Reports and Alerts on SARS, Flu and Pandemic Prevention.
CHERRY HILL, New Jersey (CNN) -- Medical authorities said Sunday they suspected that a woman attending a convention in suburban Philadelphia died of pulmonary bacteria pneumonia -- and not meningitis, as initially thought.
Joanne Hemstreet, 45, of Kingston, Massachusetts, died early Sunday at Kennedy Memorial Hospital in Cherry Hill, New Jersey, according to hospital officials, at least four days after coming down with flu-like symptoms.
"We don't know the exact cause of her demise at this time, though ... this looks like a case of Pneumococcal pneumonia with a very severe complication," said Dr. David Condoluci, the hospital's chief of infectious diseases.
The hospital admitted six women and one man staying at the same Hilton Hotel in Cherry Hill, about 10 miles southeast of Philadelphia.
Five suffered from flu-like symptoms and two from pneumonia, but none had the same severe form of pneumonia that killed Hemstreet, according to medical authorities. All were in stable condition Sunday.
"Most of these cases would probably not be admitted under normal circumstances, but they're being admitted for observation because of what's happened here, and [for] treatment until we have a little better idea of what's happening," Condoluci said.
Hemstreet, one of 400 Cendant Mortgage employees attending their annual national sales meeting, was already suffering from headache, fever, chills, vomiting and shortness of breath when she checked into the hotel Wednesday, said Condoluci.
On Saturday afternoon she told co-workers she felt worse and retired to her room. She was taken to the hospital by ambulance around 8:15 p.m. ET, the hospital said in a statement.
Over the next four or five hours, she developed a rash over her entire body, her blood pressure dropped and she went into shock before dying at 3:14 a.m. Sunday, Condoluci said.
Doctors initially believed Hemstreet's death was caused by an infection of pneumococcus or meningococcus bacteria, said hospital spokeswoman Nicole Pensiero.
Meningococcus bacteria can cause meningitis -- or the often fatal swelling of the brain -- as well as pneumonia, arthritis and bacteremia, or bacteria in the blood. Transmitted by coughing, sneezing, nasal discharge and saliva, it takes one to 10 days for symptoms to appear after exposure.
Pneumococcal disease -- caused by the bacterium Streptococcus pneumoniae, or pneumococcus -- is the leading cause of death from vaccine-preventable bacterial disease in the United States. The bacteria can cause pneumonia, blood stream infection and meningitis.
Hoping to stem a potential meningitis outbreak, hotel officials quarantined the building from 2 a.m. to 10 a.m. ET Sunday, said Steve Kronic, Hilton's senior vice president. No one had checked in since the hotel reopened, a hotel desk clerk told CNN around 6 p.m.
Authorities urged anyone who had direct contact with Hemstreet, as well as with other hotel guests, to seek medical attention.
At least 84 people treated at Kennedy Memorial Hospital -- including the emergency room staff -- were given prophylactic antibiotics as a precaution, Pensiero said.
While they believed Hemstreet died of an aggressive form of pneumonia, doctors said they were still concerned that her rash might have been caused by the type of bacteria that causes meningitis. A definitive diagnosis, they said, should be available Tuesday or Wednesday.
Officials said they were also testing for Legionnaires' disease. The first known cases of this disease broke out in July 1976 during a Pennsylvania American Legion convention at a Philadelphia hotel.
A total of 221 people contracted the illness and 34 died, including 29 Legionnaires or their family members. Symptoms of the pneumonia-like illness begin appearing two to three days after exposure.
But Condoluci said urine samples taken from the seven hospitalized Cendant Mortgage employees seemed to indicate they had "a flu-like illness," not Legionnaires' disease.
An Internet newsgroup commentator on this case made these salient points:Hilton New Jersey 2002 = Metropole Hong Kong 2003?
Very likely. We now have a rash connection.
Dr. Chao of Singapore had passed away of Sars. But unlike most of them, he developed rashes over his body, back and limbs.
Then one recalls an SCS post: "First Case of Sars" regarding a mystery virus which caused flu-RASH-pneumonia and rapid death in an American woman in 2002.(see story above)
"on 12/02, Joanne Hemstreet is dead and more than 80 others have been treated at hospital after falling ill at a convention held at the Hilton Hotel in Philadelphia in the US over the weekend."Furthur research revealed that she suffered all SARS symptoms caused by A STILL UNEXPLAINED MYSTERY VIRUS.FACTS:
She had flu-like symptoms for 4 days before she died She got all Sars signs: fever, shortness of breathe, aches, vomiting She developed a rash [like Dr. Chao or 10% of Sars cases] She developed pneumonia within the 4 days of flu She died within 24 hours of hospitalization 2 of 8 hotel guests admitted for flu-like symptoms developed pneumonia Hilton Cherry Hill was quanrantined and sterilized Doctors confirmed the cause a "virus" [see reports below] Despite initial bioattack fear, virus origin remains a mystery Fact: Dr. Chao was in the US appx one week before onset of fever. Like Ms Joanne of NJ, he developed first the fever, then a rash, and died rapidly from a manageble state to death in less than 24 hours.
And more on this strange case...
CHERRY HILL, N.J. -- Health officials said a convention-goer who died over the weekend had a form of meningitis, but that so far her case doesn't appear to be part of a larger outbreak.
Joanne Hemstreet, 45, of Kingston, Mass., had been suffering from a viral, flu-like illness for about two days before becoming seriously ill Saturday night, officials said. She was taken to Kennedy Memorial Hospitals-Cherry Hill and died early Sunday.
Authorities said Sunday evening the death was caused by fulminant bacterial pneumonia, an aggressive infection that usually starts after an upper respiratory tract infection such as influenza damages the lungs.
Yesterday morning, they said she was also infected with Neisseria meningitidis, a bacteria that causes rapidly worsening infections. It is not as contagious as viral meningitis, but occasionally causes small outbreaks among people in close contact, such as in college dormitories and in military barracks.
Lorraine Hynes, a spokeswoman for the Camden County Department of Health, said yesterday it didn't appear that there was an outbreak of meningitis and that the woman probably had the disease before she arrived at the convention.
Hynes said a state health department lab was working to confirm the presumptive meningitis diagnosis and results could be available later yesterday.
Massachusetts Department of Public Health spokeswoman Roseanne Pawelec said the department has contacted Hemstreet's family and close friends in Kingston and given them antibiotics. That includes her two children, her sister and her fiance, she said.
Relatives in Florida whom Hemstreet had recently visited were also contacted and are taking antibiotics, Pawelec said.
"Meningitis is not spread through the air. It's primarily spread by saliva," Pawelec said, adding that secondary cases of the disease are rare. Meningitis is most commonly spread by regular close, personal contact with an infected person, such as shared drinking glasses or eating utensils, she explained.
Hemstreet was attending a national sales convention at the Cherry Hill Hilton with about 500 other employees of Cendant Mortgage. Seven other convention-goers remained hospitalized yesterday morning with flulike symptoms.
Dr. David Condoluci, chief of infectious diseases with the Kennedy Health System, said the seven had developed fevers, chills, sore throat and general weakness, and two have pneumonia. They were given antibiotics, either rifampin or ciprofloxacin, and were admitted for further treatment and observation as a precaution. None was in critical condition.
"Most of these cases probably would not have been admitted under normal circumstances," he said. Convention-goers and Hilton employees who were in close contact with Hemstreet, and might have shared drinking glasses or eating utensils, were also given antibiotics as a precaution.
The others who went to the hospitals could have suffered from other wintertime bugs, Hynes said.
"If I was closely associated with this woman for a few days and I had a cold, I'd be in the hospital," she said.
"It was important to us to take an aggressive stance in addressing this case, since there was the potential that many people may have been impacted," said Condoluci.
None of the seven people hospitalized -- a man and six women -- were known to be in close contact with Hemstreet during the convention.
About 80 other people, who might have had contact with Hemstreet at the convention, went to the hospital emergency room for evaluation, hospital spokeswoman Nicole Pensiero said.
Hemstreet developed a fever, headache, vomiting and shortness of breath Saturday and was rushed to the emergency room that night.
Condoluci said Hemstreet's initial flu-like illness worsened to pneumococcal pneumonia, which is not generally contagious. In her weakened condition she apparently also developed another infection.
Despite antibiotic treatment and other measures, within four to five hours she developed a rash, her blood pressure plunged and she went into shock, Condoluci said. She died at 3:14 a.m.
Health officials initially had worried that the outbreak was caused by anthrax or Legionnaires' disease.
Legionnaires' disease, caused by a bacterium that grows in water and can be spread through air-conditioning ducts, takes its name from a July 1976 outbreak that killed 29 people at the Pennsylvania American Legion convention at a hotel in nearby Philadelphia. It causes pneumonia-like symptoms.
The hotel was quarantined from about 2 a.m. until 10 a.m. Sunday. A fur sale went on as scheduled at the hotel Sunday morning, and most of those at the Cendant meeting quickly left the Hilton once it was reopened.
Condoluci said hotel guests who did not have close contact with Hemstreet and have not shown any symptoms -- such as fever, chills, sore throat and general weakness -- were unlikely to get sick. "They should not worry. They should be fine," he said.
And, finally, this followup report on the mysterious 2002 New Jersey outbreak:
CHERRY HILL, N.J. (AP) ---- Eight people who were hospitalized with flu-like symptoms during a weekend convention do not seem to have the virus that killed one of their colleagues, authorities said Monday.
Joanne Hemstreet, 45, of Kingston, Mass., suffered from a flu-like illness for about two days before becoming seriously ill Saturday night, officials said. She died early Sunday at a hospital.
Dr. David Condoluci, head of infectious diseases with the Kennedy Health System, said the death was caused by pneumonia and meningococcemia, a blood infection caused by a bacteria that can also cause meningitis.
That bacteria, Neisseria meningitidis, exists harmlessly in the throats of about one-fourth of the population, but can cause serious illness if a person becomes sick with something else, state epidemiologist Eddy Bresnitz said.
Authorities said there were no signs of a widespread outbreak. Bresnitz said there is no indication that an environmental cause like bad food, water or air would have caused the disease.
