LUXEMBOURG -- EU foreign ministers on Tuesday declared the spread of bird flu from Asia into Europe a "global threat" requiring broad international co-operation to contain.
The ministers were to issue a statement at a special meeting, saying they recognize bird flu poses a serious, global health threat if it shifts from birds to humans and one "that requires a co-ordinated international reaction."
The foreign minister were holding emergency talks Tuesday on the widening bird flu scare as Greece banned the export of live birds and poultry meat from the area where the EU's first bird flu case was detected a day earlier.
Poultry from Turkey and Romania have already been banned by the EU as bird flu found there was confirmed as being the deadly H5N1 strain. Tests were also being carried out on birds in Bulgaria and Croatia.
The foreign ministers were debating the international response to the westward spread of bird flu and assessed EU countries' readiness to deal with a possible pandemic.
The H5N1 strain has swept poultry populations in large swathes of Asia since 2003, jumping to humans and killing at least 61 people - more than 40 of them in Vietnam - and resulting in the deaths of tens of millions of birds.
Its spread westward by migrating wild fowl has intensified fears in Europe that the virus could mutate into one that can be easily transmitted among humans - a development that experts fear could provoke a global epidemic that puts millions of lives at risk.
The EU stepped up biosecurity measures and installed early detection systems along the migratory paths of birds to prevent contamination of domestic flocks. But there are concerns that European countries lack stockpiles of vaccines and anti-virals to cope with a major outbreak.
Seeking to calm public fears, the head of the EU's new agency for disease prevention on Monday downplayed the current risk to humans.
"The risk to human health, to public health, at this stage is minimal," said Zsuzsanna Jakab of the European Center for Disease Prevention and Control.
However, she said the Stockholm, Sweden-based agency was drawing up guidelines on how workers who deal with infected animals can protect themselves against infection.
"There is a little more risk for those who have directly worked with the infected animals, so our goal must be to further minimize that risk," Jakab said.
The World Health Organization recommends governments keep stocks of anti-viral drugs and regular human flu vaccines to inoculate at least 25 per cent of their populations.
European officials say the 25 nations in the EU, as well as Iceland, Norway and Liechtenstein, have only 10 million doses now for an area of almost 500 million people, and will have only 46 million doses by the end of 2007.
Stockpiling vaccines is difficult as flu viruses can mutate quickly.
On Thursday, EU health ministers open a two-day meeting at a conference centre in Hertfordshire, England, to assess the state of national bird flu preparedness.
There is no human vaccine for the current strain of bird flu but scientists believe the Tamiflu drug may help humans fight bird flu contraction.
BASEL, Switzerland (AP) - Swiss pharmaceutical company Roche Holding AG said Tuesday it was building a new plant in the United States to boost production of its Tamiflu drug amid fears of a global flu pandemic.
Orders for the drug have soared as health experts have been pinning their hopes on the antiviral Tamiflu, in case the bird flu mutates so that it could pass easily between people. While there is no human vaccine for the current strain of bird flu that has spread from Asia to southeast Europe, scientists believe the Tamiflu drug may help humans fight a mutated virus.
Roche said it could now go ahead with its plans to expand production in the United States because it had received approval from the U.S. Food and Drug Administration for the new plant, which it said would be one of more than a dozen production facilities worldwide. It did not disclose the location of the new manufacturing site.
"For Tamiflu, the key need today is the rapid expansion of production capacity," said William Burns, chief executive of Roche's pharmaceuticals division.
"In addition, we are prepared to discuss all available options, including granting sub-licences, with any government or private company who approach us to manufacture Tamiflu or collaborate with us in its manufacturing."
Roche, the sole manufacturer of Tamiflu, has ruled out relinquishing the patent for the drug, which is protected until 2016. But it also has said it was seeking other companies to help speed up its production due to the increased demand.
By the middle of next year, the company says, it will have boosted production tenfold in comparison to 2003.
Roche shares gained 2.2 per cent to 192.10 Swiss francs ($148.74 US) in midmorning trading on the Zurich exchange.
Last week, the Indian drug company Cipla Ltd. said it planned to bring a generic version of Tamiflu to market early next year, thus filling any potential shortages in the event of a bird flu epidemic.
UN Secretary-General Kofi Annan said this month that usual patent rules may have to be suspended if there is an outbreak of the disease so that other companies could jump in and make the medicine.
So far, nearly all the 100-plus people who have caught bird flu got it directly from birds. More than 60 people have died, but the virus has not been effective at spreading between people.
ATHENS, Greece -- Authorities in Greece are confirming the country's first case of bird flu on a turkey farm on the Aegean Sea island of Oinouses, near the Turkish coast.
