The deaths in China of more than 1,000 migratory birds from the flu strain H5N1 has left experts struggling to square the outbreak with their knowledge of the virus. At the same time, rumours are beginning to circulate that humans in the region have also fallen victim to the disease — although official sources have so far denied this.
The H5N1 strain has killed at least 53 people in Asia since late 2003, and is seen as one of the prime candidates for sparking a human pandemic. Migratory birds can act as carriers of flu, but their role in spreading highly dangerous strains such as H5N1 remains a matter for debate.
Until the latest outbreak, only a handful of migratory birds were known to have died from H5N1. This led some experts to suggest that the migrants are asymptomatic carriers of the virus, causing the occasional outbreak among poultry populations along their migration routes. Others believed that the small number of deaths among migrants were simply the result of wild birds picking up the infection from local ducks or chickens.
But the revelation on 21 May that at least 500 wild birds across five different species had died from the virus has dramatically altered the situation. With H5N1 now seeming to be highly infectious and lethal among the migrants, experts fear that the virus's genes may have mutated or reassorted.
To find out, the World Health Organization (WHO) is pressuring China to release samples for sequencing and analysis. “This is an exceptional case,” says Maria Cheng, the WHO's spokeswoman in Beijing. “We want to see the virus as soon as we can.”
China had not reported any cases of H5N1 in people or birds since a previous poultry outbreak ended in June 2004. But several Internet sites including ProMED-mail, an online database of health-related news, are now reporting that people are dying as a result of the latest outbreak (see ‘China rejects Internet claims of human cases’, below). Some sources are claiming there have been up to 120 fatalities.
The Chinese health authorities deny that any human cases have been found. Since early May, when 178 suspicious waterfowl deaths were first reported in the Niannaisuoma village of northeastern Qinghai, authorities have quarantined the area, requiring people going there to wear goggles, masks and gowns. Increased surveillance so far has found no sick people, officials say.
There is no evidence of human to human transmission in the area, and large-scale transmission from so few wild birds directly to humans is unlikely, says virologist Vincent Deubel, who heads the Pasteur Institute in Shanghai. “A more virulent form for birds does not mean a more virulent form for humans,” he explains. “It would be unrealistic to expect so many human deaths from an outbreak in only 500 birds.”
But the numbers of reported bird deaths might hugely underestimate the actual toll, says Fusheng Guo, coordinator for the UN Food and Agriculture Organization's regional avian-flu surveillance network. “Many of them won't be found,” he says, adding that his colleagues in Qinghai are reporting many more deaths every day. “I'm very worried about this.” In fact, less than a week after the figure of 519 bird deaths was released, Jia Youling, director of the veterinary bureau at China's agriculture ministry, revised the number to more than 1,000.
Baoxu Huang, director of China's National Animal Quarantine Institute, says that the Qinghai cases are probably isolated. He adds that China has more than 450 surveillance sites looking for the virus in various animals, including migratory birds. But one source says staff at the sites lack the necessary resources and training, and are likely to be missing cases. The surveillance stations in Qinghai, the source says, have machines for diagnosing samples, but people there don't know how to use them, and don't have the necessary reagents.
TOKYO : Tests by Japanese electronics maker Sharp have found an air-purifier using plasmacluster ion technology 99 percent effective in killing-off the bird flu virus in a controlled environment.
Plasmacluster ions also proved effective against 26 other kinds of harmful airborne substances, including bacteria, mold fungi, viruses and allergens.
"The device is the first in the world to have been proven effective against avian virus," Sharp spokeswoman Miyuki Nakayama said.
Plasmacluster ion technology, developed in 2000, is an air-purification technology that disables airborne micro-organisms by releasing positive and negative ions into the air.
The Osaka-based company began five months of experiments, testing the technology on bird flu in collaboration with British research institute Retroscreen Virology Ltd, in January before announcing the results.
The virus was sprayed into a one-cubic meter (1.3-cubic yard) box, then plasmacluster ions were turned on. Samples were then taken at 10 minute intervals and injected into cell cultures.
The experiment showed that 99 percent of the H5N1 virus was eliminated.
"Four days after injection, the cells injected with the virus that had not been exposed to plasmacluster ions were deformed and damaged (by the virus).
"In contrast, cells injected with the virus that had been exposed to plasmacluster ions retained their normal condition with almost no change in evidence," the company said in a statement.
The H5N1 virus has been fingered as a possible new strain of flu that could prove devastating if it genetically mutates and develops the capacity to be transmitted from human-to-human.
"People's concern about bird flu is still high, especially in Asia, which suffered the outbreak," Nakayama said. "We hope our product can help eliminate the virus."
The technology can be installed in air conditioners, dehumidifiers and air purifiers for home and industrial use.
Fifty-four people in Vietnam, Thailand and Cambodia have died after being infected with H5N1 from birds.
Sharp shares fell 12 yen or 0.71 percent to close at 1,669 yen on the Tokyo Stock Exchange Tuesday while the benchmark Nikkei-225 index fell 0.47 percent.
BANGKOK — After poring over old medical records, studying census data and cranking out mathematical models, scientists and health officials are beginning to believe they have a chance to stop a bird flu pandemic before it kills millions of people worldwide.
The key: detecting an outbreak early and rushing powerful antiviral drugs to the source to throttle a pandemic at birth before it can bust out of Southeast Asia, carrying sickness and death around the globe. "It is the first time in the history of mankind that anyone has thought about keeping a worldwide pandemic at bay," says William Aldis, the top World Health Organization (WHO) official in Thailand.
But the window of opportunity could close quickly, and the world is not yet prepared to take advantage of it, researchers say. Rich countries are stockpiling antiviral drugs, but there is little available in the impoverished backwaters of Southeast Asia where an outbreak is likely to begin.
"The world is not dealing with this with sufficient attention," says Supamit Chunsuttiwat, disease control expert at the Thai Ministry of Public Health. "If we join hands, we might be able to stop the pandemic."
"We are not prepared," says Marc Lipsitch, an epidemiologist at the Harvard School of Public Health. "It is critical to scale up preparations on the home front, but equally urgent ... to prevent the start of a new pandemic in Asia."
