Dr Stohr, head of the WHO's global influenza programme, said this was the possible beginning of global spread of the virus.
"The situation in Asia is very concerning," he told BBC Radio 4's Today programme.
"We have an avian influenza virus which is very widespread but which has not yet, fortunately, transmitted easily, rapidly and for a long period of time between humans.
"But the capacity is there and we have a chance now to prepare for it.
"It would be
foolish to sit and lean back and wait for it to happen."
Nov 3 2004, 5:52 AM ET
HONG KONG (Reuters) - A dead gray heron found in Hong Kong near the mainland China border was found to have the H5N1 bird flu virus, the government said on Wednesday.
"The gray heron tested positive for H5N1," a government spokesman told Reuters, referring to the bird recently found dead in the Lok Ma Chau area near the mainland China border.
"We have already inspected the chicken farms nearby and we have found no bird flu symptoms or abnormal deaths among those chickens," Deputy Director of Agriculture, Fisheries and Conservation, S.P. Lau, told a news conference.
Health experts fear the virus, which has killed 12 people in Thailand and 20 in Vietnam this year, could mutate into a form that could be transmitted between humans.
Hong Kong has been a major concern for health experts, who are worried about a comeback of bird flu because the territory is a favorite resting place for migratory birds, a natural reservoir of the virus during the winter months.
China has reported bird flu outbreaks among poultry this year and experts say the disease may be carried by migrating birds.
On Tuesday, the government said the heron was suspected to have fallen victim to a virus belonging to the H5 bird flu family, which includes the H5N1 variant but also strains not known to affect humans.
Millions of chickens have been slaughtered across Southeast Asia as governments battle to contain a virus that World Health Organization officials fear could, if unchecked, eventually mutate and trigger a human flu pandemic.
The avian influenza virus was first seen in humans in 1997 in Hong Kong, where it infected 18 people and killed six.
|Health - Reuters|
Fri Nov 26, 7:23 AM ET
By Vissuta Pothong
BANGKOK (Reuters) - Every country in the world must come up urgently with a plan to deal with an inevitable influenza pandemic likely to be triggered by the bird flu virus that hit Asia this year, a top global health expert said on Friday."I believe we are closer now to a pandemic than at any time in recent years," said Shigeru Omi, regional director for the Western Region of the World Health Organization (WHO).
"No country will be spared once it becomes a pandemic," he told a news conference.
"History has taught us that influenza pandemics occur on a regular cycle, with one appearing every 20 to 30 years. On this basis, the next one is overdue," he said at a conference of 13 Asian health ministers trying to figure out how to avoid one.
"We believe a pandemic is highly likely unless intensified international efforts are made to take control of the situation," he said of the H5N1 avian flu virus, which has defied efforts to eradicate it in several Asian countries, including Thailand.
The Spanish flu pandemic of 1918 and 1919 killed upwards of 20 million people and WHO experts say the next could infect up to 30 percent of the world's more than 6 billion people and kill up to 7 million of them.
Omi said that to stave that off, the world would have to cooperate closely by sharing information promptly and openly on the virus -- such as how it spreads, why it hits children more easily than adults and how quickly it is mutating.
Secrecy in China last year helped the deadly SARS virus spread to many other countries before it could be brought under control and Beijing has also been accused of hiding the extent of its AIDS epidemic.
"Vaccine will protect you from the disease and reduce the impact individually. But vaccination alone will not prevent this outbreak," Omi said.
"Each country has to come up with a plan because, as I said, a pandemic, it will happen."
HUGE HUMAN TOLL
Two U.S. firms are working on a vaccine, but neither is likely to have one ready until March, well after the cooler Asian season in which bird flu thrives best.
The H5N1 virus, which has already killed 20 Vietnamese and 12 Thais, arrived in Asia about a year ago, probably spread by migrating birds, especially wild fowl heading to warmer climes at the onset of the northern winter.
Governments have slaughtered tens of millions of poultry in a bid to eradicate it but WHO experts say it is now probably a permanent fixture.
The wild birds, which can carry the virus without falling ill, are flying south through Asia to escape the northern winter and, in an alarming development, domesticated ducks are showing they too can have the virus without showing it, Omi said.
Experts say a pandemic will emerge from an animal, most probably a pig, which can harbor both flu viruses that affect humans and the avian flu variety. The two would mate and produce a virus to which people have no immunity, they say.
That has not happened yet, but Omi said the geographical spread and the impact of the H5N1 virus was unprecedented and had struck animals such as tigers and domesticated cats not previously known to be susceptible to avian flu viruses.
"We have found that the virus is resilient, very, very versatile," Omi said.
The Asian health ministers -- from Brunei, Cambodia, China, Indonesia, Laos, Japan, South Korea, Malaysia, Myanmar, the Philippines, Singapore, Thailand and Vietnam -- promised they would make plans for a pandemic and cooperate to stave it off.
In a joint statement at the end of the two-day meeting, they pledged to work together to develop vaccines, diagnostic tests for humans and research urgently needed to provide more information on the virus.
Sat Dec 11 2004, 9:34 AM ET
ZURICH (Reuters) - Aventis-Pasteur and Chiron Corp are due to start human testing of a vaccine against bird flu as early as this month, a World Health Organization official said on Saturday, to try to prevent a pandemic that could kill millions of people.
"Two firms, Aventis and Chiron have been working on a clinical small series. They have finished that and it is being tested," Klaus Stohr, the head of the WHO's global influenza program, told Reuters by telephone.
"At the beginning of next year or in December it will go into clinical tests on humans."
The H5N1 strain of bird flu -- an endemic in a number of Asian countries, which health officials fear could eventually mutate into a lethal new virus that will spread rapidly among humans -- has been sounding alarms with health officials.
A World Health Organization expert said last month that the H5N1 virus is most likely to cause the next human flu pandemic. Experts fear a repetition of the 1918-1919 flu pandemic thought to have killed more than 20 million people. International health officials have warned for years that a flu pandemic is overdue because the last one, which killed between one million and four million, occurred back in 1968.
The WHO has said that vaccines and antiviral drugs could then be in short supply in the first months.
On Wednesday, the WHO said it was stepping up efforts to ensure governments around the globe are ready to fight the killer flu pandemic, which the U.N. agency fears may be on its way.
While vaccines would not stop a pandemic the tests were a step in the right direction, Stohr said.
"The spread of a pandemic in principle cannot be stopped but its impact can be reduced," Stohr said.
He said the WHO's potential death toll of two to seven million deaths was a "best-case scenario," adding that hundreds of millions of people would fall ill from a pandemic.
An Aventis spokesman was not immediately available for comment.
Bird flu cases 'underestimated'
spread of the deadly bird flu virus may have been underestimated
because of a misunderstanding of how it affects the body, British
scientists have said.
Oxford University experts studying deaths in Vietnam suggest the disease can attack all parts of the body, not just the lungs as had been thought.
They told the New England Journal of Medicine they also believe humans could pass the virus on to each other.
So far, there have been 42 bird flu deaths, all in Asian countries.
But the Oxford University scientists say their findings suggests the number of cases of human infection with the virus may have been under-estimated.
The World Health Organization said it would change its definition of what constituted a bird flu infection.
So far, the WHO says there have been 55 confirmed cases of bird flu in humans, and 42 deaths.
However, experts believe millions could be at risk if the virus acquires the ability to jump from person to person by combining with a form of human flu to make a new, mutated, version.
The researchers examined the deaths of two young children - a brother and sister - who lived in a single room with their parents in southern Vietnam.
They were admitted to hospital suffering from gastro-enteritis and acute encephalitis, which are common ailments in the country.
Neither displayed respiratory problems, which have been considered typical in cases of avian flu.
But analysis revealed the four-year-old boy had traces of the virus in his faeces, blood, nose and in the fluid around the brain.
This indicates the virus - known as H5N1 - can attack all parts of the body, not just the lungs.
It is suspected his nine-year-old sister, who died two weeks earlier in February last year, was also suffering from the virus.
The lead researcher is Dr Menno de Jong, a virologist at the Oxford University Clinical Research Unit who is based at the Hospital for Tropical Diseases in Ho Chi Minh.
He said: "This illustrates that when someone is suffering from any severe illness we should consider if avian flu might be the cause.
"It may be possible to treat but you have to act in the early stages, so awareness of the whole spectrum of symptoms in an emerging disease like avian flu is vital.
"It appears this virus is progressively adapting to an increasing range of mammals in which it can cause infection, and the range of disease in humans is wide and clearly includes encephalitis."
Dr Jeremy Farrar, director of the Wellcome Trust's Vietnam unit, said: "This latest work underlines the possibility that avian influenza can present itself in different ways.
"The main focus has been on patients with respiratory illnesses but clearly that's not the only thing we should be looking for.
"Therefore the number of cases of H5N1 may have been underestimated."
Dr Farrar said the presence of the virus in the faeces suggested that it could be spread from person to person - especially where people are living in crowded conditions.
It is not believed that either of the children passed the virus on, but it is also not clear how they contracted it.
However, the girl often swam in a nearby canal which may have been contaminated by ducks carrying the virus.
Dick Thompson, of the World Health Organization, told the BBC the findings were significant.
He said: "It means the range of illnesses we have been looking for when considering a diagnosis of avian flu will now be expanded.
"We will have to change the way we conduct our
investigations, the management of hospital patients and even the way we
deal with their bodily secretions."
Ministers said without the antiviral drugs an outbreak could kill 50,000.
Experts say a pandemic is inevitable and will probably emerge in Asia if bird flu mutates with human flu, creating a highly infectious new virus.
The UK Influenza Pandemic Contingency Plan also includes quarantine measures, as well as arrangements for the emergency services.
Concerts and football matches could both be banned and travel restricted in the event of an outbreak to stop the virus spreading.
But the government decided against buying up vaccines as ordinary flu vaccines will not be 100% effective because the strain which would be responsible for any future pandemic has not emerged yet.
It could take up to six months to develop a vaccine once a pandemic has started.
BEIJING (Reuters) - China has rushed more than three million doses of bird flu vaccine to a remote western province after migratory birds were found dead from the H5N1 strain which can be fatal to humans, state media said on Monday.
Poultry across Qinghai province, neighboring Tibet and Xinjiang, had become the "target of a compulsory vaccination campaign," the China Daily newspaper said.
Scientists had proved that the virus killed scores of geese in Qinghai in early May, media said at the weekend, the first report of H5N1 detected in China since last year.
There had been no reports of the virus spreading to humans or domestic fowl in Qinghai, the Beijing News said. The area where the dead geese were found had been sealed off for 10 days.
But experts said domestic poultry could also be at risk.
"There is a significant possibility of that, given the fact that wild birds quite often use the same water sources and feeding sources as domestic ducks or domestic geese," said Malik Peiris, a microbiologist at the University of Hong Kong.
"One has to take this risk seriously."
The H5N1 strain has killed 37 Vietnamese, 12 Thais and four Cambodians since it swept across large parts of Asia in late 2003.
The World Health Organization said last week the spate of human bird flu cases in Vietnam this year suggested the deadly form of the virus might be mutating in ways that are making it more capable of being passed between humans.
China has been on high alert against bird flu after outbreaks in North Korea and Southeast Asia, which prompted it to tighten quarantine controls at its borders.
But Qinghai is far from either border and there was no immediate explanation as to how wild geese there became infected.
"I think it's sensible to take this outbreak in wild birds quite seriously and enhance surveillance in domestic poultry," Peiris said.
"Clearly it shows this virus is still causing problems in this region."END of REUTERS REPORT of MAY 23rd
They found that slightly mutated influenza A strains in New York that circulated between 1999 and 2004 gave rise to the so-called Fujian strain that caused a troublesome outbreak in the 2003-2004 flu season.
Such events probably are what lead to the occasional pandemics of flu that can kill millions of people, David Lipman and colleagues at the National Institutes of Health found.
They hope their findings, published in the journal Public Library of Science Biology, will help scientists better predict which viral strains will attack during upcoming flu seasons and design better vaccines.
Influenza viruses are notorious for trading genes back and forth and mutating. Scientists previously believed that the gene swapping occurred gradually but the new study shows that several genes can be exchanged at once, causing sudden changes in important characteristics of the virus.
