BANGKOK (Reuters) - Thailand reported a fresh outbreak of bird flu in poultry on Wednesday, saying chickens and pigeons had died in the central province of Ang Thong, the seventh province to be hit by the latest flare-up of the disease.
Officials were also awaiting lab test results from 39 other provinces where chickens were reported to have died under suspicious circumstances, senior Agriculture Ministry official Nirandorn Uangtrakulsook told Reuters.
The H5N1 avian flu virus has infected 20 people in Thailand since late 2003, killing 13 of them. The government has imposed strict measures to try to curb the spread of bird flu but the virus has surfaced again in recent months.
"Lab tests have confirmed that chickens in the province were infected with the H5N1 bird flu virus," Nirandorn said of the new outbreak in Ang Thong.
"We are investigating the cause of the infection. According to a preliminary investigation, villagers said pigeons had died first, followed by chickens," he said.
No one in the outbreak zone had been reported ill with bird flu-like symptoms, but officials would continue to monitor local people for 16 days after the chickens died as the H5N1 virus had an 8-day incubation period, another senior health official said.
Officials conducted laboratory tests on the chickens after they were found to have died under unusual circumstances late last month. Officials have since culled 100 chickens in the area, Nirandorn said.
So far, seven of 76 provinces, mainly in central Thailand, have been affected by bird flu so far this year and are under 21-day surveillance, Nirandorn said.
The H5N1 virus has killed 62 people and infected 122 in four Asian countries since the virus resurfaced in Asia in late 2003.
The World Health Organization has said the H5N1 strain is endemic in poultry across much of Asia and it could only be a matter of time before it develops the ability to pass easily from human to human, triggering a pandemic that could kill millions.
Nov. 2 (Bloomberg) -- Malaysia, whose two nearest neighbors are fighting an outbreak of avian influenza, may produce Roche Holding AG's Tamiflu locally to stockpile enough medication to treat 10 percent of its population for the disease.
The country's health ministry has ordered 600,000 tablets of Tamiflu, also known as oseltamivir, which is enough to treat 60,000 people, to prepare for a possible avian influenza outbreak. It's seeking an additional 189 million ringgit ($50 million) from the government to buy enough medication to treat a 10th of Malaysia's 26 million people, an official said.
``Some people have spoken to us about the fact that they have got some understanding that they can produce Tamiflu,'' Mohd Ismail Merican, director general of health, said in a telephone interview, without naming the companies.
The urgency to stockpile Tamiflu is growing on concern the deadly H5N1 virus, which has killed 62 people since December 2003, may mutate into a form that can spread among humans, sparking a global outbreak of lethal flu similar to the one that killed as many as 50 million people worldwide in 1918. The drug's supply has been strained by the rising demand and it may be too expensive for some countries.
Countries including India and Vietnam are considering alternative sources of the flu drug, which has been shown to fight the H5N1 avian and human virus strains in test-tube and animal tests.
Effective
Both Tamiflu and GlaxoSmithKline Plc's Relenza, also known as zanamivir, are effective in lessening the symptoms and shortening the duration of illness caused by the virus, said Dr. Lorena Brown, an influenza specialist at the University of Melbourne.
The current manufacturing capacity will produce only enough Tamiflu to treat 20 percent of the world's population in 10 years, the World Health Organization said on its Web site.
Malaysia's target is to have enough antiviral drugs to treat a quarter of its population, which would cost 400 million ringgit, Ismail said. The health ministry is asking for enough funding for 10 percent of the population initially, which should be ``acceptable to the government,'' he said.
The WHO doesn't have a specific recommendation on the amount of antiviral drugs countries should stockpile, although previous influenza epidemics show that about 30 percent of a country's population could become infected during a new influenza pandemic, said B. Venugopalan, the Kuala-Lumpur based technical officer for the WHO representative office for Brunei, Malaysia and Singapore.
Drug Capacity
Roche has been working to expand manufacturing capacity for Tamiflu as it faces pressure from politicians to give up its patents for the product. The company said earlier this month it's willing to discuss granting sub-licenses to any government or private company interested in manufacturing Tamiflu or collaborating with its production.
India may allow its drugmakers to make their versions of Tamiflu, Heath Minister Anbumani Ramdoss said on Oct. 26. Taiwan's government said last week it will make its own version of Tamiflu if unable to reach an agreement with Roche.
Vietnam is in talks with Roche on the production of Tamiflu and retains the right to declare an emergency under which it could make its own version of Tamiflu without Roche's agreement, Tuoi Tre newspaper reported on Oct. 27, citing a Ministry of Health official. No vaccine for the H5N1 virus is available, although one is being developed in several countries.
Infection
Since the current avian influenza outbreak started in December 2003, at least 121 people in Cambodia, Thailand, Vietnam and Indonesia have been infected through birds, according to the WHO. Most of the human victims probably came into contact with excrement or blood from infected domestic birds, such as chickens.
Malaysia last detected the H5N1 avian influenza virus in poultry on Nov. 22, following an outbreak in the northeastern state of Kelantan, which borders Thailand, in August 2004. The government declared the country free of the virus on Jan. 6. No human cases of influenza caused by the H5N1 virus have been detected in the country.
Malaysian authorities are maintaining a ban, in place since early 2004, on imports of birds, poultry and related products from countries experiencing outbreaks of avian flu, including Thailand and Indonesia, both of which border Malaysian states.
The Veterinary Services Department is also monitoring ``high risk bird populations,'' including migratory birds, said Kamaruddin Md Isa, head of the disease control unit at the department.
Ban
Neighboring Singapore, which buys half of its poultry and two-thirds of its eggs from Malaysia, banned the import of poultry from its neighbor for several weeks as a result of the bird flu outbreak last year.
Malaysia lost about 40 million ringgit in poultry export revenue as a result of Singapore's 43-day ban, Kamaruddin said. Shipments to the island republic are ``almost back to normal,'' he said.
The government spent about 5 million ringgit on equipment, chemicals and overtime pay for its workers to fight the outbreak, and paid about 250,000 ringgit in compensation to farmers for culling their poultry.
``Most of the Southeast Asian countries still are having problems,'' Kamaruddin said. ``None of them are able to get rid of the disease.''