Avian influenza, an infectious disease of birds caused by type A strains of the influenza virus, jumped to humans in 2003. The H5N1 strain that has infected people has killed 54 of the 98 people infected, a 55% death rate. The WHO, a United Nations health agency coordinating the bird flu battle, warned in a January report about the potential for a pandemic: widespread infection — and death.
"Never before had so many countries been so widely affected by avian influenza in poultry in its most deadly form," the report said. "Never before had any avian influenza virus caused such extremely high fatality in humans."
The clock seems to be ticking. Vietnam on May 23 reported its 38th bird flu death, a 46-year-old man who succumbed May 19. Chinese officials quarantined parts of remote Qinghai Province and rushed 3 million doses of bird flu vaccine for use in poultry, not humans, after an outbreak among migratory birds. There have been no confirmed human cases in China.
The WHO in May expressed concern that strains of the deadly H5N1 bird flu virus circulating in northern Vietnam are becoming more infectious to humans.
The nightmare scenario: The virus mutates into a type that can pass easily from human to human, something that apparently has not happened yet. If it does, the world could face a pandemic like the one that killed at least 40 million people in 1918-19. The WHO warns that an uncontained bird flu pandemic could kill 2 million to 50 million people worldwide.
But researchers are beginning to believe the tragedy could be stopped if the world responds aggressively to the first signs of a pandemic outbreak. "It's an opportunity not to be missed," says Scott Dowell, Bangkok-based director of a joint program between Thai health officials and the U.S. Centers for Disease Control and Prevention. "In 1918, they didn't stand a chance. But we're not in 1918. We're in 2005."
The lessons of 1918
In contrast to previous pandemics, researchers this time know what to watch for: the lethal H5N1 avian influenza virus, which first showed up in humans eight years ago in Hong Kong and which mutates rapidly.
So countries in the regions have been training their health workers to identify bird flu and to isolate patients who have it. If a pandemic strain begins, they will notice clusters of human cases — for example, 20, 30, 40 cases in a single village. That has not happened yet.
Researchers at the Harvard School of Public Health found the flu virus that generated the 1918-19 pandemic was less contagious than believed. Their conclusions, published last December in the journal Nature, suggest another influenza pandemic might be easier to contain than previously feared. The Harvard team studied influenza deaths in 45 U.S. cities during the 1918-19 pandemic. Using old medical records and sophisticated mathematical models, the team concluded that each influenza victim infected two to four people, not up to 20, as researchers had previously suspected.
Why do researchers care about this arcane statistic, known as the "reproductive number"? Because the disease will quickly die out if health officials can intervene aggressively enough with some combination of antiviral drugs, vaccines and low-tech measures such as travel restrictions and quarantines. The goal: to push the reproductive number below 1, the point at which each victim infects less than one more person.
Cutting the reproductive number below 1 from 4 is still difficult, but it's a lot easier than the "almost impossible" task of getting it there from 20, says Harvard's Lipsitch, a co-author of the study. "It means that there is a good chance that very intense control measures could work, and we should take it."
A human vaccine would be the best way to stop a bird flu pandemic. But creating a vaccine for a pandemic strain of virus that doesn't exist yet would take at least several months. In the meantime, researchers are becoming more confident that antiviral drugs, designed to treat the flu once people get sick, can be used to prevent a pandemic viral strain from spreading. Unlike vaccines, antivirals have a shelf life of up to five years, can treat a range of viruses and can be stockpiled well in advance of a pandemic.
Ira Longini, a professor of biostatistics at Atlanta's Emory University, and a team of numbers crunchers have created statistical models to calculate the effectiveness of antiviral drugs in stopping a bird flu pandemic.
In a telephone interview, Longini says the results, which will appear in a paper submitted to the journal Nature and are expected to be published this month, are promising: Health officials in rural Southeast Asia would have more time and would need less antiviral medicine to stop a pandemic. The team created a model of a 3,500-square-mile area populated with 500,000 people in rural Thailand, where the pandemic is likely to emerge.
If it did break out there, Longini says, health officials would have two to three weeks, and perhaps as long as a month, to intervene with antivirals and quarantines before the disease broke loose and began spreading. The reason for the time lag: People in rural Southeast Asia don't travel very often or very far; the disease is unlikely to spread quickly beyond their communities.
By targeting the source of the outbreak, not distributing antivirals across an entire country, health officials can limit the amount of drugs they need. "We are putting the drug where the transmission is and not wasting it," Longini says.
Antivirals pose their own problems. The most effective antiviral drug is oseltamivir, a tablet developed by Swiss pharmaceutical giant Roche and Gilead Sciences of Foster City, Calif., and marketed by Roche as Tamiflu.
A protein on the surface of the flu virus called neuraminidase lets the virus move from one cell to another. Tamiflu prevents the neuraminidase from doing its job and stops the virus from infecting new cells.
The supply problem
The U.S. Food and Drug Administration approved Tamiflu for treating adults in 1999 and for prevention (in people older than 12) in 2000. Tamiflu helped control an outbreak of the H7N7 avian flu strain that caused one death in the Netherlands two years ago.
But Tamiflu takes a year to manufacture and is expensive. At U.S. pharmacies, it costs about $6.50 per capsule, though Roche is offering undisclosed discounts to governments that stockpile the drug and has donated about 120,000 10-capsule treatments to the WHO, Roche spokesman Terence Hurley says. The recommended dosage is 10 (two a day for five days) for treatment; and at least five (one a day for five days) for prevention, WHO spokesman Peter Cordingley says. So the cost can add up, especially in a country such as Laos where the annual per capita income is less than $2,000.
As the bird flu threat has grown, wealthy countries have started stockpiling Tamiflu. The United Kingdom has amassed 14.6 million 10-capsule treatments, enough to cover a quarter of its population. The United States last year had stockpiled 2.3 million treatments, enough for less than 1% of the population, according to Roche.
Supplies are scarce in the countries where a pandemic is likely to emerge. The WHO has sent just 2,500 treatments to Vietnam and 500 treatments to Cambodia. It has a stockpile, mostly donated by Roche, of more than 120,000 treatments at its regional offices in Manila and New Delhi, ready to be delivered by courier anywhere a pandemic emerges.
