News - Pigs also at risk if deadly bird flu reaches U.S.

WASHINGTON (Reuters) - If deadly bird flu spreads to the United States, the disease could have a sweeping impact on pig production because the animals are susceptible to the H5N1 disease, according to industry and veterinary experts.

The H5N1 strain of avian influenza is known to have killed more than 70 people. To stop the spread of the disease, some 150 million birds have been destroyed worldwide, mostly in Asia, The virus also has been found in Europe.

No cases of H5N1 have been discovered in humans, chickens, turkeys or migratory birds in the United States.

"Not only do poultry people need to look into increasing their biosecurity, so do the swine (farmers)," said John El-Attrache, a veterinary pathologist with Texas A&M University. "Bird flu can readily infect a swine species and for the most part, go from swine on into humans," he added.

Experts do not believe pigs played a role in spreading H5N1 throughout Asia and eastern Europe. But pigs do have receptors for both avian and mammalian viruses. Some fear pigs could act as a "mixing bowl" -- especially on farms where they coexist with humans and poultry -- creating a new virus that spreads from person to person.

Biosecurity efforts at most U.S. farms already include keeping pigs confined and separate from other animals. Human contact is limited and farm employees are encouraged to get annual flu shots.

A spokeswoman for Hormel Foods Corp., which buys hogs from some 1,500 farmers in the Midwest to make Spam and other meat products, said it has safeguards in place for many diseases including bird flu.

Hormel updated its business and crisis plans for all animal diseases after mad cow was found in the United States in December 2003.

Bird flu is "one of many things we're watching," said Julie Craven, a Hormel spokeswoman. "There is a lot of what could best be described as speculation between how the (H5N1) virus might travel, in between what species and what kind of timeline it's on."

The National Pork Board, which represents the industry and is responsible for the "Pork, the other white meat" slogan, said the bird flu situation in Asia and eastern Europe has sparked discussion among members.

"We have to make sure we're doing everything we can to keep it out of our herds and keep it from spreading to protect our species," said Liz Wagstrom, a veterinarian with the National Pork Board.

In addition to surveillance and routine swine vaccinations, Wagstrom said the industry must be prepared to alert farmers swiftly to impose stricter precautions, if needed.

Hogs and pigs have an annual flu season just like humans, poultry and other species.

The United States is the third largest pork producer in the world behind China and the European Union, according to U.S Agriculture Department figures. In its September hogs and pigs report, USDA said hog and pig inventory in the United States was 61.5 million head, up slightly from a year ago.

The USDA said it is not planning to require any new safety measures among pig farmers due to bird flu.

"We're aware that people worry about H5N1 in hogs... but any safeguarding now would be from the bird standpoint," said Jim Rogers, a spokesman with USDA's Animal and Plant Health Inspection Service.

The Bush administration asked Congress in November for $91 million for the USDA as part of a broader request for $7.1 billion in emergency funding to prepare for a possible bird flu pandemic.

Global Coverage Article | Reuters.co.uk

News - Christmas trees combat bird flu

Your used Christmas tree might save you from a bird flu pandemic.

As governments around the world scramble to stockpile the antiviral Tamiflu, generic drug maker Biolyse Pharma Corp. plans to begin next month making shikimic acid, the main ingredient in the manufacture of oseltamivir, commonly known as Tamiflu, from the needles of discarded Christmas trees.

Tamiflu, as almost everybody knows by now, treats seasonal influenza and is also being championed as a first line of defence against a possible pandemic outbreak of bird flu, which has been devastating chicken populations across Southeast Asia and parts of Europe.

So far, the H5N1 virus, which usually strikes people in close contact with diseased fowl or their droppings, has infected an estimated 130 people, killing 70. The worry is that H5N1 will undergo a genetic mutation with a human seasonal influenza virus, morphing into a deadly strain that could jump between people like the common cold.

After being rejected as a Tamiflu supplier by Swiss drug maker F. Hoffmann-La Roche Ltd., which has a monopoly grip on the manufacture of the drug, Biolyse turned its sights to making shikimik acid.

The reason: the price of shikimik acid has soared to more than $500 (U.S.) a kilogram from $45 in the past 12 months on shortages of Tamiflu and skyrocketing demand.

Biolyse specializes in extracting chemicals from plants and biomaterials at its plant in St. Catharines, Ont., and now makes a generic version of the cancer drug paclitaxel from yew trees.

?Our research has shown that 2-to-3 per cent of the biomass from various pine, spruce and fir trees is extractible shikimic acid,? Biolyse principal Claude Mercure said yesterday.

As the process moves to the commercial stage from the laboratory, he said the company is aiming to eventually produce one-to-three tons of shikimic acid a month.

To get started, next month it will receive some 500,000 Christmas trees to be donated by Toronto-based Gro-Bark, a forestry recycling company.

Most shikimic acid is now extracted from star anise, the fruit of a slow-growing evergreen in China, which is harvested for several months each year. That's why Roche's production of Tamiflu takes about 12 months and there isn't nearly enough of the drug to go around for government stockpiling.

?What makes our process more viable is the fact that the particular species of pine, spruce and fir that we are working with are far more abundant than the seedlings of star anise,? said John Fulton, Biolyse's vice-president for new product development.

Mr. Mercure said Biolyse has no plans to make Tamiflu unless Ottawa grants compulsory licences under the Patent Act in a national emergency. In such a case, he said the company could produce the drug in five weeks.

In countries where Roche's patents on Tamiflu aren't recognized, like the Philippines and Thailand, he said Biolyse is in discussions to sell shikimic acid and provide technical assistance so the drug can be manufactured for use in that country.

The Globe and Mail: Christmas trees combat bird flu

News - Tamiflu resistance in avian flu victims sparks concern

A new report says oseltamivir-resistant forms of H5N1 avian influenza virus were found in two Vietnamese girls who died of the infection, raising doubts about the antiviral drug that many countries are counting on to help protect them from a potential flu pandemic.

One of the two girls died even though she started receiving oseltamivir (Tamiflu) within the first 2 days of her illness, the recommended window for effective treatment, according to the report in today's New England Journal of Medicine. The other girl was not treated until the sixth day of her illness.

The authors of the report say their findings suggest that a higher dosage, longer treatment course, or combination with other antiviral drugs may be necessary to ensure the effectiveness of oseltamivir.

Roche, the manufacturer of oseltamivir, agrees with that assessment and says that studies of the safety of a higher dosage are about to get under way.

Second study weighs in on stockpiling
In a separate article published today, a group of experts who have been monitoring resistance to oseltamivir and similar drugs says the evidence so far?including the New England Journal report?does not suggest that stockpiling of the drug is useless.

"The available data do not indicate that potential oseltamivir resistance should be a deterrent to its stockpiling for pandemic response," says the report by Frederick Hayden and other members of the Neuraminidase Inhibitor Susceptibility Network (NISN). It was published online today in Antiviral Therapy.

The report on the Vietnamese patients was prepared by a team from the Hospital for Tropical Diseases in Ho Chi Minh City, Vietnam, and Hong Kong University, with Menno D. de Jong of the Vietnamese hospital as first author.

Their study focuses on eight patients who were treated for confirmed H5N1 infection at the Hospital for Tropical Diseases between February 2004 and January 2005. Throat samples were collected from the patients for analysis at admission and later in their illness. H5N1 infection was confirmed by polymerase chain reaction.

All the patients were started on oseltamivir the day of admission to the hospital, which varied from 2 to 8 days after the onset of illness. They received the recommended regimen of 75 mg twice a day for 5 days. Four of the patients died.

The researchers did a sequence analysis of the H5N1 virus's neuraminidase gene to look for resistance, signaled by the substitution of tyrosine for histidine at amino acid position 274. This mutation was found in two patients, a 13-year-old girl and an 18-year-old girl.

The 13-year-old was hospitalized the day after she fell ill with a fever and cough, which was also the day after her mother had died of H5N1 infection. Despite oseltamivir treatment, the girl's condition worsened on her fourth day in the hospital, and she died of severe pneumonia on the seventh day.

The viral load in her throat was higher by the time of her death than it had been earlier, which, along other laboratory evidence, suggests that "the development of drug resistance contributed to the failure of therapy and, ultimately, the death of this patient," the report says.

The 18-year-old was hospitalized and started on oseltamivir 6 days after she had fallen ill, but she died after 2 weeks in the hospital. Nonresistant H5N1 virus was found in a sample taken 2 days after she was hospitalized, but the resistant form was found 6 days later.

Although the connection between viral resistance and the 18-year-old girl's death was less clear than in the case of the 13-year-old, "The presence of replicating virus after 14 days of illness suggests an effect on the outcome," the article says.

It also says the viral load in throat specimens from the four patients who survived dropped quickly to undetectable levels during their treatment.

"Our observations suggest that at least in some patients with influenza A (H5N1) virus infection, treatment with the recommended dose of oseltamivir incompletely suppresses viral replication," the authors write. Consequently, "Strategies aimed at improving antiviral efficacy (e.g., the use of higher doses, longer durations of therapy, or combination therapy) may deserve further evaluation."

Tamiflu manufacturer, study authors comment
Roche, Swiss-based maker of Tamiflu, released a statement today agreeing that such strategies deserve consideration. The company said some data already support the safety of using a higher dosage of the drug, and clinical trials assessing the efficacy of a higher dose are scheduled. Roche is collaborating with the National Institutes of Health and the World Health Organization (WHO) on that research, the statement said.

Tran Tinh Hien of the Hospital for Infectious Diseases, one of the study's authors, says Vietnamese health officials are already recommending increasing the dosage of oseltamivir for avian flu patients, according to a Reuters report published today.

"We still recommend the use of Tamiflu for bird flu cases as soon as possible and at higher doses as there is no replacement yet," he said. He added that the Vietnamese Ministry of Health has increased the treatment period to 7 days from 5 days.

The article published today by NISN, the experts who have been monitoring resistance to the neuraminidase inhibitors, say the new findings do not contraindicate stockpiling of oseltamivir, but much more research is needed. The neuraminidase inhibitors include oseltamivir and zanamivir (Relenza).