This is why a new flu epidemic sweeps the world every year, killing between 250,000 and 500,000 globally and 36,000 people in the United States alone every year.
Each year, experts must predict which strains will be most common and design a new vaccine to fight them. Some years, such as in 2003-2004, the vaccine does not include the most common strain.
Lipman and colleagues sequenced the genomes of 156 influenza A viruses, named H3N2, that were collected by New York State public health officials between 1999 and 2004.
"We found that there are co-circulating minor variants that are not infecting many people," Lipman said in a statement. "One of these can cause the next major epidemic."
They found "at least four reassortment events occurred among human viruses during the period 1999-2004" -- meaning there was an exchange of genes four different times.
LURKING UNDER THE RADAR
The newly mixed viruses, previously unnoticed because of their low virulence, suddenly became capable of infecting thousands of people.
This suggests that scientists need to study circulating flu viruses more carefully because important mutations can occur suddenly and without warning, the researchers said.
Experts say a new and deadly flu pandemic is certain to come but it is impossible to predict when. The H5N1 avian flu virus, which arrived in Asia in late 2003, has so far killed more than 50 people in the region including Vietnam, Thailand and Cambodia.
It does not easily pass from person to person yet but health officials say it can acquire this ability at any time and if it does, it could kill millions.
A second study, published in the Proceedings of the National Academy of Sciences found that an early wave of the 1918 "Spanish Flu" pandemic may have hit New York City several months before a big epidemic exploded globally.
The 1918-1919 pandemic was the worst in recorded history, killing as many as 40 million people.
An outbreak at the end of the previous flu season may have killed 3,000 children and young adults, Donald Olson of the New York City Department of Health and colleagues found.
"The historical lesson from 20th-century influenza pandemics is that they occur in multiple waves," Olson said in a statement.
Russia's first recorded bird flu outbreak has killed more than 2,700 birds in the Novosibirsk region and a handful of others that border Kazakhstan. Authorities believe the virus was brought to the country by migratory birds that fly north from Southeast Asia in the spring.
The virus has swept through poultry populations in large areas of Asia since 2003, killing tens of millions of birds and at least 60 people, most of them in Vietnam and Thailand.
In June, Kazakhstan boosted epidemiological controls on its border
with China, following a bird flu outbreak in neighbouring western
SITUATION SUMMARY AUGUST 31st 2005
By Maggie Fox, Health and Science Correspondent Thu Sep 15, 8:04 AM ET
MEMPHIS (Reuters) - It seems an unlikely place to launch a war against a bird virus that health officials believe could soon mutate into a human pandemic that will kill millions -- a hospital filled with children fighting devastating genetic diseases and rare cancers.
But Robert Webster likes the daily reminders, in the form of children pulled around in colorful wagons or sitting propped against a mother's lap, that the work begun in a laboratory has real life-and-death outcomes.
And the private funds raised by St. Jude's Children's Research Hospital in Memphis are helping Webster and his team of international virus experts fight what experts say may be the biggest threat to humanity right now -- avian influenza.
"We could be heading for a global catastrophe," Webster said in an interview in his corner office overlooking the expansive campus of the hospital.
If bird flu were to start spreading among people, more than 25 million hospital admissions and up to 7 million deaths globally would follow within a short period, according to British experts who model epidemics using computer programs.
Webster's team works out of high-tech labs set up by the giant St. Jude organization, launched by Lebanese-American entertainer Danny Thomas in the 1950s to care for children with cancer and other hard-to-treat diseases.
Webster is not exactly calm -- the 73-year-old Webster doesn't say anything calmly. But he has been making ominous warnings for decades and he seems resigned to it.
Ever since Webster and colleagues discovered that aquatic birds such as ducks were the natural reservoirs of influenza, and that the virus has several ways of changing quickly into a mass killer, he has said it is only a matter of time before one flu virus takes on a form that will kill millions of people.
"You just don't know when it is going to happen," Webster said. "But I think some of the policy makers and politicians are starting to listen."
RECOGNIZING A KILLER
When Webster saw the avian flu strain called H5N1 for the first time in Hong Kong in 1997, he knew this might be it.
The virus hopped from ducks to chickens, killing chickens in a day, and infected 18 people who handled infected birds, killing six, before Hong Kong authorities stopped it with a decisive slaughter of poultry and closings of bird markets.
No one thought it was gone for good and in fact when flu experts first heard about a mysterious virus that was killing people in China's Guangdong Province at the end of 2002, they feared that H5N1 had come back. In fact, it was Severe Acute Respiratory Syndrome or SARS.
The panic over SARS upstaged the reappearance of H5N1 in China in 2003, and this time the authorities did not act so quickly or decisively.
Now it has killed or forced the slaughter of tens of millions of domestic birds in China, Vietnam, Thailand, Indonesia, Cambodia, Japan and elsewhere. It has killed more than 60 people although it does not yet easily infect humans or pass from human to human.
It has been found in wild birds in Mongolia and now in flocks in Kazakhstan and Russia.
"This virus keeps extending its range," Webster said. "It is out there spreading like crazy among the wild birds of Asia."
Not everyone is convinced that it is migrating birds that are spreading H5N1, but Webster is.
He grew up on a farm in New Zealand, where they raised an egg-laying breed of ducks called Khaki Campbells.
Between studying dead birds in Australia and the viruses that infected them in London, Webster and colleagues worked up the idea that influenza viruses originate in birds -- mostly ducks.
These natural hosts, or reservoirs, do not usually become ill when infected but incubate and spread the viruses.
But how do the viruses acquire the ability to infect new species, and how does their disease-causing nature change? Webster also helped discover how viruses do this.
One way is by steady mutation. Influenza is an RNA virus, meaning it is error-prone because it only uses one copy of the genetic code to replicate itself. That results in frequent variation, or mutation, of the virus, and ultimately one form will spread from person to person.
"The clock keeps ticking. Every time this virus replicates, it makes mistakes," Webster said. "Sooner or later it will make the mistakes that will allow it to go human to human."
There is a quicker way. If two different viruses are in a cell together, they can swap pieces of their genes, a process called reassortment. "It's virus sex," said Webster.
This reassortment caused the global flu pandemics of 1957 and 1968 that killed many people -- 4 million in 1968 -- because people had no immunity to the new viruses that arose.
All it takes is for one person to become infected with H5N1 while also infected with ordinary human flu. This may have happened in 1918, when a new strain of flu killed as many as 40 million people globally, most of them healthy young adults.
"We don't even know the mistakes it made in 1918 that allowed it to go human to human," Webster said.
Specialists in the Biosafety Level 3 lab at St. Jude's are studying the genetics of H5N1 to try to find precisely what "mistake" H5N1 needs to make to make it something that people can easily transmit to one another.
In this lab, with its specially sealed doors, air circulation controls and showers to scrub down everyone who exits, it is possible to play around with deadly viruses.
Webster has been working here since 1968, when he was recruited to study influenza coincidentally just as the last global pandemic of disease was getting under way.
GLOBAL EFFORT IN A SINGLE LAB
His team of international experts has helped lead the way in what progress has been made against H5N1.
German Erich Hoffmann helped develop the "reverse genetics" approach that was used to make the seed virus for the current H5N1 vaccine being tested in volunteers. A seed virus elicits an immune response without causing disease.
Dr. Elena Govorkova, a Russian medical doctor, is testing various combinations of antiviral drugs against H5N1.
There are four antivirals that are used against influenza -- amantadine and rimantadine, and two newer drugs -- Roche's oseltamivir or Tamiflu and GlaxoSmithKline's zanamivir or Relenza.
"Early on in the pandemic there will be no other options except for antivirals," Govorkova said in an interview. Amantadine did at one time work to treat H5N1 but it no longer does because the virus has developed resistance.
She is working to see if combining flu drugs into cocktails will provide better protection and has found some indication that they do. Tamiflu and amantadine may work well together.
And the good news is that, while the virus can also develop resistance to the newer drugs Relenza and Tamiflu, which governments and the World Health Organization are stockpiling, these resistant mutants do not survive well.
The work these scientists are doing now will help not only if the current H5N1 makes the jump into people, but also if some other variant proves to be the next threat. In their freezers in the St Jude laboratory are hundreds of samples of flu viruses.
They also have an approved vaccine factory where a new vaccine could quickly be churned out. All influenza vaccines must be made fresh to precisely match the strain of virus they are targeting.
A top United Nations public health
expert has warned that a new
influenza pandemic could kill as many as 150 million people.
Dr David Nabarro, of the World Health Organisation, says a pandemic could hit at any time.He has called for governments to take immediate action to address the threat.
"We expect the next influenza pandemic to come at any time now, and it's likely to be caused by a mutant of the virus that is currently causing bird flu in Asia," he said.
The bird flu strain has swept through poultry populations in Asia since 2003, infecting humans and killing at least 65 people.
Although the current strain cannot be passed from person to person, experts expect this to change if the virus mutates.
Dr Nabarro said it would be "extremely wrong" to ignore the possibility of a global outbreak.
"The avian flu epidemic has to be controlled if we are to prevent a human influenza pandemic," he said.
Dr Nabarro said the size of the pandemic would depend on where it started, how quickly the international community reacted and how it responded.
In 1918, an influenza pandemic killed more than 40 million people.
END OF NEWS REPORT
My thoughts on the above: When an
expert says flu will kill people, we need to know if all they mean is
flu will be the cause of death for those near to death anyway, those
within 10 years of their expected natural death, or those for whom
death will be seriously premature. There are 6 and a half Billion
people on the planet and 3 more people being born every second than are
dying. That's an increase of about 31 Million every year. I am afraid
.this flu is not going to even halt the rise. We need something
OCTOBER 7th 200
WASHINGTON (Reuters) - Officials from 80 countries gathered on Friday to come up with plans to quickly fight the next deadly flu pandemic while President George W. Bush urged pharmaceutical executives to focus on influenza vaccines.
The U.S. State Department sponsored the closed-door meeting of delegates from around the world on Friday, including experts from U.N. agencies and the European Union."There is no issue more important right now," Kent Hill, an assistant administrator at the U.S. Agency for International Development, told the opening session.
Experts have been warning for years that the H5N1 avian influenza is the biggest current health threat to the world but policy efforts to battle it have only reached a peak in recent weeks.
Bush was holding his own meeting on Friday with the chief executive officers of several companies that make vaccines to talk about ways to encourage more drugmakers to get into or stay in the uncertain business of making influenza vaccines.
Earlier in the week Bush asked Congress to consider giving him powers to use the military to enforce quarantines in case of an avian influenza epidemic.
The H5N1 bird flu virus has killed at least 60 people in four Asian nations since late 2003 and has killed or forced the destruction of tens of millions of poultry.
Experts say the H5N1 strain is mutating steadily and fear it eventually will acquire the changes it needs to spread easily from person to person. If it does, they say, it will sweep around the world in months and could kill millions of people.
U.N. Secretary-General Kofi Annan called on world leaders on Thursday to pool resources, including antiviral drugs and vaccines, to ensure that all countries are ready to fight an epidemic.
Only 40 of the World Health Organization's 192 member countries have drawn up pandemic preparedness plans, according to Margaret Chan, the WHO's top official for the pandemic. Only 30 wealthy countries have stockpiled or ordered antivirals.
But experts also stressed that there are ways to stop the epidemic among poultry.
STOPPING IT IN BIRDS
David Harcharik, deputy director-general of the U.N. Food and Agriculture Organisation, called for quicker action is needed to fight outbreaks.
"We very much believe in FAO that there has to be greater emphasis on stopping this disease at its source right now," he said in an interview. "We don't think enough is being done there."
Harcharik expressed frustration with the slow action by some governments to pay attention to H5N1.
"It was very difficult to get the attention of political leaders and the donor community at a time when they could take decisive action in a cost-effective way," he said.
So the flu spread. "Then it become a disaster," Harcharik said. "If more had been done earlier on, we think it could have cost a lot less money."
Harcharik said he would be telling the 80-nation meeting that there is still time to act by helping Asia's millions of small farmers change their methods to discourage the spread of the virus.
H5N1 naturally exists in water fowl such as ducks, geese and wild aquatic birds. It does not usually cause disease in these species but kills chickens quickly when it spreads to them. Wild birds also may be spreading it.
