Egypt: 4 yr old girl infected by avian flu

The WHO reported on its website on Tuesday that a four-year-old girl has contracted the bird flu virus in southern Egypt. Egypt has had 36 case human cases of avian flu and 15 have been fatal.

Note:
* The outbreak of the highly dangerous H5N1 avian influenza began in Asia in 2003.

* Outbreaks have been confirmed in 59 countries and territories, according to the World Organisation for Animal Health.

* Over 30 countries have reported outbreaks in the past year, most involved wild birds.

* 190 people have died from the virus since 2003, according to the WHO. Countries with deaths include: Azerbaijan, Cambodia, China, Egypt, Indonesia, Iraq, Laos, Nigeria, Thailand, Turkey and Vietnam.

* The virus is known to have infected 312 people since 2003, according to the WHO. The death rate seems to be particularly high among children and young adults.

* Vietnam and Indonesia have the highest number of cases, accounting for 121 of the total deaths.

* The same virus caused an outbreak in Scotland in 1959.

* The H5N1 virus first jumped to humans in Hong Kong in 1997, 18 people were infected and six died.

Most americans dont know enough about bird flu

A nationwide survey has been carried out into public knowledge, attitudes, intentions and behaviors in regard to the threat of highly pathogenic avian influenza.

Researchers at the Food Policy Institute at the Rutgers New Jersey Agricultural Experiment Station carried out 1200 telephone interviews between May 3 and June 5, 2006.

The results show that most Americans have heard about avian influenza but admit the dont know much about it. Most know that there is a highly pathogenic H5N1 avian influenza in people, birds, and poultry globally, but many didnt know that there have been no human or animal cases in the U S.

Americans judge their current risk of avian influenza infection as low and aren't worried about it. They see the supply of chicken products as safe and continue to eat it.

Interestingly, most felt the risks of infection from avian influenza was much greater for other people than for them.

“This tendency to believe that others are at greater risk may be a problem in getting messages across, in influencing perceived susceptibility, and in persuading people to adopt appropriate behaviors,” says Sarah C. Condry, the lead author of the study.

According to the United States Department of Agriculture (USDA)
“The chance of infected poultry or eggs entering the food chain would be extremely low because of the rapid onset of symptoms in poultry as well as the safeguards in place, which include testing of flocks and Federal inspection programs.”

The USDA also claims that, “Cooking poultry, eggs, and other poultry products to the proper temperature and preventing cross-contamination between raw and cooked food is the key to safety.”

Despite this, according to William K. Hallman, director of the Food Policy Institute,

“The results of the study suggest that much of the American public does not yet have the information they need to make informed choices about purchasing, preparing, and consuming poultry products, should avian influenza emerge in the United States.”

Less than half of those surveyed believed that cooking chicken to the recommended temperature kills the avian influenza virus and only four-in-ten believed that the avian influenza virus is not transmissible to humans from eating fully cooked chicken or eggs.

“The methods for destroying avian influenza during the cooking process are the same as for destroying salmonella,” said Hallman. “If poultry contaminated with avian influenza is cooked properly, a person cannot get sick from eating the finished product.” According to the USDA, poultry and egg products should be cooked to the minimum safe internal temperature of 165 °F.
One problem is that surveys by the Food and Drug Administration suggest that fewer than 60 percent of Americans own a meat thermometer and only 12 percent always use it when they cook chicken or chicken parts.

According to Condry, “Consumers are likely to try to eliminate the risk entirely by avoiding consumption of poultry altogether.”

The study concluded that if pathogenic avian influenza was found in chickens in the United States, almost 40% of Americans say they would stop eating chicken products altogether. Even after receiving reassurances that it is safe to eat chicken, it would take an average of nearly five months for the majority to start eating it again.

This would of course result in a major drop in domestic consumer demand and would result in significant economic losses for the poultry, food industry and for families.

According to Hallman, “Chicken serves as a popular, low-cost source of protein for many American families.”

The result would be increases in the prices of alternative sources of animal protein resulting from higher consumer demands for substitutes for chicken products and the costs of feeding a family would rise.