Those who have been hospitalized all attended a national sales conference for Cendant Mortgage at the Cherry Hill Hilton with Hemstreet. They have flu-like symptoms, but authorities said they did not seem to have the deadly meningococcemia and were taking antibiotics.
All were in good condition Monday and were expected to be released within two days, when more conclusive test results are returned.
Another Internet commentator made this concluding statement:
For those who have no clue about the long nasty pioneering history of US/UK biochemical weapons, New Jersy hosts some of the most advanced military biochemical warefare research/production facilities for anthrax, smallpox, and possibly this SARS. CIA also run a host of biochemical warefare facilities around Washington DC. Anglos tested their biochemical weapons initially in North American Indian reserves both in USA and Canada and in China North East, via their pre-1942 Jap pals. Later all the Jap war criminals responsible for testing/deploying biochemical agents on Chinese/Russians were pardoned by US in exchange of their test/research results. US shipped these Jap war criminals back home to put them in a lab called "731", named after the notorious Jap biochemical army unit, in Maryland to conduct further research/testing of biochemical weapons.
A new wave of SARS in Asia probably would cause some companies to "modestly" reduce investments there. But few companies would be likely to pull plants out of China unless SARS debilitated or killed large numbers of workers, the report predicts.
Sizable outbreaks in the United States and Europe, which were not greatly affected by the first wave of SARS, would probably generate more public fear than new outbreaks in Asia. "The economic costs of SARS probably would skyrocket if fears grew about the transmission of the disease in planes or on objects," the report says. Because of the high political and economic stakes, "some jurisdictions probably would try to fudge health data in an effort to avoid official health warnings or get them lifted more quickly."
[See also: National Intelligence Council report on SARS
http://www.cia.gov/nic/pubs/other_products/SARS/ICA03_09.htm
THE LAST decades have seen a resurgence of the disease influenza in a variety of forms. They seem to start somewhere in Southeast Asia - China and Hong Kong in particular - and spread elsewhere.
First was the pandemic of the 1957 Asian Flu. It subsided in time to re-appear as the Hong Kong Flu of 1968. We thought we were relieved of it, till it struck again in various avatars during the period 1986-97.
Then we had the virus that produced the Severe Acute Respiratory Syndrome or SARS. As it subsided, we had the outbreak of the Bird Flu of Thailand, which too was detected in nearby countries, including a few reports from Pakistan. Thankfully neither SARS nor the bird flu hit India in any significant manner.
But we still recall the pictures of men and women in the Far East going around with facemasks to protect against SARS inhalation, and the sad scenes of millions of chicken being culled in Thailand to rid the spread of the Bird Flu.
Gratifyingly however, we too have to become much more efficient in containing it through effective screening of people in the airports and national borders and quarantining suspected cases, eliminating the carrier birds through large scale culling, and recommending the use of protective masks to stop the infection.
These are small steps but heroic ones; recall that SARS was detected as a contagion in China in mid-2002, but by mid-2003 the WHO could declare that the outbreak was over.
Why does the flu bug invariably arise from birds in the first place and how does it then jump on to humans?
A study of this riddle was undertaken by looking at samples of the pathology material of humans, stored in hospitals since the time of the Hong Kong Flu epidemic of 1918. Genetic analysis of the infective agent present in the samples revealed it to be a virus, and one that affects chicken and ducks.
Further analysis showed that the virus had undergone genetic modifications, or mutations that helped it jump from birds to barnyard animals, and thence to humans. What made this avian to porcine to human route possible? It appears to be the lifestyle adopted by Chinese farmers, who lived in huts and tenements, with chicken and ducks in the yard and pigsties in the basement.
This riddle of transmission was solved about ten years ago at the Centre for Disease Control and Prevention (CDC), Atlanta, GA, USA, and the heroines who cracked this puzzle were Nancy Cox and Kanta Subbarao.
Incidentally, this research effort highlights the importance of storing samples in the pathology labs of hospitals and research centres. Next time you see bottles containing tissues and organs stored in smelly formalin at these places, show them more respect!
We have known Kanta Subbarao since her school days at IIT Kanpur, where her father, the distinguished material scientist Professor EC Subbarao and I were colleagues. We are in close touch with the family since then. We thus feel personally proud of her! Her mother Kamala was an affectionate and indulgent hostess. Her sister Veni and my wife taught at the same school in campus. Her brother Ram used to drop by our home occasionally.
Kanta went on to get her MBBS at CMC Vellore, and moved to the US. Her husband, Siddharth Mahanty too was a campus child of IITK, son of the late Professor Jagdish and Saroj Mahanty. He too is a medical researcher, focusing his attention on another scourge, malaria.
Kanta has been `caught by the bug' since those days, and concentrated her research on the flu virus - the mechanisms it uses to change its makeup and the ways to contain it. Her latest work, published in the April 2004 issue of Journal of Virology, has hits the headlines of all newspapers across the US and Europe. And for good reason.
When bacteria infect us, we use one of two ways to rid ourselves of the attack. One is to use antibiotic drugs. These choke the biochemical reactions that help the bug grow and multiply.
The other is to vaccinate ourselves with the bacterium itself - dead ones, or a small, below-danger, amount of live ones, or even bits of the broken down bacterium.
The immune mechanism in our body recognises the intruder, and makes specific molecules called antibodies. The antibody molecule is a shape-fitter that recognises the face or the external surface of the bug. Having done so, it clings to this surface (glove in hand, key and lock) and brings down the whole bacterium, and the clearing squad machinery rids the body of the alien. Viruses, unlike bacteria, do not live independent lives; they grow by using the biochemical machinery of the organism they colonise. This is why the usual antibiotics do not work against viruses, and special anti-viral drugs need to be formulated. Fortunately however, vaccination does work. Vaccination eliminated small pox and will rid the world of polio shortly. If only we had a vaccine against flu and SARS!
This is where Kanta's paper gives us hope. It is classic Jenner revisited. She obtained a sample of SARS virus from CDC, and injected mice with sub-lethal doses. Within a week, the mice cleared the SARS virus out of their system. They fought the virus and won, using pre-existing immunity devices.
In the process, they also recognised the face of the SARS and made antibodies against it (for future use). The parenthesis was verified when Kanta took the same mice and injected much larger doses of SARS into them four weeks later. The mice fought and won. Third, she took serum from these mice, and injected the serum to another set of mice, which had never encountered SARS before. When SARS was injected into these `naïve' or `innocent' mice, they fought the virus and came out healthy.
Voila! we now have an animal model to help the vaccinologists who are working towards developing the anti-SARS and anti-flu vaccines! Yes, mice are not men, not even monkeys.
But we have a lead. If the vaccine works on mice, we can definitely think of clinical trials on humans. No wonder this breakthrough by Kanta Subbarao was splashed all over the media.
Kanta and others realise, of course, that in order to survive the wily virus continually reorganises its genetic make up, and changes its face in each of its avatar.
Two molecules, hemagglutinin (H) and neuraminidase (N), on the external surface of the flu virus, serve as its identification marks. A vaccine that recognises the shapes of H and N would be very effective in killing the virus. But, during each of its mutations, the virus changes the shapes of H and N ever so subtly.
To date, there are about 15 different Hs and 9 different types of N. Understanding how the virus reorganizes its genome to generate this diversity, and how it interleaves its own genes with those of its ``hosts'', so as to jump from bird to cattle to humans is a major challenge. And Kanta says she is game to help crack this puzzle as well. Make way for the flu buster!
John M. Barry presents evidence in his new book, The Great Influenza: The Epic Story of the Deadliest Plague in History, that this plague began in Haskell County, Kan.
Haskell County, Kan.?
Yes! If Barry's conclusion is true, it carries no onus for our great state or that southwestern Kansas county. Rather, Barry documents the high practice standards of Dr. Loring Miner, who identified the first cases of the virulent influenza in February 1918, the last year of World War I.
Miner aggressively sought help from colleagues in combating the killer. He first contacted the U.S. public health system for help, and later to report the cases he had treated, although influenza was not a reportable disease.
According to accounts at the time, the influenza epidemic of 1918-19 killed 21 million people. But today, epidemiologists estimate the pandemic killed at least 50 million and as many as 100 million among the Earth's then nearly 2 billion inhabitants.
Barry used Haskell County newspaper reports to establish that Miner's cases were the first reported, and he noted how newly inducted Haskell County men moved to Camp Funston on the Fort Riley reservation.
The mortality was fairly low in Haskell County and at Funston. But as the virus passed through many hosts around the world over the weeks and months, it became highly virulent, often killing within hours of the first symptoms. Health workers were stricken. As the numbers rose, hospitals, morgues and, eventually, streets were filled with putrefying corpses.
I was excited by Barry's story, so I made some calls.
Olga Montgomery, librarian at the Finney County Historical Society in Garden City, said Barry's story was new to her. She recalled hearing that the great flu epidemic started at Camp Funston, which is generally accepted history.
I had a delightful phone conversation with Katherine Hart, granddaughter of Dr. Miner and daughter of the late Dr. Oliver Miner, who practiced medicine and surgery for 35 years in Garden City.
She said, "I am sure Dad knew the story," but she first heard about it when she was called by Barry's New York editor to check facts based on the author's interviews with Mrs. Hart's aunt.
She has read Barry's book and found small inaccuracies, including the colorful old story -- she says it is just that, a story -- that Dr. Miner's patients would rather have him drunk than other doctors sober.
Much history and water have been mined in southwest Kansas. There is still some of each left, even after Barry's startling story about how the 20th century's single greatest human catastrophe -- killing about as many as the two world wars -- began in Haskell County and was identified there by a darn good Kansas doctor.
(Bill Roy is a retired physician and former member of Congress who represented northeast Kansas)
VANCOUVER : Canada laid plans Monday to slaughter 19 million chickens, turkeys and ducks in a bid to halt highly contagious bird flu, which has now infected 18 farms near Vancouver.
Agriculture Minister Bob Speller told reporters all poultry on about 600 commercial farms and small domestic farms in western Canada would be killed.