Greece's agriculture minister says the H5 virus was been detected in one of nine turkeys tested.
Tests are being conducted for the possible presence of the deadly H5N1 virus. That's the virus that world health experts fear could mutate to a human form and cause a flu pandemic.
Over the weekend, tests on birds from Romania confirmed the arrival of bird flu in Europe -- two days after it was verified on Europe's doorstep in the Asian part of Turkey.
The U.N. health agency emphasized that while the arrival of the bird virus in Europe complicates efforts to stamp it out, the aggressive response by Turkey and Romania was reassuring.
The bulk of the problem is in Asia, where the virus has become endemic in some areas, creating multiple opportunities for a human pandemic strain to emerge, WHO said.
"There's no question that we will expect further outbreaks of avian disease in different countries," said Dr. Michael Ryan, director of the Department of Epidemic and Pandemic Alert and Response at the WHO. "Certainly North Africa and other countries in the African region are potentially in line for the introduction of the avian disease."
He added, "These introductions in Europe do represent a worrying development. We may see introductions into further countries over the coming weeks."
However, he said,"The problem is still very much focused in Asia."
In Hanoi, Vietnam, the United Nations' point man on bird flu told The Associated Press the world is not ready to cope with a potential pandemic that would skip across borders and oceans.
Dr. David Nabarro, the U.N. coordinator for bird and human influenza, said a pandemic could cause "billions, even trillions" of dollars in damage.
"I think that this is a very strong set of economic arguments that do mean that it is right for the world to invest quite generously in the actions required to both delay the pandemic and, then if it comes, to make sure we're ready for it," he said.
"I think that the world is now aware of the scale of the problem and is going to put in the resources."
As the H5N1 virus is detected in poultry in new countries -- the latest being Turkey and Romania -- Nabarro said it was reasonable to believe that more poultry infections could occur along natural bird migratory routes in Europe, the Middle East and Africa.
Bird flu has killed more than 60 people in Southeast Asia since late 2003. Most cases have been traced to contact with birds, but experts fear a genetic mutation could spark a global pandemic.
(CP) - Clustering of human cases of H5N1 avian flu infections has occurred on at least 15 occasions since late 2003 and limited human-to-human transmission of the virus may have occurred in several of these groupings, researchers will report in an upcoming issue of the scientific journal Emerging Infectious Diseases.
But key information on several of the clusters - the most recent documented in the paper occurred in early July - is still outstanding, illustrating some of the problems international health authorities will likely face if they try to put into action a plan to extinguish an emerging pandemic at source.
The lead author admitted that the rate at which information about human cases has emerged from affected countries raises worries about how clear a picture international authorities have when such events occur.
"Part of the reason to highlight this is to suggest any cluster should be viewed as a worrisome event and should be thoroughly worked up so that we can ascertain if it's person-to-person (spread) or rule it out," said Sonja Olsen, acting director of the U.S. Centers for Disease Control's International Emerging Infections Program, which is based in Bangkok.
"I'm sure some of these are just clear that there was no person to person and some to me seem less clear from the data that we have. But I think it raises the issue of: Do we have enough data on each of these?"
Mathematical modelling work published in August suggests an emerging pandemic strain could be snuffed out at source.
But success was predicated on rapid identification of clustering of cases and likely human-to-human spread so that contacts of infected people could be quickly placed on antiviral drugs. Measures would also have to be taken to cordon off an affected area to ensure infected people didn't flee and spread the disease.
The authors combed published reports and consulted regional contacts looking for clusters of cases within families that occurred from January 2004 to July 2005. Since their report was submitted another family cluster occurred in Indonesia involving a woman and her young nephew, both of whom tested positive for H5N1 virus.
Their report will appear in the November issue of the journal, which is published by the CDC.
A cluster was considered two or more cases, where at least one member tested positive for the virus and other members of the cluster experienced severe pneumonia or death from respiratory disease.
Olsen said where human-to-human transmission may have taken place, the dates of onset of illness suggest transmission stopping after one generation. In other words, if a person passed the disease on to someone else, the newly infected individual did not appear to have spread it further.
"It's not to say there weren't tertiary cases, but we're not clearly seeing that in these data," she said from Bangkok.
Most clusters comprised two or three cases, though one stretched to five. The researchers could not determine what happened to the members of that cluster, which occurred in Vietnam in early March.
In one grouping of three family members in Vietnam, two nurses who looked after someone with the virus were subsequently hospitalized with severe pneumonia. But infection with H5N1 was confirmed in only one of the health care workers.
An infectious disease expert said the holes in the data on the various cases in the study highlight "the complexity of working these kinds of cases up."