Source: news release; Rutgers, State University of New Jersey.

WHO findings on bird flu treatment

on Friday the World Health Organization (WHO) reported the early conclusions of a group of international experts who met last month to compare evidence on treatments, including attempts by some doctors to use steroids in addition to other treatment measures.

The experts conclude that Bird flu patients given early treatment with the antiviral drug Tamiflu have the best chance of surviving but that using steroids can do more harm than good, .

"Corticosteroid therapy has failed so far to show effectiveness," the WHO warned in a statement. "Prolonged or high dose corticosteroids can result in serious adverse events."

Frederick Hayden of WHO's global influenza program said some doctors in Vietnam and Indonesia, had used steroids to try to save quickly deteriorating bird flu patients. Published research showed eight of nine had died.

"A concern is some treatment is of unsubstantiated value and in some instances may be doing more harm than good," he told Reuters.

The WHO confirmed that early treatment with Tamiflu (known generically as oseltamivir reduces mortaality from the H5N1 virus. Giving it to people with advanced symptoms was also "warranted".

"Data presented gave strong support that early treatment makes a difference," Hayden said, citing data from Egypt where 20 of 34 bird flu patients have survived to date.

"Unfortunately the problem is many patients are coming in late with shortness of breath and progressive symptoms that would indicate advanced viral pneumonia," he said.

Tamiflu can also be used at a two-fold higher dosage and possibly in so-called "dual antiviral therapy" with an older class of drugs known as amantadine, the WHO said, in line with previous recommendations.

But such decisions should be made on a case-by-case basis, especially in patients with pneumonia or progressive disease.

Combining Tamiflu with amantadine may be especially useful in countries where the virus is susceptible to amantadine.

These countries include China and parts of Europe and Africa where a particular H5N1 subvirus or "clade" has spread, causing human cases since January 2006, according to Hayden. He cited Turkey, Egypt and Azerbaijan.

Antibiotics should not be given preventively, due to possible resistance and side-effects but according to the WHO should only be given if there is good reason to suspect the patient has a bacterial complication to pneumonia.

Caterpillars produce flu vaccine

Flu vaccine is normally made using chicken eggs but now for the first time research has shown that genetically engineered flu vaccine can be made from yellow striped caterpillars according to a University of Rochester study.

Early results suggest that this caterpillar method could be a faster, easier alternative to traditional egg-based production. If this proves to be the case when scaled up then this might provide a quicker vaccine development cycle in response to a pandemic.

The research was funded by the vaccine's maker, Protein Sciences Corp. The company designed the study with Dr. John Treanor, director of UR's Vaccine Treatment and Evaluation Unit and lead author of the study. Dr.Treanor, is also professor of medicine and of microbiology and immunology at UR.

The results are reported in the Journal of the American Medical Association.

The experimental vaccine used in the research was designed to protect against three of the common influenza strains. Among participants who got single high-dose injections, none developed the flu and at least two-thirds had a strong immune response.

More than half of those given a lower dose had a strong immune response, and two got flu.

In a control seven patients who received a dummy vaccine got the flu.

451 adults took part in the study during the 2004-05 flu season.

Current production methods takes about nine months to produce vaccine supplies and rely on hens laying millions of eggs. Live flu viruses are injected into the eggs and multiply, then the shells are broken and the viruses inactivated and treated to create vaccine.

The experimental method uses fall army worms — abundant caterpillars that are vulnerable to a caterpillar virus. The researchers replaced a gene from that virus with a flu virus gene, then injected it into the worms to make more flu viruses. The process took about a month less than the egg method and didn't involve using live flu viruses.

The study is likely to boost interest in insect production methods as an alternative to traditional egg based methods for producing flu vaccine.

Flu Transmission via hands and surfaces

While most people are aware that colds and flu are transmitted from person to person via coughing and sneezing there is less awareness that people can catch flu and colds through other forms of direct and indirect contact.

One of the pre-requisites in preparing the public for any pending pandemic will be to greatly increase public awareness of these forms of transmission and effective measures for controlling them.

