06/01 | Daily BF: " Bird flu explodes in Indonesia, one death every 2.5 days in May"

Link to yesterday's thread: http://www.timebomb2000.com/vb/showthread.php?t=199132

Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO:

http://www.who.int/csr/disease/avian_influenza/country/cases_table_2006_05_12/en/index.html

Thursday June 1, 2006

Bird flu explodes in Indonesia, one death every 2.5 days in May​

JAKARTA, Indonesia (AP) - Indonesia averaged one human bird flu death every 2 1/2 days in May, putting it on pace to soon surpass Vietnam as the world's hardest-hit country.

The latest death, announced Wednesday, was a 15-year-old boy whose preliminary tests were positive for the H5N1 virus. It comes as international health officials express growing frustration that they must fight Indonesia's stifling bureaucracy as well as the disease.

"We're tying to fix this leak in the roof, and there's a storm,'' World Health Organization spokesman Dick Thompson said. "The storm is: The virus is in animals almost everywhere and the lack of effective attention that's being addressed to the problem.''

Indonesia, a massive archipelago of 17,000 islands that is home to 220 million people, has a patchwork of local, regional and national bureaucracies that often send mixed messages. The ultimate impression, officials said, is often that no one is truly at the helm.

"I don't think anyone can understand it unless you come here and see it for yourself,'' said Steven Bjorge, a WHO epidemiologist in Jakarta. "The amount of decentralization here is breathtaking.'' He said health ministry officials will often meet with outside experts to formulate plans to fight bird flu, but the schemes are rarely realized.

"Their power only extends to the walls of their office,'' Bjorge said, adding their advice must reach nearly 450 districts, where local officials decide whether to take action in a nation that spans roughly the width of the United States.

Indonesia has undergone a sometimes rocky transition to democracy since dictator Suharto was ousted in 1998. Many powers once held in Jakarta have been given to regional and community governments.

But the process has been haphazard, and funding and policy decisions are often at the whim of inexperienced officials, mayors and village heads.

National government officials concede the problem. "The local government has the money, thus the power to decide what to prioritize,'' Wibisono said. "If some district sees bird flu as not important, then we have a problem.''

Indonesia has logged at least 36 human deaths in the past year - 25 since January - and is expected to soon eclipse Vietnam's 42 fatalities. The two countries make up the bulk of the world's 127 total deaths since the virus began ripping through Asian poultry stocks in late 2003.

Attention has been fixed for the past week on one village on Sumatra island where six of seven relatives died of bird flu. An eighth family member was buried before samples were collected, but WHO considers her part of the cluster.

Experts have not been able to link contact between the relatives and infected birds, which has led them to suspect limited human-to-human transmission may have occurred. But no one outside the family of blood relatives - no spouses - has fallen ill and experts have said the virus has not mutated in any way.

Scientists believe human-to-human transmission has occurred in a handful of other smaller family clusters, all involving blood relatives. Experts theorize that may mean some people have a genetic susceptibility to the disease, but no evidence supports that.

The disease remains hard for people to catch and most human cases have been traced to contact with infected birds. Experts fear the virus will mutate into a highly contagious form that passes easily among people, possibly sparking a pandemic with a death toll of millions.

Experts say the best way to battle bird flu in Indonesia is to tackle it in poultry. But that message is not getting through to all levels. Many local governments have refused to carry out mass poultry slaughters in infected areas and vaccinations have been sporadic at best.

Such measures have helped other hard-hit countries like Vietnam and Thailand to curb outbreaks. Both have strong central governments that have taken a leading role in ensuring plans are carried out at the village level.

The U.N. Food and Agriculture Organization has been working with officials to improve poultry surveillance in Indonesia and quicken response times to outbreaks. But public awareness and bio-security standards remain low in the densely populated countryside, home to hundreds of millions of backyard chickens.

"It's not quite so easy here, where you have to have the local authorities and provincial authorities and national all on board,'' said Jeff Mariner, an animal health expert from Tufts University in Massachusetts working with the FAO in Jakarta.

"We find outbreaks every week scattered throughout Java. It's a diffusely endemic disease. In most districts, you can find it at any time,'' he said. "It's a staggering undertaking in a decentralized country.'' - AP

http://thestar.com.my/news/story.asp?file=/2006/6/1/apworld/20060601085252&sec=apworld

U.S. Poultry Experts Using Google to Beat Bird Flu​

May 31, 2006

By Reuters , eWEEK
LOS ANGELES (Reuters)—Poultry experts are turning to sophisticated computer imaging to help them prepare for the expected arrival of the deadly bird flu virus in the United States later in 2006.

Geographic Information System (GIS) technology is being used to pinpoint the location of commercial poultry flocks, feed mills and processing plants, said Sherrill Davison, professor of avian medicine at the University of Pennsylvania.

The information will be used to help create buffer zones around an infected flock and contain the H5N1 strain when it makes its U.S. appearance.

Since the beginning of the year, experts have also been using Google Earth, which combines satellite imagery, maps and the company's search engine to span the globe. It gives extra details including the location of buildings, schools and roads near large chicken and turkey farms and production facilities.

"Twenty years ago we had to drive around the countryside and find the chicken farm that reported a disease, but now everything is on a mapping system," Davison told Reuters in a recent interview.

"Now, we can very quickly, within about an hour, know exactly how many farms are in an (affected) area. Then we can know which farms to send teams to for extra sampling.

"It may be there is an infected flock but they are out in the middle of nowhere and so the probability of spread to another farm is very minimal," she said.

The H5N1 virus that has infected birds and chickens in Asia, Africa and Europe and caused more than 120 deaths there is expected to arrive in North America this summer via migrating birds flying from Asia to Alaska and southwards.

Testing of wild birds is already underway in Alaska but no signs of the bird flu virus have yet been found.

Davison and colleagues at the University of Pennsylvania were among the first to develop GIS technology to monitor poultry flocks in the state in 1998.

They have since used it to detect and control—by swift culling—minor outbreaks of avian diseases in Pennsylvania, which ranks third in the United States in chicken production.
Other U.S. states have since adopted the system.

"Many states do have this type of a mapping system which helps with a rapid response that reduces the spread of disease," Davison said.

"We began using Google Earth to help us locate poultry farms more exactly. In the past we knew the chicken house was on a parcel of land but now we can zoom in and tell exactly where on the property it is. ... It is another tool to add into our rapid response program."

http://www.extremetech.com/article2/0,1697,1969701,00.asp

Indonesia has logged at least 36 human deaths in the past year - 25 since January - and is expected to soon eclipse Vietnam's 42 fatalities. The two countries make up the bulk of the world's 127 total deaths since the virus began spreading in Asian poultry stocks in late 2003.
19:05:02 EDT May 31, 2006
MARGIE MASON

Compare this tally to the WHO-

Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO

12 May 2006


Indonesia total 25


Something does not compute ??? Could someone clarify this for me ???

Wargus said:

Indonesia has logged at least 36 human deaths in the past year - 25 since January - and is expected to soon eclipse Vietnam's 42 fatalities. The two countries make up the bulk of the world's 127 total deaths since the virus began spreading in Asian poultry stocks in late 2003.
19:05:02 EDT May 31, 2006
MARGIE MASON

Compare this tally to the WHO-

Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO

12 May 2006


Indonesia total 25


Something does not compute ??? Could someone clarify this for me ???

Click to expand...

It appears WHO has not updated their numbers since May 12th. Their webmaster is asleep at the wheel?

Not surprising... CDC was slow to update their numbers, and a couple of weeks ago completely quit the H5N1 tables, they had been keeping since 2003.

=



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Study: Animal Vet Shortage May Affect Food ​

UPDATED - Thursday June 01, 2006 5:03am from our sister station WJLA-TV

KANSAS CITY, Mo. (AP) - Food safety and America's ability to handle outbreaks of catastrophic animal diseases are being threatened by a projected shortage in food animal veterinarians, a new study shows.The study, commissioned in 2004 by a coalition of veterinary organizations and conducted by Kansas State University's College of Business Administration, projects a major shortfall in the vets, which specialize in handling livestock, by 2016.

The projected shortfall comes as Americans are increasingly aware of bird flu and foot-and-mouth disease, and meat exports have been curtailed by skeptical nations like Japan, which has twice cited concerns over mad cow disease (news) in closing its lucrative market to U.S. beef.

"Not having enough veterinarians in rural communities, out in the field, to do adequate disease surveillance threatens our food security," said Dr. Lyle Vogel, director of the Animal Welfare Division of the American Veterinary Medical Association. "For the first time, this study has scientifically documented there is a shortage and shown the shortage is going to get worse."

The study, released Thursday and the most comprehensive of its kind, found that while demand for food animal veterinarians is projected to increase 12 to 13 percent over the next decade, four out of every 100 jobs will go unfilled.

The shortfall is also expected to affect government agencies like the U.S. Agriculture (website/news) Department's Animal and Plant Health Inspection Service, which is entrusted with protecting U.S. agricultural health.

USDA officials declined to comment without seeing the report. Spokesman Jim Rogers said disease response teams can be on the ground anywhere in the U.S. within four hours.

The study also debunked the myth that food animal veterinarians earn less than small-animal practices. According to 2003 data from the AVMA, only 4 percent of all veterinarians worked exclusively on large animals. But their median income was about $6,000 per year more than those working exclusively on small animals.

But donning overalls and rubber boots to deliver calves at all hours of the night remains an intrinsic part of the job — an unappealing aspect to students who are coming in fewer numbers from rural backgrounds.

"It's a national trend," said Dr. Ralph Richardson, dean of the College of Veterinary Medicine at Kansas State University, one of the nation's top agricultural and veterinary schools. "I've tracked the job opportunities for veterinary graduates and it's fairly consistent. It's clearly an increasing problem."

