Mysterious Pig Deaths in Thailand cause Alarm(H5N1) July/7/05

The Flying Dutchman · Jul 7, 2005

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 You know folks; it is a real shame when *Pride* dictates in matters where the
disputed subject is also at the same time, information which is needful for us to know.

And from the lack of there being an avian thread on the board today; I can only conclude that if the H5N1 news; and an updated situation on it, is to be available to the Tb'ers perusal today.

I had better scramble and *go out* and find out what that news is.

<center>Thursday, July 7, 2005

Why mysterious pig deaths in Thailand are cause for alarm

By JEFF NESMITH
<A href="http://seattlepi.nwsource.com/health/231490_flustorm07.html">COX NEWS SERVICE</A>

WASHINGTON -- During ordinary times, the mysterious deaths of pigs in a distant place might not have attracted so much attention.</center>
But because of fears that the world faces a pandemic of avian flu, a report three weeks ago about pig deaths in Khon Kaen, Thailand, found its way within hours to an Internet site frequented by U.S. scientists.

Seemingly healthy young hogs were dying abruptly, according to the report by the Thai News Agency. The animals fell into seizures, and their pink ears turned purple just before they died.

The Thai government has not said what killed the pigs, but "I'm betting cytokine storm," one visitor to the Web site commented.

The possible emergence of that frightening and lethal immune system reaction presents a fresh worry for health experts responsible for preparing for a possible avian flu pandemic and treating victims if it occurs.

Current prevention and treatment plans focus on the very young and very old. But about half the victims of the 1918 Spanish flu pandemic, thought to have triggered the reaction, were largely healthy and between 18 and 40.

In addition, a flu that caused widespread cases of cytokine storm would leave health authorities short of the medical equipment most needed to treat it.

In a cytokine storm, a healthy and vigorous immune system goes into an uncontrolled response to the flu virus. A biochemical "cascade" of cells and the products they release -- substances such as interferon, interleuken, monokines and cytokines -- floods into the lungs.

"The immune system sees this virus that it has never seen before, and it just goes bananas," said Laurie Garrett, a health writer and fellow at the Council on Foreign Relations.

Soon, the patient falls into a condition called acute respiratory distress syndrome (ARDS), in effect suffocating from his or her own disease-fighting chemistry.

Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, compares cytokine storm to what might happen if someone throws a match into a trash can.

"Somewhere a fire station is supposed to pick up a signal from the smoke alarm and respond," he said. "But imagine if every fire station in the city responded to the alarm and sent firemen into that room."

Since pigs easily contract strains of flu known to infect humans, experts say that if a pig becomes infected with both human flu and the deadly avian flu, the two strains could combine to produce a lethal human virus.

The experts fear that if the virus was able to pass between humans, it could rapidly spread around the world and kill hundreds of millions of people.

The great influenza epidemic of 1918-1919 was a global disaster of a similar scale, and Osterholm said that cytokine storm appears to be the reason it killed so many young, healthy people. There were reports at the time of young soldiers turning purple in the face and dying within a day of developing the flu.

He noted that influenza pandemics in 1957 and 1968 produced U-shaped mortality curves, with deaths concentrated among very young and very old victims. This is the pattern seen in annual epidemics of "garden-variety flu," Osterholm said yesterday.

But in 1918, the mortality curve was W-shaped, he said. "You have this big rise in deaths of healthy young adults" in the middle.

Osterholm, who also is an associate director of the National Center for Food Protection and Defense of the federal Department of Homeland Security, described the cytokine storm phenomenon in a recent article in the New England Journal of Medicine.

One reason the phenomenon frightens health officials is the fact that the recommended treatment for ARDS includes respiratory support with hospital ventilators.

There are 107,000 ventilators in all of America's hospitals, Osterholm said, and in an influenza pandemic the need could quickly reach 400,000 or more. There would be no way to get them manufactured on time, he said.

Wayne Wrolstad, national marketing director of Hamilton Medical Inc., one of about nine major manufacturers of hospital ventilators worldwide, said most companies build "10 to 16 per day" at a cost of about $25,000 each.

The Flying Dutchman · Jul 7, 2005

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<center>Migratory Bird H5 Sequences in 2003 Shantou Chicken

<A href="http://www.recombinomics.com/News/07070501/H5_Migratory_Shantou.html">Recombinomics Commentary</A>
July 7, 2005

Today's Nature describes H5N1 bird flu isolates from migratory birds at Qinghai Lake. These isolates are unique and the sequences will soon be publicly available at GenBank. The most closely related H5N1 currently available is A/Ck/ST/4231/03(H5N1) and the closely related A/Ck/Yamagichi/7/04(H5N1). These two isolates are closely related to the other four H5N1isolates from Japan (A/chicken/Kyoto/3/2004, A/chicken/Oita/8/2004 , A/crow/Kyoto/53/2004, A/crow/Osaka/102/2004 as well as two H5N1 isolates from South Korea (A/chicken/Korea/ES/03, A/duck/Korea/ESD1/03).</center>
However, the Shantou sequence also has a number of rare polymorphisms that are found in a wide variety of H5 sero-types that stretch from Europe to Russia to Australia, strongly suggesting that the Shantou sequences evolved from migratory birds that fly over Asia and Europe. Included in the list are A/Anas platyrhynchos/Chany Lake/9/03(H5N3), A/Mallard/64650/03 (H5N7), A/duck/Primorie/2633/01 (H5N3) A/chicken/Italy/8/98 (H5N2), A/duck/Singapore/3/97 (H5N3), A/Guinea Fowl/Italy/330/97 (H5N2), A/Duck/Potsdam/1402-6/86 (H5N2), A/Duck/Potsdam/2216-4/84 (H5N6), A/Duck/Ireland/113/83 (H5N8), A/Turkey/Ireland/1378/83 (H5N8), A/Duck/Hong Kong/698/79 (H5N3), A/Duck/Ho Chi Minh/14/78 (H5N3), A/duck/Hong Kong/342/78 *H5N2), A/Duck/Hong Kong/205/77 (H5N3), A/shearwater/Australia/75 (H5N3).

The sequences at Qinghai have the PB2 mutation at 627 that confers virulence for a large number of sero-types, which may be related to the large number of migratory bird deaths. The shared sequences above indicate the migratory birds can transmit to domestic ducks sold in live markets such as those in Shantou, Japan, or South Korea and the birds are likely responsible for the new sequences which appear each season throughout Asia.

However, the latest H5N1 isolates from Qinghai Lake are particularly lethal in mammals, killing laboratory mice in just 4 days and readily transmissible among migratory birds at Qingahi Lake. The widespread distribution of shared polymorphisms suggests the Qinghai sequences will be appearing throughout Asia and Europe. These sequences also support transmission of sequences from India to Qinghai Lake, since the Qinghai polymorphisms are so widely dispersed.

Analysis of the new Qinghai sequences will determine if the above observations on the Shantou sequence extends to Qinghai Lake, but clearly Shantou 4231, which was isolated in 2003, demonstrates that migratory bird sequences are in domestic chickens in Shantou, and suggest H5N1 is widely distributed in China and the rest of Asia.

The Flying Dutchman · Jul 7, 2005

-Note: For anyone who wishes to keep abrest of the "How to Protect ones self" I reccommend this site be *booked* and they go over it's information - there is a LOT OF IT.

Shakey

<center>Disease Transmission Primer

<A href="http://www.fluwikie.com/index.php?n=Science.DiseaseTransmissionPrimer">Courtasy of the Flu Wiki Site</A>

Knowing the clinical appearance of influenza and the details about the virus is only part of the picture. We also need to know something about how the virus spreads through the population and how quickly. For this we need some basic information on infectious disease epidemiology. </center>
As discussed in the Influenza Primer I and II, the ability to cause disease (pathogenicity) and the severity of the disease (virulence) are not properties of the virus alone but of the complicated relationship of the virus, the host (say a human or a bird) and the environment they all live in. This relationship itself isn’t constant but is constantly changing as the three parts (host - agent - environment) change. This is clear when we talk about how the disease spreads. The immune status of the host or its state of health, the specific strain of the virus and how it changes as it multiplies in the host, and how close together people are and how often they are in contact with each other are all critical factors to how influenza spreads. In order to bring some order into this we need some basic terms and ideas.

<center>Stages of infections</center>

Infection begins when an intact virus (sometimes called a viral particle or a virion) enters a host cell and begins to replicate. For a time, called the latent period, the host has no symptoms nor is he (we’ll fix the victim to be male) infectious because he hasn’t yet started to shed virus into his environment. The point where this starts to happen is the end of the latent period and the beginning of the infectious period. Also at some point after infection the subject may start to have symptoms of infection (sore throat, aching or fever). This is the start of the symptomatic period. The time from the start of the latent period to the start of the symptomatic period is called the incubation period and may or may not include some of the period of infectiousness.

What makes this scheme more complicated and also very important from the public health point of view is that the order in which the infectious period and the symptomatic periods happen is not fixed for different diseases. Thus in SARS people became sick (symptomatic) before they were maximally infective, so health care workers rather than the general population were most likely to be exposed. It was thus also easier to control the disease because apparently well people were not infectious. With influenza, on the other hand, the infectious period begins about 24 hours before the symptomatic period. This gives influenza a head start in infecting people, before the person knows he is sick and thus more likely to have contact with others.

People can also become infected and sick but never infectious (although this would be rare for influenza), but more importantly they can become infected and infectious but not sick (inapparent or silent infection). These people are “healthy carriers.” There are estimates as high as 30% to 60% for infected people who are infectious for influenza but otherwise healthy. Until recently most aquatic wildfowl were also healthy carriers, although now migratory birds in China have been reported to be sickened by the virus, not just carriers. One concern about the use of vaccination in domestic poultry is that it might convert birds who would otherwise obviously be sick to normal-looking healthy carriers.