Animal experts say changes to farming practices can minimize the virus's spread.
"First and foremost we think there have to be efforts at the country level on surveillance and diagnosis to identify affected animals," Harcharik said. Affected flocks have to be culled immediately, he said.
Next, farmers have to be helped in changing their practices, such as keeping ducks fenced in and chickens in coops, he said. Workers also must follow hygiene procedures to prevent the spread.Harcharik estimated $150 million would be needed from donor countries to fund some of the efforts. So far about $20 million has been pledged by the European Union, the World Bank, the United States, the Netherlands, Japan and Switzerland .
WASHINGTON (Reuters) - Officials from all over the world will meet in Geneva in early November to discuss setting up a global fund to tackle the deadly H5N1 avian flu virus, a senior World Bank official said on Wednesday.
Jim Adams, the World Bank's chief for operations policy and country services, said the meeting -- on November 7 to November 9 -- would try to co-ordinate a global response to the H5N1 strain and identify shortcomings in veterinary and health systems.
"The intention is then to be prepared to go out more aggressively to raise some money to deal with those gaps," Adams told Reuters.
He said the trust fund would require initial donations of between $300 million to $500 million to help countries set up programs to deal with the risk of a pandemic of bird flu, which experts fear could eventually mutate enough to become transmissible among humans.
The H5N1 strain has already infected 121 people in four Asian countries and killed 62 of them, according to the World Health Organisation.
Adams said governments and organisations have become more aware of the threat as the virus has spread to the eastern edge of Europe from Asia.
"What has happened is that everyone has accepted that over time this is going to become a global issue and in that context (efforts have) been ratcheted up a level," Adams said.
"Like every issue, it has been actively discussed at the technical level and the point now is to get everyone in a room together to review what has been done."
WORLD BANK RESPONSE
The World Bank is also preparing its own response to bird flu through a financing mechanism that any country can seek access to, Adams said.
"After the Geneva meeting, we're hoping to be able to go to our board with a proposal and hopefully the first couple of countries that are interested actually participating in that," he said.
He said countries would receive their financial help through grant handouts rather than loans.
"Our honest sense is that in preparing for a potential problem, the challenge is always what can be done before it happens with the real possibility that it may not happen," Adams said.
Mark Wilson, director for rural development and natural resources for East Asia and Pacific region at the World Bank, said financial compensation to poultry farmers and producers for stock losses would be a major part of donor aid to governments.
He said it was important that governments establish in advance a "fair market value" for compensation, which will offer an incentive to farmers to report cases of Avian flu.
Wilson said programs to combat the spread of Avian flu would need to include proper surveillance to spot cases of the virus, strengthening laboratory testing and better co-ordination among ministries of agriculture and health.
"The key is to hit it at its source and hit it hard and if you do so, you can slow it down," Wilson said, noting that in hard-hit Vietnam the government was about to overhaul the poultry industry including removing livestock from urban areas.
Since the outbreak of Avian flu in Vietnam in 2003, the country has culled about 44 million birds or 17 percent of its poultry at a cost of $120 million, or 0.3 percent of gross domestic product.
An internal World Bank document obtained by Reuters says the costs of Avian flu outbreaks in Southeast Asia have not had a major economic impact, but significantly hurt its poultry industry -- running at more than $10 billion since 2003.
The World Bank said the most direct economic impact of an avian flu
pandemic would be through a fall in labour productivity. Other
long-term affects would play out as the increased costs of preventing
and treating disease reduced savings and investments.
NOVEMBER 06 2005
The deadly H5N1 virus is known to have killed 63 people in four Asian countries and led to the culling of 150 million birds worldwide. It has recently been detected in birds in eastern Europe and experts expect it to reach the Middle East and Africa in the near future.
The virus remains hard for people to catch and is passed on almost exclusively through human contact with birds.
But scientists say it is steadily mutating and could acquire changes that make it easy to spread from human to human, potentially triggering a pandemic in which millions could die and the global economy could be crippled.
The senior U.N. coordinator for avian and human influenza, David Nabarro, told Reuters he expects health and veterinary officials to draw up a sweeping plan against the disease during three days of talks hosted by the World Health Organisation.
A global programme would mean investing in veterinary services, boosting human disease surveillance, scientific cooperation on vaccine development as well as negotiations with drug companies on access to existing antivirals, he said.
Nabarro also said that as part of the plan, the World Bank would propose setting up a fund to help both countries and agencies respond to the crisis.
"I think there is a reasonably good chance ... that people will congeal around a set of basic principles and elements for what will become an international programme which can then be presented to the donor community over the next couple of months," Nabarro told Reuters in an interview.
"The actual pledging, I understand, will take place in the new year... That is definitely in the plans," he added.
Jim Adams, the World Bank's chief for operations policy and country services who will make a financial presentation to the talks on Wednesday, has said a trust fund would require initial donations of $300 million (171 million pounds) to $500 million to help countries set up programmes.
Experts say the virus must be stopped in poultry to prevent more people catching it and nowhere is that fight more crucial than in densely populated Asia, where farmers and even city dwellers live side-by-side with poultry and other livestock.
There are also fears that the virus could spread rapidly if it takes hold in Africa's rural hinterlands where similar living conditions exist.
"We've got to be ready for the bird flu epidemic extending into the Middle East and Africa. We just hope that they are stamped out as effectively as they appear to have been in some isolated European outbreaks," Nabarro said.
"This is a global thing. There is no reason to think that the
will start in countries currently affected by avian influenza, although
obviously that is where minds are most focussed," he said.
thoughts on death/survaval-rates and resulting immunity
By Tan Ee Lyn
Fri Nov 18, 3:09 PM ET
HONG KONG (Reuters) - Deadly strains of the H5N1 bird flu virus have killed about half of all people known to have been infected and most people assume that survivors should be protected by antibodies and so immune to repeat infections.
But experts say that may not always be the case.
The virus, which has infected 130 people in Asia and killed 67 of them since late 2003, is changing constantly and repeat infections by new strains could still leave a birdflu survivor in peril, just as people can catch a new form of the flu every year.
"Infected people with antibodies (to H5N1) should be protected for years against the same virus. But usually influenza viruses are changing constantly. You may not be protected from viruses with some changes," said Hitoshi Oshitani, a World Health Organisation Advisor on communicable diseases.
"This is why we have seasonal outbreaks of influenza every year and people can be infected with influenza every year," he wrote in an e-mail in reply to questions from Reuters.
Health experts are warning that the virus, which is spreading in poultry in parts of Asia and which has mostly jumped directly to humans from birds, will mutate into one that is easily passed between people and set off a pandemic, killing millions.
Influenza is an RNA virus, which is unsteady when it replicates. This results in frequent variation, or mutation, and finally one form will spread from person to person.
Samson Wong, a microbiologist with the University of Hong Kong, said no one knows if a birdflu survivor would be immune to future attacks of the virus.
"No one knows if a survivor will survive a repeat attack, because it is a new disease. They should have protective immunity, but like human influenza, H5N1 could mutate, and if the person is infected by a different strain, he may get sick all over again,' Wong told Reuters.
"If the person is infected by the same strain, he should have immunity, but nobody knows for how long."
How well survivors tackle repeat H5N1 attacks may also depend on how well their systems "remember" the virus strain.
Lymphocytes, the blood cells that make antibodies, have memory cells and this function allows them to remember a past encounter with the H5N1 strain, and produce antibodies to neutralize the virus in future encounters, experts say.
"If the survivor is infected by the same strain of H5N1, he should produce large amounts of antibodies to fight repeat infections," said William Chui, honorary associate professor at the department of pharmacology at the University of Hong Kong.
"But that depends on how long the memory stays ... how long
this memory lasts, no one knows. Memory is stored in B-memory
cells (in lymphocytes), which is key to whether survivors can
withstand later attacks."
END OF REUTERS ARTICLE
discuss the point that it is a violent immune
response, generated after a considerable presence of the infection has
built up that is usually responsible for the death of those who do not
survive. The immunity needs to kick in early enough if a host
metabolsim is to shoot down the invader without destroying its own
body. Those who survive do so because of the quickness of their
response to danger. For this reason a person who has survived one
attack is likely to have apparent immunity even if the virus mutates,
their successful immune system having been encouraged and trained in
early response. JB
Fri Dec 9, 5:28 AM ET
BANGKOK (Reuters) - The rise of deadly new diseases such as SARS and bird flu could be linked to the destruction of the environment, the World Health Organization said on Friday.
"Human health is strongly linked to the health of ecosystems, which meet many of our most critical needs," Maria Neira, director of WHO's Department of Protection of the Human Environment told a news conference at the launch of a new report.
Population growth and economic development were leading to rapid changes in global ecosystems and this was affecting human health, the report said.
It said natural resources such as water, food, fuel and climate were important to prevent diseases and sustain good health as many human diseases originated in animals.
Such diseases, including influenza, tuberculosis and measles, established themselves in human populations after crossing from domesticated animal species including chickens, cattle and dogs.
"As a result of human actions, the structure and the world's ecosystems changed more rapidly in the second half of the twentieth century than at any other time in human history," the report said.
About 60 percent of the benefits that the global systems provided to support life on Earth were being degraded and used substantially, said the report, which involved more than 1,300 experts worldwide.
Harmful consequences to human health were being felt and could grow significantly worse over the next 50 years, it said.
Pressure on the environment could have unpredictable and potentially severe future impacts on health, the WHO said. It said regions facing the greatest risks included sub-Sahara Africa, Central Asia, parts of Latin America and parts of South and Southeast Asia.
"For the poor people, they might represent the problem in terms of food production, in particular, drought and flooding. And the problem is increasing," Neira said.
The report said some of the most serious problems included nutrition as degradation of fish stocks and farmland were factors in the malnutrition of some 800 million people around the world -- nearly all of them in poor countries.
Water-associated infectious diseases claimed 3.2 million lives each year, about 6 percent of all deaths, the report said.
Yet more than 1 billion people lacked access to safe water supplies and 2.6 billion lacked adequate sanitation, it said.
JANUARY 08 2006
Turkey is now suffering seriously from Avian Flu and several children have died. Infection of humans has now spread from Eastern Turkey to Ankara. Slaughter of birds is taking place but the authorities are overwhelmed. So far there is no evidence of the disease passing between humans. The first level of investigation is to discover why children are articularly vulnerable, but I assume that is because they have not inherited or acquired as much adaptable immune reaction as adults.
What puzzles me is that people are more
worried about how many people are going to die than how many birds are
going to die and be slaughtered. We have 4 billion more humans than we
need on this planet. We only need 2 billion if it is going to be
sustainable. But we need food, and birds and their eggs are vital to
our food supply. We are already in trouble with the fish stock. Fewer
people and plenty of birds is fine. Fewer birds and the same or more
people is not.
ANKARA (Reuters) - A U.N. health expert said on Wednesday the case of two Turkish boys who tested positive for bird flu without developing symptoms provided a chance to learn more about the virus which has killed 78 people worldwide.
The two children contracted the virus after playing with two dead birds they found near their home in the central Turkish town of Beypazari, west of the capital Ankara.
"This is a very interesting case. They have still shown no symptoms of the virus and yet have tested positive," said Dr Guenael Rodier, head of a(WHO team visiting Turkey.
"The normal flu virus is always at its most virulent at the start of the process, but you don't necessarily exhibit the symptoms at that stage," he said, suggesting a possible similarity between avian influenza and the normal flu virus.
"If so, we have diagnosed the H5N1 virus at the very early stages (in the boys). We hope to study this case carefully. This is an opportunity to learn about the disease."
Rodier said the anxious parents had brought the boys to hospital in Ankara, knowing the risks of infection from dead or sick birds. They were diagnosed positive on Sunday.
"This shows that the system is working well. The family was taken seriously, they were not turned away because the children showed no symptoms," Rodier told reporters.
The boys are being treated with anti-viral drugs at the Kecioren hospital on the outskirts of Ankara.
Rodier stressed the WHO laboratory in Britain had not yet confirmed that the boys' were positive. "But we expect the results back soon," he said.
Turkey is the first country outside China or Southeast Asia where humans have contracted the H5N1 strain of bird flu. The WHO has confirmed two teenagers from the same family died from the virus.