The group said no one knows how often resistance emerges in H5N1 patients being treated with oseltamivir, and the clinical consequences of such resistance are also unclear.

Many H5N1 patients treated with oseltamivir have died, but in most cases treatment was started late, after pneumonia had already developed, the report says. Some evidence suggests that the emergence of oseltamivir resistance early in treatment may lead to treatment failure, but more studies are needed.

The group also said there is no indication that H5N1 viruses now circulating in birds are resistant to neuraminidase inhibitors. Further, the likelihood that oseltamivir-resistant strains will spread in the community appears low, in contrast to the situation with two older antiviral drugs, amantadine and rimantadine, to which ordinary flu viruses are often resistant. In animal studies, the article says, the mutation that confers resistance in both H5N1 and H1N1 viruses reduces infectiousness 100-fold and reduces viral replication more than 10-fold.

The NISN statement also says that all avian and human H5N1 isolates tested so far by the Centers for Disease Control and Prevention have been susceptible to zanamivir. However, zanamivir, which is inhaled, has not been tried in human H5N1 patients.

Despite this, "Inhaled zanamivir would be a therapeutic consideration if oseltamivir resistance were likely to be present," the NISN members write. They also say the drug would be "an appropriate choice for pandemic response stockpiles."

Other experts offer opinions
To infectious disease expert Michael T. Osterholm, PhD, MPH, the report from Vietnam "reminds us again that none of us know how much drug [oseltamivir] we have in the stockpile." If a longer, higher-dose regimen is needed, a stockpile now described as 3 million treatment courses is actually smaller, said Osterholm, director of CIDRAP, publisher of this Web site.

Osterholm also said the report suggests oseltamivir resistance can have much graver consequences in H5N1 cases than in ordinary flu. In the latter, drug resistance has not been associated with treatment failure or a severe outcome, but "with H5N1 this may be a very different outcome," he said.

Osterholm called for clinical studies of the use of oseltamivir very early in the illness and at a much higher dosage than is used in ordinary seasonal flu. If that approach improves outcomes, it would have "tremendous implications for how we get Tamiflu to patients in a timely manner," he said.

A WHO official said the resistance findings are "not necessarily alarming" but do point up the need for more information, according to the Reuters report.

"What really is critical is understanding whether the way we are using the drugs contributes" to resistance, said Keiji Fukuda of the WHO's global influenza program.

Some resistance is expected whenever antivirals and antibiotics are used, Fukuda said, adding that using too-small doses or too short a treatment regimen can promote resistance.

CIDRAP >> Tamiflu resistance in avian flu victims sparks concern

News - Abra organizes avian flu task force

Provincial Veterinary Office here is set to create a Provincial Avian Flu Task Force to oversee preventive measures against the bird flu virus.

Dr. Ruston Valera, provincial veterinarian said he is set to present to the Provincial Board a proposal for the creation of said task force. The proposed task force shall be composed of various teams with specific tasks such as quarantine, monitoring, information, education and rapid action, he explained.

"Although there are no reported cases of the virus yet in the country, Abrenios should not take it lightly," Valera added.

The virus which was first discovered from migratory birds in Southern China has affected chicken and other birds. The World Health Organization later found that the virus is deadly to humans. From December last year, 42 human deaths have been reported in Vietnam, five in Indonesia, 20 in Thailand and four in Cambodia.

Valera also said that since there are no traces of migratory birds' visit in the province, importation of poultry products is likely the most possible means of the virus' entry. The virus, he further explained, can only be acquired through direct contact.

Workers in poultry farms are the most vulnerable to contract the virus. However, according to experts, there is no danger in eating contaminated poultry products provided that these are properly cooked. The virus cannot survive under normal cooking temperature, Valera added.

PIA News Releases

News - Bird Flu Expands Worldwide in 2005

Fears of a long-predicted global influenza pandemic grew stronger in 2005 as a deadly form of the virus spread among birds worldwide and killed 36 more people in the disease's Southeast Asian epicenter. Governments and international organizations stepped up cooperative measures to isolate the disease and to deal with a possible pandemic.

The number of human deaths from bird flu more than doubled in 2005 to over 70, according to World Health Organization numbers. So far, bird flu deaths are limited to East Asia, mainly the Southeast, with Vietnam the hardest hit. The death toll accounts for half of all human cases, an alarming death rate in the view of physician Gregory Poland of the Mayo Clinic College of Medicine in Minnesota.

"If that virus gains the ability to easily transmit from human-to-human, it will be a disaster of unprecedented proportion," he said.

Fueling this fear was the global spread of infected birds from Asia, thanks to seasonal migrations. By year's end, birds with the deadly H5N1 form of avian flu had been detected in Europe and Canada. In countries where it was found, tens of thousands of poultry were slaughtered.

The first sign of this spread came in late April at central China's Lake Qinghai, a migratory fowl congregation point where more than 6,300 birds of different species perished within weeks. Until then, the disease had been seen only in domestic poultry, thought to be its source. World Health Organization (WHO) spokesman Dick Thompson said migrating birds must be tracked.

"There's an urgent need to sample and tag and track as many of these species as feasible, especially considering the narrow time frame that we've got available to do it. We need more information on the migratory routes regarding these birds," said Mr. Thompson.

To confront its outbreaks, China embarked on an ambitious effort to vaccinate all of its many billions of chickens, ducks, and geese ? 20 percent of the global total. Vietnam, Indonesia, and Pakistan also inoculated birds against the flu.

The European Union, meanwhile, temporarily banned live bird imports.

The ongoing outbreaks raised concern about the ability of public health systems to respond to an expected influenza pandemic. About three pandemics occur per century and it has been 37 years since the last one. U.S. Health and Human Services Secretary Michael Leavitt said if it comes, it could kill up to 7.5 million people around the world.

"Pandemics happen. It is a fact of biology. When it comes to a pandemic, we are overdue and underprepared," he said.

To overcome the preparation deficit, international conferences were held in Ottawa, Canada and Geneva, Switzerland in October and November to coordinate the responses of governments and global agencies.

Together, the meetings identified five major goals -- reduce human exposure to sick animals, strengthen surveillance and reporting of disease, develop national preparedness plans, intensify rapid containment operations, and accelerate global research to overcome the shortage of vaccines, antiviral medicines, and production capacity.

Canadian Prime Minister Paul Martin emphasized the importance of global teamwork.

"Within our countries and among our countries, each of these efforts will require cooperation and coordination on a scale that is virtually unprecedented," said Mr. Martin. "The consequences of a world that is unprepared are simply unacceptable."

The global standards were in line with President Bush's September announcement at the United Nations of the International Partnership on Avian and Pandemic Influenza. Its aim is to bring key nations together to improve global readiness by elevating the issue on their national agendas and coordinating efforts among donor and affected nations.

Within his own government, Mr. Bush asked Congress for $7 billion for flu pandemic preparations, a large portion of which would go toward new vaccine research. Other money would help other nations train personnel to expand detection and testing.


George Bush
"Together, we're working to control and monitor avian flu in Asia, and to ensure that all nations have structures in place to recognize and report outbreaks before they spread beyond human control," said Mr. Bush.

The lack of medical defenses against bird flu clouds the future. A study from the U.S. government's Centers for Disease Control (CDC) showed that worldwide resistance to influenza drugs increased by 12 percent in the last decade. H5N1 is resistant to one of the two major classes of flu drugs, amantadine, and scientists reported signs in Asia it is learning to defy the other one, which includes Tamiflu, the major drug nations are stockpiling against the disease.

Moreover, no one knows if existing flu vaccines will work against H5N1, and a vaccine specific to it is only in the testing stage.

So University of Maryland flu researcher Daniel Perez said the slaughter of infected birds will a crucial protective measure for the time being.

"Right now, that is the only tool that is effective in controlling avian influenza," said Mr. Perez.

VOA News - Bird Flu Expands Worldwide in 2005

News - Tamiflu could make avian flu pandemic worse - 23 Dec 2005 - World News

The only drug available against a threatened pandemic of avian flu may be useless for many of those infected and could make the pandemic worse, say scientists.

The warning came after a study of 13 Vietnamese patients infected with avian flu and treated with the anti-viral drug Tamiflu found two developed a resistant virus which contributed to their deaths.

Seven of the 13 patients died.

The New England Journal of Medicine, which publishes the findings today, describes them as "frightening". Governments are stockpiling Tamiflu to be used as the first line of defence against a pandemic.

But indiscriminate use of the drug in the event of a pandemic could fuel the growth of a resistant virus, triggering a second wave of infection against which there would be no defence, researchers say.

Sir John Skehel, director of the National Institute for Medical Research, London, and one of the world's leading virologists, said: "That is the great worry. The fear is that all the virus that comes here [to Britain] might be resistant."

Sir John said Tamiflu was better at preventing infection with flu than treating it.

"It's a prophylactic, not a therapeutic. If you give it before the infection develops it is a good drug but if you give it after symptoms appear it has declining value."

He urged the Government to broaden Britain's defence against a pandemic.

Relenza, a drug which works in a similar way to Tamiflu, has not shown signs of triggering resistance but Governments have ignored it because it is harder to take.

"We should be stockpiling other drugs. Some of these mutations are only resistant to Tamiflu. But I am not aware how much Relenza is available," Sir John said.

The H5N1 virus has infected 138 people in the Far East and killed 71, but the fear is it could mutate to become transmissible among humans and spread around the world.

In the Vietnamese study, one of the patients, a 13-year-old girl whose mother had died of avian flu, was treated within 24 hours of developing a cough and fever with a high dose of Tamiflu when "the greatest clinical benefit could have been expected".

But although her condition improved at first, it later worsened and she died eight days after starting treatment. Resistant virus was isolated and at the time of her death the amount of virus in her throat had increased.

"These observations suggest that the development of drug resistance contributed to the failure of therapy and, ultimately, the death of this patient," the authors from the Hospital for Tropical Diseases in Ho Chi Minh City report.

