News - Bird flu and travel: the facts

Panic about bird flu is spreading. All last week television news bulletins showed pictures of chickens being slaughtered in Turkey, and headlines warned tourists to stay away. But advice to travellers has been confused, with even official sources giving contradictory signals - on the same day that the chief executive of the government-funded Medical Research Council advised people not to go east of Ankara, the British ambassador said there was 'absolutely no reason' to cancel trips to Turkey. Our guide to the facts should help you make your own decision.
Q: Is the official advice to stay away from Turkey?
A: No, contrary to the impression given by some media reports, the Foreign Office says the risk from bird flu is 'very low' and is not advising against travel. Some have accused the Foreign Office of being slow to react and playing down the risks, but the American State Department, which usually takes a more cautious line, plus the World Health Organisation and the American government's Center for Disease Control and Prevention (CDC) are all taking a similar view. They suggest you should stay away from infected areas, take some basic precautions, but otherwise advise holidays can go ahead.
Q: How many people have died?
A: As we go to press, there have been three confirmed deaths from bird flu in Turkey, and 15 more people are confirmed to have the disease. Worldwide 79 people have died since the outbreak of the H5N1 virus in Vietnam in 2003. To put that into perspective, malaria kills between 1.5 million and 2.7 million people every year, but around 3 million British tourists still travel to infected areas without taking the correct precautions. 'Ordinary' flu kills around 3,000 to 4,000 in Britain per year, and in 1989, an epidemic year, the figure was 30,000.
Q: Are lots of tourists cancelling trips?
A: Not yet, according to the Association of British Travel Agents, which says it has had only two phone calls on the matter. This is probably mainly due to it being low season in Turkey.
Q: Which areas are affected, and are they near resorts?
A: None of the confirmed human cases are close to Turkey's popular seaside resorts. There have been three cases in the capital Ankara, but few tourists fly there. However, infected birds have been discovered in Istanbul and in the coastal resorts of Izmir and Kusadasi. Officials are culling birds in all the affected areas.
Q: Isn't that enough reason not to go?
A: Officials have not sounded the alarm bells so far because it is only people who have been in direct contact with poultry who have been infected, particularly farmers or children. Tourists run little risk provided they avoid all contact with poultry - including live, healthy looking birds, and surfaces contaminated with uncooked poultry, bird droppings or feathers. The upshot is that poultry farms, slaughter houses and butchers should be avoided - hardly likely destinations for tourists - as well as markets selling live animals.
Q: How do you catch it?
A: Typically like this: infected birds (normally chickens) shed the virus in their faeces, then humans breathe in dust from dried droppings. Many of those infected have been children, who have been playing near chickens, touched their droppings and then put their hands to their mouths. The virus will also be present in poultry meat, blood and eggs.
Q: So can you get it from eating chicken in a resort?
A: The virus is killed by temperatures of about 70C, so if the chicken is well cooked there should be no problem. The same applies to eggs, although yolks must not be left runny.
Q: What about wild birds?
A: Ducks can carry it without suffering its symptoms and most wild birds can catch it. So avoid contact with wild birds.
Q: Should we take special medical kit?
A: As with most infectious disease, hand washing is one of the most important preventative measures. The US CDC recommends you take a bottle of alcohol handwash so you can clean your hands even when not near soap and water.
Q: What if it spreads suddenly?
A: The key fact is that so far there have been no recorded cases of human-to-human infection. So, as long as you avoid birds, you have little to fear. However, the more humans are infected the greater the chance that the virus will mutate and start to be transmitted between humans. If that happens, as with Sars (see below), the WHO and similar bodies would almost certainly change their guidance and order widespread travel bans. During Sars they warned against travel to all of China.
Q: Where else is there a risk?
A: People have died in six countries, with most confirmed human cases in Vietnam, but there have been no new human cases confirmed this month outside Turkey. In China there were eight human cases and five deaths in the last six weeks of 2005. Experts suggest visitors to all six countries should take similar precautions about avoiding poultry in farms and markets.
Q: What are the symptoms?
A: Fever, cough, sore throat and trouble breathing. The CDC advises checking for these symptoms for 10 days after you return from an affected country.
Q: Will tour companies cancel trips?
A: Very unlikely. Tour operators are loath to cancel trips unless the official FO guidance warns against travel.
Q: If I cancel, will I get my money back?
A: Probably not. The normal cancellation conditions will apply, ie the same as if you cancelled for your own reasons. If it's a long way before your departure, you may lose the deposit; close to departure and you may lose it all.
Sars: The pandemic that never was
Severe Acute Respiratory Syndrome, or Sars, was the bird flu of 2003. Scientists cited it as the 'long overdue pandemic' which would sweep across the world.
The disease took hold in November 2002 in the Chinese province of Guangdong, but the Chinese government covered it up until February 2003, by which time 305 of its citizens had been infected and it was on its way around the world. By April, Sars was perceived to be a major international health risk and had spread to 20 countries, infecting 3,400 people.
The lack of a cure and the fact that Sars is transmitted easily through coughing or sneezing caused panic. Tourism and the air industry suffered and at the scare's height almost half of Cathay Pacific's fleet was grounded.
But while fear spread, scientists indicated that Sars might have been blown out of proportion. Governments' efforts to quarantine people displaying symptoms paid off, and by June 2003 the disease was under control. After Sars had infected 8,459 worldwide and killed 805, the World Health Organisation declared the threat over.

The Observer Travel Bird flu and travel: the facts

News - Blood of bird flu victims to create vaccine

HEALTH officials have drawn up a radical plan to create a "makeshift vaccine" from the blood of bird flu survivors if Britain is hit by a pandemic.
The scheme is being examined as a vital back-up to the government stockpiles of the anti-viral drug Tamiflu amid fears the flu virus may develop resistance to the drug.
It will also buy the public time while scientists work to create a full vaccine against the flu virus, which is expected to take more than six months after a pandemic strain first emerges.
Details of the proposals emerged following reports that the bird flu virus ravaging Turkey is showing signs of mutation.
Health experts fear that, if the bird flu virus mutates and combines with a human flu virus, it could form a new strain that would spread uncontrollably from person to person around the world and cause up to 50,000 deaths in Scotland.
Under the new plans, patients who survive the infection will be asked to donate blood from which antibodies against the flu virus can be harvested, purified and pooled.
The resulting serum would then be injected into key workers and members of the public to help give them short-term protection from the virus until they could be given a proper vaccine.
Doctors also hope they will be able to use the jabs, known as passive immunisation, to treat patients suffering from the early stages of the disease.
The scheme is outlined in a report on the government's influenza pandemic contingency plans by the House of Lords Science and Technology Committee.
Ministers at the Department of Health are now examining the report before it goes before MPs at Westminster.
Scotland on Sunday can reveal the Department of Health is already looking at ways to introduce emergency powers in the event of a pandemic outbreak that will overturn strict rules governing the use of blood products.
Pooling blood serum and injecting it into patients is currently banned under regulations designed to protect the public from variant Creutzfeldt-Jakob Disease.
But officials are carrying out risk assessments of the potential dangers of vCJD versus the potential life-saving benefits of passive immunisation.
A spokeswoman for the Department of Health said: "The department is aware of the issue and we are looking to see if there is some way of overcoming the CJD regulations.
"There has been no decision made yet, but the report is being considered by the department before it goes before parliament."
The UK is stockpiling 14.9 million courses of the anti-viral drug Tamiflu, enough to offer protection to more than a quarter of the population.
Frontline health workers, police and relatives of flu patients would also be among the first to be given the drug.
But last month doctors in Asia warned that the virus was beginning to show signs of resistance.
In the UK, medics have now called for the government to use passive immunisation to supplement the Tamiflu stocks.
The technique is far faster than that needed to produce a full vaccine, taking weeks rather than months, as it essentially borrows immunity from a patient who has already survived an infection.
Antibodies from survivors from outside of the UK would also be imported under the plans being considered as initial survivors of the virus are likely to be from the country where the pandemic strain first appeared.
Once survivors in the UK begin to emerge, the Blood Transfusion Service will be asked to collect, purify and compile serum. Experts believe one pint of blood from a survivor could confer temporary immunity to several other patients.
Last night health officials in Scotland said the measure would be a useful tool to fight a flu pandemic should it hit this country.
Dr Jim McMenamin, from Health Protection Scotland, said: "It could particularly be used by the NHS as a therapy to stop people acquiring an infection, but it could also be used to treat patients who are already suffering from the early stages of infection.
"But it is difficult to say exactly how effective passive immunisation would be until we know how many people we can harvest blood from."
Professor Ian Jones, director of molecular virology at Reading University, said: "In the early stages of an epidemic, the number of people at risk will far outweigh the number of individuals infected.
"Passive immunisation is certainly worth considering, though, as it would provide some later protection."
Fears that a flu pandemic strain will soon emerge have been fuelled in recent weeks by the rapid spread of the H5N1 strain of bird flu in Turkey.
Three children from one family have already died of the lethal animal virus, which is caught by humans from close contact with poultry, and another 15 people have been infected in the country.
Officials at the World Health Organisation have also confirmed that the global death toll from the virus has risen to 80, with more than 162 infected since 2003.

