A leading scientist warned yesterday that the avian flu virus is on the point of mutating into a pandemic disease and says that current estimates that such a pandemic could cause 7.5m deaths may understate the threat. His warnings come as experts writing in today's edition of Nature voice concerns about the world's inability to manufacture sufficient vaccines for a pandemic and warn of the impact that the virus - H5N1 - could have on the global economy.
In an accompanying editorial Nature argues that so far such warnings have "fallen on deaf ears". It backs a call by Prof Osterhaus and his colleagues at the Erasmus Medical Centre, in Rotterdam - one of the world's leading virus research labs - for a global taskforce to strengthen agencies on the ground.
There have been 90 human infections in south-east Asia , from which 54 people have died. But while culling and the vaccination of poultry appears to have slowed outbreaks in Thailand and other parts of south-east Asia, this year Vietnam has seen a worrying number of human infections in the same family groups. According to Prof Osterhaus such clustering could mean the virus is becoming more efficient at infecting humans - a precondition for a pandemic.
Another concern are reports which emerged from China last weekend that H5N1 was responsible for the deaths of 178 migratory geese at a wildfowl reserve in the western province of Qinghai earlier this month. Prof Osterhaus says the geese's deaths could be another indication that the virus is mutating and becoming more virulent. The problem is that countries such as China and Vietnam are not providing animal and human health officials with enough data, leaving scientists in the dark.
According to the WHO, within a few months of the pandemic 30 million people would need to be hospitalised, and a quarter could be expected to die. In his Nature commentary, Prof Osterhaus describes current estimates that a pandemic could infect 20% of the world's population and cause 7.5m deaths as "among the more optimistic predictions of how the next pandemic might unfold".
Such pandemic viruses emerge every 30 years or so. The most virulent was the 1918 Spanish flu pandemic, which is believed to have claimed 40 million lives worldwide. By contrast the 1957 Asian flu pandemic and 1968 Hong Kong flu claimed less than one million lives each. Prof Osterhaus wants the WHO, the UN Food and Agricultural Organisation and the World Organisation for Animal Health to set up global teams of vets, medics, virologists and agriculturalists to respond rapidly to outbreaks.
His comments are backed by the other experts in Nature, who also criticise the WHO and international efforts to develop vaccines against H5N1 and other strains of avian influenza.
According to Michael Osterholm of the University of Minnesota, antiquated vaccine manufacturing systems mean that countries like the US are unable to protect their populations against annual flu strains, let alone pandemic ones.
A FIFTH of the world's population could be struck down with a new influenza pandemic, triggering global economic meltdown and a complete freeze on international travel, experts have warned.
Scientists say world leaders should start planning now for an outbreak that could lead to several million deaths, widespread panic and the collapse of international trade.
Only a global response, rather than countries focusing wholly on their own protection, would stand any chance of averting the catastrophe, it is claimed.
Fears of a pandemic have arisen after outbreaks of the H5N1 bird-flu strain in south-east Asia, which has caused a total of more than 50 confirmed human deaths. The fatality rate of humans infected by the virus is as high as 60 per cent.
At present, there is no evidence that the strain can be transmitted from one person to another, but it may only be a matter of time before the virus mutates into a form that can easily pass between people. Should that happen, it would spread rapidly around the world, with devastating consequences.
Scientists writing in the journal Nature said the world today was far more vulnerable to the effects of a pandemic than it was in 1918, when a deadly strain of influenza killed between 20 million and 40 million people.
An optimistic estimate suggests that the next flu pandemic could cause 20 per cent of the world's population to become ill. Within a few months, almost 30 million people would need to be hospitalised, and a quarter of them would die.
But the effects on today's highly interconnected world economy would be just as serious, it is claimed.
Professor Michael Osterholm, of the Centre for Infectious Disease Research and Policy at the University of Minnesota in Minneapolis, said: "The arrival of pandemic flu will trigger a reaction that will change the world overnight.
"There will be an immediate response from leaders to stop the virus entering their countries by greatly reducing and even ending foreign travel and trade - as was seen in parts of Asia in response to the severe acute respiratory syndrome [SARS] epidemic.
"These efforts are doomed to fail given the infectiousness of the virus and the volume of illegal crossings that occur at most borders. Global, national and regional economies will come to an abrupt halt."
International co-operation was vital to minimise the impact of a pandemic, Prof Osterholm said. In particular, a global effort was needed to develop a new type of vaccine that could be manufactured quickly and that targeted multiple strains. But he added: "Unfortunately, most industrial countries are looking at the vaccine issue through myopic lenses."
He warned that time was running out to prepare for the next flu pandemic and said there was a "critical need" for medical and non-medical planning, involving both the public and private sectors, at a level beyond anything considered so far.
Meanwhile, four Dutch experts, led by Dr Albert Osterhaus, from the Erasmus Medical Centre in Rotterdam, made an urgent call for a global taskforce to control a future pandemic.
It would consist of leading specialists in the fields of human and animal medicine, virology, epidemiology, pathology, ecology and agriculture. It would also include experts in translating science into policy. Management teams would be available to target specific flu outbreaks occurring anywhere in the world.
"Given the large geographical area in which the H5N1 virus has become endemic, and the greater potential for rapid virus spread, an efficient, effective, outbreak management team strategy, with centralised guidance, is urgently needed," the Dutch team said. Early detection and a rapid response to bird flu at a global level would greatly reduce the cost of dealing with a full-blown outbreak, they added.
Hugh Pennington, the internationally renowned emeritus professor of bacteriology at Aberdeen University, said: "If the mutation takes place or some kind of gene exchange happens to allow it to spread from person to person, then we get into the severity that this article [in Nature] discusses.
