International air travel would virtually stop if bird flu triggered a lethal human pandemic in the Asia-Pacific region, Australia’s health minister said today, as Chinese media reported plummeting poultry sales in Beijing and Shanghai.
Bird-flu prevention teams were fanning out across China’s capital to ensure no wild birds were being sold at the city’s markets, the Beijing News newspaper reported today, after 182 wild birds were found at one market on sale against regulations.
Beijing has banned the sale of wild birds, since it cannot guarantee they haven’t come from bird flu-infected areas.
Vietnam reported yesterday that two people had died after they displayed flu-like symptoms in the central Quang Binh province in the past week but no diagnosis could be made because blood samples were taken before they were buried.
Australia’s Health Minister Tony Abbott did not directly respond to questions on whether Australia would expel foreigners, close its ports or accept "flu refugees" in the event of a pandemic breaking out in neighbouring Indonesia.
"If there is a pandemic, international travel will almost cease I suspect for a significant period of time," Abbott told Ten Network television. "Regardless of what border controls countries might put on, there will be very few people who’ll be wanting to travel."
He said the government would help Australians wanting to return home if there was a global pandemic.
Australia will host an Asia-Pacific Economic Co-operation forum of health and disaster officials in the east coast city of Brisbane tomorrow to co-ordinate the international response to a human pandemic that could result from the virulent H5N1 strain of the bird flu mutating into a form easily transmitted between humans.
H5N1 has already killed at least 62 people after jumping from sick birds as well as millions of poultry is Asia since 2003.
The two-day meeting is expected to be the largest ever gathering of the 21 APEC members’ chief pandemic disaster managers.
As the US contributes to the APEC debate on global cooperation, US President George Bush will visit the US National Institutes of Health on Tuesday to announce his administration’s strategy on how to prepare for the next flu pandemic, whether it’s caused by the bird flu in Asia or some other super strain of influenza.
As an island continent, Australia has a natural sea barrier to many Southeast Asian diseases and is protecting itself by investing in neighbours’ efforts to contain the virus.
Australia’s bird flu strategy has come under criticism from some experts who say Canberra plans to waste most of its stockpile of four million courses of anti-viral drugs by using it as preventative medication for essential workers instead of saving it for those who contract the disease.
Abbott justified the strategy, saying the anti-virals Tamiflu and Relenza “will provide effective prevention but we are by no means certain that they will be a cure if you’re already symptomatic".
Meanwhile, the China Daily reported yesterday that although there is no evidence that humans can catch the virus through properly cooked poultry, sales at Shanghai’s biggest poultry market have plunged by 80%. China has yet to record a single human fatality but has experienced three outbreaks among poultry flocks.
In Vietnam, a 14-year-old girl died on Oct. 23 and a 26-year-old man died in the same province on Thursday, said Nguyen Duc Hanh, a doctor at the hospital where they were treated.
Hanh said both had typical bird flu symptoms, including high fever, breathing difficulties and a rapid lung infection.
Vietnam has been hardest hit with more than 40 human deaths from H5N1 since 2003.
In Indonesia where four people have died from the virus this year, university officials said hundreds of students are ready to begin house-to-house checks of backyard chickens for bird flu as part of a “military-like" door-to-door campaign launched by the UN Food and Agricultural Organisation.
International health experts and disaster management coordinators will discuss cooperation in the event of a bird flu outbreak at an Asia-Pacific Economic Cooperation (APEC) meeting in Brisbane this week.
The two-day "Avian and Pandemic Influenza Preparedness and Response meeting", starting Monday, is expected to consider issues such as border closures, antiviral drugs and how to maintain essential services during an outbreak.
Federal Health Minister Tony Abbott said Australia had already been a good regional mate to Indonesia, providing it with 50,000 courses of the antiviral medication Tamiflu.
"In respect of helping our neighbours, we've already invested some $15 million in surveillance and preparation in Indonesia, we've invested another $15 million around other countries in the region," Mr Abbott told the Ten Network.
"And we will look at what more needs to be done to build up international stockpiles.
"All reasonable steps will be considered and so far all feasible steps have been taken."
Asked if Australia would open its doors to people trying to escape a bird flu pandemic in their own countries, Mr Abbott replied: "I don't believe the kind of people who will be the most at risk in countries like Indonesia will be the sort of people who will be clamouring on the door at our airport."
Prime Minister John Howard said Australia was better prepared than probably any other country in the world to deal with any outbreak of avian influenza.
"We have allocated more than $170 million over four years to stockpile anti-viral medicines, boost funding on research, develop possible vaccines, fund border protection measures and provide educational material.
"And we have tightened our already strict quarantine measures.
"More money will be made available if necessary, but a critical element in any plan to prevent an outbreak, and deal with one if it occurs, is cooperation between countries and between agencies."
The meeting of APEC's 21 member economies, including Australia, Indonesia, the US, Japan and Malaysia, follows reports last week that China had suffered its third bird flu outbreak in two weeks.
China's Agriculture Ministry said 545 chickens and ducks died in a village in central China.
The outbreak in central Hunan province prompted authorities to destroy 2,487 other birds in an effort to contain the virus.
New bird flu outbreak has been registered in Tambov region, in Central Russia.
For the first time in the region, the poultry death of bird flu infection was registered a week ago, medical officials were quoted by RIA-Novosti news agency as saying. On Saturday, infected birds were found in private farms in the village of Streltsy. The loss of poultry started there on October 21.
Investigations also found bird flu virus in a bird body in Vladimir region. Private farms were disinfected.
Previous outbreaks had been confirmed in Omsk region in eastern Siberia and Kurgan region in southern Urals.
So far, about 60 infected locations in Siberian, Urals and Central Russian regions have been detected. In about 100 locations, poultry was under suspicion of infection.
The chief Russia’s sanitary inspector Gennady Onishchenko quoted by Oreanda news agency said the human flu was more dangerous than the bird flu, counting on the assumption of damages to people’s health and economy. He added that the bird flu virus had been circulating in the whole world since 1997 and there had been no case of its transmission from person to person. However, Onishchenko did not rule out that a stage could come when people would be often infected by the bird flu.