Influenza is of course highly contagious, in particular for those who don't have any pre-existing antibodies against influenza obtained through previous viral exposure. This will typically include young children during inter-pandemic phase influenza and almost everyone during a highly mutated viral pandemic.

Commonly around 50% of all "normal" influenza infections are asymptomatic and this is particularly common in children. Most influenza virus is transmitted via droplets through the coughing and sneezing of infected persons. It can however also be transmitted by direct and indirect contact and many people seem unaware of this.

Direct-contact transmission involves skin-to-skin contact and the physical transfer of the virus to a susceptible person from an infected person.

Such direct contact transmission can occur in a hospital or care setting for example as staff perform patient care activities involving physical contact. Direct-contact transmission in these settings can also occur between two patients (e.g., by hand contact). In domestic settings when people fall ill, awareness of contact transmission will be less and the risks of this route may be higher.

Indirect-contact transmission involves a contaminated intermediate object, usually inanimate, in the infected persons environment. There is some evidence that flu virus can survive outside the human body for some time. The infected persons may contaminate a surface through coughing , sneezing or hand contact ( if hands have come into contact with mouth or nose). Another person touching this surface with their hands may then transfer this infection to themselves through hand to face contact. (There have been suggestions that influenza can even infect through the eye membranes).

There is insufficient data to exactly determine the proportion of influenza transmission that is attributable to direct or indirect contact.

So apart from being actually coughed or sneezed upon by an infected person, the most common way to catch the flu is by touching something which has been coughed on or sneezed upon by an infected person. The person who used that door handle before you had the flu. They covered their mouth with their hand as they coughed then used that same hand to open the door. You touch the same place and without thinking later rub your eye or nose. You have introduced the virus to your most vulnerable point of infection.

Good hand washing practice and awareness of such transmission routes is vital.
Droplet transmission is still thought the predominant overall form of spread particularly in a setting such as a crowded space where air exchange is limited. However contact transmission should always be controlled for.

Good hand washing practice should involve the use of reliable soaps and/or wipes.

Type B flu virus resistance to Tamiflu and Relenza

Japan has been known for prescribing antiviral flu drugs more frequently than other countries and now one of the less common strains of flu has shown hints of resistance to Tamiflu and Relenza among patients in a small study of patients who had type B influenza.

Type B is normally milder and causes smaller outbreaks than the more common type A.

The findings indicate that doctors may eventually need new medications to treat drug-resistant flu if the viruses become more prevalent.

Previous studies, including work by the same researchers, have found a few cases of resistance to Tamiflu in type A flu, the variety thought most likely to cause a pandemic if bird flu mutates into a human transmissable form.

Dr. William Schaffner, an infectious-disease specialist at Vanderbilt University who was not involved in the study, said Japanese doctors prescribe anti-flu drugs perhaps too often, giving viruses a chance to evolve.

''We were afraid this might happen.'' Schaffner said.

Tamiflu and Relenza, designed to treat seasonal flu, are thought likely to be helpful in treating a global epidemic but this finding confims the importance of vaccination and other preventive measures.

The U.S. government has stockpiled Tamiflu and Relenza, and has funded new anti-flu drug development.

Evolving resistance among viruses is of course biologically inevtiable when doctors use anti-viral drug widely which is why the continual development of new drugs is vital.

The study appeared in Wednesday's Journal of the American Medical Association. Samples from 74 children before and after they were treated with Tamiflu showed drug-resistant virus in one of the children after treatment, indicating the resistance had emerged during treatment.

Samples from 422 untreated children and adults with flu showed drug-resistant virus in seven patients.

The rate of resistance to this family of drugs, less than 2 percent, was lower than for type A influenza where drug-resistant type A virus has been reported at 18 percent.

Note that the study had financial support from the Japanese and U.S. governments. Some researchers reported receiving speaking fees or previous grant support from drug companies, including a company developing a new anti-flu drug.

Bird Flu Round Up 5th April 2007

The Gulf Times reports that bird flu has spread to a new poultry farm in Bangladesh despite the efforts by vets and health workers.
An official of the Fisheries and Livestock ministry reported that “The latest farm confirmed to have H5N1 virus is in northern Jamalpur 200km (125 miles) from the capital Dhaka,” .

