12/05 H5N1 | Schools Study H5N1/Bracing for a Plague

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<B><center>Some schools are preparing a lesson plan if bird flu strikes

<font size=+1 color=red>Districts are in varying stages of preparation, but online work is being talked about in at least one.</font>

Dan Wascoe
Last update: December 4, 2005 at 9:50 PM
<A href="http://www.startribune.com/stories/462/5763277.html">Star Tribune </a></center>

• Would school districts offer classwork online? Edina officials are hearing that idea from parents.

• Could closed schools become impromptu health centers if hospitals and clinics can't keep up? Anoka-Hennepin is pondering that choice.

• Would health officials use schools to administer flu shots to people, assuming there's an effective vaccine? White Bear Lake has just such a plan.</b>

Plans are developing unevenly throughout metro area schools as the world waits to see what will happen.

What's not clear yet: If schools close, who would close them?

"We'd look to the state for leadership," said Tony Taschner, spokesman for the Rosemount-Apple Valley-Eagan district. Same goes for South Washington County. Fridley and Anoka-Hennepin said they'd work closely with county public health and emergency agencies before acting.

If necessary, "the governor has authority to close schools," said Aggie Leitheiser, director of emergency preparations for the Minnesota Department of Health.

Leitheiser said schools could play several roles in a potential bird-flu outbreak.

Teachers and school nurses could be important "early identifiers" of students and co-workers who show bird-flu symptoms, she said.

Even now, a doubling of school absentees triggers a report to county authorities, said Tammy Nihart, a school nurse with the Fridley district.

In the Robbinsdale district, spokesman Jeff Dehler got a recent example of how the state's current network monitors communicable diseases.

"My son is a sixth-grader and he had a serious cough, including symptoms of pertussis [also known as whooping cough]," he said.

The school advised that the 12-year-old stay home. Shortly thereafter the Dehlers got a phone call from the state epidemiology office.

The caller confirmed the information it had received from their son's school and offered advice about how long the Dehlers' son should stay home.

'We would use the media'

The prompt response was "truly amazing," Dehler said.

Leitheiser said that such personal follow-up probably would not be possible if a bird-flu pandemic caused many thousands of Minnesotans to get sick at the same time.

"We would use the media more to provide information," ranging from avoiding crowds to wearing masks, if necessary, she said.

Schools also could inform students and parents how to prevent getting or spreading the disease. Such lessons could be as basic as washing hands often and avoiding crowds.

Finally, Leitheiser said, in a pinch, school buildings could become "places to care for the sick."

A key problem with preparing for the bird flu is uncertainty over its timing, strength and contagious power. The virus so far has not shown it can spread broadly from animals to people.

Kris Ehresmann, an epidemiologist with the state health department, said decisions about how to react would hinge on "how the outbreak is progressing," including which types of people are getting sick and dying.

But one model for reacting might resemble city fire departments.

"You don't expect your house to burn down, but you want the fire department to have all the equipment and training," she said.

"We may never see a major outbreak, but being unprepared would be irresponsible. Houses do burn down."

<B><font size=+1 color=brown><center>CHRONOLOGY - Bird Flu Developments</font>

WORLD: December 5, 2005
<A href="http://www.planetark.com/dailynewsstory.cfm/newsid/33802/story.htm">Planet Ark</a></center>

Indonesia had its eighth human death due to bird flu confirmed by a Hong Kong laboratory affiliated with the World Health Organisation, a senior Health Ministry official said on Saturday. </b>

Here is a chronology of major bird flu developments:

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

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

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

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

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

Oct 21 - Hungary says an experimental vaccine against the deadly strain of bird flu has proven effective.

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

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

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

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

Dec 3 - Indonesia suffers its eighth human death due to bird flu confirmed by a Hong Kong laboratory affiliated with the WHO. This brings the confirmed human death toll throughout Asia to 69, comprising 42 in Vietnam, 13 in Thailand, eight in Indonesia, four in Cambodia and two in China.

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<B><center>Chasing The Flu
(Page 1 of 3)

Dec. 4, 2005
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<A href="http://www.cbsnews.com/stories/2005/12/02/60minutes/main1094515.shtml"> CBS News.com</a>

Quote

<font size=+1 color=green>“For the first time in history we are seeing a pandemic unfolding in front of our eyes.”</font>

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Dr. Margaret Chan</center>

(CBS) If this year of tsunamis, earthquakes and hurricanes has taught us anything, it’s that worst case scenarios do sometimes happen. Now with winter upon us, the latest thing to worry about is the avian flu -- a particularly deadly bird virus that is ravaging the poultry industry in Asia, and has, on rare occasions, infected humans, killing half of its victims. </b>

Fewer than 100 people have died worldwide, yet the World Health Organization calls it the most serious health threat facing the planet, greater than AIDS or tuberculosis. Because humans have no immunity to the virus, and there are no proven drugs or vaccines to stop it, it has the potential to cause an influenza pandemic similar to the one that killed 50 million people in 1918. It may not happen, but billions of dollars are being spent to sequence its genes, track its movement, and slow its progress in what many people believe could be a race against time. 60 Minutes set out for Europe and Asia chasing the flu.