"Against this virus, we don't have any immunity, and it is the fact that it is brand new to our immune systems that gets people worried.
"How serious it is will depend on the kind of virus that develops, but we have no way of knowing, so it is really quite difficult to make any definitive predictions or put any odds on it happening at all. They are right to be concerned, and to call for well-formulated contingency plans, but it is very much something that we will have to wait and see about."
China has reported its first outbreak of H5N1 bird flu since last year, when it seemed to have brought a widespread epidemic in poultry under control. This time, the virus has been found in wild geese in a nature reserve.
On 4 May, 178 bar-headed geese that had just completed their arduous annual migration over the Himalayas from northern India were found dead at Qinghai Lake Nature Reserve in western China. After initial denials, the Chinese agriculture ministry announced this week that the birds died of H5N1, and that the same fate had also befallen 340 gulls, cormorants and ducks in the reserve. China is vaccinating all poultry in the region, and has closed nature reserves to the public.
Scientists consider it unlikely that the geese carried H5N1 into China, though this cannot be ruled out. Rather, the deaths could show that H5N1 is continuing to circulate in China, despite the mass vaccination of poultry. One of the hazards of vaccination is that unless there is stringent monitoring it can allow the virus to persist silently while suppressing visible outbreaks. This could mean that H5N1 remains widespread in Chinese poultry, despite the lack of reported cases.
"We can't be sure until we see the genetic sequence, but it is not unlikely that these cases are spillback from local poultry," says Albert Osterhaus, a leading flu expert at the University of Rotterdam in the Netherlands.
LONDON, May 25 (UPI) -- Scientists Wednesday warned of the devastating impact a pandemic of avian flu would produce.
In the latest edition of Nature, the editors warn tens of millions worldwide might die, leaving the global economy in tatters.
"The first act, the spread of avian flu to, and probably between, humans, has already started across Asia," the editors wrote "Unless the international community now moves decisively to mitigate this pandemic threat, we will in all probability pay heavily within a few years. Then, hard questions will be asked as to why we were not prepared."
The editorial noted skeptics are not convinced of the danger avian flu poses.
The editors called on national agriculture and veterinary departments, the U.N. Food and Agriculture Organization and the World Organization for Animal Health to take steps to prevent a pandemic strain and develop a vaccine against it -- and fast.
"Each human case that occurs in Asia is potentially a global threat. The international virology community needs to be permanently there, on the ground. We need to diagnose cases swiftly, and treat the patients and all their contacts immediately with antiviral drugs to try to kill the pandemic at source," the editorial said.
LONDON, May 25 (Reuters) - It could infect 20 percent of the world's population, kill many millions and create an economic crisis but scientists say not enough is being done to combat a bird flu virus that could trigger a global pandemic.
The Asian H5N1 virus that first surfaced in poultry in Hong Kong and China eight years ago has killed 37 people in Vietnam, 12 in Thailand and four in Cambodia.
Global health officials fear it could mutate into a lethal strain that could rival the 1918 Spanish flu pandemic that killed between 20 and 40 million people.
"Time is running out to prepare for the next pandemic," said Michael Osterholm, of the University of Minnesota, on Wednesday in a special section of the journal Nature devoted to avian flu.
"There is a critical need for comprehensive medical and non-medical pandemic planning at the ground level that goes beyond what has been considered so far," he added.
Scientists believe the next pandemic, which many believe is overdue, will probably originate in poultry in Asia. To become a pandemic strain, H5N1 will have to adapt sufficiently on its own, or mix its genetic material with a human virus to become highly infectious in humans, who have no protection against it.
Although this strain of bird flu has been circulating in Asia for years, Albert Osterhaus and virologists at Erasmus Medical Centre in Rotterdam in the Netherlands said research into outbreaks in Asia has been patchy and uncoordinated.
They believe more is needed.
"We propose establishing a permanent global task force to control a flu pandemic, in which relevant agencies would work together with leading research groups from different disciplines," they said in the journal.
The scientists estimate that the task force, which would consist of specialists in human and animal diseases, as well as pathologists, ecologists and agricultural experts, would cost less than $1.5 million a year.
Human and bird vaccines
Developing countries are now stockpiling Roche's
Although Roche has quadrupled its production capacity for the drug, experts believe global stockpiles will not be enough if a pandemic develops. The drug will not prevent a pandemic but it can reduce the duration of flu symptoms.
So far about 50 countries have drawn up plans to deal with a pandemic but only a few are in Asia where it is likely to start.
Other experts believe too little attention has been focused on a global strategy to prevent a pandemic at its source -- in animals and particularly poultry.
Hong Kong destroyed 1.5 million birds in 1997 when the H5N1 virus appeared. It also introduced surveillance and movement restrictions for poultry. Other nations decided to vaccinate animals or opted for surveillance programmes.
Scientists are already testing the safety of an inactivated H5N1 virus made by Sanofi-Aventis
"This effort will ensure that, should the need arise, the manufacturing techniques, procedures, and conditions for large-scale production are already in place," said Dr Anthony Fauci of the National Institutes of Health in Bethesda, Maryland.
Unlike other pandemics, scientists now have the knowledge and technology to develop countermeasures against the disease.
"However, unless we improve our capacity to produce such countermeasures, we may experience again the devastation of past pandemics," Fauci added.
The world is unprepared for an influenza pandemic that would infect more than a billion people and trigger global economic disaster, leading scientists warn today.
International leaders are ignoring indications that the virulent H5N1 strain of avian 'flu presents a severe threat, and have failed to introduce the cross-border measures that are essential if a worldwide outbreak is to be contained.