But Dr. Michael Osterholm, who is skeptical that containment of a pandemic could be achieved, said when a pandemic virus starts to spread, the clusters of cases won't look like the ones Olsen and her co-authors found.
"The cluster or clusters signalling this will look very different. Even in the first week to 10 days, there may be 20, 30 or more cases in a given area," said Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
A spokesperson for the World Health Organization said the data, while helpful, are retrospective.
"If transmission from birds to humans had become more efficient, then we would be seeing more cases," Maria Cheng said from Geneva.
"But it's certainly very useful to have this information in terms of tracking the disease in the future."
LONDON -- Bird flu can be expected to spread to other countries, but the biggest threat of it mutating into a human virus that could kill millions across the world remains in Asia, the World Health Organization said Monday.
Tests on birds from Romania confirmed the arrival of bird flu in Europe on Saturday, two days after it was verified on Europe's doorstep in the Asian part of Turkey.
The U.N. health agency emphasized that while the arrival of the bird virus in Europe complicates efforts to stamp it out, the aggressive response by Turkey and Romania was reassuring.
The bulk of the problem is in Asia, where the virus has become endemic in some areas, creating multiple opportunities for a human pandemic strain to emerge, WHO said.
"There's no question that we will expect further outbreaks of avian disease in different countries," said Dr. Michael Ryan, director of the Department of Epidemic and Pandemic Alert and Response at the WHO. "Certainly North Africa and other countries in the African region are potentially in line for the introduction of the avian disease."
He added, "These introductions in Europe do represent a worrying development. We may see introductions into further countries over the coming weeks."
However, he said, "The problem is still very much focused in Asia."
In Hanoi, Vietnam, the United Nations' point man on bird flu told The Associated Press the world is not ready to cope with a potential pandemic that would skip across borders and oceans.
Dr. David Nabarro, the U.N. coordinator for bird and human influenza, said a pandemic could cause "billions, even trillions" of dollars in damage.
"I think that this is a very strong set of economic arguments that do mean that it is right for the world to invest quite generously in the actions required to both delay the pandemic and, then if it comes, to make sure we're ready for it," he said.
"I think that the world is now aware of the scale of the problem and is going to put in the resources."
As the H5N1 virus is detected in poultry in new countries -- the latest being Turkey and Romania -- Nabarro said it was reasonable to believe that more poultry infections could occur along natural bird migratory routes in Europe, the Middle East and Africa.
Bird flu has killed 60 people in Southeast Asia since late 2003. Most cases have been traced to contact with birds, but experts fear a genetic mutation could spark a global pandemic.
BUCHAREST -- Countries in the Danube delta region scrambled yesterday to prevent the spread of lethal bird flu deeper into Europe as Britain's chief medical officer warned there was no way to avoid a flu pandemic.
British scientists on Saturday formally identified the strain of flu virus detected in Romania as H5N1, which has killed more than 60 people in Asia since 2003.
"It seems that some villagers are still trying to hide birds in the hope of preserving them, but those are isolated cases," a representative of the Romanian veterinary health agency said.
The deadly avian influenza virus found in Turkey and Romania is bound to combine with a human variety at some point and cause a pandemic, or global outbreak that would kill around 50,000 people in Britain, the country's chief medical officer warned yesterday.
"The significance of it isn't that there will be a pandemic of bird flu itself, the significance of it is that at some point, and we go by the lessons of history, the bird flu virus will combine with a human flu virus and then it will become easily transmissible," Liam Donaldson told BBC television.
The growing threat of bird flu spreading across Europe was also set to top the agendas of EU leaders this week after the deadly Asian strain of the virus landed on the continent for the first time.
Scientists and the European Union's political chiefs are trying to ease public concern after the H5N1 virus was confirmed in Romania only two days after its presence was identified in Turkey.
EU foreign ministers will discuss the outbreak at emergency talks in Luxembourg tomorrow, while bird flu will dominate the agenda of a meeting of health ministers later in the week.
On Wednesday, health commissioner Markos Kyprianou will present a pandemic simulation exercise aimed at testing the preparedness of the bloc's 25 members for such an outbreak.
Countries in the Danube delta have begun working on a co-ordinated response to the threat, Romanian officials said.
President Traian Basescu discussed possible steps with his Moldovan counterpart, Vladimir Voronin, by telephone on Saturday, according to presidential spokeswoman Adriana Saftoiu.
Agriculture Minister Gheorge Flutur said he was also seeking to involve Ukraine, which also shares the delta, in drawing up a joint strategy, and would later be contacting Bulgaria.
The Danube delta is one of Europe's biggest bird reserves and is on the UNESCO list of world heritage sites.