Scotland on Sunday - Top Stories - Blood of bird flu victims to create vaccine

News - Bird Flu: Death in the air

This is how the nightmare begins: a child plays with chickens in her yard and catches bird flu. She already has ordinary flu. The two mix inside her body, combining to produce a new virus that passes easily from human to human. It spreads fast. No existing vaccine is effective. Before long, millions of people are dead.

This is not a scare story. It is the scenario that three research scientists at a locked and sealed laboratory in north London expect to meet every day they go to work. Their high-security lab, hidden away in the unsuspecting suburb of Mill Hill, is suddenly on the front line of the global fight against bird flu.

Yesterday they were placed on high alert as it seemed the nightmare was about to become real. A Russian journalist had got off a flight from an infected area in Turkey and had gone straight to hospital with flu-like symptoms.

He was put in isolation; blood tests were taken and Mill Hill prepared for samples to arrive. Panic began to rise all over Europe. But then the Belgian health minister announced to a packed press conference that the test results had made doctors "100 per cent sure" their patient did not have bird flu after all. Panic over. For now.

If (or when, as the scientists say) the virus does make the change that would enable it to cause a pandemic and kill up to 150 million people worldwide, the British scientists will probably be the first to spot it. The faster they can do so, the more lives will be saved.
"We do have a great responsibility here," says their boss, Sir John Skehel. "Flu research requires that you accept that."

Alan Douglas is one of the scientists, a 54-year-old research associate who last week became the first person to isolate and grow the strain that had killed three children in a village in Turkey. He and his colleagues at the World Influenza Centre worked flat out on their samples for days. They knew people were dying, but that their results would tell doctors which drugs to use against the virus.

They were also looking for evidence of the big change that the world dreads. Two days ago the World Health Organisation announced that the H5N1 virus found in the body of a 14-year-old boy from a village in Turkey had mutated. The protein spikes on its surface had changed and it was now more attracted to people than birds. This was not the nightmare scenario, insisted Sir John Skehel, but it was "one step along the way".

He is director of the National Institute for Medical Research at Mill Hill, which contains the World Influenza Centre on its 50-acre site. The centre is one of four labs that receive samples from new victims of bird flu - but as the others are in America, Japan and Australia, it is London that will test the European outbreaks first. Few outsiders ever see the lab, but last week The Independent on Sunday was given unprecedented access.

The head of the centre, Dr Alan Hay, cut short a holiday when he heard the news of an outbreak in the Van region of Turkey. The other scientists cancelled days off as samples from the dead boy and his sister were flown to London, a week ago last Thursday. They were driven to Mill Hill from the airport in a car with Turkish diplomatic plates. As it swept through red and white security barriers the passenger, a woman from the Ministry of Health in Turkey, may just have felt she had seen the institute before. The main block is a tall building with a presence unsettling enough to have been used as an asylum in Batman Begins.

The samples were driven down the hill overlooking the parklands and big houses of Totteridge - "where the millionaires live", as one member of staff on government wages puts it - to Containment Four, the laboratory with the highest level of security. From the outside, the lab looks like the boiler house on a 1960s polytechnic campus, with pipes and ducts sprouting from the walls. Only four people have permission to enter the laboratory: the security manager and three scientists.

Before starting work, Alan Douglas showered and left his clothes in a decontamination room, then dressed in royal blue overalls very like a surgeon would wear in an operating theatre, with a white laboratory coat. He unlocked the door and entered the laboratory, the air in which passes through a complicated series of filters, each sterilised with formaldehyde. This is to stop unwelcome particles from ruining experiments, but it is also to stop viruses with which the scientists work from escaping into the atmosphere.

The air pressure inside the building is lower than outside, so that if an accident happens air will be sucked inside rather than out. Black polythene is taped up at the windows to prevent sunlight from getting in. All waste leaving the lab is sterilised.

The Turkish samples came in plastic tubes, protected by bubble wrap, in a box containing carbon dioxide to keep them at the right temperature. One by one they were placed in an airtight chamber, then passed into a main cabinet. Mr Douglas and his colleagues work with their hands and arms thrust through a portal into gloves, or look into a microscope that extends out of the cabinet as a hood.
The best of the samples was a swab or slice from the lungs of Mehmet Kocyigit, a 14-year-old boy who had lived on a farm thousands of miles away in the village of Dogubayazit, in the mountains close to the border with Iran. He had died from the pneumonia-like symptoms of avian flu which have hospitalised 78 other people across Turkey. It is thought that Mehmet and his siblings had been playing with the severed heads of infected birds. His sisters Fatima and Hulya also died.

"I knew the boy offered our best chance of isolating and growing the virus," says Mr Douglas, who diluted the sample, and from part of it extracted the RNA, the genetic material that is the virus equivalent of DNA. This was then analysed.

The rest of the sample was shared out between dishes in which the virus might grow. Some contained chicken eggs, which are usually used for growing ordinary flu viruses; others contained tissue culture made from canine kidney cells.

"Four of us were working flat out," says Mr Douglas, 55, a research associate who was in the laboratory all last weekend. More people were being hospitalised in Turkey as he worked. "I came in on Sunday morning, checked the tissue culture under the microscope in the hood and took out fluids from all the eggs, and found out that the virus had grown."

He was thrilled. Nobody in Turkey had been able to grow, isolate and test the strain. Nobody else in the world had been asked to try. "On Monday morning I continued extracting, and I got the results that afternoon, then repeated the tests."

The World Health Organisation (WHO) let it be known that the virus had been isolated. American newspapers got hold of the story early and described Mill Hill as only one of the labs working on it. Mr Douglas and his colleagues were furious. "It was as if we were just another bunch of people working away in the background, but that's not true. We are the only ones in the world who have grown this virus. A lot of people are asking for it now, obviously. The Americans are going to be last on the list, I can tell you."

This is not merely a spat. The scientific world depends on patronage, which depends on kudos. The institute has been threatened with a move into central London and its workers do not want to go. They want the world to know about the work they are doing, and the Government to let them stay put. Another colleague shakes his head when asked about the Americans he perceives to be glory-grabbers: "Bastards," he sighs.

The World Influenza Centre used to spend most of its time tracking changes in human flu, but now it also has to keep pace with the avian virus that has so far infected 150 people and killed at least 78. People working with chickens in Hong Kong and South Korea were the first to die in the current outbreak, in 1997 and 2003. Since then there have been outbreaks and mass bird culls across South-east Asia. A South American parrot in a quarantine centre in Essex was said to have brought the virus to England in November, but the real carriers were 53 Taiwanese finches in the same compound. No humans were infected here.

Wild ducks can carry the virus without symptoms as they migrate, and give it to domestic poultry. British bird owners have been told to keep them away from lakes and waterways where the ducks might land during the migratory season. Once chickens are infected, humans can pick up the virus by touching the birds, their droppings or secretions, or inhaling faecal dust. Somebody with the virus might travel to another country before succumbing to the symptoms, as may have been the case with the suspected bird flu reported in Belgium yesterday. But so far humans cannot pass it to each other.

The tests at Mill Hill last week enabled the WHO to confirm that the anti-viral drugs Tamiflu and amantadine are effective against the Turkish strain. The British Government is one of many around the world stockpiling Tamiflu in case of an outbreak: the UK has four million doses now and expects to have another 10.6 million by the end of the year.

But the tests also showed that the H5N1 virus had changed in the boy's body. "Each virus contains eight RNA molecules carrying information for the proteins in the virus," says Sir John Skehel. "In one of the samples, one of the proteins had mutated in a way that would allow it to move from bird to human cells more effectively." That has been seen before, in Hong Kong in 2003 and Vietnam last year, but two more genetic changes will probably have to take place before the virus becomes infectious among humans, says Sir John.
In the meantime, the fewer people who become infected with avian flu now, the less likely one of them will be a host in which it mutates. "This is why all these chickens need to be killed," says Sir John. "It is not that they have done anything at all wrong; it is just that we cannot afford for them to infect large numbers of humans."

The leader of the World Influenza Centre, Dr Alan Hay, flew to Turkey last week to advise doctors and scientists there. "A flu pandemic really is inevitable," he said last year. "We don't know when it will arrive, but we are anticipating it."

There on a hill in north London, hidden in a lab that looks like a boiler house, his team will be ready to tell the world if the nightmare comes true.

THE HUMAN MIXING BOWL

How avian flu could mutate and cause a pandemic

1. WILD DUCKS

Migrating wildfowl may carry the H5N1 virus without symptoms as they fly thousands of miles to another continent

2. CHICKENS

Domestic poultry become infected with the virus if they have contact with the nasal secretions or faeces of migrating wildfowl

3. HUMANS

People working closely with chickens inhale faeces dust or touch secretions and droppings carrying the H5N1 virus

4. MUTATION

If avian flu infects a patient who also has human flu the body may act as a mixing bowl for the two. They will combine to form a new avian/human flu virus with a new genetic make-up. The protein spikes on its surface are a new shape, making the virus resistant to all known vaccines. The victim could travel to another country before succumbing to the symptoms

5. PERSON TO PERSON

The new virus may be so different that humans have little or no immunity. This would allow it to spread across the world very quickly, carried through the air like old-fashioned flu by droplets from coughs and sneezes. Experts say it could kill as many as 150 million people
1997 was when the current outbreak of avian flu first killed a human being

6 people died in Hong Kong that year and 18 were infected

72 more people have been killed by the virus since that time

158 have needed treatment in countries spreading from Thailand to Turkey

14.6m shots of the Tamiflu anti-viral drug ordered by the British government

150m people could die across the world if the virus mutates and causes a pandemic

This is how the nightmare begins: a child plays with chickens in her yard and catches bird flu. She already has ordinary flu. The two mix inside her body, combining to produce a new virus that passes easily from human to human. It spreads fast. No existing vaccine is effective. Before long, millions of people are dead.