A third sibling also died, but did not test positive for the virus. Thirteen other people, including the two boys, have tested positive, but Health Minister Recep Akdag described their condition on Wednesday as "good."
In Asia, the fatality rate among confirmed bird flu victims has averaged a little more than fifty percent.
The fact that no other patients in Turkey have yet died or indeed have experienced any significant deterioration in their condition has prompted speculation that human bird flu may not be as deadly as previously believed.
It also raises the possibility that doctors battling the disease in Asia had identified only the most serious cases.
In Geneva, another senior WHO official told Reuters that it was too early for conclusions about the strength of the virus.
"Maybe the situation is good and the virus is not as lethal, but we will not know that for some time," said Mike Perdue, leader of the WHO's response to the situation in Turkey.
However, based on initial genetic tests, which pointed to the virus not having changed on its way from east Asia, there was no reason to think that it had become more benign, he added.
(Additional reporting by Richard Waddington in Geneva)
An important advance
By Patricia Reaney
LONDON (Reuters) - Scientists have solved the genetic puzzle of how influenza A viruses -- including the H5N1 bird flu -- replicate inside cells, which could help to speed up the development of new drugs to avert a pandemic.
As governments bolster efforts to halt the spread of avian flu which has killed 83 people since 2003, an international team of researchers has discovered that the flu virus infects cells by organizing its genetic material in a set of eight segments.
"We've found that the influenza virus has a specific mechanism that permits it to package its genetic materials," said Professor Yoshihiro Kawaoka, of Wisconsin-Madison School of Veterinary Medicine, who headed the research team.
"All influenza viruses have the same mechanism, including bird flu," he added in an interview on Wednesday.
Influenza A is the family of viruses responsible for seasonal flu as well pandemic strains such as the 1918 Spanish Flu that killed as many as 50 million people worldwide.
Scientists fear H5N1 could cause the next pandemic if it mutates on its own or mixes with a human virus to form a strain that can spread easily from person to person.
So far it has not shown it is highly infectious in humans but knowing how the virus replicates and the mechanism that controls it could provide new targets for antiviral drugs.
"If we can disrupt this interaction ... we may be able to stop the virus replication," said Kawaoka, who is also a professor at the University of Tokyo in Japan.
UNWRAPPING THE PACKAGE
Influenza A viruses enter cells and reproduce their own genetic material, or RNA, into infectious particles that are released and then infect other cells. How it manages to do it has been a mystery, until now.
With the help of an electron microscope, Kawaoka and a team of scientists from Japan, Sweden, and the United States used a technique that generates three-dimensional images to see how the virus packages the segments of RNA into the infectious particles.
They found the material is organized in a circle of seven RNA segments surrounding another segment to make a set of eight. Kawaoka said no one had identified that before.
"We need to have more antivirals for influenza," said Kawaoka, who reported his research in the journal Nature.
"And as these segments get incorporated into the particle as a set, it suggests these elements could be a target of disruption. There must be a genetic element in each of the eight segments that allows them to interact," he added.
The scientists are trying to identify what is important for the interaction among the eight segments and are looking for molecules that will inhibit it, to prevent the virus from replicating.
BUT AT DAVOS, THE CALL IS FOR MORE FUNDING.
By Ben Hirschler
DAVOS, Switzerland (Reuters) - Greater economic incentives are needed for companies to accelerate development of vaccines against killers like AIDS and bird flu, according to the head of the International AIDS Vaccine Initiative.
Dr. Seth Berkley, president of the non-profit group, said the threat posed by bird flu highlights the folly of not taking a long-term approach toward vaccines.
The world is ill-prepared to make the large quantities of flu vaccine that will be needed if avian flu triggers a human pandemic, as many scientists fear, because few companies remain in the business and there has been no investment in modern production methods.
Flu vaccine is still made laboriously in chicken eggs, rather than in cell-based manufacturing systems that are widely used for producing other biotechnology products.
"The whole system for vaccines is not aligned properly," Berkley told Reuters. "We have to find better ways to accelerate research, to finance research and to create incentives for pharmaceutical companies."
He plans to lobby for such commitments in discussions with policymakers at the annual meeting of the World Economic Forum in Davos this week.
With 4.9 million new HIV infections in 2005 alone, scientists agree a vaccine is desperately needed to end the AIDS epidemic.
The G-8 group of industrialized nations noted AIDS vaccines as a priority area during its meeting in Gleneagles, Scotland, in 2005. But Berkley said it was the sixth time the group had expressed support, and implementing such promises remained a critical requirement.
Changes were needed both to push forward good scientific ideas and to pull big drug makers into the field, by offering them advanced purchase commitments that would guarantee a market for any products developed, he said.
Although more than 30 HIV/AIDS vaccines are now being tested in clinical trials around the world, Berkley said there would not be a useable product on the market until the next decade, even in a best-case scenario.
The first-ever large-scale AIDS vaccine trial was completed in 2003, but it failed to provide protection.
Since then, Merck & Co Inc has reported encouraging early-stage results with an experimental vaccine, called MRKAd5, prompting it to expand testing last year.
Doubts remain, however, as to how well Merck's vaccine, which uses a common-cold virus to carry HIV genes into human cells, would work in the developing world.
Another problem is that all the most advanced AIDS vaccine candidates use a similar approach, known as cell mediation, and Berkley said there is an urgent need to study other approaches as well, notably antibody-based vaccines.
That will require more money, and Berkley repeated his call for annual global investment in AIDS vaccines to be doubled to at least $1.2 billion a year.
By Thomas Atkins Sat Jan 28, 6:16 PM ET
DAVOS, Switzerland (Reuters) - The United Nations is
considering using "flu-casters," modeled on television weather
forecasters, to publicize vital information if a global flu
"The flu-casters would draw out the maps and keep people engaged at regular intervals ... beaming it from the WHO bunker," Nabarro told Reuters in an interview at the World Economic Forum in Davos.
The WHO's Geneva bunker, a $5 million facility built in a former cinema, is the world's nerve-center for tracking bird flu and other deadly diseases.
The room will become a global command center if the H5N1 bird flu virus, which has killed at least 83 people in Asia since 2003, mutates into a form which spreads easily among humans and sparks a flu pandemic which could kill millions.
The screen-filled bunker could link the "flu-casters" with TV networks via satellite feeds.
Nabarro was speaking as the United Nations analyzed results from a top-level catastrophe simulation to set policies that envisage governments, companies and the media working together to fight a global flu pandemic.
The exercise has produced surprising conclusions that could prove key should the disease start to spread quickly among humans.
One of the most important conclusions was that maintaining infrastructure -- water, power and the provision of food -- could take a higher priority than providing care to the sick, Nabarro told Reuters.
"It is maybe even more important to concentrate on the essentials of life for those who are living than it is to focus on the treatment of those who are sick," he said. "We learned a lot."
A pandemic could see travel and trade halted, workers forced to stay home, schools closed and a number of other dramatic measures designed to limit the spread.
The U.N. aims to forge fixed partnerships with key actors who would be involved in any pandemic response effort, which would include community groups, aid groups like the Red Cross, businesses and the media, Nabarro said.
"The focus on business is important. They have skills and can do things that governments cannot," he said. Clear communications would also be crucial.
The simulation assumed that the world was 40 days into the outbreak of a deadly pandemic.
"What became clear to us was, if we don't work together effectively and get prepared, we will be badly hit by that pandemic," he said.
The pandemic preparations will call for novel approaches if officials are to limit the potential catastrophic damage -- such as the use of mobile phone technology to distribute questionnaires and information, Nabarro said.
Nabarro also warned there was still a lot of work to be done in the event of an outbreak.
"Governments are starting to realize that they are nowhere
near prepared for the damage that it could cause," he said at a
JANUARY 30th 2006
By Jeremy Smith Mon Jan 30, 5:45 AM ET
BRUSSELS (Reuters) - EU regulators may allow national governments to vaccinate poultry flocks as a precaution against the spread of dangerous strains of bird flu, officials said on Monday.
Until now, vaccination has been allowed only in limited circumstances. But with the lethal H5N1 virus creeping closer -- the latest case is in birds in northern Cyprus -- that may change, especially as the spring migratory season approaches.
The European Commission, which monitors national programs to fight the virus, has shied away from generalized preventive vaccination, saying the disadvantages outweigh the advantages.
"With H5N1 on Europe's borders for several months now, there is an ongoing risk. It's a new situation, and in a new situation, new approaches may have to be considered," a Commission official said, adding that this was still an internal discussion.
"Until now, it (vaccination) has been allowed for emergency vaccination but not preventive. Now, preventive vaccination could be allowed based on the risk and an analysis of the risk. It's an option that could be considered," he said.
Preventive vaccination is being used in a pilot project in certain areas of Italy where low pathogenic bird flu viruses often recur. But the Commission has said it would be impossible to maintain the strict checks necessary to vaccinate the billions of poultry kept for farming purposes across the EU.
Bird Flu is endemic in poultry across parts of Asia and has spread to flocks in eastern Europe. The virus can infect people who have close contact with infected birds and has killed at least 83 people since it reemerged in late 2003.
A number of EU governments, such as the Netherlands, have expressed interest in vaccination as a precautionary measure.
One of the world's top poultry exporters, the Netherlands is seen as a country where the risk of the disease spreading is higher than elsewhere in the EU due to its huge poultry flock.
Allowing mass preventive vaccination also raises a number of trade issues, with a possible loss of sales and export revenue from consumer rejection of products from vaccinated animals.
EU rules require that vaccinated birds can be differentiated from infected birds and that specific surveillance and control measures are in place -- to minimize restrictions on trade in poultry and poultry products from the vaccinated areas.
If preventive vaccination were to be become accepted as a
mainstream measure against bird flu, the member state would
first have to apply to Commission authorities in Brussels with
a detailed justification, the official said.
Bird flu has become endemic in Hong Kong after its recent discovery in both local wild birds and chicken, the territory's health secretary said today.
"Since different kinds of wild birds and chickens have this virus, we can be quite sure that this virus is endemic in our birds," York Chow said.
"It's not just Hong Kong. This virus will exist in neighbouring areas - southern China as well as Hong Kong," he said.
Bird flu has become endemic in Hong Kong after its recent discovery in both local wild birds and chicken, the territory's health secretary said today.
"Since different kinds of wild birds and chickens have this virus, we can be quite sure that this virus is endemic in our birds," York Chow said.
"It's not just Hong Kong. This virus will exist in neighbouring
areas - southern China as well as Hong Kong," he said.
FEBRUARY 10th AVIAN FLU HAS REACHED
NIGERIA AND THE VIRUS STRAIN IS CONFIRMED
UN urges Nigeria bird flu action
must step up its measures to prevent further spread of the deadly bird
flu virus, the UN has warned.
The government needs to clamp down on the trade in poultry and intensify culling and movement controls, said two UN world bodies.
Nigerian officials have confirmed the virulent H5N1 strain of the virus is affecting poultry in three states.
Chickens started dying four weeks ago, leading to fears that the emergency measures may come too late.
The Food and Agriculture Organisation and the World Organisation for Animal Health also urged neighbouring Benin, Cameroon, Chad, Ghana and Niger to tighten border inspections.
The agencies said they would send a joint mission to Nigeria within 48 hours to assess the situation.
The World Health Organization (WHO) has called for a massive public education campaign, to stop bird flu from spreading to humans in Nigeria.
The WHO says it is also sending experts to Nigeria who will use a mass polio vaccination from Saturday to help detect possible human cases of the virus.
"All countries must take measures to protect human health against avian flu and prepare for a pandemic," WHO director general Lee Jong-Wook said.
The deadly H5N1 strain of bird flu was found on
more farms in the north of the country on Friday, where thousands of
poultry have died recently.
The new cases - confirmed by National Veterinary Research Institute head Doctor Lamy Lombar - are in Kano State and Plateau State, on either side of Kaduna, where the first case was found on Wednesday.
Samples have now been sent abroad for further analysis.
The WHO's regional director in Africa said international support had arrived but most of it in the form of technical advice and not what the region needs most - money.
Police marksmen, ordered to cull 180 ostriches at a farm in the virus-stricken north, killed only 120 birds before running out of bullets, the Associated Press news agency reported.
