flu outbreak.

The establishment of the task force, which will be chaired by Dr. Peter Dietrich, the medical director of University Health Services, comes as one of many responses within the UC system to stop the potential spread of Avian flu and other types of influenza.

The task force will have its first meeting in October to outline its responsibilities and the planning process it will undertake in the coming months.

The group will work closely with the campus Center for Infectious Disease Preparedness, the Office of Emergency Preparedness and other campus groups to prepare a comprehensive plan to deal with a possible pandemic flu outbreak.

"The task force is meant to review the operational readiness of the campus," Dietrich said. "(What we will be) thinking about is what the critical processes, procedures and functions are, how to deal with staff out due to infection and the need to protect our student population."

Dietrich said the goal is to have a complete plan of action finalized by April 2007, but added that an outbreak before that time would cause their efforts to accelerate significantly.

"We certainly don't want to engender any fear in people, but we still need to be responsible to prepare for a larger scale epidemic," Dietrich said. "Our hope is that it's a reassuring message to people that there are plans going on."

A number of projects have been under way at nearly all UC campuses within the last year to research potential treatments for not only the avian flu, but other types of influenza strains as well, according to a statement released by the university in January.

The UCLA Center for Vaccine Research was already in the process of clinically testing bird flu vaccines at the beginning of this year, according the statement.

According to Dietrich, it is hard to say exactly what the result of a pandemic flu outbreak would be as the response would depend on the severity of the outbreak.

However, he said there would at the least be a mobilization of the newly created task force and that they would follow the advice of government health agencies.

"We would link up and work with the recommendations of national and local health agencies to follow their recommendations about treatment, isolation, quarantine, other intervention measures," Dietrich said.

Contact Matthew Koh at mkoh@dailycal.org.

BERMUDA'S DOCKWORKERS FIRST LINE OF DEFENSE

Last modified: September 20. 2006 10:21AM

Avian flu: Coping with a pandemic

By Roger Crombie

Bermuda’s dockworkers could become the Island’s most important citizens in the wake of a pandemic such as the avian flu. That was the opinion yesterday of Dr. Graham Sher, the chief executive officer of Canadian Blood Services, the company that manages Canada’s blood supply.
Dr. Sher was speaking on the morning of the second day of the Bermuda Captive Conference being held at the Fairmont Southampton Hotel. Dr. Sher had been selected to speak on a panel addressing preparedness for a pandemic because his company has a Bermuda captive, without which, he said last year, Canada could not manage its blood supply.
“Most experts believe that the threat of a pandemic is real and imminent, while others claim it will fizzle out,” Dr. Sher said. He forecast that in an outbreak of flu similar to the Spanish Flu pandemic of 1918, “absenteeism from work might be in the range of 20 to 50 percent for as much as six to eight weeks for each phase of the pandemic.” The World Health Organisation, he said, forecast two or three such waves over a 36-week period. “With three months between the waves, a pandemic such as this would last eight months,” he said.
A rapt audience of about 100 people was told that a pandemic was “inevitable, but not imminent”, by fellow panellist Colin Rainier, managing director of Hannover Life Re. Using the 1918 flu outbreak as an example of what might happen sooner or later, Mr. Rainier said: “The life insurance industry is really not worried about epidemics, but we should be very, very concerned about pandemics.”
He said that “our industry has $250 billion in capital – not assets, but reserves set aside to meet this sort of thing – and a routine flu epidemic tends to (result in claims) that cost us about $9.5 billion in losses.
An event such as the Spanish Flu, were it to occur today, would cost six and a quarter times as much, which would be about $109 billion. That’s less than half the capital the industry has in hand.”
Mr. Rainier praised Bermuda’s reinsurance sector. He pointed out that there are “more than a thousand life insurers, but only about a dozen life reinsurers.”
Two, Scottish Re Group and Wilton Re, are Bermuda-based, although several other Bermuda companies have life insurance and reinsurance operations.
The third panellist, Mark Baker, is head of global markets at HSBC, having transferred to Bermuda from New York. He ran down the scenario of how the financial markets might cope with a pandemic.
“The markets are incredibly flexible and good at adapting,” he said, “but economic activity could severely decline. Investments may be postponed. Asset prices and operational disruptions are the two main areas of concern.” Mr. Baker forecast that although “cash would be popular, as would gold”, the markets would survive a pandemic similar to the 1918 flu outbreak.
An audience member asked how Dr. Sher thought Bermuda might deal with the effects of a pandemic, particularly if the US suffered from disruption and the Bermuda food supply were threatened as a result.
In response, Dr. Sher said: “I think it would force the Bermuda Government to look at its workforce.
Dockworkers would become more important than bankers; in fact they might become the most important citizens. In preparing for pandemics, organisations have to look right down to the front line and determine the weak links in the system.”