Correspondent Steve Kroft reports.

It’s called the H5N1 virus, a primitive piece of genetic material so small it can barely be seen under the most powerful microscopes. Like all flu viruses, it is constantly evolving and every day scientists record the latest changes as it moves silently around the globe in the bellies of birds.

The virus has infected the waterfowl now migrating the flyways over Southeast Asia. This is the front line in the battle against avian flu, where the most cases have been identified and the most people have died.

Ducks and geese have passed it along to domestic poultry, and humans have gotten it from sick birds. So far, the virus can’t pass easily from human to human, but a single deadly mutation could change that and trigger the deaths of tens of millions of people.

“Time is the essence,” says Dr. Margaret Chan, the World Health Organization’s chief of Pandemic Influenza in Geneva. She calls it a warning signal from nature.

“For the first time in history we are seeing a pandemic unfolding in front of our eyes,” says Dr. Chan.

No one has more experience with H5N1 than Dr. Chan. She was director of health in Hong Kong when the first outbreak occurred there in 1997.

This is a virus that affects mostly birds and has killed fewer than 100 people. Why does Dr. Chan see it as such a serious health threat?

“We are seeing very worrying signs, the geographical spread of this virus, and it has extended beyond the usual sort of poultry sector. It is infecting cats. It's causing death in tigers, and so on and so forth. Now we are getting all these signals, and we are tracking the changes of the virus,” she explains.

“If you look at the disease it causes in human being, [it] is very severe, with a very high fatality rate. More than about half of the people infected die. We have not seen anything quite like it,” says Dr. Chan. “And also, this virus causes unprecedented spread in the animal sector. And we have never seen this in the entire history of mankind.”

The best minds in health, science and veterinary medicine have been mobilized to try and stop the bird flu before it can become highly contagious in humans.

Nearly 200 million chickens exposed to the virus have already been destroyed, yet, in the last few months the H5N1 virus has spread from Asia into Europe.

Every morning at the World Health Organization’s Strategic Health Operations Center, scientists and public health officials gather to go over the latest information and monitor every suspected human infection. They call it the morning prayers. The man in charge is Dr. Mike Ryan.

“Most of these cases represent a situation in which the virus has breached a barrier between animals and humans. And every time it breaches that barrier is a potential opportunity for a pandemic to start. So each and every one of those cases is important and vital for us to understand what's going on,” says Dr. Ryan.

There have been several cases in Vietnam and Thailand, where the virus seems to have spread from human to human, but only to close family members and caregivers. Then the transmission stopped.

“What we haven't seen is sustained efficient human to human transmission. We have not seen chains of infection. And of that we're sure. And that's what we need to look out for,” says Dr. Ryan.

To do it, Ryan is building an international surveillance system with ministries of health all over the world that he hopes would be able to detect the trigger point of a pandemic, the first signs that the virus has become contagious in humans. The plan calls for medical SWAT teams to be flown to the site, to quarantine the area, and begin administering millions of doses of a drug called Tamiflu, the strongest anti virals available.

“We won't have time, possibly, at the beginning of a pandemic even to get laboratory confirmation. It may take days to get laboratory confirmation,” says Dr. Ryan. “We may have to make this judgment on the basis of the existence of a cluster that's spreading quickly. And that signal will be very strong. You'll see the disease extend very quickly from two to four to ten. To 20. To 30, 50, and beyond number of… And when you start to see that mini explosion of cases, we're going to have a very, very short time in which to do something about that. Very short.”

How long do scientists have?

“The intervention time will be measured from days to weeks. I think no longer than a month at the extreme,” says Dr. Ryan.

Dr. Ryan says if an outbreak isn’t stopped or controlled in 30 days, scientists may lose the battle, “and nobody knows whether that can be done.”

How good is Dr. Ryan’s surveillance system?

“My fear is that there are blind spots. That there are blind spots in our surveillance system at national level. And that creates blind spots globally,” he explains.

One of those blind spots is in Cambodia, the poorest of the Southeast Asian countries where the virus is most active. Migratory waterfowl have already infected domestic ducks and chickens, a major source of protein for most the people here. Many of them live in poverty with no access to health care.

So far, the virus has killed four people in Cambodia, all of them thought to have been exposed to the blood or droppings of infected chickens and ducks, which are still slaughtered and sold in open air markets all over the country. And doctors here are as scarce as hens’ teeth.

One of them is Dr. Ly Sovann, the Cambodian government’s director of disease surveillance -- the man in charge of stopping the avian flu here.

Dr. Sovann says the government is prepared for the event of an outbreak, but says “we are not really good prepare yet.”