The Russian agriculture minister Aleksei Gordeyev said on Friday the Russian media was guilty of exaggerating bird flu scares. He said “this subject will be closed and forgotten in a week or two.” Earlier, eccentric Russian MP Aleksei Mitrofanov said that bird flu was invented by Americans who wanted to dominate the world’s poultry markets.
A deputy of the ultranationalist Liberal Democratic faction of the Russian State Duma, Aleksei Mitrofanov, has said in a parliamentary speech that bird flu was invented by Americans who wanted to dominate the world’s poultry markets.
"There is no such thing as bird flu, just as there is no AIDS, tulip or mad cow disease," Mitrofanov was quoted as saying by the Rosbalt news agency.
"It is a provocation by Americans. They want to eliminate all chickens in Europe so that we have to import ’Bush’s legs’," he said. "Bush’s legs" is a Russian saying for deep frozen chicken thighs massively imported from the U.S. under President George Bush Sr.
Mitrofanov suggested that the State Duma invite Agriculture Minister Aleksei Gordeyev to discuss the bird flu problem, but the initiative was not supported by his fellow parliamentarians.
HANOI, Vietnam, AP - Two people died in Vietnam after experiencing bird flu-like symptoms, but the cause of their deaths is not known because no samples were taken before they were buried, an official said Saturday.
A 14-year-old girl died in central Quang Binh province on Oct. 23 and a 26-year-old man died in the same province on Thursday, said Nguyen Duc Hanh, a doctor at the hospital where they were treated.
Hanh said both had typical bird flu symptoms, including high fever, breathing difficulties and a rapid lung infection. Quang Bing is about 490 kilometers (305 miles) south of Hanoi.
Mai Xuan Su, deputy director of Quang Binh provincial Preventive Medicine Center, said the cases were not reported to provincial health officials until after the patients died and no samples were taken.
"When we came, their relatives had already taken the bodies home for burial," he said. Accurate test results are difficult to obtain from exhumed bodies.
He said the man had contact with poultry and ate chicken at his in-law's house a week before falling ill, but no contact with birds was established for the 14-year-old girl.
No bird flu outbreaks among poultry have been reported in the two districts where they lived, Su said. Heath experts say humans cannot be infected by eating properly cooked poultry.
The World Health Organization is working with the government to ensure that hospitals nationwide report and test everyone admitted with flu-like symptoms, said Hans Troedsson, WHO representative in Vietnam.
"It is worrisome if health care workers are not alert and taking specimens if they suspect an influenza-type illness," he said. "It's better to take too many specimens than not enough."
Troedsson said it's impossible to know whether either victim was infected with bird flu because similar symptoms are associated with many other diseases, including other types of human influenza and pneumonia.
HANOI, Oct 29 (Reuters) - Vietnam, where the bird flu virus has killed more than 40 people, has two new suspected human deaths from the disease, a hospital official said on Saturday.
"It's very, very clear that all the critical symptoms pointed to bird flu," Dr Nguyen Ngoc Tai, the director of the Vietnam-Cuba Hospital in Dong Hoi, central Vietnam, told Reuters.
The Tuoi Tre (Youth) newspaper quoted a report from the hospital in the central province of Quang Binh as saying the victims, a 14-year-old girl and a 26-year-old man, had eaten duck and a chicken's egg around a week before they got sick.
The girl died on Oct. 23 and the man died on Oct. 26.
It said doctors at the hospital said they both had severe respiratory problems, fever and lung infection -- symptoms similar to bird flu.
Tai said a third person with symptoms of the disease had been sent to a better-equipped hospital in Hue City, central Vietnam, for treatment.
He said his hospital was ill equipped to treat bird flu patients and called for immediate supplies of the antiviral drug Tamiflu and flu vaccines to cope with the situation if more bird flu patients emerged.
"There is another case of a 27-year-old man who is suspected to have been infected with bird flu but in a milder form," Tai said.
Yunnan Province in southwest China will designate seven hospitals and two labs to monitor possible bird flu outbreaks in the province, an official said here on Sunday.
The surveillance work will mainly target the people who have raised, sold, slaughtered, processed or gave medical treatment to sick or dead poultry, those who killed and handled sick or dead poultry without proper protective measures, those who have contacted the excrement of the sick or dead poultry, and those who live in an environment polluted by the excrement of poultry.
The people who have lived together with patients suspected or confirmed to contact with flu or bird flue, taken care of the patients or contacted with the secretion, excrement and body fluid of the patients will also be put under surveillance.
The surveillance results will be reported to the provincial disease prevention and control center on a daily basis.
When a bird flu case is reported, the seven hospitals will provide medical help to those living within a radius of three kilometers from the epidemic center.
All data of the surveillance will be put into an online information system, according to the center.
The two bird flu monitoring labs will be established in the provincial disease prevention and control center and the disease prevention and control center of the Hani-Yi Autonomous Prefecture of Honghe.
The labs will be responsible for timely separating and identifying the flu virus.
Chinese Health Minister Gao Qiang said at a ministerial-level international meeting in Canada earlier this week that China had set up 192 flu monitoring stations nationwide. The ministry will send doctors and experts to assess the health of local people if a monitoring station reports evidence of a bird flu outbreak.
Yunnan shares the same border with Vietnam, which is facing a high risk of large bird flu outbreaks. Experts in the province have called on the local people not to be overreactive or panic to bird flue.
Source: Xinhua
PHILADELPHIA - Face masks are in hot demand - but not because of Halloween.
The scary prospect that avian flu could morph into a deadly human pandemic has triggered a surge in orders for respirators that could protect against a deadly influenza virus.
One New York City independent distributor said his daily online sales have soared from an estimated 25 masks to 5,000 in the past week.
"It's an uncontrollable ascent in sales," said Howard Ryan, owner of 3MMasks.com, which is not affiliated with the 3M company. Ryan said his firm has acquired over 1 million respirators, and charges under $3 for most.