<center>Transmission probability</center>

The thing most people want to know about the risk of getting influenza is how likely they are to become infected if exposed. This is called the transmission probability and is one of the key numbers to consider in disease spread. Technically, it is the probability (the chance) of the disease being transmitted from one person to another or from a bird or other animal to a person, given that there has been contact between them. While this definition seems fairly clear at first, it has a lot of “interior” parts because it depends on characteristics of the host (for example how much virus he is shedding and how he is shedding it), the particular viral strain (for example, how well does it survive in various environments and how easily does it infect various hosts), the possible new host (e.g., what her immune status is or her age) and what we mean by “contact” (being in the same household? The same room? Having touched the infected person? Etc.) Thus this is not either a single number or even one that is easy to estimate in a given situation. In order to understand what any given figure for transmission probability means you need to know quite a bit about how it was measured and importantly what definition of “contact” was used.

One frequently encountered indicator of transmission probability is the Secondary Attack Rate (SAR) (which technically is not a rate but a proportion). The SAR is the probability of disease among known (or presumed) susceptible people following contact with a known primary case (often called the index case). It is often measured in some convenient population like a household, classroom or airplane. It measures only the “first level” of infections, not any secondary infections that occur later from those infected by the index case.

SAR has been the subject of some discussion in trying to decide whether H5 N1 has gone “human-to-human” in southeast asia. To understand what this is about we need to consider the definitions we just gave for latent period, infectious period and incubation period. These times are not the same for everyone so we need to consider both a minimum and maximum latent period, a minimum and maximum infectious period, and a minimum and maximum incubation period.

Consider someone who is exposed to an infected chicken on day one. The minimum and maximum latent times tell when the earliest and the latest they will be infective. The minimum and maximum incubation period tells the earliest and latest that an exposed person would come down with disease. So if you take the shortest time that a person can first become infectious together with the shortest incubation time, that will tell you the shortest interval between two cases you could have for person to person transmission. Any shorter time interval and you would consider two cases in the same family to be co-primaries (to have gotten it from the same or different sources but not from each other). A time interval longer than the combined maximum latent interval, maximum infectious period and maximum incubation period tell you how far apart two cases might be before you would consider them not to have been transmitted one to another. This is the basis for the famous “bimodal” family clusters (i.e., cases that are separated by an interval that could possibly, but not necessarily, indicate transmission from one person to another).

For influenza H5 N1 these intervals are not known with any precision but generally the latent period is thought to be 24 to 48 hours and the same for the incubation period, with infectiousness lasting several days to a week. This means that a secondary case (one acquired from the first, or index case) would have to be one that first experiences symptoms more than 24 hours and perhaps less than two weeks after the first person. A second case that occurs inside that window is a good candidate for a human to human case but not proof of one. Cases outside that window (especially less than 48 hours) would not be likely human to human cases.

<center>Basic Reproductive Number (R0)</center>

The other “number” that is frequently mentioned in the influenza case and infectious disease epidemiology is called the Basic Reproductive Number, usually designated by the symbol R0 (pronounced ‘R naught”). It is the expected (average) number of new infectious cases in a completely susceptible population produced by a single case during its entire period of infectiousness. Like transmission probability, this simple definition hides some subtleties.

The number of cases produced does not include any additional cases caused by the secondary cases (that is, further down the chain) and it does not count any new non-infectious cases. The reason for this is that R0 is meant to measure how likely is the disease to spread. If all the cases produced by the original case were non-infectious the disease couldn’t spread. Also, if the number of cases, on average were less than one, then eventually the disease would die out. (This assumes the disease is of some limited duration, either because of recovery or death. Clearly if a case lasted for a lifetime, eventually it would spread to the entire population, as long as R0 were greater than zero.) When R0 = 1.0, each case just reproduces itself so the number of cases stays steady, neither growing nor shrinking. Thus a higher R0 represents a more transmissible the disease and the more broadly it can spread in the population. R0 for some diseases like measles is up around 10. For influenza there have been various estimates but it is generally thought to be below 4, perhaps in the 1.5 to 3 range.

But R0 is not the whole story. It, too, has “component” parts not visible in the single summary number. First, it is an average, so in some cases R0 will be greater than one and spread locally, producing a cluster, and others less than one and not go anywhere. But more importantly, R0 has four components built into it: how long the infectious period is; how many contacts an infectious person makes in a period of time; the transmission probability (above); and the probability that someone who gets infected is themselves infectious. You can see from this that R0 is not actually a characteristic of the virus or the disease (although it is sometimes spoken of in this way) but of the virus in a specific population at a specific time and place. By altering some or all of the components you can also alter R0.

This strategy of altering R0 is behind many of the public health interventions suggested for controlling influenza. For example, consider the contact rate. By quarantine, self-isolation or canceling school or public events this is reduced, thus reducing R0. Similarly, treatment with antivirals may both reduce the infectious period by a day or two and also the amount of viral shedding, both of which will reduce R0.

Because it is a composite number, R0 is not as good for comparing infectious diseases as would seem at first. Halloran, in her chapter on Infectious Disease Epidemiology in Rothman and Greenland’s Modern Epidemiology (second edition) gives an instructive example. R0s for measles and HIV are both about 9, but measles has high probability of transmission and a short infectious period, measured in days, while HIV has low probability of transmission but a very long infectious period, measure in years. Both produce major epidemics but over vastly different time scales. R0 does not tell the whole story.

Moreoever R0 is the average number of new infectious cases in the susceptible population. But we know that not everyone may be susceptible, say, because they were treated prophylactically with antivirals or (if available) a vaccine. Thus the effective reproductive number will be less than R0 and is just designated R. This illustrates another fact, that the underlying assumptions about R0 usually don’t hold: not everyone is susceptible, not everyone is equally likely to be in contact with the index case, not everyone has the same duration of infectiousness, etc. Various sophisticated methods have been devised to account for some of these departures from the ideal case.

Finally, it is sometimes said that the “natural” evolution of a virulent virus is toward a state of more mild disease. However considering the components of R0 one can see this is not necessarily true. On the one hand, if the disease is so virulent it kills its host quickly, less time is spent in the infectious state and R0 decreases. This is not good for the virus and one might then expect it to adapt by becoming less virulent. However it might also be true that increased virulence increases the transmission probability, say because there is more violent coughing, or bleeding that soils bedsheets and contaminates care-givers more readily. Positive and negative selective pressures on the virus will be a balance of the various components of R0. As one increases, another may decrease and the relative amounts will be related to virulence in a complicated way that will probably also depend on the setting (contact rate, environmental conditions) and the host status.

The Flying Dutchman · Jul 7, 2005

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Please note the lenths of time that avian flu can live in water (and the water temps as well).

<center>Persistence of avian influenza viruses in water.

Stallknecht DE, Shane SM, Kearney MT, Zwank PJ.

Department of Epidemiology and Community Health, School of Veterinary Medicine, Louisiana State University, Baton Rouge 70803.</center>

Persistence of five avian influenza viruses (AIVs) derived from four waterfowl species in Louisiana and representing five hemagglutinin and neuraminidase subtypes was determined in distilled water at 17 C and 28 C. Infectivity was determined over 60 days by microtiter endpoint titration. One AIV was tested over 91 days at 4 C. Linear regression models for these viruses predicted that an initial concentration of 1 x 10(6) TCID50/ml water could remain infective for up to 207 days at 17 C and up to 102 days at 28 C. Significant differences in slopes for AIV persistence models were detected between treatment temperatures and among viruses. Results suggest that these viruses are adapted to transmission on waterfowl wintering habitats. Results also suggest a potential risk associated with waterfowl and domestic poultry sharing a common water source.

<A href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2142420&dopt=Abstract">(LINK)</A>

The Flying Dutchman · Jul 7, 2005

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<center>July 07, 2005 edition

When warnings become a scare

By Gregory M. Lamb
<A href="http://www.csmonitor.com/2005/0707/p14s01-stgn.html">The Christian Science Monitor</A>

Just as scientists are pursuing early-warning systems for everything from earthquakes to hurricanes, public-health officials are monitoring potential epidemics as never before. </center>
There's just one problem. Better detection has spawned several false alarms over the past few decades, potentially undermining the credibility of warnings. That dynamic is pushing governments and news media into unfamiliar territory.

How should they warn about something that might never occur? Does talking about an uncertainty help - or simply raise unnecessary fears?

These questions are becoming ever more relevant as the world confronts the spread of the virus H5N1 - better known as avian flu, or bird flu. The challenge: Even if many scientists say it's only a matter of time before the epidemic spreads, no one can predict how soon the day will come, or whether it will prove as harmful to humans as it has to domestic and wild birds.

So what should they tell the public?

"We need an informed concern - that's different than fear," says Howard Markel, director of the Center for the History of Medicine at the University of Michigan and author of a book on global epidemics. The difficulty, he says, is "how not to play Chicken Little. Because if you keep saying the sky is falling, and the sky isn't falling, people don't listen to you after three years."

The world has had its share of scares that didn't pan out. Two previous avian flu scares in Asia in the 1990s resulted in only a handful of human deaths, not the thousands that some feared. In 2003, severe respiratory syndrome (SARS) earned weeks of headlines but only 774 fatalities were attributed to it - far fewer than the deaths attributed to communicable diseases in the world during a single day.

Perhaps the most famous false alarm came in 1976, when a soldier at Fort Dix in New Jersey fell ill and died from what was called "swine flu." President Gerald Ford authorized a $135 million immunization program. About 40 million Americans received shots before the program was shelved as unnecessary. No further deaths occurred, no swine flu epidemic developed, and eventually many questioned whether the government had overreacted badly.