If there are signs that the disease is spreading among humans, Dr. Sovann’s job is to report the first outbreaks to officials in Geneva and wait for international help to arrive. But when 60 Minutes visited Cambodia last month, Dr. Sovann said he had fewer than 150 doses of the antiviral drug Tamiflu for a nation of 13 million people.

Dr. Sovann says there is only one dose per province. “But we need more,” he says.

Dr. Sovann and his six member staff work out of a small room on the third floor of the health ministry, where he keeps an emergency supply of biohazard suits piled in his office. The power goes off every night at 7 p.m.

If he’s called to a pandemic emergency, he’ll have to take a taxi. He is supposed to be in charge of the national reporting system, but there is one office phone for the entire staff.

The national pandemic hotline is his personal cell phone. But when you travel outside the city, you realize it may not matter. In most villages there are no telephones to call Dr. Sovann. And even if there was, Dr. Megge Miller, an Australian who is the World Health Organization’s epidemiologist in Cambodia, says there’s little awareness of avian flu once you get out to the countryside.

In the villages, people live with their chickens and ducks. “They are members of the family,” says Dr. Miller.

There are lots of things in Cambodia that kill people. Every year, thousands die from TB, malaria, tetanus and other infections. Bird flu is not yet a major concern.

“People don't believe in avian influenza,” says Dr. Miller.

She says it is possible cases of avian flu in Cambodia may have gone undetected. “It's possible that we have missed cases, because we won't pick up every single case occurring singly,” Dr. Miller says.

Asked if she thinks the surveillance system is good enough to detect when the virus makes the jump, Dr. Miller says, “We're not going to pick up the first case or the second case. I don't think we'll pick up the first jump. We're just not going to. What we're hoping to be able to do, and I'm fairly confident we should pick this up, if we get a family cluster, it will worry people. And so they'll go looking for answers. So, hopefully, in that looking for answers, they'll get to the right people and the alert will be triggered,” she says.

Dr. Miller says the quality of healthcare in many villages is primitive. “Thankfully in this village, it's not too difficult to get to a health center. I mean, whether someone is there is the big issue. And also whether they're aware of the symptoms of bird flu,” she explains.

The skill level for health care workers is rudimentary at best. Less than half the provinces have received training sessions in the WHO’s plan for flu surveillance, response and containment.

That plan, says Dr. Miller, might be workable in Cambodia. “There are a lot of logistical issues around mobilizing a lot of medicine and a lot of people in a short space of time. I mean we could get the medicine to Phnom Penh, but then how do we get the medicine from Phnom Penh airport out to the province? And one of the things we need to do with this sort of containment strategy is put a ring around the village and make sure no one goes into the village and no one goes out. Which is going to be the most difficult thing to control, because people are just used to going everywhere,” she says.

Dr. Miller says the Cambodian government is not yet fully prepared to respond to an outbreak of bird flu.

But neither is the rest of the world. If H5N1 were to become highly contagious in humans this winter it could spread to every country in the world in a matter of months. There is no way governments, health organizations, and pharmaceutical manufacturers would be able to produce sufficient amounts of the strongest anti viral drugs or vaccines to contain it.

“Right now, and we all admit that, right now if we had an explosion of an H5N1 we would not be prepared for that,” says Dr. Anthony Fauci of the National Institutes of Health. He is the nation’s point man on the avian flu.

The NIH is now testing a vaccine made from the current bird virus, but whether it would work against some future mutant strain that is contagious in humans is anybody’s guess.

This virus has been around since 1997 and there are people who say that it hasn't made the jump yet to the point where it can affect humans. Is it not going to?

“It is conceivable that this virus has already reached its dead end and these little blips of infections are just things that are manifestations of where it would like to go, but it's never going to get there,” says Dr. Fauci. “On the other hand, the more this virus is infecting and killing chickens, and the more people that get infected by it, that's going to give the virus a greater chance of doing what you hope it never does.”

The White House has proposed a $7.1 billion program to prepare for a pandemic. Plans are underway to stockpile drugs and medical supplies and to develop treatment plans, quarantine strategies, and better and quicker ways to manufacture vaccines. But what money can’t buy is time.

Dr. Fauci says he doesn’t see the preparations for the H5N1 virus as an exercise to improve capabilities of fighting off a pandemic. “Well, I don't see it as an exercise because it could be the big one. It could be. And if it is, our rushing around doing what we need to do, pushing the envelope, is not for naught or in vain.”

What, in his opinion, are the chances there could be a pandemic during this flu season?

“The probability of next month a H5N1 turning into a widely disseminated 1918 version, given where we are now, in my opinion, is low. Is it zero? No. Since it isn't, I'm assuming the worst case scenario will happen,” says Dr. Fauci.