Liberia battles against bird flu

Liberia: Gov't. Prepares to Combat Bird Flu



The Analyst (Monrovia)

September 20, 2006
Posted to the web September 20, 2006

J. Ebenezer Daygbor

The government of Liberia, through the National Task Force on the control and prevention of Avian Influenza (bird flu), has announced series of mechanisms to battle the virus, which is mainly found in birds.

Making the disclosure recently in Monrovia, the Minister of Agriculture, Dr. Chris Toe, said the government has developed a national contingency plan for the eventual prevention and control of Avian Influenza in the country.

Minister Toe said the plan is designed within the context of a national preparedness strategy to deal effectively and efficiently with any outbreak in Liberia, adding that the plan has been submitted to international donors including the United States Aid for International Development for funding.

He members of the National Task Force include the Ministers of Agriculture, Health and Social Welfare, Internal Affairs, Education, Commerce, and Information. Other members include Bureau of Immigration, Customs, National Port Authority as well as several international partners.

The Agriculture boss said local task forces have been created at the district and community levels to raise awareness about the disease and educate the public how to handle and report cases of dead birds suspected of Avian Influenza.

According to him, the task force has also embarked on strengthening and building human resource and institutional capacities to deal with any eventual outbreak of the disease in Liberia.

A Liberian veterinarian doctor has been trained in Malawi to manage cases of Avian Influenza and other livestock while personnel from the Agriculture Ministry and the Health Ministry have also received training in Kenya and Burkina Faso respectively to deal with the situation if it arises.



According to the Minister, government is currently discussing with the UN Food and Agriculture Organization (FAO) to establish central and regional veterinary diagnostic laboratories in the country to test suspected cases.

Dr. Toe pointed out that a communication group of the National Task Force has organized three separate awareness and sensitization workshops for media institutions as well as members of the local task forces and disclosed that the group has produced and distributed thousands of posters with different messages on the prevention and control of Avian Influenza including radio announcements and jingles in eight local Liberian dialects.

He said the government has established hotlines to report suspected cases of dead or sick birds and the numbers are: LoneStar GSM 190; Libercell's 0479000; and Cellcom's 180555; Commium's 1425 and other networks to Cellcom -071800555.

Uganda worried about Sudanese bird flu cases

Uganda on high alert as bird flu breaks out in neighboring southern Sudan


Health experts in Uganda are on high alert and ready to counter any outbreak of H5N1 avian influenza, popularly known as bird flu, following an outbreak in neighboring southern Sudan.

Sam Okware, chairman of the National Task Force on bird flu, was quoted by local media on Wednesday as saying that the east African country was at high risk of registering bird flu cases after the deadly virus was confirmed in poultry in the southern Sudanese city of Juba, 180 km north of Ugandan border.

The H5N1 strain of bird flu has been confirmed in several African countries including Nigeria, Niger, Cameroon and Burkina Faso.

The World Health Organization has reported 190 human cases of bird flu worldwide, more than 100 of them fatal, and the strain has forced the slaughter of millions of birds as the disease has spread from Asia to Europe, Africa and the Middle East.