Those who closely study the H5N1 virus, including scientists at the World Health Organization, say that their concern that it might become a pandemic among humans is real and based on sound medical research and theory.

Since the late 1990s, scientists have become increasingly alarmed as they linked H5N1 to epidemics among bird populations from Hong Kong to Thailand and, in rare instances, to fatalities among humans. What researchers fear is that the virus might mutate so that instead of jumping from, say, a chicken to a human, it would pass from person to person.

A study released in late June by the research group the Trust for America's Health estimates that a moderately severe outbreak of H5N1 in humans could kill more than 500,000 Americans.

Nothing like that has hit the world since 1918-19, when the spread of Spanish flu was blamed for some 500,000 deaths in the United States and 20 million or more worldwide. But that era was far different than today. Then the epidemic hit with little warning. Health officials coped as best they could. Now, public-health officials usually have plenty of warning.

Any effort to underplay a potential threat creates its own problems, experts say. "When you're not transparent, you're not forthright, it causes more problems than good," Dr. Markel says.

In 2003, for example, China hid the SARS epidemic from its people for months. The result was public panic - and international criticism that China's bureaucratic inaction caused the disease to spread further than it otherwise would have.

Sometimes, politicians can worry too much about public reaction, these experts say. "When you tell me about a new risk, very briefly I'm genuinely more frightened," says Peter Sandman, a risk-communication consultant in Princeton, N.J.

But only briefly. People may worry more about avian flu, he says, but they'll compensate by worrying less about something else, like pollution or crime.

"The notion that if we warn people about avian flu that they're going to stop being the levelheaded people they were yesterday is nutty," he says.

For example: The press doesn't shy away from reporting on hurricanes for fear that it will create hysteria, experts say.

Such lessons extend to reporting on epidemics, they add.

"The media needs to simply report what is. Give people information to let them make the judgment of how afraid to be and what to do about it," says David Ropeik, director of risk communication at the center for risk analysis at the Harvard School of Public Health and a former television reporter. .

"It's very hard to get media to do a story about a hazard that isn't happening yet," he says.

When Americans were told that there was a limited supply of flu vaccine last year, millions of Americans showed "some very decent behavior" by passing up shots so that those deemed to be at higher risk could receive them instead, Sandman says. Only a few behaved badly. "You level with people, and they do OK," he says.

The Flying Dutchman · Jul 7, 2005

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<center>Avian flu found in migrating geese in China
Scientists fear birds may transport virus
By Stephen Smith,
<A href="http://www.boston.com/news/world/asia/articles/2005/07/07/avian_flu_found_in_migrating_geese_in_china/">Boston Globe </A>
July 7, 2005

The spread of a highly lethal strain of avian flu to thousands of migrating geese in China is stirring concerns among disease trackers that the birds could transport the virus to vast new swaths of the world, with the potential of igniting a long-feared global influenza epidemic in humans.</center>
Chinese scientists yesterday, in articles in the journals Nature and Science, described the sudden deaths of bar-headed geese in recent months at a sprawling saltwater lake in the western part of the nation. It marked the first time that avian flu, which had proved deadly mainly to poultry in the past, has killed big flocks of migratory birds, with at least 6,000 dying so far.

Already, scientists are drafting plans to track the movement of the geese from China and into India and elsewhere in South Asia. There, the waterfowl could cross paths with birds winging their way from Europe in coming weeks.

Since 1997, when avian flu first struck humans, disease specialists have watched with growing unease as an especially infectious strain of the virus felled poultry in Southeast Asia and sickened humans. In the past two years, bird flu has infected 108 humans, killing 54, who suffered severe respiratory complications.

And those human cases gave birth to an even more foreboding scenario: The bird flu could meld with human influenza strains and spawn a super bug capable of being spread person to person -- so mighty it could wipe out millions.

''That is what we have all been fretting about for so long -- that this is the spark that would set off the forest fire of a pandemic," Dr. William Schaffner, a flu specialist at Vanderbilt University, said yesterday in a telephone interview.

Now, the Chinese scientists report, the discovery of bird flu in geese capable of covering hundreds of miles a week could signal that the virus has found a vehicle to spread far and wide -- and swiftly.

''We do know that if this virus continually expands its distribution even farther, this means much more human population will be exposed to this virus," said Yi Guan, an author of the Nature report and bird flu specialist at the University of Hong Kong. ''In India or Bangladesh, these birds have the opportunity to meet birds from Europe. If this virus circulates among them, who knows? Next year, maybe the birds come back to Europe with this virus. This is the nightmare for the world."

While scientists expressed deep concern about the emergence of avian flu in migratory birds, they also acknowledged that at the moment it is impossible to gauge exactly how much danger the fowl pose to humans. In the past, the virus has been transmitted to humans through close contact with infected poultry.

The spread of a highly lethal strain of avian flu to thousands of migrating geese in China is stirring concerns among disease trackers that the birds could transport the virus to vast new swaths of the world, with the potential of igniting a long-feared global influenza epidemic in humans.

Chinese scientists yesterday, in articles in the journals Nature and Science, described the sudden deaths of bar-headed geese in recent months at a sprawling saltwater lake in the western part of the nation. It marked the first time that avian flu, which had proved deadly mainly to poultry in the past, has killed big flocks of migratory birds, with at least 6,000 dying so far.

Already, scientists are drafting plans to track the movement of the geese from China and into India and elsewhere in South Asia. There, the waterfowl could cross paths with birds winging their way from Europe in coming weeks.

Since 1997, when avian flu first struck humans, disease specialists have watched with growing unease as an especially infectious strain of the virus felled poultry in Southeast Asia and sickened humans. In the past two years, bird flu has infected 108 humans, killing 54, who suffered severe respiratory complications.

And those human cases gave birth to an even more foreboding scenario: The bird flu could meld with human influenza strains and spawn a super bug capable of being spread person to person -- so mighty it could wipe out millions.

''That is what we have all been fretting about for so long -- that this is the spark that would set off the forest fire of a pandemic," Dr. William Schaffner, a flu specialist at Vanderbilt University, said yesterday in a telephone interview.

Now, the Chinese scientists report, the discovery of bird flu in geese capable of covering hundreds of miles a week could signal that the virus has found a vehicle to spread far and wide -- and swiftly.

''We do know that if this virus continually expands its distribution even farther, this means much more human population will be exposed to this virus," said Yi Guan, an author of the Nature report and bird flu specialist at the University of Hong Kong. ''In India or Bangladesh, these birds have the opportunity to meet birds from Europe. If this virus circulates among them, who knows? Next year, maybe the birds come back to Europe with this virus. This is the nightmare for the world."

While scientists expressed deep concern about the emergence of avian flu in migratory birds, they also acknowledged that at the moment it is impossible to gauge exactly how much danger the fowl pose to humans. In the past, the virus has been transmitted to humans through close contact with infected poultry.

Page 2 of 2 --In telephone interviews this week from China, authors of the reports conceded the virus could, for example, burn itself out within the infected flocks, with contagious birds dying before they could transport the virus elsewhere. Or the waterfowl that survive the infection could turn out to be efficient carriers of the virus.

Sign up for: Globe Headlines e-mail | Breaking News Alerts ''Will the birds carry the virus? Will the virus fly to places like India? At this point, we can't say," said George F. Gao, a microbiologist at the Chinese Academy of Sciences and an author of the report in Science. ''But we can't rule out this possibility."

Because the stakes are so substantial, Guan recommended urgent actions to contain the spread of avian flu among waterfowl and to monitor their travels as they soar across the Himalayas in late summer, bound for South Asia. In the past, when bird flu has swept chicken flocks, millions of birds were slaughtered to prevent further spread.

The tracking, Gao said, will probably consist of collecting fecal droppings from the birds and analyzing their contents for the presence of a particularly dangerous strain of bird flu known as H5N1.

Dr. David Ozonoff, a Boston University professor who has studied the flu, said even more aggressive measures are warranted to follow the birds, including placing bands on them that would track their progress. Even so, Ozonoff said, there's no real hope of being able to contain the movement of the waterfowl.

''What can you do?" said Ozonoff, a professor of environmental health at BU's School of Public Health.

''These are wild birds flying all over the place. The genie is out of the bottle. I just don't see that there's much that can be done about this."

In late April and early May, a scattering of dead birds was discovered on islands in Qinghai Lake in western China. In the Nature account, scientists report that by May 4, birds were dying at a rate of 100 a day.

By this month, Guan said, the count of dead geese and gulls had grown to 6,000.

Avian flu had been found in migratory fowl before, but, in most cases, it didn't appear to make the birds ill. And when they did become sick and die, they typically were found adjacent to poultry farms where the virus continues to circulate.

The mass deaths in Qinghai Lake, a secluded nature reserve far from any chicken farms, were a disturbing anomaly, scientists said. Somehow, the virus had made subtle changes in its genetic clothing -- changes that allowed the birds to spread the germ to each other.

That caught the attention of health agencies that have been warning about the potential of a flu pandemic, which could claim millions of lives and overwhelm medical systems.

In their accounts, the Chinese scientists document that genetic alteration: The virus extracted from the dead birds, they reported, belongs to the same family as the form of H5N1 that has killed humans in Southeast Asia, but is not a twin.

Further analysis showed that its genetic profile is similar to a virus found in poultry in southern China, leading to suspicions that the waterfowl contracted the infection from chicken.

The implications of the genetic shift in the H5N1 virus are unclear, scientists said. They cannot say whether it might pose more of a threat to humans or less, but they do know it is sufficiently similar to the virus infecting humans that it bears watching.

''I think it would be very, very foolish and imprudent to think that something worse couldn't happen," Ozonoff said.