This is not a scare story. It is the scenario that three research scientists at a locked and sealed laboratory in north London expect to meet every day they go to work. Their high-security lab, hidden away in the unsuspecting suburb of Mill Hill, is suddenly on the front line of the global fight against bird flu.

Yesterday they were placed on high alert as it seemed the nightmare was about to become real. A Russian journalist had got off a flight from an infected area in Turkey and had gone straight to hospital with flu-like symptoms.

He was put in isolation; blood tests were taken and Mill Hill prepared for samples to arrive. Panic began to rise all over Europe. But then the Belgian health minister announced to a packed press conference that the test results had made doctors "100 per cent sure" their patient did not have bird flu after all. Panic over. For now.

If (or when, as the scientists say) the virus does make the change that would enable it to cause a pandemic and kill up to 150 million people worldwide, the British scientists will probably be the first to spot it. The faster they can do so, the more lives will be saved.
"We do have a great responsibility here," says their boss, Sir John Skehel. "Flu research requires that you accept that."

Alan Douglas is one of the scientists, a 54-year-old research associate who last week became the first person to isolate and grow the strain that had killed three children in a village in Turkey. He and his colleagues at the World Influenza Centre worked flat out on their samples for days. They knew people were dying, but that their results would tell doctors which drugs to use against the virus.

They were also looking for evidence of the big change that the world dreads. Two days ago the World Health Organisation announced that the H5N1 virus found in the body of a 14-year-old boy from a village in Turkey had mutated. The protein spikes on its surface had changed and it was now more attracted to people than birds. This was not the nightmare scenario, insisted Sir John Skehel, but it was "one step along the way".

He is director of the National Institute for Medical Research at Mill Hill, which contains the World Influenza Centre on its 50-acre site. The centre is one of four labs that receive samples from new victims of bird flu - but as the others are in America, Japan and Australia, it is London that will test the European outbreaks first. Few outsiders ever see the lab, but last week The Independent on Sunday was given unprecedented access.

The head of the centre, Dr Alan Hay, cut short a holiday when he heard the news of an outbreak in the Van region of Turkey. The other scientists cancelled days off as samples from the dead boy and his sister were flown to London, a week ago last Thursday. They were driven to Mill Hill from the airport in a car with Turkish diplomatic plates. As it swept through red and white security barriers the passenger, a woman from the Ministry of Health in Turkey, may just have felt she had seen the institute before. The main block is a tall building with a presence unsettling enough to have been used as an asylum in Batman Begins.

The samples were driven down the hill overlooking the parklands and big houses of Totteridge - "where the millionaires live", as one member of staff on government wages puts it - to Containment Four, the laboratory with the highest level of security. From the outside, the lab looks like the boiler house on a 1960s polytechnic campus, with pipes and ducts sprouting from the walls. Only four people have permission to enter the laboratory: the security manager and three scientists.

Before starting work, Alan Douglas showered and left his clothes in a decontamination room, then dressed in royal blue overalls very like a surgeon would wear in an operating theatre, with a white laboratory coat. He unlocked the door and entered the laboratory, the air in which passes through a complicated series of filters, each sterilised with formaldehyde. This is to stop unwelcome particles from ruining experiments, but it is also to stop viruses with which the scientists work from escaping into the atmosphere.

The air pressure inside the building is lower than outside, so that if an accident happens air will be sucked inside rather than out. Black polythene is taped up at the windows to prevent sunlight from getting in. All waste leaving the lab is sterilised.

The Turkish samples came in plastic tubes, protected by bubble wrap, in a box containing carbon dioxide to keep them at the right temperature. One by one they were placed in an airtight chamber, then passed into a main cabinet. Mr Douglas and his colleagues work with their hands and arms thrust through a portal into gloves, or look into a microscope that extends out of the cabinet as a hood.
The best of the samples was a swab or slice from the lungs of Mehmet Kocyigit, a 14-year-old boy who had lived on a farm thousands of miles away in the village of Dogubayazit, in the mountains close to the border with Iran. He had died from the pneumonia-like symptoms of avian flu which have hospitalised 78 other people across Turkey. It is thought that Mehmet and his siblings had been playing with the severed heads of infected birds. His sisters Fatima and Hulya also died.

"I knew the boy offered our best chance of isolating and growing the virus," says Mr Douglas, who diluted the sample, and from part of it extracted the RNA, the genetic material that is the virus equivalent of DNA. This was then analysed.

The rest of the sample was shared out between dishes in which the virus might grow. Some contained chicken eggs, which are usually used for growing ordinary flu viruses; others contained tissue culture made from canine kidney cells.

"Four of us were working flat out," says Mr Douglas, 55, a research associate who was in the laboratory all last weekend. More people were being hospitalised in Turkey as he worked. "I came in on Sunday morning, checked the tissue culture under the microscope in the hood and took out fluids from all the eggs, and found out that the virus had grown."

He was thrilled. Nobody in Turkey had been able to grow, isolate and test the strain. Nobody else in the world had been asked to try. "On Monday morning I continued extracting, and I got the results that afternoon, then repeated the tests."

The World Health Organisation (WHO) let it be known that the virus had been isolated. American newspapers got hold of the story early and described Mill Hill as only one of the labs working on it. Mr Douglas and his colleagues were furious. "It was as if we were just another bunch of people working away in the background, but that's not true. We are the only ones in the world who have grown this virus. A lot of people are asking for it now, obviously. The Americans are going to be last on the list, I can tell you."

This is not merely a spat. The scientific world depends on patronage, which depends on kudos. The institute has been threatened with a move into central London and its workers do not want to go. They want the world to know about the work they are doing, and the Government to let them stay put. Another colleague shakes his head when asked about the Americans he perceives to be glory-grabbers: "Bastards," he sighs.

The World Influenza Centre used to spend most of its time tracking changes in human flu, but now it also has to keep pace with the avian virus that has so far infected 150 people and killed at least 78. People working with chickens in Hong Kong and South Korea were the first to die in the current outbreak, in 1997 and 2003. Since then there have been outbreaks and mass bird culls across South-east Asia. A South American parrot in a quarantine centre in Essex was said to have brought the virus to England in November, but the real carriers were 53 Taiwanese finches in the same compound. No humans were infected here.
Wild ducks can carry the virus without symptoms as they migrate, and give it to domestic poultry. British bird owners have been told to keep them away from lakes and waterways where the ducks might land during the migratory season. Once chickens are infected, humans can pick up the virus by touching the birds, their droppings or secretions, or inhaling faecal dust. Somebody with the virus might travel to another country before succumbing to the symptoms, as may have been the case with the suspected bird flu reported in Belgium yesterday. But so far humans cannot pass it to each other.
The tests at Mill Hill last week enabled the WHO to confirm that the anti-viral drugs Tamiflu and amantadine are effective against the Turkish strain. The British Government is one of many around the world stockpiling Tamiflu in case of an outbreak: the UK has four million doses now and expects to have another 10.6 million by the end of the year.
But the tests also showed that the H5N1 virus had changed in the boy's body. "Each virus contains eight RNA molecules carrying information for the proteins in the virus," says Sir John Skehel. "In one of the samples, one of the proteins had mutated in a way that would allow it to move from bird to human cells more effectively." That has been seen before, in Hong Kong in 2003 and Vietnam last year, but two more genetic changes will probably have to take place before the virus becomes infectious among humans, says Sir John.
In the meantime, the fewer people who become infected with avian flu now, the less likely one of them will be a host in which it mutates. "This is why all these chickens need to be killed," says Sir John. "It is not that they have done anything at all wrong; it is just that we cannot afford for them to infect large numbers of humans."
The leader of the World Influenza Centre, Dr Alan Hay, flew to Turkey last week to advise doctors and scientists there. "A flu pandemic really is inevitable," he said last year. "We don't know when it will arrive, but we are anticipating it."
There on a hill in north London, hidden in a lab that looks like a boiler house, his team will be ready to tell the world if the nightmare comes true.
THE HUMAN MIXING BOWL
How avian flu could mutate and cause a pandemic
1. WILD DUCKS
Migrating wildfowl may carry the H5N1 virus without symptoms as they fly thousands of miles to another continent
2. CHICKENS
Domestic poultry become infected with the virus if they have contact with the nasal secretions or faeces of migrating wildfowl
3. HUMANS
People working closely with chickens inhale faeces dust or touch secretions and droppings carrying the H5N1 virus
4. MUTATION
If avian flu infects a patient who also has human flu the body may act as a mixing bowl for the two. They will combine to form a new avian/human flu virus with a new genetic make-up. The protein spikes on its surface are a new shape, making the virus resistant to all known vaccines. The victim could travel to another country before succumbing to the symptoms
5. PERSON TO PERSON
The new virus may be so different that humans have little or no immunity. This would allow it to spread across the world very quickly, carried through the air like old-fashioned flu by droplets from coughs and sneezes. Experts say it could kill as many as 150 million people
1997 was when the current outbreak of avian flu first killed a human being
6 people died in Hong Kong that year and 18 were infected
72 more people have been killed by the virus since that time
158 have needed treatment in countries spreading from Thailand to Turkey
14.6m shots of the Tamiflu anti-viral drug ordered by the British government
150m people could die across the world if the virus mutates and causes a pandemic

Independent Online Edition > Science & Technology

News - Laos, Apparently Without Bird Flu, Is Still Pressed by the West to Join Global Fight - New York Times

Khamla Sengdavong, the manager of a state-owned farm here, still remembers his horror and dismay when bird flu suddenly killed a quarter of the farm's 2,000 chickens in five days in January 2004.