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Dr. Fauci says it is the only way to proceed, but not the only possible outcome. It is conceivable that a human pandemic of H5N1 could emerge from the masses in Asia and turn out to be no more deadly than a bad case of the flu, which people often forget kills, on an average, 36,000 Americans every year.

<B><font size=+1 color=blue><center>Authorities culling, burning fowl after recording bird flu outbreak in Ukraine's Crimea</font>

12/4/2005 10:25:55 PM
<A href="http://www.wkrc.com/news/world/story.aspx?content_id=EED6408C-DBAF-4628-A8C4-C2A523817AFB">WKRC 12.com</a></center>

KIEV, Ukraine (AP) - Authorities were culling and burning fowl Sunday in three Crimean regions where Ukraine's first bird flu outbreak was recorded, an emergency official said. </b>

Ihor Krol, spokesman for the Emergency Situations Ministry, said more than 2,500 birds had already died of the virus, and authorities were killing fowl in an attempt to stop the disease's spread.

"People understand all our measures and are doing their utmost to help emergency workers," he said.

Samples were sent to laboratories in Italy and Britain to determine whether the disease could be the deadly H5N1 strain, which is being monitored for fear it could mutate into a form that is easily transferable among humans.

The emergency order bars people from entering or leaving the quarantined area, and experts will visit every home to inform residents and to count flocks. All birds - even if healthy - will be slaughtered and their carcasses burned over the next four days.

No human infections have been reported, he said.

Bird flu was detected in neighboring Romania nearly two months ago, and Ukrainian officials scrambled to reassure this nation of 47 million that they were well-prepared.

Worldwide attention is focused on the H5N1 strain. That outbreak began in 2003 in Asia, where it has killed at least 69 people.

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<B><font size=+1 color=purple><center>H5N1 Tree Sparrows in Henan Contain H3N2 Polymorphisms</font>

<A href="http://www.recombinomics.com/News/12040501/H5N1_Henan_H3N2.html">Recombinomics Commentary</a>
December 4, 2005</center>

The four recent whole genome sequences of Henan tree sparrows are cause for concern. The two surface proteins are HPAI H5N1 and the multibaisc HA cleavage site generates a string selective advantage that allows for wide distribution of the additional 6 genes. These genes have many polymorphisms found in H9N2 and H3N2 isolates.</b>

Many of these polymorphism are in 2003/2004 isolates from South Korea, indicating the sequences are not limited to the terrestrial birds in Henan. The genes also have considerable amounts of recombination, which is why they were not well defined in the Journal of Virology paper.

These mammalian sequences are of considerable concern, because they are also appearing as novel sequences in human H3N2 isolates as well as canine H3N8 isolates.

As H5N1 wild bird flu sequences come into the area, new recombinants will be formed and distributed. This may account for the limited success using animal vaccines to control the outbreaks in eastern China. Since the Henan isolates do not produce symptoms in ducks, they may be much more widespread than the tree sparrow population in Henan.

Avian influenza sequences are clearly recombining and reassorting at a high rate. The amount of sequence data in Asia has been limited, especially this year, as the recombination rate appears to be accelerating in association with increased genetic diversity and an expanded host range of H5N1.

Release of more sequence data from isolates linked to the recent outbreaks in China as well as earlier collections from indigenous populations of birds worldwide, would be useful

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<B><font size=+1 color=red><center>H5N1 False Negatives in Europe and the Middle East</font>

<A href="http://www.recombinomics.com/News/12030503/H5N1_False_Europe_ME.html">Recombinomics Commentary</a>
December 3, 2005</center>

Dead birds found dead over the past two months in the Black Sea peninsula tested positive for the H5 subtype……</b>

Domestic fowl began dying in Ukraine's Crimean region on Oct. 18, but the deaths increased significantly last month, rising to 1,621……

"It's a frightening, lightning-fast form (of the virus)," Maria Trukhanovskaya, chief veterinary official of the Crimea region, said in televised comments.

The above comments suggest the H5N1 wild bird infections have been present on farms in the Crimea peninsula for the past 6 weeks without OIE notifications. Moreover, farmers have been improperly disposing of the dead birds and allowing H5N1 to incubate on the farms, which may have generated a more virulent version of H5N1.

Unfortunately, it is likely that the above scenario is not limited to the Crimean peninsula. Romania filed an Oct 7 OIE report on H5N1 in the Danube Delta, which also is adjacent to the Black Sea. Media reports suggest birds were dying there since August. Moreover, a significant portion of the Danube Delta is in the Unkraine and dead birds have been found near the border with Ukraine as well as Moldova, which has acknowledged H5N1 infections but has also not filed an OIE report.

H5N1 infections in Croatia, Turkey, and the Volga Delta suggest that most of not all countries bordering the Caspian Sea or Black Sea have H5N1 infections (see map).

H5N1 infections in Kuwait as well as H5 antibodies in an Israeli linked to wild birds suggest the H5N1 infections are throughout Europe and the Middle East, but countries continue to cite negative test results on large numbers of birds.