Health experts say at least some of the Tamiflu should be diverted from rich Western countries to Southeast Asia, where it's needed.
"Several million courses sent to Thailand would be more effective than hoarding for nearly 300 million people" in the USA, Emory's Longini says. "If you stop the spread at the source, it's much better."
In fact, Longini believes that as few as 120,000 treatments — the amount the WHO has stockpiled in Asia — might be enough to stop a bird flu pandemic in its tracks. But he still says individual Southeast Asian countries should have their own stockpiles to react if necessary to multiple outbreaks.
"We should be moving quickly on regional stockpiling," the WHO's Aldis says. "If I were a donor country and I heard that there was a way to switch off a pandemic before it happened, I'd have my checkbook out."
Only two prefectures have prepared guidelines to contain an outbreak of a new type of influenza that experts say could infect up to 25 percent of the population and kill 170,000 people, according to an Asahi Shimbun survey.
Despite international warnings of possible flu pandemics, only Miyazaki and Hiroshima prefectures have guidelines on information distribution and the roles of medical organizations and staff to prevent the disease from spreading to other regions, the survey showed.
The vast majority of prefectures lack medical supplies and coordination plans in the event of a new influenza outbreak, the survey showed.
In fact, not one prefectural government has prepared a budget for stockpiles of the virus-resistant flu medicine Tamiflu, although they are required to have enough shots for 3.7 percent of their populations, according to the survey.
"We would have no time to quarantine patients of a new-type influenza, so we must come up with countermeasures, and that includes ordinary medical organizations," said Akihiko Kawana, a specialist in infectious diseases at the International Medical Center of Japan. "Each prefectural government should establish guidelines of countermeasures according to the levels of infection."
The World Health Organization in May warned of a possible emergence in Vietnam of a highly contagious form of avian flu virus, which is spread from birds to humans.
In light of the situation, the Ministry of Health, Labor and Welfare has instructed all prefectural governments to come up with guidelines for an outbreak, including methods to screen for the virus and ways to store anti-virus medication.
In January this year, the Miyazaki prefectural government completed its guidelines concerning policy decisions, health-related organizations and measures on collecting and providing information.
Hiroshima Prefecture followed suit with its guidelines in April.
But according to the Asahi survey, only nine other prefectures, including Tokyo, Osaka, and Fukuoka, said they were in the process of compiling guidelines. The remaining 36 said they have no such plans.
Many of the prefectures cited a lack of funds. Others said the central government should be the one making the guidelines.
Many prefectural governments plan to use existing guidelines for severe acute respiratory syndrome to cope with a new type of influenza. However, health experts say SARS is much easier to control than new-type influenza at its initial stage.(IHT/Asahi: June 7,2005)
WASHINGTON When we think of major threats, the first to come to mind are nuclear proliferation, rogue states and global terrorism. But another kind of threat is lurking, one from nature, not humans - an avian flu pandemic. An outbreak could cause millions of deaths and threaten the security of governments around the world.
This year, Dr. Julie Gerberding, director of the U.S. Centers for Disease Control and Prevention, called the possibility of avian flu spreading from Southeast Asia (its likely place of origin) "a very ominous situation for the globe." A killer flu could spread around the world in days, crippling economies. From a public health standpoint, Gerberding said, an avian flu outbreak is "the most important threat that we are facing."
International health experts say that two of the three conditions for an avian flu pandemic in Southeast Asia have already been met. First, a new strain of the virus, called A(H5N1), has emerged, and humans have little or no immunity to it. Second, this strain can jump between species. The only remaining obstacle is that A(H5N1) has not yet mutated into a form that is easily transmitted from human to human.
However, there have been some alarming developments. In recent months, the virus has been detected in mammals that have never previously been infected, including tigers, leopards and domestic cats. This suggests that the virus is mutating and could eventually emerge in a form that is readily transmittable among humans, leading to a full-blown pandemic. In fact, according to government officials, a few cases of human-to-human spread of A(H5N1) have already occurred.
The precedent that experts fear is the 1918 flu pandemic, which began in the American Midwest and swept the planet in the era before air travel, killing 20 million to 40 million people.
At the moment, effective responses to an avian flu pandemic are limited and would come far too late for many people in Southeast Asia; so far more than 60 percent of those diagnosed with avian flu have died. There is no proven vaccine for the A(H5N1) strain and it could take months to produce a fully effective one. Some antiviral treatments may help flu sufferers, but they are not widely available and must be administered within 24 hours after the onset of symptoms.
It is essential for the international community, led by the United States, to take decisive action to prevent a pandemic.
So what should we do? Recently, the World Health Organization called for more money and attention to be devoted to effective preventive action, appealing for $100 million.
The U.S. Congress responded promptly. A bipartisan group of senators obtained $25 million for prevention efforts (a quarter of the request, the traditional contribution of the United States), allowing U.S. agencies to improve their ability to act.
In addition, the Senate Foreign Relations Committee unanimously approved legislation directing President George W. Bush to form a senior-level task force to put in place an international strategy to deal with the avian flu. We urge the Bush administration to form this task force immediately, without waiting for legislation to be passed.
But these are only modest first steps. International health experts believe that Southeast Asia will be an epicenter of influenza for decades. We recommend that the Bush administration work with Congress, public health officials, the pharmaceutical industry, foreign governments and international organizations to create a permanent framework for curtailing the spread of future infectious diseases.
Among the parts of that framework could be these:
(Barack Obama, Democrat of Illinois, is a member of the Senate Foreign Relations Committee; Richard Lugar, Republican of Indiana, is its chairman.)
It's known by the man in charge as "the outhouse", yet it is Australia's front line of defence against a killer flu pandemic.
On the eve of the unveiling of the latest anti-pandemic strategy, Australia's flu fighters are still based in hopelessly outmoded headquarters. Signs warn of ants in the kitchen, tape holds the air-conditioning flues together, and the biosecurity measures are inadequate. The Australian World Health Organisation Collaborating Centre for Reference and Research on Influenza is a series of ageing red-brick buildings on the site of CSL's big vaccine-making plant in Parkville, opposite the Commonwealth Games village.