Although the government said it will compensate farmers if their poultry are killed, people have been rushing to sell sick or dead chickens in the markets before restrictions are imposed.
It is not clear how the virus has spread to Nigeria. It was first found in South-East Asia and more recently Turkey and Russia.
Some experts blame illegal poultry imports; others migrating birds.
More than 80 people have died of H5N1 bird flu since the disease's resurgence in December 2003 - most of them in South-East Asia.
Experts point out that cross-infection to humans is still relatively rare, and usually occurs where people have been in close contact with infected birds.
But they say if the H5N1
strain mutates so it can be passed between humans, it could become a
global pandemic, killing millions.
GENEVA (Reuters) - The World Health Organisation (WHO)
called today (Friday) for urgent studies to determine optimal doses
of flu drug Tamiflu to be used in the fight against human bird
The highly pathogenic H5N1 strain of bird flu has killed 98 people, roughly half of the 177 who have contracted it since late 2003, but experts fear a pandemic if the disease evolves into a form which can be transmitted easily between humans.
Swiss drug maker Roche said on Thursday it was boosting output of Tamiflu, whose generic name is oseltamivir, by a third to meet increased demand from governments building stockpiles for a potential pandemic triggered by bird flu.
"There is no direct clinical trial evidence that shows that oseltamivir is effective in human H5N1 disease because such studies have not yet been conducted," the WHO said in a statement posted on its Web site www.who.int.
"Because the optimal dosage has not been resolved by clinical trials, and because H5N1 infections continue to have a high mortality rate, prospective studies are needed urgently to determine optimal dosing and duration of treatment for H5N1."
The United Nations agency gave recommended doses for both treatment and prevention in adults and children above one year old. Its recommended treatment for adults suspected to have the disease is 75 mg twice a day for five days.
"It is possible that severely ill patients might benefit from longer duration of therapy (for example 7-10 days) or perhaps higher doses (for example 300 mg/day), but prospective studies are required," it said.
Children should be given the drug preventively for the same length of time in weight-adjusted doses.
"For people with repeated or prolonged exposure such as healthcare workers or personnel involved in bird culls, pre-exposure courses, repeat post-exposure courses or continuous treatment may be necessary," it said.
The recommendations are based on limited data from human outbreaks, animal models, and extrapolated results of trials in patients with ordinary influenza.
The WHO said it would continue to monitor the situation but it could not be held liable for damages arising from its advice.
By Patricia Reaney
LONDON (Reuters) - Scientists said on Wednesday they may have uncovered why the H5N1 avian flu that is so lethal in birds has not been able to spread easily among humans.
It is because bird flu viruses attach to receptors, or molecules on cells, in different regions of the respiratory system from human influenza viruses.
Receptors act like doorways that allow the virus to enter the cell, multiply and infect other cells. Humans have receptors for avian viruses, including H5N1, but they are found deep within the lungs.
Cells in the upper airway in humans lack the receptors targeted by avian flu viruses, which limit their ability to spread from person to person.
"For the viruses to be transmitted efficiently, they have to multiply in the upper portion of the respiratory system so that they can be transmitted by coughing and sneezing," said Dr Yoshihiro Kawaoka, a virologist at the University of Wisconsin-Madison, who led the research team.
The H5N1 bird flu virus has killed 103 people and infected 184 since late 2003. People infected with the virus, which has spread from Asia to Europe, the Middle East and Africa, have had close contact with diseased birds.
Scientists fear the virus could mutate into a pandemic strain that could become highly infectious and capable of killing many millions of people.
"Our findings provide a rational explanation for why H5N1 viruses rarely infect and spread from human to human, although they can replicate efficiently in the lungs," Kawaoka and his team said in a report in the journal Nature.
Professor John Oxford, a virologist at St Bartholomew's and the Royal London Hospital, Queen Mary's School of Medicine and Dentistry in London, said the research provides a reasonable explanation for the small number of human cases.
"This gives some meaning to the great conundrum at the moment, the fortunate conundrum of why this virus is not going from human to human," Oxford said in an interview
"It looks like a deep scientific study into that and we need more of those studies."
Kawaoka and a team of researchers in Japan infected human tissue with bird flu viruses. Their findings suggest that strains of H5N1 circulating in birds would have to undergo several key genetic changes to become easily transmissible in humans.
"The virus has to mutate to recognize human virus receptors which are in the throat," Kawaoka told Reuters.
"Certainly, multiple mutations need to be accumulated for the H5N1 virus to become a pandemic strain."
Scientists do not know how far the H5N1 has mutated to become a pandemic strain but Kawaoka's findings show the importance of looking for changes in virus recognition of human receptors.
The changes or mutations must occur in the hemagglutinin protein, the "H" in the virus designation, for avian H5N1 viruses to recognize human receptors, according to the researchers.
"Identification of H5N1 viruses with the ability to recognize human receptors would bring us one step closer to a pandemic strain," Kawaoka added.
The exact virus strain is not known, but tests were continuing and further results were expected on Thursday.
The Scottish Executive said restrictions had been put in place around Cellardyke, east of Anstruther.If the disease is confirmed as the deadly H5N1 strain there may be further restrictions set up.
By Lisa Richwine Mon Apr 10, 7:42 PM ET
Avian flu experts appealed on Monday to engineers -- a group largely left out of flu preparedness efforts -- to come up with potential breakthroughs for speeding vaccine production in case of a deadly pandemic.
The hope is that engineers could use their expertise in areas such as assembly lines and production techniques to help vaccine developers jump hurdles.
The matter has gained urgency as the H5N1 flu strain moves quickly among birds in Asia, Europe and Africa. Experts worry it could change to a form that spreads easily among people and kills millions.
An effective flu vaccine would be key to slowing the movement of the virus, but producing sufficient quantities would take time.
"We have so far a situation that is not satisfactory ... it's very difficult for many people to predict how much (vaccine) is going to be available two, three or even five months after a pandemic has emerged," said Klaus Stohr, head of the WHO's influenza team.
It could take at least nine months to have 1 billion doses available for the world's 6.4 billion people, he said. "By this point in time, the virus may have gone around the world already twice," he said.
Stohr spoke to a meeting sponsored by the Institute of Medicine and the National Academy of Engineering. It was held on the campus of Case Western Reserve University in Cleveland.
The idea of turning to engineers emerged when some Case faculty heard Dr. Julie Gerberding, head of the Centers for Disease Control and Prevention, warn that a vaccine could not be produced fast enough during a flu pandemic.
"As engineers we sat there ... and said, 'Why can't we do that?"' said Dr. John Anderson, a chemical engineering professor at Case Western.
"Research from the engineering community needs to look at processes that have been entrenched, in a rut, for decades," said Patrick Scannon, chief scientific and medical officer for biotechnology company Xoma Ltd., a small biotechnology company.
In the meantime, governments have been urging companies to step up production capacity. Existing vaccine factories can make only 900 million doses of influenza vaccine globally -- far short of what would be needed in a pandemic when billions of people would need to be vaccinated.
Preliminary tests showed the virus was likely to be an H7 strain of bird flu, not the lethal H5N1 avian virus that has infected 204 people and killed 113 since 2003.
"There is no evidence this is H5N1. We think it will turn out to be H7,"
the government's chief vet Debby Reynolds said. [THIS IS NOW CONFIRMED - JB]
She said tests were continuing but there was unlikely to be any further information on the outbreak until Thursday evening at the earliest.
"It is far too early to say how serious this is," she told a news conference in London.
The Department for the Environment, Food and Rural Affairs (DEFRA) said all birds on the farm near Norwich, an area which is home to some of Europe's biggest poultry farms, would be killed as soon as possible as a precautionary measure.
Britain has been on high alert for bird flu since it discovered the lethal H5N1 virus in a wild swan in Scotland earlier this month.
The swan was the only wild bird found in Britain so far to have the H5N1 virus, which has spread from Asia to Europe, the Middle East and Africa, and led to the death and culling of 200 million birds since late 2003.
Scientists fear bird flu could become highly dangerous to humans if the virus mutates into a form easily passed on from one person to another.
Animal health experts had not yet decided whether to impose an exclusion zone around the poultry farm near the market town of Dereham to prevent the spread of the virus.
Results of the tests will determine whether it is highly pathogenic or low pathogenic.
Freda Scott-Park, the president of the British Veterinary Association, said the avian flu strain did not pose a threat to public health. But she said poultry workers and veterinarians looking after the farm would have to take extra precautions.
"There is absolutely no risk to health," she said.
That view was supported by Anthony Gibson, spokesman for the National Farmers' Union.
"The implications for public health and for the safety of eating properly cooked chicken and eggs are zero," he said.
An outbreak of the H7N7 bird flu strain in the Netherlands in 2003 led to the culling of 30 million birds, about a third of all Dutch poultry at a cost of hundreds of millions of euros.
A veterinarian working on an infected Dutch farm caught the disease and later died of pneumonia. It infected more than 80 people in total.
Both highly pathogenic and low pathogenic avian influenzas can infect humans but rarely do so. H5N1 is the bird flu strain which poses the biggest threat to public health, although cases of human infection remain relatively infrequent.APRIL 29th 2006
"We can confirm preliminary tests indicate H7N3 (bird flu), but further tests are being carried out," said a spokeswoman, adding two free-range flocks will be slaughtered.
The H7N3 strain of bird flu was found on another farm nearby in the eastern English county of Norfolk earlier this week where 35,000 birds are being culled. The strain is less dangerous to humans than the feared H5N1 bird flu virus.
Japan said earlier on Saturday it was suspending poultry imports from Britain to prevent the spread of bird flu to domestic fowl.
Norfolk is home to some of Europe's biggest poultry farms and the spokeswoman said a restrictive zone of one km was being put in place around each farm.
Britain's chief veterinary officer Debby Reynolds said further premises may be involved.
"We are investigating whether there any links or movements between the two suspect farms and the confirmed infected premises," Reynolds said in a statement.
"The working hypothesis remains that the most likely source of the virus is from another premises or from wild birds."
The government has been on high alert for bird flu since it discovered the H5N1 virus in a wild swan in Scotland earlier this month.
The swan was the only wild bird found in Britain so far to have the H5N1 virus, which has spread from Asia to Europe, the Middle East and Africa, and led to the death and culling of 200 million birds since late 2003.
H5N1 has infected 205 people and killed 113 since 2003.
The environment ministry said it had not been informed of the Japanese suspension of poultry imports.
"If it is the case we will contact the Japanese embassy to explain our view on it which is that a ban would not be appropriate given the circumstances and that would be consistent with the World Animal Health Organisation guidelines," said a spokesman for the department.
The Veterinary Laboratories Agency may have the results of tests from the two new farms on Sunday or early next week.
The Department for Education and Skills guidance says a rapidly spreading outbreak is inevitable and could kill up to 700,000 in waves lasting months.
| By Caroline Parkinson
BBC News, health reporter
Winter is the time of year when people's thoughts turn to flu.
But this time last year, it wasn't the usual seasonal flu which was occupying the thoughts of doctors, the media and the public - it was bird flu.
Twelve months on, how have things changed? Are we still at risk? And are we any better placed to fight the deadly H5N1 virus?
The H5N1 virus is still around. But experts say it has been largely "dormant" in recent months.
Europe has seen no cases since the outbreak in Turkey, nor has Africa been hit by any major outbreaks since the beginning of the year.
In South-East Asia, where most cases of bird flu are seen both in animals and humans, there have been no cases in Vietnam this year, whereas it was previously a hot-spot for bird flu.
Experts say this is probably because people have learnt to restrict access to birds and so reduced infection risk, and because monitoring systems have been improved so the virus would not have the chance to spread unchecked.
Variation, not mutation
Dr Alan Hay, head of the World Influenza Centre at the National Institute for Medical Research said: "Things have been quiet for the last six months in most parts of the world.
"In Europe it has calmed right down, and there hasn't been a resurgence in Africa.
"Once people know what to avoid and what measures to take, you don't get the cases."
|| There is no evidence the virus
has an increased capacity to spread
Dr Alan Hay, WHO influenza centre
But he said: "We don't know what's smouldering away in some part of the world we can't keep our eye on."