Although there are many potential reasons for false negatives, the lack of detection and reporting H5N1 in the region is cause for concern.

New outbreaks are now being reported in the Volga and Danube Deltas and the comments above suggest the H5N1 may have evolved into a more virulent form via incubation in the domestic poultry.

Timely and accurate reporting of H5N1 in Europe and the Middle East would be useful.

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<B><center>Bracing for a Plague

<font size=+1 color=brown>The physician charged with preparing the world for a flu pandemic reflects on the threat</font>

<A href="http://msnbc.msn.com/id/10312471/site/newsweek/">MSNBC.com</a></center>

Newsweek
Dec. 12, 2005 issue - Dr. David Nabarro was going about his business on Sept. 12 when the head of the World Health Organization hit him with a three-Rolaid question. Would he mind moving from Geneva to New York—right away—to oversee global preparations for a catastrophic flu pandemic? Nabarro reported for work in Manhattan two weeks later (his family plans to join him next year). By early November, he had barnstormed around Southeast Asia and helped organize a summit of world leaders on influenza back in Geneva, but he hadn't had a chance to empty his briefcase. "I'm not sure I'm even being paid," he says, pacing his still-vacant United Nations office. "The paperwork is trailing somewhere behind."</b>

As the United Nations' senior coordinator for avian and human influenza, Na-barro is up against one of the worst health threats imaginable: a human outbreak of avian flu. So far, doctors have recorded just 133 cases and 68 deaths, mainly among people exposed to infected birds in Asia. But if an infection that deadly started spreading from person to person, it could quickly claim tens of millions of lives. Nabarro's job is to prepare a half-dozen U.N. agencies—and 191 member states—for a seamless international response.

It's the kind of challenge this intense 56-year-old physician relishes. Nabarro spent his early career running medical-relief efforts for the British government in South Asia and sub-Saharan Africa. More recently, as director of the WHO's Health Action in Crisis program, he has helped mobilize medical responses to the Iraq war, the Niger famine and the 2004 tsunami. He spoke with NEWSWEEK's Geoffrey Cowley about the prospects for meeting this new threat. Excerpts:

COWLEY: You've been given a daunting job. Have you figured out where to start?

NABARRO: We've got three big challenges—a technical one, a political one and an institutional one—and I think the first two are moving well at the moment. The U.N.'s specialized agencies have some of the world's best doctors and agriculturalists working on the threat of a flu pandemic, and heads of state are very eager to do something about it. We don't have to go around and convince presidents and politicians that this could have absolutely massive consequences for their people. They know, and they're worried. But I'm still concerned about the institutional part. How do you get public-health systems and veterinary agencies going after years of inadequate investment? How do you minimize human contact with birds in places where backyard farming is a matter of subsistence? How do you get disease surveillance up to speed in remote rural areas? Those are still big, big challenges for countries and for the world.

Are you war-gaming outbreaks to see how they might play out?

Yes, we're working to set up a simulation network. We'll look at different scenarios to see what happens when particular variables change—the location of the first cases, the speed of the response, the availability of antivirals and surgical masks. It's not just make-believe. You're sitting there with the people who would have to execute these responses, and you're looking at how a breakdown in transport or security or food supplies could affect disease spread. What happens when the utility company loses its staff and electric power starts to fail? How does that change the epidemic, and how can you prevent it or plan for it?

What lessons have we learned so far?

The surest way to prevent a human pandemic is to control influenza in domestic birds. That's a huge challenge that could take years to address fully. If an avian virus starts spreading among people in the meantime, we will have very little time to respond. The first things we'll need are good surveillance systems and fast, open communications. We know from the SARS epidemic that you can't have an effective response unless governments share information quickly and freely, and in ways that keep people from panicking. Panic can set off migrations that affect everything from air travel to housing and food supplies. The other priority is to quickly isolate affected people and their contacts. You've got to have antivirals like oseltamivir [Tamiflu] on hand to treat people at risk of exposure, and you've got to have masks and protective clothing available to health workers.

That's a lot to ask of countries that lack functioning health systems. Can they afford to invest for potential health problems when they're so burdened by real ones?
We can't put the burden on individual countries. This is a global danger, and we need a global framework for responding to it. The cost of creating one could exceed $2 billion over the next three years. The U.N. member states will meet in Beijing in January to pledge funding support, but money isn't the only thing needed. We also need to devise a system for shifting resources and expertise around the world quickly as needs change. I hope we can avoid the situation we've faced with HIV/AIDS, where the efforts of different donors sometimes overlap or compete with each other.

The Bush administration's new $7 billion preparedness plan includes several billion dollars for vaccine research, but only $250 million to help other countries contain outbreaks. Are you pleased with the U.S. response?
We're glad that the plan includes some international support. Yes, it's heavily weighted toward biomedical measures, less toward public health. But we do need better tools, so I'm glad someone is investing in them. One could say that the money the U.S. invests in vaccine development will help everyone, including the developing countries.