The second patient died after 14 days of illness, also showing signs of an increase in the amount of virus.

Tamiflu could make avian flu pandemic worse - 23 Dec 2005 - World News

News - NIH Vaccine: Live Bird-Flu Virus

In an isolation ward of a Baltimore hospital, up to 30 volunteers will participate in a bold experiment: A vaccine made with a live version of the most notorious bird flu will be sprayed into their noses.

First, scientists are dripping that vaccine into the tiny nostrils of mice. It doesn't appear harmful -- researchers have weakened and genetically altered the virus so that no one should get sick or spread germs -- and it protects the animals enough to try in people.

This is essentially FluMist for bird flu, and the hope is that, in the event of a flu pandemic, immunizing people through their noses could provide faster, more effective protection than the troublesome shots -- made with a killed virus -- the nation now is struggling to produce.

And if it works, this new vaccine frontier may not just protect against the bird-flu strain, called H5N1, considered today's top health threat. It offers the potential for rapid, off-the-shelf protection against whatever novel variation of the constantly evolving influenza virus shows up next -- through a library of live-virus nasal sprays that the National Institutes of Health plans to freeze.

"It's high-risk, high-reward" research, said Dr. Brian Murphy, who heads the NIH laboratory where Dr. Kanta Subbarao is brewing the nasal sprays -- including one for a different bird-flu strain that appeared safe during the first crucial human testing last summer.

"It might fail, but if it's successful, it might prevent hundreds of thousands of cases" of the next killer flu, Murphy said.

FluMist is the nation's nasal-spray vaccine that prevents regular winter flu. Developed largely through Murphy's lab, it's the only flu vaccine made with live but weakened influenza viruses.

The new project, a collaboration with FluMist manufacturer MedImmune, piggybacks cutting-edge genetics technology onto that vaccine to create a line of FluMist-like sprays against different bird flus.

"That is a great, great idea," said Dr. John Treanor of the University of Rochester, among the flu specialists closely watching the project.

Regular winter flu shots are made with killed influenza viruses, and the government is stockpiling experimental bird-flu vaccine made the same way. But those bird-flu shots don't work as well as hoped. They require an incredibly high dose, delivered in two separate injections, to spark a protective immune response in people.

"In theory, a live-virus vaccine might actually work better. We don't know that because we've never tried one before," Treanor said.

Influenza is like a magician, constantly changing its clothes to avoid detection, thus making it difficult to develop effective vaccines. Studding the virus' surface are two proteins called hemagglutinin -- the H in H5N1 -- and neuraminidase, the "N". They act as a wardrobe: There are 16 known hemagglutinin versions, and nine neuraminidases.

They're also what triggers the immune system to mount an attack, particularly hemagglutinin, the protein the body aims for when it makes flu-fighting antibodies.

When people catch the flu, they usually get H1 or H3 flu strains, which their bodies can recognize because variations have circulated among humans for decades. Occasionally, genetically unique strains emerge. Until 1997, H5 strains had never been seen outside of birds. The virus essentially put on a coat that human immune systems didn't recognize. The result: Since 2003, a particularly strong H5N1 strain has infected more than 130 people in Asia, killing at least 70.

H9 and H7 strains also recently have jumped from birds to people, although so far they haven't been nearly as dangerous.

Researchers hope to create at least one live-virus nasal spray for each "H" subtype, a project costing about $16 million of the NIH's annual $67 million budget for flu vaccine research.

"The hemagglutinin is the major protective antigen, so that is what we're focusing on," explained Subbarao, a molecular geneticist who heads the project.

First on her list are the riskiest known bird flus: H5N1, with human tests planned for April. H9N2, which recently underwent the first round of human testing in an isolation ward at Johns Hopkins Bayview Medical Center. Then an H7 strain, followed by an H6 strain believed to share genes with the H5N1.

"By no means are we confident we're picking the right strain" to make first, because flu mutates so easily, Subbarao cautioned.

She chooses vaccine strains from those that U.S. scientists who are monitoring influenza in Asia cull from ducks, chickens and geese, and ship home for research. Subbarao must customize those strains for safe vaccination: First, using a new technique called reverse genetics, she selects genes for bird-flu H and N antigens and removes genetic segments that make them dangerous. Then she adds the remaining gene segments to the regular weakened FluMist virus.

Stocks of the custom virus are grown in fertilized chicken eggs. Each is then carefully cracked by hand to drain out virus-loaded liquid that in turn is purified and put into a nasal spray.

In a high-security section of the lab, Subbarao dons a biohazard suit and exposes vaccinated mice to various bird-flu strains.

Then it's time for human testing -- in a hospital isolation ward just in case the weakened virus could infect someone. It shouldn't, because "those problems don't exist in FluMist," said Murphy, citing studies of regular FluMist in day-care centers where youngsters routinely pass viruses back and forth.

Some studies have found that people can shed the virus shortly after receiving regular FluMist. But, "to spread infection, you'd need much more (virus) than replicates in the nose," he said.

Hopkins researchers gave the first of Subbarao's vaccine candidates -- the H9N2 spray -- to 30 volunteers last summer. To be sure they couldn't spread the virus by coughing or sneezing, the volunteers underwent daily tests of their noses and throats.

The vaccine appeared safe. Scientists now are analyzing whether it also spurred production of flu-fighting antibodies, a sign that people would be protected if they encountered the H9N2 strain. Subbarao expects results by February.

In April, pending final Food and Drug Administration permission, Subbarao will put an H5N1 spray to a similar test.

Here's the catch: Each flu strain has subtypes. An Indonesian version of H5N1, for example, was recently discovered that differs from a Vietnamese strain on which Subbarao's nasal spray -- and the government's stockpiled shots -- are based. She's now testing whether her vaccine protects mice against that new Indonesian strain.

If a novel flu strain begins spreading among people, how will Subbarao tell if her stored nasal vaccines are a good match to fight it?

NIH also will store blood samples from the people who test those sprays. Say a new H9 strain sparks an outbreak. That virus will be tested against those blood samples, and NIH could predict within a day which spray candidates work. If one does, the government could order doses manufactured from that frozen stock; if none do, scientists would have to try to brew a new vaccine.

How quickly doses could be manufactured is a different issue. All influenza vaccines, shots or spray, currently are brewed in chicken eggs, a time-consuming process that other research is seeking to improve.

"These are research projects," Murphy stresses -- the nasal-spray concept could fail. But he's optimistic. Live-virus vaccines, he maintains, are better immune stimulators.

Wired News: NIH Vaccine: Live Bird-Flu Virus

News - CHRONOLOGY-Bird flu developments

Indonesia has confirmed two more human deaths from bird flu, the World Health Organization (WHO) said on Friday, taking the global death toll from the disease to 73, all in Asia.

Here is a chronology of major bird flu developments:

Dec 15, 2003 - South Korea confirms a highly contagious type of bird flu at a chicken farm near Seoul and begins a mass cull of poultry when the virus rapidly spreads across the country.

Jan 8, 2004 - Vietnam says bird flu found on poultry farms.

Sept 27 - Thailand says it has found a case where one human probably infected another with bird flu. It said this was an isolated incident posing little risk to the population.

Oct 10, 2005 - The European Commission announces a ban on imports of live birds and feathers from Turkey to the 25-nation EU. This was in response to Turkey reporting its first case of bird flu two days earlier. It was later confirmed as the type dangerous to humans, the H5N1 strain.

Oct 15 - British tests identify H5N1 in three ducks found dead in Ceamurlia de Jos in Romania, the first case in mainland Europe of H5N1.

Nov 9 - Three days of talks among health experts in Geneva agree a billion dollar strategy to minimise the virus threat at source in animals and humans.

Nov 11 - Kuwait reports the first known case of deadly bird flu in the Gulf Arab region, saying a culled flamingo was carrying the deadly strain of the H5N1 virus.

Nov 15 - Britain says 53 finch-like mesias imported from Taiwan died last month in a British quarantine center where they were believed to have introduced the H5N1 virus. In October, Britain had said a parrot imported from Suriname had been found to have the virus and a mesia may have caught it.

Dec 3 - Ukraine introduces tough steps to combat its first outbreak of bird flu, sending troops to patrol exclusion zones in the Crimea peninsula where the virus was detected.

Dec 23 - Indonesia confirms two further deaths from bird flu. That brings the death toll in Asia to 73, comprising 14 victims in Thailand, four in Cambodia, 11 in Indonesia, 42 in Vietnam and two in China.

Global Coverage Article Reuters.co.uk

News - Spain provides fund to WHO to fight bird flu

The Spanish government has agreed to give the World Health Organization (WHO) some 2.4 million U.S. dollars to help the organization's anti-bird flu programs, local media reported on Friday.

The WHO is developing international structures of support mostly to Asian and African countries to halt the spread of the disease and help them adopt measures to protect their people.

At the same time, Spain is giving some 1.2 million dollars to European Union's research program to develop anti-Human Immunodeficiency Virus (HIV) vaccines, as part of the European and Developing Country Trail Program whose activities include research and development of technologies used to fight malaria, tuberculosis and HIV.

Xinhua - English

News - Stop hoarding bird flu virus samples, China told

The World Health Organization has urged China to share bird flu virus samples with foreign scientists, saying Beijing has failed to release samples of the deadly H5N1 virus from any of 31 reported outbreaks in Chinese poultry this year.

"If we received these samples from animals we would know what kind of changes the virus is undergoing, which is very, very vital in fighting against any potential pandemic," Shigeru Omi, WHO's western Pacific director, told a news conference on Friday.

There was no immediate response from Chinese officials. It was not clear why they would be reluctant to provide virus samples, especially after being criticized for a coverup that delayed other countries' responses to the SARS outbreak of 2003.

Although it still mostly attacks birds, the virus has proved deadly when it jumps to people who handle infected poultry. Scientists fear mutations will enable it to spread easily from person to person, setting the stage for a global tragedy.