UGANDA AT RISK

Although Uganda has not reported a single incidence, health experts believe the increased traffic flow to and from southern Sudan elevate the country's chance of being hit by the highly infectious virus.

Traders from central, eastern and northern Uganda are doing business in southern Sudan dealing in items like beer, bananas, tomatoes, cabbages, chicken, soda and fish.

A tray of eggs reportedly cost about 18,000 Ugandan shillings ( 9.7 U.S. dollars) in Juba while in Uganda they cost 3,000 shillings (1.6 dollars), thus prompting Ugandan traders to flock Juba with poultry products.

Okware warned however the problem is that materials like trays and vehicles can bring in the virus, while the close proximity between poultry and human beings on small farms such as the affected homesteads in Juba pose a realistic threat.

Experts believe that another factor that puts Uganda at risk is the many water bodies and its location in the western rift valley, which are sanctuaries for migratory birds responsible for the spread of the disease.

"Avian influenza is a recognized trans-boundary disease. Being in the rift valley, which is a migratory flyway, is a definite risk," said Chris Rutebarika, the assistant commissioner for disease control in the ministry of agriculture.

Uganda lies on major migratory routes of birds moving to southern Africa from Europe and West Africa.

PRECAUTIONARY MEASURES

The Ugandan government has formed teams in northern region to help border districts put up rapid response mechanism in the event of an outbreak.

Six more rapid response teams from the agriculture ministry have been strengthened to give support to other "higher-risk" districts bordering water bodies.

Last month, over 40 samples collected from various parts of the country were analyzed at the Uganda Virus Research Institute and results came out negative.

Meanwhile, the ban of the poultry importation is still valid, which was issued following a previous threat as a precautionary measure.

"We have directed border authorities, particularly those with Sudan and the Democratic Republic of Congo, to effect the ban except parent stock from the UK, the Netherlands and Belgium," said Okware.

Source: Xinhua

Standards of care in bird flu

WHO, Indonesia disagree on bird flu diagnosis

Adisti Sukma Sawitri, The Jakarta Post, Jakarta

Although the Health Ministry has confirmed two new victims of bird flu under a new World Health Organization (WHO) case definition, it has yet to decide whether to adopt the new standard in the fight against the killer virus.

The head of the ministry's bird flu patient verification team, Santoso Soeroso, said the WHO definition is less restrictive, so that possible cases can be identified earlier.

Based on the new guidelines, patients can be considered possible bird flu victims when they are suffering from acute lower respiratory problems with fever and cough, shortness of breath or difficulty breathing.

The Health Ministry, by contrast, has been using acute upper respiratory illness as the main symptom for declaring people to be suspected victims of the disease.

"It's like catching fish with big-holed nets. We may be able to identify possible cases when patients reach the stage that the flu is incurable," said Santoso, who is also the head of Jakarta's Sulianti Saroso hospital for infectious diseases.

He added that a quick response is important to bird flu patients due to the short effective period of oseltamivir, the only medicine available so far to treat the illness.

Oseltamivir, or Tamiflu, is most effective when patients take it on the first two days after the initial symptoms are detected. The medicine's effectiveness falls by 80 percent after that.

The WHO recently issued its first international case definition for avian flu to create a single standard for all countries across the globe.

The standard is expected to help the WHO do a multinational analysis of the data and classify the H5N1 infections reported by national and international health authorities.

Based on the new case definition, the WHO retroactively added two bird flu victims to Indonesia's case list last week.

The first was a five-year-old child from East Bekasi, West Java. He developed bird flu symptoms on March 5 and died two weeks later.

The second was a 27-year-old man from Solok, West Sumatra, who took care of his sister when she fell ill with bird flu. She died in May. The man survived.

The two retrospectively confirmed cases bring the total in Indonesia to 65. Of these cases, 49 were fatal.

The WHO representative for Indonesia, George Petersen, said that although it was a little late for his agency to promote the international standard, it would help make the global fight against bird flu more effective

"It is important to have one proper definition that every country uses, so we can compare the statistics," he told The Jakarta Post.