Respirator makers, such as 3M and Kimberly-Clark, say they are revving up production to meet demand created by avian flu fears. Hurricanes Katrina and Rita also have played roles in the demand because respirators can be used during mold remediation, said Jacqueline Berry, a 3M spokeswoman.
Berry declined to quantify 3M's sales growth. David Parks, Kimberly-Clark's general manager for the global infection control business, said his company is ramping up its respirator production to 100 percent, up from 30 percent capacity.
The sharp increase in mask sales coincides with a spate of unsettling news about the virus, including the discovery of infected birds in Greece, Turkey and Romania. The virus, called H5N1, has ravaged bird flocks in Asia, and sickened 121 people and killed 62 since December 2003, according to the World Health Organization.
So far the avian strain hasn't jumped readily from birds to humans. But if that occurs, flu can turn into a deadly pandemic. The 1918 virus killed as many as 50 million people.
Still, it remains uncertain what type of face coverage the general public should use if a pandemic erupts, flu experts say. A good respirator, for example, won't protect a person if it doesn't fit properly.
N95-rated respirators protect against avian or seasonal influenza because they block smaller particles than the droplets the influenza virus travels on, said Dr. Mark Loeb, a Canadian infectious disease specialist, who advised his government during the SARS outbreak.
Loeb also believes surgical masks would be effective too.
Typically, "surgical masks protect the patient and the N95 protects the wearer," said Sharon Krystofiak, manager of infection control at Mercy Hospital of Pittsburgh and a member of the Association for Professionals in Infection Control and Epidemiology.
Respirators fit tighter than surgical masks and are made to filter out smaller particles.
Emergency Filtration Products in Nevada makes a different type of mask, which, the company said, is nearly 100 percent efficient in protecting against microorganisms. The firm said business is increasing dramatically, too, because of concerns about avian flu.
Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said the medical community has not concluded what type of mask would be needed to prevent avian flu transmission. "We need hard scientific data to guide us," he said.
Meanwhile, the federal Centers for Disease Control and Prevention has no recommendation for face-mask use among the general population. "We still view this as essentially a bird disease," said Dave Daigle, a CDC spokesman.
Australia's health minister, Tony Abbott, has dismissed suggestions the government should authorise the manufacture of cheap generic drugs to treat avian influenza.
Concerns have been raised that companies like the Swiss biotech firm, Roche, which holds the patent on the antiviral drug Tamiflu, won't be able to meet demand in the case of a global bird flu pandemic.
But Mr Abbott says patent law is not affecting supplies, but the problem is production capacity.
"Tamiflu is not that easy to make. If it was easy to make, Roche would have ramped up their production a long time ago," he said.
WASHINGTON -- Two years ago we were awakened most days by the rooks. As we left home, heading for the car, one rook in particular, perched at the top of a tree, would voice a warning to other birds and the squirrels that humans were about. But not now because of West Nile Virus, believed to be carried by rooks, a stealth program appears to have eliminated every colony of rooks in Washington.
Now, with the threat of a pandemic of avian bird flu and the United Nations predicting the range of deaths could be between 5 million and 150 million before the disease runs its course, the mere flapping of wings sends television presenters into a frenzy of fearful imagination.
As we accelerate toward the possible first global influenza outbreak of the 21st century it must be remembered that the new H5N1 virus is thought to be able to leap from birds to humans. This is not new to our Armed Forces Institute of Pathology, whose Jeffrey Taubenberger has linked it to the Spanish flu of 1918. He believes that the massive movement of people during World War I, overcrowded living conditions and a population explosion, created prime incubation conditions.
Controlling the avian flu must include watching for symptoms in pigs and birds as well as humans, he says.
If a pandemic should erupt, there won't be enough medicines ready to use. Dare we say, as usual, the government is a day late and a dollar short?
Citing security, we have stockpiled smallpox vaccines for the improbable spread of that virus by terrorists.But there are only very limited stocks of Tamiflu available from the Swiss manufacturer, Hoffman-La Roche.
Sure, by the flu season of 2006 there may be more Tamiflu available; a new factory is being planned in the United States. This month, Hoffman-La Roche commenced talks with a number of other companies to produce the drug. But it is a long way from the research lab to the locked closets of our local pharmacy.
Tamiflu really is big business. The drug is made from an acid produced from the Chinese star anise plant, which only grows in four Chinese provinces and is only harvested between March and May. A 10-pill course of the drug is said to cost at least $60. With some 40 countries scrambling to fill their stockpiles, Roche's earnings went from $70 million in 2001 to an estimated $700 million this year.
Little wonder that the Indian drug company Cipla Ltd., and one in Thailand, have said that if Hoffman-La Roche won't grant them a license to manufacture Tamiflu, it will make a generic version. And, a Taiwanese company has said it will pirate the Tamiflu formula (but no pills would be available until October 2006).
We can see the danger as flocks of migrating birds fly south across the sky, each bird potentially carrying the H5N1 virus. A goose flying south from Pennsylvania might "overnight" three times before crossing the borders to Mexico and warmer climates.
Domestic chickens and ducks, where the geese have roosted, may become carriers. And if they are infected with H5N1 virus, we are next in the chain.
Dateline D.C. is written by a Washington-based British journalist and political observer.
DISASTER experts from the Asia-Pacific region will meet in Brisbane today to discuss how to cope with a global outbreak of deadly bird flu, amid warnings that international travel would be virtually wiped out in a pandemic.
Health Minister Tony Abbott yesterday said overseas travel would almost cease for a "significant period" if avian flu broke out in the region.
"Regardless of what border controls countries might put on, there will be very few people who will be wanting to travel," Mr Abbott told Channel Ten.
He said Australia would do all it could to bring home Australians abroad during a pandemic. He would not be drawn on whether Australia would accept so-called flu refugees — a new class of migrant escaping a flu pandemic in their own countries.
Mr Abbott last week said Australia would consider closing its borders in a pandemic.