The World Health Organization voiced concern at the Romanian outbreak and admitted the risk of bird-to-human transfer had increased.
"The presence of this virus in Romania worries us because it proves that it is in the birds' environment and that increases the possibility of transmission to humans," said a spokesman.
Villagers in the Romanian village Ceamurlia de Jos, one of two sites where the deadly strain of bird flu has been found, may be more afraid of going hungry this winter than of the spread of the disease as they watch their poultry flocks slaughtered.
"After the slaughter of my 43 chickens and turkeys, I lie awake at night trying to think of other ways to feed my wife, my parents and my four children," said Tudor Soare, a subsistence farmer.
The cull of chickens continued in the southeastern village of Maliuc, the second site of a bird flu outbreak, with veterinary officials saying they expect to complete the slaughter of about 1,500 chickens by Tuesday.
Confirmation from a British laboratory whether the outbreak is also the deadly H5N1 strain is expected within days, said Mr. Flutur.
The British health official said a normal winter flu killed more than 12,000 people in Britain annually.
"But if we had a pandemic, the problem would be that our existing vaccines don't work against it; we would have to develop a new vaccine, and people don't have natural immunity because it hasn't been around before."
Mr. Donaldson, however, stressed that the pandemic was less likely to occur in Europe this winter. "The attention is focused in Europe because of these outbreaks. That doesn't mean that the pandemic flu is creeping closer to the U.K.; it simply means that bird flu is occurring in other parts of the world, as it has over the last five to six years."
French Finance Minister Thierry Breton said the country had set aside US$242-million for the prevention of bird flu in 2005 and will increase the sum if necessary next year.
"We have to guard ourselves, protect ourselves in case we see, as is not yet the case today, this animal disease spreading in Europe," Mr. Breton said on Sunday on radio and television.
HAIPHONG, Vietnam -- Health and Human Services Secretary Mike Leavitt finished up a four-country tour of Southeast Asia a week after officials from 80 countries met in Washington to discuss how to prevent and contain a potential global health threat.
After watching chickens and ducks being gutted and cleaned on the sidewalk, Leavitt said it would be difficult to change behavior that is a regular part of people's lives.
"It's evident to me that part of the dilemma here is the cultural momentum because it's happened for hundreds of years, and the chances of changing it anytime soon are very low," he said while walking through the open-air market. "It adds obviously to the equation and to the possibility that you will see an outbreak at some point."
During Leavitt's Southeast Asian trip, which also included stops in Thailand, Cambodia and Laos, he has repeatedly warned of a potential flu pandemic and the importance of all countries rallying together to quickly come up with preparedness plans. The deadly H5N1 bird flu virus was confirmed in birds in Turkey this week.
The disease has hit Vietnam harder than any other country, killing 43 people and 45 million birds, decimating the flocks of poor farmers.
Health experts have warned that the world is due for the next pandemic and fear that the H5N1 virus could mutate into a form that is easily passed among people.
Leavitt on Saturday compared the spread of a pandemic to a brush fire, and said the "chances are not good" of being able to monitor the "spark" when a virus mutates and then quickly contain it.
"There is a spark where every fire starts, and if you're able to be there at the moment it occurs it's possible to simply stamp it out," he said. "If you allow it to burn for an hour, often it will gain enough momentum that it's uncontainable and begins to start other fires."
The U.S. has committed $25 million to address the threat in Asia, and Vietnam will receive more than $6 million for preparedness.
Leavitt was traveling with U.S. Centers for Disease Control and Prevention Director Dr. Julie Gerberding, U.S. National Institute of Allergy and Infectious Diseases Director Dr. Anthony S. Fauci, and Margaret Chan, the World Health Organization's top official in charge of monitoring avian influenza.
Fauci said the potential severity of a bird flu pandemic remains "extraordinarily variable."
"We as public health officials ... must assume the worst-case scenario, and H5N1 now is giving us a lot of signs that it is becoming a little bit more worrisome, if not a lot more worrisome, because of the events that are going on," he said.
Two of the last three global pandemics, all in the 20th century, originated in Asia.
The Asian flu of 1957-58 and the Hong Kong flu of 1968-69 each killed more than 1 million people. Neither compared to the Spanish flu of 1918-19, which killed up to 40 million people and sickened an estimated 20 percent to 40 percent of the world's population.
So far, most human cases have been linked to contact with birds. More than 60 people have died from the virus in Southeast Asia since the disease began ravaging poultry stocks in the region two years ago.
HOW SERIOUS IS BIRD FLU?
Avian influenza is caused by viruses closely related to human influenza viruses. Transmission to people in close contact with poultry or other birds occurs rarely and only with some strains.