However, he said, the new standard would depend on the needs of each nation, and would only prove its effectiveness over time

Prevention of bird flu spread key

19 Sep 2006
Intelligent Ways to Prevent a Bird-flu Outbreak

Targeting the vulnerable areas seems to be the new modus operandi at Britain’s farm ministry, with a view to evolving intelligent ways to nip a potential bird-flu outbreak in the bud, as a preparation before the autumn season.

The susceptible flock includes ducks, geese, swans, gulls and waders, seen as potential H5N1 disseminators of infection into British soil. The current plan will be to increase surveillance and testing in the areas frequented by migratory birds.

According to The World Health Organization, the virus has claimed nearly 143 people since 2003 in many parts of Asia and the culling of nearly 200 million birds.

Source-Medindia
SAV

News today

Avian flu - 'yesterday panic, today forgotten'


In Short:

The current "nothing's going to happen" attitude vis-à-vis the potential of a bird-flu pandemic is "completely unacceptable", argues the president of the European Health Forum Gastein.

RELATED

* Avian influenza

Brief News:

A new study on bird-flu pandemic preparedness, conducted by the London School of Hygiene and Tropical Medicine, criticises the lack of co-ordination between human medical and veterinary measures and argues that international co-operation on pandemic preparedness is "often mere lip-service" and therefore can not function in an emergency situation.

In addition, the study's findings show that many countries still lack appropriate national strategies for containing potential pandemics, as they think that pandemic dangers only come from abroad. Furthermore, countries have vaguely formulated crisis plans, which often don't cover issues such as supply of vaccines or fast provision of laboratory capacities for testing and developing new medicines.

"Yesterday panic, today forgotten," comments Günther Leiner, the President of the European Health Forum Gastein (EHFG) the study's findings in the EHFG press release on 19 September 2006. "As a whole, the result of the much-heralded creation of modern, efficient and resilient structures for battling pandemics in Europe is not at all inspiring." One year after the 'first' bird-flu crisis, there is no real improvement in EU pandemic prevention, argues EHFG. The results of the study will presented in detail at the European Health Forum Gastein on 4-7 October 2006.

The EHFG will hold a special session on the issue of Facing the threat of modern pandemics to discuss what Europe is facing and to highlight the fact that communicable diseases remain a significant threat to public health.