The disaster experts from the Asia-Pacific Economic Co-operation forum's 21 member countries, including Australia, Japan, Indonesia and the US, will meet in Brisbane today and tomorrow to discuss a co-ordinated response to an outbreak. It is hoped any gaps in preparedness will be identified.
Observers from the Pacific Island Forum, Burma, Cambodia, Laos and International Red Cross will also attend.
Seven Indonesians have contracted the deadly H5N1 strain of bird flu since last December. Four have died. In the latest outbreak of the virus in China, about 2600 birds died at a farm near the Inner Mongolia provincial capital of Hohot last week.
The Australian Government last week announced tougher quarantine measures after authorities in Melbourne found three pigeons imported from Canada had been exposed to the bird flu.
Prime Minister John Howard said that so far, the avian influenza virus had not mutated into a form that could spread easily from human to human.
"The risk of that happening, according to advice to the Government, is low," Mr Howard said in a fortnightly column he writes for national circulation. "But we are leaving nothing to chance."
Mr Howard said Australia was probably better prepared than any other country to cope with bird flu. The Government had allocated more than $170 million over four years to stockpile anti-viral medicines, boost research, develop vaccines and fund border protection measures, he said.
The Australian Medical Association has called on APEC delegates to develop a response based on education and information, not fear and panic.
President Mukesh Haikerwal said there had been fewer than 100 cases of bird-to-human transmissions of the virus and no cases of human-to-human transmissions world wide.
"From the evidence and the incidence of bird flu that is out there at the moment, it is probably a bit early and irresponsible to be talking of widespread doom, destruction and death," Dr Haikerwal said. "People need to be able to get on with their lives without the prospect of some sort of ornithological Armageddon creating fear in the community."
Meanwhile, Mr Abbott ignored calls to override the patent for the antiviral drug Tamiflu, which can moderate avian flu symptoms, and authorise manufacturers to produce a generic version.
Washington - A long-awaited government plan on how to fight the next super-flu will likely include beefed-up attempts to spot human infections early, both in the United States and abroad.
President George W Bush on Tuesday is visiting the National Institutes of Health to announce his administration's strategy on how to prepare for the next flu pandemic, whether it's caused by the bird flu in Asia or some other super strain of influenza.
Federal health officials have spent the last year updating a national plan on how to do that.
The president will ask Congress for unspecified new money, not just for a vaccine against bird flu but to fund a build-up of infrastructure ready to deal with any pandemic, said a senior administration official, who spoke Saturday on condition of anonymity.
Expect recommendations on how to isolate the sick. Governors and mayors are on notice to figure out who will actually inject stockpiled vaccines into the arms of panicked people.
Stockpiling drugs and vaccines is just one component.
"Understand that a lot of the things we need to do to prepare are not related to magic bullets," said Michael Osterholm of the University of Minnesota, an infectious disease specialist who has advised the government on preparations for the next worldwide flu outbreak but has not seen the final version of the plan.
How to provide food supplies, everyday medical care for people who don't have the super-flu, basic utilities and even security must be part of the plan, Osterholm and others have counseled the Bush administration.
"In this day and age of a global economy, with just-in-time delivery and no surge capacity and international supply chains - those things are very difficult to do for a week, let alone for 12 to 18 months of what will be a very tough time," he said.
While it is impossible to say when the next super-flu will strike, there have been three pandemics in the last century and influenza experts say the world is overdue. Concern is growing that the bird flu could trigger one if it mutates to start spreading easily among people - something that hasn't yet happened.
Already the government is buying $162.5m worth of vaccine against that bird flu strain, called H5N1, in case that happens. It is also ordering millions of doses of Tamiflu and Relenza, two antiflu drugs believed to offer some protection against the bird flu, stockpiles that the pandemic plan is expected to order be augmented.
Lawmakers angry at months of delay have already given Bush money to begin those preparations: $8bn in emergency funding that the Senate, pushed by Democrats, passed on Thursday - and an amount considered close to what federal health officials will need.
The money is to be spent at the president's discretion, but senators said it should be used both for medications and vaccine and for beefing up hospitals and other systems to detect and contain a super-flu.
The Bush administration's plan to fight the next super-flu likely will include attempts to spot human infections early, both here and abroad.
Governors and mayors are on notice to figure out who will use stockpiled vaccines.
President Bush on Tuesday will visit the National Institutes of Health to announce his administration's strategy on how to prepare for the next flu pandemic, whether it's caused by the avian flu in Asia or some other super strain of influenza. Federal health officials have spent the last year updating the national plan.
The president will ask Congress for unspecified new money, not just for a vaccine against bird flu but to fund a buildup of infrastructure ready to deal with any pandemic, said a senior administration official, who spoke yesterday on the condition of anonymity.
Stockpiling drugs and vaccines is just one component.
"Understand that a lot of the things we need to do to prepare are not related to magic bullets," said Michael Osterholm, an infectious disease specialist at the University of Minnesota who has advised the government on preparations for the next worldwide flu outbreak but has not seen the final version of the plan.
How to provide food supplies, everyday medical care for people who don't have the super-flu, basic utilities and even security must be part of the plan, Mr. Osterholm and others have told the Bush administration.
While it is impossible to say when the next super-flu will strike, there have been three pandemics in the last century, and influenza specialists say there may be another soon. Concern is growing that the avian flu could trigger one if it mutates to spread easily among humans -- something that hasn't yet happened.
The government already is buying $162.5 million worth of vaccine against that avian flu strain, H5N1, from two companies -- Sanofi-Aventis and Chiron Corp. -- in case that happens. It also is ordering millions of doses of Tamiflu and Relenza, two anti-flu drugs thought to offer some protection against the avian flu.
Lawmakers already have given Mr. Bush money to begin the preparations: $8 billion in emergency funding that the Senate passed on Thursday.
That money is to be spent at the president's discretion, but senators said it should be used both for medications and vaccine and for beefing up hospitals and other systems to detect and contain a super-flu.
Sen. Edward M. Kennedy, Massachusetts Democrat, called the funding "a victory for common sense."