KUALA LUMPUR (AP): Malaysian villagers on Borneo island are smuggling pet birds and fighting cocks from neighboring Indonesia, despite a government ban meant to keep the country free of bird flu, a news report said Wednesday.
Veterinary authorities in Malaysia's eastern Sarawak state - which shares an extensive land border with Indonesia's Kalimantan province - will cull smuggled birds and any local poultry that had contact with them, Sarawak Deputy Chief Minister George Chantold The Star newspaper.
"Pet birds and fighting cocks are being smuggled across the border at illegal entry points," Chan said. "We have already given a lot of advice to the people near the border, but the dangers of disregarding the ban do not seem to matter to some ofthem."
Chan did not elaborate on how many offenses have been detected. A spokesperson for his office and Sarawak's veterinary department could not immediately be reached for comment.
Sarawak imposed a ban on birds from Indonesia last month. People caught smuggling poultry face up to two years' imprisonment and maximum fines of 5,000 ringgit (US$1,351).
So far, no humans are known to have been infected with bird flu in Malaysia, which suffered an outbreak in poultry in a northern state last year believed to be sparked by fighting cocks smuggled from Thailand. Malaysia declared itself free of bird flu in January this year.
The virus has killed four people and sickened three others in Indonesia, and has taken at least 62 lives across Asia since late 2003.
Samples from 704 birds found 24 percent tested positive for strains of the H5 subtype of avian influenza. None is believed to be the H5N1 strain that officials fear will infect humans, but more tests to identify the strains are being conducted.
"No question, we're surprised by large number of H5 samples... In this instance we do not believe any of these are pathogenic," British Columbia's chief veterinarian, Ron Lewis, told reporters.
There are H5 strains of influenza that do not result in the carrier getting sick, and none of the birds showed signs of being ill, Lewis said.
The migratory birds were sampled in a tagging program in August near Merritt, in British Columbia's Interior region, as part of a national study launched after an outbreak of bird flu in Canada near Vancouver in 2004.
"We've never tested birds in this flyway before so we have no idea if this is a normal factor, or whether they are increased numbers or decreased numbers, Lewis said.
British Columbia's chief health officer also downplayed concern over the birds, saying they were safe to be eaten if properly cooked.
"I would think that hunters have been shooting and killing and eating birds that carry H5 and H7 and other influenza viruses for centuries," Perry Kendall said.
Federal officials said on Monday that bird flu had also been found in migratory birds in Manitoba and Quebec.
None of the birds was found to be carrying the H7 strain of avian influenza that was blamed for the 2004 outbreak, which was believed to have started with a virus spread from a wild duck to a commercial chicken farm.
If bird flu strikes the USA, is there a proven vaccine to protect you?
Not yet.
Even if there were, only one plant in the nation produces flu vaccine, which takes months to make. And once it's made, few states or cities have workable plans for rapid distribution.
Now, for the good news: Avian flu is not an immediate threat in the USA. And on Tuesday, President Bush, albeit belatedly, put forth a strategy to deal with a bird flu pandemic. He laid out a $7 billion federal plan to stockpile antiviral drugs, rebuild the U.S. vaccine industry, spur development of faster ways to produce vaccines, and improve local flu surveillance and vaccine distribution.
All worthwhile steps, but will they work? That depends on when bird flu gets here. Bush's plan will take years to implement.
It also depends on whether federal, state and local officials can muster a sense of urgency that has been lacking. And whether they can solve such contentious issues as who should be vaccinated first, given that supplies inevitably will be scarce for days or weeks after the flu strikes.
For nearly two years, scientists have warned about a virus, known as H5N1, that has killed millions of birds in Asia and Europe. In rare cases, the virus has jumped from bird to human, infecting 122 people and killing more than half. The concern is that it could mutate into a virus that is easily passed among people and is more deadly than the ordinary annual forms of influenza. Then, the danger would be global.
The USA is a long way from ready, and very-recent history raises doubts about the administration's ability to prepare. After 9/11, the Homeland Security Department spent billions preparing for disasters. Yet its response to Katrina was nearly as disastrous as the hurricane itself. Now, Bush has handed that same agency a key role in coordinating the pandemic response.
Closer to home, people have reason to question local public health capabilities. According to a report by the non-profit Trust for America's Health, 20 states didn't even have a publicly available plan last year to respond to a pandemic. Pennsylvania did but kept its plan so guarded the public couldn't see it, making it almost worthless. A summary is now posted on its health department's website.
This strain of avian flu might never reach our shores. Even so, a flu pandemic occurs on average every 30 years, and with it will come panic and shortages. That can't be stopped, but a plan developed before a crisis, not in the midst of one, can dramatically reduce the chaos and the human toll.
A US doctor says a drug used in World War II to make antibiotics supplies go further may help in the response to any avian influenza pandemic.
Dr Joseph Howton, from the Adventist Medical Centre, says using the antiviral treatment Tamiflu in conjunction with a drug called Probenecid makes the bird flu treatment last twice as long.
Dr Howton says he was reviewing studies on the interaction of drugs when he came across the idea.
"I found that they talk about being careful when you use Probenecid with Tamiflu because it raises the drug level," he said.
"I thought about it from the opposite perspective: this a wonderful side effect.
"If you look at Tamiflu the same way we looked at penicillin during World War II - and penicillin was in very short supply - and as a result we gave Probenecid with penicillin to enhance the effect and extend the supplies.
"Why not use that same idea for Tamiflu?"
Probenecid is primarily used to treat gout.
Dr Howton says it reduces the amount of certain drugs that are excreted from the body.
"Tamiflu is a drug that's a weak organic acid," he said.
"Probenecid blocks organic acid from being excreted by the kidneys ... and therefore you have much less of the intact drug excreted.
"It stays around and recirculates and you have better virus-killing effect."
Dual uses
Dr Howton says his discovery can be used in two ways.
"We can give a half-dose of, or even less than half of a dose of Tamiflu, along with Probenecid and we should get roughly the same levels as if we had just given a full dose," he said.
"Therefore we can treat twice as many people with the same amount of drug.