Links

Pandemic flu preparation

Simple precautions can help prepare against flu germs
09/20/2006

By Jim Brock
Staff Writer
jim.brock@gwinnettdailypost.com

LAWRENCEVILLE — The avian flu, known by most as bird flu, is a hot topic for media worldwide, but local residents should also be aware of the potential danger of a deadly pandemic flu.
“That is a big, big subject for us and is our priority right now,” said Vernon Goins, spokesman for the Gwinnett County Health Department. “We had a countywide pandemic flu summit back in May, where we brought in the civic and business leaders. ... (and) started discussion about how to prepare by developing a strategic plan and a tactical plan for responding to an influenza pandemic, which is a worldwide epidemic from which no community would be safe.”
With all the talk on the local, state, federal and worldwide level, protection from the potentially deadly strain at this point is simpler than one would think, Goins said.
“Get a flu shot, get all your vaccines and get healthy before this thing gets here,” he said. “Quit smoking, eat right, drink plenty of fluids, get enough rest and exercise. There is no substitute for that. Take care of your immune system.”
Pandemic flu is created when the human strain and the bird strain mutate within a mammal host, of which humans and pigs are ideal hosts, Goins said.
Goins said a comparable pandemic occurred a little less than 100 years ago with the 1918 Spanish flu that killed millions of people in its path.
Flu shots are now more important than ever because of the likelihood of pandemic flu making its way to the United States, Goins said.
Understanding the different types of flu is one of the first steps in prevention.
The first strain of flu, known as the human flu, can be prevented in many cases with a simple flu shot.
But while flu shots cannot protect against a pandemic strain or the bird flu virus, they can help safeguard the immune system and prevent human flu, which again is a component in the mutation of pandemic flu.
CDC statistics show that an average of 36,000 Americans die from the human flu every year, and 114,000 are
hospitalized.
Furthermore, upward of 60 million citizens contract the flu annually but don’t require hospitalization.
Studies show that flu spreads rapidly in the fall and winter months because people stay indoors, and germs are spread more easily in an enclosed area, be it at home, work or any indoor venue where people are in numbers.
“This epidemic could be significantly reduced if we all carried handkerchiefs or tissues and used them,” Goins said.
“All flu viruses are spread via the sneezes and coughs of humans and animals. If we practiced cough and sneeze etiquette, the cold and flu viruses could be defeated.
“These viruses depend on us sneezing and coughing on those near us. They also depend on others touching surfaces on which we’ve left droplets after sneezing and coughing.”
The bird flu, carried in the intestines of wild birds, is rarely transmitted to humans. Goins said.
Goins said transmission from bird to human can occur from a human ingesting undercooked, infected domestic poultry or handling an infected bird, but these situations are rare.
First off, the migration of infected birds from Southeast Asia that mix with birds in Alaska is one way for bird flu to spread into the U.S., Goins said.
Secondly, bird flu can be brought to the mainland U.S. through the illegal importation of fighting cocks, which are popular in both Southeast Asia and in southeastern U.S.
A third means of entry into America could be through the illegal importation of exotic birds, which could carry the bird flu. Goins said this is the way bird flu made its way to England.
“The H5N1 strain of bird flu that is making its way around the earth has not yet mutated into a virus that is easily spread from human to human,” Goins said. “It is still largely concentrated in Southeast Asia, particularly in Indonesia. The World Health Organization and the CDC are monitoring it closely, anticipating its eventual mutation into a form easily contracted by humans.”
WHO has a six-phase table for pandemic viruses. Currently, H5N1 is only at stage three, but if the strain were to mutate and reach pandemic proportions, it could spread uncontrollably worldwide, Goins said.
“No one will be left untouched by a pandemic,” he said. “Only those who are prepared will experience its minimal effects. Those who are not prepared could be devastated.”
For more information, visit www.cdc.gov.

High risk bird flu countries

Africa, Indonesia, China bird flu hot spots -- experts


Associated Press
Last updated 01:13pm (Mla time) 09/17/2006

SINGAPORE -- Africa and East Asia, especially Indonesia and China, are particularly at risk for bird flu outbreaks despite progress in combating the disease in many countries, World Bank and UN experts said Sunday.

"We are worried within the African continent that we don't have access yet to the same level of resources as we have for East Asia and Eastern Europe," said Jim Adams, who heads the World Bank's bird flu task force, speaking on the sidelines of the bank's annual meeting.

The UN's chief for bird flu, David Nabarro, also expressed concern about the widespread appearance of the virus in Africa, but said the greatest worries still were in East Asia.

Indonesia, the country hardest hit by human fatalities from the H5N1 strain of the virus, has reported the virus in 260 of its 444 districts, Nabarro noted.

"It would be fair to say that there is a lot of H5N1 avian influenza virus in that country and that is a cause for concern," Nabarro said.


Copyright 2006 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

Avian flu prep

by Jan Dunlop




What you need to know to survive an avian bird flu pandemic

Avian Bird Flu has the potential to cause a major pandemic around the world, estimates are that up to 150 million people would die. The Spanish flu of 1918 killed 50 million. Most scientists now say that the question is not if but when this will occur. If Avian Bird Flu mutates so that it can be transmitted from human to human, it will probably spread rapidly. This will trigger a massive rush to secure flu vaccines, protective masks and other essential supplies.