But amid growing public fear about the avian flu, federal health officials are concerned that if the worrisome strain in fact fizzles -- or is contained in birds and never threatens Americans' health -- there will be strong skepticism next time.
"Will critics say, 'We have been crying wolf,' and lose the sense of urgency we feel about this issue?" Health and Human Services Secretary Michael O. Leavitt asked last week .
They shouldn't, he says, because pandemic preparations to improve how vaccines are made and diseases are detected will improve public health overall.
PEOPLE who breach orders to stay at home, in hospital or within their city during an influenza outbreak could be jailed for up to 10 years.
But the ACT's chief health officer, Charles Guest, has warned against overreacting in the face of rising concern about bird flu, saying movement restrictions are "exceedingly unlikely ever to happen".
The Federal Government warned this week that it may ban travel interstate and between other sections of the country to prevent the spread of any deadly strain of the virus that enters Australia.
The tough quarantine penalties apply under current Commonwealth law.
But Dr Guest said Canberrans' first and best defence against a possible pandemic would be to heed simple public health measures.
He said people should focus on "common sense" precautions, such as responding to symptoms early, washing hands and visiting their local GP.
"[It's] important to communicate the things that people can do now to contain infection," he said. "Don't go to work if you're sick - don't be a hero."
But he also confirmed that the ACT Government had prepared a range of more robust containment options, including school closures, home detention, converting public buildings into quarantined clinics, and roadblocks, which it would enforce with police and possibly military assistance in the "unlikely" event that the infection became widespread.
The quarantine measures appear in a confidential ACT pandemic action plan prepared by staff from government departments, emergency and police services and non-government agencies.
The federal Health Minister Tony Abbott warned on Wednesday at an international bird-flu conference in Canada of the potential need for movement bans.
"Cancellation of interstate travel, border closures between different parts of the country, cancellation of large public gatherings [are being considered]," he said.
On Friday, the Queensland Parliament passed new laws that empower its state Government to detain people infected with the virus for up to 28 days.
But Dr Guest said he doubted either option would be necessary in the ACT.
"It will depend on what is happening," he said. "We have to be flexible and adaptive."
He said the most likely consequence of a widespread outbreak of a deadly flu strain would be that a small number of Canberrans would be confined to hospitals or makeshift "fever clinics".
Discretionary health-care services, such as elective surgery, would be suspended while general practitioners and other medical staff were mobilised to assist infected patients. Since bird flu resurfaced in the region late in 2003, it is known to have caused more than 60 human deaths.
Dr Guest said while the risk of a pandemic hitting the ACT was low, it would eventually happen.
"History tells us that there will be a pandemic," he said. "We must plan as though it's going to happen, because that is the best way to be prepared."
For two years, a deadly strain of chicken flu known as H5N1 has been killing birds in Asia. While slightly more than 100 people are known to have contracted the disease, and 60 of them have died, there is still no sign that the flu has begun to spread from person to person.
That hasn't prevented a recent outbreak of apocalyptic warnings from health officials and experts about the specter of a worldwide pandemic. In Hurricane Katrina's wake, health officials in the United States are talking more and more about pandemic preparation. Some of these ideas — such as stockpiling vaccines — are sensible, whether or not bird flu turns into a human disease and begins to spread rapidly.
But other ideas aren't. A few scientists have suggested "priming" people with a dose of the new vaccine against H5N1 before we even know whether a pandemic is coming. Vaccinating large numbers of people against a disease that may never appear carries its own risks. Remember the swine flu debacle of 1976? At least 25 people died from vaccine complications and no epidemic ever erupted. That should be warning enough.
Another dangerous idea for pandemic preparation has come from President Bush. Earlier this month, he suggested using the military to enforce a quarantine. "Who (is) best to be able to effect a quarantine?" he asked rhetorically at a press conference. "One option is the use of a military that's able to plan and move."
The very term quarantine can be misunderstood (not to mention the military's role). Did the president mean gathering those exposed to flu in a single location and forcing them to stay there? Did he mean isolating them in their homes? Cordoning off whole communities where cases crop up? Not all quarantines are alike; each carries its own risks and benefits.
If this were idle presidential speculation, it wouldn't be worrisome. But he isn't the only one talking about quarantines and calling in the troops. In an Oct. 5 interview on The NewsHour With Jim Lehrer, Julie Gerberding, director of the Centers for Disease Control and Prevention, also wondered whether the government would need to turn to "containment" or "quarantine the people who are exposed." She too remarked that the military or the National Guard might be summoned "to maintain civil order, in the context of scarce resources or an overwhelming epidemic. ... It would be foolish not to at least consider it and plan for that as a possibility."
This is an example of a cure that is as frightening as the disease. It is hard to imagine how the military would oversee a quarantined area. If a health worker, drug addict or teenager attempted to break the quarantine, what would soldiers do? Shoot on sight? Teenagers and health workers were the people who most often violated quarantine rules in Toronto during the severe acute respiratory syndrome (SARS) scare in 2003. Moreover, the use of a quarantine to control a flu pandemic isn't only a potential threat to life and civil liberties; it's also a waste of money, resources and time. The reason: There isn't any kind of quarantine that will do any good — at least not for a pandemic influenza.
Quarantine, from the Italian "quarantina," which means "space of 40 days," dates from 15th-century regulations devised in certain Italian cities to control the spread of plague by sequestering those thought to have been exposed to the disease. Along with isolation — secluding those who are clearly sick — it can be an effective tool for controlling outbreaks of certain types of disease. In 1910 and 1920, before antibiotics, plague experts in Manchuria controlled several deadly outbreaks of pneumonic plague using quarantine and isolation alone. But pneumonic plague, now rare, spreads in a very different way than flu does. Pneumonic plague germs are coughed out in large droplets that quickly fall to the ground. If you are more than six feet away from a plague patient, you're unlikely to catch the disease. Also, plague patients are typically very ill before they can transmit the germ to others. "There is no disease more susceptible to quarantine than plague," wrote the physician Wu Lien-teh, who helped break the Manchurian epidemics.