Do you look forward to coming to work each day?

Absolutely. Bill Aldis [the WHO's representative in Thailand] met me at the airport in Bangkok a few weeks ago. As I was throwing my bag into the boot of the car, he shook his head and said, "Look what you've gotten yourself into now!" But then he said, "This is what you've been training for all your life." I think that's right. This job involves the big vision of health that I like so much—health as a reflection of larger political forces. This threat could help unite people behind a shared vision of better health for all. I've worked in emergencies, so I'm used to intensity. But I don't mind admitting this is scary. When you're dealing with something this big, you've just got to be careful not to let it overwhelm you.

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<B><font size=+1 color=green><center>Indonesia confirms 13 human cases of bird flu </font>

12/05/2005 -- 11:45(GMT+7)
<A href="http://www.vnanet.vn/NewsA.asp?LANGUAGE_ID=2&CATEGORY_ID=33&NEWS_ID=177552">www.vnanet.vn</a></center>

Jakarta (VNA) - Indonesia has confirmed 13 human case of bird flu, including eight deaths, said health official.</b>

Hariadi Wibisono said that tests by the World Health Organisation (WHO) showed that the 25-year-old woman, who died early last week, was infected with H5N1 virus, local media reported on December 3.

He attributed almost all infections in Indonesia to direct or indirect contact with ill poultry.--Enditem

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<B><center>Senate formulates emergency plans
<font size=+1 color=blue>Leaders prompted after growing concerns about avian flu</font>

By Kate Campbell Senior staff writer
December 05, 2005
<A href="http://www.diamondbackonline.com/vnews/display.v/ART/2005/12/05/4393d7d77f158">diamondbackonline.com</a></center>

The university may soon have a contingency plan to continue holding class through natural disasters such as an avian flu outbreak, following the creation of two university task forces.</b>

One group, led by Assistant Vice President for Student Affairs Robert Waters, is charged with finding a way for students to continue their classes in the event of a long-term campus closing, caused by a disaster such as the avian flu.

Waters isn’t a stranger to disasters, after living through San Francisco’s 7.1 magnitude earthquake that ripped through the University of San Francisco in October 1989.

That quake flattened the San Francisco-Oakland Bay Bridge, ruined the World Series, and rocked the small campus. While no buildings collapsed, the school shut down for a week and it took months to complete repairs and for students settle back into a normal routine.

Waters spent the days immediately following the disaster walking to work and piecing together a phone chain to spread information.

“Today I think we’d have an advantage because I think students would go to the website, faculty would go to the website,” he said.

After dealing with a natural disaster more than 10 years ago, Waters said new technology such as the Internet will help in planning for future disasters with his group, which is composed of members of the University Senate and administration.

Officials said warnings from the Centers for Disease Control and Prevention prompted the formation of the task forces.

“The CDC is alerting all sorts of jurisdictions about what their responses should be,” said Vice President for Student Affairs Linda Clement. “I don’t think we’ve received any word that we’re at an extraordinary risk, but we have a lot of people in residence, we’re close to D.C. and there’s lots of international travel.”

Avian flu is a virus that infects birds and pigs and may transfer to humans through contaminated meat, according to the CDC. Human infections, which may result in pneumonia and organ failure, have been recently confirmed in Cambodia, Indonesia, Thailand and Vietnam. While the virus is destroyed through proper cooking practices and there are drugs to treat infections, the CDC warns nations should prepare themselves for the possibility of an avian flu pandemic.

Waters said his committee will likely focus on establishing ways for professors to move their classes online or meet off the campus should the school shut down because of an avian flu outbreak. Schools on the Gulf Coast devastated by hurricanes Katrina and Rita have provided valuable models for his plan, he said.

“The University of New Orleans, for instance, has moved most of their classes online,” Waters said. “They also gave the students the option of taking classes at different campuses.”

Online classes and off-campus meetings are a way for the school to maintain contact hours between students and staff, Waters said.

“There’s a certain point where the semester loses so many hours that you get to the point where it’s not a legitimate semester,” he said.

Dale Anderson, director of university human resources, is heading the task force to ensure that essential staff can get to the campus in the event of an outbreak. At this time of year, he said, staff are focused mostly on dealing with closings due to snow.

“What we’re going to be looking at is something we don’t have a lot of experience with,” he said.

The task force is likely to address issues including ensuring staff can receive medical attention, getting pay to hourly and student employees and scheduling shifts.

Waters said his committee hopes to submit their recommendations to the Provost’s office by the end of the month.