"Another approach might be to use a standard dose of Tamiflu, along with Probenecid, and thereby getting a higher than usual tissue level of Tamiflu, which might actually be necessary."
But Dr Howton cautions that the discovery is not an answer to the possibility of a bird flu pandemic.
"The only way we're going to prevent just massive numbers of fatalities in the event or a major pandemic is by a vaccine," he said.
"The whole idea of a drug like Tamiflu is to buy us time, so that the vaccine can be developed."
The research has been published in the journal, Nature.
A common medication could be used to double the scarce supply of the antiviral drug Tamiflu in order to protect people in a deadly bird flu pandemic, some doctors say.
Probenecid, which is sold under brand names such as Benuryl and Benemid, stops many drugs from being removed from the blood by the kidneys and excreted in urine.
It was first put to the use in the Second World War to extend limited supplies of penicillin, and is still given in emergency rooms when doctors want to ensure patients maintain high levels of antibiotics in their blood.
Now some doctors are suggesting it be used to stretch the world's precious supply of Tamiflu, the main medication being recommended by the World Health Organization to fight a flu pandemic, according to a report in the Nov. 1 online edition of the journal Nature.
Dr. Joe Howton, the medical director of the Adventist Medical Center in Portland, Ore., estimated that probenecid could be used to more than double the Tamiflu stocks.
While reading through information on Tamiflu from its Swiss manufacturer Hoffman-La Roche last week, Howton noticed that Tamiflu is actively secreted by the kidneys like penicillin - and thus can be inhibited in the same way by probenecid.
Taking the two drugs together would double the time the Tamiflu's active ingredient stays in the bloodstream, double its maximum concentration there, and multiply a person's total exposure by two to five times, says the report in Nature.
In essence, half a dose of Tamiflu combined with probenecid would equal a full dose of the antiviral drug alone.
"It dawned on me that the data potentially represented a tremendous therapeutic benefit," Howton told the journal.
Tamiflu's manufacturer said Howton's idea was interesting but said there wasn't enough information about combining the two drugs to say whether the method would be safe or effective.
The WHO declined comment on the idea.
Dr. Peter Zed, a specialist in emergency medicine at the Vancouver General Hospital, told Nature that he didn't think specific regulatory approval would be needed to use the two drugs together.
"There would be nothing unique about using probenecid with Tamiflu," said Zed, who has published several safety studies on probenecid and antibiotic combinations.
However, other doctors and bird-flu experts warned that even if probenecid acted, in effect, as a Tamiflu booster, it still wouldn't leave enough to protect the world's population if a pandemic springs from the H5N1 avian flu virus that has killed 62 people and millions of birds in Asia before recently spreading to Europe.
They also pointed out that there's no guarantee that Tamiflu will work against whatever viral strain evolves to spread from human to human.
The WHO has urged governments to stockpile enough Tamiflu to treat at least a quarter of their populations in case of a flu pandemic.
Canada has stockpiled 35 million pills - enough to treat 3.5 million people out of the total population of 32 million.
In fact, the federal government has built up a stockpile that is bigger for the size of the population than almost any other country.
But the current world supply is only enough to treat an estimated two per cent of the planet's 6.5 billion people, experts say.
WASHINGTON, Nov. 1 - President Bush announced Tuesday that he would ask Congress for $7.1 billion to prepare the nation for the possibility of a worldwide outbreak of deadly flu. Most of the money would be spent on research and a national stockpile of vaccines and antiviral drugs.
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How Flu Money Would Be Spent "Our country has been given fair warning of this danger to our homeland and time to prepare," Mr. Bush said. "It's my responsibility as the president to take measures now to protect the American people."
Mr. Bush made his announcement in a speech at the National Institutes of Health, in nearby Bethesda, Md., before an audience that included six cabinet secretaries and the nation's top health care officials. He spoke for nearly 28 minutes and gave a detailed summary of the history and risks of flu pandemics.
"A flu pandemic would have global consequences," he said as he jabbed his lectern, "so no nation can afford to ignore this threat, and every nation has responsibilities to detect and stop its spread."
In the wake of the government's poor response to Hurricane Katrina, the Bush administration has been at pains to reassure the country that it is taking seriously the threat of a pandemic flu, which some experts see as the next calamity that could befall the United States.
But in the Senate, where a measure to spend $8 billion on pandemic flu preparations passed on a vote of 94 to 3 last week, Democrats immediately criticized the president's plan Tuesday as inadequate. One of them, Senator Edward M. Kennedy of Massachusetts, said Mr. Bush's proposal "needs to be stronger," and called for more spending to ensure that hospitals and other health care facilities have the capacity to handle a flood of patients. Another, Senator Charles E. Schumer of New York, said the president's plan did not envision buying enough Tamiflu, an antiviral drug, to protect the United States.
The Senate Republican leader, Bill Frist of Tennessee, praised Mr. Bush.
"The president's bold and decisive leadership today reflects his understanding of the urgency of confronting this issue," Mr. Frist said.
The chief government spending under the president's plan would be $2.8 billion for researching more reliable and faster ways to produce vaccines, $1.2 billion to buy 20 million doses of a vaccine against the current strain of avian flu (the choice of who would have priority for the vaccine is a decision not yet final) and $1 billion to buy the antiviral medications Tamiflu and Relenza.
Concerns about pandemic flu have intensified in recent years with the spread of a deadly avian flu strain among birds in Asia that has decimated entire flocks. This bird flu has infected about 120 people and killed 60. But the virus has yet to pass easily among humans, as is necessary to create a pandemic. Experts debate whether it ever will, but most believe that a pandemic flu someday is inevitable.
Pandemic flu has struck the nation three times in the last century. The first occasion, and the worst, was in 1918, when 500,000 people in the United States and 20 million worldwide died of what has since been identified as an avian flu. But a pandemic flu could also result from unexpected genetic changes to the seasonal human flus that circle the globe and already cause about 36,000 deaths a year in the United States.
The familiar flu shot - "I had mine," Mr. Bush said in his speech - prevents seasonal flu or eases its symptoms. The president's plan would end frequent shortages of seasonal flu shots while also preparing for a wider, more lethal flu outbreak, officials said.