Influenza is entirely different. The virus spreads explosively. Coughing, sneezing, or even speaking launches flu particles in an aerosol cloud of tiny droplets, which can drift in the air for some distance.
Physician and flu researcher Edwin Kilbourne, who worked with flu patients during the pandemic of 1957-58, points out that people with flu may shed the virus even before they know they're sick — not much, but enough to transmit the disease. Worse, some 10 percent to 20 percent of flu patients have subclinical infections; they never look sick at all. Yet they can still spread infection. Faced with a flu pandemic, you'd hardly know where the disease was coming from.
How can you quarantine a disease like that?
According to Kilbourne, you can't. "I think it is totally unreasonable on the basis of every pandemic we've had," says Kilbourne. "Every earlier pandemic seeded in multiple foci at the same time. Quarantine simply will not work."
Indeed, a strictly enforced quarantine could do more harm than good. Herding large numbers of possibly infected people together makes it likely that any influenza strain passed among them would actually increase in virulence.
Usually, to spread, human flu germs need hosts mobile enough to walk around and sneeze on other people. Those flu strains so deadly that they kill or disable their hosts won't get the chance to spread and will die off. This keeps human flu virulence within bounds.
If you let people walk around freely, only those strains mild enough to allow people to stay on their feet would spread easily.
If quarantine won't work, what would? What about medication?
Kilbourne is not optimistic about the vaunted (and expensive) antiviral drug Tamiflu, which can be taken to prevent or treat flu. "The problem with antivirals is that they are untried on any mass basis," says Kilbourne. "How long are you going to keep people on antivirals? Also, we don't know about any side effects of the newer antivirals. Older antivirals cause neurological problems in older people."
Kilbourne thinks that preventive vaccines are our best, and only, strategy for combating a pandemic flu threat. The new vaccine, developed with National Institutes of Health sponsorship, shows some ability to protect. But Kilbourne, who in 1969 developed the first reassortant flu vaccine (one made by combining snippets of genetic material from different flu strains), isn't enthusiastic.
First, the new vaccine must be given in two doses, at very high concentrations. And it's hard to grow. Kilbourne adds, "We don't have enough if a pandemic happened tomorrow."
Still, vaccination is the gold standard for pandemic preparation — once we know that a contagious human disease is emerging and the risk of vaccination becomes less than the risk of disease.
That's a long way from now. Despite all the hysteria, there isn't a shred of evidence that a pandemic is actually on the way. Developing new flu vaccines is useful. Pandemic or not, flu kills thousands every year. But devising quarantine plans is useless.
Orent, an Atlanta-based writer, is the author of Plague: The Mysterious Past and Terrifying Future of the World's Most Dangerous Disease (Free Press). Readers may e-mail her at orentw@mindspring.com. This article originally appeared in The Washington Post.
LONDON, Oct 29 (Reuters) - Britain's plan to cope with a human outbreak of bird flu is among the best in the world, a government scientist said on Saturday.
Professor Roy Anderson, an authority on infectious diseases at Imperial College London, told BBC Radio the Department of Health had prepared well and was backed up by a "very strong" scientific community in the study of epidemics.
"I had the privilege ... of chairing a G7 meeting on preparedness plans in the summer of this year and my own personal view was that our plans were as good as, if not better, than any other of the G7 countries," he said.
Since 2003, more than 60 people have died of bird flu in Vietnam, Thailand, Cambodia and Indonesia and another two people showing symptoms of the virus died in Vietnam in the past week.
Britain has had its first contact with the disease after one, and possibly two, birds with the deadly H5N1 strain died in quarantine. At least 32 other birds that died in captivity are now being tested. Anderson said the risk existed that if a person with human flu became infected with bird flu, a resultant strain could combine "the bird flu virus (with) the transmissibility of the human virus".
"That's the worst option," he said. "These events are the events that typically trigger new global pandemics in the human species."
But the professor said that although it was likely bird flu would spread in Britain and western Europe, that did not necessarily mean a human strain would develop.
He said that was most likely to happen in China.
"The density of ducks and geese and chickens per human is very high there," he said, "(and) the social environment is such that humans have great intimacy with their poultry livestock.
"All conditions for intimacy and evolution are present".
China has revealed three outbreaks of the H5N1 virus that killed 3,800 chickens, ducks and geese since last week.
It has reported no human bird flu infections since the latest H5N1 outbreak surfaced in Asia in late 2003 although it is being pressed by the World Health Organisation to provide information on a 12-year-old girl who has died.
Chinese officials said she died of pneumonia although she was initially suspected of having bird flu.
CHIANG RAI (TNA) - Two more suspected avian influenza patients have been found in two northern Thai provinces of Chiang Rai and Phichit, doctors said on Saturday.
An 18-year-old man has been admitted at a hospital in Chiang Saen District of Chiang Rai Province since October 26 after he came into contact with dead chickens for unknown reasons.
Trained volunteers are now closely monitoring the deadly disease in villages in this province, as winter is approaching--when the danger increases.
Bird flu prefers cold weather, according to experts.
The second suspected victim is a 49-year-old man and is now receiving a treatment at a hospital in Phichit Province.
Doctors have sent his blood for test to the Department of Medical Sciences and the result is expected to be known on Monday.
According to doctors, the victim raised a flock of more than 100 chickens and ducks at his home and felt sick after eating his dead birds.
The doctors said two women who were also suspected of having contracted the disease and were admitted at the hospital earlier are still in critical condition now.
Two boys who were admitted to hospital in Phichit on Wednesday have been released after doctors said the patients suffered from ordinary influenza and not bird flu.
The road from Budapest meanders through forested hills and quiet villages, before reaching a neat yellow building guarded by an old man in a boiler suit and a barking alsatian. This is the unlikely front line in the global war against bird flu.
At this laboratory, Hungary is leading the fight against the H5N1 virus, which has arrived in Europe after killing dozens of people in Asia, and preparing for deadly future forms of an ever-changing disease that could cause a flu pandemic.