Compared with its three partners in Atlanta, Tokyo and London, it is a relic. The centre's deputy director, Alan Hampson, began his career here in 1958 - and he is on the verge of retirement.
Now that Asian bird flu is threatening to become a pandemic, the work identifying the virus' characteristics has to be done elsewhere in Victoria - such as in the highly secure animal biosecurity laboratory in Geelong. "We can't handle the live virus here in our lab," Mr Hampson says. "We have to rely on other laboratories to help us."
Despite such drawbacks, the country has managed to become what Australia's Chief Medical Officer, John Horvath, believes is one of the best-prepared nations for a flu pandemic. The Federal Government put aside $114 million in last year's budget to build a stockpile of anti-viral drugs, 50 million syringes, 40 million surgical masks and extra hospital equipment. This followed an estimate that a major flu pandemic could lead 2.6 million Australians to seek medical attention, put 58,000 people in hospital, and kill 13,000.
For its preparedness, Australia can probably thank Mr Hampson, who initiated pandemic planning in the mid-1990s. He became concerned about a flu pandemic, and began knocking on the doors of health officials - without much success.
"When the chicken flu thing broke out in 1997, people started to listen," he said.
In the latest federal budget, $23 million was allocated to rebuild the WHO centre. Although he will not reap the benefit, Mr Hampson is pleased there will be a new laboratory - expected to be finished within 18 months, somewhere yet to be announced. He has also contributed to the most up-to-date strategy for coping with a killer flu pandemic. This is expected to be launched tomorrow by federal Health Minister Tony Abbott, who has described the pandemic as potentially "a worldwide biological version of the Indian Ocean tsunami".
The strategy, supported by all states and territories, is an attempt to prepare for the consequences if Asia's avian flu strain, now caught only from birds, mutates to enable human-to-human transmission in a severe form.
Australia's plan is expected to settle the contentious issues of border control, quarantine and who gets access to anti-viral drugs. Drawn up by the National Influenza Pandemic Advisory Committee, it will set out what will be done to slow the spread of a pandemic and establish how essential services will be maintained while vaccines are developed to protect the whole population.
Health authorities have warned of a possible re-run of the Spanish flu pandemic of 1919, which killed an estimated 40 million people worldwide, including 12,000 in Australia.
To date, fewer than 100 people have died as a result of the flu in Asia, where it has been devastating bird life. But the virus' behaviour led WHO to warn earlier this year that the world was "now in the gravest possible danger of a pandemic". Health authorities are taking the threat seriously.
The long-term solution is to invest billions of dollars and a huge amount of political capital in persuad ing peasant families throughout China and south-east Asia to change the way they raise their poultry. The urgent short-term task is to develop a mass-producing influenza vaccine far faster than is now possible. It’s urgent because “the world is in the gravest possible danger of a global pandemic,” as Shigeru Omi, Western Pacific regional director of the WHO, told an emergency conference on avian flu in Vietnam two months ago.
The virus first crossed into human beings in 1997, but it has clearly been mutating in ways that make it more capable of moving from birds to people. The spate of human infections in mid-2003 in China and south-east Asia was so serious that over 100 million domestic birds were killed or died before it subsided in early 2004, but there was only a few months’ respite before bird-to-human transmission began again.
The virus has now appeared in wild birds who can carry it far beyond its original reservoir in domestic chickens, China closed all its nature parks after 178 migratory geese were found dead from the virus in Qinghai province. The most recent outbreak has so far killed 53 people in Vietnam, Thailand and Cambodia. More ominously, the first case of human-to-human transmission was recorded last September in Vietnam.
Real danger
The danger of a global flu pandemic that could be as bad as or worse than the Spanish influenza outbreak of 1918-19 comes from the fact that a strain of influenza virus that normally affects only birds can swap genes with a strain that is highly infectious between human beings. If people with the human type of influenza should also be infected with the avian type, the gene swap can easily occur and direct human-to-human transmission becomes possible. At that point, given current patterns of international travel, the world might be weeks away from a global pandemic.
The virus is resistant to most anti-viral drugs, and in the avian form, it has been getting stronger. Early outbreaks killed around 10 per cent of poultry flocks; more recent ones have been killing up to 90 percent. In people who have caught avian flu, the death rate has been horrendous: 50 to 75 per cent of those infected. To make matters worse, this version of flu has a long incubation period. Unlike the SARS virus, it may be very hard to stop before it spreads to the population.
Tough task
If infections start to spread, there could be not only huge loss of life, but economic chaos as air travel is shut down, borders are closed, and essential services break down because too many of their workers are off sick or just hiding from the flu at home.
Governments are arming themselves to deal with this pandemic. President Bush added “influenza caused by novel or reemergent influenza viruses that are causing, or have the potential to cause, a pandemic” to the list of diseases for which a quarantine can be declared. But there is no vaccine. As things stand now, none could be available for months. That is why five teams of scientists urged a permanent global task force to react quickly to outbreaks of bird flu.
The first opportunity to create such a task force will be at the G-8 summit next month, and its first priority must be to develop new and easily-produced vaccines to deal with the outbreak. But lasting progress, as Samuel Jutzi of the UN’s Food and Agriculture Organization said at Vietnam , depends on “addressing the transmission of the virus where it occurs, in poultry...chickens and wetland-dwelling ducks.” A hundred million Asian peasants have to be persuaded to stop living in the same space as their poultry. A tall order, but a necessary one.
After poring over old medical records, studying census data and cranking out mathematical models, scientists and health officials are beginning to believe they have a chance to stop a bird flu pandemic before it kills millions of people worldwide.
The key: detecting an outbreak early and rushing powerful antiviral drugs to the source to throttle a pandemic at birth before it can bust out of Southeast Asia, carrying sickness and death around the globe. "It is the first time in the history of mankind that anyone has thought about keeping a worldwide pandemic at bay," says William Aldis, the top World Health Organization (WHO) official in Thailand.
But the window of opportunity could close quickly, and the world is not yet prepared to take advantage of it, researchers say. Rich countries are stockpiling antiviral drugs, but there is little available in the impoverished backwaters of Southeast Asia where an outbreak is likely to begin, reports USA Today.