"They bled from the nose and the backs of their heads turned purple and then black, and then they died," he said, gesturing with his hands.

But bird flu seems to have disappeared almost as quickly as it appeared in Laos, and Mr. Khamla and others in this impoverished Communist country on China's southern border have restocked their coops.

Not one human case of bird flu was ever confirmed in Laos, and thousands of chickens have been tested in recent months without finding the slightest trace of the disease.

Despite the seeming disappearance of bird flu here, it has consumed most of the time and attention of Laos's best doctors and veterinarians for the past two years.

Pressed by United Nations agencies, the United States, the European Union and other big donors, top officials at the health and agriculture ministries have set aside previous priorities - deadly scourges like tetanus, rabies, swine fever and poultry cholera - to focus on a disease that could someday set off a global epidemic but poses less of an immediate threat here.

As the global effort to combat bird flu has increased, Laos and other poor countries have become the front lines, expected to manage extensive programs to battle bird flu despite struggling to marshal enough doctors and veterinarians against diseases even in the best of times.

Next week, those pressures will reach a new level when health ministers, leaders of United Nations agencies and top officials from the World Bank and other lending institutions gather in Beijing to raise as much as $1.5 billion to fight bird flu.

Almost nobody questions that a global campaign is needed to stop the disease: if the bird flu virus, A(H5N1), evolves to be able to pass easily from person to person in the next few years, it could kill enormous numbers of people. But health experts are starting to raise questions about the trade-offs involved in such a huge effort.

The danger, even some managers of bird flu programs are starting to say, is that donors focus so intently on a single disease that they unintentionally disrupt many other health programs. "We could overlook that people could quite literally be dying because of this," said Finn Reske-Nielsen, the top United Nations official in Laos.

In separate interviews, Mr. Reske-Nielsen and two of Laos's top disease fighters - Dr. Phengta Vongphrachanh, the country's foremost epidemiologist; and Dr. Somphanh Chanphengxay, the director of veterinary planning - said continued routine testing had not yet shown a resurgence here of other diseases despite the preoccupation with bird flu. But they and other officials in Laos and at aid agencies elsewhere said participants in the Beijing conference would face a series of hard choices.

Among the first of those trade-offs will be between short-term programs, useful mostly for fighting bird flu, and longer-term programs that may carry broader health benefits but do less to stamp out bird flu this winter or next winter.

The Asian Development Bank, a Manila-based multilateral lending institution like the World Bank, is one of the first organizations to start worrying about the bird flu trade-offs, partly because it has already had to make a hard choice.

Indu Bhushan, the leader of the bank's bird flu task force, said that after approving a $40 million preventive health program in Vietnam last year, the bank decided this winter to turn the effort into a bird flu project instead, saving time over having to design a program from scratch.

The redesigned project will still address other communicable diseases, like dengue fever, because it may improve detection. But it will no longer cover noncommunicable diseases like hypertension and diabetes, Mr. Bhushan said.

He noted that the Asian Development Bank was also preparing $68 million in new grants for bird flu that do not involve taking money from other programs. But he said it would be important at the Beijing conference that donors not redirect large sums previously approved for other programs.

"While emergency response is great, let's not get carried away here," he said.

The emerging debate over spending on bird flu closely parallels the debate in the 1990's over whether donor nations were paying so much attention to AIDS in the developing world that they were neglecting diseases like malaria and tuberculosis. That debate has helped lead to increased aid for research into tropical diseases, mostly from rich countries and the Bill and Melinda Gates Foundation.

Following that example, it is possible that bird flu may yet prompt broader and more strings-free aid to poor countries in areas like veterinary care. But for now, much of the money being offered to poor countries to fight bird flu involves loans, not grants.

And health officials in poor countries are leery of borrowing heavily; no country has yet tapped the Asian Development Bank's $300 million in loans available for bird flu programs.

Laos is one of the world's poorest countries, rivaling Chad in Central Africa in having one of the world's highest maternal death rates - problems related to pregnancy kill one mother for every 2,000 births, mainly in childbirth.

With the government able to spend less than $2 per person annually for health care, officials have been reluctant to take on debt.
"We try our best to utilize the grants first, and we reserve the loans for emergency response," Dr. Phengta said. That emergency response has not been needed.

Unlike in neighboring Vietnam, Thailand and China, where live poultry is often transported large distances to markets, sometimes on bicycles, most chickens and ducks in sparsely populated Laos are raised in backyards and eaten by their owners. That limits the spread of the disease, Dr. Somphanh said.

Turkey has captured international attention with 18 human cases, three of them fatal, in the past two weeks.

But Dr. Shigeru Omi, the World Health Organization's regional director for the Western Pacific, noted Thursday that Asia remains the center of the disease because contact between infected birds and humans is greatest in this region.

Laotian government officials reported to the W.H.O. within hours on a weekend last September the country's only suspected human case of bird flu so far. A lab in Japan determined it was a false alarm.

The quick notification was one of several signs that Laos does not appear to be concealing any bird flu cases, although it may be hard at times even for the government to determine what is happening in the one-third of Laotian villages that lie a day's walk or more from the nearest road of any sort, said Dr. Dean A. Shuey, the top World Health Organization official in Laos.

Dr. Shuey's aunt and grandmother died in the Spanish influenza outbreak of 1918, which scientists now attribute to another avian influenza virus. Despite that family history, Dr. Shuey of Nebraska says he worries that too much emphasis now on bird flu may create problems for Laos's health system.

"The intense donor meetings, the number of conferences, the travel is taking a lot of time for people who have other things to do," he said.
The United States, Japan and the European Union have donated advanced virus freezers and other high-tech gear to help Laotians gather any viral samples and ship them to labs in rich countries as fast as possible, where they can be analyzed for the possible creation of a vaccine.

But with flu vaccine production capacity short in industrialized countries, no one expects Laos, with no vaccine factories, to receive more than a few doses of any vaccine.

American aid has included hundreds of sets of masks, goggles and full-body suits that would be sweltering in the tropical climate here and that have limited use except for slaughtering sick birds.

Dr. Phengta called for general-purpose protective equipment. Health workers in Laos now receive only one gown and one surgical mask each year.

Laos, Apparently Without Bird Flu, Is Still Pressed by the West to Join Global Fight - New York Times

News - The Observer | World | Turkey to test thousands in bid to contain bird flu outbreak

Tens of thousands of men, women and children across Turkey may be tested for bird flu, to see whether they carry any symptoms or have developed antibodies to it, in a concerted attempt by international experts to stop the virus before it becomes fully contagious to people.

The World Health Organisation has asked Turkey for permission to send teams into infected villages to take blood samples, swab throats and interview families. They would like to start the work this week to prevent the disease spreading into new regions.

Dr Guenael Rodier, a communicable diseases expert at WHO, said experts need to gain more insight into how the deadly H5N1 strain is spreading and whether it is mutating, as they race to contain the virus in case it becomes easily transmissible from person to person. So far, health experts have focused on the 18 people in Turkey - including three children who died a week ago - who have confirmed H5N1 infection, and on others kept in hospital with flu-like symptoms. All are thought to have caught it after having close contact with chickens.
One of the 18 people known to be infected with the deadly strain, Gulsen Yesilirmak, was discharged from hospital yesterday after responding well to treatment. She had contracted the disease after throwing dead chickens out of a coop.

There was a bird flu scare in Belgium yesterday when a man, thought to be a journalist, fell ill with flu symptoms. The unidentified man was isolated in a hospital in Brussels after a visit earlier in the week to the Turkish province of Van, which has suffered three bird flu fatalities. But blood tests showed that he tested negative for the deadly H5N1 strain. British health officials stress that the level of risk to the UK remained the same, as there was still no evidence yet that the virus was easily transmissible to people.

Meanwhile, the countries surrounding Turkey - Iran, Georgia, Armenia, Iraq, Syria, Bulgaria and Greece - have been put on high alert by the WHO to keep vigilant for any early signs of infected birds.

Turkish officials are trying to organise the culling of thousands of birds in order to wipe out the disease, which has hit their farming industry badly. More than half a million birds have already been culled, but the disease appears to be rife in 13 of Turkey's 81 provinces, with a further 18 provinces thought to be affected. Millions of Turkish families keep chickens, and there is confusion over whether they will be allowed to do so following the outbreak of the disease.

The Observer World Turkey to test thousands in bid to contain bird flu outbreak

News - Common Sense and the Flu by Donald R. May - Jan 15, 2006

We are confronted daily with the specter of a global flu pandemic decimating civilization and killing a good portion of our fellow humans. How great is the danger, and other than finding a deserted island or becoming a hermit, what is a person to do?