Now is the time to act. If you get prepared ahead of time you can avoid most of the panic that will occur. Here are some simple steps you can take to ensure you are prepared:

Stock up on Flu Antiviral Drugs

According to the Center for Disease Control CDC, there are four different influenza antiviral drugs that are approved by the U.S. Food and Drug Administration (FDA) for the treatment of influenza: Oseltamivir (Tamiflu), Zanamivir (Relenza), Amantadine and Rimantadine. All four have activity against influenza A viruses. However, sometimes influenza strains can become resistant to these drugs, and therefore the drugs may not always be effective. For example, analyses of some of the 2004 H5N1 viruses isolated from poultry and humans in Asia have shown that the viruses are resistant to two of the medications (Amantadine and Rimantadine).

Purchase N95 Masks

Masks serve two purposes. First, they reduce the risk of infection from an infected person and two, they also stop the spread of infection from someone who is infected.

N95 masks are used to protect against highly transmissible respiratory infections. “N” stands for NIOSH – The National Institute for Occupational Safety and Health of the USA, and “95” reflects the filter efficiency of the mask. So “N95” indicates the mask is 95% efficient at filtering out particles of a size of approximately 0.3 microns and above. A N100 mask has a 99.7% efficiency of filtering out these small particles. Other paper or surgical masks are not suitable.

Get your Emergency Supplies in Order

Planning ahead of time will allow you to reduce your risk of exposure to the bird flu and to take better measures at protecting yourself and your family.

WHO rates pandemic flu risk as high

WHO: Bird flu pandemic risk still high

By MARGIE MASON
AP MEDICAL WRITER

AUCKLAND, New Zealand -- The risk of a flu pandemic remains high despite possible public fatigue with the issue, but the World Health Organization is hopeful the bird flu virus will do less damage than in past years during Asia's upcoming colder months, an official said Sunday.

"The virus seems to be very embedded in the environment and, in our view, the risk of a pandemic continues unabated," Richard Nesbit, WHO's acting regional director for the Western Pacific, told reporters prior to a weeklong meeting in Auckland, New Zealand.

"Recently, we've seen new outbreaks in poultry in Cambodia and also in Thailand, besides seeing continuing outbreaks in Indonesia," he said.

Bird flu is expected to be one of the top items discussed for the third straight year at the annual WHO regional meeting, which helps set the organization's strategic agenda. The H5N1 virus has killed at least 144 people since it began ravaging Asian poultry stocks in late 2003, and experts worry more fatalities will emerge as the cooler months approach.

Nesbit said he's encouraged by the progress Vietnam has made in beating back the virus. The communist country has recorded the second-highest number of fatalities after Indonesia, but has not detected a human case since November 2005. Vietnam has credited its success to a mass vaccination campaign of poultry and strong political will.

"I think that we've made a lot of effort in building up capacity in other countries, so I'm also hopeful that we will see a much improved situation (and) that we will not get human cases," he said of the cooler weather, when bird flu outbreaks and human cases are often logged.

Bird flu remains hard for humans to catch, but experts fear the virus could mutate into a new form that spreads easily among people. So far, most human cases have been traced to contact with infected birds, but Nesbit said the public should not lower its guard even though the warning has now become somewhat old.

"The scientists are telling us that the risk is just as present as ever. ... We are seeing continuing evolution of these viruses and that's been very well documented now both in humans but as well also in poultry," he said. "After three years now, I'm sure that many journalists and the public are starting to get tired of the same message that there's a potential global pandemic around the corner, but we have a responsibility to continue to give this message."

In Singapore, officials from the World Bank and United Nations expressed worry on the sidelines of the bank's annual meeting about bird flu in Africa and Asia, particularly China and Indonesia.

Last week, David Nabarro, the U.N.'s point man on bird flu, said he would push for donors to give more money to help Indonesia, which has been hit by a string of bird flu cases and has become the worst-hit nation with 49 human deaths.

The WHO meeting in New Zealand, attended by 37 countries and territories, also will address a number of other major health issues affecting the region, including heart disease, diabetes, AIDS and tuberculosis. Smoking and alcohol control also will be discussed, along with the migration of health care workers throughout the region.