Such a pandemic could affect at least 20 per cent of the world’s population, hospitalising 30 million and killing a quarter of these, according even to optimistic predictions.
It would also lead to the collapse of international trade, causing economic and social chaos even in rich countries such as Britain that can protect their populations with drugs and vaccines.
In a series of expert commentaries published today in the influential journal Nature, some of the world’s foremost authorities on 'flu argue that only a meticulously-planned response employing a global 'flu taskforce to investigate and contain outbreaks stands a chance of averting a catastrophe.
Urgent action is needed to develop new ways of designing and manufacturing vaccines against the virus - a process that currently takes six months - and to agree international guidelines for eliminating reservoirs of potentially dangerous strains in poultry and wildlife.
The calls come amid growing concern that the H5N1 virus circulating in Asia has the potential to start a human pandemic. It has already infected at least 88 people in Thailand, Vietnam and Cambodia, of whom 51 have died.
There are emerging indications of occasional transmission between people, the key step the virus must take to become a pandemic. Last week, the World Health Organisation officials said it is concerned about possible human-to-human infection in northern Vietnam, though this has not been confirmed.
Even if H5N1 does not start a pandemic, another is certain to strike: pandemics generally occur at intervals of approximately 30 to 40 years and the last took place in 1968, killing a million people. The worst on record was the "Spanish flu" of 1918-19, which may have caused as many as 50 million deaths.
Michael Osterholm of the University of Minnesota said "bold leadership" and meaningful financial investment in vaccine research is required from the G8 industrialised countries, which are not taking the issue sufficiently seriously.
"When the G8 leaders next meet in Scotland in July, avian flu will be one the agenda, but major commitments are unlikely," Dr Osterholm said. "This is not good enough. These nations urgently need to recognise the economic and security and health threat that the next flu pandemic poses, and invest accordingly."
Even in the unlikely event that rich countries manage to insulate themselves from the health impact of a pandemic, they would still be seriously damaged by its economic effects.
"The arrival of pandemic flu will trigger a reaction that will change the world overnight," Dr Osterholm said. "There will be an immediate response from leaders to stop the virus entering their countries by greatly reducing and even ending foreign travel and trade, as was seen in parts of Asia in response to Sars ... Global, national and regional economies will come to an abrupt halt.
"A purely national approach fails to consider the nature of the modern world, a world of globally distributed, just-in-time inventories for almost all consumer products, including medical supplies."
Scientists have renewed their warnings about the potential global effect of a flu pandemic on health and economy.
Experts estimate a fifth of the world's population could be affected, with 30m needing hospital treatment and around 7.5m dying.
Writing in Nature, they warn the world's economy could also be damaged by effects on international trade as well the effect of death and illness.
The US and Dutch experts call for a unified approach to the problem.
They say only a global effort, rather than separate work by individual countries, will mean any pandemic can be contained.
Mutation fear
Fears of a pandemic have arisen because of outbreaks of the H5N1 bird flu strain in south east Asia, which has caused a total of 53 confirmed human deaths, according to the World Health Organization.
There are indications that it can spread between humans, although so far not in the feared mutated form which could fuel a pandemic.
A case in Thailand indicated the probable transmission of the virus from a girl who had the disease to her mother, who also died.
The fear is that if the H5N1 virus did mutate and spread amongst humans, it would do so rapidly and affect millions.
Experts repeatedly warn such a pandemic would be far worse than the one which occurred in 1918, which killed between 20 and 40 million people.
Scientists are working to develop a vaccine against bird flu, but are hampered by not knowing what form it would take, should it spread amongst humans.
In addition some countries, including the UK, have announced plans to stockpile millions of doses of anti-retroviral drugs which could be used to treat people during a pandemic.
'Ad-hoc responses'
Writing in Nature, a team from the Dutch Erasmus Medical Centre led by Dr Albert Osterhaus, said there was currently a lack of coherence in how countries tested for avian flu in people, and in how the effects of the disease were monitored.
The scientists also called for better surveillance of bird populations to assess which strain of bird flu they are carrying.
They write: "To limit the effects of flu on public health and livestock production, integrated and effective action from all the disciplines involved is urgently needed, rather than ad-hoc responses at a national level.
They called for a global task force, including human and animal health experts, as well as health policy advisors to be set up under the auspices of the WHO.
And Professor Michael Osterholm, from the Centre for Infectious Disease Research and Policy at the University of Minnesota in Minneapolis, US, writing in the same journal, said: "The arrival of pandemic flu will trigger a reaction that will change the world overnight.
"There will be an immediate response from leaders to stop the virus entering their countries by greatly reducing and even ending foreign travel and trade - as was seen in parts of Asia in response to the severe acute respiratory syndrome (Sars) epidemic.
He added: "These efforts are doomed to fail given the infectiousness of the virus and the volume of illegal crossings that occur at most borders. But government officials will feel compelled to do something to demonstrate leadership.
"Individual communities will also want to bar 'outsiders'. Global, national and regional economies will come to an abrupt halt."
He added: "Unfortunately, most industrial countries are looking at the vaccine issue through myopic lenses."
Professor Osterholm warned: "National, regional or local plans based on general statements of intent or action will be meaningless in the face of a pandemic."
BEIJING, May 26 (Reuters) - China has developed vaccines that block the spread of the deadly H5N1 strain of bird flu among birds and mammals, Xinhua news agency reported, as scientists in the west warned of a possible global pandemic killing millions.
Scientists fear that avian flu, which is infectious in birds but does not spread easily among humans, could mutate into a form more capable of passing from animals to people.
The H5N1 strain first surfaced in poultry in Hong Kong and China eight years ago and has killed 37 people in Vietnam, 12 in Thailand and four in Cambodia.
