Bird flu viruses diversifying, making vaccine target harder to pick: WHO

Bird flu viruses diversifying, making vaccine target harder to pick: WHO
19:23:04 EDT Aug 18, 2006
Canadian Press: HELEN BRANSWELL, The Canadian Press

(CP) - The World Health Organization urged influenza vaccine makers Friday to use newer strains of virus when making vaccine to protect against H5N1 avian flu, saying the evolution of the microbe has led to increased variety in circulating strains.

While the diversity creates challenges for vaccine manufacturers - and potentially additional costs for the governments paying them to make and test vaccine against H5N1 - it does not mean the worrisome virus has moved closer to being able to spark a human flu pandemic, a senior official of the World Health Organization said.

"I don't think it's possible to interpret these kinds of changes in terms of whether the virus is moving closer to developing greater transmissibility properties among people," said Dr. Keiji Fukuda, co-ordinator of the WHO's global influenza program.

"I think what it simply reflects is that influenza viruses have evolutionary pressures on them and they evolve. They change. And that's what we're seeing."

Experts who have studied numerous samples of the virus have suggested nothing in them points to the development of mutations that would increase H5N1's ability to infect people and spread among them.

But an infectious diseases expert at the University of Minnesota questioned whether the scientific community knows enough about how influenza viruses adapt to a human host to be sure it would recognize it if H5N1 were on that path.

"What does it mean for an influenza strain today to be more adapted towards human-to-human transmission?" Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy, wondered.

He said he was not suggesting the virus is becoming more transmissible, only that the patterns that would lead to that end aren't defined.

With the spread of the virus to many different countries, sublineages of H5N1have emerged, each with distinct genetic properties. It's been known for at least a year that the viruses break down roughly into two families or "clades."

Clade 1 viruses have circulated in Cambodia, Thailand and Vietnam and caused human infections in those countries during 2004 and 2005. Clade 2 viruses circulated in birds in China and Indonesia in 2003 and 2004 and have since spread westward through the Middle East, Russia, Europe and Africa.

It is the clade 2 viruses that have caused most of the human H5N1 cases that have occurred since last 2005. And it is with representative samples from these viral strains that the WHO is now recommending vaccine makers work.

The Geneva-based agency isn't recommending work on vaccines made with the earlier strain - a virus isolated in Vietnam in early 2004 - be abandoned. At least a dozen companies are working on vaccine based on that seed strain.

Fukuda said there is an upside to working with additional virus types. The more practice manufacterers have working with the virus, the better placed they will be to move quickly to make a vaccine should H5N1 become a pandemic strain.

"To be able to work with more than one strain of H5 vaccine just gives the manufacturers that much of a leg up in terms of the experience that they may need later on," he said.

Since the current outbreak of H5N1 flu erupted in late 2003, at least 239 people have been infected with it and 140 of them have died.


© The Canadian Press, 2006

New Weakness in Avian Flu Virus Found

New Weakness in Avian Flu Virus Found
08.16.06, 12:00 AM ET

WEDNESDAY, Aug. 16 (HealthDay News) -- British researchers have identified a feature of the avian flu virus that could be a target for new drugs.

"This points the way to the development, in the future, of other types of drugs," said Dr. Pascal James Imperato, distinguished service professor and chairman of the department of preventive medicine and community health at State University of New York Downstate Medical Center in New York City. "The results of the research do not nullify the effectiveness of current drugs, but simply show that there may be a possibility of developing new ones in the future."

Imperato was not involved in the research, which was published online Aug. 16 in Nature.

Any new drug development is not going to happen right away, however.

"Given the long time period that it takes in research and development of such drugs, and then FDA approval, I don't see that occurring probably for several years," Imperato added. "There's no immediate benefit."

On the other hand, once drugs are developed, they could be applied to other viruses as well.

Health officials across the globe have worried that the bird flu virus that has infected 238 people and killed 139 worldwide might mutate, possibly in tandem with a more common flu virus, unleashing a new type of flu virus that could prove even more deadly because people's immune systems would not be able to fend off the disease.

Different nations have been stockpiling the drugs oseltamivir (Tamiflu) and zanamivir (Relenza) should the current H5N1 bird flu mutate and become able to infect humans.

Both drugs inhibit the enzyme neuraminidase (the "N" in "H5N1"), found on the surface of the avian flu virus, but they only block the N2 and N9 versions.

"Those drugs were designed using the structure from one group of neuraminidases and, it turns out, genetically, there's another group," said John Skehel, senior author of the study and director of the National Institute of Medical Research in London. "The first group contains five neuraminidases, and the second group contains four."

"What we've done is determine the structure of three of those four, which hadn't been done before and, it turns out, they show some structural differences from the group that was used to develop Tamiflu and Relenza," he continued. "The major difference is the presence of a cavity next to the active site of the enzyme. In this group, the cavity is a constant feature."

This suggests that it may be possible to design or identify other compounds that would block neuraminidase activity.

"Relenza and Tamiflu work, so the idea is that this difference in structure might be used to develop new drugs which would block the neuraminidase just in this group," Skehel explained. "It may also well be that they block activity in both groups."

And it may block activity in viruses as well.

Skehel's group is currently working with pharmaceutical interests to find or develop new drugs. It's possible that new drugs might work in tandem with Tamiflu and Relenza to overcome resistance to those agents. "It would be a combination therapy like you have in HIV," Skehel explained.

Few would deny the need for new weapons against avian flu, but a human pandemic may not loom quite as large as it once appeared.

When government researchers recently tried to combine the deadly H5N1 strain of bird flu with a common strain of flu that infects humans, they were unable to produce a strain that could be transmitted easily. This indicates that the road to easily transmissible bird flu is more complicated than once thought.

Also, Bloomberg News recently reported that two Michigan swans infected with bird flu don't have the lethal form spreading elsewhere.

More information

Visit the U.S. Centers for Disease Control and Prevention for more on bird flu.

Bird flu vaccination can ‘worsen spread’

Bird flu vaccination can ‘worsen spread’
JAMES MORGAN

August 17 2006
Vaccinating poultry flocks against bird flu could make the spread of deadly strains such as H5N1 worse, Scottish scientists have found.

An Edinburgh University study concluded that, even though the available vaccines are effective on individual birds, the disease is likely to spread unless more than 95% of a flock has been protected.

The paper, published in the journal Nature, is the first to quantify how incomplete vaccination of flocks can contribute to the undetected spread of the disease.
In Vietnam, where 42 people have died of bird flu, mass vaccination of poultry has been successful in checking the spread of H5N1.

The Netherlands has already started unrolling a vaccination programme even though it has not yet been hit by H5N1.

But despite the Cellardyke swan, the UK authorities have ruled out a vaccination programme, on the grounds that it would disguise the spread of a much larger outbreak of H5N1.

"Silent spread" occurs because immunised birds can still catch and pass on avian flu, but without presenting any symptoms.

Therefore, as protection levels rise in a vaccinated flock, it becomes ever harder to detect the spread of avian flu, simply because fewer birds die. The result is increasing amounts of bird flu virus contaminating the birds' surroundings without farmers realising it.

The UK government's fears appear to be borne out by the new study, led by Dr Nick Savill, of the university's centre for infectious diseases.

Using computer modelling, Dr Savill found that, in practice, it is very hard to protect more than about of 90% of the birds in any given flock, and protection levels are usually much lower.

New Bird Flu Drugs Possible, Study Says

ABC News
New Bird Flu Drugs Possible, Study Says
New Bird Flu Drugs Possible, Study Using Advanced X-Ray Technology Discovers
By MARIA CHENG
The Associated Press

LONDON - Advanced X-ray technology has helped scientists spot a new target that drug designers might use to attack the dreaded bird flu virus.

Though a new drug would still be years off, the new research being published Thursday offers hope of a fresh way to fight a disease that health experts fear could one day evolve into a deadly human flu pandemic.

"This gives us a new target that we didn't know we had before," said Dr. Michael Perdue, a flu expert at the World Health Organization, who had no role in the study.

Researchers used advanced X-ray technology to provide an "atomic picture" of the atoms and molecules that comprise one of the two surface proteins in the H5N1 virus.

Neuraminidase the "N" in H5N1 is the protein in bird flu that allows the virus to spread to other cells in the body. Drugs currently used to treat bird flu are based on other neuraminidase models that are not specific to H5N1.

By identifying H5N1's unique blueprint, researchers may one day be able to use drugs that home in on the strain that has killed 139 people in the past three years.

New drugs targeting H5N1 could potentially be used in combination with the current leading bird flu medication Tamiflu to reduce the risk of the virus mutating into a resistant form, said John Skehel, lead author of the paper appearing in the journal Nature.

Drug combinations can reduce the risk of a virus becoming resistant to one drug, a lesson learned in the fight against AIDS, noted Skehel, director of the National Institute for Medical Research in London.

Research into new flu drugs has traditionally focused on the neuraminidase protein because flu's other surface protein hemagglutinin, the "H" in H5N1 has proven harder to attack.

To date, Tamiflu, which was developed to treat human flu, is the only drug shown in lab studies to be somewhat effective against H5N1. However, there have been isolated instances of strains resistant to Tamiflu.

Experts agree on the importance of having more drugs in the arsenal to fight bird flu.

"Right now, our options are really quite limited," said Dr. Fred Hayden, an antivirals and influenza expert at the WHO. "We're really down to Tamiflu and Relenza, so there is a need for an alternative."

Though the timeline for producing a new drug usually takes between three to five years, it could potentially be shortened as countries accelerate their pandemic preparedness plans.

"Since drug companies have already attacked neuraminidase before, they should already have a lot of information on how to build compounds that would work in attacking it," said Perdue, who cautioned that the process of conducting clinical trials in humans could still take years.