The Flying Dutchman · Jul 7, 2005

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<center>*Bump*</center>

Fuzzychick · Jul 7, 2005

Pigs a prime mixing vessel....China has had the notoriety of living with the animals...got Swine flu that way....viruses exchanging their matter to become a prime conduit for passing on to humans...sick pigs=TROUBLE...just MHO here... :shk:

A really bad news date this is becoming isn't it..

F.Drew · Jul 7, 2005

There are 107,000 ventilators in all of America's hospitals, Osterholm said, and in an influenza pandemic the need could quickly reach 400,000 or more. There would be no way to get them manufactured on time, he said.

Wayne Wrolstad, national marketing director of Hamilton Medical Inc., one of about nine major manufacturers of hospital ventilators worldwide, said most companies build "10 to 16 per day" at a cost of about $25,000 each.

He's quite the pessimist, and not very resourceful (must be a strict traditionalist). Wonder if, in a pinch, these CPAP machines for sleep apnea might work as ventilators... you betcha! and somewhat cheaper, too.

http://resmed.com.au/portal/site/ResMedAU/index.jsp?front_door=true

Fuzzychick · Jul 7, 2005

Shakey said:
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<center>Avian flu found in migrating geese in China
Scientists fear birds may transport virus
By Stephen Smith,
<A href="http://www.boston.com/news/world/asia/articles/2005/07/07/avian_flu_found_in_migrating_geese_in_china/">Boston Globe </A>
July 7, 2005

The spread of a highly lethal strain of avian flu to thousands of migrating geese in China is stirring concerns among disease trackers that the birds could transport the virus to vast new swaths of the world, with the potential of igniting a long-feared global influenza epidemic in humans.</center>
Chinese scientists yesterday, in articles in the journals Nature and Science, described the sudden deaths of bar-headed geese in recent months at a sprawling saltwater lake in the western part of the nation. It marked the first time that avian flu, which had proved deadly mainly to poultry in the past, has killed big flocks of migratory birds, with at least 6,000 dying so far.

Already, scientists are drafting plans to track the movement of the geese from China and into India and elsewhere in South Asia. There, the waterfowl could cross paths with birds winging their way from Europe in coming weeks.

Since 1997, when avian flu first struck humans, disease specialists have watched with growing unease as an especially infectious strain of the virus felled poultry in Southeast Asia and sickened humans. In the past two years, bird flu has infected 108 humans, killing 54, who suffered severe respiratory complications.

And those human cases gave birth to an even more foreboding scenario: The bird flu could meld with human influenza strains and spawn a super bug capable of being spread person to person -- so mighty it could wipe out millions.

''That is what we have all been fretting about for so long -- that this is the spark that would set off the forest fire of a pandemic," Dr. William Schaffner, a flu specialist at Vanderbilt University, said yesterday in a telephone interview.

Now, the Chinese scientists report, the discovery of bird flu in geese capable of covering hundreds of miles a week could signal that the virus has found a vehicle to spread far and wide -- and swiftly.

''We do know that if this virus continually expands its distribution even farther, this means much more human population will be exposed to this virus," said Yi Guan, an author of the Nature report and bird flu specialist at the University of Hong Kong. ''In India or Bangladesh, these birds have the opportunity to meet birds from Europe. If this virus circulates among them, who knows? Next year, maybe the birds come back to Europe with this virus. This is the nightmare for the world."

While scientists expressed deep concern about the emergence of avian flu in migratory birds, they also acknowledged that at the moment it is impossible to gauge exactly how much danger the fowl pose to humans. In the past, the virus has been transmitted to humans through close contact with infected poultry.

The spread of a highly lethal strain of avian flu to thousands of migrating geese in China is stirring concerns among disease trackers that the birds could transport the virus to vast new swaths of the world, with the potential of igniting a long-feared global influenza epidemic in humans.

Chinese scientists yesterday, in articles in the journals Nature and Science, described the sudden deaths of bar-headed geese in recent months at a sprawling saltwater lake in the western part of the nation. It marked the first time that avian flu, which had proved deadly mainly to poultry in the past, has killed big flocks of migratory birds, with at least 6,000 dying so far.

Already, scientists are drafting plans to track the movement of the geese from China and into India and elsewhere in South Asia. There, the waterfowl could cross paths with birds winging their way from Europe in coming weeks.

Since 1997, when avian flu first struck humans, disease specialists have watched with growing unease as an especially infectious strain of the virus felled poultry in Southeast Asia and sickened humans. In the past two years, bird flu has infected 108 humans, killing 54, who suffered severe respiratory complications.

And those human cases gave birth to an even more foreboding scenario: The bird flu could meld with human influenza strains and spawn a super bug capable of being spread person to person -- so mighty it could wipe out millions.

''That is what we have all been fretting about for so long -- that this is the spark that would set off the forest fire of a pandemic," Dr. William Schaffner, a flu specialist at Vanderbilt University, said yesterday in a telephone interview.

Now, the Chinese scientists report, the discovery of bird flu in geese capable of covering hundreds of miles a week could signal that the virus has found a vehicle to spread far and wide -- and swiftly.

''We do know that if this virus continually expands its distribution even farther, this means much more human population will be exposed to this virus," said Yi Guan, an author of the Nature report and bird flu specialist at the University of Hong Kong. ''In India or Bangladesh, these birds have the opportunity to meet birds from Europe. If this virus circulates among them, who knows? Next year, maybe the birds come back to Europe with this virus. This is the nightmare for the world."

While scientists expressed deep concern about the emergence of avian flu in migratory birds, they also acknowledged that at the moment it is impossible to gauge exactly how much danger the fowl pose to humans. In the past, the virus has been transmitted to humans through close contact with infected poultry.

Page 2 of 2 --In telephone interviews this week from China, authors of the reports conceded the virus could, for example, burn itself out within the infected flocks, with contagious birds dying before they could transport the virus elsewhere. Or the waterfowl that survive the infection could turn out to be efficient carriers of the virus.

Sign up for: Globe Headlines e-mail | Breaking News Alerts ''Will the birds carry the virus? Will the virus fly to places like India? At this point, we can't say," said George F. Gao, a microbiologist at the Chinese Academy of Sciences and an author of the report in Science. ''But we can't rule out this possibility."

Because the stakes are so substantial, Guan recommended urgent actions to contain the spread of avian flu among waterfowl and to monitor their travels as they soar across the Himalayas in late summer, bound for South Asia. In the past, when bird flu has swept chicken flocks, millions of birds were slaughtered to prevent further spread.

The tracking, Gao said, will probably consist of collecting fecal droppings from the birds and analyzing their contents for the presence of a particularly dangerous strain of bird flu known as H5N1.

Dr. David Ozonoff, a Boston University professor who has studied the flu, said even more aggressive measures are warranted to follow the birds, including placing bands on them that would track their progress. Even so, Ozonoff said, there's no real hope of being able to contain the movement of the waterfowl.

''What can you do?" said Ozonoff, a professor of environmental health at BU's School of Public Health.

''These are wild birds flying all over the place. The genie is out of the bottle. I just don't see that there's much that can be done about this."

In late April and early May, a scattering of dead birds was discovered on islands in Qinghai Lake in western China. In the Nature account, scientists report that by May 4, birds were dying at a rate of 100 a day.

By this month, Guan said, the count of dead geese and gulls had grown to 6,000.

Avian flu had been found in migratory fowl before, but, in most cases, it didn't appear to make the birds ill. And when they did become sick and die, they typically were found adjacent to poultry farms where the virus continues to circulate.

The mass deaths in Qinghai Lake, a secluded nature reserve far from any chicken farms, were a disturbing anomaly, scientists said. Somehow, the virus had made subtle changes in its genetic clothing -- changes that allowed the birds to spread the germ to each other.

That caught the attention of health agencies that have been warning about the potential of a flu pandemic, which could claim millions of lives and overwhelm medical systems.

In their accounts, the Chinese scientists document that genetic alteration: The virus extracted from the dead birds, they reported, belongs to the same family as the form of H5N1 that has killed humans in Southeast Asia, but is not a twin.

Further analysis showed that its genetic profile is similar to a virus found in poultry in southern China, leading to suspicions that the waterfowl contracted the infection from chicken.

The implications of the genetic shift in the H5N1 virus are unclear, scientists said. They cannot say whether it might pose more of a threat to humans or less, but they do know it is sufficiently similar to the virus infecting humans that it bears watching.

''I think it would be very, very foolish and imprudent to think that something worse couldn't happen," Ozonoff said.

So just how are we supposed to control birds and their migratory patterns...no harm no foul here, but this is impossible to do unless you shoot every damn bird out of the sky :cmpcf:

The Flying Dutchman · Jul 7, 2005

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<A href="http://www.recombinomics.com/online.html">Everything you ever wanted to know about H5N1 (avian Flu) but were to afraid to ask</A>

Lilbitsnana · Jul 7, 2005

thanks Shakey........I think.

you got that right Fuzzychick. Bad news day all the way around. Terrorism, weather (hurricanes), and now health. I don't know if I want to keep scanning threads or not, there might be something else making headlines today that is bad.

Fuzzychick · Jul 7, 2005

F.Drew said:
Wonder if, in a pinch, these CPAP machines might work as ventilators... somewhat cheaper, too.

http://resmed.com.au/portal/site/ResMedAU/index.jsp?front_door=true

SORRY...F.Drew...hate to be the bad messenger here but alot of people are going to die....there will not be enough of anything in the health care, the resources will be stretched to the hilt when this hits....in weeks, my only advice would be to stay AWAY from people the minute it actually becomes mainstream news...sorry no plug here but I recommend going here...curevents.com...Canada Sue sums it up pretty soberly...