Accordingt o the Age, now that Asian bird flu is threatening to become a pandemic, the work identifying the virus' characteristics has to be done elsewhere in Victoria - such as in the highly secure animal biosecurity laboratory in Geelong. "We can't handle the live virus here in our lab," Mr Hampson says. "We have to rely on other laboratories to help us."
Despite such drawbacks, the country has managed to become what Australia's Chief Medical Officer, John Horvath, believes is one of the best-prepared nations for a flu pandemic. The Federal Government put aside $114 million in last year's budget to build a stockpile of anti-viral drugs, 50 million syringes, 40 million surgical masks and extra hospital equipment. This followed an estimate that a major flu pandemic could lead 2.6 million Australians to seek medical attention, put 58,000 people in hospital, and kill 13,000.
For its preparedness, Australia can probably thank Mr Hampson, who initiated pandemic planning in the mid-1990s. He became concerned about a flu pandemic, and began knocking on the doors of health officials - without much success. "When the chicken flu thing broke out in 1997, people started to listen," he said.
In the latest federal budget, $23 million was allocated to rebuild the WHO centre. Although he will not reap the benefit, Mr Hampson is pleased there will be a new laboratory - expected to be finished within 18 months, somewhere yet to be announced. He has also contributed to the most up-to-date strategy for coping with a killer flu pandemic. This is expected to be launched tomorrow by federal Health Minister Tony Abbott, who has described the pandemic as potentially "a worldwide biological version of the Indian Ocean tsunami".
- NR
Swiss pharmaceuticals giant Roche has been flooded with orders for Tamiflu, the only antiviral drug deemed to be efficient against the avian flu virus.
World Health Organization (WHO) warnings in February of a pandemic that could kill seven million people sparked an enormous global demand for the drug.
The deaths of 53 people in Asia from the H5N1 strain of avian flu are increasing the fears of governments and health authorities that the virus is acquiring the ability to spread more easily among humans.
As a result, 25 countries – including Switzerland – have heeded the WHO’s warnings and placed orders for the drug.
However, production takes 12 months: Britain's order for 14.6 million five-day courses of treatment, for example, will take two years to fulfil.
Some scientists say this might be too late to prevent a pandemic, but Roche denies it is struggling with the heavy demand.
No guarantees
"There is no production bottleneck," Martina Rupp, a spokeswoman for Roche, told swissinfo. "We increased production significantly last year, we will do so again this year and we have fulfilled all orders to agreed timelines."
"We have however made it very clear that we cannot guarantee adequate supplies at the time of a pandemic so it’s key that countries start stockpiling well in advance."
To satisfy demand from the United States, Roche is planning to open a new production plant in North America later this year.
Roche is also working on methods of synthesising the drug from scratch. At present Tamiflu is made from star anise, a plant which is in limited supply.
"The manufacturing process of Tamiflu is complex and takes a long time so it’s important that countries follow the WHO’s recommendation," says Rupp.
Tough decisions
The WHO has been urging governments not to leave plans for coping with a pandemic until it is too late.
"It’s a fact that there’s not going to be enough Tamiflu available to meet the needs of everybody who’s going to want it," Dick Thompson, communication officer in the communicable diseases section of the WHO, told swissinfo.
"The occurrence of a pandemic is going to call for some hard decisions – and we believe that it’s best to make those decisions now before there is an actual outbreak."
Thompson is unequivocal when asked whether governments, especially richer governments, are doing enough. "Absolutely not," he says. "The consequences of a pandemic are just too large to not speak about it."
"We have to talk about this looming public health threat now even though there’s a real possibility there won’t be a pandemic anytime soon."
Responsible partners
Pharmaceutical companies – with their duties to shareholders – have in the past been accused of exploiting fatal diseases, such as Aids, for profit.
Roche says it is working closely with governments and the WHO as a responsible partner and has come up with an innovative solution which will benefit poorer countries where the virus is most likely to break out.
"Our distribution policy is first come, first served," says Rupp. "But we offer the capsules at a significantly reduced price to governments for their pandemic stockpiling."
"Countries can buy capsules on the one hand or they can buy the API (active product ingredient), a powder which needs to be mixed with water and a preserving agent [before it is] distributed in small bottles."
"When governments buy the API they get another price reduction – the API is half the price of the already reduced capsules."
European reaction
"An influenza pandemic seems inevitable," said Markos Kyprianou, the EU health commissioner last month as he launched the EU’s European Centre for Disease Prevention and Control (ECDC) in Stockholm.
The ECDC will coordinate efforts in the 25-member EU to control disease by identifying risks and providing advice. "Diseases know no borders, and so the fight against diseases should know no borders," Kyprianou said.
He said the EU wanted its members to increase their orders of vaccines now to encourage drug companies to expand their capacity so that they could produce enough vaccines in the event of an outbreak.
Kyprianou added that the EU was also proposing a €1 billion (SFr1.5 billion) fund in case of a health crisis.
In April the Swiss government announced that it was drawing up emergency measures that would come into force in the event of a flu pandemic.
swissinfo, Thomas Stephens
China has confirmed an outbreak of bird flu in its northwestern Xinjiang region, saying 460 geese had died of the H5N1 strain of the virus but the situation was under control.
The outbreak occured at a farm in Tacheng city in the Xinjiang autonomous region.
More than 13,450 fowls have been slaughtered to prevent the disease from spreading while the local government has isolated and disinfected the area, it said.
"The outbreak had been brought under control and the source of agent was being investigated," Jia Youling, director general of the Veterinary Bureau of the ministry, was quoted as saying by Xinhua.
In his report to the World Organization for Animal Health (OIE), posted on its website, Jia said the geese were infected by migratory birds.
As well as the OIE, the United Nations Food and Agriculture Organization and authorities in Hong Kong and Taiwan had been informed, Xinhua said.
The outbreak follows the deaths from H5N1 of more than 1,000 migratory birds last month in Qinghai province which borders Xinjiang, the first confirmed outbreak in China in nearly a year.