Top public health officials who attended the president's speech praised the administration's efforts.
"This is a historic day in public health," said Dr. Julie L. Gerberding, director of the Centers for Disease Control and Prevention. "We have worked for more than a decade to put influenza on the table, and now the president and leaders of Congress are completely engaged."
Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, said the presence of so many top government officials at the gathering demonstrated how seriously the administration was taking the risks of pandemic flu. Dr. Fauci said the president had been personally involved in the plan's development.
Administration officials described Mr. Bush's speech as an overview of a broad effort involving at least seven government departments. Still, $6.7 billion of the $7.1 billion proposed appropriation would go to just one of them, the Department of Health and Human Services.
Michael O. Leavitt, secretary of health and human services, will unveil the final version of his agency's pandemic flu plan, a document more than a decade in the making, during Congressional testimony on Wednesday.
According to a draft of that plan, obtained recently by The New York Times, the nation is woefully ill prepared for a flu pandemic. Were one to occur, it says, hospitals would be overwhelmed, riots would engulf vaccination clinics, and even power and food would be in short supply.
The draft does not specify how troops might be used and who would be in charge under various circumstances - crucial decisions that bedeviled the response to Hurricane Katrina. Administration officials have said that such operational decisions will be made in the coming months through cooperation among cabinet secretaries.
In written remarks that Mr. Leavitt is to deliver Wednesday on Capitol Hill, he says cooperation among federal, state and local governments will be crucial in the event of a pandemic.
"For example," he says, "the federal government can deliver stockpiles of medication and supplies to a city in the U.S. in a matter of hours, but it is distribution at the state and local level that defines victory."
"Over the coming days," Mr. Leavitt's testimony says, "I will be asking the governors, mayors, and state and local health and preparedness officials to join me in a concern we all must share - preparing for a pandemic should one happen. Everyone in society has a role."
"This arrangement will also ensure a more coordinated intergovernmental approach," the secretary says, "in the acquisition of antiviral drugs and predeployment stockpiles of antivirals around the nation."
The federal government will even rely on state and local governments to pay 75 percent of the costs to buy 31 million of the 81 million courses of antiviral medications that will be part of the national stockpile, according to the secretary's testimony.
The president said in his speech that he would ask Congress to grant vaccine makers liability protections, which the industry has sought for decades.
The industry already enjoys such protections for vaccines produced for children, and they are essential, Mr. Leavitt says in his prepared testimony, to enable flu vaccine manufacturers to increase capacity enough to meet a goal the administration has set for 2013: being able to deliver 600 million doses against any newly discovered strain within six months of an outbreak.
The UN official charged with preparing the world for a flu pandemic said yesterday that there was a danger of panicked countries closing their borders, withdrawing their diplomats and operating a general "lock down" as soon as the disease began to spread.
David Nabarro, the senior UN system coordinator for avian and human influenza, painted a graphic picture of the effect of such defensive measures to the House of Lords science and technology committee, which he said would make it harder to check the spread of disease.
Many countries were likely to refuse to allow their professionals to move around, which would anyway become more difficult as pilots became unwilling to fly to infected areas.
What could happen was clear from the preparations being made by big companies, he said. "Large multinational companies have started to do their own risk assessments and risk planning," said Dr Nabarro, giving evidence to the committee's inquiry into pandemic influenza.
"I find them very, very scary. They are about closing down, retrenching, locking the doors, one or two months' survival rations ... their own Tamiflu stocks. That sort of response will make the task (of dealing with the pandemic) very, very difficult."
Dr Nabarro, speaking by videolink from the US where George Bush was launching his pandemic flu strategy, said it would be necessary to move very fast once the virus began to spread easily between humans. "It looks as though we really do only have a window of about three weeks to get moving if we are going to delay the pandemic at source," he said.
Not only the health and agriculture ministries but also the defence ministries in each country would be essential to dealing with the pandemic. The military would have to be called upon for help in getting essential professional staff to disease outbreaks quickly.
"I believe it will be necessary to have dialogue with military capability," Dr Nabarro said. "Given that we are going to have very limited time to move staff and we don't know to where that is going to be and there may be difficulties with civilian transport once the first rumours begin, we are going to have to use military transport."
It was important to think about "what steps we can take to try to prevent there being a general lock-down the moment the thing starts", he said. He believed each country should have its own minister responsible for coordinating the response to a flu pandemic, who would be at a higher level than the individual ministers of health, agriculture and defence.
"All the evidence I have had over the last few months is that it is very hard to get government departments and ministers to work together in a joined-up way on contingencies unless they are encouraged by the highest authority," he said.
Earlier, the government's adviser on immunisation revealed that talks were going on with the pharmaceutical companies over the possibility of protecting them from being sued if a fast-tracked flu vaccine had serious side-effects for some people. David Salisbury had been asked by Lord Winston, a member of the Lords' committee, whether it would be possible to indemnify drug companies against "adverse consequences" in the interests of cutting through the bureaucracy involved in the drug licencing process.
"It is certainly being discussed on both sides of the Atlantic because manufacturers feel very vulnerable on the issue of preparing a vaccine that is not going through all the usual steps," said Dr Salisbury, sitting alongside Rosie Winterton, a health minister.
DRUGS companies would be protected from legal action if fast-tracked anti-bird flu treatments had damaging side-effects, under plans being discussed by the government and pharmaceutical firms.
David Salisbury, the head of immunisation at the Department of Health, revealed that talks were already taking place between manufacturers and governments on both sides of the Atlantic.
Dr Salisbury made his remarks to the House of Lords science and technology select committee, which is conducting an inquiry into a possible influenza pandemic.
One committee member, Lord Winston, the fertility expert and TV presenter, asked yesterday if it would be possible to indemnify manufacturers against any "adverse consequences" of a vaccine.
Dr Salisbury told the committee: "This is being discussed on both sides of the Atlantic ... because manufacturers feel vulnerable on the issue of preparing a vaccine which is not going through all the usual steps.
"We will have to find a way that is acceptable to the purchaser and the provider, so that there is indemnity."
Dr Salisbury did not spell out exactly how any such arrangement would work.
