The deaths go on and on...

Further Bird Flu Death in Indonesia Spread of the disease may be assisted by the approaching rainy season Aloysius Wisnuhardana (wisnuhard) One more person has died of the bird flu virus in Indonesia. Taufik Zakariah, a 20-year-old man from Bandung, died on Thursday four days after his brother. Both were suspected of catching bird flu after feeding their dogs with dead chickens they bought in the market near their house. After the two brothers died their cousin was also suspected of having bird flu. She was brought to Hasan Sadikin Hospital in Bandung after attending the burial of the brothers. Soon afterwards the 18-year-old female developed a high fever, coughing, and found it hard to breathe. Her body temperature reached 39 degree Celsius. This girl was suspected for bird flu because she lived in the same house as Taufik, the first person to die in the family. However, laboratory tests have yet to be conducted on her blood sample. Meanwhile, the young sister of this family, a 15-year-old female, is also being treated in Hasan Sadikin Hospital due to a high fever and breathing difficulties. The laboratory test revealed that she was negative for the bird flu virus, but the medical staff still gave her medical treatment. She initially required an oxygen tube but she is now breathing unaided. The doctors will keep her in hospital for the next seven days to make sure that her condition becomes normal. They are also waiting for a third laboratory test. To prevent the situation worsening, health officers have now taken blood samples for examination from about 20 people who live near the dead patients. Meanwhile Mike Perdue, a doctor from the W.H.O., was reported by AFP as explaining that H5N1, otherwise known as the bird flu virus, never sleeps and is still a danger. As the rainy season approaches and the weather becomes colder, the risk of virus mutation is more possible and at the same the human body's resistance drops. That is the best time for viruses to hit humans. Perdue warns that although a virus mutation incident has not happened, it remains a possibility. Health Minister Siti Fadilah Supari said yesterday on television that the government was not too slow-going to fight against the bird flu spreading across Indonesia. She explained what her side had done and would do, including distribute more bird flu antibiotics, especially into the regions where there are bird flu outbreaks. Another factor behind how the bird flu virus continues to spread and is becoming difficult to stop is economic. In the latest cluster the victims became infected after buying dead chickens from the market. It is possible that other people actually were infected by the same virus. The problem is understanding what caused the traders to sell the dead chickens. There were undoubtedly economic motivations. Beside this factor, another factor is awareness about how to prevent the bird flu virus among people who live with poultry or chickens near their houses. Again and again we find that economic considerations prevent people from living their lives without chickens, even for just a little while. ©2006 OhmyNews

NEW CLUSTER IN INDONESIA?

Bird flu case confirmed in possible cluster

The Jakarta Post, Bandung, Jakarta

Health officials said Tuesday they were examining possible intra-human transmission of bird flu in West Java, where a hospitalized 20-year-old male resident of Bandung tested positive for the virus.

It brings bird flu cases to 67 in Indonesia, which holds the world record of 51 deaths, including 40 this year.

The director of Hasan Sadikin General Hospital in Bandung, Cissy Rachiana Prawira, said Tuesday the central laboratory in Jakarta confirmed the young man was infected with H5N1.

His 23-year-old brother had died Sunday afternoon before he could be taken to hospital for testing. Their sister, aged 15, was admitted to the hospital Monday night after developing a fever and cough.

It has led to speculation that it is a cluster infection, with the family possibly infected from the same source.

Hadi Jusuf, who heads the bird flu team at Hasan Sadikin, said the younger brother's condition had not improved since his treatment began in an isolation ward at the hospital.

He remains unconscious and showed signs of respiratory distress, Hadi said. His white blood cell level is still under 2,000.

"He's still on a ventilator and we are watching him closely. The pneumonia which was previously only found on the lower side of his left lung has now spread to both sides."

The parents of the three are still in shock, especially with the investigation into their eldest son's infection with H5N1 focusing on the family's feeding of dead chickens to their dogs.

"I don't want my youngest child to be sick either. That's why when she complained that she had fever, headache and cough, I immediately took her to the hospital," the mother told journalists at home, as the Bandung agriculture office took blood samples of 13 chickens and four ducks they kept to see if the animals were infected with H5N1.

The head of the Bandung health office, Gunadi S. Bhinekas, said his office would increase its public awareness campaigns about bird flu and sanitation to keep the virus from spreading. Poultry infections in Bandung have been found in 14 subdistricts.

"We are working with the agriculture office to closely watch the slaughterhouses and to do mapping of the areas with bird flu cases in poultry."

The head of the Bandung agriculture office, Yogi Supardjo, said his office had difficulty in monitoring the traffic of poultry in the West Java capital.

"We can't monitor it all the time, so we're asking people to take the initiative to vaccinate their poultry and maintain proper sanitation."