Copyright 2006 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

Copyright © 2006 ABC News Internet Ventures

AVIAN INFLUENZA Low Pathogenic H5N1 vs. Highly Pathogenic H5N1

Release No. 0296.06
Contact:
USDA Press Office (202) 720-4623

AVIAN INFLUENZA Low Pathogenic H5N1 vs. Highly Pathogenic H5N1
Latest UPDATE August 17, 2006

There are two types of avian influenza (AI) that are identified as H5N1. A difference exists in the virus classification; one is low pathogenic (LPAI) and the other is highly pathogenic (HPAI). Pathogenicity refers to the ability of the virus to produce disease.

HPAI H5N1, often referred to as the "Asian" H5N1, is the type causing worldwide concern. LPAI H5N1, often referred to as the "North American" H5N1, is of less concern. Following is an explanation of the differences between them.

LPAI H5N1 ("North American" H5N1)

LPAI, or "low path" AI, commonly occurs in wild birds. In most cases, it causes minor sickness or no noticeable signs of disease. It is rarely fatal in birds. LPAI strains are not a human health concern. This includes LPAI H5N1.

Evidence of LPAI H5N1 has been found in wild birds in the United States in recent years and is not closely related to the more severe HPAI H5N1 circulating overseas. Examples of historical reports of LPAI H5N1 received by USDA include:

1975 – LPAI H5N1 was detected in a wild mallard duck and a wild blue goose in Wisconsin as part of routine sampling, not as a result of noticeable illness in the birds

1981 and 1985 – the University of Minnesota conducted a sampling procedure in which sentinel ducks were monitored in cages placed in the wild for a short period of time and LPAI H5N1 was detected in those ducks in both years.

1983 – LPAI H5N1 was detected in ring-billed gulls in Pennsylvania.

1986 - LPAI H5N1 was detected in a wild mallard duck in Ohio as part of routine sampling, not as a result of noticeable illness in the birds.

2002 – LPAI H5N1 antibodies were detected in turkeys in Michigan but the virus could not be isolated; therefore this detection could not be confirmed.

2005 LPAI H5N1 was detected in ducks in Manitoba, Canada.

In the past, there was no requirement for reporting or tracking LPAI H5 or H7 detections in wild birds so states and universities tested wild bird samples independently of USDA. Because of this, the above list of previous detections might not be all inclusive of past LPAI H5N1 detections. However, the World Organization for Animal Health (OIE) recently changed its requirement of reporting detections of avian influenza. Effective in 2006, all confirmed LPAI H5 and H7 AI subtypes must be reported to the OIE because of their potential to mutate into highly pathogenic strains. Therefore, USDA now tracks these detections in wild birds, backyard flocks, commercial flocks and live bird markets.

HPAI H5N1 ("Asian" H5N1)

HPAI, or "high path" AI, spreads rapidly and is often fatal to chickens and turkeys. This includes HPAI H5N1. Millions of birds have died in countries where HPAI H5N1 has been detected. This virus has also infected people, most of whom have had direct contact with infected birds.

HPAI H5N1 has not been detected in the United States. However, other strains of HPAI have been detected and eradicated three times in the United States: in 1924, 1983 and 2004. No significant human illness resulted from these outbreaks.

The 1924 HPAI H7 outbreak was contained and eradicated in East Coast live bird markets.

The 1983-84 HPAI H5N2 outbreak resulted in humanely euthanizing approximately 17 million chickens, turkeys and guinea fowl in Pennsylvania and Virginia to contain and eradicate the disease.

In 2004, USDA confirmed an HPAI H5N2 outbreak in chickens in Texas. The disease was quickly eradicated thanks to close coordination and cooperation between USDA and State, local, and industry leaders.

TERMINOLOGY

Avian influenza (AI)--the bird flu--is a virus that infects wild birds (such as ducks, gulls, and shorebirds) and domestic poultry (such as chickens, turkeys, ducks, and geese). There is flu for birds just as there is for humans and, as with people, some forms of the flu in birds are worse than others.

AI viruses are classified by a combination of two groups of proteins: the hemagglutinin or H proteins, of which there are 16 (H1-H16), and neuraminidase or N proteins, of which there are 9 (N1-N9).

Pathogenicity: the ability of the virus to produce disease. AI strains also are divided into two groups based upon the ability of the virus to produce disease: low pathogenic (LP) and highly pathogenic (HP).

Low Pathogenic or "low path" avian influenza (LPAI): LPAI occurs naturally in wild birds and can spread to domestic birds. In most cases it causes no signs of infection or only minor symptoms in birds. These strains of the disease pose little significant threat to human health. These strains are common in the U.S. and around the world.

Highly Pathogenic or "high path" avian influenza (HPAI): HPAI is often fatal in chickens and turkeys. HPAI spreads rapidly and has a high death rate in birds than LPAI. HPAI has been detected and eradicated three times in U.S. domestic poultry. HPAI H5N1 is the subtype rapidly spreading in some parts of the world.

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Out of obscurity step our best hope for bird-flu vaccine

Out of obscurity step our best hope for bird-flu vaccine
Sunday, August 13, 2006
BY KITTA MacPHERSON AND ED SILVERMAN
Star-Ledger Staff

For years, the world's vaccine companies have labored in the shadows of the pharmaceutical industry, vilified by parent groups who claim childhood vaccines can cause neurological disorders like autism.

Now, almost overnight, these same companies have been thrust to the forefront of a massive campaign to produce a vaccine against pandemic flu. Not since Jonas Salk's work to find a cure for polio in the 1950s have vaccine scientists been so squarely in the vanguard of medicine.

The challenges are vast. The unanswered questions surrounding the influenza virus are profoundly difficult, the process for producing vaccines is slow and unwieldy, and the infrastructure needed to make major advances quickly has suffered from decades of neglect.

"I can't emphasize enough how daunting the task is to go about creating the industrial infrastructure to make hundreds of millions of doses in periods of months using technology that is on the drawing board," said Bruce Innis, vice president of clinical research and development for GlaxoSmithKline Biologicals in North Carolina.

But with avian flu spreading through flocks in Asia, Europe and Africa, raising the specter of a global pandemic, it's no longer a matter of choice.

The race is on.

INSUFFICIENT STOCKPILES
The influenza virus is one of nature's most talented chameleons. Its genetic matter allows for a constant reshuffling of genes.

This process, known as antigenic drift, alters the shape of its surface proteins in a way that can fool antibodies generated by the body to seek and destroy older versions of the flu virus.

Flu also is what scientists describe as a "superspreader." Its animal and human carriers are highly infectious before they even realize they are ill.

The bird flu virus known as H5N1 is a particularly lethal variant. Beyond wiping out millions of chickens and other birds, the virus has killed more than 130 people around the globe. Humans have no natural immunity.

The pathogen has not yet mutated to allow easy transmission between people, but government and industry scientists agree that society's defense system against such a threat is inadequate.

For starters, there is no surefire vaccine against the H5N1 virus. Even if there were, the ability to produce it quickly on a large scale is limited.

Officials at the federal Centers for Disease Control and Prevention have stockpiled new batches of H5N1 vaccine in an undisclosed location for safekeeping. But there is evidence the bird flu virus in circulation has mutated enough so that the vaccine supply may no longer provide protection, according to many scientists.

"We need a better vaccine -- clearly, one that works against multiple strains," said Anthony Fauci, director of the National Institute of Allergy and Infectious Disease. The agency, lead actor in the federal government's vaccine effort, funds research into bioterrorism countermeasures and treatments for diseases such as flu, AIDS and immune disorders.

The existing vaccine stockpile is also much too small to protect the general population. Of the 4 million doses available, one-third would be given to the military and the rest would be severely rationed.

"No matter how you slice that one, we don't have a large enough stockpile," Fauci said.

Traditionally, flu vaccines are grown in millions of fertilized chicken eggs, a process that can take six to nine months. Such a lengthy production cycle gets in the way of responding quickly to mutating flu strains.

Science and technology are not the only factors that have held back the field.

For many years, the inventions produced by vaccine companies were not viewed by the pharmaceutical industry as life-saving instruments, but as unprofitable commodities. Unlike treatments for chronic illnesses, which can reap billions for drug companies, vaccines could block an illness with a single shot.

Industry mergers and corporate decisions to leave the business because of low profits ended up reducing the size of the specialized, century-old field. Controversies, such as concerns over side effects and additives such as thimerosal -- which is at the center of the debate over childhood autism -- pushed the industry further to the margins.

Now, nearly overnight, the ground has shifted.

A BOOM IN THE MAKING
The global vaccine business is surging, according to a report by Richard Bernstein, chief investment strategist at Merrill Lynch. He forecasts double-digit growth rates over the next decade.

There are several reasons: New research techniques have created fresh opportunities for manufacturers; the demand for protection against bioterrorism has increased; developing nations have sought to raise immunization rates; and there has been a new emphasis on vaccines to treat, not just prevent, disease.

But clearly the biggest factor has been the avian flu outbreak.

The U.S. National Institutes of Health is pouring tens of millions of dollars into basic research on flu vaccines in both private industry -- mainly biotechs -- and academia. The effort has not been dampened by a report issued earlier this month by federal scientists that found it would not be so easy for the virus, genetically speaking, to mutate and spread among humans.

That report "provides meaningful information," said José Galarza, a vaccine scientist at TechnoVax Inc. in Tarrytown, N.Y. But scientists can't rule out the possibility that the right mutation could produce a true pandemic form, he said, and it's "necessary that we maintain surveillance."

The NIH's parent agency, the Department of Health and Human Services, is funneling more than $1 billion to major drug firms such as Novartis, GlaxoSmithKline and Sanofi-Aventis to enhance manufacturing capacity, support new construction and speed the conversion from egg-based vaccine creation to a process known as rapid cell-culture. This technique allows for the proliferation of animal cells infected with flu virus, nimbly producing the key content of vaccines.

Developing new kinds of weapons against pandemic flu requires massive investment and a sturdy infrastructure -- acres of property, huge plants and highly trained personnel.

Faced with this task of creating this arsenal, scientists, engineers and production experts are under unprecedented pressure to reinvent and scale up their most basic manufacturing processes -- and to stretch their thinking beyond available technologies.