The health minister, Rosie Winterton, confirmed that discussions were taking place.
CAIRO: Migratory pathways make an outbreak in the Middle East of H5N1 bird flu almost inevitable, although no evidence of the virus’ deadly strain has yet been found in the region, a senior official said. "As the migratory season progresses, the Middle East will become more threatened while Europe will be less at risk," Ken Earhart, executive officer of Naval Medical Research Unit (NAMRU) in Cairo, told AFP.
Scientists believe that the deadly strain of avian influenza is spreading through the movements of migratory birds, which peak in mid to end November when they move to their winter locations. "We have found no evidence of the H5N1 moving to the Middle East," said Earhart, whose research centre is the most sophisticated virology laboratory in the region and receives samples to be analysed from several countries.
H5N1 is an avian influenza subtype with pandemic potential, since it might ultimately adapt into a strain that is contagious among humans. Only three flu pandemics occurred during the entire 20th century. The H5N1 bird flu virus has killed more than 60 people and prompted the culling of 140 million birds in Asia in the past two years. Samples from two dead chickens found in northern Iraq have been sent for analysis in the Cairo centre but no evidence of the deadly strain was discovered to date. afp
Don't panic. But wash your hands.
President Bush yesterday added urgency to the government's preparations for a possible worldwide flu pandemic, but from an individual's standpoint, the so-called "bird flu" is for now more a cause for concern than alarm.
It's true that the strain of influenza now spreading through flocks in Asia and Europe, known as H5N1, has proven deadly in the relatively few people infected since 2003.
But the death toll has been modest because the virus, which spreads quickly among birds, only occasionally jumps from birds to people.
That could change. Influenza viruses are notorious for how frequently they mutate. That's why conventional flu shots must be updated each year, adjusted to account for genetic drift.
H5N1 is no different. Though it is commonly referred to as the bird flu or avian flu, all influenzas are bird flus. Human flu viruses begin in birds and then undergo genetic changes, or fuse with human viruses, so that they can be transmitted from human to human.
So it's quite possible that H5N1 will undergo a similar genetic change.
What no one knows is exactly what that genetic change will entail or exactly when it might occur. It could be happening now, or it might not happen for another 10 years.
"People shouldn't be panicked at all," said Dr. Lee Harrison, an infectious disease expert at the University of Pittsburgh Graduate School of Public Health. H5N1 is only a potential threat.
But that doesn't mean government agencies, academic researchers and pharmaceutical firms shouldn't be paying attention to the bird flu and making preparations. "The warning signs are growing," Dr. Harrison said. "Everything is in place now for a pandemic to begin."
The most recent pandemics occurred in 1918, 1957 and 1968. It is the 1918 "Spanish flu" pandemic, which killed more than 50 million people worldwide, that most worries health officials. Unlike the common flu which leaves people vulnerable to bacterial infections such as pneumonia, the 1918 flu directly caused deadly pneumonias that progressed rapidly.
H5N1, which has killed more than half of the people it has infected thus far, has many of the hallmarks of that killer 1918 flu. Many of the dead were healthy children and young adults, not the chronically ill and elderly most at risk for conventional flu.
Health officials can see a catastrophe coming, but can do only so much. Dr. Bruce Dixon, director of the Allegheny County Health Department, nevertheless will convene a meeting of experts from local hospitals this Friday to discuss what to do if pandemic influenza comes to the area.
The potential for a dramatic increase in demand for a limited number of hospital beds, medical staff and equipment will be high on the agenda, said Dr. Charles Mackett, executive vice chairman of the family medicine department at the University of Pittsburgh Medical Center.
"We believe if we were faced with hundreds or perhaps thousands of extra patients needing respiratory support, we would quickly outstrip our normal availability of hospital beds and isolation rooms, ventilators, those sorts of things," he said.
It might even be necessary to quarantine patients at home in order to reduce the spread of disease, Dr. Dixon said.
Vaccines would be the most effective response, but a vaccine developed against the existing H5N1 virus may have little effect on the pandemic version of the virus.
Mr. Bush's plans call for spending $1.2 billion to stockpile 20 million doses of just such a vaccine, though he acknowledged it would not be a perfect match to the pandemic disease. It might prove worthless.
More promising are new types of vaccines, such as a viral vector vaccine being developed at Pitt by Dr. Andrea Gambotto and his colleagues. Conventional vaccines, produced by injecting flu viruses into eggs, take six to nine months to develop and produce. Dr. Gambotto was able to produce his H5N1 vaccine in six weeks.
Animal experiments with the vaccine have been very encouraging, he said yesterday, though he's remaining mum about the details until a scientific paper on the vaccine has been accepted for publication. But he and his colleagues hope to move ahead soon with a clinical trial of the vaccine here; a grant application is now pending with the National Institutes of Health.
The point of the clinical trial wouldn't be to get a vaccine against the current H5N1 on the market, but to demonstrate that the viral vector vaccine is effective, determine optimal dosing protocols and work out the kinks of vaccine production. That would make it possible to rapidly develop a vaccine against the pandemic form of H5N1, if and when it emerges.
That's the sort of strategy that would be supported by a $2.8 billion effort outlined by Mr. Bush to speed development of new vaccines. The viral vector vaccines take certain genes from the virus and combine them with a modified cold virus; the machinery of the cold virus causes the flu genes to produce proteins that trigger an immune response.
Approaches being pursued in other labs include so-called DNA vaccines, which include the genes for proteins found on the outer surface of the virus that trigger an immune response. These vaccines can be developed and produced rapidly, but researchers still must prove that they are effective and affordable.
Anti-viral drugs such as Tamiflu are being stockpiled by many countries -- Mr. Bush proposes $1 billion to stockpile the drugs -- though some evidence is emerging that H5N1 may be resistant to Tamiflu, Dr. Harrison said.
Roche, the maker of Tamiflu, suspended shipments to the United States last week because of concerns that the drug was being hoarded because of bird flu fears. To ensure that Tamiflu is available to flu sufferers this season, Roche officials said they would hold back shipments until more flu cases begin appearing.
Conventional flu, after all, is a much bigger killer than H5N1. About 36,000 people in the United States will die of complications of the flu this year.