"We are dealing with a very serious and highly contagious disease," he said in Ottawa.
"These are necessary measures to stop any further spread and protect the long-term viability of the poultry industry."
Although several farm workers have contracted the disease, H7 avian flu found in Canada is considered far less dangerous to humans than a strain that killed 23 people in Asia this year.
Speller said meat from slaughtered birds that are shown by tests to be free if of flu will be sold for human consumption, while carcasses from flocks where the virus is found will be incinerated.
Affected farms are all in the Fraser Valley, a rich band of farmland contained by mountain ranges that extends inland from the western Canadian coast.
Speller's announcement was greeted with resignation in an industry, struggling to shake off the stigma of bird flu, which is worth 850 million dollars (650 million US) in British Columbia province alone.
"This is the most difficult decision we can make," said David Fuller, chairman of Chicken Farmers of Canada, which represents 2,800 producers.
"Now, we're at the point where the only option is to clean everything out and start over, rather than going in incremental steps that could cause even more hardship on us all."
But producers on smaller organic and free-range farms, however, were furious.
They blame factory farming methods, in which thousands of birds are couped up in small areas for the spread of the virus, and note that none of the infected birds have been found on farms where birds are less crowded.
"We feel they're the creator of this problem and we're dragged into it," organic farmer Fred Green told a Vancouver radio station.
The first case of the H7 avian flu was detected on February in a farm in Abbotsford, near Vancouver.
British Columbia produces about 12 percent of all Canadian poultry. About 80 percent of the province's production is from the Fraser Valley.
The European Union last week lifted a blanket ban on poultry imports from Canada and the United States, leaving restrictions only on fowl from affected areas, but Canadian poultry is still banned in a host of other countries.
Though they stress that Canada's variety of bird flu is not a threat to humans, officials at the British Columbia Centre for Disease Control are mindful the disease can mutate within humans.
The so-called Spanish Flu of 1918, which killed millions of people around the world, is thought to have started as a bird flu.
Q: Are there different kinds of avian flu?
A: There are many different forms of avian, or bird flu, a contagious disease caused by viruses that normally infect only birds.
The first type, known as a low pathogenic form, causes mild illness in birds, and is often detected by a drop in egg production. The more severe kind, known as highly pathogenic, spreads rapidly and has a high mortality rate, often wiping out entire flocks. The H7N3 virus in the Fraser Valley is highly pathogenic. Several strains have spread from chickens to humans. H5N1 (which is now rampant in Asia) has proved fatal. An outbreak of the H7N7 virus in the Netherlands last year caused the death of one veterinarian and mild illness in 83 poultry workers. The H9N2 strain caused mild illness in two children in 1999. H7N3 has made two people ill in the Fraser Valley. Both had mild symptoms, including pink eye, and both recovered fully.
Q: How are infected humans treated?
A: A variety of drugs are available that are effective regardless of the strain of virus. The infected workers in B.C. were treated with oseltavimvir and quickly recovered.
Q: What are the signs of sickness?
A: The symptoms of avian flu in humans can include fever, cough, sore throat, muscle aches, eye infections, pneumonia, acute respiratory distress, viral pneumonia.
Q: Why are health authorities so concerned?
A: Avian flu has proved fatal to humans in only a handful of cases (23 deaths in Asia, one in Europe), but health authorities worry that if a human who already has flu gets infected with avian flu, the virus could mutate, turning into a disease that spreads as rapidly through the human population as it does through chickens. That would create a pandemic that could overwhelm the health system. There is some evidence that the 1918-1919 pandemic of Spanish flu may have come from birds.
Q: Can you get it from eating chicken?
A: Avian flu has never been transmitted to humans from eating poultry meat or eggs. The virus is killed by a temperature of 60 to 70 degrees Celsius. However, the virus can be contacted from live birds or by handling the carcasses of infected birds. There is a low risk from raw poultry meat, and people are advised to wash their hands and kitchen utensils whenever handling chicken.
Q: Why kill all chickens?
A: Infected chickens must be killed immediately to stop the virus from spreading. A broader cull of healthy chickens is called for when the virus is spreading rapidly to deny the virus a host. Emergency workers liken it to putting out a fire by removing the fuel.
Q: Are free-range chickens affected?
A: The initial outbreaks of the disease in the Fraser Valley were all found in large chicken farms, where flocks of tens of thousands of birds were housed together in barns. However, subsequent tests found avian flu had also spread to small back yard flocks. All chickens are susceptible.
Q: How do chickens get infected?
A: Avian flu is common in wild birds, particularly ducks, which aren't killed by the virus. It is speculated that wild ducks infect domestic poultry either through direct contact on farms or through infecting water supplies.
Q: How is avian flu spreading in the Fraser Valley?
A: Authorities have not yet determined the route by which the virus is moving from one farm to another, but the best guess is that humans are carrying it on their boots, clothes or on farm equipment. Strict movement controls are now in place.
Q: How are infected chickens disposed of?
A: The birds are killed by gassing them. The carcasses are either trucked to an incinerator or they are composted. -
IOWA CITY (AP) -- Farmers are flirting with an avian flu pandemic by raising chickens and hogs on the same farm, an influenza expert says.
"I would encourage authorities to think about why people are putting hog houses and chicken houses down at the same properties," said Robert Webster of St. Jude Children's Research Hospital in Memphis, Tenn. "It doesn't make sense."
He said if farmers don't keep chickens and turkeys away from hogs, a repeat of the 1918 flu epidemic that killed millions of people worldwide is possible.
Mary Gilchrist, a microbiologist who heads the University of Iowa Hygienic Laboratory, said the state has enough farms that raise both animals to warrant a state ban on the practice.
University of Iowa scientist Kelley Donham, a veterinarian, said "it would be very unusual" in Iowa to see chickens or turkeys raised beside hogs.
State officials haven't tallied how many chicken and hog operations are in the same vicinity. However, state permits show that it has been the case in the Clarion and Alden areas.
Scientists have long believed that hogs are the primary carriers of the virus after it leaves birds and before it gets to humans.
Liz Wagstrom of the National Pork Board said there is still a variety of scientific opinion on hogs' possible role in the spread of avian flu.
Livestock-confinement operators work to keep viruses out of their buildings and many have launched elaborate "biosecurity" efforts that include showers for workers before and after they leave buildings.
In Asia, where recent bird-flu outbreaks have been international news, the viruses sometimes jump straight from birds to people.
Europe is 'hardly' ready for the 'definite probability' of a flu pandemic wiping out tens or even hundreds of thousands of lives.
This was the prophecy of doom from Brussels on Wednesday, announcing talks with EU governments towards preparing Europe's defences for an eventual serious outbreak of influenza.
One senior European Commission official, speaking on condition of anonymity, said a pandemic was "something which I'm afraid has a definite probability of happening".
"Are we prepared now?"
"Hardly."
A pandemic could, he said, mean the death of "tens of thousands or even hundreds of thousands" of people in Europe.
In an infamous outbreak of what became known as 'Spanish flu' in 1918-1920, 15 to 20 million people died in Europe, and 40 to 50 worldwide.
And something like the recent outbreaks of avian flu in Asia and the US could well be the source of a future human pandemic.
"We were lucky this time," the official said. But with poor health controls in South East Asia fostering an ideal breeding ground for another bad outbreak "we might not be so lucky next time," he added.
But the source may not even be accidental. The official said that it "cannot be exluded" for bio-terrorists to exhume victims of the Spanish flu outbreak to wreak further havoc.
"From the Spanish flu pandemic there are corpses that still have the virus. Some are buried in Siberia, in Canada, in Alaska."
"A malevolent mind could recover and release it again."
Currently the EU can only provide for around a quarter of the potential needs for vaccines should there be a pandemic.
And with the current state of scientific knowledge and bureaucracy it could take six months for EU governments to react to a pandemic with appropriate jabs.
Fast-track vaccine approvals through the European Medicines Evaluation Agency is one way around this particular problem.
More broadly, the commission in its 'consultation' paper today, suggests EU capitals creating national reference laboratories for influenza, networked across the continent.
EU action may also be necessary to create 'outbreak assistance teams' of experts to help governments tackle suspected new worrying strains to nip a pandemic in the bud.
And the commission has created a blueprint for what EU health commissioner David Byrne on Wednesday called a kind of "Richter scale" defining what actions - vaccinations, isolations and the like - should correspond to what severity of outbreak.
In a seperate announcement today, the commission hailed the approval by member state governments of the EU's new European Centre for Disease Prevention and Control.
This body would provide risk assessments vital to drawing up the EU response to outbreaks.
Doctors are beginning the first test in the United States of a vaccine designed to protect people against one form of bird flu should an outbreak of the virus occur in humans. While the vaccine under study is not designed to protect against the precise bird-flu virus causing the current outbreak in poultry and in people, scientists will learn whether it protects against another strain of the virus that infects birds and people.
Physicians at the University of Rochester and Baylor College of Medicine (BCM) have embarked on an eight-month study to test an investigational vaccine in about 200 people. The study is being done at the request of the National Institute of Allergy and Infectious Diseases (NIAID), which funds a network of institutions to test new vaccines against diseases like flu, smallpox, and pneumonia.
The study overall is led by Robert L. Atmar, M.D., associate professor of medicine and molecular virology and microbiology at BCM. John Treanor, M.D., professor of medicine and director of Rochester's Vaccine and Treatment Evaluation Unit, is leading Rochester's portion of the study.
Nurses and doctors will enroll participants in the study during the next two months, and then for six months they'll closely monitor the participants, checking their health and taking blood tests to check the immune response created by the vaccine.
While only about two dozen people worldwide have died in recent months after becoming infected from a strain of flu known as H5N1 that is normally found in birds, bird flu is seen as a potent threat to human health because of its potential to rip quickly through a human population. A typical flu virus that normally circulates in humans causes tens of thousands of deaths each year, even though most people have some immunity against this "normal" flu. But avian flu is feared by doctors because hardly anyone carries any defenses.