After the fact discoveries of bird flu cases

Reports of missed mild bird flu cases raise questions about scope of spread
17:54:50 EDT Sep 17, 2006
Canadian Press: HELEN BRANSWELL

(CP) - Recent reports from South Korea and Indonesia of after-the-fact discovery of a handful of mild human cases of H5N1 avian flu have again raised questions about whether the disease's extraordinarily high death rate is being inflated because mild cases are being missed.

Experts say the evidence to date points away from that notion. But they add that it is important to continue to search for mild cases. Understanding the true number of human infections and the range of symptoms experienced could help scientists better assess the pandemic risk posed by the virus.

As well, tracking mild cases over time could provide an early warning if important changes to H5N1 occur, they suggest. Climbing rates of mild cases might signal the virus was adapting to become a human flu strain, moving closer to triggering a flu pandemic.

"We need to keep monitoring it," Dr. Michael Osterholm, director of the University of Minnesota's Center for Infectious Diseases Research and Policy, said Sunday.

"Because frankly, one of the indications that there may be a changing epidemiology (disease pattern) with this is in fact if we start seeing larger and larger percentages of individuals who are asymptomatic or only mildly ill that we can clearly confirm as having H5N1 infection."

The World Health Organization announced last week blood tests done on an Indonesian man showed he became infected, likely in May when he helped nurse his sister, a confirmed H5N1 case. The man reported having a cough and abdominal discomfort but his symptoms weren't diagnosed as H5N1-related at the time.

And South Korean officials revealed that testing of blood samples from more than 2,000 workers who culled diseased poultry in late 2003 and early 2004 showed five had developed antibodies to the virus - a sign they had been infected. An earlier round of testing in South Korea turned up four cullers with antibodies.

None of these people had serious illness at the time; none has yet been added to the WHO's official case list.

To the best of the scientific community's knowledge, the H5N1 virus is not adept at infecting people. But when it does, it appears to cause severe disease. Nearly 60 per cent of the 246 confirmed cases have died; many of the survivors battled for their lives.

But there has always been a suspicion in some quarters that a significant number of mild cases are being missed - a theory these new reports may fuel.

Many - though not all - diseases cause a spectrum of illness ranging from undetectable to life-threatening infection. With polio, for instance, it is estimated there are 200 inapparent infections for every person the virus paralyzes. On the other hand, rabies is almost 100 per cent fatal.

If the confirmed H5N1 cases were the proverbial tip of the iceberg, the death rate attributed to the virus would tumble. That in turn might ease worries about the threat posed by H5N1 - though a flu virus that killed even 10 or 20 per cent of its victims would still be a source of serious concern.

Dr. Angus Nicoll, an influenza expert with the European Centre for Disease Control, said these new asymptomatic cases don't change the fact that the bulk of evidence to date suggests such cases are rare.

A number of small studies have been done to test the blood of people who've been in contact with confirmed cases. They have turned up few or no cases that missed earlier detection.

The most recent study - published in the October issue of Emerging Infectious Diseases - looked at blood samples from 351 Cambodians who had been in contact with a man who died from the disease. None developed antibodies to the virus.

"It's still a plausible hypothesis but it's becoming a less likely one," Nicoll said of the notion that there may be a significant number of asymptomatic and mild cases of the disease.

"My bottom line would be: I'm sure we're going to find the occasional mild case. I'm sure we're going to find, eventually, an asymptomatic (case)," he said from Sweden.

"Even if you find just a few asymptomatic and mild cases, that's not going to change the our risk assessment."


© The Canadian Press, 2006

Britain surveys for bird flu

Surveillance checks for bird flu
Wild ducks
There are fears that bird flu could arrive through migrating birds
New tactics are being adopted in an attempt to prevent an outbreak of bird flu in Britain.

A surveillance operation to check for infected wild birds will concentrate on favourite spots of migrating waterfowl.

These zones include the northern and West Midlands, the south coast, parts of the West Country, Anglesey, eastern Scotland and much of East Anglia.

The operation will also focus on poultry farms which could be at risk from the H5N1 bird flu virus.