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<B><font size=+1 color=red><center>Brum gran's bird flu horror</font>

Exclusive By Fionnuala Bourke
December 4 2005
<A href="http://icbirmingham.icnetwork.co.uk/sundaymercury/news/tm_objectid=16450048%26method=full%26siteid=50002%26headline=brum%2dgran%2ds%2dbird%2dflu%2dhorror-name_page.html">Birmingham.icnetwork.co.uk</a></center>

A MIDLAND grandmother's holiday has turned into a bird flu hell - with crows falling dead from the sky.

Mai Barnes loves Goa.</b>

She is a regular visitor to the paradise Indian resort, now so popular with Midland holidaymakers.

But Mrs Barnes, of Handsworth Wood, is worried - because dead birds keep falling from the sky.

The scenic views in the idyllic area of India have been blighted by the sickening sight of dozens of bird carcasses lying on the ground.

Last night, the 63 year-old gran - a regular visitor to Goa - spoke from her hotel about the flu scare.

"Every day for the past week, I've noticed dead crows in the road near my apartment," she said.

"They're scavenged by animals and other crows, but each day there are more carcasses."

No cases of the killer disease have so far been officially reported in the South Asian country.

Retired civil servant Mrs Barnes spends six months a year in the region but has never seen such frightening sights.

She explained how tourists had seen birds fall from the trees.

"One of the people here was watching a brightly-coloured bird when it just plummeted to the ground," she said.

"It opened its beak a couple of times and promptly died," she said.

Although the Indian government has not officially acknowledged any cases, the country is in a state of high alert.

Two days ago, the Health Minister warned the country faced a 'winter of tension' because of the bird flu threat.

And the Confederation of Indian Industry warned that 'it was not a question of if but when' an epidemic broke out.

Mrs Barnes fears that the authorities are trying to cover up the unexplained bird deaths.

"Tourism is the lifeblood of this area, and it's understandable that they want to protect a major source of income," she said.

"But it's very worrying that British tourists are being unknowingly exposed to the threat."

Hundreds of Midlanders flock to Goa during the tourist destination's holiday period from October to March.

Many are planning to spend their Christmas in the popular south Indian sun spot - and the England cricket team is due to fly out to the area in the new year.

Bird flu has steadily moved from Asia into Europe, spread by migrating birds. A number of birds which died in UK quarantine centres recently were found to have had the deadly H5N1 strain of the virus.

The strain has already killed 67 people in China, Vietnam, Thailand and Indonesia since it broke out in 2003. A further 60 have been infected as a result of close contact with contaminated birds.

As yet, there is no evidence that the disease can pass from person to person. But if, as expected, it does mutate then experts fear it could eventually claim 150 million lives.

Yesterday, the Ukraine became the latest country to fall victim to the virus after domestic fowl were found to have the variety dangerous to humans.

Officials in the former Soviet state yesterday declared a state of emergency after 1,600 birds were found to have died from the illness.

Turkeys and chickens have been slaughtered in their millions in South East Asia, Russia, Turkey, Romania and Greece since the virus first emerged in China in 2003.

In the Indonesian holiday hotspot of Bali thousands of birds were burned alive on huge pyres in scenes reminiscent of the foot and mouth outbreak in the UK.

Indian Health Minister Anbumani Ramadoss said he feared the arrival of thousands of migratory birds from nearby countries hit by avian flu could spark an epidemic.

"This is a winter of tension," he said. "If there were to be human-to-human transmission, it would be a huge challenge for us. We want to nip bird flu in the bud.

"When an outbreak comes, we need the drugs to be available."

By the end of 2006, the Indian Government plans a stockpile of 10 million doses of Tamiflu, the anti-viral avian flu drug supplied by the World Health Organisation.

The country currently has only 20,000 doses - woefully short supply for a country with a population of over a billion.

Dr Swati Piramal, vice-chairman of the Confederation of Indian Industry, said India could face a severe humanitarian crisis if bird flu hit the country. "It is not a question of if, but when," she warned.

"Although the Indian Government has announced there is no cause for alarm, it not prepared for such an eventuality."

Reports of the smuggling of poultry across the border from Myanmar to India and the deaths of as many as 1,500 bar-headed geese in China last May sounded an alarm.

These are birds which migrate to India in winter and could directly spread bird flu.

The Foreign and Commonwealth Office said 400,000 British tourists travel to India every year. The Government department has issued no warnings about bird flu in its travel advice.

But last night, a spokesman said: "We are monitoring developments of avian flu closely and any developments are reflected in our travel advice."

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<B><center>2 Men with Bird Flu Infection Fears in Eastern Romania</font>

Politics: 5 December 2005, Monday.
<A href="http://www.novinite.com/view_news.php?id=56146">www.novinite.com</a></center>

Two men have been hospitalized in Tulcea in Eastern Romania over fears that they have been infected with the deadly bird flu strain H5, local Averia newspaper reports.</b>

The two men have been isolated as a precautionary measure and their health condition is subjected to constant observation. At present the only confirmed diagnose in pneumonia, the head of the local Public Health Directorate said.