Meanwhile, the Indonesian Committee for Bird Flu Control and Influenza Pandemic Preparedness said the government was investigating the latest bird flu fatality, a nine-year-old boy who died Friday in Jakarta.

The boy, believed to have had contact with sick chickens, died in a hospital nine days after he first showed symptoms of the virus, including high fever and difficulty breathing.

In a statement released on Monday night, the committee also urged local figures and leaders to be involved in the campaign to raise public awareness about bird flu.

Heroin, not bird flu?

Bird flu man may have been drug courier



September 27, 2006 - 11:49AM


A man who sparked a bird flu scare when he became ill on a flight to Sydney from Vietnam may have been a drug courier whose illness was caused by a heroin-filled condom bursting in his stomach.

Neither the Australian Federal Police (AFP) nor the Ambulance Service of NSW would comment on media reports the man was a drug courier trying to smuggle heroin into Sydney.

Ambulance officers saved the man by administering Narcan, which is used to treat heroin overdoses, the reports on the Seven and Nine networks said.

The man, aged in his 30s, was placed in quarantine after being stretchered off a Vietnam Airlines flight which arrived at Sydney Airport from Hanoi via Ho Chi Minh city about 8.30am (AEST).

NSW Health Communicable Diseases director Jeremy McAnulty said initial tests at St George Hospital showed it was very unlikely he had the deadly avian influenza.

NSW Health Minister John Hatzistergos said he did not want to comment on the matter as the AFP had become involved.

The AFP said the man was a person of interest but would not comment on the drug courier allegations.

"This man is now a person of interest to the AFP and investigations are continuing," a spokesman said.

Dr McAnulty said the man's recent history of being in an area with chickens in Vietnam and having a previous influenza-like illness had sparked concern when he arrived in Sydney.

"It turns out that is a very unlikely diagnosis," Dr McAnulty told reporters.

"But the person's still being assessed in hospital.

"Our concern is whether a person has a quarantinable disease or avian influenza and at this stage it seems very unlikely that that's the case."

Mildly unwell when he boarded the plane, the man had become "difficult to rouse" when the flight touched down in Sydney, Dr McAnulty said.

Quarantine officers wearing protective clothing had boarded the aircraft, isolated the man and escorted him to a waiting ambulance.

He said even if the man had contracted avian flu, the chances of his travelling companion or other passengers being infected were extremely low.

"At this stage we think that the likelihood that he'd be infectious to other people is extremely low," he said.

"However, if that changes, then we have mechanisms in place to follow up other passengers, but at this stage we don't believe (there is) any risk.

"... the risk of person-to-person transmission is extraordinarily low. There's only really been one or two of those possibilities around the world in the past."

The federal government has developed a detailed plan to combat the flu if it reaches Australian shores.

About 50 million surgical masks and 40 million syringes have been stockpiled along with mass quantities of anti-virals including Tamiflu, widely regarded as the best drug for combating bird flu.

© 2006 AAP
Brought to you by aap

More grief for Indonesia

Indonesian man sickened by the H5N1 bird flu virus, new family cluster feared
The Associated Press

Published: September 26, 2006
JAKARTA, Indonesia An Indonesian man hospitalized with symptoms of bird flu has the disease, health officials confirmed Tuesday, pointing to a possible new family cluster in the nation hardest hit by the virus.

The older brother of the 20-year-old patient — who is being treated in the city of Bandung — died Sunday with symptoms of the disease before samples could be taken, said Fatimah Resmiati, a West Java health official.

Their 15-year-old sister has a high fever and respiratory problems and is also being treated as a suspected bird flu case, officials at Hasan Sadikin hospital said.

Resmiati suggested that the siblings could represent a new family cluster of the disease.

Experts closely monitor such cases for signs that the virus may have mutated into a form more easily passed between humans.

The H5N1 strain of bird flu has killed at least 146 people worldwide since it started ravaging poultry stocks in Asia three years ago, hitting Indonesia the hardest, according to the World Health Organization.

At least 51 people have died across the sprawling archipelago, most of them on the densely populated island of Java, and another 17 patients have been sickened.

At present it is difficult for people to catch — with most infections being linked to close contact with infected birds or their droppings. But experts fear the virus could mutate into a form that is more easily transmissible between humans.

Gunawan, the cousin of the three family members believed to have been affected in recent days, said the siblings had been in contact with chicken carcasses, feeding them to their pet dog.

It was not immediately clear if the dead birds were infected with bird flu.

Will medicinal herbs hold an answer for avian flu?

Progress in search for 'bird-flu herbs'

Identifying the right herb as an alternative treatment for the bird-flu virus could take years, as it would not be simple to narrow down the list and complete testing, researchers have said.

Until recently, they were concerned about the cost of using the conventional tissue-culture method on 30,000 substances derived from 150 types of herbs to decide which could be effective.