"People generally haven't been exposed to bird flu viruses and so they have no immunity. A bird flu virus that acquired the ability to thrive in people could cause a severe epidemic," says Treanor.
Indeed, just last month, researchers announced that the worst flu epidemic on record, the 1918 outbreak of the Spanish flu, appears to have been caused by a virus that jumped from birds to humans. That outbreak claimed anywhere from 30 to 40 million lives worldwide, historians estimate.
During the past few months, millions of chickens and turkeys, mainly in Asia, have been killed as authorities seek to halt the spread of a particularly lethal type of bird flu. South Korea, China, Thailand, Vietnam, Pakistan, Indonesia, Cambodia, Japan, and the Netherlands are among the nations that have seen outbreaks of bird flu in chickens and other birds recently. In the United States there have been outbreaks of bird flu in poultry farms in Maryland, Texas, New Jersey, Pennsylvania, and Delaware.
While a few people in affected areas have died, the real danger is if a bird flu virus infects a person who is also infected with the usual human flu. With some minor genetic modifications, bird flu could gain the potential to be transmitted from person to person.
While vaccines to protect against normal flu are widely used every year, there is currently no vaccine approved to protect against any of the more than a dozen forms of bird flu. The vaccine that Baylor and Rochester researchers are studying aims to protect people against a form of the virus, H9, which infected several people in Hong Kong in 1999. Other researchers are now developing other vaccines that could protect against the H5 form, which is responsible for most of the recent deaths in Asia.
"When you're talking about bird flu, you're really talking about many different viruses," says Treanor. "We are doing our best to be prepared for as many of them as possible."
HANOI: Vietnam's hopes of declaring an official end to its bird flu crisis at the end of this month have been dealt a blow with the announcement that a 12-year-old boy had died from the disease.
With 16 deaths from the highly pathogenic H5N1 strain of avian influenza, Vietnam is in human terms the worst affected of the eight Asian countries where the strain has been detected. Eight people have died in Thailand.
Cao Van Khay from the southern province of Tay Ninh, which borders Cambodia, died on Monday at a local hospital, five days after being admitted.
"It is a very strange case because it happened after a long time without any new H5N1 cases," Phan Van Tu, a virologist at the Pasteur Institute in Ho Chi Minh City, told AFP.
"Local authorities said the family of the boy did not raise any chickens but in their area there are dead poultry which have not been properly buried."
Tu said experts from the Pasteur Institute would carry out tests on other family members on Tuesday.
The Vietnamese government has said it has "basically" brought bird flu under control and will officially declare that it has been eradicated on March 30.
However, UN health and animal agencies have repeatedly cautioned countries against prematurely declaring victory, saying the crisis is far from over.
Anton Rychener, head of the Food and Agriculture Organization (FAO) in the communist nation, said earlier this month he was worried that Hanoi may be sweeping the disease under the carpet and deliberately withholding information.
Bui Quang Anh, director of the animal health department at the Ministry of Agriculture and Rural Development, said Saturday an investigation would be carried out into how the latest victim had contracted the virus.
"We don't understand how it is transmitted because a lot of veterinarians and other people who have been in direct contact with sick poultry did not fall ill," he told AFP.
More than 38 million poultry have died or been slaughtered across the country as a result of the virus, which was detected in 57 of its 64 provinces. However, no new outbreaks have been reported since the end of February.
On Friday, a World Health Organisation (WHO) epidemic disease expert urged Vietnamese authorities to remain vigilant.
"The main risk is that as long as there continues to be avian influenza in the region, there is still the potential for outbreaks," said Dr. Richard Brown, head of a special WHO outbreak response team.
"As long as there are sick animals, there is the possibility of human cases or a new form of the virus," he said.
The FAO and the World Organisation for Animal Health also warned Friday that Asian governments must not drop their guard.
On Tuesday Thailand postponed plans to declare itself free of bird flu and said there were fears that the disease had re-emerged in 11 provinces, dashing hopes of reviving its 1.2 billion dollar poultry exporting industry.
Besides Vietnam and Thailand, H5N1 infections have also broken out in Cambodia, China, Indonesia, Japan, Laos and South Korea.
BEIJING, April 17 (Xinhuanet) -- Chinese scientists have found that the coronavirus that causes severe acute respiratory syndrome(SARS) is also carried by foxes and cats, not just civets, according to the Guangzhou Evening Newspaper.
Lin Jinyan, the leader of a SARS control and prevention research team in south China's Guangdong Province, reported in a seminar held in Guangzhou that other wild animals were also found to carry the virus.
The team had tested thousands of people carrying SARS antibodies in 16 cities in Guangdong and found that among 994 people working in animal markets, 10.6 percent carried positive antibodies, and among 123 civet cat husbandry staff, only 3.25 percent tested positive.
Experts have also tested foxes, hedgeshrews and cats collected in the province and discovered that some carried the SARS coronavirus.
On January 16, World Health Organization experts claimed that SARS or a SARS-like coronavirus was linked to civet cats.
WHO epidemiologist Robert Breiman said it's possible that otheranimals were also involved in the spread of SARS.
After two years of state-imposed firings and staff reassignments and the suspension of one of its sister publications, the Chinese authorities have sharply stepped up their tactics in a campaign to rein in China's most widely respected news organization.
In recent weeks, alleging managerial corruption, provincial courts have handed down harsh prison sentences for senior executives of the Southern media group's Southern Metropolitan Daily and have initiated charges against the newspaper's top editor.
The provincial authorities in Guangzhou, China's third-largest city and a longstanding incubator of innovative journalism, have accused the newspaper's leaders of embezzlement. But reporters throughout the country and international advocates of press freedom see the case as a major test of China's new, reform-minded leaders' pledges to transform the country into a law-based society that tolerates greater freedom of expression.
Chinese journalists say that more than any other publications, Southern Metropolitan Daily and its sister magazine, Southern Weekend, the country's most popular weekly, have been responsible for reinventing the Chinese press, by creating a journalism that even within the constraints of state ownership and censorship pushes for the truth.
In the last several years the publications have broken news about deaths in police custody and environmental damage related to the huge Three Gorges dam pro-ject and have celebrated repeated scoops over the outbreak, cover-up and then recurrence of the SARS virus.
If the newspaper's leaders lose their judicial appeals, journalists from the Southern media group, Chinese intellectuals and colleagues from other publications say, the embattled newspaper will have also exposed the limits of free expression and political reform in their country.
In an unusually bold petition, dozens of prominent journalists and academics have decried the prosecutions as the "illegal use of all kinds of measures, including juridical methods to limit press freedoms and crack down on the media and limit its space."
If the persecution of the newspaper did not end, the signers warned that "the authority and credibility of the party and the government bodies and the legislature will be questioned, and news media whose responsibility is to push the society forward will find it difficult to survive."
Although the official charge was embezzlement of bonuses, most observers believe the most immediate apparent cause for the Southern Metropolitan Daily's legal troubles was its reporting, last December, of a suspected reemergence of the SARS virus.
Yu Huafeng, the newspaper's general manager, was recently sentenced to 12 years in prison. Li Minying, a former editor-in-chief, was sentenced to an 11-year-term. Cheng Yizhong, the paper's top editor, is under arrest and has also been charged with embezzlement.
"The convictions and trials are a severe blow to the country's media reforms," said Xiao Qiang, director of the University of California-Berkeley's China Internet project.
"It shows the leadership fears the country's press might be getting out of control, and has decided to strike back," Xiao said.
The Southern media group has curious origins for a muckraking paper that regularly irritates the authorities. It was founded in 1997 by the provincial Communist Party, just as the region's economic growth kicked into high gear.
For weeks, reporters and editors at the newspaper and at Southern Weekend have been unwilling to speak publicly about their situation for fear of inviting further trouble for their publications, or being made targets themselves.
Privately, however, several spoke of an atmosphere of fear, but also of intense pride at what their journalism has been able to accomplish.
"There is an end-of-an-era feeling about this building, filled with all kinds of feelings: depression, sadness and anger," said one newsroom veteran.
But even if the news staff realized it had to be cautious for now, the reporter said, it would be difficult to stop the push for freer expression.
"I don't think you can say we are all afraid," he said, speaking on condition of anonymity. "If it closes it closes, but that would create a very strong feeling among people -- both readers and within the industry."
Another staff member from the group echoed a view shared by many journalists.
"If they close the Southern Daily, it wouldn't matter," he said. "The newspaper's example has already been absorbed by journalists all over China, and their goal is not just to copy it, but to do even better."
A year ago, the editors of the Southern Metropolitan Daily were hailed as heroes for pushing back the boundaries of media freedom in China.
Now they are languishing in jail, the victims of a revenge campaign by the authorities whose corruption, incompetence and cover-ups they exposed.
That, at least, is the view of their supporters, who have launched an unusually vocal campaign to secure the release of the three in a case that has highlighted the growing pressure for press liberty in this authoritarian state.
Yu Huafeng, Li Minying, and Cheng Yizhong, the former senior editors of the pioneering daily, based in Guangzhou, Guangdong province, face up to 12 years in prison.
They are ostensibly being punished for embezzling state funds, but their biggest "crime" could more accurately be described as embarrassing local police and health officials with a series of powerful scoops.
Under the trio's leadership, the Southern Metropolitan Daily and its sister publication, the Southern Weekend, set new standards of hard-hitting journalism in China.
Although the newspaper is nominally controlled by the local Communist party, it was able to thrive in the relatively liberal climate of Guandong, which was the first Chinese province to benefit from the opening-up policy initiated in 1978, and is now a centre for domestic entrepreneurs and foreign manufacturers.
With its reputation and readership spreading nationwide, the paper last year ran several scoops that influenced central government policies and led to the dismissal of senior officials in Beijing and Guangzhou - something that would have been unheard of a few years ago.
At the start of the Sars crisis in late 2002, when the Southern Metropolitan Daily consistently broke news about the disease and official attempts at a cover-up, its circulation surged above 1.2 million, up by around 20% from two years earlier.