China shared samples from people but not birds

Speaking to reporters in Beijing, Omi praised Vietnam for making virus samples from its poultry outbreaks available to WHO scientists.

And he commended China for sharing samples from infected people, if not from birds.

Of more than 70 human deaths attributed to the virus across Asia, China has confirmed just two.


FROM DEC, 22, 2005: Bird flu kills 2 in Vietnam, despite drug treatment

An Oxford University study published this week concluded that in two fatal cases in Vietnam, the virus had developed a resistance to Tamiflu, a drug seen as the best defence against it so far.

Omi said ordinary Chinese remain dangerously ignorant of the risk of infection.

During a five-day visit to China, he talked to a nine-year-old boy who survived the disease in Hunan province, Reuters reported.

"The boy that I met, he did not know anything about this," Omi said. "For him, chickens are friends, so he touched (them)."

CBC News: Stop hoarding bird flu virus samples, China told

News - Europe braces for bigger bird flu outbreak this spring

ISLE OF RIEMS, Germany - No one is worried about the traditional Christmas goose in Europe this year, but health officials are scrambling to prepare for what some believe is the certain arrival this spring of a deadly strain of bird flu in migrating wild birds.


Europe first saw the deadly H5N1 bird flu strain this autumn, with cases discovered among dead wildfowl or small flocks of domestic birds in Croatia, Romania, Russia, Turkey and Ukraine. Experts are convinced that those cases are only a warning of what's to come.


Thomas Mettenleiter, the president of Germany's leading animal disease center, the Friedrich Loeffler Institute, said millions of wild birds left Europe flu-free this autumn to winter in Africa. There they'll mix with migrating birds from Southeast Asia, where the lethal strain of the virus is far more common.


Of the ways the disease could arrive in Europe - through infected meat, live poultry or pets - migration is the most troubling. Government has no control over how many birds will arrive and where they'll land.


"March and April are going to be high alert times here," said Mettenleiter. "We've got a lot of work to do before then."


The European Union issued a directive Tuesday urging nations to deal aggressively with low-threat strains of the virus. Investigations should be launched whenever a suspicion of infection arises, it said.


Philip Tod, a spokesman for the EU Health and Consumer Protection Commission, said bird breeders should enclose their pens to limit contact with wild fowl and that signs of the flu should trigger mass culling in infected areas.


Reinhard Burger, the vice president of Germany's infectious disease center, the Robert Koch Institute, said that in the past Europeans could cull infected birds. "But we've never seen numbers approaching what we're expecting to see - hundreds of millions of infected birds will likely be returning to Europe with the spring weather.


"We're walking on a narrow ledge in high mountains this winter. We're very worried," he said.


The bird flu virus started killing birds in Southeast Asia in 2003. Farms with 10,000 birds were wiped out in 48 hours. Millions of birds died or were culled. Since then, the lethal virus has jumped to humans in 141 cases, resulting in 73 deaths, according to the World Health Organization on Friday.


As Mettenleiter explains: "We don't know if H5 strains can sustain a human pandemic, but if they can, the results are potentially catastrophic."


Humans have no immunity to new strains, and some experts estimate that a pandemic could kill more than 100 million people worldwide.


Currently, the flu passes from infected birds into humans through extended contact. But the virus is constantly mutating. A pandemic could start if it mutates into a form that easily transmits from human to human.




Most troubling is the possibility that humans who already have a human strain of flu will be infected. Flu has the ability to "gene-swap," or essentially trade genetic coding. So the H5N1 strain could turn a nonlethal strain that spreads easily among humans into a lethal one.


A vaccine would greatly decrease the number of deaths from bird flu, but a human vaccine isn't possible until the precise mutation that's passing among humans is known, and that hasn't developed yet.


There is a vaccine for birds. But it only would make them more resistant to flu, not stop them from spreading the disease, Mettenleiter said. "If the strain can jump to humans, that's the last thing we want. For now, at least, chickens are our sentinels."

KR Washington Bureau 12/23/2005 Europe braces for bigger bird flu outbreak this spring

News - Indonesia says 2 more avian flu cases confirmed

Indonesia's human death toll from H5N1 avian influenza rose to 11 today with the report that tests have confirmed that a man and a boy who died last week had the virus.

Samples from a 39-year-old man and an 8-year-old boy tested positive at the US Centers for Disease Control and Prevention, said Hariyadi Wibisono of the Indonesian health ministry, as quoted by Agence France-Presse (AFP) today. The CDC tests confirmed earlier test results in Indonesia.

Their cases are the 15th and 16th reported as confirmed in Indonesia. The World Health Organization (WHO) had not yet included the cases in its online tally at this writing. The WHO's overall count currently stands at 139 cases with 71 deaths in the past 2 years.

The two victims lived in different sections of Jakarta, according to a Bloomberg News report today. The man died Dec 13, and the boy died Dec 15, according to AFP.

The Bloomberg report said the man had had no known contact with sick birds before he died, while the boy lived not far from a market where pet birds are sold.

The story said community groups, soldiers, and student volunteers began a door-to-door campaign in Jakarta today to find and destroy sick birds in houses and backyards.

CIDRAP >> Indonesia says 2 more avian flu cases confirmed

News - Govt informed of bird flu contingency plan - NDTV.com - News on Govt informed of bird flu contingency plan

The Union Cabinet was informed of the contingency plan to be undertaken by the Health Ministry in the event of an outbreak of avian influenza in the country.

The contingency plan will deal with detection of avian flu in birds and detection of avian flu in humans, an official release said.

In both situations, the rapid response teams from the National Institute of Communicable Diseases (NICD) will get mobilised.

Health parameters

In case of avian flu in a bird, the action will be confined to surveillance of the local community and monitoring the health parameters of the cullers and the supporting staff as well as the workers in the farm.

However, if there was a human case of avian flu, then all clinical management protocols will be operationalised and the patient will be isolated in an appropriately equipped hospital. (PTI)

Govt informed of bird flu contingency plan - NDTV.com - News on Govt informed of bird flu contingency plan

News - Global Flu Pandemic Stirs Plenty Of Fear, But Little Perspective

Time for a reality check about avian flu.

The virus already has prompted dozens of governments and thousands of U.S. and European consumers to stockpile Tamiflu, the antiviral drug from Roche that will soon be licensed to other firms.

To companies in the human-resources and workplace environmental field, the fear factor surrounding avian flu has become a business opportunity to promote pandemic action plans for corporations.

And when seasonal flu hits ? as it does every year ? folks might wonder, "Is this the big one?"

"I hear of kids having nightmares and people unsure if they should eat chicken," said Dr. David Butler-Jones, Canada's chief public health officer.

Part of that fear is driven by mathematics. There were three flu pandemics in the last century. The 1918 pandemic was followed by Asian flu in 1957 and Hong Kong flu in 1968.

The concern is that the world is ripe for another pandemic, says Dr. Arnold Monto, professor of epidemiology and a flu expert at the University of Michigan.

"Some of us speculate that because we've had no pandemic since '68, we're due for one," Monto said. "The longer you have not seen the big one, the more you think you're becoming due for the big one."

For his part, Monto says the fear is unwarranted. Butler-Jones echoes that opinion, saying that predicting a new pandemic based on historical patterns is "a mug's game."

"If you toss a coin and get five heads in a row, your chance of another heads on the next toss is still 50-50," Butler-Jones said. "Some kind of pandemic is inevitable, but this strain of flu pandemic is not inevitable."

Should it strike, he says, it won't be like the 1918 flu pandemic, which we now know was also an avian flu.

First, the world population today is healthier. There are no troops in cold, wet World War I trenches. And we know much more about nutrition and hygiene and the science of viral genetic mutation.

Another difference: In 2005, the whole world is on watch.

"In 1918, the avian virus flu could not be recognized," Butler-Jones said. "Now we're looking for it."

Even if the virus mutates from fowl to people ? then mutates again so people can transmit it to other people ? the result need not be calamitous.

"Avian flu could become like SARS in terms of its limited ability to spread," Butler-Jones said.

He should know. SARS, or severe acute respiratory syndrome, hit Canada in 2003. It was brought by travelers from Asia. The Canadian government created Butler-Jones' agency after the SARS epidemic.

For all the drama and disruption over SARS, the virus infected only 8,000 people, killing 800.

SARS was a learning experience. One thing Butler-Jones says he learned is that there's a "fine balance" between preparing for the worst and being immobilized by fear.

Preventive Medicine

While Monto says it's unlikely an avian flu pandemic will happen, it doesn't hurt to be prepared on the off-chance it does.

"You just don't have the lead time once you realize the virus has become pandemic," he said. "That's why we stockpile Tamiflu."

Speed counts when coping with a viral outbreak. One study shows that an avian flu pandemic could be contained if officials act fast with quarantines, vaccine and antiviral drugs.

That positive analysis came from the Models of Infectious Disease Agent Study, a project funded by the National Institute of General Medical Sciences.

Researchers using computer simulations calculated how 500,000 Thais might spread the virus through their daily actions. More such studies are under way.

Authorities in most countries are competent enough to handle a pandemic once one is recognized, Monto says. The wild card is whether they'll be able to recognize it early enough.

Authorities must also be willing to make public what they've learned. Some local Chinese officials have withheld information because they look at it as an "admission of guilt" that they're having problems, Monto says.

Beijing is putting a stop to that practice.

"Everyone now realizes full disclosure is important," Monto said.

Public health agencies worldwide collect and share data. In addition to Tamiflu, governments are stockpiling Relenza, an anti-viral inhalant made by GlaxoSmithKline. (GSK)

Flu vaccine manufacturers Chiron (CHIR), Sanofi-Aventis (SNY) and Glaxo are increasing capacity for seasonal and avian flu.

On Dec. 16, Sanofi-Aventis announced that early tests of its experimental avian flu vaccine showed "good immune response in a significant number of volunteers."

Monto sees another payoff from the work being done to thwart avian flu. "We can use our pandemic preparation to respond to seasonal influenza. It kills 36,000 Americans every year unnecessarily ? and many think the number is conservative."