The fear is that the H5N1 virus will combine with a human flu virus and mutate into a pandemic strain which could spread easily between people.
There have been no indications over the last 12 months that this is any closer.
But the virus has not gone away.
It has changed, as all viruses do. And there have been cases, such as a cluster in Indonesia, where family members have contracted bird flu.
But, importantly, it was H5N1 they caught, and not a mutated strain.
Dr Hay said: "There is some evidence of variation in the strain, but there is no evidence the virus has an increased capacity to spread. We haven't seen any change."
And we are better placed to fight any pandemic which does occur.
There are several trials of vaccines against the existing H5N1 virus which are showing promise.
Professor John Oxford, a virologist at Queen Mary School of Medicine, London, said: "Things have changed tremendously over the last 12 months.
"Every major vaccine manufacturing group has now got an H5N1 vaccine in production. A year ago, that didn't seem possible.
"And the stockpiles of antiviral drugs are increasing."
But Dr Hay added: "The concern is that, as winter approaches, the birds will migrate southwards towards Europe and Africa. We really don't know what they are carrying.
So how worried should members of the UK public be? The experts say they should not panic.
Dr Hay said: "There is no reason for the individual to have any reason for concern unless they're involved in dealing with birds.
"People shouldn't feel in danger. Contingency measures are in place to monitor wild birds.
"And there have been very few poultry workers who have been infected and shown clinical symptoms."
It is likely that the coming months will see more cases of birds infected with the H5N1 virus.
But the experts' conclusion is that the chances it will mutate into a dangerous pandemic strain are no greater than they were this time last year.
That strain can be fatal if it is passed on to humans but experts stressed the outbreak was contained and posed little danger to humans.
The Department for Environment, Food and Rural Affairs and the European Commission carried out virus tests at laboratories in Weybridge, Surrey.
The 159,000 other turkeys on that farm will now have to be slaughtered.
A three-kilometre protection zone and a 10km surveillance zone will be set up around Holton, which is approximately 17 miles south-west of Lowestoft.
In addition Defra has revoked the national general licence on bird gatherings and bird shows and pigeon racing will not be permitted.
A spokeswoman has also said the risk of the disease spreading to humans was low and there was no need for panic.
A statement released by Defra said: "Further tests to characterise the virus are under way in order to ascertain whether or not it is the Asian strain.
"Strict movement controls are in place, poultry must be kept indoors, there is a prohibition on gatherings of poultry and other birds and on-farm biosecurity measures will be strengthened."
The strain of H5N1 found in Asia has proved to be fatal in humans.
Fred Landeg, Britain's Deputy Chief Veterinary Officer, told BBC News that vaccinations for poultry were not currently being considered.
"There are a number of problems with vaccination in that it takes about three weeks to get immunity.
"In relation to human beings we are in touch locally with the Health Protection Agency and they are advising on the treatment of workers on Bernard Matthews' farm and indeed with... staff who are dealing with the disease on the premises."
Vets were called to the Bernard Matthews farm on Thursday night.
A statement from the company said: "While Bernard Matthews can confirm that there has been a case of H5N1 avian influenza at its Holton site, it is important to stress that none of the affected birds have entered the food chain and there is no risk to consumers.
"Bernard Matthews is working closely with Defra and other industry bodies to contain the infection.
"The company meets and in many cases far exceeds Defra's biosecurity standards for combating avian flu."
National Farmers Union president Peter Kendall told BBC News 24 the top priority would be eradicating the outbreak.
"[We will be] making sure we get the message across about how well this will be managed and controlled.
AVIAN FLU FACTS
There are 15 types of bird, or avian, flu.
The most contagious strains, which are usually fatal in birds, are H5 and H7.
There are nine different types of the H5 strain.
The nine types take different forms - some are pathogenic, others are harmless.
"We're encouraging all farmers to be incredibly vigilant, look at their flocks carefully and we do need to reassure consumers that this is not an issue about the safety of poultry - it's completely safe to eat."
Professor John Oxford, a virologist at the London Queen Mary's School of Medicine and Dentistry, said he was confident the outbreak could be contained.
He said: "I don't think it has made any difference as a threat to the human population. The most likely explanation is that a small bird has come in through a ventilation shaft.
"One good thing about this virus is that it's easily destroyed. You can kill it with a bit of detergent.
"You want to move in and take action straight away and I'm sure they'll be doing that."
The farm has been placed under tight restrictions and samples from the dead birds were examined at the Veterinary Laboratories Agency in Weybridge, Surrey.
Defra said the alarm was raised by the farmer after he noticed "significant mortality" among his flock.
The first deaths happened on Tuesday 30 January when 71 chicks died, said Defra.
A further 186 died the following day and 860 died on 1 February.
HAVE YOUR SAYThe people most at risk are farmers and their families
Andrew Olgado, London
Some 1,500 died on Thursday, making a total of 2,617.
There are 15 types of bird, or avian, flu. The most contagious strains, which are usually fatal in birds, are H5 and H7.
There are nine different types of H5. The nine all take different forms - some are highly pathogenic, while some are fairly harmless.
The type currently causing concern is the deadly strain H5N1, which can prove fatal to humans.
In May last year, more than 50,000 chickens were culled after an outbreak of the H7 bird flu in farms in the neighbouring county of Norfolk.
One member of staff at the farm contracted the disease and was treated for an eye infection.
In March 2006, a wild swan found dead in Cellardyke, Fife, was found to have the H5N1 strain of the virus, which has been responsible for the deaths of more than 100 people, mostly in Asia.
Suffolk County Council have set up a bird flu helpline on 08456 032 814.
WHEN BIRD FLU HITS THE UK1: Scene of outbreak
All poultry to be culled
Visitors disinfected and restricted access2: 3km Protection Zone
Poultry kept indoors and tested3: 10km Surveillance Zone
No movement of poultry to or from area except for slaughter
Rail transport restricted to non-stopping movements
Bird fairs and markets banned
Increased surveillance of wetland areas
Domestic birds not to share water used by wild birds
Footpath restrictions likely only on free-range farms
People in towns not affected unless they keep poultry.Source: Defra
More than 160,000 birds were killed after an outbreak of the virulent H5N1 strain of the disease on a farm owned by the firm in Suffolk in February.
The company said it always maintained biosecurity standards, and had taken steps to enhance measures.
The Conservatives have criticised the decision to award compensation.
Commons leader Jack Straw has also said MPs are uncomfortable at the "high levels of compensation" awarded to the company.
The payout for healthy birds killed was announced in Defra's final epidemiology report into the avian flu outbreak.
Officials say compensation is provided under the Animal Health Act 1981 to encourage early reporting of bird flu to minimise the spread of the disease.
If the disease is allowed to spread it would cost taxpayers much more, they add.
The report analyses all the possible ways the virus could have arrived at the farm in Holton.
No specific proven source has been found but the reports says the most likely explanation is that the infection came from the importation of turkey meat from Hungary.
In response to the report, Bernard Matthews said it had "undertaken rigorous internal investigations and audits" in the wake of the outbreak.
|| This episode reflects the need
for constant vigilance
Animal Health Minister
Commenting on the findings, Chief Veterinary Officer Debby Reynolds said: "Most potential routes of infection are controlled through current procedures.
"However, the outbreak in Suffolk appears to be the outcome of a series of normally low probability events and circumstances which cumulatively led to the introduction of disease."
She said the report was an important part of increasing the understanding of bird flu.
There was a continuous low level risk of the introduction of avian flu to the UK, she added.
The National Emergency Epidemiology Group produced the report in consultation with the European Commission and Hungarian authorities.
Animal Health Minister Ben Bradshaw praised what he described as a "comprehensive report".
He said: "Although we cannot be sure how the outbreak happened, this episode reflects the need for constant vigilance, high levels of biosecurity and robust and well-developed contingency planning in dealing with animal disease outbreaks."
Mr Straw said in the Commons: "Of course we'll look for an opportunity to debate this, and all of us are uncomfortable about the reports of high levels of compensation paid to Mr Matthews' firm."
Shadow Environment Secretary Peter Ainsworth told the Commons that many people would be "astonished" that no-one was being prosecuted for what he called a "serious breach of biosecurity".
He said it was time to look again at the rules covering the import of poultry meat.
Junior Environment Minister Barry Gardiner responded that the government had been praised for its handling of the outbreak, including by the former Conservative Agriculture Minister John Gummer.
A report on the lessons learned from the outbreak will be released later this year.
Following an investigation the Food Standards Agency has said there is insufficient evidence to provide a realistic prospect of a conviction.
PARIS (AFP) - With only a few exceptions, countries are successful in eradicating outbreaks of H5N1 flu among birds, according to the world agency for monitoring farm animal trade.
"In the first half of 2007, countries reported fewer deaths of wild and migratory birds, which could indicate the disease is coming closer to the end of a cycle," World Organisation for Animal Health (OIE) director general Bernard Vallat said Monday.
However, "poultry outbreaks still continue to be infected in some countries and that shows the international community needs to keep up its high level of prevention and control measures of the disease in animals."
Since 2003, 59 countries have reported outbreaks of H5N1, and in most cases, their veterinary services have dealt successfully with these cases, Vallat said in a press release.
However, H5N1 "remains endemic" in at least three countries -- Indonesia, Nigeria and Egypt -- and continues to pop up in previously unaffected countries, he said.
Vallat said it was essential for governments to have strong veterinary services that are able to monitor, circumscribe and stamp out H5N1 outbreaks.
Preventing the spread of disease among poultry is the best way of preventing it infecting humans, he said.
Bird flu has killed 185 people, mostly in Southeast Asia, according to figures posted on Monday on the World Health Organisation (WHO) website.
In its present form, H5N1 is lethal for birds and people who are in close proximity to infected fowl.
The fear is that if the virus is allowed to circulate widely, it could swap genes with a human flu virus, enabling it become highly contagious among people.
OIE delegates were meeting in Paris this week to review international standards in world animal trade and farm products.
The year five pupil at Ysgol Henllan, Denbighshire, is linked to a smallholding near Corwen, Conwy, where a mild form of the virus was found.
A dozen children aged nine and 10 and two teachers are being given tamiflu treatments as a precaution.
Four people have tested positive for bird flu and 12 have flu-like symptoms, but no-one is seriously ill.
The number of people who may have had contact with the disease has risen to 142.
Of those, 47 came into contact "in the household setting," 14 in the school and 81 in "the workplace setting".
The child who is believed to have the virus is said to be responding to treatment at home.
The children and teachers have been identified as having been in prolonged close contact with the pupil, on days when there was a "small risk" of the child being infectious.
|| This is an
unusual step for us to take because the risk of the
infection being passed from the child to other pupils is so small
Dr Brendan Mason, NPHS
There are 58 children at the school but only those 12 who have been in close contact with the infected child, will receive tamiflu - an antiviral medication which reduces the severity of any impact of the infection.
The parents of each child are being contacted by staff at the National Public Health Service for Wales (NPHS).
Dr Brendan Mason from the NPHS, said: "This is an unusual step for us to take because the risk of the infection being passed from the child to other pupils is so small.
"However, this particular virus usually only affects birds and is relatively unknown in humans. Its clinical characteristics have not been fully defined.
"It is very rare to see this particular flu virus so we are taking every reasonable precaution to eliminate it from the community."
The NPHS wrote to all parents to invite them to meet officials at 1700 BST on Monday and Tuesday.
"From a public health perspective, the school will be safe to reopen as normal after the half term break. The risk of avian flu to the public is low."
The confirmed case involved a smallholding at Llanfihangel Glyn Myfyr, Conwy.
Owners Tony Williams and Barbara Cowling, who have tested negative for the virus, called in a vet after their Rhode Island Red chickens began to die.
They bought the chickens at Chelford Market at Macclesfield, Cheshire, some 70 miles (112 km) away, on 7 May.
A total of 30 chickens from the smallholding have now been slaughtered after 15 birds died.
Officials have stressed that the disease found at the Conwy farm was the H7N2 strain of bird flu, not the more virulent H5N1.
The second possible case emerged on Saturday about 35 miles (56 km) away, at a farm on the outskirts of Efailnewydd, near Pwllheli. It has also been linked to the market.