The study suggested improved recruiting strategies emphasizing food animal careers, loan forgiveness and other incentives, and improving the image of rural veterinarians as the most promising ways to attract students.

Congress in 2003 approved legislation to provide college loan forgiveness for newer veterinarians, although Vogel said the program has not received adequate funding, and states like Kansas have implemented similar programs to retain students willing to work in underserved areas and disciplines such as large animal care.

http://www.wjla.com/headlines/0606/332615.html

:VIK:

my daughter who is now 18, has planned to be a livestock vet since she was about 5

small animal vets are a dime a dozen around here, and have shown that they are all after the big bucks--I can't have our cats vaccinated for rabies without having a 100.00 physical exam for each one

There are no more livestock vets around for what few farmers there are who keep livestock

so her plan has always been to work livestock as a help to the small farmers at about cost, and then work small animal some each month for living expenses

she's a very compasionate, thoughtful, dig really deep to find out what the problem is type--some would call her overthinking--she had a teacher who did that, but it's a good trait for a vet

she'd like to donate a couple of years to Heifer Internatioanl after graduation

she is actualy, and has been planning this for years, going to get her undergradute degree in poultry science

sounds like she's been on the right path

just hope these articles don't fill the vet school ahead of her--if the world is still in some symblance of normal

anyone ever feel like they're living in two worlds?

In searching for more info to address adhgal's query from yesterday, I have been reading several of the Preparedness pages at http://www.fluwikie.com/pmwiki.php?n=Consequences.PandemicPreparednessGuides and found this to be especially thorough:



Personal Pandemic Preparedness
by eyeswideopen


Preliminary considerations:

There will most likely not be a targeted vaccine until about 6 months after pandemic has begun; any vaccine prepared ahead of the pandemic will likely confer only partial protection

There will most likely not be enough antivirals for treatment, let alone prophylactic use

Assume a quarter to a half of the public will become infected over a 3 month period (a flu wave, of which there usually are 3 — the worst being the 2nd — a few weeks or months apart) and 3/4 to a half staffing everywhere for various durations

Virus will be shed before symptoms appear (which can be 3 - 6, up to even 17 days) and after symptoms (21 days for children, 3–5 days for adults, longer for the immunocompromised)

Children and otherwise healthy young adults are disproportionately at risk
All bodily excreta will be very dangerous, especially feces and sputum/mucus; virus often multiplies in gut and diarrhea is often first symptom, preceding respiratory symptoms

We will probably need two or more times the hospital beds and ICU facilities
There will probably be mortality of at least an extra 50% beyond normal; a high percentage of these are likely to be under 65 years old, which comprise workers in essential services

Most patients should probably be treated in the home, or if more critical, in secondary ICU-like set ups in schools or other locations

Hospitals will need to continue their usual work and erect a firewall to protect vulnerable inmates from flu

Childcare and family nursing responsibilities will strain ability of healthcare workers and other essential infrastructure workers to provide services

Public services such as water, power, waste disposal, communications, and transportation will likely be intermittently interrupted

Deliveries of food and other essential commodities may be disrupted
There may be civil disorder due to shortages and desperation

↓ edit · top ↑


Personal Bird Flu Preparedness

Don’t panic.

Get into the habit of washing your hands 20 seconds hot water with soap or ethanol hand sanitizer; carry antiseptic wipes

Get into the habit of coughing/sneezing into the crook of your arm/sleeve or better yet, use tissue, not your hands; hands are a major means of spreading germs; virus lasts up to 48 hours on steel and plastic; 12 hours on cloth and paper.

Get a flu shot and if over 50 a pneumovax

Consider preparations to isolate yourself for about 3–6 months

Stock up on potable water and food with long shelf-life, water, medicines, basic household necessities (toilet paper, paper towels, plastic bags, tissues, plain bleach, soaps and detergents, batteries etc) masks, latex gloves, sugar, salt, multivitamins, and other staples

Accumulate vacation time

Make contingency arrangements with your workplace to be able to work from home if possible

Be prepared for essential services to be interrupted: see AlphaGeek’s 5 part series on emergency preparedness and the Red Cross’s Disaster planning booklets from the Pandemic Preparedness Guides page

Learn how to treat water to make it potable (or at least usable for washing) in case of interruptions of water supply link

If possible, start a vegetable garden and/or orchard

Learn basic cooking if necessary

Get a clothesline and clothespins or folding drying rack

Put together a basic set of handyman tools and learn how to use them

Have a mobile phone and an email address; get high-speed computer access

Get a passport or other photo ID and credit card if you don’t already have them; use electronic transactions preferentially

Save money; have cash on hand

Consider getting a good bicycle

Consider learning self-defense and acquire pepper spray and/or stun device

Ensure car(s) are in good working order, have good spare tires, maps, and keep car filled with fuel. Get a good fuel can for extra fuel

Remember that your car is a generator; all you need is a DC/AC inverter and cable (do not idle car in closed area where Carbon Monoxide poisoning may occur)

Exercise regularly in order to strengthen your heart and lungs; taking care of your health now will benefit you later

If you smoke, stop now

Get a physical exam and get your medical history and records in order; include list of necessary medicines

Put medical and financial records onto a small flash data card (keep updated)

If you have high cholesterol, take statin drugs — they apparently reduce flu complications as a beneficial side effect

If you have gout, use probenecid, as it will double the half-life of Tamiflu in the body, thereby stretching supplies

Learn how to take blood pressure, pulse, temperature, respiration rate; learn basic first aid and nursing procedures

Stock your medicine cabinet: aspirin and other OTC pain relievers, codeine, phenergan, vallium, Tamiflu or Relenza (use Relenza only in those 7 years or older, without COPD or asthma) if possible

Obtain a stockpile of essential medicines; contact your doctor explaining why; watch expiration dates

Be sure you have a complete first aid kit

Prepare a living will and a regular will; arrange for organ donation (if you wish)

Network with your friends and family about plans with respect to pandemic

Think about how to isolate yourself and your family, minimizing contact with others, for 3 months

Learn as much as you can about bird flu

Consider how you can help during a pandemic (preferably if you are resistant to the virus through vaccination or survival); volunteer for training with local hospital, CERT or Red Cross

Expand alternate means of communication such as teleconferencing, cell phones, landlines, email, ham radio, CB radio with single sideband capability

Until further notice, avoid getting pregnant

↓ edit · top ↑


Should Birds in the US Become Infected:

Wash eggs to remove fecal traces and cook all poultry products thoroughly (use food thermometer — cook to 158 degrees F.) if you continue to consume them; eggs should not be runny; avoid raw egg products such as mayonnaise, some ice creams, etc.

Avoid contaminating other foods with raw poultry juices

Wash hands before and after handling food

Sanitize cutting boards, knife, and counter tops with hot soapy water or a bleach solution 1 tsp bleach to 1 qt water)

Avoid sick or dead birds, especially wild birds

If you keep birds, prevent any contact with wild birds or the excreta thereof; keep them under cover

Report suspicious instances of sick or dead birds

Keep pet cats away from dead birds; A(H5N1) can infect cats. Although A(H5N1) has not been seen in dogs, it would be wise to keep pet dogs away, too

Put enhanced hygiene measures into high gear

↓ edit · top ↑


Should a pandemic occur:

Put enhanced hygiene measures into highest gear

Avoid close contact and shaking hands, restrict visitors, avoid mass transit and gatherings of people. Infective radius around someone with flu is about 3 feet, so adjust your social distance

Avoid touching eyes, nose and mouth

Wear glasses instead of contact lenses so you minimize touching your eyes

Don’t share eating utensils, glasses, etc.

Avoid directly touching water taps and doorknobs

Wash or sanitize hands after touching anything that others may have touched

Disinfect surfaces (door knobs, keyboards, phones, money, taps etc.) with 1:50 bleach (1 cup bleach to 5 gallons water) or 70% alcohol solution: leave on surface for 2 minutes; surfaces contaminated with body fluids should sit 10–15 minutes in a 1:10 (1 cup bleach to 1 gallon water) bleach solution

Wear disposable surgical masks in public

Pull your kids out of school; home school (hopefully using internet resources to be made available)

Work from home if possible

Organize your neighborhood so you can share goods and take care of each other; survivors will be more resistant and thus able to run essential errands for others, if they have fully recovered

Learn how to identify bird flu symptoms and learn effective nursing specific to the disease (classes may be offered at your local hospital)

Designate a sick room area that is treated with an increased hygienic sensibility, make it easy to clean; perhaps use an antiviral air filter

Laundry should be done in hot water, with bleach to sterilize
If you can afford it, get an oxygen concentrator and needed tubes

Download a copy of Dr. Woodson’s Personal Preparedness Guide for Avian Flu

Keep your plumbing in good working order via preventive measures; should someone in your household become ill, feces are full of virus and thus are very dangerous; it may become very difficult to find a plumber (copper sulfate for tree roots in pipes, bleach gel for clearing pipes (never use bleach with ammonia), or use commercial treatments)

Keep yourself informed with updates

Handle incoming mail with caution

Sterilization of appropriate items can be done in a microwave (3 minutes on high)

Get a trash can with a foot-activated lid to use as a bag-lined biohazard waste bin for used masks, gloves, etc.