Investor's Business Daily: Global Flu Pandemic Stirs Plenty Of Fear, But Little Perspective

News - Avian flu scare at NSW farm

A NSW property has become the first in Australia to be locked down because of bird flu fears after a chicken had a weak reaction to an avian influenza test.


Agriculture Minister Peter McGauran yesterday revealed the quarantine measure had been taken as a precautionary step on the property at Wentworth, near the Victorian border.

Fears were sparked after the chicken was submitted to a NSW laboratory for routine testing with suspected Marek's disease, a common endemic disease.

Subsequent tests found the weak reaction to an avian influenza test. However, further laboratory testing excluded highly pathenogenic avian influenza (HPAI).

The CSIRO's Australian Animal Health Laboratory in Canberra is now conducting further testing for bird flu on samples from the chicken.

Chickens and ducks on the property were yesterday placed in cages to avoid contact with migratory birds. But consumers have been advised that it is safe to eat chicken.

Mr McGauran said it was also highly unlikely the chicken had contracted the low pathenogenic influenza strain.

"While it is the remotest of possibilities that any avian influenza variant is present we are taking every precaution," he said.

"Birds are contained on site and with the highly pathenogenic strain ruled out there is no risk to humans."

Concern about an influenza pandemic has intensified in the past year amid fears that avian influenza could mutate into a form that could be transmitted between people.

More than 60 people have already died from avian influenza, mostly in South-East Asia, and experts warned this week that the virus may be mutating to become resistant to the main drug used to fight it.

This came after a 13-year-old Vietnamese girl died despite receiving the right doses of the drug early in her illness.

The Federal Government has spent $555 million on pandemic preparedness and has stockpiled enough anti-viral drugs to give half the population.

However, experts are now warning that new antiviral drugs must be developed to fight the disease.

Mr McGauran yesterday insisted the risk of HPAI was very low but authorities were taking a cautious approach.

"This is consistent with Australia's conservative approach to managing animal health and disease risks," he said.

"I would stress that there is no food safety implications to consumers of poultry products arising from this incident."

Mr McGauran said he would keep the public informed of all results.

A team of experts from NSW yesterday visited the Wentworth property, which is understood not to be a poultry farm, and found no sick or dead birds in the flock.

Tests conducted were negative. However, Mr McGauran said there were "some weak inconclusive results".

The Courier-Mail: Avian flu scare at NSW farm [24dec05]

News - Two more avian-flu deaths in Indonesia

WASHINGTON, Dec. 23 (UPI) -- Two more people have died from avian influenza in Indonesia, the World Health Organization confirmed Thursday.

The latest victims, an 8-year-old boy and a 39-year-old man, both of whom had been previously reported as suspected avian-flu cases, take the total number of bird-flu fatalities in Indonesia to 11.

Meanwhile:

-- Following reports that H5N1 is developing a resistance to Tamiflu, Roche, the makers of the anti-viral, has announced that it is investigating new ways of using Tamiflu effectively in the face of a potential pandemic.

One approach may be to increase the doses, which would have the side-effect of further reducing a global stockpile that has already been deemed insufficient.

The World Health Organization attempted to reassure the public in the face of this latest potential pandemic setback. "Whenever you use any kind of drugs, anti-virals or antibiotics, you expect to see resistance develop," the BBC reported Keiji Fukuda, a scientist in the WHO's global influenza program, as saying.

-- Avian influenza outbreaks in birds are drawing ever closer to the Romanian capital of Bucharest.

On Wednesday outbreaks were reported 100 miles east of the city.

Government officials Thursday confirmed the presence of an H5 avian-influenza outbreak in a village 60 miles east of Bucharest, although they are awaiting confirmation regarding the N1 substrain.

In response to the outbreak, the now usual quarantines and culling of domestic birds have been imposed.

-- Bird flu has been ruled out as the cause of death of thousands of birds found dead in Malawi last week.

Instead, it appears that the birds died as a result of heavy rains.

United Press International - Consumer Health - Two more avian-flu deaths in Indonesia

News - Russia free of bird flu: minister

Russian Agriculture Minister Alexei Gordeyev said on Thursday the country has been cleared of bird flu cases in fowl.

"No industrial facilities or private households have bird flu at the present moment," Gordeyev told a press conference, quoted by the Itar-Tass news agency.

But Russian experts do not rule out a comeback of the virus in spring, when migratory birds return.

Six Russian regions were affected by the disease since its outbreak in July, according to the Emergency Situations Ministry.

As of early November, 4,500 domestic birds died of bird flu and another 180,000 were culled to prevent the virus from spreading. No bird flu cases have been registered among humans.

Gordeyev said compensation for destroyed fowl was solved at the regional level and did not affect the federal budget.

The bird flu virus, strains of which can spread to humans and can be fatal, has claimed the lives of more than 70 people in Southeast Asia since 2003.

People's Daily Online -- Russia free of bird flu: minister

News - Bird flu may have killed Vietnamese Man

Bird flu may have killed a 36-year-old man in the south of Vietnam, where the deadly virus remains in 10 of the country's 64 provinces, doctors said on Friday.

The man, who was a teacher in Soc Trang province, died on Wednesday of severe lung infection just five hours after being admitted to the Bac Lieu General Hospital in the nearby province of Bac Lieu, doctors at the hospital told Reuters.

They said samples had been sent to the Pasteur Institute in Ho Chi Minh City for laboratory bird flu testing. Results are expected by late next week.

The teacher's family raised fighting cocks but all of the birds were healthy, the doctors said. Soc Trang has had no recent bird flu outbreaks.

The H5N1 virus has killed 73 people in Asia including 42 in Vietnam, the country worst affected, since it swept through late 2003.

Global Coverage Article Reuters.co.uk

News - Bird Flu Drug Resistance Fears

Indonesia's confirmed bird flu death toll has risen to 11 as new disturbing evidence emerges that the virus may be developing resistance to Tamiflu, the only drug known to be effective against the virus.

A 39-year-old man and an eight-year-old boy were Indonesia?s latest victims of the H5N1 strain of the virus, a hospital spokesman said.

"It's been confirmed. We were informed of the results this morning," Ilham Patu, a spokesman for Sulianti Saroso hospital, Indonesia's main centre for the treatment of bird flu said.

Routine samples

Indonesia, the world's fourth most populous nation, routinely sends samples of cases that test positive locally abroad for verification.

The man, a resident of South Jakarta, died on December 13, a day after being admitted to the hospital. The boy died two days later at a private hospital in Jakarta.

Health ministry official Hariyadi Wibisono said the test results were from the Centers for Disease Control in the US and not from a World Health Organisation-linked laboratory in Hong Kong, as Dr Patu said earlier.

Asked about the contradictory information, Dr Patu said: "My information was obtained from the health ministry's research and development center. But in any case, it's confirmed."

Most victims in Indonesia have come from densely-populated Jakarta, where many people still live in close proximity to poultry, providing ideal conditions for the virus to pass to humans.

Hundreds of officials and veterinary students began visiting houses across the capital, looking for sick poultry as part of a nationwide campaign to fight the disease.

"The surveillance is aimed at monitoring poultry that may be infected with bird flu," said agriculture ministry official Makmur.

He said that the students were trained last month by experts from the UN Food and Agriculture Organisation.

Tamiflu resistance

In Vietnam, bird flu had become resistant to the anti-viral drug Tamiflu in two fatal cases, a doctor said in what he called a worrying development.

Tamiflu is considered a frontline defence against bird flu and the most effective treatment available to counter the H5N1 strain.

Menno de Jong, from the Institute of Tropical Diseases in southern
Vietnam's Ho Chi Minh City, said Tamiflu was ineffective in fighting the virus in two girls who died despite being given full doses of the drug.

"Our two patients became resistant despite a full dose of treatment. Both died and in one patient there are some suggestions that the therapeutic failure and ultimately her death may have been caused by the development of resistance," he said.

This patient was a 13-year-old, who died eight days after showing the first symptoms. The other, 18, died three weeks after the onset of symptoms.

"What will be important is to try to learn as much as possible from the next patients. We need to improve treatment of bird flu in this region," he said.

Vietnam has been the country hardest hit by bird flu, which has killed more than 70 people across Asia.

In China state media reported that human trials of a bird flu vaccine had begun this week, with six volunteers being given shots.

The experiments, which will be carried out on 120 volunteers in Beijing, will last nine months but preliminary conclusions are expected in around three months.

Various companies around the world are trying to develop a vaccine against the virus.

But the WHO's top official in China has said that they might be useless in the event of a pandemic because the virus would have mutated.

Scientists fear that H5N1 may mutate into a form that could be easily passed between humans, sparking a pandemic with a potential global death toll of millions.

Increase doses

Swiss pharmaceutical group Roche says increased doses of Tamiflu may be needed to treat human cases of virulent bird flu because of the virus?s growing resistance.

The company says in a statement it may also be necessary to combine the drug with other antiviral agents to treat H5N1.

It says other treatments for the virus need to be explored including higher dose and/or longer duration of treatment with Tamiflu or a combination of antiviral agents.

"Roche agrees that other treatment regimens for the H5N1 virus need to be explored, including higher dose and/or longer duration of treatment with Tamiflu, or a combination of antiviral agents."

Roche said that safety data supported the use of higher doses.

Clinical research was already underway with the World Health Organisation (WHO) and the US National Institutes of Health to assess the effectiveness of a higher dose, before the study on drug resistance was published, Roche spokeswoman Martina Rupp said.

SBS - The World News

News - WHO warns China of possible bird flu attack

The World Health Organization (WTO) warned Thursday that it is too early to tell if the avian influenza in China is under control, adding that prevention and detection measures should be stepped up.

Dr. Shigeru Omi, WHO's Western Pacific regional director, made the remark during a visit to the home of a nine-year-old boy in central China's Hunan Province who survived a bout of the flu. He was China's first human case of H5N1.

"It is too early to say if it is under control," said Dr. Omi. "I will not be surprised if we have more human cases during the winter months."

