Archive Number 20051010.2949
Published Date 10-OCT-2005
Subject PRO/AH/EDR> Avian influenza, human - East Asia (143)



AVIAN INFLUENZA, HUMAN - EAST ASIA (143)
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[1]
Date: Sun 9 Oct 2005
From: ProMED-mail
Source: The New York Times, Sun 9 Oct 2005 [edited]



Danger of flu pandemic is clear, if not yet present
---------------------------------------------------
Fear of the bird flu sweeping across Asia has played a major
role in the [United States] government's flurry of
preparations for a worldwide epidemic. That concern prompted
President Bush to meet Friday [7 Oct 2005] with vaccine
makers to try to persuade them to step up production, and it
led Health and Human Services secretary Michael O Leavitt to
depart yesterday [8 Oct 2005] for a 10-day trip to at least
4 Asian nations to discuss planning for a pandemic flu. But
scientists say that although the threat from the current
avian virus is real, it is probably not immediate.

Dr Anthony S Fauci, director of the National Institute of
Allergy and Infectious Diseases, said a bird flu pandemic
was unlikely this year [2005]. "How unlikely, I can't
quantitate it," Dr Fauci said. But, he added, "You must
prepare for the worst-case scenario. To do anything less
would be irresponsible." "I would not say it's imminent or
inevitable," said Dr Jeffery Taubenberger, chief of the
Molecular Pathology Department at the Armed Forces Institute
of Pathology. "I think in the future there will be a
pandemic." But, he said, whether that pandemic will be bird
flu [that is, avian H5N1 influenza] or another type, no one
can say.

The Bush administration is in the final stages of preparing
a plan to deal with pandemic flu. A draft shows that the
country is woefully unprepared, and it warns that a severe
pandemic will kill millions, overwhelm hospitals, and
disrupt much of the nation. What worries scientists about
the current strain of bird flu, known as H5N1, is that it
has shown some ominous traits. Though it does not often
infect humans, it can, and when it does, it seems to be
uncommonly lethal. It has killed 60 people of the 116 known
to have been infected. Alarm [increased] on Thursday when a
scientific team led by Dr Taubenberger reported that the
1918 flu virus, which killed 50 million people worldwide,
was also a bird flu that jumped directly to humans. There is
a crucial difference, however: the 1918 flu was highly
contagious, while today's bird flu has so far shown little
ability to spread from person to person. But a mutation
making the virus more transmissible could set the stage for
a pandemic. Another concern is that H5N1 has become
widespread, killing millions of birds in 11 countries and
widely dispersing as migratory birds carry it even greater
distances. This month [October 2005], it was reported in
Romania [as of 9 Oct 2005 not yet confirmed as caused by
avian H5N1 influenza virus].

Meanwhile, it is spreading widely among birds in Asia. And
it has unusual staying power: it has persisted in different
parts of the world since it emerged in 1997. "Most bird flus
emerge briefly and are relatively localized," said Dr Andrew
T Pavia, chief of the Division of Pediatric Infectious
Diseases at the University of Utah and chairman of the
Pandemic Influenza Task Force of the Infectious Diseases
Society of America. The most worrisome thing about H5N1, Dr
Pavia said, is that it has not gone away.

Some scientists suspect that if H5N1 has not caused a
pandemic by now, then it will not, because it must be
incapable of making the needed changes. But others say there
is no way to tell what the virus will do as time goes on.
And they point out that no one knows how long it took for
the 1918 virus to develop the properties that led to a
pandemic. Meanwhile, H5N1 seems to be finding its way into
more and more species. Once known to infect chickens, ducks
and the occasional person, the virus is now found in a wide
range of birds, and it has infected cats. "It killed tigers
at the Bangkok zoo, which is quite remarkable because flu is
not traditionally a big problem for cats," Dr Pavia said. It
has also infected pigs, which in the past have been a
vehicle to carry viruses from birds to humans. "We should be
worried but not panicked," Dr Pavia concluded.

The timing of the bird flu's emergence also makes scientists
nervous, because many believe that based on history, the
world is overdue for a pandemic. Pandemics occur when a flu
virus changes so markedly from previous strains that people
have no immunity, and vast numbers fall ill. "In the 20th
century there were 3 pandemics, which means an average of
one every 30 years," Dr Fauci said. "The last one was in
1968, so it's 37 years. Just on the basis of evolution, of
how things go, we're overdue."

But not everyone is equally worried about the bird flu. The
fear "is very much overdone, in my opinion," said Dr Edwin
Kilbourne, an emeritus professor of immunology at New York
Medical College, who has treated flu patients since the 1957
pandemic and has studied the 1918 flu. The bird flu, he
said, is distantly related to earlier flu viruses, and
humans have already been exposed to them, providing some
resistance. Scientists also say that the death rate may not
be as high as it appears, because some milder cases may not
have been reported. Dr Kilbourne and other experts also
noted that when viruses become more transmissible, they
almost always become less lethal. Viruses that let their
hosts stay alive and pass the disease on to others, he
explained, have a better chance of spreading than do strains
that kill off their hosts quickly.

Moreover, he said, while much has been made of comparisons
between the current avian flu and the 1918 strain, the
factors that helped increase the flu's virulence in 1918 --
the crowding together of millions of World War I troops in
ships, barracks, trenches and hospitals -- generally do not
exist today for humans. But an essential difference is that
people carrying the flu today can board international
flights and carry the disease around the world in a matter
of hours.