Utilize electronic and internet transactions preferentially; delivery systems should be less vulnerable due to limited interactions with people, although driver and fuel shortages could hinder

Consider removing facial hair to improve fit of filtering masks

Learn how to properly fit filtering masks to avoid leaks

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If you get sick:

Stay home if you become ill or if you feel you might have been exposed to the virus; see below, last entry

If you are concerned that you have been exposed and possibly infected, immediately contact healthcare professionals

If you get sick, immediately get Tamiflu or Relenza and take it — it must be taken within 36 hours of onset; do not take it as a preventative as it only protects for the duration you take it. You are vulnerable thereafter. Tamiflu: 2 x 75 mg caps for 7 days

If you get very sick, contact healthcare professionals or go to designated medical facility for A(H5N1)

Wear a mask as much as possible when others are around

↓ edit · top ↑


If you are nursing a sick patient:

Wear N95 mask (ensure proper fit), gown, hair covering and goggles

Wash up thoroughly after every contact

The most important thing is to keep patient hydrated to avoid dehydration; diarrhea, vomiting, and high fever make this all the more critical

You will need to make a fluid replacement fluid using clean water (1 qt.), sugar (3 Tbsp.), and salt (1/4 tsp.) (see Dr. Woodson’s guide for directions); you will have to force fluids, drop by drop if necessary

You will need Tamiflu or Relenza, hydrocodone, phenergan, and vallium as well as antipyretics such as aspirin, acetaminophen, ibuprofen

Give patient a bell or other means of signaling you

You may need an oxygen concentrator to deliver oxygen to the patient: there are services renting these but they will probably be in short supply

Lower a very high fever to about 101 degrees F, the optimum temperature to fight the virus; use antipyretics like acetaminophen or ibuprofen or (in adults) aspirin and a lukewarm moist compress

Patient may have diarrhea early on; feces contain virus; you may need a bed pan or bedside commode; be very cautious in emptying; sterilize with bleach solution

Consider rigging a make-shift curtain around the patient if possible

Be exceedingly careful in handling all materials in contact with the patient such as laundry and utensils; disinfect using bleach

Burn all used kleenexes used by flu patient; they are hazardous waste

Use trash bag-lined biohazard trash bin (foot activated lid)

All contacts of A(H5N1) victim should monitor their own temperature and symptoms; self-quarantine for 1 week and check daily for 14 days after last exposure for signs of fever, influenza-like symptoms, and gastrointestinal symptoms; possible postexposure chemoprophylaxis with 75 mg Tamiflu 1x day for 7–10 days, ask healthcare professional (it is doubtful there will be sufficient Tamiflu for this sort of usage except in very serious situations)

Isolate the patient from CDC and WHO “Infection Control for Viral Haemorrhagic Fevers”

Planning and setting up the isolation area from CDC and WHO “Infection Control for Viral Haemorrhagic Fevers”

↓ edit · top ↑


WHEN SERVICES FAIL:

Electricity:

all else flows from electricity: heat, food preparation, communications, lighting, computing, entertainment

DC to AC inverter to use car as generator (not in a closed space: CO poisoning) as long as there is gasoline; have a self-contained jumpstarter on hand in case you run down your car battery, REMEMBER: use the inverter off the car battery with the engine off

For short term AC: House power to truck battery charger to 75 amp batteries in parallel to inverter, charge one battery then add batteries one at a time, wire size dependant on the number of batteries

5 gallon (bright red) fuel can full, stabilized with Sta-Bil (a double dose keeps it fresh 2 years), stored carefully, protected, away from the house; date it

Consider a backup solar system with battery array

Lighting:

Battery-operated LED lanterns for ambient light

Solar battery charger (solar and LED gear: http://store.sundancesolar.com)

If you use candles or candle lantern, be careful as they are a fire hazard

Hand-crank or shake flashlights

LED lightbulbs (standard base) 2 or 4 watt, if you have limited backup electricity like solar/wind/batteries

Communications:

passive:

Radio: hand cranked or battery-powered, solar battery charger; XM satellite radio has a 24/7 emergency channel, consider getting a receiver

TV: small portable TV with multiple power options (assuming TV stations are up and running)

active: phones, internet, loud whistle

Roll of quarters, prepaid phone card for pay phones (locate them in your area)

Have at least one old-style low-power telephone (not cordless) that can function without electricity

Prepare and carry a laminated card with all important contact information

Obtain a cellphone if you don’t already have one; learn how to send/receive text messages on your cellphone; familiarize yourself with wireless data capabilities of phone

Manual cell phone charger like Sidewinder

For internet when there is no electricity: use battery-powered laptop; recharge via car/DC-AC inverter or portable solar panel, REMEMBER: use the inverter off the car battery with the engine off

Entertainment:

Books, games, musical instruments

Battery-operated DVD and CD players

Natural gas:

Warmth:

Close off unused areas of house; seal off with plastic and duct tape; cover walls and floors with rugs and blankets;

Fireplace with reflector or wood stove; fleece clothing

Emergency heating: Coleman Catalytic Heater and lots of 1 lb propane canisters (3/day)

Cooking and hot water:

Barbecue with briquettes or coal (must be used with proper ventilation)

Jetboil or other camp stove such as Coleman, plus fuel cartridges

Solar cooker and solar water heater (Super solar shower, 4 gal capacity)

Grate for cooking on fireplace fire

Water:

Store about 50 gallons of potable water; consider obtaining a food grade 55 gallon water storage barrel, keep it fresh

Learn how to purify water (rolling boil for 10 minutes, use AquaPak solar sterilizer, filtration. chemical, etc) link

Obtain water purifier such as Exstream Orinoco or Exstream Mackenzie water bottle for small amounts; First Need Deluxe Portable water purifier/filter for groups (get spare cartridges)

Use swimming pool water for non-drinking uses such as washing

If water pressure drops, indicating failure, shut off master valve to avoid contamination to water in your system; then, water in hot water heater tanks can still be used

Food:

Dried and canned foods, rice and beans, food bars, trail mix, candy bars, etc

Staples such as sugar, flour, salt, pepper, spices, Parmalat or dried or canned milk

Plant fruit trees, vegetable garden

Food preservation: 5 day super-insulated coolers with wheels; unload the contents of your freezer into them as soon as power goes out; keep in cool place; consider getting a small car-sized 12 volt DC mini cooler if you have medicines requiring refrigeration

Transportation:

mobility may be restricted, mass transit could be hazardous, and fuel shortages are likely

Consider getting a bicycle

Safely store extra fuel (see above, under electricity)

Get car with highest MPG

Hygiene:

Laundry, dish washing, hand washing all need hot water (see above, under natural gas)

Human waste: porta-potty, bucket with lid, or use strong trash bags duct-taped into drained (shut off water to it and then flush until empty) toilet, seal completely and dispose of after use; there are digesting enzymes and deodorants for toilet bags; use bleach solution to sterilize

Trash: compost pile for non-meat organic waste; paper can be burned if trash and recycling pickups are interrupted

Baking soda and white vinegar can serve as cleaners and deodorizers for many purposes if you run out of detergents

Moist baby wipes (unscented), Purell waterless hand sanitizer (use one with ethanol), rubber gloves

The above “When Services Fail” section is a very brief outline largely based on pertinent aspects of AlphaGeek’s excellent and highly recommended 5 part guide on Disaster Preparedness (scroll down to links) or at Daily Kos

Vere My Sone said:

my daughter who is now 18, has planned to be a livestock vet since she was about 5

Click to expand...

VMS, sounds like the 'All Creatures Great and Small" books...

It appears she has a bent for a field which will be in demand... if she plays her cards right, there might be minimal loans to deal with later... good luck

Surface Disinfectants and Germicides
So Many Choices, So Many Bugs
By Kathy Dix

Keeping healthcare surfaces clean is not just a matter of slapping bleach on a tabletop and calling it clean. In general, cleaning staff can use a broad-spectrum, all-purpose disinfectant, but in special cases, the healthcare team must consider which product is right for the situation.

E nvironmental services (ES) staff is often at a disadvantage — they may not be aware of a particularly hardy bug that has been discovered in a patient room or a procedure room. Nurses and other healthcare personnel must be responsible for notifying ES staff if a patient is found to have C. difficile or another hard-to-kill bug. These situations call for special solutions.

Observations From the Manufacturer

“Overall, in most cases, they talk about standard disinfection for noncritical surfaces, which are housekeeping surfaces (tables, etc.), and then medical (non-critical) equipment that would touch intact skin like a blood pressure cuff or a stethoscope,” says Judy Anderson, marketing manager for healthcare in 3M’s Commercial Care division. “Standard disinfection procedures are adequate for surfaces contaminated with blood and body fluids.

“There are some antibiotic-resistant organisms like methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE), which are easy to kill with low-level disinfectants like a quaternary,” she continues. “They typically will kill those bugs. Norovirus is another one we hear the most about (on cruise ships), but it does happen everywhere, and it is pretty contagious. For norovirus, the Centers for Disease Control and Prevention (CDC) recommends bleach when you have an outbreak. There are some other disinfectants like phenolics that they recommend at two-to-four times the normal dilution rate.

“The thing to consider is that when there is an outbreak on a regular basis, you’re not going to want to do that; bleach is hard on people and hard on hands and surfaces,” she adds.

Clostridium difficile is the pathogen Anderson hears discussed most frequently. C. difficile, which produces spores, is particularly difficult to eradicate. “The bacteria produces spores that are hard to kill, and it’s passed from the fecal route to the hands,” Anderson says. Incontinent patients, and the toilets or other devices they use, will need special attention. Some medical devices that come into contact with the GI tract, like endoscopes and thermometers, also will require special attention, as well as the hands of caregivers. “So much is dependent on the hand contact. That’s where we want to spend our time cleaning — high hand-contact areas,” she adds. “We want to clean the floor so it looks nice, but germs aren’t transmitted from the floor. They’re transmitted from the high hand-contact areas.”