The daring stories, which were widely emulated by other media organisations as the outbreak spread across the country, contributed to the forced resignations of the health minister and the mayor of Beijing. This was hailed as a sign that the popular new Chinese government of the president, Hu Jintao, and the prime minister, Wen Jiabao, was ready to loosen constraints on the press.
Such hopes were raised by the response to another Southern Metropolitan Daily scoop last April. It told the story of the death in police custody of a college student who had been detained and beaten up for failing to show his ID - a common fate for migrant workers.
The Sun Zhigang affair, as it became known, forced the central government to rewrite police regulations and address the plight of the huge population of itinerant labourers.
But it may also have sealed the fate of the newspaper's editors. According to the local media, the Sun Zhigang report crushed the promotion prospects of the Ghuangzhou police chief, who begged the newspaper not to break the story, and then vowed revenge after it published.
The local government has denied that the subsequent crackdown is a form of retribution, but the timing of Yu's initial detention - only days after the Southern Metropolitan Daily broke the news of the return of Sars in late December - has created far more sceptics than believers.
Yu and Li were formally arrested in February, and sentenced to 11 and 12 years in jail for using advertising revenue to pay staff bonuses. Prosecutors argued that this was a form of embezzlement, because the income should have gone to the Communist party-run parent company.
Cheng, the former editor in chief, was arrested last month, and now faces similar charges.
A growing number of critics believe that the charges have been trumped up to punish editors for their refusal to toe the party line. In a rare challenge to the authorities, a group of prominent academics and media leaders have held symposiums, set up websites, and filed a petition against what they have described as "illegal measures" to limit press freedoms.
Unless the crackdown against the Southern Metropolitan Daily is called off, the petitioners warn that "the authority and credibility of the party, government bodies and the legislature will be questioned, and news media will find it difficult to survive".
After giving so much ground to the media during the Sars crisis, it would be astonishing if the authorities backed down again. Instead, Yu, Li and Cheng, the severed heads of the Southern Metropolitan Daily, are likely to be held up as a warning to other journalists about the perils of overstepping the tight limits imposed on the Chinese media.
However, that is unlikely to be the end of the battle. The increasingly competitive pressures at work in the Chinese media will push papers to print more circulation-boosting scoops.
The country's leaders, Mr Hu and Mr Wen, must also be asked how their image as "men of the people" can be reconciled with a crackdown on attempts to inform the public about official wrongdoing and health risks.
TORONTO (CP) - The Ontario Superior Court judge investigating what went wrong with the province's handling of last year's SARS outbreak delivered an interim report to Health Minister George Smitherman on Thursday.
A source said the report dealt exclusively with the public health response to the outbreak and was "very critical."
Justice Archie Campbell personally presented Smitherman with the report, which makes recommendations for change. A spokesman for the SARS commission headed by Campbell suggested the judge is keen to see a quick release of the document.
Smitherman indicated he plans to release it in about a week, though some translation of the 200-page report into French must be done first.
"Once we've got some translation done, we'll get that out in the public," said the minister, who added he'll likely read it over the weekend.
"I'm anxious to get my eyes on it. As soon as I've had a chance to do that, and to get it out there in the public domain, then I'll be able to comment further."
Smitherman said Campbell told him the report was based on interviews with or submissions from some 300 Ontario residents.
Campbell has held two sets of public hearings. But the bulk of his fact-finding has occurred behind closed doors, in interviews with all the key players in the crisis as well as front-line public health and hospital workers.
A former provincial deputy attorney general, Campbell was appointed last June by then-premier Ernie Eves to conduct an independent investigation into the way the province handled the deadly disease.
His final report was expected by the end of this year but may not be ready until early 2005, the commission spokesman said.
A federal government investigation into the outbreak, headed by Dr. David Naylor of the University of Toronto, was released last October. It criticized the inadequate and ill co-ordinated responses of all levels of government, highlighting severe, ingrained problems that exacerbated the scope of the Toronto crisis.
Ontario's SARS outbreak killed 44 people. There were a total of 247 probable and 128 suspect cases of the disease.
Only the "heroic" efforts of Ontario's front-line health workers kept last year's deadly SARS outbreak from exacting a far heavier toll, says a report on the crisis released today that delivers a scathing indictment of the province's public health system. Justice Archie Campbell, appointed last year to examine the province's handling of the outbreak that killed 44 people and sickened hundreds more, was unequivocal in his assessment of a public health system that utterly failed the people of Canada's most populous province.
"Ontario was fortunate that SARS was ultimately contained without widespread community transmission or further hospital spread, sickness and death," Campbell writes.
"SARS was contained only by the heroic efforts of dedicated front-line health-care and public health workers and the assistance of extraordinary managers and medical advisers. They did so with little assistance from the central provincial public health system that should have been there to help them."
That system was "unprepared, fragmented, poorly led" and "inadequately resourced," the report said.
"These problems need urgently to be fixed."
Campbell, an Ontario Superior Court judge, heaps praise on the Herculean efforts of the front-line health and hospital workers who worked tirelessly to slow the disease's advance, and takes pains to distinguish their work from the failings of the system in which they toiled.
"Twenty-hour days were common," Campbell writes. "They faced enormous workloads and pressures in their tireless fight, in a rapidly changing environment, against a deadly and mysterious disease. . . . We should be humbled by their efforts."
And while he warns against using hindsight to judge those who struggled "in the fog of battle" against the disease, Campbell concedes that the work of the people who "stepped up" is the only redeeming element of the province's ham-fisted handling of the crisis.
"It cannot . . . be said that things went right because SARS was eventually contained," Campbell writes. "For the families of those who died from SARS and for all those who suffered from it, little if anything went right."
Campbell lists a "constellation" of 23 problems that exacerbated the crisis, including the long-standing decline in public health, the absence of a plan to deal with a flu pandemic, a lack of provincial public health leadership and a lack of laboratory capacity.
He also assails the absence of a public health communications strategy, poor co-ordination with Ottawa, legal confusion about liability and responsibilities, and the system's inability to handle a sudden surge in demand for health services.
Campbell also details 21 "principles" to guide the province in its public health reform efforts, including a new mandate, new leadership, and new resources for public health, centralized accountability, direction and control for public health, and ``uploading" certain municipal public health services to make them the province's responsibility.
The report also recommends that the province pay at least 75 per cent of the cost of public health and municipalities be on the hook for no more than 25 per cent of funding.
Dr. Donald Low, the chief microbiologist at Mount Sinai Hospital in Toronto and a central figure in last year's crisis, hailed the report as "brutally honest" and urged the province to heed its warnings.
"(Campbell) obviously has a strong opinion that downloading public health from the provinces to the municipalities was the wrong thing to do," Low said.
"As a result of that, public health never really got a fair shake."
Health Minister George Smitherman described the report as a ``passionate call to arms" and promised to unveil a comprehensive action plan on public health reform within the next two months.
That plan will include measures to bolster leadership and accountability, strengthen the role of the chief medical officer of health, and set up a health protection and promotion agency for the province, he said.
The Campbell report, together with reports by Dr. David Naylor of the University of Toronto and Dr. David Walker of Queen's University in Kingston, Ont., will together form a blueprint for reform, he said.
"These reports call out, in language that could not be described as anything less than stunningly clear, the need for reform in these crucial areas," Smitherman said.
"Therefore, reform will occur. . . . There will be a substantial move forward in every one of those areas."
Campbell makes it clear that it now falls to the current Liberal government to find the political will to ensure the province is better prepared for the next infectious outbreak.
"If it lacks the necessary political will, it can tinker with the system, make a token investment, and then wait for the death, sickness, suffering and economic disaster that will come with the next outbreak of disease."
Campbell also has harsh words for the leadership of Dr. Colin D'Cunha, who was Ontario's chief medical officer of health at the time and for many in Ontario the face of the crisis during daily televised media briefings.
D'Cunha, Campbell writes, was "the wrong man in the wrong place at the wrong time" who often frustrated colleagues and underlings with his management style.
"Many of us involved during SARS shared that opinion that leadership was lacking, and that you needed the right general to lead it," Low said.
"We didn't have the right general."
Campbell notes he found no evidence of misconduct or wrongdoing and that the outcome of the crisis likely wouldn't have differed with someone else at the helm.
D'Cunha has since been replaced by Dr. Sheela Basrur, who was Toronto's chief medical officer of health at the time of the crisis.
The final version of the Walker report is expected Wednesday.
Campbell's 222-page report is based on interviews with or submissions from some 300 Ontario residents. A final version of the report is expected either late this year or early in 2005.
CONTACT:
Anne A. Oplinger,
aoplinger@niaid.nih.gov,
301-402-1663
An experimental vaccine based on a critical piece of the SARS virus protects mice from SARS infection, researchers from the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, have found.
When exposed to the SARS virus, immunized mice produced SARS-specific antibodies, and virus replication was nearly eliminated.
The new report, to be published this week in the Proceedings of the National Academy of Sciences online, is the second from NIAID in recent weeks describing a promising SARS vaccine candidate.
"We now have two candidate vaccines, based on two distinct technologies, shown to be effective against SARS infection in mice," says NIAID Director Anthony S. Fauci, M.D. "The animal model employed in both studies was developed by NIAID researchers as well. By taking various approaches to vaccine development, we are making significant research progress against a disease that was unknown little more than a year ago."
SARS is caused by a coronavirus, a family of viruses so named because spikey proteins protrude from the virus's surface, giving the microbe a crown-like appearance. The newly described vaccine is based on the spike (S) protein. Because the virus initiates infection by attaching to and entering cells using its S protein, a vaccine based on this protein should closely mimic natural infection, notes senior author, Bernard Moss, M.D., Ph.D.
Investigators inserted the gene encoding the S protein into a virus called modified vaccinia Ankara (MVA). Neither MVA nor the solitary gene from the SARS virus can cause disease. Instead, MVA simply ferries the SARS gene into the body. First developed as a vaccine against smallpox, MVA has an excellent safety record in humans, says Dr. Moss, and it efficiently stimulates both the antibody and cellular arms of the immune system.