Last week Romanian authorities quarantined a Danube Delta village near the Ukrainian border after eight chickens have tested positive for the H5 subtype of bird flu. The prefect in Tulcea County confirmed that the virus struck again in Periprava, a village near the city of Tulcea. The H5 virus was found after tests were made in a local's household. Two localities in Braila are suspect of being possible centers for new bird flu outbreaks.

First cases of the H5 virus in Romania were discovered in mid October in Ceamurlia de Jos and Maliuc villages. British lab tests confirmed the H5N1 strain of bird flu was present in these areas, where authorities killed all the birds and isolated the region in an effort to contain the virus.

Shakey--I waded through a couple pages of posts before starting my thread. i just couldn't find yours.

Maybe a mod can combine our threads for today? Please.

Thanks, again, you guys, for all the info. It almost seems, since Bush acknowledged it, it's dropped out of consciousness. .gov knows about it, so all is well.

squeeks

BTTT

Thanks for keeping these threads up. We may not have much to say about them, but we certainly do appreciate them.

Thanks for the good work..and you are not the only one I have had to thread chase for mine a couple of times also..and i have had to repost in it just to see where it was...I post and then when i go back it is not on the page at all and I have to scroll back to make sure it posted...

Is India hiding something?

Although the Indian government has not officially acknowledged any cases, the country is in a state of high alert.

Two days ago, the Health Minister warned the country faced a 'winter of tension' because of the bird flu threat.

And the Confederation of Indian Industry warned that 'it was not a question of if but when' an epidemic broke out.

Mrs Barnes fears that the authorities are trying to cover up the unexplained bird deaths.

Geesh - I was worried about China cooking the numbers.....

Bumpity-bump.

Pucker Factor Meter reading here is a 6 of 10

DM

It looks like the WHO is continuing to qualify the level of the Pandemic by adding more adjectives to describe the current Pandemic Level, which they are holding at Level 3.

The above article quotes not yet "sustained efficient H2H" with the new qualifier being "sustained", suggesting the bug has become more efficient.

The HPAI H5N1 appears to be recombining with other more contagious flu types and sprouting more human cases in more diverse geography.

I suppose it is too late to confine this to birds - Pandora's Box has been opened.

I wonder if the WHO will jump the Pandemic Level to a 5 and just skip 4?

DustMusher said:

Pucker Factor Meter reading here is a 6 of 10

DM

Click to expand...

<center>

Ya might want to bump that up a tad



When you read today's H5N1 thread.
Note how many groups/Govts are
preparing for a *Worst Case* senerio</center>

Moved to todays thread.....

30 million doses is not much of an effort - just a drop in the bucket. I suspect this prophylaxis is for the Caregivers/First Responders/Politicians and is preliminary to Pandemic Level 6 in Asia in next 30 days.

--------------------------------------------------------------------------------

http://www.channelnewsasia.com/stor.../182281/1/.html

Time is GMT + 8 hours
Posted: 06 December 2005 2144 hrs

WHO starts stockpiling antiviral drug Tamiflu for region
By Hasnita A Majid, Channel NewsAsia





SINGAPORE : The World Health Organisation is stockpiling the antiviral drug, Tamiflu for the region in case of an outbreak of the H5N1 virus among humans.

It says the best chance of preventing a pandemic is for the avian flu virus to be contained early in the rural areas of any country and it is taking no chances.

The WHO is working on pre-emptive measures such as stockpiling 3 million doses of the antiviral drug, Tamiflu by next June, to help countries with outbreaks that could potentially become a pandemic.

Dr Hitoshi Oshitani, Regional Advisor in Communicable Disease, Surveillance and Response, WHO, said: "We are talking about prophylactics, not treatment. We want to contain a virus with pandemic potential in the early stage so therefore prophylactics. The recommended dose may be enough to prevent transmission in the people."

However he noted that there was still no case of an efficient human to human transmission.

"There could have been an event that might have been caused by some limited human to human transmission. But as long as the current situation continue with the large outbreaks in poultry and the continuing human cases, the risk of pandemic is increasing but it's difficult or impossible to say when such a pandemic will start," he added.

Roche, the pharmaceutical company that produces Tamiflu is providing 10 million Tamiflu tablets.

WHO is in talks with countries like Japan and the Asian Development Bank to provide the other 20 million.

The topic of drug donation will also be the main issue for discussion at a meeting in Beijing next month.

Roche is also providing the WHO with 10 million Tamiflu tablets by the end of the year.

The H5N1 virus which originated from poultry has infected 133 people in Asia, with 68 deaths.

Dr Oshitani says that there's evidence that the H5N1 virus is already entrenched in some Asian countries.

Outbreaks have occurred despite aggressive control measures including the culling of 150 million poultry since September this year.

As such, WHO has urged countries to have a national pandemic preparedness plan to prepare for an outbreak.

It's looking at helping countries fund these programmes. - CNA/ch/ls