Since bird flu was detected in six farms at Savar near the capital in March 72,000 chickens have been culled from 26 farms and 500 workers at infected farms given a local version of the Tamiflu anti-viral drug.

About 4m Bangladeshis are directly or indirectly associated with poultry farming.

The Arab Times online reports that on Wednesday Kuwait sent samples from Bangladeshi bird handlers to WHO laboratory in Cairo for confirmation of test results conducted in Kuwait - according to Dr Ahmad Al-Shatti, spokesman for the Health Ministry. Test results are expected Thursday. The four workers had earlier shown bird-flu symptoms.

Dr Al-Shatti said the bird flu situation in the Kuwait was under control, : “The bird handlers are in good health and there is no cause for concern. We have plans in place to deal with any emergent situation."
Since Kuwait reported a bird flu outbreak late February authorities have slaughtered around 1.6 million birds. The four Bangladeshi bird handlers were part of the task force slaughtering birds in Wafra area, where most positive cases were discovered.

In the US, at a farm in West Virginia test results from turkeys have indicated exposure to H5N2 virus according to World of Poultry.
The test samples were part of routine, pre-slaughter surveillance and the turkeys showed no signs of illness and no mortality.
USDA Chief Veterinarian John Clifford stressed, "Every indication is that the virus is consistent with low pathogenic strains of avian influenza, or LPAI, which are commonly found in birds and typically cause only minor sickness or no noticeable symptoms. We can say for certain this is not the highly pathogenic H5N1 strain." The National Veterinary Services Laboratory plans to run sequencing and pathogenicity tests to further identify the virus.

Around 25,000 turkeys were slaughtered and poultry operations within a 6-mile radius of the affected farm closely monitored.

UN FAO on mobile bird flu rapid detection

The UN Food and Agriculture Organization (FAO) has reported that a mobile rapid-detection technology could revolutionize the fight against bird flu and many other livestock diseases.

The FAO in a press release said Animal health experts from 15 nations are meeting in Vienna to discuss and examine the new technology over the course of five days.
"The kit could even be adapted to detect the strain of bird flu, including H5N1 - the cause of death of millions of poultry and numerous human fatalities. Moreover, such systems could easily be adapted to send results to a main control centre, allowing a much faster response to an outbreak," the FAO said.

The organization noted that the talks were focused on reducing the main device's size from a small portable television "into what researchers call a 'laboratory in a pen'." The current size groups a USD 1,000 mobile test system and reader. According to FAO, the global poultry sector has lost over USD 10 billion since the bird flu's outbreak in Asia at the end of 2003.

Advisory Committee recommends approval of Sinofi Aventis bird flu vaccine

Tuesday: a federal advisory committee recommended approval of a vaccine produced by the French drug company Sanofi Aventis. This is the first bird flu vaccine for humans and the recommendation comes despite concerns about its safety and evidence that the shots won't protect most people.
The panel recognised that the vaccine had significant shortcomings but concluded it was safe and effective for use during a pandemic or in high-risk situations, such as military deployment to regions facing an outbreak. The vaccine will not be commercially available.

The US government plans to stockpile vaccine doses for 20 million people, including health-care workers and emergency personnel.Panel member Robert Webster, chairman of the department of virology and molecular biology at St. Jude Children's Research Hospital in Memphis, Tenn., said the vaccine would be better than nothing."We need this pre-pandemic stockpile," he said. "It worries me that if we don't license this vaccine, what are the consequences?"

Norman Baylor, director of the FDA's vaccine office, told the panel that "There are numerous vaccines under development that are potentially better than this one," but felt that the Sanofi Aventis vaccine would be useful as a stop gap measure.