He said bird flu outbreaks in December, January and February, can be much more serious.

So far, China has reported two deaths among six human cases of bird flu in Hunan, Anhui, Guangxi, Liaoning and Jiangxi provinces.

"Based on the experiences from other countries, the number of cases will drop and then rise again," said Dr. Omi.

"A temporary reduction in the number of cases doesn't mean the circulation of the virus has been halted. We have to assume that the virus is still circulating. That the virus is still there in the environment at least among chickens and ducks," he said.

He warned that the highly pathogenic avian influenza virus is very unpredictable and unstable and could mutate into a form that can pass easily between people, leading to a human pandemic.

"We have to assume that it is impossible for this virus to become so infectious that a global pandemic might happen," he said. "We are very concerned about the possibility this virus can efficiently transmit human to human."

"We don't know when it will happen," he said. "But we have to prepare for the worst situation, and the international community has to do its utmost to try to avert or prevent it."

Vietnam, Thailand and Indonesia have also reported human cases of bird flu in the past few months.

"Fortunately, so far all the reported human patients were infected by sick poultry and where not acquired from human transmission," Dr. Omi said. It is crucial to detect the occurrence of human cases of bird flu.

"Each human case is very important," he said.

The WHO delegation including Henk Bekedam, WHO's representative in China, Lee Chin-Kei, project officer of WHO in China and Roy Wadia, Who's information officer in China congratulated Hunan for successfully treating the nine-year-old boy.

The WHO delegation met with local health officials in Hunan and called for the prompt and quick detection of human cases of bird flu and enhancement of the reporting of animal outbreaks.

WHO warns China of possible bird flu attack

News - Interactive. Bird flu

Check our this Bird Flu interactive provided by the Guardian Unlimited.

Guardian Unlimited Special reports 26.01.04 Interactive. Bird flu

News - Tamiflu still best hope against bird flu, says WHO

A senior World Health Organisation official yesterday sought to calm fears that the drug the world is stockpiling may have limited usefulness in a flu pandemic.
Evidence that some people with bird flu in Vietnam rapidly developed resistance against the drug Tamiflu and died was not necessarily a cause for alarm, said Keiji Fukuda, an expert at the WHO's global influenza programme. More research was needed, however, on the use of the drug.

His comments follow publication of a report in the New England Journal of Medicine on eight people with bird flu in Vietnam who were treated with Tamiflu. Four of them died. In two cases, the patients were very sick and although Tamiflu temporarily improved their condition, they died.
The other two cases have sounded warning bells around the world. Both had the usual strain of bird flu when they were admitted to hospital, but after some days of treatment with Tamiflu, the virus in their bloodstream mutated and became resistant to the drug.

The scientists, from the Oxford University Clinical Research Unit in Ho Chi Minh City, voiced concern that if a resistant strain of flu became easily transferable between humans - as bird flu is not at the moment - it could worsen any pandemic.

Yesterday, however, Dr Fukuda said that resistance was inevitable with any drug and Tamiflu was at the moment the best available treatment.

"Whenever you use any kind of drugs, antivirals or antibiotics, you expect to see resistance develop in organs," he said. "Finding some resistance in and of itself is not surprising and is not necessarily alarming."

The study revealed the need for more information, he said. "What really is critical is understanding whether the way we are using the drugs contributes to that [resistance]," he said.

Work needed to be done on the optimal dose of the drug against H5N1 (bird flu) and the length of the course of treatment.

The study's authors, Jeremy Farrar and colleagues, say that other antiviral drugs are needed alongside Tamiflu. The only other candidate, however, is Relenza, which has limited usefulness because it is administered as a nasal spray. It cannot be used by people who have trouble breathing, which occurs if it is severe flu. Its manufacturer, the British company GlaxoSmithKline, said it would be two years before they could produce an injectable form.

The deputy director of the Hospital for Tropical Diseases in Ho Chi Minh City, who was a member of the study group, said they were still using Tamiflu. "We still recommend the use of Tamiflu for bird flu cases as soon as possible and at higher doses as there is no replacement yet," said Tran Tinh Hien. "More in-depth research is needed to determine the effectiveness of Tamiflu against the H5N1 virus."

Guardian Unlimited Special reports Tamiflu still best hope against bird flu, says WHO

News - China, WHO in cooperation

Chinese scientists have presented the World Health Organization with two samples of the H5N1 strain of bird flu, along with their genetic sequences.

The samples will help scientists worldwide better understand how the highly pathogenic virus mutates. WHO officials say China has made a great contribution by sharing the samples. WHO Western Pacific Regional Director, Doctor Shigeru Omi says China is an important battleground for bird flu and they hope to widen cooperation.

Doctor Shigeru Omi said: "It's not just China. In many countries in Asia, the virus is already entrenched and imbedded in many parts of the countries. It is not an easy task and the challenge is a very difficult one. I think the Chinese government has showed very strong commitment and political leaders are already committed and so is the Ministry of Health."

CCTV-English Channel-????

News - UN urges RI to anticipate bird flu pandemic

The United Nations (UN) urged Indonesia to prepare a contingency plan for the possibility of the avian influenza turning into a global pandemic, a senior UN official said.

UN systems senior coordinator for avian and human influenza David Nabarro said a pandemic of the H5N1 bird flu strain could occur at any time and any place and therefore urged the Indonesian government to start developing a plan for such an eventuality.

"It will happen at some point. Act as though a pandemic will start tomorrow. Don't assume we can wait around and not worry that it won't start in the next six months or one year. If we do, once it starts it will be too late to prepare and we will all will be in crisis," he said at a recent workshop on avian influenza pandemic contingency plans held at the Office of the Coordinating Minister for People's Welfare on Monday.

He warned that should there be a pandemic, it would threaten half the world's population as no medication would be able to stem the tide of illness.

"At that stage, the virus may be resistant to Tamiflu, so we can't rely on Tamiflu," he said, referring to the drug currently given to bird flu patients.

The highly pathogenic H5N1 strain remains a virus essentially in birds. However, scientists fear that it could mutate into a form that could pass easily from human to human.

The government said that as of July, the country was in phase three of the six phases of a flu pandemic, meaning there was the possibility of facing a new subtype of the virus.

There have been bird flu breakouts in Indonesia, Cambodia, China, Laos, Thailand and Vietnam since August 2003. To date, there have been nine confirmed bird flu deaths in Indonesia and more than 10 million poultry killed.

Nabarro stressed the danger of a poor response to the possibility of an outbreak and pointed out that the 1918 Spanish flu was caused by the H1N1 subtype virus and killed 40 million people across the globe.

"To cope with such a threat, we should prevent, prepare and respond," he said.

Coordinating Minister for People's Welfare Aburizal Bakrie said that the government had formulated a plan to control avian influenza and to cope with a possible flu pandemic.

"Among other things, in the near future we will set up an integrated and autonomous organization to do tangible work to prevent and cope with any flu pandemic," he said.

The "National Strategic Plan to Control Avian Influenza and Preparedness to Face a Influenza Pandemic, 2006-2008" proposal says the government will introduce more than a dozen strategies to control the bird flu, including organizing mass culls and poultry vaccinations as well as increasing the stockpile of antiviral drugs and organizing research on bird flu vaccines.

Should a pandemic occur, the government proposal says it will isolate areas in which 80 percent of the population is infected and will mobilize manpower, including soldiers and police officers, to help limit the pandemic spread.

However, Aburizal said he did not know how much money would be needed to finance the implementation of the plan.

"All we have at present is US$150 million, which was agreed upon during the last WHO meeting in Geneva, and the government will add another $10 to $20 million," he said, adding that international aid would be needed to support the government's drive.

Deputy to the State Minister of National Development Planning Dedi M. Masykur Riyadi, whose office drafted the proposal, said should all of the strategies be implemented, the government would need about Rp 15.7 trillion ($1.5 billion) from 2006 to 2008.

The Jakarta Post - UN urges RI to anticipate bird flu pandemic

News - Indonesia confirms bird flu deaths

AN Indonesian man and boy have been confirmed by World Health Organisation tests as having died of bird flu, bringing the country's death toll from the virus to 11, a hospital spokesman said today.

Asked whether test results on the pair had been received from a Hong Kong laboratory, Sulianti Saroso hospital spokesman Ilham Patu said: "It's been confirmed. We were informed of the results this morning.
"So we have now 16 confirmed cases and 11 deaths," he said.

Five people have survived infection of the virus.

The Daily Telegraph | Indonesia confirms bird flu deaths

News -Tamiflu found ineffective in bird flu treatment

The drug most of the world is counting on to prevent an avian flu pandemic may not be a failsafe defence, according to a New England Journal of Medicine report.

The authors say they have found evidence the H5N1 virus can mutate into a form unaffected by Tamiflu -- rendering the world's ever-growing stockpiles of the drug ineffective if the mutated strain were to spread.

According to the study, completed by Dr. Menno de Jong at the Hospital for Tropical Diseases in Ho Chi Minh City, Vietnam, four out of eight avian flu patients who were given the medication died despite the treatment.

This has many health care experts worried, since many predict bird flu will be the world's next major pandemic.

Toronto infectious disease consultant Dr. Neil Rau says the study has serious implications.

"Here you have the optimal situations, the right dose, the right duration, the right timing and administration and yet you have a bad outcome. That's not a good thing to see," Rau told CTV News.

The drug's maker, Swiss firm Roche AG, said it's trying to figure out why it doesn't work in some patients, and is looking at whether severe cases should be given a higher dose or longer duration of treatment.

Another article in the same journal cautions doctors against prescribing the drug for patients to stockpile. It says if not administered in a large enough dose, the chemical structure of Tamiflu could allow the virus to develop a resistance to the treatment.

Dr. Allison McGeer thinks this should remind doctors and researchers to keep looking for new solutions.

"There's one other drug, GlaxoSmithKline's Relenza, that is licensed that people are starting to talk about stockpiling," said McGeer, a Toronto infectious disease microbiologist. "There are also some other drugs in development. It really tells us that we need to move those drugs in development forward as fast as possible."

