Thread: Bird Flu's Risk Far From Over, Experts Warn

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Bird flu's risk far from over, experts warn
By Donald G. McNeil Jr.

Wednesday, February 14, 2007


Last winter, as the deadly bird flu virus marched out of Asia, across Europe and down into Africa, public health experts warned of the potential for a catastrophic pandemic like the Spanish flu of 1918.

This year, by contrast, bird flu seems all but forgotten, mentioned occasionally when it claims another life or when it causes an outbreak in, say, a British turkey farm. With flu season reaching its peak, the question for many people now is whether the threat they are facing is not Spanish flu but swine flu — another widely advertised menace that never materialized.

But that is premature, scientists say, warning that the bird flu virus is as dangerous and unpredictable as ever. It killed more people in 2006 than it did in 2005 or 2004, and its fatality rate is rising — 61 percent now, up from 43 percent in 2005.

More worrisome, they said, is that the disease is out of control in birds in more locations than ever, including places like the Nile Delta and Nigeria, where public health mechanisms are weak to nonexistent. That increases the chances of a mutation in the virus that would allow human-to-human transmission.

"I've gotten at least 10 media calls in the last few months asking me to deliver the death sentence for avian flu," said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. "But at any conference, if you get a group of virologists at the bar, after the fourth beer, they let their hair down and admit it — they don't know what is happening. They've been incredibly humbled by this virus."

Since viruses with very high fatality rates, like Ebola, tend to burn themselves out by killing victims faster than they can pass it on, the increasing fatality rate — which is still unexplained — may be a silver lining of sorts.

But the virus has plenty of mutational wiggle room — the 1918 virus had a 2 percent fatality rate and still it killed 50 million to 100 million because it was so transmissible. That is why health experts remain cautious, warning that the pandemic could begin at any time, and that February is a particularly risky month.

Robert Webster, a virologist at St. Jude's Children's Research Hospital in Memphis, ended a talk with a slide of three animals in a reference to Asia. "We've survived the Year of the Chicken and the Year of the Dog," he said. "Will we survive the Year of the Pig?"

The Year of the Pig begins Sunday, and the Lunar New Year celebrations in China and Vietnam have become associated with flu outbreaks because so much poultry for family feasts is on the move. "My take-home message," Webster added, "is don't become complacent. Don't trust this one."

Poultry outbreaks in England and Hungary were not particularly worrisome, the United Nations Food and Agriculture Organization said. They may have been linked to shipments of raw turkey between plants in both countries, investigators said.

The British are very proficient at eliminating veterinary diseases by killing and incinerating animals, officials said, noting that more than 160,000 birds were swiftly killed to contain the British outbreak and that the Hungarians are believed capable of the same sort of response.

But the virus is out of control in poultry in three countries — Indonesia, Nigeria and Egypt — with combined populations of 447 million people. A year ago, it was out of control only in Indonesia, and Thailand and Vietnam had stifled outbreaks, although the virus returned. China remains a mystery — despite official denials, there is evidence that it is circulating there.

Most alarming to the experts, although it got relatively less attention, was the death last month of a 22-year-old Nigerian woman, an accountant who lived in the crowded financial capital, Lagos.

Officially, only one death from H5N1 was confirmed, but Nigerian newspapers said the woman's mother died with similar symptoms two weeks earlier, and a female relative was sick but recovered. If true, that suggests a cluster of cases with possible human-to-human transmission. Tests on them were negative, but human H5N1 tests are best done on fresh samples from deep in the lungs, which are hard to obtain, and false negatives are common.

In Nigeria, despite the culling of 700,000 birds, the flu has been found in 19 of 36 states, said the UN Food and Agriculture Organization.

Oyedele Oyediji, president of a Nigerian veterinarians' association, told local newspapers that bans on poultry movement and culling orders were simply not being enforced. "If you go to the markets in Lagos now," he said, "you would notice that poultry products like guinea fowl, ducks, turkey and chicken from the northern part of the country are still available."

Nigerian farmers have complained that government cullers pay them only $2 for chickens that cost them $5 to $7 to raise. But payments, supported by the World Bank, seem to be made fairly promptly through local police stations.

Indonesia, by contrast, provides farmers with $1 vouchers that may not be cashed for three or four months, said Tri Satya Putri Naipospos, the country's chief veterinarian. "It's our weakest implementation," she admitted. "It should be treated as an emergency, but we still follow routine budget mechanisms."

Eighty percent of all Indonesian households keep poultry, she said, the flu is in 30 of 33 provinces and still few take the threat seriously enough. "Farmers say dying chickens are normal in life," she said. "And you must realize that 62 dead people in one and a half years? That's not very much in Indonesia. Three hundred thousand die from TB, from dengue. People in the villages don't grab what is a pandemic."

The picture is not entirely bleak. Despite serious problems in Nigeria, Indonesia and Egypt's Nile Delta, Joseph Domenech, the chief veterinarian of the UN Food and Agriculture Organization, said he thinks the prospects for controlling the spread in birds are "a lot better than three years ago or even one year ago."

For unknown reasons, possibly weather patterns and better poultry vaccination in northern China, not as many migrating swans and geese carried the virus up to Siberia, across Western Europe and down into Africa this winter as did last winter. The main culprit now in spreading the virus seems to be illegal or improper trade in poultry, health officials said.

Also, Domenech said, more poor countries have become alert to outbreaks, and either snuff them out or ask for outside help. For example, he said, the virus was found last year in spots from the Ivory Coast and Burkina Faso to Niger and Cameroon, a 1,600-kilometer, or 1,000-mile, stretch of west Africa, in countries with "very weak animal health prevention." Despite nominal customs bans, Nigeria exports poultry throughout the region, he said.

"But we did not have any explosive outbreak," he said. "If it is explosive, you cannot miss it."

The virus has also been found in cats. That is not new; one of the most startling outbreaks killed 103 tigers in a Thai zoo in 2004. But no human has been known to have been infected by a cat.

World Health Organization reports almost always link human cases to proximity to dead poultry, but Naipospos, the Indonesian flu expert, released data at a flu conference in Washington on Feb. 1 calling that into question. In the 82 human cases studied, she said, only 45 percent of victims had direct exposure to sick poultry.

An additional 35 percent had "indirect" exposure, which meant sick birds in the neighborhood, and 20 percent were "inconclusive." "Unlike in Thailand and Vietnam," she said, "our risk factors are not clear." Virologists believe that the situation that must be avoided at all costs is to have humans with seasonal flu catch H5N1, too, because the viruses could mix.

Indonesia's best prevention against that, Naipospos said, is the "Tamiflu blanket." "We learned that in Garut," she said of a cluster of cases last August in West Java. More than 20 people died or suffered serious symptoms.

The government quickly gave the antiviral drug to more than 2,000 people.

Ultimately, only three cases in the cluster were confirmed, but scientists suspected some were missed and the drug suppressed the virus to undetectable levels in others.

An Israeli product called Sambucol has been demonstrated to be over 99% effective against the avian flu virus in recent studies. Not only is the stuff free of all the potential side-effects of the vaccines for bird flu, it's more effective and only costs between $7 and $10 for 30 lozenges or a 20-dose bottle of the liquid form.

I've been using this stuff for influenza for years now and I can tell you firsthand that it works like a charm. It will usually take out a flu bug in less than 12 hours. It works by enzymatically inhibiting the virus's replication process by damaging the protein spikes the virus uses to penetrate the cell membrane. It doesn't even taste bad, but if you take too much it may give you a bit of a sour stomach.

I'll have to try some next time I get sick. Thanks for the info. Not like I want to get sick at all

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