The Food and Drug Administration is not required to follow the advice of its outside experts but typically does.
The US Department of Health and Human Services has funded research of more than 30 potential bird flu vaccines.
In clinical trials, two-shot doses of Sanofi vaccine provided protection in 45% of adults who had the highest dose, according to an FDA analysis. The New England Journal of Medicine last year published an interim analysis showing the vaccine protected 54% of adults.This is below the level provided by other approved vaccines.
The seasonal flu vaccine protects 70% to 90% of people. The FDA usually looks for antibody response in at least 70% of vaccine recipients. Although no serious side effects were detected among the 450 healthy adults in a clinical test some panel members were concerned that the trial was too small to show rare side effects. There have also been concerns possible allergic reactions to the vaccine because it needs 12 times the dose of the seasonal vaccination.

Bird flu - Now its Afghanistan

KABUL, Afghanistan: An outbreak of H5N1 avian flu has been reported in Afghanistan and Afghan authorities are culling poultry after the virus was found in chickens in the eastern provinces of Nangarhar and Kunaraneastern Afghan city, a U.N. official reported on Wednesday.

SergeVerniau is the representative of the U.N.'s Food andAgriculture Organization in Afghanistan.

The virus in the Nangarhar provincial capital of Jalalabad is reportedto be the H5N1 bird flu strain but there is no confirmation yet of the strain involved in the outbreak in Kunar.The first Afghan outbreaks of H5N1 were March and April 2006 in Kabul and Kapisa, Logar and Nangarhar provinces. There have been no infections of humans however.

Interestingly the reports of an Afghan bird flu outbreak come just a day after reports that neighbouring Pakistan closed a zoo in Islamabad after tests confirmed H5N1 in peacocks and geese. Afghanistan is a migratory bird crossing point and there is considerable trade between neighbouring countries. However Verniau said that it was not yet clear if the same strain was involved in the Afghan and Pakistan outbreaks.

Employers - How to plan for bird flu

How will you manage your business if an flu pandemic occurs? Do you have flu pandemic plans?
We have already outlined some factors that will be pertinent to pandemic planning in the food supply sector. here we look at some more general issues.

First lets deal with the solution that most people think of first. Asking staff to work from home.
This may be feasible for organisations if home working is already an established practice and in particular if there is already the IT infrastructure to support this. For organisations which require staff to be based on the premises this is less of an immediate solution however.
If you are planning for this you need to be aware of some issues in managing this strategy for maintaining business continuity during a pandemic.

Many other companies and organizations are likely to try to also arrange for staff to work from home. These staff as well as working are likely to want to use their internet resource to communicate with friends and family about the impact of the epidemic.
You must anticipate that a flu pandemic will strain the infrastructure of the intranet and that there will be a great demand for intranet resources. Individuals and companies may need to restrain themselves from surfing high-bandwidth sites, such as YouTube if the Internet is to continue to function. Failing this it is possible that governments may be forced to limit Net usage during a pandemic.

In 2006, at the World Economic Forum in Switzerland, a group of telecom and government officials conducted a pandemic exercise based on a hypothetical bird flu outbreakin central Europe.

The scenario assumed total absenteeism of 30% to 60% and absentees trying to work from home. This would have overwhelmed the Internet and so building an assumption of business or organisational continuity based solely on staff working from home is probably untenable.

You should not completely discount home working from your flu pandemic planning but you should also not assume that productivity will be unaffected or that this will be an unproblematic solution.

Factors to consider in Business planning for a flu pandemic.

Most of all don't assume that your business or organisation will operate as normal. You should identify the core activities of your business and be prepared to retrench to them. You might find it useful to plan for staged retrenchment linked to differing levels of staff absence in different sectors of you business.

1) You should assume staff shortages, through employees taking time off ill, to care for others, or to avoid infection, at the 30% to 60% level - 50% is probably a reasonable planning figure.

2) You should not assume that you will be able to find cover for these absent staff.

3) Don't assume home working will maintain your business uninterupted - it will provide some insurance but may be subject to internet overload issues. Factor in additional cost for home-working for those unable to attend work. Look at alternative methods of communication, including web casting and video conferencing. Reconsider policies on flexible working and home working and have alternatives ready that can be triggered if a pandemic strikes.

4) Build in the cost of stringent health & safety policies and procedures for preventing spread of the virus .

5) Factor in public transport disruption making it difficult or impossible for staff to get to work.

6) Consider and plan for problems caused by disruption to your supply chain.