Dr. Moss and his colleagues collaborated in this research with fellow NIAID scientist Kanta Subbarao, M.D., whose lab recently developed the mouse model of SARS infection. In the current study, two groups of eight mice received doses of the MVA/S vaccine, delivered either into nose or as an injection into muscle, four weeks apart.
One month after the second immunization, the rodents were exposed to SARS coronavirus via their nasal passages, mimicking the natural route of infection. Two days later, scientists examined the animals' lungs and nasal passages for evidence of SARS coronavirus replication. Almost no virus was seen in the lungs, and virus levels in the nose were greatly diminished. The results were the same regardless of the vaccination method.
The NIAID scientists also tested the blood of immunized mice to determine the level of antibodies that neutralize the virus. Mice immunized with the MVA/S vaccine developed S-specific neutralizing antibodies. Control mice immunized with MVA alone did not develop antibodies and were not protected from SARS infection.
Finally, the investigators determined that immunity to SARS can be passively acquired. Blood serum from MVA/S immunized mice (which contained anti-SARS antibodies) was injected into non-immunized mice. The non-immunized mice could then fend off SARS infection almost as well as vaccinated mice.
Now that the essential role of S protein in a SARS vaccine has been demonstrated, says Dr. Moss, the researchers will begin to selectively modify the protein in an effort to enhance its immune-stimulating powers.
Meanwhile, work is continuing in Dr. Subbarao's lab to develop improved rodent models of SARS. Currently, while mice can be infected with SARS virus, they do not become ill. Thus, the protective value of the experimental vaccine can only be inferred, not shown directly.
NIAID is a component of the National Institutes of Health, an agency of the U.S. Department of Health and Human Services. NIAID supports basic and applied research to prevent, diagnose and treat infectious diseases such as HIV/AIDS and other sexually transmitted infections, influenza, tuberculosis, malaria and illness from potential agents of bioterrorism. NIAID also supports research on transplantation and immune-related illnesses, including autoimmune disorders, asthma and allergies. Press releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at http://www.niaid.nih.gov.
Note: Media may request a copy of the paper by calling the National Academy of Sciences at 202-334-1310. Ask for manuscript number 01939.
References: H Bisht et al. Severe acute respiratory syndrome coronavirus spike protein expressed by attenuated vaccinia virus protectively immunizes mice. Proceedings of the National Academy of Sciences 17:6641-46 (2004). DOI: 10.1073/PNAS.040193901.
Z Yang et al. A DNA vaccine induces SARS coronavirus neutralization and protective immunity in mice. Nature 428:561-64 (2004). DOI: 10.1038/nature02463.
K Subbarao et al. Prior infection and passive transfer of neutralizing antibody prevent replication of severe acute respiratory syndrome coronavirus in the respiratory tract of mice. Journal of Virology 78:10-16 (2004). DOI: 10.1128/JVI.78.7.
The occurrence of avian influenza in humans is a reminder of the vulnerability of people to an emerging pandemic, Mayo Clinic researchers warn in the current issue of Mayo Clinic Proceedings. Mayo Clinic researchers review the latest outbreak of highly pathogenic avian influenza (H5N1 strain) that occurred recently among poultry in eight Asian countries. The researchers review current knowledge about avian influenza and how to manage this emerging disease.
"“An immediate priority is to halt further spread of epidemics in poultry populations that would reduce the opportunities for human exposure to the virus," says Larry Baddour, M.D., of the Mayo Clinic Division of Infectious Diseases and Internal Medicine and the lead author of the article. "Clinicians should be cognizant of human influenza H5N1 infection among patients with the appropriate epidemiological exposure, so that patients can be identified quickly and managed appropriately and health care workers can be protected."
Dr. Baddour also notes that a vaccine against this virus needs to be developed.
Since mid-December 2003, Cambodia, China, Indonesia, Japan, Laos, South Korea, Thailand and Vietnam have reported outbreaks of the avian influenza strain H5N1. Vietnam and Thailand have reported influenza H5N1 infection in humans with 32 laboratory-confirmed cases and 22 deaths, a mortality rate of nearly 70 percent. More than 100 million domestic poultry have been killed to halt the epidemic and prevent transmission to humans.
Two of the three criteria that characterized the influenza pandemic of 1918-1919 have already been fulfilled in the current epidemic of avian influenza: the ability of the virus to infect humans resulting in high mortality, and a global immunologically naive human population. The third criterion, efficient human-to-human transmission, has not been observed.
Researchers are concerned because influenza viruses mutate frequently, potentially allowing them to change the host receptor specificity from avian to human.
The authors of the Mayo Clinic Proceedings report offer some general precautions for preventing the spread of the virus, such as performing thorough and frequent hand washing using soap and water or alcohol-based hand rubs. The virus can be killed with heat (132 degrees Fahrenheit for three hours, 140 degrees for 30 minutes or 158 degrees for one minute) or common disinfectants such as alcohol or bleach for inanimate objects contaminated by the virus.
All hospitalized patients diagnosed as having or being evaluated for avian influenza should be isolated for 14 days after onset of symptoms, until an alternative diagnosis is established, or until diagnostic test results indicate that the patient is not infected with influenza A. The same time frame should be used for outpatients.
Others who contributed to the report include: Andrej Trampuz, M.D., Rajesh Prabhu, M.D., and Thomas Smith, Ph.D., all from Mayo Clinic.
A peer-reviewed journal, Mayo Clinic Proceedings publishes original articles and reviews dealing with clinical and laboratory medicine, clinical research, basic science research and clinical epidemiology. Mayo Clinic Proceedings is published monthly by Mayo Foundation for Medical Education and Research. The journal has been published for more than 75 years and has a circulation of 130,000 nationally and internationally. A copy of the article will be available on-line after the embargo lifts at http://www.mayo.edu/proceedings.
he case of a Westchester County man who survived an extremely rare case of avian flu last fall has local, state and federal health officials grappling with a troubling mystery.
Five months after the patient checked into Westchester Medical Center complaining of fever and cough, no one can say how he was infected with avian influenza. The man recovered and went home after a few weeks, but it was not until a month ago that the federal Centers for Disease Control and Prevention suspected an avian virus had caused his illness, and only last Friday that the centers confirmed that diagnosis.
As health officials continue to interview the man, his family and people he has contacted, they have found no evidence that he had contact with contaminated birds, the only proven way avian flu can be contracted, forcing them to consider another means of transmission.
Health officials say that any new case of avian flu must be taken seriously because it can spread rapidly among birds and it can be quite serious in humans on the rare occasions when they are infected. In recent years, cases of avian flu in Asia, Europe and North America have prompted the slaughter of millions of chickens and ducks. The World Health Organization has sounded an alarm because some strains of the virus - not the one found in Westchester - have killed people, including at least 16 victims in Vietnam and Thailand early this year.
Invariably, the human victims have turned out to be people who had close contact with birds. In the only previous case in the United States, in 2002, the patient was a poultry worker in Virginia.
Human cases that do not fit that pattern are particularly worrisome because scientists theorize that inside a human host, the viruses for avian and human influenzas could swap some genetic material, creating an avian flu that transmits readily from person to person. They fear that such a development could lead to a flu pandemic like the one that killed tens of millions of people in 1918 and 1919.
Local and federal health officials say they have found no evidence that the Westchester County patient had direct contact with birds or had traveled to any region affected by avian flu.
"We can't figure out how he was exposed and why he's an isolated case," said Nancy J. Cox, an influenza expert at C.D.C. "We need to understand how he got infected."
Dr. Joshua Lipsman, the Westchester County health commissioner, said, "While we can't rule out it being person-to-person transmission, the likelihood is still very small." He added that the patient "had some potential exposures that we're looking into," but declined to elaborate.
Officials said the man was infected with Type A influenza, Strain H7N2, the same one that hit chicken farms in New Jersey, Maryland and Delaware this year. The H7 viruses are thought to be less virulent in humans than the H5 strain that appeared in Southeast Asia in recent months. Other H7 strains were responsible for outbreaks in Canada this year, and in the Netherlands last year.
The Westchester patient, a Caribbean immigrant, lives in Yonkers with his wife and children, officials said. (Hospitals and health officials do not reveal the names of patients in cases involving public health issues.) He entered the hospital in November suffering from other serious ailments that weakened his immune system and that might have masked the symptoms of avian flu. One official said the patient had symptoms of a respiratory illness, including coughing and an abnormal chest X-ray. Doctors at first suspected tuberculosis.
"We knew it was something weird, but we didn't know what it was," said Claire Palermo Flower, spokeswoman for the hospital. "They did an elaborate culture and asked the lab to do more than the usual tests."
The county's laboratory tentatively identified the virus as a human flu strain, H1N1, and sent sputum samples to C.D.C. in Atlanta, said Ms. Flower and Dr. Cox. The specimen was set aside because few H1N1 cases were reported last winter, and the centers routinely concentrate on testing the most prevalent strains.
It was not until February that C.D.C. tested the sample, when scientists there found that the virus was not from the H1 group, Dr. Cox said. A subsequent test ruled out another family of flu viruses, Type B. Further testing showed that it was Type A, but not the H1, H3 or H5 subtypes.
Finally, on March 17, scientists using other tests identified the virus as H7N2. The next day, Dr. Cox said, C.D.C. notified health officials in New York that they had a suspect human case of avian flu. To be certain that the sample had not been contaminated in a laboratory, they did further tests.
Doctors asked the patient for another blood sample, to compare antibody levels in it with another sample kept from the initial phase of his illness. Last week, the tests confirmed a recent infection with H7N2, and the C.D.C. alerted state and local officials in a conference call on Friday.
Westchester officials and the state Department of Health have also tested the man's family, co-workers and close contacts - none of whom were sick - without finding evidence that any had also been infected.
C.D.C. officials said the federal agency did not believe that the case represented an imminent threat to public health.
Dr. Cox said C.D.C. reported the case Monday to the World Health Organization, which has repeatedly warned about the threat of avian flu. But a W.H.O. spokesman said that as of 5 p.m. in Geneva, where the agency is based, no such report had been received.
A new study has shown that SARS in Hong Kong had spread by travelling on microscopic airborne water droplets. This is how the SARS virus contaminated a whole block of apartments in Hong Kong last year, says the study.