Officials have said there is not a "significant risk" to public health. A helpline has been set up to offer information about bird flu. The number is 0845 600 3678, and it is open from 0700 - 2000 BST daily.
They are asked to contact their local animal health office or the Defra helpline 08459 335577. Lines are open between 0900 - 1700 BST seven days a week.
Tests have found that birds at a poultry farm in southern Germany died of the H5N1 strain of bird flu, and some 160,000 birds were being slaughtered as a precaution, authorities said.
The virus was detected in ducklings at the farm near Erlangen, in northern Bavaria. A federal lab confirmed that the birds died of the "highly pathogenic" H5N1 variant, the state consumer protection ministry said Saturday.
More than 400 birds had died over a short period of time at the farm, ministry spokeswoman Sandra Brandt said. Authorities planned to start Saturday evening with the slaughter of the 160,000 birds at the farm.
Several cases of the virus have surfaced among wild birds in Germany this year. Last month, it was detected in a domestic goose in the east of the country.
The H5N1 virus has killed more than 190 people worldwide, according to the World Health Organization.
It remains hard for humans to catch, but experts fear it could mutate into a form that spreads easily among people, potentially sparking a global pandemic. So far, most human cases have been traced to contact with infected birds.
A mathematical analysis has confirmed that H5N1 avian influenza spread from person to person in Indonesia in April, U.S. researchers reported on Tuesday.
They said they had developed a tool to run quick tests on disease outbreaks to see if dangerous epidemics or pandemics may be developing.
Health officials around the world agree that a pandemic of influenza is overdue, and they are most worried by the H5N1 strain of avian influenza that has been spreading through flocks from Asia to Africa.
It rarely passes to humans, but since 2003 it has infected 322 people and killed 195 of them.
Most have been infected directly by birds. But a few clusters of cases have been seen and officials worry most about the possibility that the virus has acquired the ability to pass easily and directly from one person to another. That would spark a pandemic.
Ira Longini and colleagues at the Fred Hutchinson Cancer Research Center in Seattle looked at two clusters -- one in which eight family members died in Sumatra in 2006, and another in Turkey in which eight people were infected and four died.
Experts were almost certain the Sumatra case was human-to-human transmission, but were eager to see more proof.
"We find statistical evidence of human-to-human transmission in Sumatra, but not in Turkey," they wrote in a report published in the journal Emerging Infectious Diseases.
"This does not mean that no low-level human-to-human spread occurred in this outbreak, only that we lack statistical evidence of such spread."
In Sumatra, one of Indonesia's islands, a 37-year-old woman appears to have infected her 10-year-old nephew, who infected his father. DNA tests confirmed that the strain the father died of was very similar to the virus found in the boy's body.
"It went two generations and then just stopped, but it could have gotten out of control," Longini said in a statement.
"The world really may have dodged a bullet with that one, and the next time, we might not be so lucky," he added.
The researchers estimated the secondary-attack rate, which is the risk that one person will infect another, was 20 percent. This is similar to what is seen for regular, seasonal influenza A in the United States.
The researchers developed a software product called TranStat and said they would provide it free of charge on the National Institutes of Health's Models of Infectious Disease Agent Study, or MIDAS, Web site.
"We know the key to preventing a pandemic is early detection, containment and mitigation with antiviral therapy and this tool will enable those on the front lines, such as physicians, epidemiologists and other public-health officials, to carry that out efficiently," said Elizabeth Halloran, who worked on the study.
The virus was discovered on Sunday at Redgrave Park Farm near Diss, where all 6,500 birds, most of them turkeys, are being slaughtered.
A 3km protection zone and a 10km surveillance zone have been set up and the farm is co-operating with vets.
Environment Secretary Hilary Benn said that there might be further undisclosed cases of the disease in the area.
Mr Benn told the House of Commons: "I'm not going to speculate as to whether this outbreak is going to get larger.
"What we're doing is working our darndest to make sure that it stays where it is.
"The most important thing, having locked it down, is to trace the contacts and movements so we can take appropriate action."
A national and a local disease control centre have been established in Bury St Edmunds, with text messages sent to all bird keepers nationwide - especially those in zones on the poultry register.
Mr Benn said that movements within the restricted zones can take place, but not out of it. General licences for low risk movements out of the zone are expected to be available "shortly".
All birds at the affected premises - including approximately 5,000 turkeys, 1,000 ducks and 500 geese - will be slaughtered.
Police officers are at the entrance to the farm, and vehicles are being sprayed with a jet hose.
The BBC's Andrew Sinclair, who is at the farm in Suffolk, said large trucks and gas canisters had been moved on to the premises earlier in preparation for the cull.
It is expected that all the birds will be gassed and then put in sealed containers.
Officials said further local surveillance work would happen before deciding on any culls on neighbouring farms.
The Department for Environment Food and Rural Affairs (Defra) said some 10% of birds in one shed at the farm had died during one night.
Redgrave Poultry Limited, which is operating the farm, has issued a statement in which it said it had continued to fully co-operate with Defra over the outbreak.
It also said the farm was seasonal and prepared birds for Christmas.
"As such, no birds from the farm have been slaughtered for food or sent to customers," the statement added.
|| The top priority is to get
controls in place, to inform people of the controls in place
Heather Peck Defra regional manager
Acting Chief Veterinary Officer Fred Landeg said there was "still some uncertainty" over the situation.
"We are at a very early stage of the investigation," he said.
"The initial sequence data suggests that it's closely related to outbreaks in the Czech Republic and Germany, which does suggest a possible wild bird source.
"However, at this stage we are looking with an open mind as to the origin and all potential sources of the origin will be investigated."
Mr Landeg also said there was a lake at the affected site with a number of wild fowl on it and that "no two outbreaks of the disease are ever the same".
"This will not be a quick exercise. This is a particularly challenging site and our priority is to adhere to strict bio-security, and the health and safety of staff on site is paramount."
Earlier, Mr Landeg had said the risk of bird flu spreading was increased during the autumn months because of wild bird migration.
The affected birds were free-range - meaning they had access to the outdoors and may have been at greater risk of catching the disease.
There was a H5N1 outbreak at a turkey farm, also in Suffolk, in February.
| By Emma Wilkinson
Health reporter, BBC News
A universal flu vaccine which could mean an end to the annual jab is being tested on UK volunteers.
It targets a different part of the virus to current vaccines, which means it does not have to be altered every year to match circulating strains.
If successful, the vaccine developed by Oxford University researchers would also be a key weapon in a flu pandemic.
Experts said such a vaccine was the "holy grail" for flu researchers but there was still a long way to go.
Study leader, Dr Sarah Gilbert, said traditional influenza vaccines are designed to prompt an immune response to H and N proteins on the outer shell of the virus.
|| With this vaccine, we could end
up having pretty much everyone
vaccinated - a situation more like measles where you don't really see
Dr Sarah Gilbert
But these proteins are prone to mutation - and every year the vaccine has to be reformulated on the basis of the strains likely to be most prominent.
So instead, the researchers have developed a vaccine on the basis of proteins inside the cell, which are far more similar across different strains.
The vaccine uses a weakened smallpox virus to carry the proteins into the body - a technique that has already been used in malaria and TB vaccines.
Once the virus has invaded the cell and starts to multiply, these inner proteins called matrix protein 1 and nucleo-protein, are revealed to the immune system.
A specific type of immune cell, called a T cell, then learns to recognise and destroy cells containing the proteins the next time it encounters them.
Initially 12 people will be vaccinated to test the dose before further studies are done to check its effectiveness in people exposed to flu.
Dr Gilbert said if they were successful it could drastically change the way flu vaccine is used.
"With having to make new vaccine every year there's never enough to go around.
"With this vaccine, we could end up having pretty much everyone vaccinated - a situation more like measles where you don't really see it anymore."
In the case of a pandemic, stockpiles of the vaccine could be made in advance instead of having to wait for an outbreak to then identify the particular strain of flu.
Potentially, once people had received the vaccine they would only need a booster once every five to10 years.
But she added the research team had five to 10 years of further tests ahead of them.
However, it is hoped a similar approach might eventually also be used to combat HIV, TB, malaria and even cancer.
Professor John Oxford, a flu vaccine expert at Queen Mary, University of London said such a vaccine would be the "ultimate prize".
"But it's a fairly difficult prize to get - it may just be a question of luck.
"There are people trying all kinds of strategies."
He added that having to manufacture different flu vaccines every year was a "huge burden" on pharmaceutical companies.
"This team have experience with this type of vaccine so they may well get there."
National public health bodies are co-ordinating their work to prevent the spread of a new swine flu virus, the World Health Organization says.
Mexico has reported 71 deaths but "we don't know how many are new swine flu infections," Dr Keiji Fukuda said.
Mexican authorities have taken drastic measures to contain the virus.
The latest cases to be confirmed were among New York students but "there is no need for Americans to panic," White House spokesman Robert Gibbs said.
The World Health Organization (WHO) says the situation remains serious but "the picture is evolving".
The US cases of infections had not had contact with pigs, the WHO said.
"We think this will continue to spread but we working aggressively" to contain the virus, said Dr Richard Besser, acting director of the US Centers for Disease Control and Prevention (CDC).
He said the US was working with Mexico to establish more laboratory facilities to help confirm the existence of the virus in individual cases.
The latest cases to be confirmed are eight New York students.
The other US cases confirmed are seven in California, two in Texas, two in Kansas and one in Ohio.
H1N1 is the same strain that causes seasonal flu outbreaks in humans, but the newly detected version contains genetic material from versions of flu which usually affect pigs and birds.
The respiratory virus - which infects pigs but only sporadically humans - is spread mainly through coughs and sneezes.
The WHO has warned the virus has the potential to become a pandemic, and has urged all governments to step up surveillance.
Several countries in Asia and Latin America have begun screening airport passengers for symptoms.
Although all of the deaths so far have been in Mexico, the flu is spreading in the United States and suspected cases have been detected elsewhere:
The Mexican government, which has faced criticism for what some see as a slow reaction to this outbreak, is now taking an increasingly hard line to try to contain the virus, says the BBC's Stephen Gibbs in Mexico City.
Public buildings have been closed and hundreds of public events suspended.
Schools in and around Mexico City have been closed until 6 May, and some 70% of bars and restaurants in the capital have been temporarily closed.
People are being strongly urged to avoid shaking hands, and the US embassy has advised visitors to the country to keep at least six feet (1.8m) from other people.
Mexico's Health Secretary, Jose Cordova, said a total of 1,324 people had been admitted to hospital with suspected symptoms since 13 April and were being tested for the virus.
"In that same period, 81 deaths were recorded probably linked to the virus but only in 20 cases we have the laboratory tests to confirm it," he said.
Mexico's President Felipe Calderon has announced emergency measures to deal with the situation.
They include powers to isolate individuals suspected of having the virus without fear of legal repercussions.
In the US, seven people in California, two people in Texas, and two people in Kansas have been infected with the new strain.
In New York, city health commissioner Dr Thomas Frieden said preliminary tests conducted on the ailing students showed they were possible cases of swine flu.
Further tests will clarify if it was the same strain that was detected in the other three states.
Following a meeting of its emergency committee on Saturday, the WHO said the virus had the potential to become a pandemic but it was too early to say whether that would happen.
WHO Director General Margaret Chan said recent events constituted "a public health emergency of international concern" and that countries needed to co-operate in heightening surveillance.
The WHO is advising all countries to be vigilant for seasonally unusual flu or pneumonia-like symptoms among their populations - particularly among young healthy adults, a characteristic of past pandemics.
Officials said most of those killed so far in Mexico were young adults - rather than more vulnerable children and the elderly.
There is currently no vaccine for the new strain but severe cases can be treated with antiviral medication.
It is unclear how effective currently available flu vaccines would be at offering protection against the new strain, as it is genetically distinct from other flu strains.
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A third of the world's population could be infected with swine flu, expert projections suggest.
Researchers say swine flu has "full pandemic potential", spreading readily between people and is likely to go global in the next six to nine months.
Although one in three who come in contact will likely become infected, the Imperial College London team declined to estimate the death toll.
The study based on Mexico's experience is published in the journal Science.
The number of laboratory-confirmed swine flu cases has reached 5,251 in some 30 countries around the world, with 61 having died from the disease, the World Health Organization has confirmed.