Whether the next deadly pandemic will arise from the current H5N1 avian flu virus or from a seasonal human influenza virus, we have an unprecedented opportunity to prepare. Common sense prevention decreases the spread of flu and cold viruses. Changing our personal habits may significantly decrease our chances of becoming ill and can help to protect us when a pandemic occurs.

Flu and cold viruses are transmitted from contaminated objects and by breathing in aerosolized fluid droplets containing viruses. Frequent hand washing is recommended as our fingers are considered culprits in transmitting viruses. Contaminated food, utensils, and beverage containers are additional offenders.

The coarsening of our society with the related erosion of common sense and public manners has made us increasingly susceptible to infectious diseases. In years past, wait staff would not touch the rim of a glass or cup with their fingers or with the spout of a coffee pot or water pitcher. It would be grasped away from its rim, and beverages would be poured without touching the rim with the pouring spout.
Watch your servers. Almost invariably they will grasp a glass or cup at the rim whether they are serving or taking the item from you. When offering a refill, they will place the spout on your cup or glass rim and that of everyone they serve. You have effectively kissed everyone they are serving. If you are fortunate, they will not stick fingers in the beverage. Ask for a straw and carry a supply of wrapped straws with you to bypass this problem.

Refrain from picking your nose or teeth, biting nails, or rubbing eyes with your fingers. Wash your hands before touching food, your nose, eyes, or mouth, including teeth brushing and flossing. Use a hand brush to clean under your nails. Move food onto your fork with your knife and not with your fingers.

As people use restrooms to blow their noses and cough up accumulated secretions, restrooms are a higher risk environment. Watch how many people depart opening the door with unwashed hands. If you touch that door, you are effectively shaking hands with them. After washing your hands in a public restroom, use towels to shut off the water, dispense towels, and open doors. Carry paper towels, napkins, or tissues to use when towels are available.

Open doors and shake hands with your right hand and keep your left hand clean. Avoid eating with your fingers. Use forks or toothpicks for hors d’oeuvres.

Do not drink or eat from containers of others or share flatware. If you share food or beverages, serve portions into separate containers. Request Communion from individual glasses.

Cough and sneeze into tissues and flush them. In the event of an outbreak, wear a surgical mask in public places.
Avoid close contact with the ill and stay home when you are ill. Avoid restaurants where the employees touch foods with bare hands.
Talk with your physician about immunizations. Most people are benefited by a yearly flu immunization. You may also benefit from a pneumonia immunization.

The H5N1 avian flu virus thus far appears to have infected only humans who have direct contact with domestic birds. If there has been any human-to-human spread, it has not been sustained. It is possible that if a virus were to occur that could be transmitted among humans, it would not carry the virulence of H5N1. It is also possible that only the most severe human cases of avian flu are being recognized and that H5N1 is not as deadly as feared. As these are unknowns, it remains prudent to prepare for the worst.
Innovative vaccine and medication development is essential. At best, the billions spent in taxpayer and pharmaceutical company dollars will better prepare us for the next highly pathogenic viral pandemic. With current technology, it takes many months to prepare flu vaccines for the most likely viral strains. New technologies, achievable only with years of work and billions for scientific research, can greatly reduce the time it takes to produce vaccines.

Antivirals such as Tamiflu http://www.tamiflu.com/ are effective at shortening symptoms and saving lives with seasonal influenza and may be effective in treating avian flu. Ask your doctor which medications can benefit you. Avoid medications purchased on the Internet as fraudulent Tamiflu has already reached the US.

Purchase medications on which your life depends only at reputable US pharmacies.

If we want new vaccines and drugs to protect our lives from future diseases, we must pull the bureaucrats, politicians, and trial lawyers off the backs of scientists and the pharmaceutical industry. Reasonable and prudent oversight of vaccine and drug development and production and holding persons and companies financially and criminally liable for actual negligence and fraud is appropriate and necessary.

Vaccines and medications will have negative effects on some people, and medical science cannot totally prevent this. The public must understand that vaccines and medicines offer an increased chance of disease survival and taking them entails risk.

Common sense changes in our personal habits and those of society can help protect us against infections. Innovative vaccines and medications will protect us only if they are available.

Townhall.com :: Columns :: Common Sense and the Flu by Donald R. May - Jan 15, 2006

News - Bird Flu: Need we panic?

The confirmation this week that 16 people have tested positive for the H5N1 strain of Bird Flu, which is deadly to humans, has heightened fears that the virus is spreading west into Europe.

The country often seen as the meeting point of East and West, is now, it seems, the gateway into Europe for this dangerous strain of the avian flu.

The deaths of three children in Turkey have brought home the stark reality for many that Bird Flu isn't just a South East Asian phenomenon, but is on the cusp of entering the European Union.

Up to 1.7 million people from the UK visit Turkey each year. It has steadily grown to be an extremely popular tourist destination with the first direct flights to Turkey from Belfast starting in May.

Scientists have warned that the strain could cause a lethal pandemic if it develops into a form that can be spread from human-to-human, but many stress that the risk remains low.
Bird Flu was thought only to infect birds until the first human cases were seen in Hong Kong in 1997. Since then, according to the World Health Organisation, 77 people have died in countries mostly located in South Asia - until now.

So as the disease moves ever closer, how worried should we be and what can be done to ensure it doesn't become a pandemic?

A Bird Flu pandemic is a global threat, which ignores borders and requires a co-ordinated international response. Only this week the world's third-largest bank, the HSBC announced contingency plans to deal with an outbreak which, it fears, could leave up to half of its staff off work.

Given the trans-national nature of this disease we need member states in the European Union to work together to ensure that Avian Flu does not spread.

Back in October of last year Greece became the first EU country to confirm a case of Bird Flu and since then the European Commission has taken the issue very seriously. European Commission surveillance measures were stepped up significantly last October and in the past four months about 25,000 wild birds have been tested in the EU for the avian flu.

In addition the EU banned imports of live birds and poultry products, including feathers from Turkey and, from this week, imports of untreated bird feathers are also banned from countries bordering Turkey.

But the current patchwork of preparedness in the European Union would mean that an outbreak in an ill-equipped country could quickly spread and would be more likely to mature into a human-to-human strain of the disease.
What is clear is that in the coming weeks and months, the European Union must create its own stockpiles of anti-viral medicines so that outbreaks in less prepared countries can be contained without other member states relinquishing their own stockpiles.

This proposal seems to have been met with some sympathy by EU Health Commissioner Markos Kyprianou who announced that the issue is likely to be on the agenda when EU ministers next meet to discuss the Bird Flu threat.
Recently the European Parliament approved a new directive to prepare for a Bird Flu outbreak. It contains proposals to create logistical restrictions preventing an outbreak from spreading, but also an amendment from the European Parliament aimed at helping the poultry industry in the event of an outbreak. This amendment proposes the destruction of all infected meat, with co-financed compensation for affected farmers.

The European Commission's initial proposals were weak and would have permitted poultry infected with low-pathogen Bird Flu to be sold in British supermarkets.

Belfast Telegraph

News - Avian flu 'may be spread by humans' Sick mother and child could be victims of first transmission

Health authorities are studying whether the latest fatal outbreak of bird flu in Turkey has been spread by human-tohuman contact for the first time.The World Health Organisation is examining a mother and her child who were infected with the virus to determine whether a mutation of the H5N1 strain has occurred which could trigger a global pandemic.The 78 people who have died from bird flu to date are thought to have caught the disease from direct contact with infected poultry. However, Guenael Rodier, the WHO's head of communicable diseases and response, said yesterday questions had been raised by the latest outbreak. He said: "When you have a mother and a child, and both get sick, you don't know if they both were exposed to the chickens, or if the mother got sick because she was caring for the child. It leaves room for some question marks. We have not documented every transmission story."Preliminary tests have confirmed H5N1 in 18 Turks, including three children who died last week.The Medical Research Council in Britain announced on Thursday that the H5N1 virus detected in Turkey had mutated into a form that could bind more easily to human cells than those of birds. A similar mutation occurred during the flu outbreaks in Hong Kong in 2003 and Vietnam in 2005.However, there is no evidence that the virus has undergone the further changes needed before it can be transmitted between humans. The WHO stressed that, even if this was the case, the outbreak could still be contained and would not necessarily start a pandemic which could kill millions of people. Mr Rodier added: "The virus could spread like Sars and still be contained."In Britain, health authorities have begun stockpiling Tamif lu, the antiviral drug which has proved effective against the symptoms of bird f lu, but there has been criticism from microbiologists that not enough is being done to develop an effective vaccine.Despite reassurances by the Scottish Executive that a robust pandemic contingency plan has been in place since 1997, GPs appear not to have been informed of what measures are in place.Mary Church, joint chair of the British Medical Association's Scottish GP committee, said emergency measures were being drawn up by the chief medical officer, but doctors had not yet been informed of them.She said: "At the moment, the number of beds we have may not be sufficient to cope with the number of very ill people who may have to be treated. People who would normally be treated in hospital may have to be treated in the community. That would involve training non-medical staff."As reports of more deaths emerged from Turkey this week, British vets warned that measures should be taken to keep domestic birds away from lakes and waterways where they could come into contact with wild carriers of avian f lu.Bob McCracken, a former president of the British Veterinary Association, said the bird flu danger would be greatest during the wild duck migratory season.The WHO has asked Turkey's health ministry for permission to conduct more intensive screening and tests in areas where outbreaks have occurred.Patients seemed to be responding well to Tamiflu, Mr Rodier said.Some experts have expressed concern that H5N1 could become entrenched in Turkey, and that a permanent presence of the strain on the rim of Europe would pose a serious threat to the rest of the continent, as well as to Africa, since the country lies on a major migratory route for wild birds.Mr Rodier said he could not say whether H5N1 would become endemic to Turkey, but conceded: "We are expecting this constant threat for months to come."