The physical process of cleaning reduces the bioload of C. difficile, says Anderson. “The physical scrubbing or disinfectant is going to reduce the bioload. The thing with C. difficile is that the spores can survive in the environment for a long time because they have a hard shell, and they are resistant to quats and phenolics. One of our infection control consultants attended the most recent SHEA (Society for Healthcare Epidemilogy of America ) meeting and says that Bill Rutala recommended using bleach only if there’s an outbreak. Don’t go there if you don’t have an outbreak; only if you have a high level of C. difficile cases. Bleach damages surfaces, and has no cleaning ability, so you have to clean first and then put it on. The shelf life is very short if it’s in an open container. The smell is bad, it’s hard on people’s skin, and it’s hard on surfaces.”

And, she adds, “There is no quat or intermediate or low-level disinfectant that has a C. difficile claim at this time.”

So in the meantime, Anderson recommends sticking with overall good cleaning procedures. “Are you paying attention to who is cleaning it? Is it an ES person? Is it somebody in nursing? A nurses’ aide? Who has that commode cleaning responsibility? It needs to be good cleaning, not just spritz and wipe. The first step in good disinfection is good physical cleaning.”

Another topic of concern is that of avian flu. “It isn’t here yet but probably will get here eventually,” Anderson observes. “Based on the type of virus it is, it’s similar to other influenzas, and we know what types of viruses those are and what kills the like viruses, so we feel good that the quats are going to kill the H5N1 avian flu.

Nobody has claims against that yet, because the Environmental Protection Agency (EPA) won’t allow the virus to be brought in to get the claim against it, but we feel confi dent that because of the type of virus we know it is and similar types of viruses killed by low level disinfectants, that quats and phenolics should be fi ne against that avian fl u.

Observations From Those “In the Trenches”

Kent Miller, CHESP/CLLM, director of environmental services/linen services at Mercy Medical Center in Cedar Rapids, Iowa, has similar feelings about bleach. “For something specialized, say C. difficile or gastroenteritis, we use a bleach and water mix. I refuse to have staff use all bleach. We use it in high-contact areas only, because it’s so hard on floor surfaces and wall coverings,” he explains.

“Bleach is hard on surfaces and staff. Some places use bleach for disinfectant, but it doesn’t clean; it just kills germs,” he points out. “Our infection control coordinator has been pushing for the use of a standard germicidal, and does not wish to use specialized disinfectants [unless it’s necessary]. That’s fine with me. I turn chemicals down as much as I can to make it less confusing to the staff. You know at least they’re killing 90 percent of germs with the germicidal anyway.” When wiping down a surface with C. difficile on it, Miller suggests using friction to try to remove it from the surface. “That’s the only way to get it off there,” he says.

The hospital has encouraged nurses to notify ES of what special cleaning needs exist with customized signage. “We have several postings for that; our nursing staff are required to put specialized isolation signs on the door if there is going to be contact with gastroenteritis. The sign tells the staff what product to use when they go into the room: ‘You are supposed to use this product,’ is shown right on the placard,” he adds.

“Training” the nursing staff took time, and a subtle approach. “I worked with infection control on this for a while. The nurses were not observing the protocol with signage; they were not putting it up or were not putting up the right sign, designating contact, airborne, or gastro precautions. Our infection control coordinator and the committee already talk to the staff and do audits for hand hygiene. They’re asking about signage when they’re doing that. They ask the staff, ‘How do you wash your hands? Do you use alcohol, or are you washing your hands with soap and water for 15 seconds? What do you do for this isolation room?’ It’s very subtle, and it’s more than just nursing — they ask housekeeping, a lab tech who is on the floor. My staff is more educated than nursing because we talk about it all the time.”

Miller observes, “If ES staff members don’t do their job, we’ll have more healthcare-acquired infections (HAIs) than we need, and that emphasizes how important they are. Our infection control coordinator says the same thing when she comes to our meetings; she emphasizes how important they are. Our infection rate is quite low here. Obviously my staff is doing their job.”

Observations From a Chemist

“There are cases when you want to use something that’s broad spectrum, that has efficacy against a wide variety of pathogens — whether it’s bacteria, virus, or fungi,” agrees Charles Allgood, PhD, technology support leader in human health for the clean and disinfect business with DuPont Safety and Protection. Allgood oversees the research and development activities in support of DuPont’s line of antiseptics and disinfectants.

“But there are plenty of cases when there is a specific organism that is of concern,” he adds. “There’s the chemistry side — will this product work against this organism? Then there’s the regulatory questions — has it been tested for EPA protocols? Has it been submitted? Is it on the approved label? Can you make that claim in the marketplace? In a perfect world, they would all be consistent, but there’s a time and a cost to doing that.

“As a marketer and developer of disinfectants, you have to choose, how many organisms can I put on the label? Should I test everything out there? Obviously you have to prioritize. In some of the things we faced last year, such as with the hurricanes, when you don’t know what the particular threat is, it’s always good to go with something broad-spectrum, because obviously you have a better chance of taking care of something that could be a problem. Conversely, there are other very legitimate reasons to target specific organisms. With bloodborne pathogens, you want something that is effective against hepatitis C and human immunodeficiency virus (HIV). In other cases, if there is a situation where you know you have a problem with MRSA, if you’re in a facility or a place where it’s confirmed or it’s a high probability scenario, like a hospital or nursing home or a jail cell, then you want something that has been proven effective against MRSA,” he adds.

The mere mention of some of these pathogens strikes fear into the most fearless, but Allgood points out that many of the most fearsome bugs are feeble from a durability standpoint. “Some things don’t hang around on surfaces very long. HIV is kind of wimpy from a virus standpoint. But some hepatitis can last a week in a dried bloodstain, just lie there dormant. When it gets moist again, it can be infectious. Some of the spores can last indefinitely. There is a range of how long things will lie around,” he says.

“I think the ones of concern that we see the most are hepatitis and one we get asked about a lot is the C. difficile spores, because they do hang around indefinitely. That’s the whole point of a spore-forming bacteria — it forms the spore so it can survive a harsh environment, and it’s a survival mechanism for the species. To kill the spore is very difficult; it’s the most challenging from a chemistry standpoint. In the U.S., per regulations, something that is sporicidal is pretty much equivalent to a sterilant, so it’s the highest level of efficacy or disinfection you can get. You typically need real extreme conditions to sterilize, like a steam autoclave, which doesn’t work well on spores because they are resistant to heat, so you need very powerful chemistries, which tend to be harsh, corrosive, not nice friendly chemicals, to work with or to put in your facility, and they tend to take a long time. Depending on the chemistry, glutaraldehyde and things like that tend to be very powerful chemistries, but contact times of eight hours are not unheard of. This is in contrast to the more typical 10-minute disinfection time, which is your typical hard surface disinfection.”

Allgood reflects upon the options for killing hardier bugs, such as spores. “That is one of the areas of research in this industry that is an unmet need — something that’s friendly, not so horrible to use, something that does it in a reasonable amount of time,” he envisions. “If you’re in a hospital or something, and need to use a harsh chemistry to kill spores, that is an area that you can’t let people into. Or you’re in a production facility making pharmaceuticals, or in a room where medical procedures take place. That’s down time; that’s lost productivity. That starts to hit the bottom line pretty quickly,” he states.

There is also confusion associated with C. difficile kill claims. Some products claim to kill the vegetative form of C. difficile. “That’s confusing, because it’s the vegetative form. When that bacteria is stressed, that is when it converts itself to spores, which are what survive, so [the disinfectant is] not effective against the spores, and the spore is what’s hanging out, contaminating things, getting people sick. I question the value of a vegetative C. difficile claim, because that could potentially lead to a false sense of security. Then the spores are just getting moved around,” he adds.

“Anthrax is a spore, so it’s almost the same deal as C. difficile from a scientific standpoint on killing it. You need something very strong, something that takes a long time, and the chemistries tend to be corrosive,” Allgood explains.

Other microorganisms have been a focus of disinfectants for decades. “Tuberculosis (TB) has been around a long time; it was the benchmark for disinfectants for a long time,” he adds. “It is more difficult to kill — not as difficult as bacterial spores, but an intermediate/regular bacteria. If something can kill TB, it will kill a lot of stuff that was easy to kill. In some cases, a TB claim was good, because although it’s not a bloodborne pathogen — it’s an aerosolized bacteria. If a product has a TB claim on the label, it gets grandfathered in and is acceptable under the Occupational Safety and Health Administration (OSHA) bloodborne pathogens standard, which says that since it kills TB, there is a high likelihood that it will also kill Hepatitis B or HIV, something like that. TB is not a relic, but I don’t hear much about it from people with immediate concerns about outbreaks. Even among first responders, TB is not on the highest list. It’s always hepatitis and MRSA, which are really hitting people today, especially in the fire service, which has a big problem with hepatitis C infection,” Allgood says. “People are highly sensitized to hepatitis, as well as MRSA, which has moved into nursing homes, schools, and corrections facilities. People are seeing that infections are real, and that MRSA can kill you.”

http://www.infectioncontroltoday.com/articles/661feat6.html

Ethics of Triage and Dilemas of Hish Stress Decision Making

Vaccinate or Not? Treat or Not? Study Looks at Health Decisions
Posted on: 05/31/2006

http://www.infectioncontroltoday.com/hotnews/65h31835614761.html


If a deadly bird flu reaches America, which would you choose: To get a risky experimental vaccine now, or to forego that risk but face an even greater risk of dying in the epidemic? What would you choose for your child? What if you were in charge of public health for your community?

A new study probes how we make such tricky decisions, and how our decisions might change dramatically if we step back and put ourselves in the shoes of others.

The findings may help individuals who face tough health choices, and decision-makers who make choices for larger groups. It may also help illuminate situations where individuals make medical decisions that go against the advice from experts and authorities, and help guide doctors in advising patients.