But a new development has been helping in the fight - Kasetsart University's "Chemiebase", an Internet database of herbal extracts which could be used in simulating tests on whether certain herbal substances were worth further trial.

Containing about 100,000 3D chemical structures of herbal substances, the new database allows scientists to find herbal medication to fight bird flu.

With this "virtual screening" of 30,000 structures, it was found that only about 40 were actually worth further investigation, according to Chak Sangma of Kasetsart University's Chemino-fomatic Research Unit said.

This technique has just been introduced to herbal research in Thailand, although the programme has been widely used in the other countries such as China and India where herbal research is very advanced, said Chak, who is involved in Biotec's research.

Out of the 40 likely substances taken from a few types of plants, only one turned out to be effective in suppressing the H5N1 strain of bird flu, said Prof Pilaipan Puthavathana of Siriraj Hospital's Department of Microbiology, who tested the substances for Chak.

"This is the way to go. Even with the help of this programme, it took me several months to finish," she said. "I can't imagine how long and how impractical it would be to do a tissue culture on all of those substances to eventually get only one worth further investigation."

Developed by Kasetsart's Facul-ty of Science, the database is available free of charge at "http://chemiebase.ku.ac.th".

The researchers have decided to withhold the name of the herbal substance which in preliminary tests has proven effective in the fight against the bird-flu virus.

They were also still testing a few other substances which showed promise like the one already tested by Siriraj, according to Chak, who warned: "Don't hold your breath. It's not time to open the champagne just yet."

The researchers also have to bear in mind a drug that can effectively fight the virus in the laboratory might not always work when used on humans. So it could take 10 to 15 years to develop one herbal drug.

Arthit Khwankhom

The Nation

US Government will help with bird flu

USDA to help farms cover costs of avian flu

Sep 25, 2006 (CIDRAP News) – The US Department of Agriculture (USDA) said last week it would, under certain conditions, reimburse commercial poultry farms for the cost of stopping low-pathogenic H5 and H7 avian influenza outbreaks.

Under a new rule, the USDA promised to provide "100 percent indemnity for specified costs" involved in eradicating H5 and H7 viruses at commercial poultry operations that participate in the National Poultry Improvement Program (NPIP), a voluntary federal, state, and industry program to prevent the spread of poultry diseases.

Until now, the states usually handled reimbursement for the costs of fighting avian flu, and the provisions varied, the USDA said.

"This program expansion strengthens U.S. protections against poultry diseases such as avian influenza," said Dr. Ron DeHaven, head of the USDA's Animal and Plant Health Inspection Service (APHIS). He said the change also helps ensure US compliance with international animal health guidelines that require countries to report all H5 and H7 virus detections.

The program expansion will encourage testing and provide incentives to report outbreaks. It also demonstrates the USDA's commitment to openness about H5 and H7 viruses in the country's bird populations, officials said.

Low-pathogenic avian flu poses no risk to human health, but the USDA's policy is to eradicate H5 and H7 viruses because they can mutate into highly pathogenic forms, the agency said.

The NPIP, dating back to the 1930s, is a coordinated effort to certify poultry flocks as free of diseases. Until now, only breeder flocks could be included in NPIP avian flu programs. The new rule expands the program to include commercial production flocks, including "table-egg layers, meat-type chickens, and meat-type turkeys."

To be eligible for full indemnification, commercial poultry facilities and states must meet certain requirements. The main requirements are that:

* States must have a surveillance program for all poultry.
* States must have APHIS-approved plans spelling out response and containment efforts in case of an H5 or H7 outbreak.
* Industry must maintain active surveillance that includes testing of birds and eggs.

The new rule takes effect Sep 26, when it will be published in the Federal Register, the USDA said.

In other developments, the USDA confirmed Sep 23 that the avian flu virus found in mallard ducks in Pennsylvania last month was the low-pathogenic North American strain of H5N1.

Screening results announced Sep 2 pointed to a mild form of H5N1 virus in samples from mallards in Crawford County, Pa., but further testing was necessary, the agency said. Genetic testing excluded the possibility of the lethal Asian strain of H5N1 in the ducks.

Mild forms of H5N1 have also been found recently in mallard ducks in Maryland and in two swans in Michigan.

Update from hard hit Indonesia

Avian influenza � situation in Indonesia � update 32

As of 25 Sep 2006, the Ministry of Health in
Indonesia has confirmed 2 additional cases of
human infection with the H5N1 avian influenza virus. Both cases were fatal.

The 1st case occurred in an 11-year-old boy from
East Java Province. He developed symptoms of
fever and cough on 16 Sep [2006], was
hospitalized on 18 Sep [2006], and died the same
day. Poultry in the child's household began dying
in the month prior to symptom onset, and poultry
deaths continued thereafter in his neighborhood.