There have been some promising developments already:

Breakthroughs in fundamental genetic science. The flu has been well-studied, from X-ray images of the virus in crystalline form to wholesale genetic sequencing. Such techniques have revealed secrets such as the virus' detailed surface structure and chemical patterns responsible for many of its key features. "We now have better technologies to make better vaccines both for the regular influenza vaccine and also against pandemics," said Peter Palese, a pioneering vaccine researcher at the Mount Sinai School of Medicine in New York.

"Broad" vaccines: An inoculation that provides a degree of immunity to a range of flu viruses is being developed by several biotech companies, including Novavax of Malvern, Pa.; Vical in San Diego; Protein Sciences in Meriden, Conn.; and PowderMed in Oxford, England. And some scientists even hold out hope for a "universal vaccine," a drug that in theory could protect a person against almost any pathogen it recognizes. Though years away, such a product is scientifically feasible, according to experts like Gary Nabel, director of vaccine research for the National Institute of Allergy and Infectious Diseases.

Improved boosters: Molecules known as adjuvants, which normally boost the body's immune response when added to a vaccine mix, are showing some promise in protecting humans against different versions of the flu virus. Glaxo last month reported its adjuvant-enhanced pandemic flu vaccine is more effective than any other vaccine to date.

Revitalized cell-culture technology: Scientists are taking a technique already used to produce other kinds of vaccines and tweaking it. Using cells taken from monkey or dog organs and growing them in lab dishes, scientists are infecting them with bird flu virus and growing those in huge vats laced with growth media. All the major pharma companies are experimenting with the technique.

Enlarged capacity: Sanofi is building a new cell-culture plant at its Swiftwater, Pa., facility; Novartis also is expanding, building a new facility in Europe and another one in Holly Springs, N.C.; and Glaxo will be tripling the capacity of its Quebec vaccine plant and doubling that of a European factory. With more capacity and a faster manufacturing process, these companies are hoping to dramatically improve their ability to respond to a pandemic.

ON A MISSION
Some industry analysts speculate that big pharma and smaller biotech firms eventually may form strategic alliances for vaccine discovery and invention to capitalize on collective strengths.

"They could become knights in shining armor," said Mark Ravera, an industry analyst with Strategic Pharma in Chatham. "Because, if bird flu shows up, the general public would probably be grateful these companies had the foresight and made the investment to fight this disease."

Those who have stayed with the science are feeling a sense of mission. "I feel honored to be part of this effort and I'm excited that I can do something important," said Norbert Klein, a vaccine manufacturing executive with Novartis in Marburg, Germany. "What we are coming up with is a much more robust technology. It has very distinct advantages for future developments."

The prize, for the public and the companies who will profit, will be, if not a universal treatment, then at least broader protection against a killer that can mutate with abandon, rendering custom-tailored vaccines useless. And the technologies developed for new types of seasonal and pandemic flu vaccines could be used to fight other diseases, opening up potentially lucrative markets.

"It's a foot race all right, with everyone out there toe-to-toe waiting for the big break," said Richard Bright, vice president for vaccine development for Novavax, one of several fledgling biotechs in the hunt. "And someone is going to get it."


© 2006 The Star Ledger
© 2006 NJ.com All Rights Reserved.

Threat of avian flu prompts crisis plans

Threat of avian flu prompts crisis plans
Seminar for health care workers and area residents underscores need to prepare for pandemic

By AMBER VAN NATTEN, Special to the Times Union
First published: Friday, August 11, 2006

Messages like "Keep your germs to yourself. STAY HOME!" or "Did you ask about masks?" greeted Kathy Beers and Tina VanDerwerken on a recent visit to Glen Sanders Mansion in Scotia.

The women -- Beers of Schenectady and VanDerwerken of Scotia -- attended a Schenectady County seminar on pandemic flu preparedness. And they weren't alone, more than 200 health care workers, volunteers and concerned citizens participated in the day-long sessions that covered everything from explaining what bird flu is to explaining how families can protect themselves.

"According to the World Health Organization and the Department of Health, we're overdue for a pandemic," said Glynnis Hunt, health education coordinator for the Schenectady County Health Department. "We feel it is a real concern and we're preparing for that."

Besides the seminar at Glen Sanders, the New York State Department of Health and the New York State Emergency Management Office also held a recent flu planning forum. In a separate event, Hometown Health Center in Schenectady brought experts and workers together to talk about worst-case scenarios and strategies to deal with them. And hospitals across the region have been running drills to test their plans and taking part in these county- and state-wide efforts.

"We feel that the more prepared people are now, the less chaotic the situation will be in the event of a pandemic," said Hunt.

The trigger of a pandemic anytime soon would most likely be avian influenza, or bird flu, which had claimed 134 lives worldwide by the end of July, according to health experts. According to the World Health Organization, a U.N. specialized health agency, more than half those that contract the disease die from it.

"I've been following the flu pandemic since it came out," said VanDerwerken, a stay-at-home mom. "I'm very interested personally in this. I'm very prepared though. I have enough food and water for six months."

Beers, a school nurse at Ballston Spa High School, said she, too, is concerned.

"People need to be informed. I feel very strongly about this," said Beers. "People are going to start to see things happen in the community a lot sooner than they might think."

In fact, the state has 60,000 flu treatments stockpiled and is purchasing more than a million anti-virals for recently infected people, according to Robert Kenny, the state health department's public affairs director. Of $29 million in the state budget for pandemic flu planning, most of it -- $23 million -- will go to medications. The rest goes to planning, equipment and supplies.

At the Glen Sanders planning session, three training seminars took place: one for health care professionals, one for volunteers and one for the community.

"We're only scraping the surface," said Dr. Russell Fricke, Schenectady County's public health commissioner. "There needs to be a broader discussion in this country."

Fricke specifically worried about broad-based financial planning.

"Businesses will have to interact with the government because what will parents or single parents do if they can't come to work for extended periods of time?" he said. "Will they still receive an income if they can't come to work because they're sick or their family is sick?"

That's partly where volunteers will come in. Health care agencies, like the county department, will need volunteers to help with child care, translation, inventory and delivering medicines quickly.

"We need a reserve of medical and non-medical volunteers to help," said Shelly Glock, Schenectady County's volunteer coordinator. "We want people to be trained, organized and ready in case of an emergency."

Anyone interested in volunteering can sign up online at http://www.schenectadycounty.com or by phone at 386-2810.

"If a large amount of people become ill, the system will become overwhelmed," said Glock. "People may need to care for their family, their co-workers and their neighborhoods and we want to train them to do that before it happens."

At the planning sessions hosted by the state, media representatives were asked to talk through how vital and possibly life-saving information in the event of a pandemic would be disseminated.

"We want to plan ahead how the Department of Health will get information to the media and how the media should take that information and present it to the public," said Rachel Smith, a state environmental scientist.

While news outlets would still be relied on to pass along accurate and timely information, they would be facing similar problems with staff shortages and a lack of resources.

"If your delivery guy sneezes on a newspaper and then drops it on your front step, that could be a problem. Does he have bird flu? Do you have it now? Is that going to make you stop reading the paper?" said Mike Spain, the Times Union's deputy managing editor, who attended the forum. "As far as covering stories, our people are going to be on the front lines if anything happens, and that could mean exposure to the virus. These are things we have to think about."

At Hometown Health Center, which serves mostly low-income residents, center workers and experts ran a planning session, called a tabletop drill to strengthen plans and check weaknesses in its system.

Besides expressing concern over possible language barriers among the center's employees and its multilingual community, the staff noted it would need backup in case workers grew ill. If nothing else, they noted, patients with chronic conditions like diabetes or AIDS would need to keep their appointments.

"There's a lot of holes between what's on paper and what we really have to do," said John Silva, the center's CEO.

Organizing and leading the center's drill was Dr. Jonathan Weinstein, emergency preparedness director for the Community Health Care Association of New York State, a nonprofit public advocacy association.

Weinstein suggested the center establish an extra fund for emergencies. In a pandemic, patients without health care or resources still would need to be treated. That and overtime worked by staff members would create a financial burden that health centers would need to prepare for.

Other than those issues, the staff said it felt reassured by the session.

"We've attended several flu presentations and we have an excellent clinical staff. I think we would be more ready than most places," said Angella Timothy, the center's executive vice president.

As for hospitals in the Capital Region, they have participated in such county- and state-wide sessions and continue with other efforts.

"Disasters affect more than just one hospital," said Scott Heller, director of the regional resource center for emergency and disaster preparedness in Albany. He works out of Albany Medical Center Hospital. "It's not just an Albany Med issue or a St. Peter's Hospital issue. It will be a problem for every health care facility in the region."

According to Paul Segovis, emergency preparedness coordinator at Ellis Hospital in Schenectady, his hospital has coordinated efforts with the county, and staff recently participated in a drill to test their emergency plan.

"Will things go perfectly? No. We can't anticipate every scenario, but we have the requirements in place to respond to any emergency that comes our way," said Segovis. "We're keeping an eye on avian flu and being aware of it, but we're also going to be ready. At this point we hope it never happens, but if it does, we'll be ready."

No plan could ever be final, as every organization tweaks its effort with new information and discussions, but Heller said, "As a whole I think we're a lot better than we were three or five years ago. Our plans are constantly changing and evolving anytime something occurs with the potential to affect us locally. We've really come a long way."

Amber Van Natten, a Times Union intern, is a SUNY Purchase sophomore. She can be reached at 454-5420 or by e-mail at avannatten@timesunion.com.

How to be prepared

Dr. Jonathan Weinstein, emergency preparedness director for the Community Health Care Association of New York State, offered these tips for how people can prepare themselves and their families before an emergency:


Have a family emergency plan. If you work and have young children, arrange now for them to stay with a neighbor, friend or family member in case of an emergency. Discuss with your family what you would do and how you would contact each other in different emergency situations.