This information could be crucial in dealing with future SARS outbreaks, or even preventing them from happening in the first place.
You can read this study in the New England Journal of Medicine.
The source of the of the SARS outbreak in the apartment complex, called the Ammoy Gardens Complex, actually came from a person with diarrhea (UK spelling diarrhoea) in building E.
The researchers from the Chinese University, Hong Kong, said the virus spread within the building. An exhaust fan in the bathroom sucked the virus up through flaps in the floor drain. Invisible, aerosol-sized droplets of water carried the virus to other parts of the building (the building had 36 floors).
Every time the toilets were flushed huge numbers of aerosols were generated, said the researchers. The team was led by Ignatius Yu.
Many residents in the building, said Yu, do not flush water down the drains when they are cleaning their bathrooms, they just mop the floor, spilling water. Hence, the traps are bone dry and do not trap what they would if they had not dried up.
By using computer simulation, the team could show how the virus spread to other buildings as the aerosol droplets travelled in the currents of air. Those who lived downwind from the apartment were the first to come down with SARS (after the ones in the initial apartments).
Work is being carried out in the building’s plumbing system to make sure that the flaps do not dry out again.
A health panel looking into the SARS crisis says Ontario must spend more than half a billion dollars over five years to implement its recommendations in order to avert a similar health emergency.
Crucial to making positive changes is creating a new Ontario Health Protection and Promotion Agency, "with core responsibilities in epidemiology, scientific analysis, risk communications, research and training, and encompassing a co-housed central public health laboratory," the final report by an expert panel led by Dr. David Walker states.
The report also says that Ontario must keep its chief medical health officer at arms-length from the government and recommends a more independent role for the official.
That includes giving the health officer the legal authority to speak up on urgent health matters, including by-passing the Health Minister if necessary.
It also wants the province to fully fund public health units, rather than sharing the cost with municipalities.
The panel, led by Dr. Walker, dean of health sciences and director of the school of medicine at Queen's University, provided a total of 50 new recommendations in its final report to the province.
"The most lasting tribute we can offer those who were impacted by SARS is to ensure that our health care providers, health-care facilities and communities have the tools, supports and resources necessary to respond effectively to Ontario's next health emergency," Dr. Walker said in his recommendations.
Dr. Walker's committee was charged with telling the province how to do that, taking a more forward-looking and scientific approach. It was asked to identify the lessons the health system needed to learn to ensure it is better equipped to handle future health emergencies.
The report projects that over the five-year period, annual spending should increase to $198.1-million in the fifth year from $27.5-million in year one.
Provincial Health Minister George Smitherman has promised to respond with a detailed action plan on public health reform within the next two months. And Premier Dalton McGuinty insisted Wednesday his government knows it has work to do. "Clearly we are in a better position today than we were prior to the advent of SARS in Ontario but also just as clearly there is much more work to be done," Mr. McGuinty said before going into a cabinet meeting Wednesday.
The Premier promised Mr. Smitherman's plan would be backed by spending pledges in the next provincial budget.
The Walker panel's final report brings to four the number of publicly commissioned reports on the SARS crisis to have been released over the past seven months.
Together they present a markedly consistent picture of health-care and public health personnel hamstrung by a wholly inadequate system as they fought valiantly against an unknown and deadly foe.
Dr. Walker's interim report in December was aimed at identifying key areas that needed immediate attention if the province was to be more successful in handling a renewed outbreak of SARS. But despite many predictions SARS might, like influenza, become a seasonal affliction, the virus did not return.
With reports from Canadian Press
A GROWING global population and unprecedented international travel have put humankind at risk of uncontrollable outbreaks of potentially hundreds of new diseases, a virus expert has warned.
The deadly SARS virus has largely been controlled and international bird flu containment efforts continue, but Professor Frank Fenner said further animal-to-human epidemics were "inevitable".
"With population growth of another three billion (projected) in the next 30 or 40 years, that's putting enormous pressure on the environment," Prof Fenner said.
"People are moving into areas where they didn't live before, or living in conditions where they do come into contact with either insects transmitting these viruses from wild animals or contact with wild animals themselves.
"Now there's such an enormous amount of air travel, and all these diseases have got incubation periods of at least a couple of days, so that's enough time for any person to get to any part of the world."
Since 1970, Prof Fenner said 35 different viruses have leapt from animals to humans then been spread to distant parts of the world.
"West Nile was the last one - that disease was confined to Europe and Asia but it got to the United States," he said.
"It's now well established in north America and it's killing off birds and human beings."
In a recent study of the viruses carried by domestic animals including dogs, cats, cattle and horses, Prof Fenner found at least 20 groups of viruses in every species.
"It's likely that wild animals are just the same," he added.
The 89-year-old academic, who was involved in the global eradication of smallpox, early World War II malaria research, and the rabbit virus myxomatosis, is to speak tonight at Melbourne's Monash University about the threat of bioterrorism.
However, he said the next disease epidemic WAs much more likely to come from nature than terrorists.
"The bioterrorism threat has been around for a long time but the only successful example of it being used was the recent anthrax scare in the United States," Prof Fenner said.
"There were under a dozen deaths and anthrax cannot be passed from one human being to another."
Despite his dire warning, Prof Fenner said the World Health Organisation's (WHO) management of SARS was encouraging.
"Containment is necessary in the case of a disease that's contagious and ... the handling of SARS shows how well it can be done," he said.
"Just as air travel puts a new dimension on spread around the world, so now we've got electronic communications and I think the WHO did a splendid job in organising communications so that people knew what to expect, knew what to do."
The World Health Organization has warned that Severe Acute Respiratory Syndrome, SARS, and bird flu still remain a major area of concern.
The director general of the W-H-O, Lee Jong-wook, says that while affected countries have succeeded in controlling SARS and avian flu, the cause of the diseases and the manner in which they spread remained a mystery.
In a speech to medical experts in China, Mr Lee said unfinished tasks include clarifying the origin and epidemiology of the infection and finding an effective treatment and vaccine.
He stressed, the "underlying problem" in many countries was poor or non-existent health systems, preventing them from handling disease outbreaks effectively.
Singapore - It will take scientists four to five years to develop a vaccine for Sars, the deadly flu-like disease that swept across most of East Asia last year, Singapore's acting health minister, Khaw Boon Wan, said on Monday.
Efforts to find a cure are still ongoing in several countries, including the United States, Singapore and China, but none have passed through to the first stage of animal testing, Khaw told parliament.
"In short, Sars vaccine research development efforts are still being actively pursued," he said.
"The World Health Organisation has estimated that it would take another four to five years before a Sars vaccine is commercially available."
Severe Acute Respiratory Syndrome (Sars) killed close to 800 people and infected more than 8 000 worldwide last year, with most of the cases in Asia.
In Singapore, Sars killed 33 people out of 238 infections and brought the city-state's economy to a standstill.
The Kyoto District Public Prosecutors Office on Wednesday indicted Hideaki Asada, president of Asada Nosan poultry firm, on suspicion of failing to report the outbreak of highly pathogenic avian influenza in late February at the firm's Funai Farm in Tanbacho, Kyoto Prefecture.
The firm also was indicted on the same charge.
Prosecutors, however, decided not to prosecute Masaaki Morita, a then-executive of the firm, and Katsuhiko Nozaki, who was formerly in charge of chicken houses, saying the two had acted as subordinates.
Asada's 67-year-old father Hajimu Asada, who killed himself along with his wife after the discovery of the flu outbreak, also was not indicted. He had been chairman of the firm at the time of his death.
The case is the first indictment on suspicion of violating the Domestic Animal Infectious Diseases Control Law.
Prosecutors decided to charge Asada and the firm because they put profits before prevention of an outbreak of the disease. Asada Nosan's inaction disrupted the distribution of chickens and eggs and had a serious economic and social impact that shattered public trust in foods, prosecutors said.
According to prosecutors, Asada learned around Feb. 22 that chickens bred at Funai Farm were suspected of being infected with avian influenza. However, he failed to report it to the prefectural Nantan livestock hygiene center as stipulated by the law.
Bird flu has spread to two more sites in B.C.'s Fraser Valley, bringing the number of infected areas to 31, but experts are optimistic that spread of the virus is slowing and say the disease is well on its way to being contained.
"The fact that we have found only two new cases ... and we expect to see fewer and fewer cases as we move forward, suggests we may be getting ahead of the disease," Dr. Cornelius Kiley, a Canadian Food Inspection Agency expert, told a press conference on Tuesday.
The new cases were found on farms in the Greater Abbotsford Area and the Cloverdale area near Surrey, some 40 kilometres apart. Both areas had previously been infected. The number of infected backyard flocks remains 10, a number unchanged for at least a week.
All of the birds in the 31 infected sites and within a one-kilometre radius surrounding each have been killed, CFIA officials announced Tuesday.
The infected flocks comprised 950,000 birds -- more than 80 per cent of which have been disposed of. The remaining birds, 175,000 from five farms, await disposal.
A massive cull, unprecedented in Canada, of all commercial poultry flocks in an area 130 kilometres long by 50 kilometres wide was ordered earlier this month to stem the spread of avian influenza in the Fraser Valley.
Most of the roughly 19 million affected birds are chickens, but turkeys, farmed geese and ducks are among them. Bird owners will be compensated for their destroyed birds.
If no further sites in the cull area test positive for the disease, flocks will be deemed negative and birds will be sent to rendering plants for eventual consumption, Dr. Cornelius said.
But even infected chicken is safe to eat, if thoroughly cooked at a temperature of at least 74 degrees celsius.
The government has placed strict restrictions on the movement of birds and eggs in the Fraser Valley, including farm gate sales of eggs.
"Buyers and sellers should be aware that fines could be issued if prohibited products are moved illegally," Dr. Cornelius said.
He also asked pet bird owners to take "common sense approaches." For example, he urged them not to pack up their pet birds in an RV and take them along on a trip to Vancouver Island.
The CFIA is considering exceptions to the cull in the case of exotic or genetically rare bird species.