Global health officials fear it could mutate into a strain that could rival the 1918 Spanish flu pandemic that killed between 20 and 40 million people.
"Experiments show the efficiency rate of the newly developed vaccines in preventing infection by the H5N1 virus is 100 percent," Chen Hualan, director of the China National Bird Flu Reference Laboratory, was quoted as saying in an overnight report.
China's Ministry of Agriculture had given its approval, and a sales permit, for the vaccines, Xinhua said, without mentioning whether the treatments had been evaluated outside the country.
The agency said supplies of the new vaccines had already been sent to far-flung western Qinghai province, where China has been scrambling to contain its first breakout since late 2004 after 178 geese were found dead of the H5N1 virus on May 4.
The new vaccines also prevented the spread of avian flu from migratory birds to waterfowl, which could easily pass the disease to domesticated birds, Xinhua said.
China was willing to provide technical anti-epidemic support to other countries and poultry farms in Vietnam had begun experimenting with the Chinese vaccines, it said.
"Time is running out to prepare for the next pandemic," said Michael Osterholm, of the University of Minnesota, on Wednesday in a special section of the journal Nature devoted to avian flu.
"There is a critical need for comprehensive medical and non-medical pandemic planning at the ground level that goes beyond what has been considered so far."
Scientists say any bird flu pandemic will likely start in Asia and could kill many millions.
New influenza strains have caused pandemics in the past, most recently in 1956-1957 and 1967-1968, killing a combined 4.5 million people.
HARBIN, May 25 (Xinhuanet) -- Chinese scientists announced Wednesday two newly developed vaccines are fully capable of stopping the spread of the deadly H5N1 strain of the bird flu virus to fowl, water birds, mammals or humans.
They also said they are willing to provide technical support inepidemic prevention to other countries and regions and contribute to the breeding industry and public health security worldwide.
Chen Hualan, director of the China National Bird Flu Reference Laboratory, based in Harbin, capital of Heilongjiang Province, said the two new vaccines developed by her lab had proved to be a success: having passed a state-level appraisal, plus a permit granted by the Chinese Ministry of Agriculture for sale on the market.
"Experiments show the efficiency rate of the newly developed vaccines in preventing infection by the H5N1 virus is 100 percent," said Chen.
In the meantime, China has developed three new technologies with which it takes less than 10 hours to confirm a bird flu epidemic, comparing 72 hours in the past, with more time being gained for prevention measures or for taking action.
Dr. Bernard Vallat, Director General of World Organization for Animal Health (OIE), said China leads the world in research on bird flu and relevant technologies for prevention.
More of the two new vaccines have been sent to Gangcha County, where dead migratory birds, confirmed by Chen's lab to be caused by the deadly H5N1 virus, were found on May 4, in a bid to preventthe deadly avian disease from further spreading.
The Chinese Ministry of Agriculture also made an announcement about the incident last Saturday. It is the first reported bird flu case on the Chinese mainland since last year when China successfully wiped out the primarily avian-borne epidemic disease.
Sources said some of the dead migratory birds discovered in Gangcha County, northwest China's Qinghai Province, migrated from Southeast Asia. Migration is blamed as an important for spreading of bird flu virus, and China is on the route of migratory birds inAsia.
There is a higher risk for waterfowl to be infected with the deadly bird flu virus after mingling with migratory birds already carrying the killer disease. The bird flu virus can easily spread to domestic fowl and even humans via the water birds infected withthe H5N1 virus.
There were no reports in the world of vaccines being tested on water birds before China began its research. The latest experimental results show that the newly developed vaccines of Chen's lab are equally effective in water fowl, and ducks and geese, which when inoculated with the vaccines did not develop bird flu symptoms.
"With the vaccines, one activated and the other inactivated, the important way for spreading of bird flu virus can be cut off,"said Chen.
Compared with conventional ones, the inactivated bird flu vaccine can provide stronger protection against infection in waterbirds such as ducks and geese upon inoculation, while the term of effectiveness on chickens will be prolonged by four months. The bird flu activated vaccine can produce a protection shield againstassault of the H5N1 virus in fowls within nine months after inoculation.
"Both the activated and inactivated vaccines are safe to food security, as the meat of fowls being inoculated with the vaccines have been shown not to be affected," said Chen.
An estimate made in February 2004 by UN Food and Agricultural Organization (FAO) said about 100 million domestic fowl died of the H5N1 virus or were culled because of the infection between late 2003 and 2004. Direct economic losses were placed at 500 million US dollars.
At least 52 people in Vietnam, Thailand and Cambodia were diagnosed as being infected with the bird flu virus and died.
World Health Organization (WHO) warned over one million more people could die if the H5N1 virus were spread from human to human.The human deaths caused by the common flu each year are between 250,000 and 500,000, but scientists believe mortality caused by the bird flu among human beings would be much higher.
According to Chen, some chicken farms in Vietnam have been conducting experiments with the new bird flu vaccines developed byChen's lab over safety and effectiveness.
Agricultural officials in Vietnam said they would inoculate alltheir domestic fowl with the new bird flu vaccines once the experiments prove positive.
"We will spare no effort in offering support to other countriesif necessary," the Chinese scientist promised. Enditem
BEIJING - China has sent more than three million doses of bird flu vaccine to a remote western province to contain an outbreak of the avian virus in migratory birds.
Authorities have confirmed that dead geese in Qinghai province had died from the H5N1 virus of bird flu.
China says it is the first time the virus has been found in China since last year and that the area will remain sealed off to tourists for more than 10 days.