In the June issue of the Journal of General Internal Medicine, a team from the University of Michigan Medical School and the VA Ann Arbor Healthcare System report the results of a medical decision-making study involving nearly 2,400 people of all ages and backgrounds who completed extensive online questionnaires.

Study participants were first randomly divided into four groups. People in one group of participants were asked to imagine themselves as patients in two different medical scenarios — an experimental vaccine against a deadly flu and chemotherapy for a slow-growing cancer — and asked to choose either to get the medical option or to take their chances without it. Each of the options carried risks and benefits, though the statistically better choice in each scenario was to get the vaccine or chemotherapy.

The remaining three groups of participants also read the same medical scenarios, but they were asked to think about the problem from different perspectives. One group put themselves in the shoes of a doctor advising a patient, another took the role of a parent deciding for a child, and a third group imagined being a medical director of a hospital making a guideline for treating many patients. All four groups made treatment choices and also reported what emotions each of those decisions provoked.

The results were striking. Only 48 percent of individuals who imagined being the patient said they would choose the flu vaccine for themselves, but 57 percent of those imagining being parents would decide to vaccinate a child, 63 percent of respondents taking on a physician role would advise a patient to get it, and 73 percent of those acting as medical directors would choose to vaccinate large numbers of patients.

The same pattern repeated for the chemotherapy scenario, with 60 percent choosing it for themselves, 72 percent choosing it for their children and 68 percent opting to advise individual patients and groups to get it.

“It’s very hard to see the big picture when faced with a tough medical decision,” says lead author Brian Zikmund-Fisher, PhD. “We get wrapped up in our own situation, and that perspective makes us focus on certain aspects of problem and ignore others.” It’s also human nature to avoid an option that might bring immediate harm upon yourself — even when a “wait and see” approach may carry even greater risks than taking action. It’s a reaction that researchers call the “omission tendency.”

“Trying to step into someone else’s shoes might give you a different perspective when you have a difficult health decision to make,” Zikmund-Fisher explains. “If we take a moment, pause and consider the situation from a different angle, then that may help us see all the different pieces of information that are relevant. If we do that, we may end up making a different choice, but even if we don’t, we can be confident that we have made an informed choice.”

The study also highlights another human tendency that arises when we’re in the position of making decisions on behalf of another person: to try to do everything in our power to help them. Whether it’s parents deciding for their children, a woman choosing for her incapacitated husband, or an adult choosing for an elderly parent, these kinds of decisions happen every day.

“In such cases, the natural assumption is that the patient’s doctors would make the same decision as you would, but that’s not necessarily true because they’re seeing the situation from a different perspective,” says Zikmund-Fisher, a decision scientist and research investigator at the U-M Medical School’s Center for Behavioral & Decision Sciences in Medicine who holds VA and U-M positions.

Just as the participants in the new study did when they put themselves in the shoes of a doctor or medical director, medical professionals may tend to choose more proactive treatment even if it carries risks, the researchers say. From their perspective, taking action is a more justifiable choice than doing nothing and accepting even greater risks. The same is true for medical directors of hospitals or insurance plans, who must make defensible, justifiable decisions for groups of patients.

The study’s results also suggest that doctors should not shy away from guiding patients’ choices, as some studies have suggested may be happening in this age of “consumer-driven” health care. Doctors can provide a valuable perspective on a medical choice, without being paternalistic, when they present patients with information about their condition and treatment options.

The study’s senior author, Peter Ubel, MD, director of the CDBSM and a professor of internal medicine at the U-M Medical School, believes that the study sheds light on tension in the doctor/patient relationship: “Most people try to follow the golden rule, doing unto others as they’d do unto themselves. But in this study, people seem to be following some other rule; the platinum rule, maybe? They do differently unto others than they would do unto themselves and, for the health situations we studied, they actually made better decisions for other people than they made for themselves. If physicians think this way when talking with patients, they may end up helping patients by talking them into decisions — good decisions — that they otherwise would not make.”

The researchers were surprised by what they found when they tabulated the emotional responses reported by the study participants for each scenario. Interestingly, the scenarios that involved deciding for a child or a patient triggered more emotional involvement than those involving decisions for oneself. Zikmund-Fisher speculates that this may be because it’s easier to summon up the potential emotional impact of making a wrenching decision for someone else than to imagine oneself in a situation that doesn’t exist.

Now, the researchers are working to extend their work into studying decisions about end-of-life situations, where choices are often wrenching for families and clinicians alike. They also hope to perform studies of specific patient populations, rather than the general public sample used in the current study. In addition to Zikmund-Fisher and Ubel, the study’s authors are Angela Fagerlin, PhD, and Brianna Sarr, BS, of the CDBSM. The study was funded by the National Institutes of Health.

Source: University of Michigan Medical School

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<B><font size=+1 color=blue><center>The scary truth about bird flu </font>

Jackie Cameron
Posted: Thu, 01 Jun 2006 16:00
<A href="http://www.moneyweb.co.za/specials/african_economic_summit/477755.htm">www.moneyweb.co.za</a></center>
With the transmission of bird flu between humans, you can expect economic growth around the world to be slashed in half and the reverberations felt through global financial markets.

Importers and exporters can expect major trade problems in general as authorities battle to stop the spread of the virus. Farmers and suppliers of chickens and related produce can expect a fall-off in demand as consumers shun them as a food source and a general panic sets in.</b>

But it’s not just those companies and people involved in the agricultural sector who have reason to fear bird flu: along with a pandemic will come mass absenteeism as businesses are required to play a role in stemming the spread of the disease.

The travel and tourism sectors will be particularly hard hit as the potentially deadly virus sweeps the continent and the globe.

A conservative 2m to 7m people are expected to die, though at least 40m deaths are possible, if the virus develops from one that is spread by birds - and only passed on to humans where there is direct contact - to one that is shared as easily as the common flu.

That was the picture painted by business and government players at the World Economic Forum (WEF) on Africa where they were grappling with the possibility that the continent could soon become a battleground in the struggle against avian influenza.

Much of the emphasis was on how the H5N1 virus would impact on people in more rural parts of Africa, where they live close to their chickens and poultry is a major source of protein.

There is the fear that the virus will not be recognised in more remote areas timeously as well as a concern that farmers will be reluctant to slaughter chickens in preventative programmes or where the virus is detected.

But if you’re in any business, large or small, you can’t expect to overlook this risk as it will affect your bottom line, warned the top-level panel of politicians and business executives in a side discussion at the WEF.

They were quick to emphasise that panic should be avoided and that, at this stage, a bird flu pandemic is just a risk.

Nevertheless, the evidence that a pandemic is just around the corner was overwhelming.

Bird flu is just a test away

World Health Organisation official Idrissa Sow said the world is “one last step” from a pandemic, with the bird flu virus fulfilling most of the criteria. “Spreading easily and sustainably from humans” to humans is the last step.

So far there is no evidence that this has happened, however health authorities are concerned about a recent case in Indonesia where at least seven in a family died and contact with the bird has not been confirmed. Mutation of the virus has also not been confirmed.

“If we get mutation confirmed in the laboratory, then we are in a pandemic. This will move around the world in six months,” cautioned Sow.

Gary Cohen, president, BD Medical, Becton Dickinson and company, said no country in the world was adequately prepared for bird flu, though some are better prepared than others.

There is no guarantee any country will be able to contain bird flu if it becomes human-transmissible.

African countries, meanwhile, have been meeting to thrash out strategies, as Thoko Didiza, Minister of Public Works and formerly agriculture minister in South Africa, notes: “There are no border gates for birds.”

She said that South Africa had achieved some success in curtailing outbreaks of other diseases in animals recently, for example foot-and-mouth and classical swine fever.

“From past experience, we have decided to slaughter (chickens) rather than vaccinate…but you need to compensate farmers or they won’t come forward,” she said.

Pharmaceutical companies, meanwhile, are working on vaccines. According to Sow, more than ten candidate vaccines were reviewed in Geneva a few weeks ago.

“However, we are still working on the Vietnam strain…and don’t know we’ll be facing the Vietnam strain,” he added.

Choosing who lives, who dies

In any event, a vaccine, when there is one, is expected to be in short supply. Issues up for consideration will include who gets vaccines and who doesn’t, though there are indications from states that they would nationalise vaccine production.

Also not to be overlooked is ensuring the disease isn’t spread by, for example, lack of hygiene with needles and poor controls in laboratories.

As Sean Cleary, MD of Strategic Concepts, SA, said: “No-one can avoid dealing with bird flu. It won’t respect boundaries.”

High-profile business players like those attending the WEF, as frequent travellers and because they are regularly in meetings, are as vulnerable as chicken farmers in remote villages.

“The standard mid-range estimate is cutting 2% off global GDP. That would involve a halving of growth rates,” said Cleary.

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<B><center>01 June 2006
<font size=+1 color=purple>WEF discusses possible bird flu pandemic in Africa</font>
Sapa

<A href="http://www.businessday.co.za/articles/national.aspx?ID=BD4A209649">www.businessday.co.za</a></center>
DEALING with three different animal diseases in five years has given SA useful experience if avian influenza were to break out, the World Economic Forum meeting in Cape Town heard today.

However, former land affairs minister Thoko Didiza was under no illusions that much more needed to be done nationally, regionally and continentally to prevent an outbreak which might kill millions of people.</b>

Readiness in the public service, improved veterinary systems in sub-Saharan Africa and investment in research were some of the requirements Didiza said.

She was speaking at a session at the WEF meeting, dealing with the effects an outbreak of avian influenza ("bird flu") would have on the continent.

Since the WEF meeting’s theme was focusing on growth in Africa, Didiza highlighted the potential damage an outbreak could have on trade.

A "realistic reaction" of developed countries was a restriction on imports.

Didiza said "regional harmonisation" was important in dealing with the H5N1 strain of bird flu carried by migratory birds.