Avian flu 'may be spread by humans' Sick mother and child could be victims of first transmission

News - Low risk of bird flu in NZ, says study - 14 Jan 2006 - Health & fitness

New Zealand faces a medium risk of bird flu spreading, but Britain could be hit hard, an international study finds. British risk consultant Maplecroft has ranked 161 countries on its overall risk for a pandemic, and while New Zealand's overall risk is low, the risk rises to medium for an inability to contain an outbreak. Britain was the only Western country considered at extreme risk from the flu. It was 25th overall, but first among those countries to which the human virus is likely to spread. Maplecroft attributed this to Britain's widespread urbanisation, high population density, and the large number of visitors to the country. Australia was assessed at low risk of not being able to control the disease, but faced a far higher risk of the virus reaching its shores and spreading. Maplecroft's map of the probable global impact of the pandemic comes as British scientists report the first signs that the avian flu virus H5N1 may be mutating into a form more infectious to humans, based on analysis of the two children who died of bird flu in eastern Turkey. Overall, New Zealand was rated 145th out of 161 countries, behind Australia at 158. The consultants base their rankings on World Health Organisation data, factoring in 32 variables such as tourist numbers, environmental conditions such as temperature, live animal trade, and the density of poultry, pigs and other livestock. Countries with reported human cases of bird flu, such as Turkey, Vietnam and China, were classed as being of high or extreme risk. National health spokesman Tony Ryall said people should not be too worried, but there was no room for complacency. He said there were still big gaps in the Government's planning, as shown by being rated behind Australia in the ability to contain a pandemic. Questions remained over how the sick would be treated at home, the supply of essential medicines such as insulin, and overall leadership. Mr Ryall said there was no one person or agency providing overall leadership. "We don't know whether this bird flu outbreak will cause a pandemic and come to New Zealand. But flu pandemics will occur again in future as in the past, so we must be prepared." The ministry's acting director of public health, Dr Ashley Bloomfield, said the report did not evaluate a country's actual preparedness, but indirect measures, such as per capita GDP and the number of doctors. He said New Zealand preparations were well-developed. The ministry's national pandemic plan was continually updated in line with World Health Organisation recommendations. A Herald-DigiPoll national survey found 55 per cent of New Zealanders believed a bird flu outbreak was either likely or highly likely to happen.

Low risk of bird flu in NZ, says study - 14 Jan 2006 - Health & fitness

News - Indonesia's confirmed bird flu deaths rise to 12

Hariadi Wibisono said the latest results from the laboratory, which is recognised by the World Health Organisation, showed the H5N1 virus had killed a 29-year-old Indonesian woman who died this week in a Jakarta hospital.
She had been in contact with dead chickens before falling ill, hospital officials have said.
"We are still waiting on the other pending result, that of the 39-year-old man," Wibisono told Reuters.
Local tests have shown that man also died of bird flu earlier this month.
WHO-recognised laboratories have now confirmed 12 deaths and five other cases in Indonesia where patients survived.
The H5N1 virus cannot pass easily between humans at the moment, but experts fear it could develop that ability and set off a global pandemic which might kill millions of people.
It has killed more than 70 people in Southeast Asia and China since 2003. Cases have also emerged in Turkey, the first human infections outside East Asia.

Reuters AlertNet - Indonesia's confirmed bird flu deaths rise to 12

News - Turkey's Bird-Flu Outbreaks Began 3 Weeks Before Initial Report

The current wave of lethal bird flu in Turkey that has infected at least 18 people began in mid November, more than three weeks before an initial report, the World Organization for Animal Health said.
Outbreaks of the H5N1 avian influenza virus affected birds as early as Nov. 21, Huseyin Sungur, a government veterinary official, said in a Jan. 12 report to the Paris-based organization. The report was posted on the organization's Web site yesterday. Turkey, in a statement on Dec. 27, said outbreaks began on Dec. 15 in Igdir province, bordering Iran.
The delay in reporting the outbreak highlights the need to improve early detection and reporting systems to help contain infections. Authorities are concerned outbreaks among birds create more opportunity for human infection and increase the risk of the virus changing into a form that is more contagious to people. Such a virus could touch off a pandemic similar to the one that killed as many as 50 million people in 1918.
At least 147 human cases of H5N1 have been confirmed in Vietnam, Thailand, Indonesia, China, Cambodia and Turkey, the United Nations health agency said on Jan. 10. Of those, 78 have died.
Turkey has reported 18 laboratory-confirmed avian flu cases, of which three, all from the same family, were fatal.
More than 11,400 poultry and wild birds have died in Turkey's current wave of the H5N1 virus, which may have started with three dead pigeons found near the village of Caglayan in the eastern province of Erzincan on Nov. 21.
Spreading Disease
The H5N1 virus was later reported to have caused outbreaks in the provinces of Agri, Sanli Urfa, Bitlis, Igdir, Erzum, Yozgat, Bursa, Van, Ankara and Istanbul, according to the government report.
More than 31,800 fowl have been destroyed in an attempt to stem the disease's spread, it said.
Turkey reported an initial H5N1 outbreak in its western region in October.
The report of outbreaks in Turkey comes as virologists worry the H5N1 strain there may be adapting to become more infectious to humans.
Samples from a patient who died in Turkey showed mutations where the virus binds to human cells, the World Health Organization said on Jan. 12. The changes indicate the virus may bind preferentially to human cell receptors more so than to avian cell receptors, the WHO said.

Bloomberg.com: Asia

News - Latest victim of deadly bird virus confirmed by WHO

The World Health Organization (WHO) is asking the Turkish government for permission to take blood samples from people living in areas where the deadly strain of the bird flu has shown up.
INDEPTH: Avian Flu
"We have some question marks. We may gather elements that show us how things are changing," said Gueneal Rodier, a communicable diseases expert at the WHO.
Rodier said the WHO wanted to determine how the virus is spreading and who is at risk. Blood tests would reveal whether people were carrying the virus and whether they had antibodies. Health authorities want to track the virus to see if it passes between humans.
The request comes as WHO confirmed Friday a 29-year-old Indonesian woman, who died this week, had become the 79th victim of the H5N1 strain of avian flu.
Turkish authorities are also testing the body of a four-year-old girl, who died Friday, for the deadly virus.
The European Union pledged $100 million US towards the fight against bird flu.
"A global threat needs a global response," said Markos Kyprianou, the EU's health and consumer protection commissioner. "The European Commission will play an important role in that respect."
The WHO recently confirmed an 11-year-old girl in Turkey died of H5N1 after the flu-related deaths of her 14-year-old brother and 15-year-old sister. It's believed all three children had been playing with dead chickens.
Including the three dead children, Turkey has reported a total of 18 cases of avian flu in humans.
FROM JAN. 12, 2006: Third Turkish avian flu death confirmed
Roche, maker of Tamiflu, the best known drug defence against the deadly strain, say they will donate more antiviral pills to the WHO for "rapid response" stockpiles.
Two children who tested positive for H5N1 were discharged from a hospital in eastern Turkey after being treated with Tamiflu.
Turkey has culled more than 450,000 birds in the past two weeks. Its neighbour, Iran, has also begun the process along its border with Turkey.
A top UN official said on Thursday the world needs to donate about $1.7 billion to fight the spread of avian flu and prevent a pandemic in humans.
The first international donors conference on avian flu is next week in Beijing.

CBC News: Latest victim of deadly bird virus confirmed by WHO

News - Bird flu: 'no need to panic'