Have basic supplies in your home to last for several days such as water (one gallon per person per day); nonperishable food; a battery-operated radio; a flashlight; blankets and a first aid kit containing over-the-counter medications for fever, pain and minor stomach problems; anti-bacterial ointments; and an extra supply of any prescription medication especially insulin or asthma inhalers.

Practice hand hygiene and respiratory etiquette. Wash your hands frequently with hot water and anti-bacterial soap. Wash hands after coughing, sneezing or blowing your nose. Cover your mouth and nose with a tissue when sneezing or coughing or cough and sneeze into the crook of your arm to avoid spreading germs. If you have flu-like symptoms or are in contact with someone with flu-like symptoms, wear a mask.

Go Online to the American Red Cross (http://www.redcross.org) or the Centers for Disease Control (http://www.bt.cdc.gov) to get more information on how you can prepare your family for an emergency.



All Times Union materials copyright 1996-2006, Capital Newspapers Division of The Hearst Corporation, Albany, N.Y.

Bird Flu Monitoring Goes Nationwide

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Bird Flu Monitoring Goes Nationwide

WASHINGTON, Aug. 10, 2006
--------------------------------------------------------------------------------
(CBS/AP) Monitoring of wild migratory birds to prevent a deadly bird flu virus is expanding to cover the entire nation and U.S. territories in the Pacific.

The stepped-up testing will be done by scientists in the lower 48 states, Hawaii and other Pacific islands. They will begin keeping an eye out for the deadly H5N1 strain of the avian flu that has killed more than 100 people, mostly in Asia.

In Alaska, where the first migratory birds began arriving, monitoring started just before summer.

"This move to test thousands more wild birds throughout the country will help us to quickly identify, respond and control the virus if it arrives in the United States," Agriculture Secretary Mike Johanns said Wednesday. "Because we cannot control wild birds, our best protection is an early warning system."

Interior Secretary Dirk Kempthorne said more coordinated monitoring by federal agencies, states and universities "will be important this fall as birds now nesting in Alaska and Canada begin their migration south through the continental United States."

The Agriculture and Interior departments are providing $4 million to state agencies to collect samples from specific species of migratory birds winging along four major U.S. migratory bird flyways. Congress budgeted $29 million for monitoring for the highly pathogenic strain of bird flu.

Feces or tissue samples from 75,000 to 100,000 wild birds will be collected, along with 50,000 samples of the water and ground that birds come into contact with. Locations where the samples will be collected will vary depending on weather and habitat conditions.

Likely sites include national and state wildlife refuges and parks, city ponds and parks, and private lands where owners have given approval.

While the much-talked-about H5N1 avian flu virus has yet to make an appearance on American soil, restaurants and other companies that rely on poultry sales are preparing for it, and for the impact it could have on their business.

Boston Market Corp. is developing and testing alternative menu items at its Golden headquarters.

Officials at Red Robin Gourmet Burgers Inc. are prepared to substitute pictures of burgers for those of chicken sandwiches on the company's menus and signs.

Executives at Red Bird Farms Co. in Englewood have drafted a nine-point plan for communicating the safety of their product.

Since 2003, the virus has infected at least 231 people in 10 countries in Asia and the Middle East, killing 133. All have contracted the virus from direct contact with infected birds and not from the food supply.

Experts say the virus cannot survive in poultry that has been cooked to 165 degrees and that infected birds are exterminated before they even make it into the food supply.

Nonetheless, a survey of 1,043 adults released this year by the Harvard School of Public Health found that nearly half the respondents who eat chicken or other poultry said they would stop doing so if an outbreak occurred among U.S. flocks.

A similar crisis hit the U.S. beef industry in 2003, when bovine spongiform encephalopathy — better known as mad cow disease — was discovered in a cow in Washington.

©MMVI CBS Broadcasting Inc. All Rights Reserved. This material may not be published, broadcast, rewritten, or redistributed. The Associated Press contributed to this report.

Release of Indonesian avian, human H5N1 viruses may offer insights on spread

Release of Indonesian avian, human H5N1 viruses may offer insights on spread
18:21:18 EDT Aug 10, 2006
Canadian Press: HELEN BRANSWELL, The Canadian Press
(CP) - The scientific community may soon have a clearer picture of what is going on with the H5N1 avian flu virus in Indonesia, the country which most concerns many experts following the worrisome virus.

After hoarding for months the genetic blueprints of the viruses isolated from both poultry and people, Indonesian officials have done an about-face and are sharing a large number of both avian and human viral isolates.

A scientist with the UN's Food and Agriculture Organization confirmed Thursday that Indonesia recently sent 91 avian viruses to the Geelong Laboratory in Australia, a reference lab for the FAO.

"We managed to get 91 isolates out to Geelong about two weeks ago. Took us months to get it to happen. But they arrived I think about 10 days ago or something like that - in good condition," Dr. Peter Roeder, an animal health officer with the Rome-based FAO, said in an interview.

"It will make a tremendous difference in the interpretation of the sequence data of the human viruses."

Last week the country's health minister, Siti Fadilah Supari, announced that Indonesia wanted the genetic sequences of all the viruses isolated from human cases in Indonesia to be put into open access databases where any scientist could study them.

The ability to compare the viruses spreading through bird populations to the ones that have jumped into people should provide badly needed insight into the H5N1 situation in Indonesia, where investigators have often been stumped trying to determine how people contracted the virus. A number of investigations have shown few if any links between human cases and infected birds.

The Geelong lab has been working to sequence the avian viruses and should have some initial results any day now, Roeder said. That information will be placed in the public domain, he added.

"As soon as the sequence data become available to the government of Indonesia we have an agreement with them that they'll make it available to the international community."

Sequence data for viruses isolated from about 40 human cases has in recent days been placed in public access databases. When the World Health Organization learned Indonesia was willing to share the data, it asked the two laboratories that had sequenced the viruses for Indonesia to put the information into the public domain. Up until then the data had been stored in a password-protected database accessible only to scientists working for the WHO or for laboratories that do this type of work for the organization.

The two labs quickly complied with the WHO request.

Last Friday, scientists at the U.S. Centers for Disease Control in Atlanta transferred the data into the open access database housed by the U.S. Department of Energy's Los Alamos National Laboratory, whose computers also host the password protected databank. The CDC was also in the process of logging the material into a second public access database, Genbank, the director of the agency's influenza division, Dr. Nancy Cox, said earlier this week.

The second laboratory, at the University of Hong Kong, is run by noted influenza expert Dr. Malik Peiris. In an interview Thursday, he confirmed that his team put the data into the Los Alamos database last Saturday.

Dr. Ilaria Capua, an Italian veterinary virologist who has spearheaded a campaign to put sequence data for all H5N1 viruses in the public domain, said Indonesia's move may be part of a trend to greater openness.

"There is a growing consensus on this data sharing," Capua, who runs an avian influenza reference laboratory for the International Organization for Animal Health, said from Rome.

"I would applaud Indonesia and then invite all the other health ministers (of affected countries) to follow that example. And then the veterinary isolates will come."

As for the human isolates, Peiris said there is a lot of overlap between the viruses his lab sequenced and the work done by the CDC.

Peiris said the viruses isolated from human cases showed no evidence of having swapped genes - the process is called reassortment - with flu viruses from humans, pigs or other mammals. Reassortment is one of the ways an avian flu virus could acquire the ability to spread easily to and among people, a development that would lead to a flu pandemic.

"There isn't anything (evident in the human isolates) that rings particular alarm bells as such," Peiris said.

But he suggested the viruses that infected people in Indonesia are only one part of the picture of what is going on there.

"It is probably important to have more avian virus sequences from the same geographical areas where the human cases are coming from," he said from Hong Kong.

Experts tracking the dangerous and economically devastating H5N1 virus have been concerned about Indonesia, where inadequate control methods have led to widespread outbreaks across the vast and densely populated archipelago.

Indonesia trailed other affected Asian countries in developing human cases, marking its first in July 2005. But since then cases in Indonesia have cropped up at a rate unparalleled elsewhere. And the country's H5N1 death toll recently surpassed that of Vietnam to make Indonesia the country that has lost the most lives to the virus.

Indonesia has logged 56 confirmed human cases, 44 of which have been fatal. Globally 236 cases of H5N1 infection have been confirmed in 10 countries since late 2003 and 138 of those people have died.

© The Canadian Press, 2006

Indonesia, Worst Affected by Bird Flu, Denies Lax Control

Indonesia, Worst Affected by Bird Flu, Denies Lax Control
Aug. 9 (Bloomberg) -- Indonesia, which has the most number of human deaths from avian influenza, said it hasn't been lax in controlling the spread of the virus.

``It's untrue that Indonesia is hesitant to act, one that suggests we're hesitant to use our own money and that we're hesitant to perform culling,'' Coordinating Minister for People's Welfare Aburizal Bakrie told reporters today.

The world's fourth-most-populous nation yesterday confirmed its 43rd fatality from the H5N1 virus, surpassing Vietnam as the country with the most deaths. Problems enforcing measures to stem the spread of the lethal H5N1 avian influenza virus have led to more Indonesians becoming infected.

Some local government leaders were deliberately ignoring culling orders, hampering efforts to stamp out infections in birds, Vice President Jusuf Kalla said on July 22.

``It's not that easy to cull because there are social issues that must be considered,'' said Bakrie, who is also the head of the nation's committee for avian influenza control and pandemic influenza preparedness. Authorities will continue to cull, ``like it or not,'' he said.

Bird flu has infected 55 people in Indonesia since July last year, according to the World Health Organization. Vietnam reported 93 cases since 2003, including 42 deaths. It hasn't reported any avian flu cases this year.

Bakrie said it is a challenge to conduct surveillance in Indonesia, the world's largest archipelago, which has 70,000 villages across 17,000 islands.

Backyard Poultry

The virus has spread in poultry in two-thirds of the country's 33 provinces since late 2003. Poultry is raised in the backyards of about 80 percent of the country's 55 million households.