Agriculture officials say some of the migratory birds found dead in Qinghai may have come from Southeast Asia. However, China's National Bird Flu Reference Laboratory says that the strain found in the geese is different from that detected in Southeast Asia, which it says is more deadly to humans.
Malaysia says it will also begin testing migratory birds for bird flu, following the outbreak in China.
The Malaysian Department of Veterinary Services says it is on full alert and will take some samples from migratory birds at all bird parks in the country.
Malaysia's ban on Chinese poultry, imposed at the end of 2003, will remain in place until further notice. Malaysia declared itself free of bird flu in January this year.
Since late 2003, bird flu has killed at least 53 people in Southeast Asia, including 37 Vietnamese, 12 Thais and one Cambodian.
Meanwhile, world health officials say it may be impossible to prevent a global pandemic if the virus mutates to a more virulent strain.
The World Health Organization [WHO] says humans may already be transmitting the virus.
The Director of the WHO global influenza program, Klaus Stohr, has warned that the disease could spread quickly once it takes hold.
During previous outbreaks in 1957 and 1968, it took six to eight months for the virus to spread from Asia across much of the world.
The WHO has also announce it is to boost global measures to tackle epidemics and the growing threat of emerging infectious diseases.
At its annual meeting in Geneva, Switzerland, the 192-country assembly of the WHO approved a proposal to update measures on quarantines and travel restrictions which date back to 1951.
The assembly has agreed to strengthen and broaden the scope of the international health regulations to cover country-hopping diseases such as SARS, new variants of influenza and polio.
"This is a major step forward for international health," said WHO head Lee Jong-wook.
"These new regulations recognize that diseases do not respect national boundaries. They are urgently needed to help limit the threats to public health," he said.
The WHO has been urging its members for several years to update the rules, which went through their last detailed revision in 1969 and effectively only allow worldwide controls to stop cholera, plague and yellow fever.
Under the revisions, countries have much broader obligations to put in place routine preventive measures, such as stricter controls at airports, ports and land borders.
with files from the Australian Broadcasting Corporation
Bejing, May 23 Bird flu has once again raised its deadly head in mainland China. The Chinese Ministry of Agriculture has confirmed that the deaths of 178 migratory birds in the country’s Northwest Qinghai province, have been caused by the avian influenza known as H5N1.
For health experts, this is further confirmation that the virus is now endemic in Asia and many say that it’s not a question of if, but when, the H5N1 mutates into a form that would enable it to spread between humans.
Despite fervent measures to contain the virus since it first appeared in late 2003, including the slaughtering of tens of millions of birds and vaccinating many more, bird flu has continued to spread in Asia. The prospects of eliminating the virus within the next few years now appear to be virtually nil.
‘‘Elimination is a strategy we are no longer looking at,’’ say Maria Cheng, spokesperson for the World Health Organisation (WHO) in Beijing. ‘‘The flu is now established in the region so that eliminating it is not a good possibility.’’ Health experts are trying instead to focus on containment, including the monitoring and vaccination of animals.
Bird flu has affected 11 countries in the region from Japan to Indonesia and WHO says the outbreak is without precedent.
Avian influenza already fulfills 2 out of the 3 conditions for causing a human flu pandemic: the emergence of a new virus to which humans have little or no immunity and the ability of this virus to replicate in humans. The third condition, that the virus must be transmittable from one human to another, is the one standing between the current situation, where the flu is by and large limited to poultry and a possible world wide human flu pandemic of staggering proportions.
Currently, H5N1 is only known to spread between birds and, more rarely, from birds to humans. But as the virus continues to spread there is a distinct possibility that it will mutate in time, enabling human to human transmission.
Says Cheung, ‘‘We have a situation at the moment where both the human influenza virus and avian flu virus are circulating in a region simultaneously.’’
If H5N1 infects a human who is also carrying a human flu virus, the chances of the two strains of virus combining to mutate into a new form are high. Another worry for health officials is the potential for the avian virus to combine with a human flu virus in an intermediary sources like a pig. Already pigs in Java, Indonesia, have tested positive for H5N1.
Last month influenza experts noted a potentially menacing changes in the avian flu virus in Vietnam. Human cases of bird flu in northern Vietnam were found to show an epidemiological pattern and virological features different from those seen in the 2004 cases. They also differed from those currently seen in human cases in southern Vietnam and other Asian countries. These differences could indicate that the virus might already have been transmitted from human-to-human, though this is not proven as yet.
GENEVA, Switzerland, May 18 (UPI) -- The World Health Organization is expected to release research that suggests avian flu in Vietnam may have been passed from human-to-human.
The BBC, which obtained an advance copy of the study, said the WHO paper calls for governments worldwide to boost public health measures to protect against an influenza pandemic.
At least 92 people have caught the avian influenza virus from handling poultry since late 2003, the BBC said. But there has been suspicion recently that the virus may have mutated and spread from person to person.
The researchers said the infection usually infects a small number of shoppers or poultry handlers and is quickly eradicated. However, in northern Vietnam, a higher number of infection clusters have been discovered where the period of infection is longer and the age range of those infected is much wider.
The scientists said the virus in northern Vietnam is genetically different from other strains.
However, the WHO said the pattern could also be caused by a more infectious form of bird to human infection.
HANOI, Vietnam, April 23 (UPI) -- Public health officials in Vietnam fear the South Asian outbreak of bird flu is becoming less virulent and, thus, more likely to spawn a pandemic.
The new fear stems, ironically, from the declining mortality rates of infected humans, the Washington Post reported Saturday.
About a year ago some two-thirds of human victims in Vietnam died, but recently that figure has plunged by nearly half.
If that trend continues, it raises the likelihood that infected humans' greater longevity will result in more people contracting avian influenza -- and thus increasing the chances it will become a global problem.