By assessing their genetic value and the extent to which each bird was kept from exposure to avian influenza, a committee will make decisions on a case by case basis in the coming days, Dr. Cornelius said.
He also noted that pigeons will be exempt from the slaughter, since they are incapable of carrying the virus.
Movement of pigeons is still restricted, however, as the pigeons can act as mechanical vectors, meaning the virus can piggy-back in their feathers.
Avian flu has not infected any more people, aside from the two workers who caught the virus while handling chickens several weeks ago. They have since recovered.
Though this particular strain, known as H7N3, is fatal to chickens, it does not pose a serious risk to humans and causes only mild symptoms, such as pink eye.
Meanwhile, actress Pamela Anderson has written a letter to federal Agriculture Minister to complain about the way chickens are being killed in her home province.
The B.C.-born star is a supporter of the militant animal-rights group People for the Ethical Treatment of Animals, which has launched many high-profile campaigns to expose alleged abuse of animals, particularly killing them for meat.
Bird flu could develop into a threat big enough to overturn world order if it evolves to transfer directly from person to person, a UK scientist says.
Dr John McCauley, of the Institute for Animal Health, said the virus could be 20 times worse than the 1918 pandemic.
That is estimated to have killed 40 million people, with later influenza outbreaks also killing millions more.
Dr McCauley said there was a realistic chance of the current avian flu virus evolving to threaten people directly.
Dr McCauley, whose research into avian influenza is being funded by the Biotechnology and Biological Sciences Research Council (BBSRC), was speaking to BBC News Online.
Practical possibility
He said: "At the moment the virus affects humans only after transferring to them from poultry. In 1997 six people died in Hong Kong after 18 became infected. This year, 23 patients have died from a total of about 34 people infected in south-east Asia.
"That means there is a mortality rate from some strains of highly pathogenic avian infuenza of between 30 and 60% of those infected. In 1918, the rate was about 1%.
"There's no reason to say the virus will not continue to evolve so that it can transmit directly from one person to another. There's a realistic chance that could happen.
AVIAN FLU ALERT First jumped "species barrier" from bird to human in 1997 In humans, symptoms include fever, sore throat, and cough Types which threaten humans are influenza A subtypes H5N1 and H9N2 --
If it does - if the virus becomes adapted to man and can transmit efficiently - there'll be no point in selling a vaccine. You might as well give it away at that stage, because money would be meaningless. The world order would change."
Dr McCauley said the global flu epidemics of 1957 and 1968 had involved a mixing of avian and human forms of the virus, and it looked as if that had happened in 1918 as well.
So people killing infected birds should be taking anti-flu drugs to guard against the possibility of being infected with both forms and creating a pandemic.
Dr McCauley said: "Any complacency could lead to devastation for the UK poultry industry. I think the avian form of the disease has not been cleared up in any of the affected countries."
Seeking answers
In poultry the effects of bird flu can range from a mild touch of disease to a highly fatal and rapidly spreading epidemic.
Teams from the Institute for Animal Health and the universities of Cambridge and Oxford are cooperating to unravel the dynamics of bird flu.
Cambridge scientists, with the Roslin Institute, are working to produce a breed of chicken that is genetically resistant to infection by the virus, engineering the bird's cells to produce small molecules of RNA that can selectively prevent its replication.
The BBSRC is to fund 14 new research projects costing £11m ($19.5m) under its Combating Viral Diseases of Livestock Initiative.
AUTHORITIES have detected two more outbreaks of bird flu in Cambodia, bringing to 12 the number of places affected by the disease in the country, agriculture officials said.
No human cases of the disease have been confirmed in Cambodia.
Cambodia's outbreaks have mostly occurred in the southern part of the country.
The latest two were reported in Takeo province, in the south, and in Kampong Cham, in the east, Agricultural Minister Chan Sarun said in a report dated April 9 and received Tuesday.
No details were available on the number of birds affected, where they were kept or who owned them. San Vanty, deputy director general of the Agricultural Ministry, said no more information was available.
Bird flu has ravaged flocks in parts of Asia and has spread to humans in Thailand and Vietnam, killing 24 people. More than 30,000 chickens, ducks and other fowl have been slaughtered in Cambodia in an effort to prevent the spread of the disease.
Influenza - a simple infection once considered as harmless as the common cold - is developing a deadly reputation.
Severe acute respiratory syndrome, the Asian bird flu and "smash and grab" flu strains in Britain have redefined the respiratory complaint. Once seen as an inevitable part of winter, the flu has become a potentially fatal complaint.
Public health experts say that although SARS and avian flu created global panic, the routine flu that hits every year should worry West Australians much more. The Influenza Specialist Group, which monitors strains in Australia and overseas, believes that the normal winter flu has a bigger capacity to kill than more exotic respiratory infections. Although there are promising signs that antiviral drugs are effective, the ISG says they should not be seen as the answer and that vaccines remained the single most important factor in preventing the spread of any infection.
Relenza and Tamiflu, which have been on the market for several years, have attracted renewed interest since it was shown Relenza was effective against the bird flu.
Earlier this year, CSIRO scientists said laboratory tests proved the drug restricted the bird flu strain H5N1, sending the drug developer's shares soaring. The drugs work by targeting a small pocket on the surface of the flu virus, acting like a plug which prevents it shedding its outer coating and penetrating cells.
Alan Hampson, convener of the ISG and deputy director of the World Health Organisation Influenza Centre, said antiviral drugs were useful but no substitute for vaccine, particularly in high-risk people.
"Antiviral drugs are expensive, you have to be treated with them early on and they don't make you instantly better, so prevention is definitely better than cure," he said.
But the marketing of the drugs had made people more aware of the risks associated with the flu and frightened some people into being vaccinated.
Mr Hampson said people needed to put the flu in perspective when it came to seemingly more dangerous diseases.
"People are terrified of SARS and the avian flu but their chances of becoming infected with them are remote," he said.
"On the other hand the chances of becoming seriously ill from the routine influenza doing the rounds each year is far greater."
PathCentre clinical virologist David Smith said because the influenza virus could change continually and because it permanently was present in the bird population, it would never be eradicated.
"It is always going to be there - the potential to move from bird populations to humans," he said. "Even once it is established in humans, the virus is able to change itself so it eludes our immunity we built up to the previous strain, either from natural infection or from vaccination, so I think it is going to be with us for an awfully long time."
Health Department communicable diseases branch medical director Tony Watson said every 20 years a completely new strain of influenza emerged from the bird population. There was about a four-yearly cycle of new drift strains of the virus which mutated in humans.
He said it would be a long, hard haul to make any big advances in flu vaccines or treatment.
Public health experts argue that in the meantime, everyone should be aware of the dangers of the flu strains which already circulate in Australia. They estimate that at least a quarter of all Australians under the age of 65 have underlying conditions that put them at risk of serious complications from the flu.
Yet only 12 per cent of this age group get vaccinated each year.
The ISG said 2.4 million people aged under 65 had chronic conditions which meant they could face life-threatening consequences of catching the flu.
Those at risk were people with a heart condition, asthma and other lung conditions, diabetes, kidney problems or a weakened immune system and people who cared for or were in close contact with others at risk also should avoid being infected with the flu in case they passed on the disease.
"We know that even with good uptake rates in the older population, there are still a lot of susceptible people out there and generally people aged under 65 have a poor record of getting their shots," Dr Watson said. "I don't think it's the cost either - it's about it not being convenient to go and get an injection if they're busy.
"But even for people who are healthy, getting the flu can be pretty inconvenient being holed in a bed for a week so it's worth making the time and effort to be vaccinated."
Mr Hampson said many people had the perception that the flu was a disease of old people. Yet a lot of younger people could die during an influenza epidemic.
It was crucial that people with risk factors were vaccinated. Everyone else needed to make their own decision whether to pay to have a jab.
Vaccinating carers of the aged could be just as effective as vaccinating the elderly themselves.
"I think a lot of people could do themselves a favour by having a flu vaccination," Mr Hampson said.
"Some people use the argument that being vaccinated doesn't guarantee you won't get the flu but generally we have a pretty good match on any circulating strains.
"There's no doubt vaccines dramatically reduce the flu rate."
Mr Hampson said it could soon become routine for people to have a flu vaccination but funding was an important issue.
Many public health experts eagerly were awaiting the findings from a Canadian study on the impact of free vaccination for everyone over the age of three.
"We're keeping a watch to see what sort of impact it has made to flu rates but my feeling is that it will be fairly dramatic," he said.
Benefits for all in workplace shots
Coughing, sneezing workmates who soldier on through the flu could be doing more than trying to prove they have a good work ethic.
They may be infecting colleagues and clients and triggering a wave of illness through the workplace. More employers are choosing to fend off this cycle by offering blanket workplace vaccination.
WA Chamber of Commerce and Industry health and safety director Anne Bellamy said the flu season was a concern for employers.
"Flu can result in a significant amount of lost time and, therefore, productivity," she said.
"For employers, there is certainly some benefit in considering flu injections . . . where they have employees at an age where they are more vulnerable or have existing health problems, they may well choose to consider balancing the cost against the cost of the injection."
She did not think it should be compulsory or expected to be provided.
Health Department communicable diseases branch medical director Tony Watson said the jury was still out on whether employers could save money by offering free flu injections.
"It depends on the flu season, how much it affects people and what the attack rate is in that particular organisation," Dr Watson said.
"There have been papers published that (say) it may save about $50 per person vaccinated and others say you break even."
Workplace vaccination specialist Gemini Medical Services has delivered 4000 flu shots in the past two years.
Spokeswoman Catherine Johnson said employers' main motivation was to protect employees, not to save money in the long term.
"Most of the employers are interested in keeping employees well so they are not having time off work," she said.
World Health Organisation Influenza Centre deputy director Alan Hampson said he was pleased more workplaces were opting for mass vaccinations, whether paying the total cost or providing discounted vaccines.
"There are cost savings to employers and . . . mass vaccination can pick up high-risk people who otherwise wouldn't be vaccinated," he said.
- PETA RASDIEN
Be on your guard
About 300 West Aus