Since 2004, 28.93 million chickens have been culled, about 20 percent of which were backyard poultry, and authorities have vaccinated 262 million chickens, Agriculture Minister Anton Apriantono said.

Experts are concerned the virus may infect people until it's controlled in poultry. The disease may spread to people in close contact with infected live birds, according to the Geneva- based WHO. Cooking kills the virus and no cases of transmission from cooked food have been recorded, the agency said.

Delays in finding and isolating cases risk exposing people to the virus and increase opportunities for it to mutate into a pandemic form.

There's a lack of trained personnel and equipment and many Indonesians are ignorant about the disease-deterring progress to control the virus, Larry Allen, senior technical coordinator with the U.N. Food and Agriculture Organization, said in a phone interview today.

``There's more disease outbreaks taking place than the central government is aware of,'' said Allen. ``It's a big problem out there but there's limited resources available to deal with it.''



To contact the reporter on this story:
Karima Anjani in Jakarta at kanjani@bloomberg.net.

Last Updated: August 9, 2006 08:41 EDT

Indonesia Records 43rd Bird Flu Death

Indonesia Records 43rd Bird Flu Death

By ALI KOTARUMALOS
The Associated Press
Monday, August 7, 2006; 11:09 PM



JAKARTA, Indonesia -- A 16-year-old boy in Indonesia died Monday from bird flu according to local test results that, if confirmed, would push the country's death toll from the disease to the highest in the world.

Normally reliable tests performed at a local laboratory showed the boy had the H5N1 virus, said Dr. Santoso Suroso, the director of the capital's infectious diseases hospital.

The boy, whose name was not released, was admitted to the hospital on Saturday.

Health officials said he had come into contact with sick chickens at his home, just east of Jakarta.

If confirmed by a World Health Organization-accredited laboratory, the death would be Indonesia's 43rd from the virus since July 2005, a third of which occurred this year.

Neighboring Vietnam is the second hardest hit at 42, but it has not recorded any deaths in 2006.

The H5N1 virus has killed at least 135 people worldwide since it began ravaging Asian poultry stocks in late 2003, according to WHO. That figure does not include Monday's death in Indonesia.

Most human cases have been traced to contact with infected birds, but experts fear the virus _ which remains hard for people to catch _ will mutate into a form that spreads easily among people, potentially sparking a pandemic.

Experts say Indonesians will continue to die until the nation stops the rampant spread of infection among its hundreds of millions of backyard poultry.

"You've got to worry about the humans, but if you don't clean up the animals, it doesn't matter what you do," Dr. Anthony Fauci, the U.S. National Institutes of Health's infectious disease chief told The Associated Press by phone.

Vietnam largely controlled the spread of the virus by launching a nationwide mass vaccination campaign for poultry last year. Thailand, which has reported 16 deaths, relies on strong village-based surveillance and mass slaughtering when outbreaks are discovered.

Bird flu in Indonesia grabbed the world's attention in May when seven members of a single family died of the virus _ the largest recorded cluster to date. The WHO concluded that limited human-to-human transmission likely occurred, but the virus did not spread beyond the blood family members.

___

Associated Press medical writer Margie Mason contributed to this report.

© 2006 The Associated Press

Are hospitals ready for a flu pandemic?

Are hospitals ready for a flu pandemic?
Editor's note: This is another in an occasional series exploring how the suburbs and state are preparing for the possibility of a deadly flu pandemic.

BY MARNI PYKE and DAVE ORRICK
Daily Herald Staff Writers
Posted Sunday, August 06, 2006

A Daily Herald survey of suburban hospitals shows many aren't fully prepared for a potentially deadly flu pandemic - a situation that reflects a national trend.

Seventeen medical centers were surveyed on their readiness for a global epidemic in the wake of concerns about avian flu. Another seven hospitals declined to take part in the study, which was based on recommendations by the federal government.

Results for the 17 medical centers that did participate, indicated that although some were well on the way to preparedness, others lagged behind.

The survey found shortfalls in critical areas.

• More than 40 percent of hospitals did not have complete plans for allocating life-saving medical resources to patients in the event of a pandemic.

Mark Welsh/ Daily Herald
The Alexian Brothers Medical Center ER prepares for a pandemic flu by staging a Code Three Drill.


• Nearly 60 percent hadn't conducted an avian-flu-specific drill.

• At total of 18 percent answered yes to all the survey questions.

"I think if anything, your survey shows we better hope there isn't a pandemic in the near future because the system isn't ready," said Jeffrey Levi, executive director of the Trust for America's Health, a nonprofit national organization that focuses on epidemic prevention.

However, other experts gave suburban hospitals higher grades, given the state of readiness nationwide and the exorbitant costs involved.

Right now, avian influenza is not a pandemic. But international scientists are cautiously tracking the spread of the H5N1 strain of bird flu.

More than 100 people, mostly in Asia and Africa, have died as a result of contact with infected birds, according to the World Health Organization. The virus has left an estimated 150 million birds dead.

Avian flu doesn't easily transmit between humans. The fear is if H5N1 mutates to a virus that spreads quickly from person to person, millions could die worldwide.

That's why health experts say it's essential hospitals be prepared for the worst.

"Pandemics have occurred many times in the past. They do occur and will occur in the future," said Dr. John Agwunobi, assistant secretary of health with the U.S. Department of Health and Human Services. "Therefore it is important that every part of the world prepare for and stay prepared for a pandemic."

Yet, "No matter how much preparation we do, it will be a very bad situation," Levi said.

No sense of urgency

Imagine a deadly disease spreading rapidly through the metropolitan area, infecting hundreds and killing 44 people, including two nurses and a doctor, within five months.

It sounds like a movie of the week, but it played out for real in early 2003 when severe acute respiratory syndrome, or SARS, made a deadly appearance in Toronto.

Brought to Canada by a woman returning from Hong Kong in February 2003, the virus wasn't identified for weeks. By that time, many medical workers had fallen sick after caring for SARS patients.

"I think SARS was a wake-up call for many," Agwunobi said.

"SARS was global, so like a pandemic it threatened more than one nation. The other thing that made it unique was that it really was a hospital-based infection. It prompted greater attention to infection control in hospitals."

Since 2003, 134 people have died as a result of coming in contact with the H5N1 virus, according to the WHO. The latest fatality occurred July 24 in Thailand, when a 17-year-old man died 14 days after burying chicken carcasses.

Despite the grim statistics, pandemic expert Dr. Eric Toner fears some hospitals are asleep at the switch.

"Most hospitals haven't taken avian flu seriously. Most have not really drilled on it," said Toner, a senior associate with the Center for Biosecurity. The center, based at the University of Pittsburgh Medical Center, focuses on societal effects of infections and diseases.

"Almost no hospitals have the necessary resources to prepare for a pandemic," he said.

By the numbers

The Daily Herald's one-page questionnaire was based on a lengthy checklist issued early this year by the federal government. The analysis of the survey was conducted using data collected in May, June and July.

Among the hospitals that participated in the study, only 41 percent had conducted an avian flu-specific drill.

About 47 percent reported carrying out a related exercise or indicated that they intended to do so in the future.

Agwunobi recommended every hospital conduct a drill.

"The reason we conduct exercises is not to show what works," he said. "Exercises should be geared to find out at what point the system breaks down."

Many medical centers - 88 percent - had created plans to prioritize workers and offer them medications to lessen the likelihood of infection.

The study also showed more than 90 percent of hospitals had named an influenza preparedness coordinator.

However, just 67 percent of medical centers had set a threshold for how many avian flu cases it would take to activate emergency plans.

And, only 56 percent had tackled tough ethical issues, such as how to ration resources if hospitals are swamped with influenza patients.

Northwest Community Hospital is at a high level of preparedness, but Emergency Response Coordinator Mary Casey-Lockyer noted the Arlington Heights-based facility is still fine-tuning issues such as rationing ventilators - a situation she said reflects what's happening nationwide.

"We don't have very many ventilators in the country," she said. "It's a question of how we disperse them and how we triage patients - who gets a ventilator and who doesn't."

One of the many challenges medical centers face as they prepare is the lack of health-care workers, said Darlene Gallagher, infection control manager at Adventist GlenOaks Hospital in Glendale Heights.

"There's a shortage of nurses, respiratory therapists, pharmacists, radiologists," she said. "What happens when they get sick? You can have the greatest plan on the books but you have to have the people."

The saving grace, Gallagher noted, is that agencies such as the Centers for Disease Control and the World Health Organization are closely monitoring the spread of H5N1.

"We will know when the virus changes to become a pandemic. It's not something where tomorrow it would be in the Northwest suburbs," she said.

Overall, the Center for Biosecurity's Toner was impressed by the survey results.

"I think the 41 percent who have done an avian-specific drill is higher than the national average," he said.

But Toner pointed out answering "yes" doesn't necessarily indicate how thorough is the planning.

"The devil's in the details," he said.

The Daily Herald consulted with experts familiar with pandemic planning to make sure the study was informed, fair and filled with questions the public should know.

Still, seven hospitals either refused to participate or submitted a generic statement.

Centegra Health System, which runs two hospitals in McHenry County, was one such organization.

"We just don't feel that the survey is a fair indicator of our level of preparedness," said Melissa Matusek, Centegra spokeswoman.

Health-care experts contend that the more information made public about a potential pandemic, the better.

"No matter how much preparation we do, this is going to be a very bad situation," Levi said. "A public that has been warned will be much more accepting."

Toner agreed. "The public needs to know this information," he said.

'Mass confusion'

Across the country, health-care leaders are worried about inadequate funding and insufficient guidance for hospitals in the event of an influenza-type pandemic.

"Hospitals have the biggest burden to address, and it's going to take far more resources than the government is willing to put on the table," Levi said.

The Center for Biosecurity estimates it will cost $5 billion to get hospitals across the country "minimally" prepared for a severe flu pandemic.

Being truly ready goes beyond drills and protocols, Toner said.