"As much as we may feel we have done everything as member states [of SADC], the reality is that... there are no border gates and customs for birds. A bird will fly across your space whether you want or don’t want (it to)," Didiza said, linking regional co-ordination to compensation for farmers whose birds are killed.

Dr Idrissa Sow, of the World Health Organisation (WHO), said bird flu was detected in seven African countries since the beginning of the year.

"... Meaning the danger is there," he said.

Egypt and Djibouti were the only two African states where human deaths from the disease were known, with the WHO website reporting a global mortality rate of more than 50%, or 127 deaths from 224 human cases.

"Nothing yet in sub-Saharan Africa... but that doesn’t mean we should not be prepared," Sow said, adding that the "last stage" of the pandemic had now been reached.

He noted an alert two weeks ago in Indonesia where seven out of eight family members died, suggesting the disease was spreading easily among humans.

Sow said 46 African states had plans of action, with the recently adopted Libreville Declaration highlighting possible gaps needing attention.

Giving a private sector perspective, Gary Cohen of BD Medical in the US, said no country in the world was prepared to deal with the pandemic flu.

"About the only thing that I can tell that is encouraging with respect to that, is that it is very uncertain that a pandemic flu will occur," he said.

Cohen said one of the key concerns was the devastating effect the flu would have in sub-Saharan Africa, which lacked adequate health care systems, and was already buckling under the strain of other diseases such as HIV/AIDS.

He said the lack of laboratories on the continent — essential in early detection and surveillance — could scupper efforts to contain outbreaks.

The animal disease SA has dealt with in recent years are foot and mouth diseases, swine fever, and avian influenza affecting ostriches.

Commentary

Indonesia Allows Release of Human H5N1 Sequences

Recombinomics Commentary
June 1, 2006

The sequences of virus from the victims of the Indonesia cluster have not been made public. Why not? In the article, there is much buck passing among the three actors involved.

1.”Malik Peiris, a virologist, doing a great honest job at the University of Hong Kong who sequenced the virus, declined to comment on any mutations, saying that making sequences public is not his call. “Our job as a WHO reference lab is to report back to the originating country and the WHO,” he says.”

2.”The WHO also declined to give any details. “We will leave that to the government of Indonesia, the owner of the data,” says Bjorge.”

3. In an email received from the Indonesian government after my deadline, it states with respect to making data public: “We are fully aware of the threat of the next influenza pandemic. And Indonesia is fully supporting whatever measures are considered necessary to prevent, control and contain a potential pandemic.

The above comments from Declan Butler's personal blog expand on issues raised by him in today’s Nature news article on the large familial cluster in Sumatra. The cluster is the largest reported to date from Indonesia and is a clear example of H5N1 transmission from the index case to family members to an additional family member (H2H2H).

Although WHO provided a description of the sequences of H5N1 from family members, the description had more information what was not said than what was said. One interpretation of the statements indicated the H5N1 was amantadine resistant with M2 polymorphism S31N, and was virulent with PB2 polymorphism, E627K, and had a wild type H5N1 HA cleavage site, RERRRKKR.

Bill P comment: This would indicate substantial mutation increasing the susceptibility for H2H transmission!!!!


None of these issues were spelled out in the update and Malik Peiris declined to comment on specific questions about these changes. The WHO statement indicated that there was no reassortment with human or swine sequences and no “significant mutations”.

Many would consider the above data “significant” because it would indicate that the H5N1 was resistant to treatment with amantadanes, and as more virulent and transmissible because of the acquisition of the human polymorphism, which allows the polymerase to be more active at lower temperatures found in the nose and throat, thereby make the H5N1 more transmissible to those in close contact to a coughing infected patient as described in the earlier WHO update.

Additional questions on H5N1 sequences in Indonesia have been raised by Andrew Jerimijenko, former head in ifluenza surveillence - US Naval Medical Research Unit 2 in Jaklarta, because the only human sequence made public had a novel cleavage site, RESRRRKKR, and reports indicate that all but one of the human sequences from the West Java region have the novel site, but no published poultry sequences have that change, raising concerns that the human infections are from a source other than poultry. If so, testing would produce a serious undercount human cases because testing is largely limited to patients with links to dead or dying poultry.

The one human sequence that has been made public is from the first reported H5N1 case in Indonesia. Although the CDC deposited the sequence at Los Alamos on August 1, 2005, it was not released to the public until March 25, 2006, after it was selected as a new target for a pandemic vaccine being developed in the United States.

Only two of the eight gene segments (HA and NA) have been released from this isolate, A/Indonesia/5/2005, and no sequences of the other human isolates, including those from the Sumatra cluster, have been released.

Instead, there has been a great deal of buck passing, but in reality the labs that generate the sequences control the release of the data and several have just tried passing the buck to the WHO and/or the governments of the countries of origin, such as Indonesia.

As noted above, Indonesia has indicated that the data can be released, and those sequences, as well as those deposited in the WHO private data base from Weybridge and other agencies, should be released immediately.

http://www.birdflubreakingnews.com/...com/News/06010601/H5N1_Indonesia_Release.html

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<B><font size=+1 color=red><center>Officials say N.J. pandemic would overwhelm facilities </font>

Thursday, June 1, 2006

By BOB GROVES
STAFF WRITER
<A href="http://www.northjersey.com/page.php?qstr=eXJpcnk3ZjczN2Y3dnFlZUVFeXkzJmZnYmVsN2Y3dnFlZUVFeXk2OTQyMzk3JnlyaXJ5N2Y3MTdmN3ZxZWVFRXl5Mg==">www.northjersay.com</a></center>
A cluster of bird flu deaths among humans in an Indonesian village may be a local problem half a world away, but local health problems can become global ones, officials warned Wednesday.

If a pandemic struck worldwide, 30 percent of New Jersey's 8.5 million population could be infected -- 40,000 of them hospitalized in intensive care and 20,000 on ventilators, they said.</b>

But New Jersey has only 25,000 licensed hospital beds, 1,750 intensive-care beds and 3,000 ventilators, state Health Commissioner Fred M. Jacobs said.

"You do the math," Jacobs told more than 500 people at a New Jersey Pandemic Influenza Summit at Rutgers University.

For now, the good news is that a recent spate of bird flu fatalities among members of an Indonesian family "is not a human pandemic," said Dr. Julie Gerberding, director of the federal Centers for Disease Control and Prevention.

The deaths apparently were caused by limited person-to-person transmission of the virus, Gerberding told the audience of public and private health professionals at Rutgers University in New Brunswick.

CDC tests of blood from the Indonesian victims do not suggest that the avian flu virus, which is transmitted to humans by birds, has mutated to a highly contagious form among people, Gerberding said.

"We're not seeing it spread beyond the family's community," she said.

But U.S. health officials would respond immediately to the first signs of an outbreak, she said.

"The first time it's human-to-human, we want to do everything to quash the first outbreak," Gerberding said. "A threat here is a threat everywhere."

"The most important strategy is to slow down the spread of disease within any community and buy time" to isolate flu victims and protect uninfected people, she added.

Nevertheless, the 190 member nations of the World Health Organization "are doing everything we can" to contain the disease, in the earthquake-ravaged nation, she added.

Bird flu has infected 224 people and killed 127 of them worldwide since the virus first swept through poultry in Asia in 2003, said Alex Azar, federal deputy health secretary.

"We take the influenza threat very seriously," he said. "It's one of the greatest public health threats we face today."

The pandemics of 1957 and 1968 were relatively minor compared with the global "Spanish flu" pandemic of 1918-19, which was "catastrophic," Azar said.

Governor Corzine, who hosted the event, and Azar signed a "planning resolution," promising federal assistance for the state's pandemic preparedness, as well as $2.6 million in funding.

Officials do not know when the next pandemic, which could kill 8,100 New Jerseyans, will strike, Azar said, "but we do know we're overdue and under-prepared. ... Every community must have its own plan."

Businesses, for example, must plan how they would stay open with 40 percent of their workforce out sick for as long as two months, he said.

Because the federal government is not able yet to manufacture an avian flu vaccine quickly, communities should stockpile anti-viral drugs, such as Tamiflu, he said.

By December, the federal government will have 26 million treatment courses of Tamiflu stockpiled, including nearly 600,000 courses for New Jersey, he said. "We're not prepared yet" for a pandemic, Azar said. "But we're a lot better prepared today than we were yesterday."

Anti-viral drugs "are not magic bullets" to successfully treat everyone, Gerberding said, but they have medical value and are worth stockpiling. New Jersey currently has 18,500 courses of Tamiflu stockpiled.

Meanwhile, the national supply of seasonal flu vaccine for this year "is the best it's been," Gerberding said.

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<B><font size=+1 color=brown><center>Crisis Management</font>

Parke M. Chapman
National Real Estate Investor
Jun 1, 2006
<A href="http://www.industryclick.com/magazinearticle.asp?magazineid=126&releaseid=14127&magazinearticleid=248033&siteid=23">www.industryclick.com</a></center>
Building owners and managers have another reason to dust off their emergency preparedness plans — the growing threat of avian flu. A January 2006 Deloitte & Touche survey of more than 100 U.S. corporate executives found that roughly two-thirds of respondents had done little or nothing to prepare for a pandemic. It also found that most of the executives hadn't even appointed someone to spearhead a flu contingency plan.</b>

Avian flu could cost the economy more than $675 billion, reports the U.S. Congressional Budget Office, with roughly 40% of all U.S. workers sidelined for weeks on end. The World Health Organization (WHO) warns that a virulent strain of the human-to-human H5N1 virus — bird flu — could develop in the coming months. WHO claims that the world is closer to a virulent flu outbreak than it's been since the late 1960s.