Mary, full of grace.
Our Lord is with you.
Blessed are you among women,
and blessed is the fruit of your womb,
Jesus.
Holy Mary, Mother of God,
pray for us sinners,
now and at the hour of our death.
Amen.

Love Fuzzy

The Flying Dutchman · Jul 7, 2005

-My dear Lady Kathy;

I fear, dear Lady that you are correct concerning the death toll from a global H5N1 Pandemic. The casualities will be on Par with those of a Global Thermonuclear War's aftermath.....

<center>Migratory Geese Goosed By Bird Flu

Jason L. Miller | Staff Writer

<A href="http://www.webpronews.com/business/topbusiness/wpn-54-20050707MigratoryGeeseGoosedByBirdFlu.html">2005-07-07</A>

An outbreak of H5N1 virus (bird flu) in western China among migratory birds has sounded alarms worldwide fueling the fear that the virus is about to go global.</center>
More than 6,000 wild birds at the Qinghai Lake reserve in China have died since early May, according to the UN Food and Agriculture Organization (FAO). Most of them were bar-headed geese, a breed of goose that migrates south to Myanmar and India in autumn.

Qinghai Lake serves as a major breeding ground for migrant birds from all over Asia and the Pacific, including Southeast Asia, Siberia, Australia, and New Zealand.

Until now the virus was limited to poultry farms and the wild birds near them. That it has spread to migrating waterfowl signals to many scientists that it now has global threat potential.

"This outbreak may help to spread the virus over and beyond the Himalayas," said researchers at the Joint Influenza Research Center at Hong Kong University and Shantou University Medical College in Shantou, China.

The virus has only been seen in China and nearby countries, geese and other breeds could spread it all over the continent into Europe, Indonesia, and the Pacific.

The H5N1 virus has already mutated to some extent, having at one time not been lethal to migratory birds. The development intensifies the concern about a possible mutation that could easily infect and spread among humans.

"Unlike most instances, this virus is showing lethality for migratory birds," the University of Virginia's virologist Frederick Hayden told USA Today. "It's a very concerning development."

Chief Veterinary Officer Joseph Domenech of FAO issued statement favoring surveillance and vaccination efforts to contain the disease rather than culling wild birds.

More than 25 million chickens have been slaughtered in Asia in an attempt to quell the spread of the virus. One hundred people have been infected.

The Flying Dutchman · Jul 7, 2005

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<center>Fears avian flu headed for Australia
<A href="http://www.abc.net.au/worldtoday/content/2005/s1409303.htm">ABC News</A>
The World Today - Thursday, 7 July , 2005 12:26:00
Reporter: Karen Barlow
HAMISH ROBERTSON: Scientists are becoming increasingly concerned that migratory birds could be carrying the deadly avian flu out of Asia, and possibly into Australia.</center>
The World Health Organisation estimates that the virus has now killed more than 5,000 geese and gulls around the Lake Qinghai nature reserve, which is a large breeding site. Many of the birds then head south during the northern hemisphere's winter.

Chinese scientists have reported today in the journals Nature and Science that the infection of migratory birds represents a global threat. But the WHO says there are also concerns about other forms of potential transmission.

Karen Barlow reports.

KAREN BARLOW: Every changing season, certain birds instinctively test their endurance. Disregarding borders and vast tracts of ocean they travel around the planet to breed or feed.

But now with Avian flu in the world, their movements may have become deadly. Since the latest outbreak started in 2003, countless domestic chickens, ducks and geese have died while more than 50 people have died in South East Asia. Scientists fear a mutation which would easily pass between humans.

The WHO's Peter Cordingly says millions of people would be affected.

PETER CORDINGLY: Nobody will be able to stop it. It would travel on planes, it would be not in the paddy fields of Vietnam as it is now and other countries around here. It would be in Washington within weeks.

KAREN BARLOW: Three United Nations agencies have just ended a conference in Malaysia into preparations for a possible pandemic. The World Health Organisation says more than a third of a billion dollars is needed by the end of the year.

It's organising a meeting later this year for donor nations. But scientists are immediately concerned about the avian flu outbreak at Lake Qinghai.

First detected on April the 30th, it's now killed thousands of birds, particularly bar-headed geese, great black-headed gulls and brownheaded gulls. The lake is an important breeding ground for birds from Australia, New Zealand, Siberia and South East Asia.

Chinese scientists believe the infected birds will carry the virus out of Asia, a situation they say makes it even more of a global threat than it already is.

But Australian migratory bird expert, Professor Richard Kingsford, says it's unlikely infected birds will fly to Australia.

RICHARD KINGSFORD: In fact the international bird migrants that we get in Australia are actually small shore birds which are like sort of sparrow size, not very much bigger than that, whereas these are obviously large geese and the gulls are quite similar to our seagulls or seltergulls (phonetic)

KAREN BARLOW: But they do travel along the same route?

RICHARD KINGSFORD: Yes, some of the small shorebirds that we get in Australia will spend our winter, the Northern Hemisphere spring, in China and Russia. So, yes, they would probably fly similar sorts of routes.

They may feed in similar sorts of places, but they're unlikely to associate together. The birds generally don't, when you get different species, they don't generally hang out together unless there are good areas to feed.

KAREN BARLOW: So overall, the Australian birds would not be interacting that much but maybe some interaction with the birds that seem to have been afflicted by the Avian flu?

RICHARD KINGSFORD: Yes, it's hard to rule out no interaction because these are all what you would call wetland birds, so they are likely at some stage to be feeding in the same sorts of habitats.

KAREN BARLOW: The WHO is also downplaying the risk of bird flu flying into Australia.

Dr Alan Hampson from the WHO's Collaborating centre for Influenza in Melbourne.

ALAN HAMPSON: I would be less concerned about it coming to Australia via migratory birds than I would be about the virus mutating, becoming a human pathogen and coming to you via infected humans.

KAREN BARLOW: All this talk about flying infected birds may be purely academic.

Professor Richard Kingsford says the infected birds may not be able to fly.

RICHARD KINGSFORD: The energy demands and even navigation demands are enormous. These birds will use, you know, the magnetic compass and stars and sun and all of those things. They have very sophisticated navigation systems, and it's very unlikely that if their brain's affected that they're going to be capable of going very far.

HAMISH ROBERTSON: That was Australian migratory bird expert Professor Richard Kingsford, ending that report from Karen Barlow.

squeeksmom · Jul 7, 2005

Thanks, Shakey! I don't post often, but I do read all your posts.
Thanks for your work.

squeeks

The Flying Dutchman · Jul 7, 2005

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<center>Flu fear in migratory birds

Dennis Chong

<A href="http://www.thestandard.com.hk/stdn/std/Metro/GG08Ak02.html">July 8, 2005</A>

Study of Qinghai outbreak shows waterfowls may be able to fly great distances despite being infected University of Hong Kong researchers have warned that South Asian countries and even Europe may be under threat from the deadly H5N1 virus.</center>
They base their fears on a study that showed certain types of geese and gulls in northwestern Qinghai province may have contracted the deadly virus from southern China.

The study has strengthened evidence that the deadly strain, which caused the deaths of dozens of people across Asia and led to the cull of millions of poultry, can be carried by migratory birds.

Researchers said that if the outbreak does not die out in Qinghai, the waterfowls could spread the virus to other parts of the world.

But the study does not address the question of climatic influences on infections and how far infected birds can fly.

Local migratory bird experts doubted that the infected birds covered in the study had flown to Qinghai from south China because they are rarely found there.

There are many ways other than migration in which the birds could have acquired the virus, they said.

Scientists from the University of Hong Kong and Shantou University in the mainland conducted genetic analyses on excretions from three kinds of waterfowl that fell sick during the Qinghai outbreak that has killed nearly 2,000 birds since April. The birds were congregating at Qinghai Lake, the biggest breeding hub for thousands of migratory birds in the mainland.

The study, which has been published in the journals of Science and Nature, found that the virus that struck down about 3,000 bar-headed geese, a few great black-headed gulls and brown-headed gulls is ``almost identical'' to those found in Fujian, Guangdong, Hunan and Yunnan provinces this year.

The report said that Qinghai Lake is an isolated nature reserve with no farms in the vicinity.

It concluded that the outbreak is a ``single introduction'' and that it was ``most probably'' triggered by poultry infections in southern China.

Qinghai Lake, the mainland's largest saltwater lake, is a major breeding ground for bar-headed geese that fly thousands of kilometers each year.

According to Guan Yi, a University of Hong Kong researcher who took part in the study, bar-headed geese can fly 1,600 kilometers a day.

He said the findings indicate an increased risk of the waterfowls carrying the virus overseas. The birds, which seldom stop off at Hong Kong, start migrating south to South Asian countries such as Burma and India in September and return to Qinghai in April.

Scientists who conducted the study are worried that the birds will spread the virus across the Himalayas to other carriers that will then take it to Europe, which has so far no record of H5N1 infections.

Scientists and bird experts have been divided over the role of migratory birds in the transmission and spreading of the avian flu virus.

Despite the occasional discovery of H5N1 in waterfowls, critics have suggested that rampant poultry smuggling in Asia is the main culprit for the quick spread of the disease with migratory birds only the dead-end victims.

Hong Kong Bird-Watching Society vice-chairman Mike Kilburn said none of the species that were infected in the Qinghai outbreak are found in southern China and Hong Kong.

Migratory bird expert Martin Williams said the study cannot establish a link that proves the H5N1 virus can be spread by migratory birds.

He said that these birds could have picked up the virus along mainland rivers in which domestic livestock owners dump bird and animal waste.