"A lot of being prepared involves stockpiling things such as masks, gowns and gloves," he said. "That's very expensive and few hospitals have resources to put away serious supplies. It also involves stockpiling medications."

Condell Medical Center in Libertyville is one hospital in the midst of ordering negative-pressure tents to deal with a surge in capacity. These high-tech tents equipped with ventilation systems could be draped over a patient's bed and filter out contaminants before air is released in the open.

"We have 11 negative-pressure rooms, but if you have 30 or 40 patients, we wouldn't have enough," said nurse Emily Bergman, Condell's Infection Prevention and Control Program coordinator. One tent alone could cost up to $6,000.

Another dilemma is a lack of detailed guidance from federal or state agencies, some experts contend.

"You will find once a hospital gets its teeth into this issue, then it starts churning out more questions," said Dr. Charles Baum, vice president for health affairs at Alexian Brothers Hospital Network.

As an example of the "mass confusion" being experienced by hospitals, Baum cites debate over flu vaccines. In the event of a pandemic where vaccines are mandatory, it's unclear who carries the insurance liability if someone falls sick as a result.

"Nationally, no one is stepping forward and saying, 'We'll relieve you of your liability for vaccination,'æ" Baum said.

Agwunobi said government agencies are issuing guidelines on a regular basis but pandemic readiness is a broad field and all the questions can't be answered at once.

Another uncertainty is paying for the uninsured.

"We have a large number of uninsured people, and we want them to come and get care," Levi said. "If hospitals take care of these individuals, the government needs to step forward and say costs will be covered. We want hospitals to be financially viable at the end of the pandemic."

Toner acknowledged that the federal government can't handle the financial burden alone. "It's (funding) got to come from a variety of sources, he said.

Agwunobi said Congress already has given out $325 million for hospital preparedness and another $250 million is on the way.

"States, local governments, the federal government - we should all be involved in a partnership to strengthen the system," he said.

Agwunobi avoided criticizing hospitals that refused to participate in the Daily Herald's study.

He said the checklist is voluntary and each hospital is unique. "The key is going to be having hospitals working closely with each other."

Overall, the state is in good shape, said Jay Bogdan, deputy director of the Illinois Department of Public Health's Office of Preparedness and Response.

"We are more prepared today than we were five years ago," he said, "and we continue to get more prepared."

Toner also saw signs for optimism. "Hospitals are beginning to get the message," he said. "Even if they're not doing what we think is necessary, they are drawing up plans and doing drills and that's at least a step in the right direction."

Daily Herald staff contributed to this report.
dailyherald.com

Vietnam kills wild storks to prevent bird flu spread

Vietnam kills wild storks to prevent bird flu spread
05 Aug 2006 03:54:14 GMT
Source: Reuters

HANOI, Aug 5 (Reuters) - Vietnam's animal health workers have killed 53 wild storks at a theme park in Ho Chi Minh City after random tests showed two of the birds carried an avian influenza virus strain, officials said on Saturday.

An official at the park said the findings of the H5 component, part of the H5N1 poultry virus, led to the slaughter of the birds even though they all appeared healthy.

Wild birds are natural hosts of bird flu viruses and often don't show symptoms but can pass the viruses to poultry. H5N1 can kill chickens within 24 hours of infection.

H5N1 is an influenza type-A virus that has killed 42 people in Vietnam since late 2003, but there have been no human infections detected in the Southeast Asian country this year.

The latest outbreaks in Laos and Thailand, where bird flu killed a teenager in late July, fanned fears that the virus known to have killed 134 people worldwide was flaring up again in Asia.

Vietnamese officials say a failure to control waterfowl, which can be silent carriers of bird flu, made the country vulnerable to new outbreaks and wild birds believed to carry H5N1 would soon migrate from the north, raising the risk of infection.

With Indonesia's say so, WHO to share bird flu data with scientific community

With Indonesia's say so, WHO to share bird flu data with scientific community
17:26:18 EDT Aug 4, 2006
HELEN BRANSWELL



Canadian Press: HED IS 77 CHARACTERS
(CP) - The World Health Organization on Friday welcomed the announcement that the Indonesian government had agreed to share with the global scientific community the genetic blueprints of the H5N1 avian flu viruses retrieved from human cases in that country.

A WHO official said the Geneva-based organization has instructed the WHO reference laboratories that sequenced the viruses for Indonesia to deposit their blueprints into Genbank, a databank which places no restrictions on who can study the genetic information it contains.

"What we will do is ensure that the labs - i.e. CDC and Hong Kong - that would have specimens from Indonesia are aware of the announcement from Indonesia . . . that there is permission," said Dr. Paul Gully, a former top official of the Public Health Agency of Canada who was seconded to the WHO's global influenza program earlier this year.

"It's not a very difficult process for the labs to actually upload that information. So I think we're just waiting to hear from them that that's actually happened."

Sequencing of viral isolates from Indonesia's human H5N1 cases has been done by a laboratory at the University of Hong Kong run by leading influenza authority Dr. Malik Peiris and by the U.S. Centers for Disease Control in Atlanta.

Indonesia only began recording human cases of H5N1 in early July of last year. But in the intervening 13 months, its problem with the devastating virus has become acute. At least 54 people in Indonesia have been infected and 42 of those people have died. Only Vietnam - with 93 infections and 42 deaths - has suffered a similar human toll.

Like authorities in several other countries, Indonesian officials have been reluctant to share their viruses with outside scientists eager to use them to try to track the evolution of the H5N1 virus and crack the mysteries of its remarkable virulence.

The journal Nature recently reported that the country has exported few, if any, virus samples retrieved from domestic poultry over the past year.

"I've learned that scientists across the world have complained that they could not access the data and made statements as if we had hidden it," Indonesian Health Minister Siti Fadilah Supari said Thursday in a news conference at which she announced the decision to share the sequence data from the human cases.

"For the sake of basic human interests, the Indonesian government declares that genomic data on bird flu viruses can be accessed by anyone."

The decision will increase dramatically the amount of sequence data on human H5N1 cases in the public domain. Many of the genetic blueprints of H5N1 cases are held in a password-protected database only available to scientists from the WHO and the laboratories which sequence viruses for it - a situation that has been harshly criticized.

Ownership of a virus rests with the country in which is was isolated. And only that country can agree to allow a viral isolate to be shared. But critics of the system suggest the reluctance to share extends beyond individual countries to some of the labs in the WHO network.

Steven Salzberg, director of the Center for Bioinformatics at the University of Maryland, is among the system's critics. And on Friday, he applauded Indonesia's decision not just to share, but to share openly.

"I think this is very good news and I'm very pleased that the Indonesian health minister has decided that it's important to share the samples and these data with the rest of the community," he said.

"I think it will help us to understand better how the flu is mutating and spreading in the population."

According to the Jakarta Post, the Indonesian health minister said the decision to put the genetic sequence information into an open-access database was based on a recommendation from the medical committee of the Indonesian Academy of Sciences, a forum of experts that advises the government.

The newspaper quoted a member of the academy, Professor Sangkot Marzuki, as saying the committee felt emerging diseases like H5N1 should be addressed promptly, by as many experts as possible. Marzuki said in making its recommendation, the academy weighed potential economic benefits to Indonesia of restricting access to the information, including possible uses for vaccine and drug manufacture as well as potential royalties from intellectual property rights.


© The Canadian Press, 2006

Avian flu pops up in German zoo

Avian flu pops up in German zoo
Aug 4, 2006 (CIDRAP News) – A swan tested positive for H5N1 avian influenza at a German zoo yesterday, signaling the virus's re-emergence in the country after a 3-month lull.

A black Australian swan at the Dresden Zoo in eastern Germany was found dead on Aug 1, but zoo officials weren't too concerned at first because deaths in the breed are common, zoo biologist Ron Brockmann told Deutsche Presse-Agentur (DPA). But after the bird tested positive for H5N1 yesterday, he said, the zoo quarantined other animals and sought government permission to vaccinate the rest of the zoo's collection of 720 birds of 112 species.

The swan was the first zoo animal infected in Germany, according to the story. Brockmann said the virus might have entered the zoo last winter when wild birds visited the zoo's ponds. The staff is worried that other animals in the zoo may become infected with the H5N1 virus if they eat dead birds, he said.

Germany's last outbreaks of H5N1 avian flu were in February among wild birds and in April in farm poultry, Agence France-Presse reported today.

In other developments, a man in Vietnam who was hospitalized with possible avian flu tested negative yesterday, according to news services. The patient is from the southern province of Kien Giang, on the Cambodian border in the Mekong Delta. Vietnam hasn't had a confirmed human H5N1 case since November 2005.

Three people in Thailand have also been cleared of H5N1 infection, according to the Bangkok Post. One is a 9-year-old girl from Lop Buri province in central Thailand who died 2 days ago. The other two patients—a 17-year-old boy and a 42-year-old woman—are from Chachoengsao province, east of Bangkok. The tests indicated that all three patients had a type A flu virus, but not H5N1, the newspaper said.

As of yesterday, the Thai Health Ministry reported that 97 patients from 24 provinces were under surveillance for possible avian flu. Those numbers were down from 164 patients in 21 provinces the previous day.

Thailand's only confirmed human H5N1 case this year was in a 17-year-old boy from Phichit province who died of the disease Jul 24. A report in the Aug 3 Eurosurveillance Weekly suggests that the boy's death indicates that poultry deaths in Thailand are being underreported. The authors observe that poultry deaths in the country were not reported until Jul 24, the day the boy died.

The boy's case may be an example of a "sentinel human," meaning a human H5N1 case that triggers reporting of the disease in poultry, the report says.