British holidaymakers were this week urged to continue travelling to Turkey despite fresh outbreaks of bird flu across the country.
Francesco Frangialli, the secretary-general of the United Nations World Tourism Organisation, said it was early to talk about a crisis in tourism in Turkey, or any other country, but gave warning that holidaymakers must be prepared for the virus to spread.
"Despite more cases of bird flu among people being reported, no transmission between humans has been detected. No tourists have been affected, and we believe the current situation does not warrant any form of restriction or other discouragement to travel to any destination," said Mr Frangialli.
The H5N1 strain of bird flu was this week detected in north, east and central areas of Turkey. So far, two people have died and a further 13 are in hospital. In total, 147 people have caught bird flu, of which 78 have died, since the virus first emerged in South-East Asia in 2003 and spread to China, Russia and Europe.
Turkey has been growing in popularity with British holidaymakers. It lies outside the euro zone and is cheaper than many other Mediterranean destinations. In January, the peak booking period for summer holidays, travel companies had already been reporting a growth in sales for Turkey.
Nick Wrightman, the managing director of Tapestry Holidays, which specialises in Turkish holidays, said: "We have sold 36 per cent of our programme for 2005, which is better than last year. But front-page stories about bird flu don't help the situation and, if it drags on, the easiest thing is for people to book holidays to other destinations. But we hope they don't do that."
A spokeswoman for the Turkish Tourism Board urged holidaymakers not to turn their back on the country. "The areas where humans have been affected are in the far east of Turkey and about 1,000 miles away from the tourist resorts in the west," she said.
Professor Colin Blakemore, the head of the Medical Research Council, has advised holidaymakers not to visit affected areas in Turkey. More than 300,000 birds have been culled in Turkey, and Juan Labroth, the health officer at the United Nations Food and Agriculture Organisation, has said that bird flu could spread to other parts of Europe. The virus has already been detected in fowl in the Aegean port city of Izmir, and in other birds at the resort of Kusadasi, near the Greek island of Samos.
The Foreign Office said that there was no need for people to cancel their holidays to Turkey. In its travel advice, it states: "The risk [from bird flu] is believed to be very low, provided you avoid visiting live animal markets, poultry farms and other places where you may come into close contact with domestic, caged or wild birds."
A spokesman for the Association of British Travel Agents also advised travellers to Turkey to avoid street markets but added: "Eating birds is not a problem, because cooking kills the virus."
Am I safe visiting regions hit by bird flu? And what precautions can I take?By Richard Dawood
Is it safe to travel to Turkey?
Yes, without hesitation. Travellers are not at increased risk. Unless you're likely to come into close contact with domestic poultry, the situation has not changed.
Avian flu is an infection of birds. Despite the massive number of birds affected across Asia, only a tiny number of humans have been infected, and these only as a result of direct contact with infected birds. To date, no tourists have been infected. The situation is certainly no worse than that in China, Indonesia, or the other countries in which avian flu has been reported. The resorts of southern Turkey and Istanbul are a world away from the remote, rural communities where close contact between humans and domestic birds is the norm.
Is it inevitable that bird flu will spread to other European countries?
Yes. Avian flu is a disease of migrating birds. The reports from Turkey are depressing, but not unexpected. They give a clear indication that we must prepare for further spread. Much more should be done to contain it.
What is the likelihood of there being a flu pandemic?
High - at some point during the next few months or years. The longer the outbreak continues among birds, the greater the opportunity for the avian flu virus to mutate into a form that could spread easily among humans, causing severe illness. With no prior immunity to protect any human population, a global epidemic, or pandemic, could follow.
Flu pandemics occur perhaps three or four times each century and it is thought that one is now "overdue". Pandemics usually take us by surprise. This is the first time in history that humans have ever been in a position to prepare for one.
What precautions should travellers take?
For now, the main precautions for anyone travelling to a country where avian flu has been reported are to avoid contact with live poultry and wild birds, steer clear of poultry farms and markets, and avoid contact with raw or undercooked poultry products. In other words, for the vast majority of travellers, business as normal.
The UK's National Travel Health Network and Centre advises travellers to report any illness with fever, cough or breathing difficulty that occurs within 14 days of returning home.
Although the vaccine against ordinary winter flu may not protect against the avian variety, it certainly does protect against the illness most likely to be confused with it.
Airlines have the right to refuse to carry any passenger with a fever, and during the SARS outbreak in 2003, many sufferers from flu found themselves in quarantine. So my personal tip, for anyone wanting to travel during the rest of the winter, would be to get a flu jab - there are plenty still around.

Telegraph Travel Bird flu: 'no need to panic'

News - Turkey epicentre of war on avian flu

Three children are dead, and this snowbound mountain town high in eastern Turkey has suddenly become the new epicentre for international concern about a disease called avian flu.
"We are the experts now," says Dr. Ahmet Faik Oner, chief of pediatric hematology at the Hascanesu Hospital, a rambling complex of four-storey, rose-coloured blocks on Maras St. in downtown Van.
For the past fortnight, the 47-year-old, Turkish-trained medical specialist has been in charge of caring for most of the patients in these rugged highlands who have been stricken by a bird-borne disease.
Previously, the H5N1 strain of avian flu had passed from birds to humans only in China and in several parts of Southeast Asia, infecting more than 140 people since late 2003. Seventy-six of them have died.
Now the same virus has come to Turkey, presumably borne by wild birds that passed the deadly micro-organism to domestic fowl, which then infected humans — 18 of them so far.
"Most of the patients are children," says Oner. "We think they all had close contact with chickens."
Despite the global attention now focused on this mountainous region of eastern Turkey, and despite the avian flu cases being treated here, there is still no sign of the kind of communal alarm that seized Toronto during the 2003 SARS outbreak.
Among the throngs of pedestrians enjoying the winter sunshine on Cumhiriyet St. yesterday, nobody was wearing a surgical mask to guard against air-borne infection.
The main hospital here seems to be going about its business normally, with no shortage of visitors crowding through the steel gates at the dank, ill-lit entrance. But SARS was a disease that could be passed between humans, and that is not true — or not true yet — of this bird-borne virus now apparently winging its way westward from Asia toward Europe.
Currently, few people know more about the malady in its human form than does Oner, a slender, soft-spoken Turkish doctor.
Wearing a white lab coat over a dress shirt and a striped red tie, the physician perches on the edge of his chair in a downtown clinic and peers out through a pair of silver-framed eyeglasses, as he proceeds to outline the local dimensions of what many experts fear could soon become a global scourge.
So far at the hospital in Van, three youngsters are dead of avian flu; a child and a young adult have recovered from the disease and have gone home; three more infected children remain in hospital; two others are in intensive care and seem about to join the list of confirmed human cases.
Oner expects to know the official status of these last two in a couple of days, when the test results come back from a laboratory in Ankara, 1,200 kilometres to the west.
That makes eight confirmed cases so far — with two more on the cusp — representing nearly half of the 18 confirmed human infections that have turned up in Turkey in recent days.
So far, the only Turkish fatalities from the disease are the three children who died in the Van hospital early this month, all siblings from the mountain town of Dogubayazit, 185 kilometres to the northeast.
Health officials here stress that all human cases in this country to date have resulted from direct physical contact with dead or sickly domestic fowl.
But many fear that the virus may yet mutate into a form that could be passed directly between humans, producing a disease that could kill millions.
Here in this ramshackle but bustling town on the frigid shores of Lake Van, Oner is chiefly concerned with the fate of 32 patients at the hospital here, including 25 children and seven adults, who either are being treated for avian flu or are under observation for signs of the disease.
The sick are being treated with a combination of antibiotics, intravenous fluids, and Tamiflu, one of the few drugs that seems to be effective against the virus. Some patients also require cardiac-management medication.
With a population of about 450,000, Van is a bustling but less than beautiful modern city set beside a volcanic lake and surrounded by a stunning landscape of cathedral mountains and barren plateaus, all blanketed now in snow.
Previously, the city was probably best known abroad for a strange breed of felines called Van cats — fluffy white creatures each with one blue eye and one yellow. But notoriety has come now in the form of a lethal disease, one that may prove to be merely a harbinger of an even more deadly plague to come.
Turkish authorities are taking few chances and have ordered that all backyard poultry in the land be culled — an aggressive tactic that people here seem to be accepting with stoic resignation.

TheStar.com - Turkey epicentre of war on avian flu

News - Some hard truths about bird flu

The issues surrounding the possibility of a pandemic of the H5N1 strain of avian flu are extraordinarily complex, encompassing medicine, epidemiology, virology and even politics and ethics. Moreover, there is tremendous uncertainty about exactly when H5N1, which now primarily affects birds, might mutate into a form that is transmissible between humans, and how infectious and lethal it might be.
It is thus hardly surprising that commentaries about avian flu often miss the mark. A recent New York Times editorial, for example, decried the "me first" attitude of wealthy countries toward a possible H5N1 pandemic, because "[t]he best hope of stopping a pandemic, or at least buying time to respond, is to improve surveillance and health practices in East Africa and Asia, where one would probably begin."
To be sure, good surveillance is needed in order to obtain early warning that a strain of H5N1 flu transmissible between humans has been detected, so that nations around the world can rapidly initiate a variety of public health measures, including a program to produce large amounts of vaccine against that strain. But the massive undertaking required to "improve health practices in the poorest countries of the world" plays better on the editorial page than on the ground.
Intensive husbandry procedures that place billions of poultry and swine in close proximity to humans, combined with unsanitary conditions, poverty and grossly inadequate public health infrastructure of all kinds, make it unlikely that a pandemic can be prevented or contained at the source. It is noteworthy that China's chaotic effort to vaccinate 14 billion chickens has been compromised by counterfeit vaccines and the absence of protective gear for vaccination teams, which might actually spread disease by carrying fecal material on their shoes from one farm to another.
In theory, it is possible to contain a flu pandemic in its early stages by performing "ring prophylaxis" -- using anti-flu drugs and quarantine aggressively to isolate relatively small outbreaks of a human-to-human transmissible strain of H5N1.
According to Johns Hopkins University virologist Donald Burke, "it may be possible to identify a human outbreak at the earliest stage, while there are fewer than 100 cases, and deploy international resources -- such as a WHO stockpile of antiviral drugs -- to rapidly quench it. This tipping point strategy is highly cost-effective."
However, a strategy can be "cost-effective" only if it is feasible. Although ring prophylaxis might work in Minneapolis, Toronto, or Zurich, in the parts of the world where flu pandemics begin, the probability of success approaches zero. In places like Vietnam, Indonesia and China -- where the pandemic strain will likely originate -- expertise, coordination, discipline, and infrastructure are lacking.
The response in Turkey -- where as many as 50 possible cases have appeared in the eastern part of the country -- is instructive. Officials in that region warned the government on Dec. 16 of a surge in bird deaths, but it took 12 days for an investigation to begin. When a 14-year-old boy became Turkey's first avian flu mortality last week (soon followed by two siblings), a government spokesman criticized doctors for mentioning the disease because they were "damaging Turkey's reputation." This is ominously reminiscent of China's initial response to SARS in 2003.
For now, it seems that all of the human H5N1 infections have been contracted from contact with infected poultry. But the situation in Turkey is what the outbreak of a human to human pandemic could look like at its earliest stages: the rapid spread of confirmed cases (and deaths) from an initial site to nearby villages and cities. We would expect to see a large number of illnesses among both employees and patients in hospitals where the victims are treated, and soon someone [perhaps even a carrier who is not ill] would spread it to Ankara, Istanbul, Tbilisi, Damascus, Baghdad and beyond.
The anti-flu drugs Tamiflu and Relenza are extremely expensive and in short supply. History suggests that if we were to make these drugs available to poor countries for ring prophylaxis, they would often be administered improperly -- such as in sub-optimal doses -- in a way that would promote viral resistance and only intensify a pandemic. Or perhaps they would be sold on the black market to enrich corrupt government officials.
A politically incorrect but rational strategy would be for rich countries to devote resources to developing countries primarily for surveillance. They would obtain timely warning of the existence of an H5N1 strain that is transmissible from human to human, but would focus the vast majority of their funding on parallel, low and high-tech approaches -- vaccines, drugs and other public health measures -- that would primarily benefit themselves.
If the pandemic were to begin relatively soon -- say, within a year or two -- there would be little that could be done to attenuate significantly the first wave of infections. But, if we're ready to rush the pandemic strain into an emergency program to manufacture vaccine, we could possibly blunt the second wave.
A flu pandemic will require triage on many levels, including not only decisions about which patients are likely to benefit from scarce commodities such as drugs, vaccines and ventilators, but also broader public policy choices about how best -- among, literally, a world of possibilities -- to expend resources.
Henry Miller is a physician and fellow at the Hoover Institution and the Competitive Enterprise Institute. From 1979 to 1994, he was an official at the US Food and Drug Administration.