7) Dont panic your employees but do inform and consult employees about your plans. Make them aware a plan exists and inform them what to do if the pandemic occurs.

8) Involve your employees in the planning - they may come up with good solutions.

9) Identify and keep records of employee skills and capabilities to assist employee redeployment if necessary.

10) Identify how you will monitor pandemic progress and have trigger points in your plan linked to pandemic severity.

Russia: No Human H5N1 infection says State

MOSCOW, February 21 (RIA Novosti) - Moscow Region health authorities
have dismissed rumors of a human avian flu case following the outbreak
of H5N1 in poultry farms in the region last week.

There had been Internet sources reporting on Tuesday that a resident
of Ramenskoye who owned poultry contaminated with the bird flu virus
had been hospitalized.

"He [the resident of the Ramenskoye district] has been admitted to the
infectious diseases ward at a local hospital, but his diagnosis is
rhinitis, or simply a common cold," a local health official said.

She said the illness had probably been caused by stress related to the
bird flu outbreak, and that lab tests did not show H5N1 virus
infection.

The Russian agricultural watchdog confirmed on Monday that last weeks
outbreak did involve the H5N1 strain of bird flu virus.

150 dead birds were found at private farms in the Domodedovo, the
Odintsovo, the Podolsk, the Naro-Fominsk, and the Taldom districts
last week, and another 75 were discovered in the Ramenskoye district
this week, but no cases of humans infected with the virus have been
registered so far.

In addition, the Russian veterinary watchdog reported on Wednesday
that 70 dead fowl had been found at poultry farms in the Republic of
Adygea, near to the southern Krasnodar Region, where the most recent
bird flu outbreak occurred in mid-January.

Russia recorded its first cases of avian flu in August 2005, but
previous outbreaks occurred only in southern provinces and in Siberia.

Bird Flu - Food supply chain planning

Food supplies may be a critical issue in the event of a flu pandemic. With predictions that up to a third of the population may become ill in such a pandemic what planning has the food industry taken for such an event?
As individuals, in western countries, we give little thought these days to the security of our food supplies. When we need food we go to the nearest supermarket or grocery store and buy what we need. Our expectation is that the food and other supplies will be there when we need it and in the amounts we need. But will this be the case if a flu pandemic occurs? How will the food industry supply us with fresh produce if their staff are affected by the pandemic? What will we do if the advice is to stay away from public places?

Mothers looking after families are normally able to rely on going to the supermarket once or twice a week for their main shopping. The prospect that families will not be able to do this will cause alarm as many families are likely to have stocks of food for no more than three or four days.

In the USA sectors like water, energy and health care have assistance from state and federal government in their disaster planning. Such assistance does not appear to have been forthcoming however for the food industry. Individual supermarket chains and wholesalers must therefore plan themselves to deal with a potentially large number of sick workers that could affect store operations and disrupt the food supply.

The U.S. Dept of Health and Human Services estimates a third of the population could fall ill if the H5N1 strain of the bird flu mutates into a form that spreads easily from person to person - although it is of course not certain that this will happen.

The U.S. Department of Homeland Security has projected that worker absenteeism could reach over 40 percent for a prolonged period. If this scale of absenteeism does occur during a pandemic, retail food stores would have major worker shortages and there would be supply chain disruption.

The U.S. Department of Homeland Security lists the food and agriculture industry among 13 critical-infrastructure sectors that must remain functional during a pandemic. Maintaining critical facilities such as power, water and food is of course vital during a pandemic.

Another factor that must be taken into account is that in the U.S. and the UK people tend to be eating out more than in the past. During a pandemic food consumption is likely to move significantly away from restaurants and fast-food back to eating at home. The consequence of this will be greater demand for groceries and a need for retailers and distributors to plan for this.
Retailers planning for a pandemic must consider alternative supply chains and anticipate products that will be in high demand during a pandemic situation - in particular medicines and staple foods.

However if retailers and suppliers make all their plans individually and in secret there is a risk that competitive behaviour during a pandemic will reduce the efficiency of a stressed food supply chain. There are strong arguments for government therefore to ensure that there is a core element of co-ordinated planning and that overall control can be assumed in the event that individual plans are unable to deliver continuing food supplies.