See also:

Eurosurveillance Weekly report on avian influenza in Thailand
http://www.eurosurveillance.org/ew/2006/060803.asp#1



Center for Infectious Disease Research & Policy
Academic Health Center -- University of Minnesota
Copyright © 2006 Regents of the University of Minnesota

Thailand confirms second bird flu death this year; raises health awareness

Thailand confirms second bird flu death this year; raises health awareness
13:35:55 EDT Aug 5, 2006
Canadian Press: RUNGRAWEE C. PINYORAT
BANGKOK, Thailand (AP) - A 27-year-old man has died of bird flu, becoming the second person this year to be killed by the disease in Thailand, a Health Ministry official said Saturday.

Dr. Thawat Suntrajarn, chief of the Department of Communicable Disease Control, said the man the local media identified as Thiangthong Singsamran came from Uthai Thani province in the country's north.

"I can confirm the man tested positive for the H5N1 virus," Thawat said, referring to results of tests carried out at Bangkok's Siriraj hospital.

The man became sick on July 24, a few days after burying one of his 16 free-range chickens that had died, a health ministry statement said.

On July 31, he was diagnosed with pneumonia and was given the anti-viral drug oseltamivir that is used to treat bird flu in humans. But his condition worsened and he died on Thursday, the statement said.

His wife has been given oseltamivir and will be monitored for the next 14 days, it added.

At least 134 people have died worldwide since the disease began spreading in Asia in late 2003, according to the World Health Organization, including 15 in Thailand.

The WHO has not yet confirmed the latest death in Thailand.

In the past two weeks, Thailand has confirmed two outbreaks of H5N1 in poultry and recorded its first human fatalities from the disease in eight months.

News of the new outbreaks triggered increased concern about the disease, and hundreds of people who earlier had bird flu-like symptoms but were cleared after testing were being checked again.

Health officials also said a special committee will be created in the northern province of Nakhon Phanom, where one of the outbreaks occurred, to assist health agencies while the province will receive equipment for rapid testing of suspected cases.

Authorities will also do more to educate people about the disease, and volunteers in every village will look for symptoms among their neighbours.

In his weekly radio address Saturday, Thai Prime Minister Thaksin Shinawatra called for farmers to quickly report the death of chickens. In the past, he has accused some farmers of trying to cover up outbreaks.

"When people who have contacted chicken become sick, it is advisable for them to immediately inform the authorities so that they could control the disease from spreading," Thaksin said.


© The Canadian Press, 2006

Thai Bird Flu Case Suggests Under-Reporting in Fowl

Thai Bird Flu Case Suggests Under-Reporting in Fowl (Update1)
Aug. 4 (Bloomberg) -- A 17-year-man who died of bird flu in Thailand last week, the country's first case this year, suggests the virus is being under-reported in poultry, the influenza team at the European Centre for Disease Surveillance and Control said.

The youth from a northern province was hospitalized on July 18 suffering fever, cough and headache and died six days later, the Thai Bureau of General Communicable Diseases said in a July 26 report. A week before his symptoms appeared he buried 10 dead chickens, touching the carcasses with his bare hands. His phlegm tested positive for the H5N1 avian flu strain.

The case ``could be an example of the phenomenon of a sentinel human already seen in other countries, where it is only the severe illness or death of a person from H5N1 that triggers detection or reporting of H5N1 in poultry,'' the team in Stockholm said in a report. ``This suggests under-detection or under-reporting of poultry deaths.''

Thailand widened the search for avian flu patients and improved surveillance for the virus in poultry as a result of the death of the youth. New cases create chances for H5N1 to mutate into a pandemic form and world health authorities are tracking the disease for signs it's becoming more contagious.

The virus is known to have infected 232 people in 10 countries, killing 134 of them. Most infections occurred in Asia through contact with birds. The disease may kill millions should it start spreading easily between people, researchers have said.

Respiratory Symptoms

Thailand is awaiting laboratory tests on 259 people with respiratory symptoms, of whom 32 are from Phichit, the same province where the teenager died last week, the country's Bureau of General Communicable Diseases said on its Web site today.

So far this year, Thai health authorities have investigated more than 2,300 clinical influenza or pneumonia patients as part of routine surveillance. Only one of these has been found to be infected with H5N1.

Thai health officials recorded 65,100 cases of seasonal influenza in the first seven months of this year. Of those patients, 370 died, Thawat Suntrajarn, director general of the health ministry's disease control department, told reporters in the capital, Bangkok, today.

``Our biggest concern is the outbreak of seasonal flu in Pichit, where the bird flu virus is still active'' in poultry, and in nearby provinces, Thawat said. The initial symptoms of both avian and seasonal influenza are similar, he said.

Health officials are concerned that people may contract H5N1 flu while they're infected with seasonal influenza. The dual infections might allow the H5N1 to mutate into a pandemic form, Thawat said.

`Very Lethal'

``Bird flu is very lethal with a high fatality rate among infected patients, while seasonal flu is easily transmitted between humans,'' he said. ``Any combination of both viruses in a person would be very dangerous.''

Laboratory tests on a 9-year-old girl, who died earlier this week in Lop Buri province, showed she had seasonal flu, not the H5N1 strain, Paijit Warachit, director general of Thailand's Medical Science Department, said in a telephone interview today.

Tests on two suspected avian flu patients in Chachoengsao also showed they have seasonal flu and not H5N1, Thawat said.

Concern of fresh outbreaks of the disease have been fanned by reports of new infections in poultry. Laos, Thailand's northeastern neighbor, said the virus killed thousands of poultry in several farms owned by a commercial producer near the capital, Vientiane, last month.

``There remains a constant risk of outbreak reoccurrence'' because of the large numbers of free-range poultry that haven't previously been exposed to the virus, and the movement and mixing of fighting cocks, the influenza team at the ECD said in its report.

Wild Birds

``There is also the additional risk from wild birds mixing with the free-grazing birds,'' the team said. The report was published yesterday in Eurosurveillance, an online journal of peer-reviewed information on communicable diseases.

In Vietnam's Kien Giang province on the Cambodian border in the Mekong Delta, a man was hospitalized with damaged lungs and high fever about a week after eating duck, the Tuoi Tre newspaper reported yesterday.

Tests on the man were negative for H5N1, said Nguyen Thi Kim Tien, director of the Pasteur Institute in Ho Chi Minh City.

The Nguoi Lao Dong newspaper reported today that he virus was found in storks in the Suoi Tien district of Ho Chi Minh City, and in ducks from two flocks in the southern province of Tay Ninh.

Tests on the duck flocks were negative for the H5 avian flu subtype, said Nguyen Xuan Binh, deputy head of the Ho Chi Minh City regional center for animal health, which is responsible for carrying out tests on animal samples from southern provinces.

``We have just received samples from the stork flock in Suoi Tien today, and tests are underway,'' Binh said.

A swan found dead in Dresden zoo in eastern Germany was infected with H5N1, the first such infection in the country in almost three months, Agence France-Presse said yesterday, citing local authorities.



To contact the reporters for this story:
Jason Gale in Singapore at j.gale@bloomberg.net;
Anuchit Nguyen in Bangkok at at anguyen@bloomberg.net

Last Updated: August 4, 2006 06:10 EDT

Thailand, Vietnam probe possible human H5N1 cases

Thailand, Vietnam probe possible human H5N1 cases
Aug 3, 2006 (CIDRAP News) – Concern about H5N1 avian influenza intensified in Thailand and Vietnam today as health officials reported more suspected human cases, but Indonesian officials said six people in two suspected case clusters in North Sumatra tested negative.

In Thailand, a 9-year-old girl from Lop Buri province died yesterday of suspected avian flu, the Bangkok Post reported. She is from the same province where a suspected case was reported in a 61-year-old woman yesterday.

A provincial health official, Pranor Khamthieng, told the Post the girl had initially tested negative for the H5N1 virus, but her symptoms suggested the disease. The Thai News Agency reported that the girl suffered fever, sore throat, and severe cough for 2 days before she was hospitalized with breathing difficulties. Samples were sent to a lab in Bangkok for a more thorough investigation, the Post reported.

The Thai News Agency said the girl’s family raises about 20 fighting cocks, but provincial authorities inspected her house and nearby areas and found that none had died suspiciously.

Elsewhere in Thailand, the Post reported today that two patients in Chachoengsao province, east of Bangkok, have been isolated at Ban Pho Hospital because of suspected avian flu. Doctors at the hospital told the Post that initial tests indicated the patients had regular influenza and that they were awaiting the results of avian flu tests.

One doctor said the patients, a 17-year-old boy and a 42-year-old woman, had touched ducks at a slaughterhouse where they both worked. A local livestock official, however, said no bird flu outbreaks had been reported on chicken farms in the province, according to the Post.

As of yesterday, the Thai Health Ministry reported that 164 patients from 21 provinces were under surveillance for possible avian flu.

Thailand’s only confirmed avian flu case so far this year was in a 17-year-old boy who died of the disease Jul 24 in Phichit province. The entire country is on bird flu alert after outbreaks surfaced in July in the northern and central provinces, ending a nearly 8-month hiatus.

In Vietnam—which hasn't had a confirmed human H5N1 case since November 2005—Bloomberg News reported today that health authorities are awaiting tests on a man from the southern province of Kien Giang, on the Cambodian border in the Mekong Delta. The report said the man was hospitalized with lung damage and a high fever about a week after eating duck.

Cao Bao Van, head of the molecular biology laboratory at the Pasteur Institute in Ho Chi Minh City, told Bloomberg that test results may be reported over the weekend.

Vietnamese news media have reported that ducks from two households in the southern province of Tay Ninh recently died suspiciously and test results were pending. Tay Ninh is also on the Cambodian border.

Meanwhile, in Indonesia, preliminary tests came back negative for H5N1 in six patients from the same district in Sumatra where the world’s first lab-confirmed human-to-human transmission of avian flu occurred in a family cluster, Agence France-Presse (AFP) reported today.

The suspected illnesses in the six patients had raised fears of more human-to-human transmission, because the group appeared to include two family clusters. Of the six patients, three were children: two siblings, aged 10 and 6, and an 18-month-old neighbor.

An Associated Press report yesterday had said there were a total of seven patients in the two possible clusters. But AFP reported today that a local hospital official in Kabanjahe village said it appeared that one patient had been counted twice.