Last week the World Health Organisation invited Hungarian officials to Geneva to discuss their vaccine.
Inside Omninvest Ltd's discreet headquarters, the nature of its work becomes apparent. The air smells faintly of disinfectant. Ferenc Zimonyi, director of operations, politely declines requests to photograph wall-mounted plans of the building's layout, and to venture beyond the outer rooms of the facility.
Deep inside, scientists in safety suits with breathing apparatus step through airlocks to the heart of the lab, where the lethal H5N1 virus is bred in hens' eggs before being extracted, concentrated, and turned into Hungary's vaccine.
'We have to apply a high level of protection to everyone dealing with this,' says Zimonyi. 'We were a little afraid of the unknown elements of H5N1. But we gave everyone who works here our vaccine, and trials have shown that it works well.'
Now Omninvest is making about 50,000 doses for London's European Medicines Agency, which tests new medicines for use in the European Union. Hungarian officials also plan to discuss the vaccine project with the World Health Organisation next week.
If Hungary beats bigger nations and pharmaceutical giants to mass production of a bird flu vaccine, the kudos for the nation's scientists would be almost as great as the potential profits. Fear of a bird flu pandemic is tightening its grip around the world.
Hungary says its vaccine is not only powerful against H5N1 - producing four times more antibodies in test subjects than the WHO requires for normal flu vaccines - but, crucially, its method is easily adaptable to fighting mutations.
'When a mutation occurs we would not have to create a new process for making the vaccine,' says Zimonyi. 'We would simply replace H5N1 with the mutated strain and, in eight weeks, we could be producing the new vaccine in industrial quantities.'
So keen was Health Minister Jeno Racz to promote Hungary's bird flu vaccine project that he volunteered to be injected with a deactivated form of the lethal H5N1 virus.
'I felt that if I am convinced that this vaccine is effective, then I could prove this best by trying it on myself first,' he told The Observer.
'The WHO gave a sample of the H5N1 virus to several countries and companies to try and develop a vaccine,' Racz added. 'We haven't heard of anyone who has had the kind of success in tests that we have.'
'It is a race against time,' says Racz, who is resigned to the possibility of losing out on the vaccine's potential profits.
'The WHO and EU can wave a country's exclusive patent to a vaccine in the case of a health crisis,' he says with a shrug. 'If a pandemic looms, humanitarian concerns must override financial questions.'
Threat to Britons is very low, says Patricia Hewitt
The threat to people in Britain of contracting bird-flu is remote, the Health Secretary, Patricia Hewitt, said yesterday.
'The World Health Organisation - to whom I spoke only a few days ago - confirmed that the threat to the general population in Britain from bird flu is very, very low indeed,' she said in an interview with the BBC.
Hewitt wanted to reassure people that the chance of picking up the lethal flu-strain, that is currently being found in birds across the world, is minimal. The H5N1 strain is able to jump from bird to human and has taken lives in Asia, but is less likely to take casualties in Britain where people do not live in close proximity to birds and poultry. For a pandemic to take hold, the virus would have to mutate into a form that could jump from human to human.
ELIZABETH JACKSON: Meanwhile, health authorities say Hungary's claim that it's developed a vaccine for deadly bird flu should be treated with caution.
Hungary says its vaccine has been successfully used on several dozen Hungarians including the country's Health Minister, and it could be ready for mass production by March.
But back home, the Health Minister, Tony Abbott, is one of a number of people casting doubt on the development.
Karen Barlow reports.
KAREN BARLOW: After about six months of development, Hungary has declared successful human tests of a bird flu vaccine with more than 100 volunteers developing antibodies against the virus.
Hungary's Chief Medical Officer, Dr Laszlo Bujdoso, has told the ABC's Lateline that he stands by the findings.
LASZLO BUJDOSO (translated): A new vaccine is considered effective if there is a 2.5 times increase of antibodies in the blood. Our vaccine increased the level of antibodies to a 10 times higher level.
KAREN BARLOW: Even Hungary's Health Minister, Dr Jeno Racz, was a willing guinea pig for the cause.
JENO RACZ (translated): When the first human vaccine was completed I volunteered to be the first to receive the test vaccine. It had risks, so if I didn't consider the likelihood of a new flu virus a very serious threat I wouldn't have lined up to do it.
The Hungarian Government claims that many countries are interested in its vaccine, but only Indonesia has publicly stated interest in getting a license to locally produce it.
But doubts about the Hungarian vaccine are being cast.
Australian virologist Alan Hampson questions whether the Hungarian scientists have taken all the necessary precautions.
ALAN HAMPSON: There are a number of issues about making the vaccine against the H5 virus because of the potential danger of the virus still, even though it has been modified, and because the virus as a modified organism comes under the control in most countries of the genetics regulators.
And so, in Australia for example, it's taken a little while I believe to get through those issues and make sure that everything is right up to speed in terms of safety and regulations.
KAREN BARLOW: The World Health Organisation says the Hungarian results need to be scrutinised, and the European Commission warns the vaccine would be useless in any human pandemic, as it's been developed against the avian strain, not a future human strain.
They're views backed by the Federal Health Minister, Tony Abbott, who's recently returned from a bird flu conference in Canada.
He's told Lateline that he's expecting the Australian vaccine effort will bear fruit with trials at CSL scheduled to be finished early next year.
TONY ABBOTT: Well we have invested $5 million in the CSL trial because we certainly think that a candidate vaccine makes a lot of sense.
The Americans had a go at a candidate vaccine, and it seems that their candidate vaccine is not particularly effective. So while this Hungarian announcement is encouraging, I think we would want to look closely at it before we suddenly said "Wacko, this is great."
And look, I don't know very much about the Hungarian vaccine industry. I do know that CSL is a highly respected vaccine manufacturer with a very good record not just here, but right around the world in producing high quality effective vaccines.
KAREN BARLOW: A regional bird flu summit will be held in Brisbane next week, with biosecurity measures, flu reporting, and the latest in vaccine development on the agenda.