It also makes sense for individuals and families to consider maintaining larger stocks of foods, in particular non-perishable staples (eg canned foods, dried fruit, powdered milk) as this will provide an element of additional insurance.

Japan - did rats carry bird flu?

JAPANESE scientists have raised the possibility that rats may have carried avian flu into four poultry farms in the past month. This worrying possibility suggests the virus may have transmission routes that have not yet been identified or controlled.

Government experts who inspected the farms in the Miyazaki and Okayama prefectures believe rodents infected by wild ducks from China may have carried the highly virulent H5N1 virus.

Nets and coverings were in place at the farms to prevent large migratory birds from coming into contact with the poultry. At three farms they found many dead chickens in areas furthest from the entrance of the coops, which caused them to speculate that wild birds were not the direct carriers.
Toshihiro Ito, professor of veterinary microbiology at Tottori University, who heads the team of specialists speculated that it may be possible that small rodents carried the virus into the chicken coops because although the nets could keep out large birds, such as ducks, they could not have stopped very small animals getting to the chickens.
If the fears were confirmed, it would be almost impossible for farmers to avoid similar outbreaks, the task force said.

Russia confirms more bird flu - is it bioterrorism?

As Russia authorities try to contain an outbreak of bird flu near Moscow news emerges that about 3,000 wild ducks have been destroyed near the Black Sea city of Anapa after a number were found dead. No human cases of bird flu have been recorded in Russia yet.
Experts are also testing at a fourth location near the capital. According to a veterinary official it is almost certain the deadly H5N1 strain, as in three earlier cases. Measures have been put in place to combat the spread of the disease. The chickens involved in all cases were thought to have been bought at a market close to the main motorway encircling Moscow. People in contact with the dead birds were taken to hospital but showed no signs of any illness. The outbreak is Russia's second this year and the first recorded close to the capital.

The chief veterinary official for the Moscow region, Valery Sitnikov, told Interfax on Sunday that bio-terrorism can not be discouunted as a cause of the Moscow poultry market bird flu outbreak. He said this was a matter for the Federal Security Service and other law enforcement services.
"The regional veterinary services have almost no doubts that the deadly illness came from Moscow's poultry market", Sitnikov said. "The birds that contracted the disease on the poultry market could have infected other fowl. Bird flu symptoms appear two-three days following infection, which can be seen from what is happening. The first decorative hen was bought on February 9. It died on February 11. In the second case, several hens, bought on February 11, died on February 13," he said. "The management of the poultry market for some reasons have failed to block the arrival of birds infected by the virus. I don't rule out bio-terrorism. The Federal Security Service and other law enforcement agencies must have their say," the official said.

Egypt -further bird flu death

The bird flu death toll in Egypt has reached 22 after an Egyptian woman died of bird flu in a Cairo hospital and a boy aged 5, became the 22nd Egyptian to test positive for the deadly disease, health officials said yesterday.
A World Health Organisation expert said a delay in reporting symptoms was largely behind the most recent deaths in Egypt. A mutated strain that killed three people in December is not suspected to have recurred, officials say.
37-year-old Nadia Abdel Hafez was at first reported to be stable and improving after being transferred to a hospital in Cairo, but her condition deteriorated.
5-year-old Mohamed Ahmed Suleiman of Sharqiya province, was in a stable condition and is being treated with Tamiflu. He tested positive for bird flu after developing a high fever on Wednesday.

Egypt has the highest known cluster of human bird flu cases outside Asia.
Thirteen have died.

Most people infected in Egypt had been in contact with poultry kept at home. Bird flu initially caused panic and did extensive damage to the poultry industry, although the sector has largely recovered.
John Jabbour, a WHO official in Cairo, said a delay in reporting symptoms was making bird flu more deadly in Egypt, where many people keep birds at home but are often reluctant to disclose that to health officials for fear of sanctions.