The programme is being introduced in time for the start of the migration season of water birds, and has three elements:

* testing of live birds which are then released
* testing shot birds - shot as part of legal fowling practices
* testing certain species of dead wild birds found in designated areas

Species considered to be most at risk of introducing bird flu including ducks, geese, swans, gulls and waders, are more likely to be targeted.

Martin Fowlie, of the RSPB, said the surveillance operation was being carried out at all the society's reserves around the country.


This new targeted strategy ensures that our operation is as sharp as possible
Debby Reynolds
Chief Veterinary Officer

"We're sending our wardens out to look at and survey different wetlands - looking for dead and dying ducks, basically," he said.

BBC rural affairs correspondent Tom Heap said the public were still being encouraged to report dead water birds.

But Defra said the likelihood of a dead wild bird found to be infected is very small.

Debby Reynolds, the UK's chief veterinary officer, said: "This new targeted strategy ensures that our operation is as sharp as possible.

"One thing that never changes however, is the need for us to work in partnership with poultry farmers, wildlife experts, scientists and the general public to keep the risk to a minimum," she said.

In August, Britain's deputy chief vet Fred Landeg expressed concerns over bird flu being passed to farm birds by migrating birds.

Earlier this year, thousands of birds were culled after a bird flu strain was discovered on three farms in Norfolk.

Bird flu and politics game

Political crisis 'may have spread bird flu'

The top United Nations official coordinating the global fight against bird flu has said the Thailand political crisis may have caused a resurgence of the disease which killed last least two people in July and August.

David Nabarro, the senior UN coordinator for avian influenza, told the Financial Times newspaper the Vietnamese response to the disease remains admirable. It remained unclear exactly why the disease resurfaced in Laos and Thailand, along the Mekong River.

But the newspaper's website quoted Dr Nabarro as saying the political crisis in Thailand might have weakened the country’s response.

"You don’t maintain control over this disease unless there is regular top-level direction from a committed senior political figure that wants to be sure that the necessary activities are being undertaken," Dr Nabarro was quoted as saying.

Prime Minister Thaksin Shinawatra dissolved parliament in February for an April 2 election that spilled into chaos and cancellation. Another election has not been scheduled, but may occur in November.

Cost of bird flu rises

Bird-Flu Pandemic Could Cost $2 Trillion
Afghanistan -- Bird flu – An Afghan woman feeds chicken in a village near Kabul, 23 January 2006. (Size: 220x155)

September 18, 2006 -- A severe bird-flu pandemic among humans could cost the global economy up to $2 trillion, the World Bank warns, sharply raising earlier estimates.

The comments on September 17 came as a senior World Health Organization official said the threat from the H5N1 avian-flu virus was just as real today as it was six months ago.

(Reuters)

Vietnamese bird flu scam

Vietnamese Police Widen Investigation Into Bird Flu Scam



HANOI (AP)--Police in southern Vietnam are widening an investigation into a scam in which tens of thousands of dollars in government funds earmarked to fight bird flu may have been misappropriated, police and officials said Monday.



State inspectors have discovered that Ha Ngoc Chien, director of the Health Department in Bac Lieu province, and some of her staff inflated the prices of masks, protective suits and other equipment by 1 billion dong ($62,500), said provincial chief inspector Dang Xuan Tinh.



Tinh said all documents relating to the case have been handed over to police.



A provincial police officer who identified himself only as Mau said police are widening their investigation into the case.



Online newspaper Vietnamnet quoted a report by provincial inspectors as saying the health department bought 5,100 masks at the price of 50,000 dong, but the market price for the masks was only 15,900 dong, while the price of a protective suit was inflated to 68,000 dong from the market price of 30,800 dong.



The prices were inflated in early 2004 when bird flu outbreaks were ravaging poultry farms across Vietnam and Asia. The outbreaks in Bac Lieu province alone cost poultry farmers 40 billion dong ($2.5 million) that year, the newspaper said.



Vietnam, where 42 people died of bird flu, has reported no outbreaks among poultry this year and no human infection since November.



Source: Dow Jones Newswire