Risk managers are advising building owners and managers to closely review their business continuity plans now rather than after a crisis has taken hold. In March, the Toronto chapter of the Building Owners and Managers Association (BOMA) released guidelines for keeping office buildings open in the event of an outbreak.

It's no coincidence that Toronto-based BOMA Canada took the lead on this issue: In 2003, the severe acute respiratory syndrome (SARS) virus killed 38 people and spurred several building closures in the Toronto CBD. Those were the only SARS-related fatalities in North America.

“Our goal was just to get building owners and managers thinking about this threat,” says Deb Cross, executive vice president at BOMA Canada. “We've talked to all of the major real estate firms in Canada about how best to prepare for this.”

SARS taught Cross that communication is vital when a public health crisis emerges because misinformation can snowball and force people into isolation. A detailed communication plan makes that scenario less of an issue.

BOMA also recommends establishing sick tenant protocols such as monitoring for symptoms, setting up lobby hand-washing stations, and possibly quarantining entire floors. Owners and managers should also make plans for critical staff members to work offsite in the event an entire building is closed. The same measures apply if a property is deemed uninhabitable following a storm.

Building owners and managers aren't necessarily in the clear once a pandemic abates. Tenants may be unwilling to return to the property unless the building manager carries out a strict sanitization campaign. OSHA guidelines say that tenants are legally entitled to break their leases if a building is deemed hazardous.

Most office leases contain so-called “quiet enjoyment” clauses requiring landlords to ensure that the space isn't hazardous. These clauses can apply to any number of hazardous conditions that would impact an office tenant.

Industry experts say that business interruption insurance is unlikely to kick in to help a landlord whose jilted tenants refuse to return and pay their rent. Business interruption insurance typically covers events such as fires, earthquakes and storms rather than an incremental crisis like bird flu. That's why risk managers advise building owners and managers to closely examine their business continuity plans.

“We highly recommend that companies conduct probing self-examinations and begin preparing for a crisis,” says Michael Lee, senior vice president at real estate services firm Jones Lang LaSalle, which manages 927 million sq. ft. of property globally. “Early planning and contingency preparation are the most powerful weapons in any firm's defense.”

Countries under–reporting bird flu
AP
Wednesday 31st May, 2006 Posted: 16:37 CIT (21:37 GMT)


ROME (AP) – Outbreaks of the deadly strain of bird flu may be underreported in Indonesia and China, and the virus could be more widespread in Africa than authorities know, said experts gathered Wednesday for a conference on the disease.

Poor monitoring and lack of compensation mechanisms that encourage farmers to report animal deaths meant that authorities were not always aware of all outbreaks of the H5N1 virus, animal health experts told reporters on the sidelines of the two–day conference in Rome.

The conference – organized by the Rome–based U.N. Food and Agriculture Organization and the World Organization for Animal Health – brought more than 300 scientists and animal experts from 100 countries together in hopes of finding ways to control the spread of the disease and to prepare in case it mutates into a virus that could threaten a human pandemic.

"We think that countries might be underreporting," said Christianne Bruschke, head of the bird flu task force at the Paris–based World Organization for Animal Health. "Most of the countries really see how serious the situation is ... but they do not know about all outbreaks in their country."

The vast areas that need to be monitored are a difficult test for countries like China and Indonesia, where veterinary services are already stretched to the limit, Bruschke said.

Slow detection of the virus coupled with lack of compensation mechanisms for farmers whose poultry are culled could mean the virus may have spread across Africa to more than the eight countries that have so far reported outbreaks, she said.

"In developing countries, where farmers will lose their livelihood, they will make the best economic decision for them. If there is no compensation they will eat or sell the animals."

Bird flu has killed at least 127 people worldwide since it began ravaging Asian poultry stocks in late 2003. Most human victims were infected through direct contact with sick birds, but experts fear the virus could mutate into a form that passes easily between humans, and spark a pandemic.


http://www.birdflubreakingnews.com/...caycompass.com/cgi-bin/CFPnews.cgi?ID=1013721

Rumsfeld: NORTHCOM's Progress 'Truly Impressive'
By Tech. Sgt. Devin Fisher, USAF
Special to American Forces Press Service


PETERSON AIR FORCE BASE, Colo., June 1, 2006 – The progress U.S. Northern Command has made since its inception Oct. 1, 2002, to defend the homeland from natural or manmade disasters is "truly impressive," Defense Secretary Donald H. Rumsfeld said here yesterday.

Defense Secretary Donald H. Rumsfeld addresses local, regional and national media during his May 31 visit to U.S. Northern Command headquarters at Peterson Air Force Base, Colo. Photo by Petty Officer 1st Class Chad McNeeley, USN (Click photo for screen-resolution image);high-resolution image available.

Rumsfeld visited NORTHCOM the day before the official start of hurricane season for an update on how the command is postured to support civil authorities in a disaster.

"The kinds of capabilities the Department of Defense is able to bring to problems are unique and distinctive, and we are part of a complicated network of responders," Rumsfeld said. He noted that DoD acts only in a support role assisting first responders -- state and local governments, and if necessary, the Department of Homeland Security -- once they assume lead responsibility.

The secretary was briefed on the NORTHCOM plans in place to respond to a natural or manmade disaster and the command's coordination efforts with other federal, state and local agencies.

He also received an update on some of the plans NORTHCOM is revising following its recent Ardent Sentry '06 exercise to ensure the command is ready when the nation calls, regardless of the circumstances.

In a continued effort to test NORTHCOM readiness, command officials said, Ardent Sentry '06 required simultaneously battling terrorist attacks on the ground, providing military assistance to civil authorities in the case of the human-to-human transmission of the H5N1 "bird flu" virus, and responding to a Category 3 hurricane striking the already devastated southeastern United States.

Navy Adm. Timothy J. Keating, NORTHCOM commander, praised President Bush and Rumsfeld on their vision of creating the command following the Sept. 11, 2001, terrorist attacks.

"America is safer today because of their vision, which led to the creation of United States Northern Command - a fully functional regional combatant command responsible for the defense of our nation," Keating said.

As for the upcoming hurricane season, the admiral stressed that NORTHCOM is prepared.

"We are ready to respond when (Rumsfeld) or the president direct us to participate in the efforts to save lives, reduce human suffering and help restore critical infrastructure," Keating said.

Rumsfeld said his trip to NORTHCOM capped off a "terrific day." The secretary began his day as keynote speaker for graduation ceremonies at the nearby U.S. Air Force Academy. He shook hands with the nearly 900 newly commissioned officers, whom he said were "stepping up and volunteering to serve our nation and help defend freedom."

(Air Force Tech. Sgt. Devin Fisher is assigned to U.S. Northern Command Public Affairs.)

http://www.defenselink.mil/news/Jun2006/20060601_5305.html

31 May 2006 15:20 GMT

Human-to-Human Bird Flu Cases Reported; Leading Investor Advisor Explains Market Reactions to Fears of a Pandemic ​

Copyright © 2006, Dow Jones Newswires

BOCA RATON, Fla., May 31 /PRNewswire/ -- Since 9/11, the U.S. has been much more tuned in to geopolitical dangers, and those fears dramatically affect the stock market. Those dangers include not only terrorist attacks, but also health epidemics that threaten a wide swath of society.

This past year both private and public health organizations across the globe have warned of the growing danger of a bird flu pandemic. It's been featured on the cover of national news magazines and even had its own movie of the week. But until a few days ago, it wasn't perceived as an imminent threat.

Fortunately, after the media raised a red flag over what was possibly the first airborne infection of bird flu, the WHO has now reported that the first person in the chain of the Indonesian family who fell ill grew and sold vegetables in a public market, and likely had contact with infected fowl, and the others probably contracted it through some of the vegetables or physical contact with the woman.

If the bird flu does mutate and become an airborne virus causing human-to- human fatalities reported on different continents, the reaction on Wall Street won't be too dissimilar to what occurred after 9/11-panicked selling.

James DiGeorgia, editor of Gold and Energy Advisor newsletter, which provides independent investor analysis ( http://www.goldandenergyadvisor.com ) does warn that predictions of a bird flu pandemic are currently premature. But if a bird flu pandemic does become evident, "it could shut down the world's commercial aviation, shipping industry and ports of entry, creating a devastating effect on the global markets.

"Three things -- in the worst case scenario -- that I predict would certainly happen are: 1. The S&P falls 100 to 200 points very quickly; 2. Gold jumps to well over $850 an ounce; and 3. The Federal Reserve jumps in to provide liquidity and cuts interest rates to prevent a Wall Street dive from becoming an economic knock out punch," DiGeorgia explained.

But not all effects of a bird flu pandemic on all financial fronts can be easily predicted.

"Make no mistake about this: a shut down like that would have a tremendous impact on the world economy. While the impact on gold and the U.S. and world stock markets is clear to me, the impact on the energy markets is less clear. Gasoline, and for that matter oil consumption, could drop as people stay home hiding from bird flu. But we have to bear in mind that our international supplies of oil would be cut off, and they provide most of the oil in the United States."

It seems only prudent that investors pay careful attention to reports of bird flu, and what could be a major market force.


About Gold and Energy Advisor

The Gold and Energy Advisor is a monthly newsletter that covers the precious metals and energy markets with the single goal of delivering money making recommendations to its subscribers. Gold and Energy Advisor is edited by James DiGeorgia, who has extensive experience in precious metals and the energy markets, and is considered one of the world's foremost authorities in both. DiGeorgia authored the popular books "The Global War for Oil" and "New Bull Market in Gold." For more information, visit GEA online at http://www.goldandenergyadvisor.com .