There's nothing individuals can do to reduce their risk of the H5N1 bird flu, but they can protect themselves from routine flu: Wash your hands regularly, cover your mouth when you cough, avoid touching your nose and eyes -- and get a flu shot.
(Post-Gazette staff writer Anita Srikameswaran contributed to this story.
WITH the annual flu season bearing down and fears of bird flu in the news, public health officials are girding for battle. Last week, Health and Human Services Secretary Mike Leavitt told Americans "we're preparing" for an outbreak of bird flu in the U.S. But, he added, Americans should be thinking instead about "something that confronts all of us right now" - regular influenza. He urged all Americans to get be vaccinated, noting that with more than 80 million doses of flu vaccine coming, shots should be available for all who want them.
What's the connection between the seasonal flu and the bird one in the news? Here are answers to frequently asked questions on the topic, based on information from the Centers for Disease Control and Prevention, the National Institutes of Health and the Food and Drug Administration.
What is the flu?
Regular flu - so-called "seasonal influenza" - hits the U.S. from early November through February each year, killing about 36,000 and hospitalizing about 200,000. It's caused by the influenza virus, essentially a family of viruses with many different strains. At any one time, just a few strains are circulating among humans. But other strains are always present in birds and other animals such as pigs and horses. These strains aren't usually a problem for people.
Flu viruses are natural shape shifters: They slowly, constantly change, requiring the vaccine to be frequently updated. Still, this year's flu probably will have many characteristics of last year's flu. If you've recently gotten a flu shot or been exposed to last year's virus, your immune system will probably recognize this year's virus somewhat and be better able to fight it off.
How is bird flu different, and why are public health experts worried about it?
There are lots of flu strains in birds; wild birds are the ultimate reservoir for all the influenzas we catch. Usually, those strains don't even harm the birds. But some can cause significant illness and death when they get into domestic poultry.
The strain that has health workers worried right now - called H5N1 - has widely infected poultry across several countries of Southeast Asia for some years. More than 120 people who had close contact with sick birds or carcasses have gotten sick. Most troubling, H5N1 appears to be a vicious flu. More than 60 of those people known to have been infected have died.
So far, the H5N1 bird flu can't easily jump from person to person, and thus can't spread widely among humans. But there are several ways that H5N1 could mutate into a virus that does spread and is foreign enough that our immune defenses can't fight it. If that happened, the virus would spread across a swath of the world (causing a so-called pandemic) and even strong, healthy people could become sick and sometimes die.
Is bird flu here? Am I in danger of getting it?
Not now. H5N1 bird flu has not been found in the U.S., either in birds or humans, although the spread of the virus through wild migratory bird populations makes it plausible that the virus could make its way here. Most important, there's no evidence that the frightening mutant described above has materialized.
Will the flu vaccine protect me from bird flu?
No. Each year's vaccine is designed to prime the body's defenses against strains of flu virus circulating now among humans. If the H5N1 bird flu mutates to jump from human to human, it probably wouldn't look anything like the virus that was the basis for this year's vaccine.
So why should I get the flu shot?
Mainly to avoid the regular flu, which can lay you low for days and cause complications such as pneumonia that, for some, can be deadly. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, says that the more flu viruses you've been exposed to in your life - either from vaccine or naturally - the wider the variety of flu strains your immune system will recognize as invaders and fight.
Public health authorities also hope lots of Americans will get flu shots to attract more drug companies to the vaccine business. Only four companies make flu vaccine for the U.S. If more Americans started getting regular flu shots, companies would be more likely to get into the business and the U.S. would be better able to produce vaccine quickly for a novel flu.
What is Tamiflu, and will it protect me from bird flu? Should I get it now?
Tamiflu, also known as oseltamivir, is an antiviral medication. If taken within a few days of the start of symptoms, it can reduce flu's severity and duration. It's one of only two antiviral medications believed - although not proved - to help fight H5N1 bird flu. (The other, Relenza, or zanamivir, is trickier to administer.)
Doctors generally prescribe Tamiflu to patients who contact them early in their illness, and to vulnerable patients in places such as nursing homes. The drug is getting harder to find because the government is starting to stockpile it for emergency use and people scared of bird flu have begun to hoard it. Only one firm - the Swiss drug company Roche - makes Tamiflu, but negotiations are underway to allow wider production.
Federal officials worry that the clamor for Tamiflu has made conditions ripe for counterfeiters. A warning: You might get a useless product, even a tainted one, if you don't deal with a reputable pharmacy.
Is there a vaccine for bird flu should it spread to the U.S.?
There's no approved vaccine right now. But scientists have used genetic engineering to create a weakened bird flu-like virus, and the government is testing an experimental vaccine made from it. If it's found safe and effective for people, it could go into large-scale production by winter 2006.
Does the government have an emergency plan for bird flu?
Yes, and it's due out as early as this week. The plan will lay out federal guidelines for detecting and tracking bird flu cases, and give states guidance on the distribution of medications and services. State and local governments would have the main responsibility for emergency response - determining whether schools or workplaces should close, for example. In some past disease outbreaks (such as polio), isolation or quarantine stations were set up and affected patients removed from the population. But legal experts say that virtually no states or local jurisdictions have the authority, or the resources, to do that today.
Should I stop eating chicken?
There's no reason to. The H5N1 bird flu has not been detected in the U.S. Because U.S. agricultural authorities are on high alert for outbreaks, it might be best to choose U.S.-raised chicken or turkey. As always, cook it thoroughly (flu viruses are destroyed by heat) and promptly wash hands and surfaces that have come into contact with raw poultry. There are plenty of germs there, even without bird flu virus.
Is it safe to travel to parts of the world that have bird flu?
The State Department has not issued any travel alerts against countries that have seen bird flu outbreaks (Cambodia, China, Indonesia, Kazakhstan, Laos, Malaysia, Mongolia, Romania, Russia, Thailand, Turkey and Vietnam). But if you go to any of these places, the CDC urges you to have appropriate vaccinations up to date, bring plenty of alcohol-based hand gel and avoid direct contact with poultry. Don't go to bird markets or poultry farms.