A Chinese veterinary official said then that the disease was spreading along a western China migratory bird route that stretched from South Asia to Central Asia and flew over the Himalayas through the Tibet and Qinghai regions.
Hong Kong immediately moved to suspend imports of poultry from Xinjiang Thursday, officials said.
Hong Kong has been quick to prevent further outbreaks of the H5N1 strain entering the territory since the variant first mutated into a form lethal to humans there in 1997, killing six people.
The H5N1 virus has been fingered as a possible new strain of flu that could be devastating to humans if it genetically mutates and develops the capacity to be transmitted from human-to-human.
The World Health Organization has warned that if this happens it could trigger a new human flu pandemic, potentially killing up to 50 million people worldwide.
So far, a total of 54 deaths have been recorded from H5N1 in Vietnam, Thailand and Cambodia.
Hong Kong has announced it is stepping up its surveillance of poultry farms, after an outbreak of a deadly strain of bird flu was confirmed in a province in western China.
Officials in Hong Kong say Chinese authorities told them about the outbreak of the H5N1 strain among geese in the north-western Xinjiang region.
More than 1,000 geese showed signs of the illness; about half died. About 13,000 birds were culled in the area and more were vaccinated.
The Chinese say the outbreak is under control.
The outbreak in Xinjiang follows the deaths of more than 1,000 migratory birds last month in Qinghai, south-east of Xinjiang.
That was the first confirmed H5N1 outbreak in China in nearly a year.
At that time, a Chinese veterinary official said that the disease was spreading along a migratory bird route that stretched from south Asia to central Asia and over the Himalayas through the Tibet and Qinghai regions.
Xinjiang and Qinghai border Tibet.
The H5N1 virus has been fingered as a possible new strain of flu that could be devastating to humans if it genetically mutates and develops the capacity to be transmitted from human to human.
The World Health Organization (WHO) has warned that if this happens it could trigger a new human flu pandemic, potentially killing up to 50 million people worldwide.
So far, a total of 54 deaths have been recorded from H5N1 in Vietnam, Thailand and Cambodia.
-BBC/AFP
TORONTO — Vietnam's ministry of health has provided the World Health Organization with confirmation of an additional three human cases of avian influenza, cases that date back weeks, the Geneva-based agency announced Wednesday.
The three cases -- including one death -- are not new infections, Dr. Klaus Stohr, director of the WHO's global influenza program said. WHO had already included them in unofficial tallies it compiles based on a variety of non-governmental sources.
"We had a difference of three cases between what we had been officially notified of by the government from Vietnam and our own counting, because we use every possible source of information," Stohr said from Geneva.
The most recent of the cases dates back to April 26.
The current wave of infections with the H5N1 virus, which began in mid-December, has seen 52 human cases occur in Vietnam. Of those, 18 people have died and two remain in hospital. This wave has also seen four cases -- all fatal -- in Cambodia.
Vietnamese authorities did not provide WHO with any clinical information about the cases, leaving it unclear in which part of the country they occurred, whether they were part of a cluster or were individual cases and what their probable source of infection was.
"All that we know is three more cases," said Stohr, who insisted more rapid and thorough reporting is needed.
"I think what we all want is ... no more cases. But if there are cases, we want them reported promptly and investigated immediately to allow prompt risk assessment."
THREE more Vietnamese have contracted bird flu, taking the number of infections in the country to 52 since December, 18 of whom have died, a health official was quoted today as saying.
The three, a 30-year-old man and two women, were detected in Hanoi since the middle of May, Trinh Quan Huan, head of the Health Ministry's Preventive Medicine Department, was quoted as saying by e-newspaper VNExpress on its website, vnexpress.net.
"All the three have been infected in relation to sick poultry," Mr Huan said in an interview. "Their condition is not serious and by now the 30-year-old man has been discharged."
The two women were still being treated in a Hanoi hospital.
"The outbreak has slowed recently," he added.
A World Health Organisation statement seen today said Vietnam's Health Ministry had informed the WHO of the three infections. It said the ministry had also confirmed a death by the H5N1 virus that was earlier reported as a suspected case.
Last month, health officials said a 46-year-old man from the northern province of Hung Yen, 65km south-east of Hanoi, was suspected of having died of the H5N1 virus.
A Health Ministry report said the virus had killed 18 people since December 16, 2004, when the disease resurfaced, taking the country's total to 38 since it appeared in late 2003.
The disease also killed 12 Thais and four Cambodians.
The government anti-bird flu committee was told yesterday that poultry in the northern province of Nam Dinh and the southern province of Tien Giang would be vaccinated later this month on a trial basis, state media said.
In August, vaccination of waterfowl and chickens would become mandatory in the regions facing a high infection risk, Tuoi Tre newspaper reported.
Bird flu first emerged in the Mekong Delta in southern Vietnam in late 2003, then spread to the northern region where the virus appears to develop rapidly during the winter.
Scientists fear the avian flu, which is infectious in birds but does not spread easily among humans, could mutate into a form capable of generating a pandemic in which millions of people without immunity could die.
HANOI, June 9 (Xinhuanet) -- Vietnam's Preventive Medicine Department Thursday confirmed that 52 local people from 21 cities and provinces were infected with bird flu virus strain H5N1 between mid-December 2004 and late May 2005, of whom 18 died.
Now, two bird flu patients, both from Hanoi, the capital city, are under treatment at the Institute of Tropical Diseases, the department told Xinhua, noting that their epidemiological signs indicate a strong link to sick poultry.
Since bird flu started to hit Vietnam in December 2003, the country has detected a total of 79 human cases of infections in 28 cities and provinces, including 38 fatalities, the department said.
Vietnam reported 23 human cases of bird flu infections and 43.9million fowls killed or culled in the first outbreak lasting from December 2003 to March 2004. The respective figures were 4 and 84,000 in the second outbreak lasting from July 2004 to August 2004, and 52 and 44.5 million in the third outbreak starting from mid-December 2004.
To prevent potential new outbreaks, Vietnam will start vaccinating poultry, especially waterfowls in high-risk areas, against bird flu viruses, including the H5N1 strain, in August 2005. The country will offer raisers financial assistance of some 600 Vietnamese dong (nearly 4 US cents) for each fowl vaccinated.