The 2nd case occurred in a 9-year-old boy from
South Jakarta. He developed symptoms of fever and
a runny nose on 13 Sep [2006], was hospitalized
on 20 September, and died on 22 September. His
history showed recent contact with sick chickens, which he kept as pets.

Of the 67 cases confirmed to date in Indonesia, 51 have been fatal.

--
ProMED-mail

China predicts problems in winter with bird flu

Avian flu 'may strike' in winter


Top influenza scientists warned on Friday of the big possibility of a major bird flu outbreak in China this winter or next spring.

Such an outbreak, which would hit poultry and human beings, would probably take place as common flu cases reach their peak, said Zeng Guang, chief epidemiology scientist at China's Centre for Disease Control and Prevention.

Zeng said that the three major bird flu outbreaks over the past three years had all taken place during the winter or spring.

Great attention must be paid to the possible occurrence of common flu and bird flu peaks at the same time, Zeng told a forum jointly held by Sanofi Pasteur and the Chinese Preventive Medicine Association in Beijing.

It remains difficult to determine how the H5N1 virus will develop, said Zeng, but he noted there was a possibility it may form a hybrid with other flu viruses.

Possible crossbreeding may result in a new form of virus which could be transmitted between humans, he noted.

Currently, all human cases of bird flu have been infected by sick birds. There is no evidence to suggest that the virus can be passed from person to person, according to World Health Organization (WHO).

WHO experts have repeatedly warned there is a major risk that the bird flu virus may be transmitted between humans, which would result in a global pandemic.

Zeng said that the three flu pandemics over the past century were all caused by a hybrid virus.

Flu pandemics generally take place three or four times per century.

The last major pandemic took place in 1918-1919 and killed an estimated 40-50 million people across the globe.

Flu viruses can be divided into three groups A, B and C. Only A, which infects many animal species such as birds and swine, and B, which only affects humans, can cause severe disease and lead to epidemics.

Bird flu is an infectious disease caused by A viruses.

Highly pathogenic bird flu, such as that caused by the H5N1 strain currently circulating in Asia and other parts of the world, is characterized by its sudden onset, severe illness, and generally quick death.

The H5N1 strain is of particular concern because it mutates rapidly and can acquire genes from viruses infecting other animal species. This highly pathogenic strain is now known to cause severe disease and death in humans.

As the disease increases among birds and humans, the likelihood also increases that a human concurrently infected with human and bird flu strains will serve as the "mixing vessel" for a new influenza subtype that can be transmitted easily from person to person, thus sparking a flu pandemic, according to the WHO.

At present, there remains one prerequisite for the start of a pandemic that the current H5N1 virus has yet to meet sustained and efficient transmission among humans.

Currently, about 250,000 to 300,000 people die across the globe every year as a result of complications caused by various types of influenza, he said.

In this regard, it is vital to prevent common influenza in the war against a possible bird flu epidemic or pandemic, he added.

In China, around 130 million people are infected with influenza every year.

From November 2003 to September 14 this year, a total of 246 people had been infected by H5N1 in 10 countries, resulting in 144 fatalities. A total of 21 people in China have been infected by the virus, with 14 losing their lives.

Evidence to date indicates that close contact with sick or dead birds, such as slaughtering or de-feathering, is the principal source of infection.

Worldwide, about a dozen companies are currently conducting clinical trials on bird flu vaccines.

As scientists still do not know enough about the virus, public education is an important way to prevent a bird flu outbreak, said Zhang Bin, an official from the Ministry of Health.

Source: China Daily

Thailand has new death from bird flu

Thailand reports bird flu death

Thailand is one of the world's largest chicken exporters
A 59-year-old farmer has died of bird flu in north-eastern Thailand, the third person to die of the disease this year, health officials say.

The man died on 10 August near the Lao border, according to Kumnuan Ungchusak, a senior health ministry official.

He was believed to have been in contact with sick chickens shortly before he became ill.

Mr Kumnuan said final laboratory tests to determine the cause of death were only completed last week.

Thailand is one of the countries hardest hit by the deadly H5N1 bird flu virus, recording 17 fatalities since 2004.

QUICK GUIDE

Bird flu
It was initially criticised for being slow to respond to the disease, but it is now considered to be one of the countries best prepared to combat the virus.

Global problem

Globally, more than 130 people have died of bird flu since late 2003. Most have been in East Asia, with Indonesia registering more human deaths than any other nation.

But the virus has also spread to Europe, the Middle East and Africa.

Millions of birds across the world have died or been culled because of the disease.

At the moment, the virus is essentially confined to birds and remains hard for people to catch.

But there is a fear that it could mutate to a form which is easily passed from human to human, triggering a pandemic and potentially putting millions of people's lives at risk.