Center for Infectious Disease Research & Policy
Academic Health Center -- University of Minnesota
Copyright © 2006 Regents of the University of Minnesota

Hybrid avian-human flu virus didn't spread in lab study

Hybrid avian-human flu virus didn't spread in lab study
Robert Roos News Editor


Jul 31, 2006 (CIDRAP News) – In an experiment designed to mimic events that could launch an influenza pandemic, a synthetic influenza virus made by combining an H5N1 avian flu virus with a human flu virus turned out to be no more contagious in an animal model than the natural H5N1 virus, US scientists are reporting this week.

Researchers at the Centers for Disease Control and Prevention (CDC) made two hybrid viruses and infected ferrets with them, according to a report to be published in the Proceedings of the National Academy of Sciences. The viruses failed to spread from infected ferrets to healthy ones in neighboring cages.

"We found that they [the viruses] were not able to transmit efficiently," said CDC researcher Dr. Jackie Katz, speaking at a Jul 28 teleconference. "In fact, they were also not as able to cause severe disease as the original H5N1 virus."

The deadly H5N1 virus has infected 232 people and killed 134 since late 2003, but it has not yet found a way to spread easily from person to person. But scientists fear the virus could pick up that ability if it combined, or reassorted, with a human flu virus, which could happen if someone became infected with both types simultaneously. The CDC set out to create such a hybrid and test it in ferrets. The animals are considered good models for flu virus research because their susceptibility to flu viruses is similar to that of humans.

CDC officials cautioned against taking much comfort from the experimental results. Although the synthetic hybrid didn't spread among the ferrets in the experiments so far, that doesn't mean the scenario couldn't happen in nature, they said. (Also, experts say the H5N1 virus could become transmissible through accumulated small mutations, without reassortment.)

"These data do not mean that H5N1 cannot convert to be transmissible from person to person; they mean it's probably not a simple process and more than simple genetic exchanges are necessary," CDC Director Dr. Julie Gerberdng said at the teleconference.

The H5N1 virus used in the study was a strain collected in 1997, when the pathogen first infected humans in Hong Kong. The human flu virus used in the study was an H3N2 strain, which has been common in recent decades. The research involved four steps, according to Katz.

First, investigators assessed whether the H3N2 and H5N1 viruses would spread in ferrets, whose cages were arranged so that viruses could spread via respiratory droplets. The human virus did spread efficiently, whereas the avian virus didn't, which signaled that the ferrets were serving as good models for human infection, Katz said.

The next step was to generate reassortant viruses. "We made two viruses that contained surface protein genes from the H5N1 virus and internal genes from the human H3N2 virus," Katz said. "We found we could make these viruses and that some of them were viable."

Third, the scientists infected some ferrets with the hybrid viruses and waited to see if they would spread to healthy ferrets. The hybrid viruses caused less severe illness than the original H5N1 strain, and they failed to spread.

Finally, the investigators wanted to know if the hybrid viruses would naturally mutate to become more transmissible if they were passed through several ferrets in succession. So the researchers infected ferrets and, after the ferrets showed symptoms, took nasal secretions and used them to infect other ferrets, repeating this step five times. Further, the researchers assessed whether the virus could spread more easily after all these generations or "passages."

"We found that the virus did not acquire any additional capacity to transmit efficiently from infected ferrets to healthy ferrets," Katz said.

Katz didn't explain why the CDC used a 1997 strain of H5N1 instead of a more recent strain, but said more recent isolates will be used in further experiments. Later versions of both H5N1 and H3N2 will be used to make further hybrids for testing in ferrets, she said. Scientists have identified a number of mutations in the H5N1 virus since 1997.

"We did test the more recent strains [of H5N1] for their ability to transmit, and like the 1997 strains, they could not transmit efficiently from one animal to the next," she said. "We need to continue to study this."

The CDC officials were asked whether reassortment "dumbs down" or weakens the virus. Katz replied that the hybrids were less virulent than H5N1, but cautioned that the results apply only to the 1997 strain.

Gerberding commented, "The pandemics of 1957 and 1968 were caused by reassortant viruses. Those were not dumb viruses."

In answering other questions, Katz said some scientists believe the 1918 pandemic virus, unlike the 1957 and 1968 viruses, arose through slowly accumulating mutations in an avian virus rather than through a reassortment event. "We're looking at the approach of the 1957 and 1968 pandemics where there was a more sudden change," she said.

The most important lesson of the research so far, according to Katz, is "the knowledge that this process isn't simple, the procedure for the virus to acquire the properties of transmissibility."

She said the CDC also created a hybrid that involved H3N2 virus surface proteins and H5N1 internal genes—the reverse of the hybrid she first described—and "that was not sufficient for transmissibility either. . . . That points to the fact that it's a complex interaction of the surface genes and the internal genes."

Gerberding warned that the findings shouldn't lead to complacency.

"I'm not reassured from the public health perspective," she said. "This virus is still out there, it's still evolving, and influenza is always unpredictable. . . . So let's not use the word 'reassuring' with respect to what might happen with H5N1."

Because of the risk that the reassortant viruses could spread, the research was done under stringent containment, involving Biosafety Level 3 with extra precautions, Katz said.

Maines TR, Chen LM, Matsuoka Y, et al. Lack of transmission of H5N1 avian-human reassortant influenza viruses in a ferret model. Proc Natl Acad Sci 2006 (published online Jul 31) [Abstract]

See also:

Jan 14, 2005, CIDRAP News story "CDC to mix avian, human flu viruses in pandemic study"



Center for Infectious Disease Research & Policy
Academic Health Center -- University of Minnesota
Copyright © 2006 Regents of the University of Minnesota

Prepare now for flu pandemic, officials warn

Prepare now for flu pandemic, officials warn

By Rebecca Vesely, STAFF WRITER
Inside Bay Area

DUBLIN — Avian flu could arrive in California as early as this fall via migrating birds, and while that doesn't spell a flu pandemic, local communities need to do more to prepare, health officials warned at a day-long conference Tuesday.
"The truth is, we are largely on our own," said Dr. Anthony Iton, Alameda County's health officer.

This first countywide pandemic flu preparedness forum, held at the county's Office of Homeland Security and Emergency Services, brought together law enforcement, firefighters, community groups, school leaders and officials from hospitals and city governments.

The emphasis on pandemic flu preparedness stems from worries about the H5N1 virus, an avian flu strain that has spread to 51 countries, infected 230 people and killed 132.

Although a new study by the Centers for Disease Control and Prevention released Monday suggested that H5N1 may not mutate easily into a rapidly spreading strain, avian flu is making its way around the globe.

Avian flu will arrive via birds on the Alaskan flyway soon, said Dr. Peter Lichty, medical director of occupational medicine at Lawrence Berkeley National Laboratory. Infected birds have been found as close to the West Coast as Siberia, whose border is three miles from Alaska.

"I'm expecting infected birds in Cali-fornia by the end of this year," Lichty said. "That's why we decided to do this (conference) now."

But the presence of H5N1-infected birds doesn't necessarily equal a human pandemic. A pandemic is defined as infecting at least 25 percent to 30 percent of the population over a prolonged period.

"There's no way to say when there will be a pandemic," said Dr. Howard Backer, California's public health officer. "We know it will happen, but we don't know when." Some researchers had predicted avian flu in North America during spring's migratory season, which didn't come to pass.

Even so, decisions about quarantines, school closures, vaccine priorities, hospital diversions, supply allocation and resource coordination largely will be left up to local jurisdictions, according to federal and state flu pandemic preparedness plans.

This year's state budget includes $214 million to handle any so-called "surge capacity" in the health system, such as supplies, drugs, field hospitals and training in the event of a flu pandemic. An additional $40 million has been allocated for antiviral drug stockpiling, disease surveillance, training and response teams.

The county has been running a preparedness program on Comcast Cable, developing a pandemic flu pocket guide and building a volunteer database to draw on in case disaster strikes.

The health department is using emergency preparedness and bioterror funds for this effort. About $100,000 was allocated this fiscal year to the county for pandemic flu, and $400,000 in future years, but the county hasn't yet received the funds, Iton said.

"Our lesson from (Hurricane) Katrina is you start with people most likely to be impacted," Iton said.

The county needs to make stronger connections with others that would be touched by a flu pandemic, including the Port of Oakland, veterinarians, environmental health officials, the military and schools, Iton said.

The H5N1 virus could develop into a pandemic if it mutates to become easily transmissible between humans. Today, reports of human-to-human infections have been scattered.

The virus would likely first come via migrating birds or animals trafficked or smuggled into the country, not from local poultry populations or from people traveling by airplane from infected areas, officials at the conference said.

An infectious disease outbreak can lead to many unexpected issues, said Dr. Robert Kosnick, an occupational physician at the University of California, San Francisco. Kosnick was working at St. Michael's Hospital of the University of Toronto during the 2003 SARS outbreak, and developed the hospital's patient and worker safety protocols.

During the SARS outbreak, the hospital had to cancel elective surgeries and clinics, and close all but one entrance and exit point for workers, where they were screened for possible infection.

Fear of the virus and uncertainty about the epidemic's duration made establishing protocols essential. The Toronto epidemic lasted three months, and during that time, 375 people were infected and 44 people died.

"The logic at the time was, 'If you touch it, you will get it, and you will die,'" Kosnick said.

The absence of a viable vaccine to combat avian flu makes community-wide preparedness even more important, officials said.

Last week, drug maker GlaxoSmithKline reported positive results from a clinical trial of its avian flu vaccine. The company said it could produce the vaccine in large quantities by next year. The vaccine uses an inactive strain of H5N1 isolated in Indonesia last year.



Contact Rebecca Vesely at rvesely@angnewspapers.com.



''There's no way to say when there will be a pandemic. ... We know it will happen, but we

don't know when."

Dr. Howard Backer

CALIFORNIA PUBLIC HEALTH OFFICER