"The virus could be adapting to humans," said Peter Horby, an epidemiologist with the World Health Organization in Hanoi, the Vietnamese capital. "There's a number of indications it could be moving toward a more dangerous virus."
By way of comparison, the 1918 Spanish flu pandemic that killed some 40 million people worldwide, had a 5 percent mortality rate. The comparable rate for bird flu has fallen from nearly 70 percent to 35 percent this year.
Also worrying health officials is the emergence of asymptomatic bird flu in poultry.
A lineup of leading infectious disease experts warned Wednesday that the world is unprepared for the health and economic consequences of an outbreak of pandemic influenza that could spring from a lethal strain of bird flu now ravaging poultry flocks in Southeast Asia.
In commentaries published in the British science journal Nature, doctors used some of the strongest language yet to suggest that the bird flu virus known as H5N1 could mutate into a form easily transmitted among people, creating a strain capable of killing millions.
"This virus has the potential to trigger the next pandemic, which, judging from history, is well overdue,'' wrote Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases in Bethesda, Md. "Clearly, there is much to be accomplished, and time is of the essence.''
Flu pandemics are global outbreaks of virulent influenza caused by a viral strain so different from those of prior years that the human population has no natural resistance to it.
The 1918 Spanish flu was such a pandemic, and it killed an estimated 20 million to 100 million people around the globe. The H5N1 virus has worried flu experts since 1997, when it first appeared in the Hong Kong chicken markets as a lethal virus dubbed bird Ebola. After it infected 18 people, killing six of them, Chinese authorities ordered the slaughter of 1.5 million chickens, abruptly stopping the outbreak.
In December 2003, H5N1 re-emerged in Southeast Asia and has killed millions of birds and 53 people. Efforts to contain the virus by culling birds have failed. The virus is being spread by wild ducks, which carry the virus but don't die of it.
In an interview, Fauci said the purpose of the Nature commentaries is to draw more world attention to the problem. "The ingredients (for a pandemic) are starting to accumulate,'' he said. "This is a situation that might go away this season, but it's not going away forever.''
Fauci said that federal spending on influenza preparedness has increased to $419 million from $40 million over the past five years but concedes he is not satisfied with the United States' current level of readiness.
For example, even though an experimental H5N1 vaccine is being tested, the system for manufacturing it -- the same system that produces millions of ordinary flu shots -- is failure-prone. "Capacity needs to be built up,'' Fauci said.
Similarly, the federal government has stockpiled only enough Tamiflu, an antiviral drug that has shown promise against bird flu, to treat 2.3 million Americans. That is less than 1 percent of the population. Great Britain has ordered enough to cover 25 percent of its people.
"We're definitely going to increase the stockpile. That's for sure,'' Fauci said, calling it a top priority of the Department of Health and Human Services. Just how much drug the government wants, he wouldn't say.
Swiss pharmaceuticals maker Roche Inc. produces the entire world supply of the drug at a single European plant. Federal authorities have been negotiating with Roche to build a Tamiflu factory in the United States.
In another Nature commentary, famed virologist Dr. David Ho of New York's Aaron Diamond AIDS Research Center argued that China needs to confront the emerging threat of bird flu openly. "The world, China included, must respond as if the next pandemic is imminent,'' he wrote. Ho estimated that up to 207,000 Americans could die in it. "What will the death toll be in China?" he asked.
Michael Osterholm, director of the University of Minnesota's Center for Infectious Disease Research and Policy, warned in his Nature paper of the economic consequences of a major pandemic.
"The world today is much more vulnerable to the collapse of trade than it was in 1918,'' he wrote. He dubbed the potential economic fallout "pandemic shock.''
Osterholm wrote that an H5N1 pandemic strain could rival the devastation of the 1918 pandemic. Industrialized nations reliant on "just in time" delivery of health care goods do not have enough medical supplies to care for the sick. "Nor are there detailed plans on how to handle the dead bodies whose numbers will soon outstrip our ability to process them,'' he wrote.
Osterholm said the world's leading economic powers need to confront the problem directly at the forthcoming G8 meeting in Scotland. He calculates that, with the world population swelled to 6.5 billion, a flu strain as lethal as the one in 1918 could kill 180 million to 360 million people worldwide.
Also an expert in terrorism, Osterholm observed that there were ample warning signs that an event such as the Sept. 11, 2001, attacks was possible. Those warnings were fully recognized only after the fact.
"People like myself are often seen as scaremongers," he said, "but I'm afraid we are doing this all over again.''
THE world is unprepared for an influenza pandemic that would infect well over a billion people and trigger global economic disaster, leading scientists say today.
International leaders are ignoring indications that the virulent H5N1 strain of avian flu presents a severe threat, and have failed to introduce the cross-border measures essential if a worldwide outbreak is to be contained.
Such a pandemic could affect 20 per cent of the world’s population, putting 30 million in hospital and killing a quarter of them, according to even optimistic predictions. It would also lead to the collapse of international trade and cause economic and social chaos even in rich countries that can protect their populations with drugs and vaccines.
In expert commentaries published today in Nature, some of the world’s foremost authorities on flu argue that only a meticulously planned global response stands a chance of averting a catastrophe.
They call for a permanent international taskforce to prepare for a pandemic, in place of country-by-country arrangements. Urgent action is needed to develop ways of designing and manufacturing vaccines against the virus - a process that now takes six months - and to agree international guidelines for eliminating reservoirs of potentially dangerous strains in poultry and wildlife.