While drugs such as Tamiflu don't cure bird flu, experts hope they will help reduce its severity if taken early enough.

Bird flu has not yet appeared in North America and there is no proof that it can spread from person to person. But officials worry that if the virus mutates, it could become as contagious as the annual flu, but much more deadly.

Since 2004, the H5N1 virus has killed at least 71 people in Asia. According to figures updated by the World Health Organization on Dec. 16, there have been at least 139 human cases, including 95 this year alone.

More than 200 companies and governments have asked Roche if they can help manufacture Tamiflu. So far, Roche has allowed Indonesia, Thailand and the Philippines to produce the drug without paying compensation. Tamiflu is not patent protected in those countries.

Counterfeits

Now, consumers are starting to have to deal with questions about Tamiflu's authenticity as well as its efficacy.

The Canadian Press report that British authorities have identified 18 websites -- including two in Canada -- selling what they believe are counterfeit products sold under the Tamiflu brand.

But Health Canada spokeswoman Jirina Vlk said the drug supplied by the Canadian sites in question is, in fact, Tamiflu, and not counterfeit medication.

"(British authorities) may think it's counterfeit because it may not meet their labelling (standards), but they're legitimate Roche products," she said.

The other sites the British authorities flagged are based in the U.S., Britain, Switzerland, Bahrain, the Channel Island of Jersey, Cyprus, Singapore and Malta.

The British Medicines and Healthcare Products Regulatory Agency launched the investigation over concerns that a shortage of the drug in the public market has fueled sales of bogus Tamiflu over the Internet. Test purchases were made from the sites and the drugs are being tested to determine if they are really Tamiflu.

U.S. customs officials recently seized a shipment of counterfeit Tamiflu in San Francisco.

Vlk said even though the Canadian drugs were not counterfeits, would-be Tamiflu buyers should beware.

"Buying drugs from Internet pharmacies that do not provide a street address and telephone number can pose serious concerns. Patients have no way of knowing where the company is located, where it gets its drugs, what is in the drugs, and how to reach the pharmacy if there is a problem,'' she said.

CTV.ca Tamiflu found ineffective in bird flu treatment

News - The psychological impact of bird flu

More than the actual damages to livelihood and health security, it is the psychological impact of a possible bird-flu outbreak that threatens to cut the Philippines gross domestic product by 23 percentage points if the disease hits the country.

The Asian Development Bank estimated that the Philippines would be the least affected by a bird-flu outbreak, but it stressed that the impact would be long term and the economic costs, staggering.

World Bank shared ADB?s observation, as it noted in its report on the avian flu that ?the most immediate economic impacts of a pandemic might arise not from actual death or sickness but from the uncoordinated efforts of private individuals to avoid becoming infected.?

Citing Asia?s experience during the outbreak of the severe acute respiratory syndrome (SARS), the World Bank warned that the economies that would be hit by a pandemic, may grind to a halt, as people try to ?avoid infection by minimizing face-to-face interactions resulting in a severe demand shock for services sectors such as tourism, mass transportation, retail sales, hotels and restaurants.?

The report entitled ?Spread of Avian Flu Could Affect Next Year?s Economic Outlook? also noted that the outbreak could cut to productivity, as employees would refuse to go to work, for fear of contracting the disease, which may force businesses to ?shift to more costly procedure.?

The World Bank warned that ?the costs arising from panic and disruption? may be magnified by ?an initial lack of public information, contributing to a large overestimation by private individuals of the perceived probabilities of infection and death,? as experienced during the SAPS outbreak in some Asian countries.

The multiagency task recently created by President Arroyo has taken into account the need to keep the public well informed of the basic information they need to know about the disease to prevent panic in case of an outbreak.

While the country remains bird-flu free, the multiagency task force, chaired by Agriculture Secretary Domingo Panganiban, has taken steps to prevent the entry of the virus, and to prepare for a worst-case scenario should the disease finds its way intro Philippine territory.

To prevent panic and confusion, Panganiban?s team, which included representatives from the government media group, headed by Secretary Cerge Remonde, set out to embark on a massive information campaign, starting at the grassroots level, top target the first ones to be affected, should the virus hit the country.

The Manila Times Internet Edition | TOP STORIES > The psychological impact of bird flu

News - Today's Trucking: The Online Business Resource for Canada's Trucking Industry

TORONTO -- Recognizing that the threat of a pandemic outbreak of the avian flu is, in the government's words, "a matter of when - not if", the Ontario Trucking Association and the Canadian Trucking Alliance have begun work on a strategy to help carriers deal with such an emergency.

The associations are contacting government agencies and business continuity planning consultants to determine what the industry can do to prepare itself for a pandemic, the OTA states.

"During the SARS crisis in Toronto a number of carriers were impacted by quarantines and other business disruptions and we want to make sure that, to the greatest extent possible, we are better prepared for the much greater threat posed by the avian flu," OTA says.

Today's Trucking: The Online Business Resource for Canada's Trucking Industry

News - OCD 12 leads efforts to avert avian flu in Soccsksargen

Koronadal City (22 December) -- The Regional Disaster Coordinating Council 12, in an effort to avert the entry of fowls carrying the killer virus causing the global disease "Avian Influenza" is now preparing a Contingency Plan which the Office on Civil Defense take the lead.

OCD 12 director Minda Morante, in a briefing with members of the Technical Working Group of the Regional Avian Influenza Task Force stressed that the Arroyo government is seriously addressing this concerns in the light of early signs that the Philippines may not be exempt to becoming host to migratory birds carrying the virus.

The group is now validating suspected areas in the region identified as "highly vulnerable" to be affected with the bird flu disease, especially the areas around the periphery of the Liguasan Marsh in Maguindanao, the forestal area of coastal town Palimbang in Sultan Kudarat province, the province's multi-awarded Bird Sanctuary at barangay Baras in Tacurong City.

The task force is also evaluating reports by the Department of Agriculture that some parts of South Cotabato, Sarangani and Cotabato province may also be visited by the virus-carrier migratory birds.

At the early signs of Bird Flu and as preventive measure, Morante in a meeting with PIA, DOH, DA, PNP and DILG, recommends the 'MANOK POWER" strategy coined by OCD deputy administrator Dr. Anthony Rolando T. Golez' as a battlecry to make Philippines a bird-flu-free country.

MANOK POWER stands for: M-igratory birds should not be disturbed, touched, shot and eaten, A-ct on unexplained deaths of birds or domestic poultry (report to the local veterinary office), N-o to smuggling of wild exotic migratory birds, O-key to eat cooked chicken, K-eep the Philippines Bird Flu-Free!, P-rotect with protective gears like masks, googles, disposable gowns and gloves, O-rder not to touch or go near dead chickens, ducks, game fowls, W-rap dead chickens in impermeable plastic/wash your hands/change your clothings and wash again, E-mphasize not to eat dead Chickens! R-eport the incident Call 117 (or any designated telephone number by BAI).

PIA News Releases

News - Tamiflu-resistant avian flu cases raise concerns

Researchers in Vietnam have reported two additional cases of H5N1 avian flu infection in which the virus developed resistance to the antiviral drug Tamiflu, raising concerns the current dosing regimen is inadequate to combat the virulent strain.
While the findings will likely lead to questions over the future efficacy of the No. 1 weapon in the limited pharmaceutical arsenal against pandemic flu, influenza experts were quick to caution against over-interpreting the results.

Dr. Menno de Jong, lead author of the report, said the drug?s performance against the current purely avian virus can?t be used to predict how effective oseltamivir, or Tamiflu, would be if H5N1 adapts to become a strain that can easily spread among humans.

?For the current sporadic infections with this avian virus, it?s bad news,? de Jong said of his team finding resistance in two of eight cases studied from December 2004 through February 2005.

?But we cannot automatically say: `So, this is the end of the world.? ?

Dr. Keiji Fukuda of the World Health Organization agreed.

?It is . . . unhelpful to paint antiviral drugs as the . . . silver bullet. And it is equally unhelpful on the other stream to start wringing one?s hands and saying, `They?re not going to be helpful,?? Fukuda, a leading flu expert, said from Geneva.

?The truth is ? as it is for every other drug out there ? in between.?

De Jong and his co-authors ? from Oxford University?s clinical research unit at the Hospital for Tropical Medicine in Ho Chi Minh City ? published their report in Thursday?s New England Journal of Medicine.

This week?s issue of the influential journal also ran two commentaries exhorting doctors to refuse requests for Tamiflu prescriptions from people looking to stockpile the drug against a possible flu pandemic.

The de Jong paper is the second in which resistance to oseltamivir has been reported. The earlier case also occurred in Vietnam.

It?s the first, however, to report that someone suffering from H5N1 infection who received standard treatment with the drug during the optimal window ? the first 48 hours ? developed resistance to oseltamivir.

The patient, a 13-year-old girl, started Tamiflu treatment a day after she developed symptoms. Many H5N1 patients have started drug therapy well outside the recommended window for commencing treatment.

But flu experts have been speculating for some time that the current dosing regime, which is based on experience with regular human flu strains, is inadequate to combat the infection caused by this virulent avian strain.

Research studies are currently being set up in Southeast Asia to try to determine whether higher doses, for longer periods, are needed to treat H5N1 infections. Antiviral expert Dr. Frederick Hayden of the University of Virginia has just returned from Asia, where he has been working to try to co-ordinate this research.

For Hayden, the study highlights the many questions that need answering.

?Is an alternative dosing regimen ? higher dose, longer treatment, perhaps combination with another antiviral or a different drug entirely ? going to get around the (resistance) problem?? he wondered.

If it turns out the current dose is too low, that could explain the development of resistance. Doses which are too low allow the virus to evade the drug?s mechanisms.

Should the research prove that H5N1 infections require more drug for a longer period, governments which have been rushing to stockpile Tamiflu would face the unwelcome realization that existing national stockpiles will not protect as many people as they had hoped.