Taipei Times - archives

News - H5N1 mutated: now it can easier affect human cells - Russian News - REGNUM

A mutation has been registered at the bird flu strain in Turkey. Now it can easier affect human cells, than birds’ ones. This conclusion was the result of a research conducted by the World Health Organization and special British Council on Medical Research in Mill-Hill near London. They investigate two fatal cases caused by H5N1 strain.
The H5N1 strain that caused the death of one of the dead was mutated in receptor fixation system, says the statement of WHO and the British laboratory. The discovered mutations do not allow the bird flu infection spreading from one person to another, of what specialists are feared most.
Total number of dead persons because of bird flu in Turkey reached three persons, 18 are infected, informs RTR-Vesti.

H5N1 mutated: now it can easier affect human cells - Russian News - REGNUM

News - BirdLife says migratory birds highly unlikely to bring H5N1 into Finland

BirdLife Finland said in a statement Friday that the spring migration was "extremely unlikely" to introduce the deadly H5N1 strain of avian influenza into Finland.
BirdLife points out that no link between migratory birds and the spread of H5N1 has been identified.
Bird flu did not spread to Africa and India with the hundreds of millions of birds that migrated there in the autumn, the statement added.
"It appears that in many countries migratory birds have been turned into scapegoats while the real causes behind the spread of the disease can be trace back to human activity," Teemu Lehtiniemi, the head of conservation and research at BirdLife Finland said.

NewsRoom Finland

News - EU Pledges $100M in H5N1 Fight

Testing is underway to establish whether a young girl in the southeastern Turkish city of Diyarbakir succumbed to the H5N1 strain. The European Commission announced the funding ahead of next week's international donors' conference in China. "Next week we have a unique opportunity to work with our international partners ... at the forthcoming international pledging conference on avian and human influenza in Beijing," said EU External Relations Commissioner Benita Ferrero-Waldner. "The costs of tackling bird flu are indeed substantial, but I am convinced that it is better to spend now on controlling avian influenza at the source … than have to spend much more at a catastrophic event of a human pandemic," she said. She said the funding will be sued to support developing countries prevent the spread o the disease, particularly those in eastern Europe, northern Africa and the Middle East to strengthen their military and health services and reform some animal husbandry practices. Turkey will receive around four million euros (A$6.5m) in anti-bird flu funding, said Ms Ferrero-Waldner. The US on Friday said it would send a team of flu experts to Turkey to assess how to help battle bird flu. ""Our goal is to learn about the actual state of the influenza so that we can support efforts to fight avian influenza and stop it from spreading," said spokesman Sean McCormack in a statement. In Ankara, Agriculture Minister Mehdi Eker said Turkey would also receive US$35 million (A$46.5m) under a World Bank-sponsored program to improve its infrastructural and technical capacity in fighting the disease. "The project will be launched in the coming days once the bureaucratic procedures are completed," Mr Eker told reporters. Flu makes further inroads in Turkey The H5N1 virus has killed three children from the same family and infected 15 others, most of them children, since it resurfaced in a remote eastern town late last month, after a first outbreak among poultry in the northwest was successfully contained in October. The deaths are the first human casualties of H5N1 outside Southeast Asia and China, where it has killed nearly 80 people since 2003. The death on Friday of two-year-and-a-half-old Sahibe Yetistiren in Diyarbakir, the central city of the mainly Kurdish southeast, sparked fears of a fourth fatality, but doctors have played down the possibility. "She had a serious bacterial infection in the right lung," and not a viral one, said Eralp Arikan, head of the hospital's microbiology department, adding that the girl did not have a history of contact with birds. However samples from the girl have been sent to an Ankara laboratory for analysis, along with other samples from people suspected of having contracted the disease in Diyarbakir province, where avian influenza has already been detected among birds. Six H5N1 carriers are currently in hospital in Ankara. The World Health Organisation (WHO), which sent a team to Turkey to investigate the outbreak, said Friday that the virus found in one of the dead Turkish children showed a mutation into a form more easily transmissible from birds to humans. Experts say the infections in Turkey are the result of contact with sick animals and there is no evidence to suggest human-to-human transmission, which scientists fear may spark a deadly worldwide pandemic. "We don't have any information to suggest that this virus is more pathogenic or dangerous than other viruses," WHO spokesman Maria Cheng told AFP. The virus has been identified either in humans or winged animals in nearly a third of Turkey's 81 provinces, including the capital Ankara and the biggest city Istanbul, on the threshold of Europe. Turkey's western neighbor Greece said it had set up emergency response centres countrywide to meet the bird flu threat, while France has extended a ban on raising poultry outdoors to 58 of the country's 96 administrative regions. Indonesia's 12th death Meanwhile, the WHO confirmed Indonesia's 12th bird flu fatality. Tests at a Hong Kong laboratory confirmed Indonesian findings that a woman, 29, who died this week had the H5N1 strain. Officials said she had been in contact with her neighbour's dead chickens in her east Jakarta home. Indonesia is also waiting for results on whether a 39-year-old man who died earlier this month had the virus.

SBS - The World News

News - Turkey Braces for Long Battle On Bird Flu

Turkey on Thursday began adjusting to the prospect of being a long-term locale for bird flu outbreaks, as physicians confirmed a third death from the disease along with its presence in two more living people, bringing the national total to 18 cases within two weeks.
The latest fatality, Hulya Kocyigit, 11, was the sister of two youths who died last week in far eastern Turkey. The linkage of her death to the H5N1 virus was confirmed Thursday. Surviving victims are either in hospitals or have been released after treatment with antibiotics.
International health officials say Turkey is now a locale for endemic bird flu. The reach of the disease alarms health workers, who fear that at some point bird flu will be passed from human to human and not be limited to isolated cases of people contracting it after contact with infected birds.
"As the new cases of human infection with the H5N1 virus in Turkey show, the situation is worsening with each passing month and the threat of an influenza pandemic is continuing to grow every day," Shigeru Omi, western Pacific director for the World Health Organization, said at a meeting in Tokyo on early response to a possible pandemic.
In Indonesia, health officials confirmed the country's 12th bird flu fatality since 2004. The official death toll stands at 80 worldwide.
Meanwhile, the public health announcements and the painstaking slaughter of poultry that might carry the disease are becoming routine.
"We take the battle very seriously. It's ongoing," said Hehdi Eker, Turkey's health minister. He said most of the infected birds in the country had been found in people's back yards. Eker said children were most at risk because they play with the birds. "We call on parents to play a bigger role," he said.
So far, there are no plans for a mass vaccination of domestic birds or proposals to kill them all. Though Turkish health officials have culled more than 300,000 birds in numerous rural districts across the country, they have not taken the kind of measures that, for instance, South Korea did in 2003, when its government ordered the killing of more than 2 million chickens.
Not everyone who catches the disease dies, and some do not even exhibit symptoms. The cases of two Turkish boys in whom the virus was diagnosed, but who did not fall ill, are similar to others previously identified in Asia, including at least three in northern Vietnam last year. International health experts note that a similar case occurred in 1997 during a short-lived outbreak of the H5N1 virus in Hong Kong.
The experts said they would be worried if the Turkish cases signaled that healthy people were increasingly carrying the illness. That would mean the virus was adapting so that it could live longer in humans and thus spread further.

Turkey Braces for Long Battle On Bird Flu