PARIS, June 8 (Xinhuanet) -- France has done a lot of work to prevent a possible massive spread of bird flu to human beings, French government health consultant Didier Houssin said on Wednesday.
According to the World Health Organization (WHO), the bird flu virus has acquired the capacity to be transmitted to human beings, although its animal-to-human and human-to-human transmission capacity is still limited at the current stage, said Houssin.
Hospitals across France are now well-prepared to host a 10- to 46-percent increase in patients in case of a possible outbreak of the virus among humans and a large team of medical personnel is ready to render home services, he said.
France currently has a reserve of 13.8 million doses of antiviral drugs and more is under production, he added.
Moreover, the country has purchased about 40 million doses of vaccine and more than 10 million masks, which will be ready for use by 2006, when maneuvers against a massive bird-flu outbreak among humans will be staged, he said.
According to reports, H5N1 bird flu has caused 54 human deaths since 2003. It is yet to know what changes the virus has experienced in birds before it was transmitted to humans.
Fearing that the virus might become adapted to human bodies, the WHO has asked countries around the world to adopt preemptive measures against massive outbreaks among humans.
Avian influenza has always posed a serious threat to poultry producers in the Mid-Atlantic states and the DelMarVa peninsula, home to some of the nation's most prolific production centers.
And recently, both the World Heath Organization and the United States' Centers for Disease Control in Atlanta have expressed serious concern about the possibility that an outbreak of avian influenza H5N1 currently affecting southeast Asia could mutate into a form that could jump species and present a global public health threat.
To help disseminate factual information about the disease as both a threat to agricultural productivity and human health and well-being, the Center for Public and Corporate Veterinary Medicine on the Maryland Campus of the Virginia-Maryland Regional College of Veterinary Medicine will present an avian influenza informational symposium from 1 to 5 p.m. Tuesday, June 14, at the Avrum Gudelsky Veterinary Center on the University of Maryland campus.
"Just in time: Avian Influenza" will feature a number of state and federal experts and offer three continuing education credits for veterinarians.
The four-hour presentation will include an opening presentation on the symposium and the meeting by Katherine Feldman, assistant director of the Center for Public and Corporate Veterinary Medicine, Maryland Campus.
Daniel Perez, assistant professor, and a scientist considered one of the world's leading experts on avian influenza, will present "Jumping influenza viruses from ducks to humans" at 1:15 p.m.
Nathaniel Tablante associate professor and extension specialist - poultry, will present "Clinical presentation and pathobiology of avian influenza" at 1:50 p.m.
Tracy DuVernoy, of the USDA's Animal and Plant Health Inspection Service (APHIS) will present "USDA involvement and response to H5N1 highly pathogenic avian influenza in Asia" at 2:25 p.m.
Tom Jacobs of the Maryland Department of Agriculture will present "Avian influenza and emergency response in Maryland" at 3:15 p.m.
Dr. Jean Taylor of the Maryland Department of Health and Mental Hygiene will present "Pandemic influenza planning in Maryland" at 3:50 p.m.
A panel discussion featuring different presenters will conclude the afternoon presentation.
Registration is limited to 40 people and costs $25. For more information, contact Katherine Feldman at (301) 314-6820 or email her at kfeldman@umd.edu.
Contact: Jeffrey Douglas
jdouglas@vt.edu
540-231-7911
Virginia Tech
http://www.vtnews.vt.edu
BEIJING, June 10 (Reuters) - The World Health Organisation urged vigilance against a deadly strain of bird flu on Friday, warning that the disease scientists say could cause a global pandemic was moving in new and unpredictable ways.
Shigeru Omi, the WHO's regional director for the Western Pacific, made the comments in Beijing a day after China said it had discovered the H5N1 strain of bird flu in the far western province of Xinjiang, its second outbreak in as many months.
"All of this shows the virus remains unstable, unpredictable and very versatile," Omi told a news conference."It may have new and unpleasant surprises in store for all of us."
Avian flu is highly infectious in birds and does not spread easily in humans, but scientists fear it could mutate into a form better able to pass from animals to people, possibly triggering a pandemic that they say would likely start in Asia.
H5N1 first surfaced in poultry in Hong Kong and China eight years ago and has killed at least 37 people in Vietnam, 12 in Thailand and four in Cambodia.
Omi said the virus appeared to be moving in different ways in different places, apparently becoming more transmissible but less fatal in Vietnam while becoming more pathogenic in China.
"It is very difficult to predict what will happen under these circumstances, but the best thing I can say is to keep our vigilance high," he said.
There were at least two cases, in Thailand and Vietnam, where the disease was likely to have passed between humans, Omi said, but added "there is no evidence for effective human to human transmission yet".
Sharing information, making virus samples available to WHO laboratories and improving animal husbandry practices were all key to preventing a pandemic, Omi said.
But the disease usually appears in rural areas where surveillance is harder and involves both health and agriculture sectors, making a coordinated response a challenge.
The World Health Organisation was still awaiting a response from China on its proposed joint mission to affected sites, but said it was satisfied with Beijing's response to the outbreaks.
"The China authorities are very serious about avian influenza. Their response has been very strong," WHO representative Hank Bekedam said.
China said the outbreak in domestic poultry in a far northwestern part of Xinjiang had been brought under control through a combination of culling, quarantines and vaccination.
The government "ordered all the poultry markets in Tacheng City to be closed down and had 17,014 birds slaughtered in the affected area, most of them chickens and geese," the official Xinhua news agency reported.
"Roads to the affected area have been blocked and traffic has been closed," it said.
Last month China reported an outbreak in wild birds in the northwestern province of Qinghai, prompting an extensive vaccination campaign.
The bird flu outbreak in distant Xinjiang should be a cause for concern in Hong Kong, a Hong Kong University scientist warned Thursday.
Lam Tai-hing, head of HKU's Faculty of Medicine's community medicine department, said that although the outbreak may not have an immediate impact, the risk to Hong Kong exists.
He explained that migratory birds are the main worry as they could spread the deadly disease to other parts of the mainland, Hong Kong and Southeast Asian countries.