HANOI, Vietnam (AP) - One of the many mysteries of bird flu is that it has not infected more people like Ha Thi Quynh.
The woman in her late 30s holds up a plump, live goose by its feet at Hanoi's largest poultry market. Although blood, feathers and bird droppings cling to her pants and rubber sandals, she doesn't worry about bird flu.
"I have no problem," she says. Quynh has driven a motorbike loaded with about 35 chickens and geese on a two-hour trip to the market every day for the past 10 years. "If customers ask me to slaughter the chicken, then I will do it."
Quynh and the others at Long Bien market say they're living proof bird flu is hard for people to catch. They work without fear or protective gear in a place where fresh blood runs through open gutters and stray feathers glide through the humid air, thick with the stench of death. They say not a single person from the market has ever become sick or died from the H5N1 bird flu virus.
Researchers agree. They're just not sure why these people have stayed healthy.
Farmers at large poultry facilities and those who transport, sell and slaughter birds daily typically have not been infected since the virus began spreading through Asia in late 2003. Even those who slaughtered hundreds of sick birds when the virus was raging did not fall ill.
The disease has attacked mostly healthy children and young adults, who may have had a few chickens pecking in their back yards or villages. Researchers wonder if maybe commercial farmers and others who have worked around poultry for a long time have acquired some sort of immunity.
"The honest truth is that on a lot of answers to these questions, your guess is almost as good as mine," said Dr. Jeremy Farrar, director of Oxford University's clinical research unit at the Hospital for Tropical Diseases in Ho Chi Minh City. "It may be . . . because of the nature of the way that people prepare chickens in their houses. It could be because there's some difference in the immune response between younger people and older people."
Farrar was part of a large research committee that reported in the New England Journal of Medicine last month what's known about those infected with bird flu. The youth of most of the victims was striking.
Out of 41 confirmed cases examined in the article (which doesn't include all of them) from outbreaks in 2004-05, the ages of those infected ranged from two to 58. In Thailand and Cambodia, researchers calculated the median age of those infected: 14 in Thailand and 22 in Cambodia. For the Vietnam outbreak in 2004, they calculated an average age of 14.
The researchers also noted that recent infections have caused "high rates of death among infants and young children. The case fatality rate was 89 per cent among those younger than 15 years of age in Thailand."
The paper says most victims were those who: plucked and prepared sick birds; handled and groomed fighting cocks; played with birds, including ducks that could have been infected but did not show symptoms; or ate raw duck blood pudding or possibly undercooked meat.
As migratory birds spread the virus from Asia into Russia, Turkey and Romania, many more people are asking how and why people become infected. World health experts warn the virus could mutate into a form that's easily passed from person to person, possibly sparking a global outbreak that kills millions.
But for now, at least 121 people have been infected and at least 62 have died in Southeast Asia, mostly in Vietnam.
Farrar said it's possible some people could have a pre-existing immunity protecting them, but there has been no research to prove that. He also said the type of contact between people and poultry could play a role.
For example, a man who grooms and bandages a prize-winning fighting cock or a child who plays with a pet duck likely have very different relationships with birds than mass poultry farmers and those who slaughter the birds.
It could also just boil down to math, said Peter Horby, an epidemiologist at the World Health Organization in Hanoi.
"Maybe it's just the actual numbers. Eighty per cent of the population is living with chickens . . . compared to a relatively low number of people being exposed to a high risk," he said. "The risk is actually very low, but because there are so many more people daily exposed to chickens, that's where most of the cases are occurring."
He and other researchers have theorized that more children may be at risk because they're closer to the ground, crawling or walking barefoot across earth sprinkled with poultry droppings and possibly putting soiled hands or dirt into their mouths.
But most of it is just guesswork.
Dr. Frederick G. Hayden is a virus expert from the University of Virginia, who also participated in writing the paper. He said scientists need to better understand how clusters of family members got sick, how and where the virus enters the body and why it sometimes spreads from the lungs to other organs and the central nervous system.
"Clearly, this is a virus that is incredibly pathogenic in multiple species and so it really requires careful monitoring," Hayden said from Ho Chi Minh City, where he was working with health officials from Vietnam, Thailand and Indonesia on a study that would help determine how to treat seasonal and bird flu patients.
He said too little is known about patients' response to antiviral medicines, including Tamiflu, the best-known drug for combatting bird flu.
Hayden said he believes a flu pandemic is coming, but there's no way of knowing when.
"My sincere hope is that the virus will give us time," he said. "This is a virus that is a global threat. There's no question about it, so the questions that can be answered here will have implications on an international scope."
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Q. I'm booked on a cruise from Bangkok that stops in Beijing, Shanghai, Hong Kong, Nagasaki, Okinawa, Taipei, Nha Grand, Ho Chi Minh City and Singapore. Because of the area's avian-flu outbreak, is it safe to go?
A. Concern over avian influenza, or bird flu, has grown exponentially, especially among travelers to Asia, where a number of people have contracted the disease in Indonesia, Vietnam, Cambodia and Thailand, and have even died from it (latest count: 60).
The U.S. Centers for Disease Control and Prevention (CDC) does "not recommend that the general public avoid travel to any of the countries affected by H5N1 (bird flu)," according to its Web site, but the agency is advising travelers to follow certain precautions when visiting these areas with avian-flu activity.
The Web site offers suggestions on how to protect yourself before departure (example: Assemble a first-aid kit with a thermometer and alcohol-based anti-bacterial gel) as well as after your trip (e.g., monitor your health for 10 days).
However, the most crucial safeguards to follow are during your trip. "Avoid all direct contact with poultry," says CDC spokeswoman Christine Pearson, who explains that the virus is transmitted through nasal secretions, feces and touching. Hence, it is best to skip the poultry markets and farms, though Pearson adds, "If you're going on a cruise, most likely you won't be going to a poultry farm."
In addition, all poultry means dead or alive, so skip shops where birds may have contaminated surfaces, such as butcher shops. As for food, heat dest