Working in collaboration with the WHO and public health agencies in Mexico, the researchers assessed the Mexico epidemic using data to the end of April and taking into account factors like international spread and viral genetic diversity.
Lead researcher Professor Neil Ferguson said it was too early to say whether the virus will cause deaths on a massive scale, or prove little more lethal than normal seasonal flu.
His "fast and dirty" analysis of Mexico's swine flu outbreak suggests that the H1N1 virus is about as dangerous as the virus behind a 1957 pandemic that killed 2 million people worldwide.
But it's not nearly as lethal as the bug that caused the 1918 Spanish flu pandemic, which caused an estimated 50 million deaths in 1918.
Its full impact on the UK is not likely to be known until the annual flu season in the autumn and winter, when a "really major epidemic" can be expected in the northern hemisphere, says Professor Ferguson.
Prof Ferguson, who sits on the World Health Organisation's emergency committee for the outbreak, told the BBC Radio 4 Today programme: "This virus really does have full pandemic potential. It is likely to spread around the world in the next six to nine months and when it does so it will affect about one-third of the world's population.
"To put that into context, normal seasonal flu every year probably affects around 10% of the world's population every year, so we are heading for a flu season which is perhaps three times worse than usual - not allowing for whether this virus is more severe than normal seasonal flu viruses."
His study suggests swine flu could kill four in every 1,000 infected people.
Professor Ferguson said his findings confirmed that decisions must be taken swiftly on vaccine production.
"We really need to be prepared, particularly for the autumn. At the moment, the virus is not spreading fast in the northern hemisphere, because we are outside the normal flu season, but come the autumn it is likely to cause a really major epidemic.
"One of the key decisions which has to be made this week by the world community is how much do we switch over current vaccine production for seasonal flu to make a vaccine against this particular virus? I think those decisions need to be made quickly."
A viral strain which can be used to make a vaccine against swine flu has been produced by UK scientists.
It is a "crucial step" for manufacturers to start large-scale production of a virus against the H1N1 strain, they said.
The National Institute for Biological Standards and Control is one of a handful of laboratories globally working towards a vaccine.
US researchers also recently produced a candidate "starting strain".
To get a strain suitable for vaccine manufacture, scientists have to create a hybrid virus which is a cross between the H1N1 virus which is causing disease and "a tried and tested laboratory strain".
Using a technique called reverse genetics the researchers took gene sequences encoding parts of the swine flu virus that are recognised by the body's immune system and combined them with gene sequences from laboratory strains.
The aim is to make a virus that is recognised by the human body as the swine flu virus but that is safe and easy to grow up in large quantities by manufacturers.
It is the same process used for the creation of seasonal influenza vaccines that are produced every year.
Without these "starting strains" vaccine production could not begin.
The candidate strain is now being made available to the pharmaceutical industry and other flu laboratories.
The UK government has deals in place with Baxter and GlaxoSmithKline for up to 90m doses of a swine flu (H1N1) vaccine by December.
Once a pandemic is declared, there is provision for everyone in the UK to get two doses of a vaccine.
Dr Stephen Inglis, director of NIBSC, said their scientists had been "working around the clock" since they received the first isolate of swine flu from colleagues in the US at the beginning of May.
"I am delighted that they have been successful so quickly.
"The strain is now available for supply to vaccine manufacturers so that they can begin the first steps in the vaccine production process, and to other flu laboratories around the world for research.
"Our WHO network colleagues in the USA and Australia are also making good progress and we expect there soon to be a number of possible strains to use for large scale manufacture of swine flu vaccine."
The World Health Organization (WHO) has declared a global flu pandemic after holding an emergency meeting.
It means the swine flu virus is spreading in at least two regions of the world with rising cases being seen in the UK, Australia, Japan and Chile.
WHO chief Dr Margaret Chan said the move does not mean the virus is causing more severe illness or more deaths.
The swine flu (H1N1) virus first emerged in Mexico in April and has since spread to 74 countries.
Official reports say there have been nearly 30,000 cases globally and 141 deaths with figures rising daily.
Hong Kong said it was closing all its nurseries and primary schools for two weeks following 12 school cases.
It is the first flu pandemic in 40 years - the last in 1968 killed about one million people.
However, the current pandemic seems to be moderate and causing mild illness in most people.
Most cases are occurring in young working age adults and a third to a half of complications are presenting in otherwise healthy people.
Dr Chan said: "We have evidence to suggest we are seeing the first pandemic of the 21st century.
"Moving to pandemic phase six does not imply we will see increased in deaths or serious cases."
She added it was important to get the right balance between complacency and vigilance and that pandemic strategies would vary between countries depending on their specific situation.
And the WHO do do not recommend closure of borders or any restrictions on the movement of people, goods or services.
But the picture could change very quickly.
"No other pandemic has been detected so early or watched so closely," Dr Chan said.
One factor which has prompted the move to a level six pandemic was that in the southern hemisphere, the virus seems to be crowding out normal seasonal influenza.
The move was not prompted by the situation in any one country but the reports of several pockets of community spread, officials said.
The BBC's Imogen Foulkes, in Geneva, says that while the number of cases has made the declaration inevitable, the WHO will have to manage the global anxiety the declaration of a pandemic will generate.
There have been more than 800 cases in the UK with some areas of Scotland being particularly hard hit.
The government has been stockpiling antivirals such as Tamiflu and has ordered vaccine, some doses of which could be available by October.
Chief medical officer, Sir Liam Donaldson said the WHO declaration of a pandemic would not significantly change the way the UK was dealing with swine flu at the moment.
But he added there could be some minor changes to who received antivirals.
"The declaration of a pandemic per se doesn't make a big difference to the to the way we are handling the outbreaks we have.
"We are going to continue to investigate every case that occurs and treat their contacts with antivirals even though they may not be ill.
"The difference is that the Health Protection Agency has learnt a lot about approaching this question of antiviral prophylaxis and they are going to be treating the closer contacts of the cases, rather than the more far-flung contacts, because they feel that that is supported by what they know so far about how the disease is transmitting.
He added: "These flu viruses can change their pattern of attack, so when we come into the flu season in the autumn and winter in this country, when we expect a big surge of cases, we need to watch very carefully to see if the character of the virus is changing."
Scottish health secretary Nicola Sturgeon said a move to level six means that countries need to be ready to implement pandemic plans immediately but the UK was already operating at a "heightened state of readiness".
But it could affect the speed at which the UK gets pandemic vaccine supplies but that had been factored into pandemic planning.
Flu expert Professor John Oxford said people should not panic as the outbreak was milder than others seen in the past century.
"It is global and fulfilling the requirements of a pandemic but I don't think anyone should worry because nothing drastic has happened between yesterday and today."
Modern factory farms have created a 'perfect storm' environment for powerful viruses
Friday, 1 May 2009
A swelling number of scientists believe swine flu has not happened by accident. No: they argue that this global pandemic – and all the deaths we are about to see – is the direct result of our demand for cheap meat. So is the way we produce our food really making us sick as a pig?
At first glance, this seems wrong. All through history, viruses have mutated, and sometimes they have taken nasty forms that scythe through the human population. This is an inescapable reality we just have to live with, like earthquakes and tsunamis. But the scientific evidence increasingly suggests that we have unwittingly invented an artificial way to accelerate the evolution of these deadly viruses – and pump them out across the world. They are called factory farms. They manufacture low-cost flesh, with a side-dish of viruses to go.
To understand how this might happen, you have to compare two farms. My grandparents had a pig farm in the Swiss mountains, with around 20 swine at any one time. What happened there if, in the bowels of one of their pigs, a virus mutated and took on a deadlier form? At every stage, the virus would meet stiff resistance from the pigs' immune systems. They were living in fresh air, on the diet they evolved with, and without stress – so they had a robust ability to fight back. If the virus did take hold, it would travel only as far as the sick hog could walk. So if the virus would then have around 20 other pigs to spread and mutate in – before it would hit the end of its own evolutionary path, and die off. If it was a really lucky, plucky virus, it might make it to market – where it would come up against more healthy pigs living in small herds. It had little opportunity to fan out across a large population of pigs or evolve a strain that could be transmitted to humans.
Now compare this to what happens when a virus evolves in a modern factory farm. In most swine farms today, 6,000 pigs are crammed snout-to-snout in tiny cages where they can barely move, and are fed for life on an artificial pulp, while living on top of cess-pools of their own stale faeces.
Instead of having just 20 pigs to experiment and evolve in, the virus now has a pool of thousands, constantly infecting and reinfecting each other. The virus can combine and recombine again and again. The ammonium from the waste they live above burns the pigs' respiratory tracts, making it easier yet for viruses to enter them. Better still, the pigs' immune systems are in free-fall. They are stressed, depressed, and permanently in panic, making them far easier to infect. There is no fresh air or sunlight to bolster their natural powers of resistance. They live in air thick with viral loads, and they are exposed every time they breathe in.
As Dr Michael Greger, director of Public Health and Animal Agriculture at the Humane Society of the United States, explains: "Put all this together, and you have a perfect storm environment for these super-strains. If you wanted to create global pandemics, you'd build as many of these factory farms as possible. That's why the development of swine flu isn't a surprise to those in the public health community. In 2003, the American Public Health Association – the oldest and largest in world – called for a moratorium of factory farming because they saw something like this would happen. It may take something as serious as a pandemic to make us realise the real cost of factory farming."
Many of the detailed studies of factory farms that have been emerging in the past few years reinforce this argument. Dr Ellen Silbergeld is Professor of Environmental Health Sciences at Johns Hopkins University. She tells me that her detailed, on-the-ground studies led her to conclude that there is "very much" a link from factory farms to the new, more powerful forms of flu we are experiencing. "Instead of a virus only having one spin of the roulette wheel, it has thousands and thousands of spins, for no extra cost. It drives the evolution of new diseases."
Until yesterday, we could only speculate about the origins of the current H1N1 virus killing human beings – but now we know more. The Centre for Computational Biology at Columbia University has studied the virus and now believes that it is not a new emergence of a triple human-swine-bird flu virus. It is a slight variant on a virus we have seen before. We can see its family tree – and its daddy was a virus that evolved in the artificial breeding ground of a vast factory farm in North Carolina.
Did this strain evolve, too, in the same circumstances? Already, the evidence is suggestive, although far from conclusive. We know that the city where this swine flu first emerged – Perote, Mexico – contains a massive industrial pig farm, and houses 950,000 pigs. Dr Silbergeld adds: "Factory farms are not biosecure at all. People are going in and out all the time. If you stand a few miles down-wind from a factory farm, you can pick up the pathogens easily. And manure from these farms isn't always disposed of."
It's no coincidence that we have seen a sudden surge of new viruses in the past decade at precisely the moment when factory farming has intensified so dramatically. For example, between 1994 and 2001, the number of American pigs that live and die in vast industrial farms in the US spiked from 10 per cent to 72 per cent. Swine flu had been stable since 1918 – and then suddenly, in this period, went super-charged.
How much harm will we do to ourselves in the name of cheap meat? We know that bird flu developed in the world's vast poultry farms. And we know that pumping animal feed full of antibiotics in factory farms has given us a new strain of MRSA. It's a simple, horrible process. The only way to keep animals alive in such conditions is to pump their feed full of antibiotics. But this has triggered an arms race with bacteria, which start evolving to beat the antibiotics – and emerge as in the end as pumped-up, super-charged bacteria invulnerable to our medical weapons. This system gave birth to a new kind of MRSA that now makes up 20 per cent of all human infections with the virus. Sir Liam Donaldson, the British government's Chief Medical Officer, warns: "Every inappropriate use in animals or agriculture [of antibiotics] is potentially a death warrant for a future patient."
Of course, agribusinesses is desperate to deny all this is happening: their bottom line depends on keeping this model on its shaky trotters. But once you factor in the cost of all these diseases and pandemics, cheap meat suddenly looks like an illusion.
We always knew that factory farms were a scar on humanity's conscience – but now we fear they are a scar on our health. If we carry on like this, bird flu and swine flu will be just the beginning of a century of viral outbreaks. As we witness a global pandemic washing across the world, we need to shut down these virus factories – before they shut down even more human lives.