However, it can be devastating for the poultry industry and deadly for farmers. Since first detected in 1997, the H5N1 bird flu virus has spread to 10 countries. More than 200 million domestic poultry and 60 people have died.
WHICH BIRDS CARRY THE VIRUS?
Bird flu can kill domesticated birds, including chickens, ducks, and turkeys. Outbreaks of the H5N1 strain occurred among poultry in Cambodia, China, Indonesia, Japan, Laos, South Korea, Thailand, and Vietnam in 2003 and 2004. More than 100 million birds died or were killed. In June 2004, new outbreaks among poultry were reported in Cambodia, China, Indonesia, Malaysia, Thailand, and Vietnam. Concern about a major spread beyond the Far East was triggered when migratory waterfowl began dying at Qinghai Lake Nature Reserve in western China in May 2005.
Bar-headed geese, great black-headed gulls and brown-headed gulls were affected. Traditionally, waterfowl and shorebirds have been reservoirs for many strains of avian influenza, but rarely fell ill. However, the current H5N1 strain has caused mortality in 40 species of wild birds, including geese, storks, egrets, herons, and falcons, and some mammals.
HOW DOES IT SPREAD?
The virus can remain viable in droppings for long periods, spreading among birds and animals through ingestion or inhalation.
WHAT ARE THE CONTROL MEASURES IN BIRDS?
Culling of all infected or exposed birds, proper disposal of carcasses and the quarantining and rigorous disinfection of farms and poultry markets. Vaccination has also been successfully used but is impractical outside commercial settings and the vaccine requires regular updating. The virus is killed by heat (56 C for three hours or 60 C for 30 minutes) and common disinfectants, such as formalin and iodine compounds. Thorough cooking of any poultry meat will destroy the virus.
COULD AVIAN INFLUENZA SPREAD THROUGHOUT EUROPE?
Despite EU and U.K. controls, bird flu could be introduced to poultry through the migration of wild birds, the importation of dead chickens, the illegal importation of live birds or the entry of an infected person.
WHY ARE PEOPLE AT RISK?
The H5N1 virus does not usually infect humans. In 1997, however, the first case of spread from a bird to a human was seen during an outbreak in Hong Kong. The virus caused severe respiratory illness in 18 people, six of whom died. Since then, there have been other human cases and 60 deaths. The World Health Organization says there is mounting evidence that the H5N1 strain has a unique capacity to jump species and cause severe disease, with high mortality, in people.
There is no evidence that H5N1 has acquired the ability yet to pass easily among people.
WHY IS THIS STRAIN SO WORRYING?
Scientists know that avian and human influenza viruses can swap genes when a person is simultaneously infected with viruses from both species.
H5N1 has already demonstrated an ability to infect people, cause severe disease and kill -- the key characteristics of a pandemic strain. The virus has the ability to mutate and acquire genes from viruses infecting other species. Experts are concerned that the virus could either adapt, giving it greater affinity for people, or exchange genes with a human flu virus, thereby producing a completely new virus strain capable of spreading easily between people. If a new strain were to occur, then few people, if any, would have a natural immunity to it and a pandemic would occur.
CAN WE TREAT BIRD FLU?
There is some evidence that recent H5N1 viruses are susceptible to a class of antiviral drugs called neuraminidase inhibitors, oseltamivir and zanimivir, although they appear resistant to the alternative M2 inhibitors -- amantadine and rimantadine. Most experts agree that neuraminidase inhibitors will be vital in controlling a future pandemic. However, flu viruses can become resistant to drugs.
IS THERE A BIRD FLU VACCINE FOR PEOPLE?
There are already several potential vaccines for protecting humans from infection with bird flu, at various stages of testing and production.
Whether they would be suitable for use against a new pandemic flu strain depends on how much that strain may have mutated from the original H5N1 virus strain.
WILL MY FLU SHOT PROTECT ME AGAINST AVIAN INFLUENZA?
Current vaccines protect against circulating human strains and thus reduce the risk that humans at high risk of exposure to the bird virus might become infected with human and avian viruses at the same time. But the usual annual flu vaccination will not provide any protection against avian flu itself.
CAN A PANDEMIC BE AVERTED?
The first priority is to reduce opportunities for human exposure to infected poultry. Computer modelling has suggested that a human pandemic could be stopped with concerted action and enough antiviral drugs for three million people.
IS IT SAFE TO BUY AND EAT CHICKEN?
Yes, as long as import controls are strictly enforced. The import of poultry products from Romania and Turkey is already banned; similar bans would be implemented if the outbreak spread.
'Is Tamiflu A Prescription For Survival?'
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