Fuzzychick · Jul 7, 2005

SARS will be compared as chump change when this hits...and it will hit... :shk:

The Flying Dutchman · Jul 8, 2005

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<center>Avian flu control plan to focus on small farms
Jul 7, 2005
<A href="http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/july0705plan.html">(CIDRAP News)</A>
International health agencies said yesterday that their plan to battle avian influenza will focus on educating small-scale farmers, segregating animal species on backyard farms, and vaccinating poultry.</center>
At the end of a conference in Malaysia, officials said their multi-pronged plan still has a chance to prevent a human flu pandemic by reducing opportunities for the H5N1 virus to spread from poultry to humans. Officials estimated the cost of the plan at about $250 million, which will have to come mostly from donor countries.

"The meeting agreed that the avian influenza situation in Asia was extremely serious but determined that there was still a window of opportunity to ward off a pandemic," the United Nations Food and Agriculture Organization (FAO) and the World Health Organization (WHO) said in a joint statement.

The H5N1 virus has infected 108 people and killed 54 since late 2003, according to the WHO. Disease experts fear that the virus will spark a pandemic if it acquires the ability to spread easily from person to person; so far it has not shown that ability.

Delegates at the meeting in Kuala Lumpur concluded that the battle against the virus should focus on small-scale and backyard farms, with which most human cases of H5N1 infection have been linked, the FAO-WHO statement said.

The plan has four objectives:

To educate farmers and their families about the dangers of high-risk behavior and how to change their farming practices
To ensure the segregation of different species, including chickens, ducks, and pigs, and to eliminate mingling of these animals with humans
To provide adequate incentives for farmers to report suspected avian flu outbreaks in their flocks and to apply control measures
To pursue the vaccination of poultry flocks as part of a multi-element response to the avian flu threat in high-risk areas
Authorities are also concerned about "wet markets, where animals are often slaughtered in unsanitary conditions," said Dr. Joseph Domenech, the FAO's chief veterinary officer.

Wet markets and the mingling of species on small farms increase the risk that avian flu viruses will pass between species and exchange genes with other flu viruses, potentially giving rise to dangerous new viruses, the agencies said.

Dr. Shigeru Omi, the WHO's regional director for the western Pacific, said the avian flu plan would give the world a "fighting chance" to stop the H5N1 virus. "We have no illusions about how hard the job will be, but we are not powerless," he said. "This plan gives us a real chance to make a mark on history—as long as we work together with maximum energy and commitment."

Dr Dewan Sibartie, deputy head of the Scientific and Technical Department of the World Organization for Animal Health (OIE), welcomed the agencies' decision to include vaccination of poultry in their strategy, according to the FAO-WHO statement.

"The acceptance of vaccination by WHO and the international scientific community as an important additional tool in the control of the disease in animals is particularly welcome, provided that the vaccine used complies with OIE standards and that vaccination is carried out under the supervision of OIE and veterinary services," Sibartie said.

To carry out the plan, it will cost the FAO and OIE about $100 million for surveillance, diagnosis, and vaccination, the agencies said. The WHO estimated the cost of public health efforts under the plan, including support for laboratory diagnosis, vaccine development, surveillance, and public education, at about $150 million.

"Without international support, poor countries will not be able to battle bird flu," said Domenech.

According to an Associated Press (AP) report yesterday, Omi said the international agencies would organize a meeting by the end of this year to encourage wealthy countries to commit at least $250 million to help affected countries battle avian flu over the next 3 years.

In related news, a WHO official voiced pessimism about the chance of containing an emerging pandemic if the H5N1 virus evolves into a form that spreads rapidly among people, according to an Agence France-Presse (AFP) report published yesterday.

Hitoshi Oshitani, a Manila-based WHO expert in disease surveillance and response, said that if the virus mutates and erupts in one of Asia's large cities, it will be impossible to prevent a pandemic, AFP reported.

"If a pandemic starts we cannot do anything to stop it," he said. "What we can do, once a pandemic starts, is just to reduce the negative impact by being better prepared."

Compared with flu, SARS (severe acute respiratory syndrome) was easy to control, because it was spread only by people who had fever, Oshitani told AFP. "Usually for influenza, it's almost impossible to control," he said. "That's why we have huge outbreaks every year."

Control measures under consideration include treating infected people and surrounding communities with antiviral drugs and restricting their movement, Oshitani said. But if people with no symptoms were spreading a deadly flu in a country that couldn't afford expensive medicine, stopping the disease would be almost impossible, he said.

He said the WHO has 60,000 to 70,000 doses of antiviral drugs in its Manila regional office, but getting them to a remote community in time to stop the disease would be difficult.

In Vietnam this week, authorities culled more than 7,000 ducks infected with avian flu in the central province of Quang Tri, according to a report yesterday by China's People Daily. The story cited the Vietnam News Agency as its source.

In Cambodia, tests have ruled out H5N1 avian flu in a 20-year-old man who died earlier this week and in 13 children who were hospitalized after eating cooked chicken, according to an AFP report today.

The test results came as Cambodian hospitals were coping with an unusually large number of children suffering from an ordinary form of flu, the story said. More than 1,000 children have been hospitalized there in recent weeks.

m801 · Jul 8, 2005

F.Drew said:
. Wonder if, in a pinch, these CPAP machines for sleep apnea might work as ventilators...

yes - you are correct.

can be bought on ebay for 10% of list price

O2BNOK · Jul 8, 2005

http://www.alertnet.org/thenews/newsdesk/SP268006.htm

First case of bird flu hits Philippines
08 Jul 2005 06:10:28 GMT

Source: Reuters

MANILA, July 8 (Reuters) - The Philippines has suffered its first case of bird flu after ducks were found to be infected in a town north of Manila, prompting the country to immediately halt poultry exports to Japan, government officials said on Friday.

Health Secretary Francisco Duque said samples have been sent to Australia to determine whether the strain of avian influenza was the same as the one that has killed dozens of people elsewhere in Asia.

"There's no cause for alarm," Duque said in a television interview. "We're still investigating the case."

The government expects to receive results of the tests on the infected strain in a week.

A quarantine zone has been set up around the town of Calumpit in Bulacan province to halt the trading and sale of poultry for a week, in addition to the immediate slaughter of the affected flocks, government officials said.

The H5N1 strain of the avian influenza virus has killed 54 people of the 154 infected in Asia so far. More than 140 million chickens have been killed in the region to halt bird flu, causing millions of dollars in losses.

Agriculture Secretary Arthur Yap said halting exports to Japan was a "voluntary" decision by the private sector.

The Philippines is not a big poultry exporter but it has been shipping cargoes to Japan, which banned supplies from Thailand where earlier bird flu outbreaks devastated the poultry industry.

The Department of Agriculture and the Department of Health jointly assured the people that it was safe to eat chicken and properly cooked duck meat.

"What we are carefully guarding against is the H5N1 strain, which is highly pathogenic and can be transmitted to other farm animals and even people," Yap said. "We can't see the symptoms of H5N1. The ducks are roaming around and are very healthy, and there are no signs of flu."

United Nations officials told a conference in Kuala Lumpur last week that bird flu was entrenched in Asia and it would take up to a decade to rid the region of the virus and declare humans, animals and meat safe from infection.

The Flying Dutchman · Jul 8, 2005

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<center>Averting an Outbreak

By KARL TARO GREENFELD | GUANGZHOU
SUBSCRIBE TO TIMEPRINTE-MAILMORE BY AUTHOR

<A href="http://www.time.com/time/nation/article/0,8599,574945,00.html">Posted Sunday, Jan. 11, 2004</A>

In recorded history, no disease has jumped the species barrier to infect humans, caused an epidemic, and then never threatened us again—not without the discovery of a vaccine or cure to curtail the microbe. Some diseases, such as chicken pox, gradually become endemic to man, eventually resulting, if we are lucky, in nothing more than a mild childhood illness. </center>
Others, such as Ebola, retreat back to whatever animal reservoir they came from, stalking humanity from their hidden lair, only occasionally lashing out to bloody a village or crash a rural hospital. But diseases don't, as a rule, just go away.

In the past two weeks, with two new cases in China's Guangdong province and suspected cases turning up in Manila and Hong Kong, it seems that SARS, too, is re-emerging. The brutal culling of masked palm civets from Guangdong wildlife markets and farms that commenced on Jan. 5 has only exacerbated the sense that matters were spiraling out of control. Department of Forestry officials incinerated some civets, boiled others to death and drowned still more in disinfectant. It was as if the Chinese government were offering thousands of sacrificial rodents to ward off the Fourth Horseman of the Apocalypse.

The inside story of how that decision to cull civets came to be made, however, is one of aggressive public health, great courage and, most important, good science. It is very possible that the research led by one virologist, Dr. Yi Guan, 42, and the extraordinary measures he took to make government officials aware of his work may have averted another disastrous SARS outbreak.

Almost every week for the past year, Yi, a microbiology associate professor at the University of Hong Kong (HKU), has been taking the old Kowloon-Canton Railway up to Shenzhen and Guangzhou to carry out his fieldwork. It was Yi, along with the Shenzhen Centers for Disease Control (CDC), who in May took samples from Shenzhen's Dongmen Market and made the discovery that the masked palm civet, as well as the raccoon dog and hog badger, carried a virus remarkably similar to the coronavirus that causes SARS. That research, initially hailed as a breakthrough in establishing the zoonotic origins of SARS, resulted in the Guangdong government temporarily shutting down the wildlife markets and banning the sale of civets. For Yi, who attended medical school at Nanchang Medical College in Jiangxi province before completing his Ph.D. at HKU, this should have been a crowning moment.