SOURCE Gold and Energy Advisor


http://framehosting.dowjonesnews.com/sample/samplestory.asp?StoryID=2006053115200005&Take=1

Expert slams Indonesia for lame bird flu measures​

http://www.thestandard.com.hk/news_detail.asp?pp_cat=17&art_id=19947&sid=8232801&con_type=1

Indonesia is using band-aid solutions to combat bird flu, a World Health Organization expert said, warning that more people could die if outbreaks among poultry are not contained.

Marianne Kearney

Friday, June 02, 2006

Indonesia is using band-aid solutions to combat bird flu, a World Health Organization expert said, warning that more people could die if outbreaks among poultry are not contained.

"The situation is that there is a leak in the roof, and the Ministry of Health is just mopping up the floor every day," epidemiologist Steve Bjorge said.

Indonesia has the world's second- highest number of confirmed human bird flu deaths after Vietnam with 36 - and the most deaths this year.

Bjorge said Indonesia had to start mass culls of infected birds and more intensive testing of fowl suspected of carrying the H5N1 virus if it wanted to stem the spreading of the virus, which he said was "pandemic in poultry."

In Papua's Manokwari district, he said, "they have had three outbreaks in the last nine months, and each time they've culled and they've stopped it. That to me means, even in Indonesia, it is possible to do it."

But the sprawling country's hugely decentralized government - spread over 17,000 islands - means that preventing the spread of the virus among birds is a very complicated task, Bjorge said, adding there is no central authority that can order culling "on a minute's notice."

Indonesian health officials are also fighting a lack of public awareness about the disease and its dangers, with many people failing to report to hospitals when they develop flu-like symptoms - even if relatives or neighbors are already ill with the disease.

In addition, many Indonesians continued to eat and slaughter sick chickens, or sell their feces as fertilizer.

Indonesia has been closely monitoring a case in a North Sumatra village, where seven family members all died of the bird flu virus, raising fears that it was the country's first case of human- to-human transmission of avian flu.

But Indonesian Health Minister Siti Fadilah Supari insisted it was unlikely that even limited human-to-human transmission had occurred.

"It's just a possibility, but based on the two criteria for possible transmission, virological evidence shows it's still being transmitted from animal to human," she said.

Still, health authorities will monitor the village for three more weeks - one more than recommended by the WHO. AGENCE FRANCE-PRESSE

Intensify Preparations For Flu Pandemic, European Agency Says​

http://www.medicalnewstoday.com/healthnews.php?newsid=44378

Main Category: Bird Flu / Avian Flu News
Article Date: 01 Jun 2006 - 10:00am (PDT)

European Union nations need to intensify preparations for a possible flu pandemic, says the European Centre for Disease Prevention and Control (ECDC) in a revised risk assessment published today. The report expresses concern about the spread of H5N1 in Africa and Asia.

Although H5N1 is currently a low risk for public health, the report explains that recent developments indicate that more humans than ever before are being exposed to the virus. This raises H5N1's chances of mutating into a human transmissible virus - leading to a flu pandemic.

Zsuzsanna Jakab, ECDC Director, said that even though we cannot be sure whether H5N1 will ever develop into a serious threat for human health, the fact that more and more people are being exposed to it brings us nearer to finding out.

Jakab stressed the importance for Europe to speed up its preparedness against a possible human flu pandemic.

Here are some details from the ECDC's New Risk Assessment

-- As some wild birds in Europe have been infected, European governments must accept that H5N1 will continue to be an animal disease capable of passing to humans (zoonosis*).

(* Zoonosis = A disease of animals which can be transmitted to humans. e.g. Rabies - you catch it from an animal. The plural of zoonosis is zoonoses)

-- According to all available evidence, H5N1 is no better at infecting humans than it was in 1997. Humans still only become infected when exposed to large quantities of the virus.

-- People living very close to poultry need to know the risks and how to protect themselves.

-- Vets and farm workers need to be protected. Precautionary measures must be followed.

-- H5N1 is a still a much lower human health threat than other zoonoses, such as salmonella, campylobacter and zoonotic strains of E. coli. Thousands of people in Europe have come down with other zoonoses - not one person in the Europe Union has become infected with H5N1.

-- We don't know if H5N1 has the capability of mutating into a form that would create a human flu pandemic. If it can, H5N1's present spread across Africa and Asia multiplies its chances for doing so.

-- Three pandemics have occurred over the last century. 1918-1920, 1957 and 1968. There is no reason to suppose another one is unlikely in the years to come.

-- The present increased human exposure means European Union members must intensify their preparedness for a pandemic.

This is from Maryland

Preparation is county's weapon against bird flu

By Stephanie Samuel

Sentinel Staff Writer


Prince George's County Health Department paired tried and true methods with an emergency response unit in preparedness plan against possible influenza pandemic.

In light of the bird influenza pandemic spreading throughout Asia, Europe and Africa, heath officials in the county are readying themselves and resident with a plan surprisingly similar to that of the regular seasonal flu.

"We don't want to focus on bird flu, we want people to focus on preparedness," said Gwendolyn T. Clerkley, acting health officer with the county's health department.

Clerkley said the methods used against the seasonal flu are also as effective in the event of a bird flu pandemic

Basic steps against the spread of the viral infection include preventive measures like covering coughs and sneezes, keeping surfaces clean and frequent hand washing.

"We tend to focus on what we would do for any viral infection, because that is what we will do for viral infections despite the source," Clerkley said.

While human-to-human transmission of the bird flu has been rare, it is reported to spread through close contact similar to the seasonal flu.

Birds carry the bird flu virus also known as avian flu. Birds carrying the H5N1 strain can possibly transmit the virus to humans.

Indonesia is the most recent country plagued by the virus. It confirmed six new cases of the infection on May 29.

The United States is currently conducting tests on thousands of migratory birds in Alaska for the H5N1 strain.

Despite the county's standard approach, Clerkley said that there is also a public health emergency response team of over 500 health employees assembled and ready to act immediately in the event of a countywide pandemic.

"This team includes representatives from hospitals, community service organizations, professional organizations of physicians, nurses, pharmacists, home healthcare organizations, emergency medical services, public health officials and other key government agencies so that we will have the capability to effectively respond to the impact of pandemic outbreak or other health emergency," said Clerkley.

This team would work closely with specialists including a disease surveillance technical expert who, in the event of a pandemic, would gather information to derive the source of infection.

"A pandemic would affect one third of your population, so in the event of a pandemic, you need every public health expert to respond," she said.

Also during the pandemic, residents would be called on to respond to their own personal health.

"If we were to have a pandemic, we would ask residents, 'If you are ill, stay home'," said Clerkley.

She believes that the best thing that residents can do now is to educate themselves about quarantine measures and other personal steps to restrict the spread of the influenza virus.

"There is a lot of education that needs to occur, so that in the event of a pandemic, we have an educated population," she said.

WHO stumped by Indonesian bird flu cluster ​

June 01 2006 at 08:11PM

By Marianne Kearney

Jakarta - The World Health Organisation (WHO) admitted Thursday it was having difficulty identifying the source of bird flu infection in a case where seven people in the same family died of the virus.

The case in North Sumatra, Indonesia's largest cluster to date, has raised fears of human-to-human transmission of the virus, which has raised the spectre of a deadly global flu pandemic.

"There are three possible sources of infection, but there is no conclusion," WHO epidemiologist Steve Bjorge told reporters at a joint press conference with Indonesian health ministry officials in Jakarta.

'No conclusion'

"It's difficult to get good information from that village, and that family," he said. "Previously it had been good."

Indonesia has the world's second highest number of fatal human bird flu cases after Vietnam with 36 - and the highest number of deaths this year globally.

The WHO has said that it could not rule out the possibility of human-to-human transmission in the North Sumatra case, where 54 people who came into close contact with the family are currently under voluntary quarantine.

Bjorge said the first family member to contract avian flu, a 37-year-old woman, could have been infected by her sick chickens, by chicken faeces used as fertiliser, or at the wet market where chickens are sold.

However, as two of the woman's chickens had fallen sick prior to her death, there was a strong possibility that the sick fowl were to blame, he said.

Voluntary quarantine

But as with two other clusters, Bjorge said WHO experts also suspected that perhaps members of the family could have been particularly susceptible to avian influenza.

"Some scientists are talking about something genetic. What we observed in all these clusters is that infections occur in closely related family members, and it is always the same bloodline," he said.

Indonesian Health Minister Siti Fadilah Supari said it was unlikely that even limited human-to-human transmission had occurred in this village.

"It's just a possibility, but based on the two criteria for possible transmission, virological evidence shows it's still being transmitted from animal to human," she told journalists.

However, as a precaution, Indonesian health authorities were to monitor the village for three more weeks - one more than recommended by the WHO.

The people in quarantine, who include family members and other close contacts, are receiving the anti-influenza drug Tamiflu as a precaution and are being checked daily for flu symptoms, said Bjorge.

The WHO expert criticized Indonesia's efforts to fight bird flu, warning more people could die if outbreaks among poultry are not contained.

"The situation is that there is a leak in the roof, and the ministry of health is just mopping up the floor every day. Until they fix that leak in the roof, it's not going to stop," Bjorge said.

"And the leak in the roof is this continuing transmission of the virus from bird to bird," he said.

Bjorge said Indonesia had to start mass culls of infected birds and more intensive testing of fowl suspected of carrying the H5N1 virus if it wanted to stem the spread of the virus, which he said was a "pandemic in poultry".

However, the sprawling country's hugely decentralised government - spread over 17 000 islands - meant preventing the spread of the virus amongst birds was a very complicated task, said Bjorge. - Sapa-AFP

http://www.int.iol.co.za/index.php?set_id=1&click_id=31&art_id=qw1149165901201B253

Link to tomorrows (6/2) Bird Flu thread: http://www.timebomb2000.com/vb/showthread.php?t=199462