?I . . . worry desperately that the timing and dosage of this drug, if it is to be effective, is going to be very different than the current H3N2 (human flu) model,? said infectious disease expert Dr. Michael Osterholm, who has been warning that current stockpiling calculations may be underestimating the amount of drug needed to treat each person.

In addition to pinpointing the optimal dosing regime, flu experts hope the research will create a clearer picture of whether drug-resistant viruses, when they do arise, are capable of transmitting and spreading in the way antibiotic-resistant bacteria do.

In theory and in laboratory testing, flu viruses that find ways to evade Tamiflu lose what scientists call fitness. In essence, they become wimpier viruses that don?t transmit well ? though there is some evidence in animal models that under the right conditions resistant viruses will spread.

Flu specialists would like to see human data ? and much more of it ? before they can feel assured that the prospect of Tamiflu-resistance viruses emerging and spreading is of low probability.

Concerns about the potential spread of drug-resistant strains of flu were behind the calls in two commentaries that strongly urged doctors to refuse requests from people looking to stockpile Tamiflu.

The authors of one of the pieces, Drs. Allan Brett and Abigail Zuger, argued that personal stockpiling exhausts limited supplies of the drug meant for the treatment of people with human flu and could lead to a rise in resistance if people take the drug inappropriately.

As well, without the guidance of a physician, people could end up taking the drug when they don?t actually have flu, they argued.

?It seems to me . . . that the potential for it to be used wrongly is just so great . . . that it would just be a colossal waste, I think,? Brett, an internal medicine specialist and professor of medicine at the University of South Carolina, said in an interview.

Experts agreed with the concerns raised. But at least one noted that urging people to wait to get and take the drug under the guidance of their doctor could be misrepresenting how likely it is they?d be able to do that during the chaos a pandemic could cause.

?I think before we just summarily dismiss personal stockpiles of this drug or any other drug, we need to be honest about that and say: `OK, what?s the likelihood that people can get this drug? And how soon can they get it?,? ? said Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

?I think that the authors make a legitimate point. But I think it?s hardly a complete point,? said Osterholm, who favours rationing Tamiflu for health-care and essential workers, to keep hospitals and crucial services operating during a pandemic.

TheStar.com - Tamiflu-resistant avian flu cases raise concerns

News - Lack of Human Immunity Makes Bird Flu More Worrisome

Amidst all the frenzy over the bird flu virus that's raging among poultry and has killed 71 people since its onset, the issue of human immunity tops the list of grave concerns.

Because the avian flu that?s spreading rapidly among birds in Asia and now parts of Europe is a never-before-seen strain of H5N1, human beings have no natural immunity to it ? and thus no way for their bodies to fight it off should it mutate into a disease that can be passed from person to person.

?People do not have any defenses against this virus because it is entirely new,? said Jennifer Morcone, a spokeswoman for the Centers for Disease Control (CDC). ?It?s not like the other flu viruses that have circulated in the past.?

Scientists and physicians know for sure that human beings don't have any natural immunity to H5N1 because they've measured and analyzed the antibodies in patients' blood serum.

To date, everyone who has fallen ill with this form of avian flu has caught it by handling or coming into close contact with infected birds. So far, there have been 139 confirmed human cases reported since 2003, when the illness was first discovered, and 71 deaths ? a 51 percent mortality rate, according to the World Health Organization?s Dec. 16 figures.

In order for bird flu to mutate so that people can catch it from each other, an infected person has to be carrying another type of human-to-human flu bug at the same time that he or she catches the bird flu, so that the two influenza strains can swap genes.

"The avian flu picks up some genes from the other flu," said Dr. Herbert L. DuPont, director of the Center for Infectious Diseases at the University of Texas School of Public Health. "This has happened three times in the past 100 years."

All three pandemic flus of the 20th century originated from birds. The legendary 1918 Spanish flu took between 20 and 50 million lives, up to 675,000 of them in the United States; the Asian flu of 1957 killed 2 million worldwide, 70,000 in the U.S.; and the Hong Kong flu of 1968 killed 1 million worldwide, 34,000 in the U.S.

With that history in mind, what worries immunologists and other health experts is the fact that the existing form of avian flu is voraciously infecting birds across a wide swath of the globe.

The H5N1 virus initially emerged in poultry in 1996 and the first human cases and deaths were reported in 1997 in Hong Kong. Alarming, widespread poultry outbreaks began happening in 2003, which was also the onset of more human cases in Hong Kong and Vietnam.

Since then, the disease has spread to Thailand, China, Indonesia and Cambodia ? where the other human deaths have occurred ? and also to Japan, Laos, Korea, Malaysia, Croatia, Kazakhstan, Mongolia, the Philippines, Romania, Russia, Turkey and the Ukraine.

"It is a real threat because we know this is a virus that just this year has spread to three different countries in Asia," Morcone said, referring to China, Indonesia and Cambodia, the countries where human deaths have been reported in 2005.

That means it's just a matter of time before this H5N1 will travel closer to home.

?Eventually, when you have migrations of birds, you?re going to get some cases in North America,? said Dr. Gilbert Ross, medical director at the American Council on Science and Health.

In addition, unlike other flu viruses that are generally only fatal among the elderly and infirm, this influenza strain has been killing younger people ? much like the 1918 outbreak. That is in part because most of those afflicted were bird handlers in their 20s to 40s, but it also could be an indication that this strain is similar to the devastating disease of the early 20th century, which was an H1 flu.

"Fifty percent of the people who died in 1918 were between the ages of 20 and 40," said Dr. Ed Septimus, medical director of infectious disease at the Memorial Hermann Healthcare System, a cluster of hospitals in the Houston region. "We're seeing a similar mortality rate and younger people being infected and dying."

Influenza is notorious among diseases for its frequent changes, or drifts, in strain, meaning it is difficult to immunize against via one of the two main ways immunity occurs ? by vaccine or by infection with the illness.

The run-of-the-mill flu that makes an appearance every year is constantly mutating, so a new vaccine needs to be developed annually to combat whatever strain is the most prevalent in the community during that season. It's a challenge to doctors and scientists, who sometimes come up with a less effective vaccine because of the unstable nature of influenza.

?Your best protection is when the vaccine matches the strain that is circulating in the community,? Septimus said. ?In the past few years, the predominant flu bug in the community was not in the vaccine; it was a mismatch. We guessed wrong. But that still gave about 50 percent protection. If it had been a match, it would have been about 80 percent.?

The drifts in the regular cold-weather flu differ from the larger "shifts" in the virus, which happen when the hemoglobin ? the H in the scientific name for the strain ? changes entirely. This current H5N1 avian flu is new because an H5 had never been seen before.

"When the hemoglobin changes, it's a big deal," DuPont said. "When it shifts and goes to a completely different hemoglobin, there's no existing immunity and we have pandemic flu."

The so-called "shift-and-drift" nature of the flu also means that human beings who get their shots or catch that particular bug are only protected from that one specific strain during that one specific time. Unlike immunity to most other diseases, immunity to influenza is fleeting.

?The protective immunity against flu is four months from the influenza vaccine ? you have protective levels of the antibody for approximately four months,? DuPont said. ?That?s why people who get the vaccine in the early part of the season can still get the flu in the later part of the season.?

Immunity is built up when parts of the virus in question are introduced into the body, either because the person has become infected or has been vaccinated. The human system then builds up antibodies to ward the illness off.

There are two types of human vaccines: live vaccines and killed ones. Most flu vaccines are killed, meaning the agent in them is dead and can no longer be grown in a lab, but still produces antibodies and protects against the virus. Vaccines for illnesses like measles, mumps and rubella are live, made with a less virulent strain of the virus that's processed in such a way so as not to cause sickness, while still providing immunity and having the ability to keep growing in a lab.

Many people are exposed to sicknesses of various stripes without ever having any symptoms, as is the case with ?the kissing disease? known as mononucleosis. Of every 1,000 people infected with mono, only five unlucky ones actually fall ill from it ? but all are immune, according to DuPont.

?The most common way to build up immunity is to have an infection with the agent, and most agents do not produce clinical disease when they infect,? he said.

Immunity to illnesses like mono, chicken pox (which is the varicella virus), measles, mumps, polio and smallpox is generally long-lasting among people, with those infected or vaccinated having protection that can last at least a generation, if not a lifetime.

In fact, even when a human immune system hasn't seen a virus for decades and then is reintroduced to it decades later, "memory cells" in the body will often recall it and begin to quickly develop antibodies to fight it off, meaning the person will either not get sick at all or will have a much milder form of the disease.

"Sometimes, seeing a virus that's similar will wake up a dormant immune system and produce antibodies very quickly in response to a challenge from a virus," Septimus said. "It may have an effect on how severely you become ill and the expression of the illness."

Human immunity does diminish slowly over time, but with most diseases other than influenza, exposure to an illness provides at least partial immunity for years even when it has decreased from what it was originally. Flu, of course, is the black sheep.

But experts are trying to soothe those frightened by the current avian influenza that has an increasingly large part of the world in its grips, saying there is hope for a flu shot to be developed that will successfully ward it off.

"We will see an effective vaccine, just like we've seen effective vaccines for nearly every other communicable disease except HIV and malaria," said the American Council's Ross.

He and others in the field urge that in the meantime, the immediate focus should be on taking precautions, both against bird flu and the regular garden variety that's crept up on us again this wintry season.

"If they're traveling to Asia, we recommend that people don't visit live bird markets and don't go to bird farms, be mindful of the food they eat and mindful that food is cooked," said the CDC's Morcone.

Avian influenza aside, the best advice could also be the best medicine: Wash your hands frequently, especially when you're sick with the flu or a flu-type bug, stay home until you get well and cover your mouth when you cough and splutter.

"Let's not get hung up on bird flu, which may not happen ? and if it happens we don't know when," Septimus said. "Do what you're supposed to do this year, and let the scientists and government work out a plan for the potential of a pandemic."

FOXNews.com - Health - Lack of Human Immunity Makes Bird Flu More Worrisome