The calls come amid growing concern that the H5N1 virus circulating in Asia has the potential to start a human pandemic. It has infected at least 97 people in Thailand, Vietnam and Cambodia, of whom 53 have died. Most of those cases were contracted from birds, but there are emerging indications of occasional transmission between people - the key step to a pandemic. Last week, the World Health Organisation said it was concerned about possible human-to-human infection in north Vietnam, though this has not been confirmed.
Even if H5N1 does not start a pandemic, another is certain to strike: they generally happen at intervals of about 30 to 40 years, and the last took place in 1968, killing a million people. The worst on record was the Spanish flu of 1918-19, which may have caused 50 million deaths.
Michael Osterholm, of the University of Minnesota, said "bold leadership” and meaningful financial investment in vaccine research is required from the G8 industrialised countries, which are not taking the issue sufficiently seriously.
"When the G8 leaders next meet, in Scotland in July, avian flu will be on the agenda, but major commitments are unlikely," Dr Osterholm said. "These nations urgently need to recognise the economic and security and health threat that the next flu pandemic poses, and invest accordingly. The arrival of pandemic flu will trigger a reaction that will change the world overnight.
"We must demand nothing less than an international effort. If industrial countries continue to develop vaccines for just themselves, they, and everyone else, will remain vulnerable to a global disaster. Even if nations vaccinate their entire populations, they cannot remain isolated from a pandemic shock."
Albert Osterhaus, ofthe Erasmus Medical Centre, Rotterdam, wants a task force of experts in human and animal medicine, virology, epidemiology, pathology, ecology and agriculture. Teams would be sent to investigate outbreaks, to assess pandemic potential and institute containment measures. Such a taskforce would cost $1.5 million (£820,000) a year.
This compares with agricultural losses of up to $880 million for H5N1 outbreaks in Thailand and Vietnam.
CASE HISTORY
1918-19 H1N1 ‘Spanish flu’ strain kills 50 million
1957 H2N2 virus kills up to 4 million people
1968 H3N2 ‘Hong Kong flu’ kills about 1 million
1997 First outbreak of H5N1 avian flu in Hong Kong. 18 people infected and six die
Feb 2003 H7N7 avian flu infects 83 people in the Netherlands by contact with birds. One man, a vet, dies
Jan 2004 H5N1 infects 11 and kills eight in Thailand and Vietnam. By August, 26 are dead
Sept 2004 First suspected case of human-to-human transmission of H5N1
March 2005 Britain invests £200 million in antiviral drugs
To prepare for a global flu outbreak that could strike one-fifth of the world’s population and kill millions, leading international disease experts are calling for more worldwide co-operation and a push for a new kind of vaccine.
Such an outbreak has long been called inevitable, once a flu virus circulating in birds infects people and mutates so that it passes easily between people.
While bird-to-human infections have been happening in Asia, they have not yet spawned a major spread of the virus person-to-person.
Even an optimistic estimate says a worldwide outbreak could sicken nearly 30 million people enough to need hospitalisation, and kill a quarter of those patients, researcher Albert Osterhaus of the Erasmus Medical Centre in Rotterdam, The Netherlands, and colleagues write in tomorrow’s issue of the journal Nature.
They and other experts made recommendations in the journal about how to prepare for a global outbreak, called a pandemic.
Osterhaus and co-authors called for a permanent global task force that includes health agencies and researchers from a variety of disciplines.
It should study the global picture of flu in various species, combine knowledge from different research areas, advance strategies for dealing with animal and human outbreaks, and offer policy advice, they wrote. When an outbreak occurs, task force representatives should join local experts and policy makers on teams to manage the disease, they wrote.
Michael Osterholm of the University of Minnesota wrote that under current technology, a vaccine for a pandemic flu strain wouldn’t be available until at least six months after a pandemic started. And at that point, the supply would cover only 14% of the global population, he said.
"We must demand nothing less than an international effort to develop a new type of influenza vaccine that can be manufactured on a much shorter timescale," he wrote.
Canadian Press, with a report from AP
Global action is urgently needed to ramp up the ability to make huge amounts of influenza vaccine to protect against a looming pandemic, experts argue in the prestigious journal Nature.
The journal poses the question: "Are we ready?" Five expert commentaries and articles by journal staff suggest the only appropriate answer is: "Far from it."
Such an outbreak has long been called inevitable, once a flu virus circulating in birds infects humans and mutates so that it passes easily between people. While bird-to-human infections have been happening in Asia, they have not yet spawned a major spread of the virus person-to-person.
Recommendations to prepare for an avian influenza onslaught range from the creation of a permanent global pandemic flu task force, to a pedal-to-the-metal drive to find ways to stretch inadequate manufacturing capacity to produce enough vaccine to protect people around the globe.
Dutch virologist Ab Osterhaus and colleagues from the Erasmus Medical Centre in Rotterdam argued the current ad hoc responses to a potential pandemic should be replaced by a permanent flu task force, drawing expertise from the human and animal-health sectors.
They suggested the unprecedented international collaboration that helped contain SARS could be a model. "I think if you look at what happened in SARS...that, in principle, it should be possible," Dr. Osterhaus said from Rotterdam.
On the vaccine front, the head of the World Health Organization's global flu program admitted it would take a veritable revolution in flu-vaccine production to provide pandemic protection for the world's masses.
"It takes a revolution, certainly. But we should not shy away from revolution," Dr. Klaus Stohr said from Geneva when asked to comment on the Nature package. "Vaccine should be affordable by every country, and if countries cannot afford it, then more developed countries should step in or international organizations should help."
Unless the developed world finds ways to assist developing countries to weather a pandemic storm, people in Canada and the United States will find themselves battling crippling shortages of essential medical supplies, consumer goods and even food, argued Dr. Michael Osterholm, a leading U.S. epidemiologist and author of one commentary.