Lam also said that, as more live chickens will be imported from the mainland during the coming Dragon Boat Festival, Hong Kongers should be more cautious of the possible risk.
Meanwhile, Secretary for Health, Welfare and Food York Chow said Thursday that the Xinjiang outbreak will not affect the import of live chickens from the mainland.
He said the relaxation of the live-chicken import ban between June 8-11 will continue because the risk can be managed.
Earlier this week, the Health, Welfare and Food Bureau announced that the daily quota of 30,000 would be lifted to meet the surge in demand for fresh chicken over the festive period, leading to Saturday's Dragon Boat Festival.
A bureau spokesman said the decision had been made after assessing the arrangements made during the Lunar New Year.
``The risk can be controlled as the source of the exports has a stringent surveillance system,'' Chow said Thursday.
Inspectors will examine 20 live chickens randomly from each truck importing the birds to Hong Kong.
The bureau spokesman said the territory has not imported any live birds or poultry meat from Xinjiang.
``Hong Kong imports it chickens mainly from Guangdong so it isn't a problem.'' the spokesman said.
The government released a statement late Wednesday saying mainland authorities had suspended poultry exports from Xinjiang after discovering bird flu there.
China's Ministry of Agriculture informed Hong Kong authorities that more than 13,000 geese had been culled at a farm in Xinjiang after 460 died and tested positive for the H5N1 avian flu virus, an AFP report said Thursday.
Xinjiang officials have vaccinated flocks at poultry farms and the situation is under control, according to the statement.
Fears of bird flu in China were rekindled after Beijing reported in late May that more than 1,000 wild birds, including geese and gulls, were killed by the H5N1 bird flu strain in Qinghai province, which borders Xinjiang.
But authorities said it was an isolated outbreak, the report said.
The Southeast Asian kingdom of Brunei has reported its first cases of bird flu.
Around 100 chickens were found to have the H5N1 virus during a routine check of a poultry farm, which was immediately quarantined.
The birds were gassed to death and their carcasses destroyed.
Officials say people living or working on the family-run village farm are being tested for bird flu infection.
The results of the tests could be known as early as Saturday.
Brunei, on Borneo island, is home to about 350,000 people.
Bird flu has been detected in poultry in neighbouring Malaysia and Indonesia, but no cases of human infection have been reported there.
More than 50 people have died from H5N1 in Vietnam, Thailand and Cambodia.
World health experts fear the virus could mutate, triggering a human flu pandemic that could kill millions of people.
Bandar Seri Begawan - Around 100 chickens had to be gassed and destroyed by veterinary experts following bird flu ‘outbreak’ that occurred in a poultry farm in Kg Kulapis.
A two-km buffer zone was quickly created in the suspected site as experts and personnel from different agencies moved in.
Members of the Royal Brunei Armed Forces together with the Royal Brunei Police Force strictly enforced a quarantine zone around the affected area as veterinary doctors collected samples from affected chickens. Tests identified some 100 chickens were infected by the H5NI virus.
A group of Agriculture Department personnel in their Personal Protective Equipment or PPE's then moved into the controlled zone and began gassing the affected birds using carbon dioxide.
Vets continued to gather samples that would be brought to the Veterinary Lab for further analysis. They will also be preparing samples to be sent to labs in Australia, Japan and Hong Kong.
Shortly after the culling process was over, the decontamination and disinfection team moved in and began to `clean' the area with disinfectants. This included the clearing of any affected organic material or waste left behind by the affected livestock. Waste, eggs and even food left behind in the chicken enclosure are capable of spreading the virus even further.
The culled chicken was moved to Kg Parit to be destroyed. The Fire Services Department's Hazmat team also set up a decontamination area.
Strict enforcement inside the buffer zone ensured those that were in direct contact with the affected livestock had to go through a Portaflex decontamination shower.
The-scenario that happened yesterday was actually a dry run or drill called 'Operasi Serama' for the task force that has been set up for a worst case scenario should a bird flu epidemic is detected in the country.
The threat of bird flu in several countries in Asia since 2004 has prompted the Agricultural Department at the Ministry of Industry and Primary Resources as well as other ministries and departments to prepare an action plan to curb any possibility of the bird flu virus from entering Brunei and also procedures to be implemented if the epidemic reaches the country:
Among actions that are already in place include the prohibition of importation of chickens or birds as well as its products from affected countries and high-risk areas.
The Agricultural Department has been continuously monitoring chicken hatcheries in farms, private houses and pet shops.
At the same time, the government has set up a National Task Force Committee to tackle Zoonatic Diseases, chaired jointly by Permanent Secretaries at the Ministry of Industry and Primary Resources and Ministry of Health.
The action plan that has been drawn by the committee will act as a guideline should there be any bird flu outbreak.
It was this action plan that was implemented yesterday morning with the cooperation of the Royal Brunei Armed Forces, Royal Brunei Police Force, Ministry of Health and the Fire Services Department.
The drill that began at 8.30am ended around 10.45 am. A post mortem meeting was held shortly after the exercise that discussed issues and problems that arose during the operation. The meeting was aimed at ironing out glitches in the procedure.
-- Courtesy of Radio Television Brunei
>> According to the New China net reported that, the Mongolian emergency case bureau person in charge said, since June, in the above two counties several households herd common people's sheep has appeared gives off heat, losses of appetite and so on the symptom, after 23 days one after another died, at present more than 20 herdsmen's flock of sheeps have received the infection, but had not discovered the person infects case of illness. (Abundant news boxun.com) <<
The deaths of 400 sheep in two counties in Mongolia are cause for concern. There was not enough detail or clinical data to indicate the cause of death, but H5N1 bird flu should be considered. Many of the bar-headed geese that winter in northern India and fly to Qinghai Lake Nature Reserve continue fly north to southern Russia, flying over Mongolia.
Reports on the H5N1 outbreak in Qingahi have indicated that over 8000 birds have died. Deaths of domestic animals, including 84 sheep were reported previously.
If the sheep in Mongolia have died from H5N1 infections, then the earlier boxun.com Qinghai reports would be more credible. It would also confirm H5N1 infection of sheep, which hasn't been reported previously
More detail on the deaths of the sheep and any associated human cases would be useful
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