IF THE worst predictions are realised, and if a lethal strain of bird flu spreads across the globe killing tens of millions of people, the chances are that it will originate somewhere like this, the simple wooden house of Bang-orn Benpad deep in the Thai countryside.
Until this month, it was an ordinary house in an ordinary village, indistinguishable from millions of small farming communities in South-East Asia.
Mr Benpad was 48 years old, a poor man with no land of his own, and he struggled to support his family with irregular work in other people’s paddy fields. Then one day came an unexpected windfall - the sudden death of dozens of chickens owned by Mr Benpad’s neighbours.
They told him that he was a fool to pluck, butcher and cook them, and reminded him of what happened to his young nephew, who died of bird flu in a nearby village. "But he was always stubborn," Pimma, his sister-in-law, said. "He said, ‘That was last year. I’m not afraid of bird flu’."
When Mr Benpad fell ill, the first test came back negative. The positive result, four days later, came during his post-mortem examination. "I saw the first X-ray and part of his lung was white," Pimma said. "But in the second X-ray all his lungs had turned to liquid."
The dead man’s seven-year-old boy is making a recovery in Bangkok. Father and son are Thailand’s first human bird flu infections for a year, and their village, Pang Tru, has become the front line of the battle against the disease. Dozens of people with flu-like illnesses are in hospitals across Thailand pending the results of tests, and yesterday, local health officials and 900,000 volunteers were bracing themselves for new infections.
The Phanom Thuan district, where Pang Tru is located, has a population of 52,000 people in 98 villages and 100,000 free-range chickens. There are many more poultry in intensive factory farms. About 23,000 of them have been stuffed into plastic bags and buried alive in mass culls. Villagers in infected areas are banned from moving poultry.
The bird flu epidemic presents two separate challenges. The first is the continuing plague of avian flu among poultry, which began in late 2003 in South Korea and has been found in farm birds in Vietnam, Japan, Thailand, Cambodia, Laos, Indonesia, China, Malaysia, Russia, Kazakhstan, Mongolia, Turkey and Romania.
About 150 million birds have since been culled. The number of humans to catch the virus from birds is small - 121, 62 of whom have died. The greater threat is what could happen inside the bodies of people such as Mr Benpad before they die.
If the bird flu virus mutates, or blends with an existing kind of human flu, it could create a new virus transmissible between humans and against which they would have no immunity.
William Aldis, the World Health Organisation representative in Thailand, said: "This is a threat to the poultry industry, but it’s not a big public health problem yet.
The problem is we just don’t know what’s going to happen in a pandemic, because it will be caused by an organism which doesn’t yet exist."
If, or when, it does happen it is most likely to be in a place where birds and people live close together, and that probably means Asia.
"In industrial farms, including ones in Thailand, there have been no human infections because the birds are well away from the humans," Dr Aldis said. "It’s going to happen in places where you have widespread backyard poultry. In other words, where little children are walking around and playing amid chicken poop."
NEW YORK (CNN/Money) - Bob Goldberg flies more than 150,000 miles a year on business, but his flight from Chicago to Singapore this Friday has him more nervous than most. The reason -- the threat of bird flu.
"Did it prompt me not to go? No, but it did raise a concern," said Goldberg, an international lawyer who is attending a meeting about a business venture there. "The meeting was originally set for Vietnam, and it was moved because they've had the outbreak there. If it hadn't been moved, I don't think I would have gone. And even though there hasn't been an outbreak in Singapore, we've had discussions about overseas travel."
The threat of a pandemic bird flu at this point is mostly hypothetical, but serious enough for President Bush to detail government preparations and propose a $7.1 billion plan to combat a potential outbreak.
And government agencies are not the only ones preparing for the threat of a disease that has the potential to kill millions around the globe and cripple commerce. Businesses are preparing for the worst case scenario, and the already-troubled airline industry is bracing in case fear of infection causes a sharp drop in travel demand.
The outbreak of SARS over nine months in 2003 is estimated to have cost the travel industry about $8 billion worldwide, even though that disease never reached pandemic status.
"Basically, travel to these affected regions, whether Toronto or Asia, came to a very quick halt," said Greeley Koch, president of the Association of Corporate Travel Executives. "At this point we have not seen anybody cut back in travel (due to risk of bird flu). But they want to be prepared, want to learn more."
Koch said a survey of his group's U.S. members found 26 percent have formed some kind of contingency plan to deal with a pandemic flu, and another 19 percent are looking into it. The group wants all its members to incorporate the threat from a pandemic into their disaster preparedness plans, and it has formed an Airborne Contagion Containment Task Force to help corporate travel managers prepare for the worst.
The Centers for Disease Control has set up quarantine stations at 11 major international airports, and it plans to have six more open soon. The stations are where passengers on incoming flights will be taken for evaluation, not for long-term treatment.
"The airlines are part of the overall surveillance network. We have a history of working with CDC to identify passengers who might be ill," said Katherine Andrus, assistant general counsel for the Air Transport Association, the U.S. airline industry trade group.
Andrus said during the outbreak of SARS, more than 1,000 flights to the United States were met by CDC or local public health officials, although only a limited number of passengers suffering from SARS were found to be on the planes.
Bird flu has so far not been shown to pose a threat of person-to-person transmission like SARS, but it has proved to be far more lethal to those stricken with the disease, primarily in Asia.
Andrus said modern jets filter air through hospital-quality filters and exchange air in the plane more frequently than does a typical office building. But she says airlines are concerned not only about the threat of pandemic bird flu, but also a hit to air travel due to public fears about the disease.
"We realize there is a possible impact (on airlines) if public fears affect travel behavior," she said. "Right now we haven't seen that. There have been no recommendations to curtail travel. We're relying on authoritative sources like the CDC so the public can understand the risk or the absence of a risk."
But assurances will do little to maintain air travel, even among hard-to-scare business travelers, if there are reports of deaths of passengers, said Kevin Mitchell, chairman of the Business Travel Coalition, a trade group for business travelers.
"It's a little early to see the impact now. Companies are now just beginning to form committees. But there is a tension in a lot of companies," said Mitchell. "Until the headline reads 'Human-to-Human Transmission,' there's no reason to trigger those changes in travel policy. But if that happens, we could end up with a lot fewer airlines globally. I think as we see images of airport quarantine rooms, people will get message that flying isn't a good idea."