A pandemic would severely disrupt manufacturing and transportation operations, potentially making even routine items such as light bulbs scarce, he warned in an interview.
The situation could make the rationing of the Second World War seem enviable. Experts believe a flu pandemic would occur in a series of waves that could last between 18 and 24 months or so.
Dr. Osterholm said G8 nations have to make pandemic preparedness -- and specifically vaccine production -- one of their "very highest priorities."
Currently, the world's flu-vaccine-production plants can make about 900 million 15-milligram doses of vaccine a year. It's estimated the world's 6.2 billion people might each need at least two doses -- each dose possibly larger than 15 mg -- to gain protection if the H5N1 virus that has flu experts on tenterhooks becomes a pandemic strain.
It is widely assumed that during a flu pandemic, countries will nationalize vaccine and drug production located within their borders -- a reason why Canada's pandemic-preparedness plan has been hailed for the foresight of including a contract for made-in-Canada vaccine.
Since early 2004, the U.S. government, through the National Institutes of Health, has poured huge sums into contracts designed to coax pharmaceutical firms to modernize flu-production capacity, hoping to stimulate the industry's move away from egg-based production and into vaccine that can be grown in cell culture.
But that alone won't produce even enough vaccine for U.S. needs, admitted Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases and an author of one of the commentaries. "Even in the best of times, the capacity for manufacturing vaccine doesn't nearly get to the level of universal vaccination."
Documented cases of avian flu since 2003
Netherlands: 1 death*
Thailand: 17 cases, 12 deaths
Cambodia: 4 cases, 4 deaths
Vietnam: 76 cases, 37 deaths
Totals: 97 cases, 54 deaths
* Not H5N1 strain
Spread: The protein neuraminidase (N) releases newly formed flu virus from the host cell to further the spread throughout the body.
Pandemic: If two different strains infect the same host, they can mix genetic material and could produce a strain that can trigger a pandemic.
Vaccine: Antibodies against (H) and (N) are essential to protect against infection and spread.
Scientists can isolate genes from a dangerous virus and alter them to make them safer. New viruses can then be used in vaccines.
SOURCE: WHO, NATURE
A NEW influenza pandemic could affect 20% of the world’s population and trigger a global economic disaster, experts warned yesterday.
Scientists called on world leaders to start planning for an event that could lead to millions of deaths, panic and the collapse of international trade. Only a global response would stand a chance of averting the catastrophe, said the experts.
Fears of a pandemic have arisen because of outbreaks of the H5N1 bird flu strain in south-east Asia, which has caused 51 confirmed human deaths. The fatality rate of humans infected by the virus is as high as 60%.
At present, there is no evidence that the strain can be transmitted from one person to another. But if that were to happen, it would spread rapidly around the world, with devastating consequences.
Yesterday, experts writing in the journal Nature warned that a n optimistic estimate suggested the next flu pandemic could cause 20% of the world’s population to become ill.
Within a few months, almost 30 million people would need to be hospitalised, a quarter of whom would die.
But the effects on today’s world economy would be just as serious, it is claimed.
Prof Michael Osterholm, from the Centre for Infectious Disease Research and Policy at the University of Minnesota in Minneapolis, US, wrote: "The arrival of pandemic flu will trigger a reaction that will change the world overnight.
"There will be an immediate response from leaders to stop the virus entering their countries by greatly reducing and even ending foreign travel and trade.
"Government officials will feel compelled to do something to demonstrate leadership. Individual communities will want to bar ‘outsiders’. Global, national and regional economies will come to an abrupt halt."
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Bird flu could cause 'global economic disaster'
By Mark Henderson,
Science Correspondent of The Times,
The Times, UK,
May 25, 2005
Renewed warning over flu pandemic
BBC News, London,
25 May, 2005
'Unfortunately, most industrial countries are looking at the vaccine issue through myopic lenses'
It is estimated that up to 60% of humans infected by the virus have died.
- Professor Michael Osterholm, University of MinnesotaChina hails bird flu vaccine amid prophesies of doom
Reuters,
26 May 2005
New vaccines developed to stop bird flu spread
Xinhuanet,
chinaview.cn,
25 May,2005.
China moves to contain bird flu virus
23 May 2005,
CBC News,
Canada.
Experts wait for the big bird flu jump
Pallavi Aiyar,
The Indian Express,
May 24, 2005
WHO: bird flu may spread between people
UPI,
18 May, 2005.
Bird flu looking more like a pandemic
UPI,
23 April, 2005
Flu pandemic looms, experts warn world
Many millions will die if Southeast Asian bird virus mutates to lethal form, spreads
Sabin Russell,
Chronicle Medical Writer,
San Francisco Chronicle,
Thursday, May 26, 2005
World unprepared for flu capable of killing 10 million
By Mark Henderson,
Science Correspondent,
The Times, UK.
May 26, 2005
Experts Call for Action over Bird Flu Pandemic
Press Association,
The Scotsman, UK,
25 May 2005
Urgent need for vaccine-making capacity
Experts say the world is 'far' from ready to face down a pandemic if the bird flu mutates
By Helen Branswell,
The Globe And Mail, Toronto,
Thursday, May 26, 2005.
Avian influenza's footprint
Figures up to May 13, 2005
In 1997 six people in Hong Kong died after being infected with the H5N1 strain of the disease. Hong Kong's entire poultry population was destroyed to avert further infection.
The influenza virus
Infection: Flu virus uses the protein haemagglutinin (H) to enter the host's cell.
Flu pandemic 'could trigger global economic disaster'
By John von Radowitz,
Irish Examiner,
26 May, 2005.
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