Instead, subsequent research by a mainland Chinese team challenged Yi's research, finding no evidence of the SARS coronavirus in civets. Meanwhile, other scientists murmured that Yi's data was based on too narrow a range of samples drawn from just one market. Perhaps those civets, some argued, had been infected by humans in that market, rather than the other way around. For Yi, a hot-tempered, chain-smoking workaholic, this was an unbearable impugning not just of his research but also his genuine desire to apply his science to public health. Even more worrying was the Chinese government's decision in August lifting the ban on sales of civets. By September, the markets were again crawling with them. One dealer in Shenzhen, when asked if he could procure a thousand civet cats, replied, "That's hard." He paused, then added, "It may take me a day to get that many."

Despite the doubts cast by other scientists, Yi was still sure there was SARS coronavirus in wildlife markets. Taking into account the possibility that seasonality was a factor in the replication of the SARS coronavirus, he waited until October—about a year since the first cases appeared—and began returning to the Guangdong wild animal markets every week with his black satchel bag full of syringes, swabs and sample vials. Working with the Guangzhou CDC and the Shenzhen CDC, he paid $6 for each animal he would test to an animal trader who supplied Dongmen Market. In Guangzhou's Xinyuan Market, Yi would buy animals and haul them away in cages to the Guangzhou CDC labs, where he would gather samples before sending the creatures to be destroyed. Occasionally, when he was in a hurry, he would sedate the animal right there in the market and draw blood and swab for feces.

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When he brought those samples back to Hong Kong, a frightening picture started to emerge. Not only was he again finding the SARS coronavirus in a host of rodent species—in addition to the civet cat, he also detected the virus in hog badgers, Eurasian badgers, raccoon badgers and ferret badgers—he was astonished, when he did the genomic sequencing, to observe that these coronaviruses had actually mutated to become more similar to the SARS coronavirus samples taken from humans during the first outbreak last spring. All this confirmed that the disease that had infected humans was again at large. The animals that showed the highest infection rate by far were the civet cats, with 16 positive cases out of 21 animals tested. These civets had come from several different markets and traders, which meant the disease was lurking in wild animal markets throughout Guangdong—and maybe the rest of China.

In late December, Yi was sitting in his apartment in Hong Kong, on his leather sofa, watching his big-screen TV, smoking his Mild Seven cigarettes and wondering about his way forward. It was only a matter of time before another outbreak would occur, he now believed. There was simply too much interaction between humans and civets for this virus not to make the jump. But it could take months to get a paper peer-reviewed and published that could impact public health by encouraging the Guangdong government to curtail the civet population or at least limit contact between humans and this animal. In that time, the disease could again gain a foothold among humans. But as long as there were no new cases in Guangdong, then perhaps he had time to fast-track his paper and get it published in a few weeks. Then his wife called from work with some news: there was a suspected SARS case in Guangdong. At that moment, "I felt like I had to do something," Yi explains. "I mean, why do you do science? To write papers? Or to make a difference in the real world?"

Yi believes deeply in the future of the People's Republic and is forgiving of its occasional foibles, dismissing malfeasances such as last year's early cover-up of the SARS outbreak with a shrug. The many top officials he has met, he believes, will always do what is right if they have the relevant information. The problem is getting that data in front of them.

So he framed a simple letter to Beijing's Hong Kong and Macau Affairs Office, which he CC'ed to the Ministry of Health and the China CDC. "With winter coming, the wildlife markets have reopened, providing the perfect conditions for another outbreak of SARS," he wrote. He went on to list his findings that the civet is the major carrier of the SARS coronavirus, that the SARS coronavirus exists in different animals from different regions, that this virus can infect humans and, most frightening, that the "transmitting mechanism for the resurgence of SARS is in place." He enclosed four pages of genetic sequences taken from civets and had the letter hand-delivered on Jan. 2. Within hours the Ministry of Health in Beijing passed the letter to the Guangdong Department of Health. Yi's reputation as a virologist was such that the Guangdong government invited him to Guangzhou on Jan. 3 to make his case.

At noon in a hotel conference room in the western part of the city, Yi met with some of the province's highest health officials. There were representatives from the Department of Health, the Guangdong CDC, and the Ministry of Health, as well as eminent doctors and scientists from other institutions. Every man in that room had lived and worked through the first-ever SARS outbreak; many were clinicians who had watched patients whither, suffocate and die from the disease. Of these physicians, the most powerful was Dr. Zhong Nanshan, director of the Guangzhou Institute of Respiratory Disease. Famed for having been a physician to Deng Xiaoping, Zhong had also pioneered the earliest clinical treatments of SARS, emerging in China as the doctor most associated with fighting, and eventually defeating, the disease. A charismatic, well-built 67-year-old, he is the best-known doctor in the mainland—and the most intimidating. One World Health Organization (WHO) official described him as being "like a god."

Zhong was willing to hear out Yi, but where was his evidence? All they had, another public-health official explained, was this letter of warning, which, frankly, seemed a little hysterical. As the letter had been passed down from the Ministry of Health, somehow those four pages of genetic sequences, which provided the evidence backing up his dramatic assertions, were lost. Yi called his laboratory in Hong Kong and had the documents e-mailed to the Guangdong CDC.

Yi's hosts were skeptical of this notoriously impetuous virologist, remembering that it had been Yi, in the early days of the first epidemic, who kept on insisting, incorrectly, that SARS was a novel form of avian influenza. Even after the genetic sequences had arrived from Hong Kong, his mainland peers were unconvinced. "When someone is showing you raw data, you have to be careful," said Dr. Xu Ruiheng, deputy director of the Guangdong CDC. "You have to ask yourself, is this real or is this fabricated?" In turn, Yi asked his Chinese counterparts if they had the sequences for the human case now recovering in Guangzhou No. 8 People's Hospital. They produced their documents. It turned out that though they had done the sequencing, they had not yet analyzed this virus' phylogenetic origins, the RNA road map that would offer some understanding of how this particular strain would be related to those previously gathered. Yi suggested they send their sequences to his lab in Hong Kong, where his technicians and assistants were standing by—they worked almost as hard as Yi—and would use their computer modeling programs to analyze the amino-acid sequences to reconstruct the evolutionary origins of this year's virus. That way, they would be able to compare the two and determine, more precisely, the real risk level. If the two phylogenetic trees were similar, Yi explained and Zhong concurred, it would confirm that the disease was again afoot and, in this case, was certainly related to the wild animal markets. The Guangzhou officials agreed, the new case's sequences were sent, and the men drank tea and smoked while waiting for Yi's lab to complete the computer modeling.

The data that was returned just an hour later revealed that the two viruses were more than similar. They were almost identical. The 14 amino-acid sequences concurred, which meant that these two viruses not only belonged to the same phylogenetic tree, they were both on the same branch, practically the same leaf. Science doesn't produce many moments like this: good luck coinciding with great research had proved that the same virus that was in those wild animal markets had somehow infected a human being. The data was so compelling that the committee resolved that afternoon to inform the governor of Guangdong and recommend a culling of civet cats.

There was only one man in that room with the clout and reputation to recommend a measure this extreme. Zhong was delegated to call Governor Huang Huahua. The argument he could give was simple: the wild animal business in Guangdong was estimated to be worth anywhere from $100 million to $200 million a year; the economic impact of another SARS outbreak, however, was immeasurable. Zhong made that call on Sunday. He can be very persuasive: the order was given later that day to the Guangdong Health Department and the Guangdong Forestry Department, among other agencies, to launch a campaign to eradicate civet cats from the province's farms and markets. By Monday morning, said Peng Shangde, deputy director of the Guangdong Forestry Department, "we were staffed and the trucks were rolling."

Officials at the Guangdong CDC, while confident that culling the civets was necessary, are not totally convinced that this will curtail an outbreak. They have ordered a further extermination of rats—a much more elusive target—because of evidence that they carry a similar virus. Dr. Rob Breiman, an epidemiologist from the U.S. Centers for Disease Control and Prevention, who is leading the WHO team currently tracing the origins of last year's epidemic in Guangdong, observes, "Everyone certainly thinks this is meaningful. But where is the civet cat in the chain? Are they getting it from another animal? Are civet cats infecting rodents as well as humans? We just don't know exactly where civet cats fit in." But he concedes, "From a political and public-health standpoint, it was a reasonable step in response to the re-emergence of SARS this year to act on the most likely source."

Yi's mentor, Rob Webster of St. Jude's Hospital in Memphis and a pioneer in establishing the zoonotic origins of many influenzas, says, "The research is solid, but still, Yi has certainly stuck his neck way out there on this one." Yi, as usual, is dismissive of any doubts. Back in Hong Kong, he explains how the virus found in other rodents such as badgers is genetically less similar to the strains found in humans, before vowing that culling civets "will break the chain of infection."

The incubation period for SARS is 14 days. The last civets were taken from the wild animal markets on Jan. 6. By Jan. 20, if no new human cases emerge, we will have a very good indication if Yi, and the Guangdong government, made the right call.

The Flying Dutchman · Jul 8, 2005

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<center>Avian influenza, Viet Nam 

<A href="http://www.who.int/wer/2005/wer8027.pdf">WHO - update1</A>

July 8 2005
During the penultimate week of June 2005, at the request of the Ministry of Health, WHO sent a team of international experts to Viet Nam to assess laboratory and epidemiological data on recent cases and determine whether the present level of pandemic alert should be increased. </center>
Team members were drawn from institutes in Australia, Canada,Hong Kong Special Administrative Region of China, Japan, United Kingdom and United States having extensive experience in the testing of avian influenza viruses in human clinical specimens.

The team completed its work on 29 June 2005 and submitted its preliminary findings to the government. The team found no laboratory evidence suggesting that human infections are occurring with greater frequency or that the virus is spreading readily among humans. The current level of pandemic alert, which has been in effect since January 2004, remains unchanged.

Some reports now circulating suggest that WHO has downgraded its assessment of the pandemic threat. These reports are unfounded.