Goldberg said some of his clients and business associates are making plans to use video conferencing or other alternatives to travel in case of an outbreak. He said he's personally more nervous flying now than he was immediately after the Sept. 11 terrorist attack.
"Sept. 11 was an aberration, four planes out of thousands of planes," he said. "This is something you can contract from someone else on the plane and you don't know what the ramifications are going to be."
Still he's not sure that staying home will be a better option for him or other business travelers if there is an outbreak.
"Who knows where we're safe," he said.
BINGHAMTON, N.Y. An upstate congressman says he believes President Bush is using concern over a possible bird flu pandemic to divert attention from the problems facing his administration.
Maurice Hinchey -- an Ulster County Democrat -- said the president runs the risk of causing Americans to panic. He described it as an example of governing "by fear."
Hinchey told a Binghamton radio station (W-N-B-F) that while the threat posed by the bird flu requires a "moderate amount" of preparation, he believes the administration is -- in his words -- "working hard to terrify people."
Hinchey said it appears the Bush administration is using the bird flu issue "to stimulate fear and to draw attention away from other things," including the indictment of the vice president's former chief of staff in the C-I-A leak case.
(Bob Joseph, WNBF, Binghamton)
CANBERRA, Nov 2 (Reuters) - Asia-Pacific leaders will be asked to approve a plan to hold simulated bird flu exercises next year to prepare nations for an avian flu pandemic, Australia said on Wednesday.
Foreign Minister Alexander Downer said an Asia-Pacific Economic Cooperation (APEC) forum bird flu meeting in Australia this week had agreed on a set of proposals to combat bird flu, including a simulation exercise.
"We will be conducting a region-wide simulation exercise or series of simulation exercises in order to ensure that we are prepared if the worst happens," Downer said.
Details of the exercises are being worked out, said an Australian official, but is likely to involve computer simulations in the first half of 2006 to test the readiness of countries in the event the H5N1 avian flu virus mutates into a form that spreads easily among people.
"It has been proposed that there be a rapid-response initiative which would include available experts and capabilities and drawn rapidly from the countries of the region," Downer said, referring to the possible creation of a regional bird flu taskforce.
Health, agriculture and disaster experts from APEC's 21-member nations gathered in the Queensland state capital Brisbane for a two-day meeting that ended on Tuesday. They discussed a rapid-response group and also agreed to establish a regional communications system linking bird flu experts.
"These proposals will be put to the APEC ministers meeting in South Korea in a couple of weeks time and to the APEC leaders meeting after that," Downer said.
The H5N1 virus has infected 122 people in Asia and killed 62, giving a known mortality rate of more than 50 percent since the virus resurfaced in late 2003. But scientists fear the virus will mutate into a form that passes easily among humans. Millions could die and economies crippled.
Avian flu remains primarily a disease in birds, particularly poultry. Tens of millions of chickens and ducks have died of infection or been culled.
BRISBANE, Australia (AP) - Countries across the Asia-Pacific region coping with an outbreak of bird flu plan to stage a mock disease outbreak next year to gauge how well they would respond to a pandemic or other major health threat, an Australian official said Tuesday.
The exercise is expected in the first half of next year and will try to identify major weaknesses in preparedness and co-ordination, Doug Chester, Australia's ambassador to the Asia Pacific Economic Co-operation forum, said at the end of a two-day meeting of disaster co-ordination experts. He did not give any details on the plan, but indicated it would focus more on strategy than field exercises.
Chester, who chaired the meeting in the eastern city of Brisbane, said planning for pandemic preparedness should not incite public panic about the potential for the bird flu virus to mutate and unleash a deadly global flu epidemic among humans.
"There is an element of scare-mongering that is undermining effective planning in some economies, and it's causing unnecessary economic damage to some economies," Chester said.
He said poultry and tourism industries in some APEC countries were already feeling the pinch.
The deadly H5N1 strain of bird flu began ravaging poultry stocks across the region and jumping from birds to people in late 2003. Since then, it has killed at least 62 people in Southeast Asia.
Health experts have warned if the current virus mutates into a form that is easily spread from human to human, it could set off a pandemic and kill millions. So far, most human cases have been traced to contact with diseased poultry.
Bird flu and pandemic preparedness is expected to be high on the agenda when the 21 APEC countries meet in Busan, South Korea, later this month.
On the meeting's sidelines, Subhash Morzaria of the UN Food and Agriculture Organization's regional office in Bangkok, said $102 million is needed to fight bird flu in poultry alone in poor Southeast Asian countries over the next two to three years. An additional $75 million will be necessary for emergency support if the disease spreads from eastern Europe to Africa.
He urged all countries to take advantage of the time they have to prepare.
A U.S. participant told The Associated Press that more emphasis must be placed on animal health and veterinary science.
"We can't just focus on human health and the consequences of a pandemic without considering the effect on animal health and the mitigations that can be used there to keep the pandemic from occurring," said Larry Granger of the U.S. Department of Agriculture.
In Canada, senior government officials said Monday nearly three dozen wild birds have tested positive for H5 influenza, but also said it is unlikely that it is the H5N1 strain of the virus.
Dr. Jim Clark, of the Canadian Food Inspection Agency, said it would take at least one week to determine whether the flu found in 33 wild ducks from Quebec and Manitoba was the deadly H5N1 strain that has ravaged Asian poultry farms.
Chester said APEC members, including Canada, discussed establishing regional experts who can be dispatched to assist countries in need. He also said the APEC countries were keen to develop a regional pandemic response mechanism that would work alongside the United Nations to address issues such as trade, assisting citizens in foreign countries and keeping essential services and businesses running.
Member countries already hit by bird flu outbreaks agreed there was still much to be done.
In Washington on Monday, China's disease control director, Qi Xiaoqiu, said the country has learned the lessons of its SARS outbreak and is committed to complete openness as it fights bird flu. China has 20 per cent of the world's domestic poultry population and has reported three bird flu outbreaks in poultry over the past month. No human cases have been reported.