Dr Kilbourne emphasized that medical care had improved
greatly since 1918. Although some flu victims then turned
blue overnight and drowned from blood, with fluid leaking
into their lungs, many more died of what are now believed to
be bacterial infections, which can be treated with
antibiotics. Although the death toll from that flu was high,
the actual death rate was less than 5 per cent. In addition,
more people now live in cities, where they have probably
caught more flus, giving them immunity to later ones. "In
1918, you had a lot of farm boys getting their 1st contact
with city folks who'd had these things," Dr Kilbourne said.

[Byline: Denise Grady; Andrew Pollack and Donald G McNeil jr
contributed reporting for this article]

--
ProMED-mail


[The views of Professor Ed Kilbourne, a scientist with long
experience of influenza viruses and human disease, which are
reported above, deserve some attention if only to moderate
some of the alarmist statements that have gone largely
unchallenged up to the present. - Mod.CP]

******
[2]
Date: Sun 9 Oct 2005
From: ProMED-mail
Source: Reuters AlertNet Foundation, Sat 8 Oct 2005 [edited]



Chronology -- key dates in Asian avian influenza outbreak
---------------------------------------------------------
Romania reported 3 cases of avian influenza in a village in
the Danube delta on Sat 8 Oct 2005 and started to cull
hundreds of birds to prevent the disease from spreading,
chief veterinarian Ion Agafitei said. Tests were being
carried out to determine which strain [serotype] of virus
was involved.

A total of 65 people have died from the disease in Asia
since late 2003, 44 in Viet Nam, 12 in Thailand, 5 [now
revised down to 3] in Indonesia, 4 in Cambodia.

Here is a brief chronology of the spread of Asian bird flu:

15 Dec 2003 -- South Korea confirmed a highly contagious
type of avian influenza at a chicken farm near Seoul and
began a mass cull of poultry when the virus rapidly spreads
across the country.

31 Dec 2003 -- Taiwan reports its 1st case and later
destroys thousands of chickens with a milder form of avian
influenza [LPAI].

8 Jan 2004 -- Viet Nam says bird flu has been found on many
of its poultry farms.

13 Jan 2004 -- The World Health Organization confirms the
deaths of 3 people in Viet Nam are linked to bird flu.

25 Jan 2004 -- Indonesia discovers an outbreak among
chickens.

26 Jan 2004 -- Thailand confirms the death of a 6-year-old
boy, its 1st human death from bird flu.

12 Feb 2004 -- The World Health Organization confirms tests
show no evidence bird flu is passing from person to person.

16 Mar 2004 -- China declares it has stamped out the disease
in all 49 hotbeds and has had no reports among poultry for
29 days.

26 May 2004 -- Thailand reports [detection] of bird flu in
several dead chickens on a university research farm in the
northern city of Chiang Mai.

19 Aug 2004 -- Malaysia says a strain of bird flu has been
found in 2 chickens that died in a northern village near the
Thai border in the country's 1st bird flu outbreak.

27 Sep 2004 - Thailand says it has found its 1st known
probable case of a human being infecting another with bird
flu. It said this was an isolated incident that posed little
risk to the greater population.

15 Dec 2004 -- Taiwan says it has discovered 2 strains of
avian flu in migratory birds in the northern part of the
island, the milder H5N2 strain and also the H5N6 strain.

5 Apr 2005 -- The UN says that the H7 strain of bird flu
previously undetected in Asia has been found in North Korea.

8 Jul 2005 -- The Philippines says it has suffered its 1st
case of bird flu, in ducks. It later says it is free from
any highly pathogenic strain of bird flu.

20 Jul 2005 -- Indonesia confirms its 1st deaths from bird
flu.

26 Jul 2005 -- Japan says a fresh outbreak of bird flu has
been discovered on a chicken farm in eastern Japan. All
outbreaks in the Ibaraki prefecture since late June have
been confirmed as the weaker H5N2 strain.

9 Aug 2005 -- Viet Nam reports one new human death from bird
flu, taking its death toll to 43. The H5N1 virus has also
killed 12 people in Thailand, 4 in Cambodia and 3 in
Indonesia.

10 Aug 2005 -- The bird flu virus has been found in Tibet,
the world animal health body OIE says.

15 Aug 2005 -- Russia reports an outbreak of bird flu in the
Urals region of Chelyabinsk, the 6th region to be affected.

23 Aug 2005 -- In Kazakhstan a bird flu outbreak of the H5N1
strain in 7 northern villages is confirmed as dangerous to
humans.

26 Aug 2005 -- Finland says it has found a possible case of
bird flu in a seagull in the northern town of Oulu. [Not
confirmed as H5N1 virus]

1 Sep 2005 -- Viet Nam reports one new human death from bird
flu, taking its total to 44.

15 Sep 2005 -- United States says it has promised Viet Nam
USD 2.5 million over 5 years to improve its collection of
information on bird flu. Viet Nam says it is vaccinating
poultry to prevent new outbreaks.

16 Sep 2005 -- Indonesia confirms 4th human death from bird
flu.

26 Sep 2005 -- Indonesia confirms 5th human death from H5N1
strain of bird flu, says disease has spread to 22 of its 33
provinces. [Death toll subsequently revised down to 3]

8 Oct 2005 -- Romania reports avian flu cases in a Danube
delta village, culls hundreds of domestic birds to prevent
the disease from spreading, unclear which strain is
involved.

--
ProMED-mail


[This is a highly selective and idiosyncratic chronology,
which nevertheless records some useful milestones. - Mod.CP]