The experts were specifically asked to search for evidence that could substantiate concerns raised first at a WHO consultation2 of international experts held in Manila, Philippines, on 6–7 May 2005. That consultation considered suggestive findings, largely based on epidemiological observations, that the H5N1 virus had changed its behaviour in ways consistent with an improved, though not yet efficient, ability to spread directly from one human to another. The specific epidemiolo-gical observations considered included milder disease across a broader age spectrum and a growing number of clusters of cases, closely related in time and place.

More recently, testing of clinical specimens by international experts working in Viet Nam provided further suggestive evidence of more widespread infection with the virus, raising the possibility of community-acquired infection. These findings have not been confirmed by the present investigative team.

Firm evidence of improved transmissibility would be grounds for moving to a higher level of pandemic alert.

Because of the huge consequences of such a change, WHO is following a cautious approach that combines heightened vigilance for new cases with immediate international verification of any suggestive findings.

Because detection of H5N1 in clinical specimens is technically challenging and prone to errors, members of the investigative team took sophisticated laboratory equipment with them to Hanoi for on-site testing. Tests were performed using WHO-approved reagents and primers.

While these first results are reassuring, further retesting of clinical specimens will continue over the next few weeks to provide the most reliable foundation possible for risk assessment.

The Flying Dutchman · Jul 8, 2005

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<center>World Bank

http://www.worldbank.org

<A href="http://www.noticias.info/asp/aspComunicados.asp?nid=81610&src=0">Sábado 9 de julio de 2005</A>

Three UN Agencies Need $250 Million To Fight Bird Flu

/noticias.info/ Three UN agencies said Wednesday they need $250 million to put into effect their strategies to stave off a global avian influenza pandemic, reports Kyodo (Japan).</center>
Experts from the World Health Organization (WHO), the Food and Agriculture Organization (FAO) and the World Organization for Animal Health (OIE) were in the Kuala Lumpur (Malaysia) for a three-day meeting that closed Wednesday to map out strategies to combat the deadly H5N1 bird flu virus that has infected 108 people in Asia, mostly Vietnam, Thailand and Cambodia, killing 54 of them since it was first discovered in late 2003.

The WHO estimated that it will cost $150 million to institute an effective response to secure public health such as putting in place emergency support in laboratory diagnosis, vaccine development, surveillance and public education. Some of the funds would also be used for antiviral drugs and personal protective equipment for people most at risk of infection. On the animal front, the FAO and the OIE had earlier announced that they need $100 million to support surveillance, diagnosis and other control measures like vaccination.

A donors' conference will be held by the end of this year to raise the funds needed, according to Shigeru Omi, WHO regional director for the western Pacific region. ''We have to face the reality that some countries face limited resources because of lack of financial capability. The message must be taken across the international community that if you fail to control this, the economic and social cost will be a lot more then the $250 million,'' he said. So far, the agencies have only managed to raise less than $20 million from the United States, the European Union and Japan and institutions like the World Bank.

The Financial Times also reports that the $250 million are needed to overhaul Asia's farming practices and upgrade its public health infrastructure in the battle to prevent bird flu from triggering a global pandemic. Peter Cordingley, a WHO spokesman said about the bird flu status: UN agriculture experts say regional governments need to offer adequate compensation to poor rural dwellers as an incentive to report sick birds and clean up poultry markets.

The Straits Times (Malaysia) adds the new strategy focused on dangerous backyard farm practices such as raising chickens, ducks and pigs close to one another and to humans, and slaughtering of animals in unsanitary conditions in wet markets. The current strategy is to focus on the source of the infection - backyard farm practices. Farmers are encouraged to segregate animals of different species and eliminate intermingling between humans and animals. There is particular concern about China where the virus recently killed 6,000 migratory birds.

Several years ago, China had suppressed information on the SARS crisis, but UN officials said it is now transparent in reporting outbreaks. It has also carried out pioneering work in vaccines. Guo Fusheng, a regional coordinator based in Beijing for the FAO, told Reuters that in China 'some of these diseases have unfortunately been breaking in villages hundreds of miles from the cities. To people in these areas, who are mostly peasant farmers, transparency is not the issue. They just don't know what the heck they're dealing with.'

The Flying Dutchman · Jul 9, 2005

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<center>Fear of bird flu flies in from China
G.S. MUDUR

<A href="http://www.telegraphindia.com/1050709/asp/nation/story_4968637.asp">The Telegraph of India</A>

New Delhi, July 8: India is among the winter destinations of migratory birds infected with the deadly avian influenza virus around a lake in China, scientists reported today.</center>
The virus, H5N1, which can spread from birds to humans, has killed 54 people in Southeast Asia over the past year. “The virus has the potential to be a global threat,” George Gao at the Chinese Academy of Sciences and his colleagues said in their report.

Over the past two months, scientists have detected more than a thousand sick or dying birds infected with the virus around Quinghaihu lake in central China.

Their studies, published this week in research journals Science and Nature, have raised concerns that migratory birds may help H5N1 spread across Asia and beyond.

“This lake is one of the most important breeding locations for migratory birds that overwinter (spend winter) in Southeast Asia, Tibet and India,” Gao and his colleagues wrote.

The infected birds include bar-headed geese, great black-headed gulls and brown-headed gulls.

While acknowledging the potential threat from migratory birds, independent scientists said it is not known yet whether infected birds can last the journey through mountain passes in the Himalayas.

“All three species visit India during winter,” said Dr Taej Mundkur, a waterbird ecologist who has been tracking bird migration in Asia. “An individual bar-headed goose tagged at Quinghaihu was once tracked all the way into Karnataka,” Mundkur told The Telegraph.

Scientists say the black-headed and brown-headed gulls are found across India, but there is no evidence to show they travel from Quinghaihu. These gulls also nest in high-altitude lakes in Ladakh.

Over the past year, Indian government scientists have screened more than 12,000 blood samples from poultry, pigeons, pigs and at least 120 wild birds.

“There is no sign of H5N1 in India yet,” said Dr Hare Krishna Pradhan, director of the High Security Animal Disease Laboratory in Bhopal.

The Chinese microbiologists extracted H5N1 from the brains and throats of the sick birds at Quinghaihu with symptoms of diarrhoea and neurological disorders. In tests to evaluate its virulence, they found that the virus killed all eight chickens and eight mice deliberately infected with it.

Experts on infectious diseases believe an influenza pandemic (an epidemic affecting a vast area) is “inevitable and imminent”. During the 20th century, the world witnessed three global epidemics of influenza. The worst of them in 1918-19 killed more than 40 million people.

Scientists fear H5N1 may exchange genes with human viruses, gain the ability to move from person to person through coughs and sneezes, and trigger the next influenza pandemic.

Most human cases of H5N1 so far have involved people who have had contact with live, diseased poultry. Infected birds secrete large amounts of virus in their droppings, contaminating dust and soil around them.

Since January 2004, unprecedented outbreaks of H5N1 in poultry and humans across South-east Asia have alarmed scientists. Millions of chickens have been affected in Cambodia, China, Indonesia, Japan, Korea, Laos, Thailand and Vietnam.

The virus has also killed 54 among 108 people infected in Vietnam, Thailand and Cambodia over the past year, the World Health Organisation said last week.

But scientists say it takes geese several weeks to fly from China to India. “It’s a stressful flight and we don’t know whether an infected bird would survive it,” Mundkur said.

Ecologists have urged studies to map distributions of these migratory birds in India and examine whether they intermingle with local birds.

The first human outbreak of H5N1 occurred in Hong Kong in 1997, when the virus killed six people. Health authorities averted a pandemic by ordering mass slaughter of 1.5 million poultry.

The Flying Dutchman · Jul 9, 2005

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<center>Center for Biosecurity
By Eric Toner, M.D.

H5N1 in Vietnam:
Pandemic Threat Remains Unchanged
<A href="http://www.upmc-cbn.org/dmz/index.html?whereto=%2F">CBN Weekly Bulletin for July 7, 2005</A>

Last week an international team of experts completed a visit to Vietnam. The purpose of their visit was to determine whether the pandemic alert level should be raised. This investigatory visit was prompted by an urgent WHO consultation held in Manila in May, which was called in response to epidemiologic evidence that suggested the possibility of limited but increasing human-to-human transmission.</center>
News stories have widely reported that the team concluded that the pandemic threat was less than previously thought. This is not true according to the WHO. In fact, the team was specifically tasked with finding confirmatory laboratory evidence of community-acquired infection. Although they did not find this evidence, these tests are preliminary and the specimens will be retested.

Several points are worth noting: First, absence of evidence is not evidence of absence. The fact that these tests did not demonstrate community transmission does not mean it is not occurring. The epidemiologic evidence that prompted this visit still exists. Second, this was far from a comprehensive survey of the country. The WHO team consisted of only a half dozen individuals who were in Vietnam for about 3 weeks.

Sporadic cases of human H5N1 continue to occur in Vietnam. There have now been 108 confirmed cases of H5N1 in Southeast Asia over the past year and a half, 64 of which have occurred in the past 6 months. The case fatality rate is now 50% and appears to be decreasing, at least in northern Vietnam. There continue to be references to unpublished serological studies that suggest that there may be a significant amount of unrecognized H5N1 infection in Vietnam.

Meanwhile, outbreaks of H5N1 in wild migratory birds continue in western China. The origin of these outbreaks is unknown, but it is clear that as these birds start to migrate to the Indian subcontinent in the next 2 months, the risk of further spread of the disease increases.

While the news of the WHO team’s visit to Vietnam is welcome, a much more vigorous international effort is needed. It is critical that a comprehensive study of the extent of H5N1 infection both in humans and wild birds be done immediately and that there be a much more robust ongoing surveillance regime.

Mysterious Pig Deaths in Thailand cause Alarm(H5N1) July/7/05

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