The fatality rate from bird flu this winter is significantly higher than it was in the same period of 2006, before the country witnessed a 5-month warm-weather lull in human cases. Then just six of 14 people .
Eight Egyptians have contracted bird flu since the disease reappeared in humans in Egypt in October and seven have died - an extrememly high mortality rate which emphasises the improtance of prompt treatment of human case of bird flu.

Moscow Russia confirms Bird Flu outbreak

Russian health authorities confirm an outbreak of bird flu in the Moscow region. Dead birds in the village of Pavlovsky have tested positive for the disease.
Nikolai Vlasov, Russia's top veterinary official, said further tests are being conducted to see if the Moscow outbreak is the H5N1 strain, which is potentially lethal to humans. Poultry farms in the area have been placed under special quarantine as a preventive measure.
Russia recently recorded its first cases this year of the H5N1 strain in dead domestic birds. The virus was found in the Krasnodar region of southern Russia.
Russia had over 90 cases of bird flu last year. Most were in the southern regions, particularly the North Caucasus bordering Georgia and Azerbaijan. Cases also occured in the Siberian regions of Novosibirsk and Omsk.

Catch the flu to avoid dying from Bird flu?

A recent study suggests that immunity to ordinary flu may confer some degree of resistance to the H5N1 bird flu virus. The study involved innoculating mice with the human virus H5N1.
The study found that these mice were less likely to die when they were then infected with a small amount of H5N1 - although protection disappeared after a greater dose of H5N1. Five out of 10 mice infected with a small dose of the full H5N1 virus lived, although all the mice infected with a big dose of H5N1 died. This suggests it is possible that people previously infected with or vaccinated against flu may have soem degree of protection from H5N1.

Richard Webby (St. Jude Children's Research Hospital, Memphis, Tennesse) writing in the Public Library of Science journal PLoS Medicine said "It is weak protection ...It is not protection from infection -- it is protection from death."

There has been speculation about the possibility that people previously infected with one strain of influenza might show partial immunity to another strain. It has always been clear that this could not confer complete immunity - because flu can infect the same person over and over again.

But there may be enough protection to stop a new infection from mutated H5N1 from being deadly to those individuals.

Webby said that it was this possibility that they wanted to test. No human has immunity to H5N1 yet as far as is known. H5N1 avian influenza virus has infected over 270 people since 2003 and over 160. The fear is that it may mutate into a form which will readily spread from human to human and kill millions of people. One of the characteristics of the Flu virus in all its forms is its ability to mutate.

Webby's team speculate that some people may have been infected with H5N1 and not became seriously ill because they have some natural immunity. So far, the virus has killed 60 percent of those known to have been infected.

This may explain why 90% of H5N1 victims are aged under 40. Older people may have a degree of immunity from earlier influenza infection. There is no clear proof of this yet and it is thought there are other explanations for younger people being more likely to be infected or diagnosed.

Influenza strains are referred to by their "H" and "N" designations. The H being the type of Hemagglutinin, the protein that the flu virus uses to get into cells, and the N is Neuraminidase, which the virus uses to get back out of infected cells and spread to others.

People have been catching H1N1 flu since at least 1918, when the worst-ever-documented influenza pandemic killed at least 50 million people globally. The type of flu which normally circualtes today is a much less dangerous descendant of H1N1 circulates and this is used the annual seasonal flu vaccine. The H5N1 flu virus differs mainly in the H5 part.

The issue therefore is whether immunity to N1, either from natural infection or the vaccine, might provide some protection from the worst effects of H5N1.

"Antibodies to the human version of the N1 do cross-react to some extent with the H5N1," Webby said. Because influenza viruses mutate constantly the match is not perfect and the N1 in human seasonal flu looks substantially different from the N1 in H5N1 avian flu. Vaccines against seasonal flu focus on the "H" part of the virus, because they are meant to block infection completely. It is not clear how much "N" component current vaccines have, Webby said.

They also tested human blood samples against two strains of H5N1 from human victims and found eight out of 38 had antibodies that reacted to one strain, and nine of 38 responded to the other.

Bird Flu - the UK hungary connection

Hungarian officials are denying any link between the recent outbreak of bird flu in Britain and the outbreak in Hungary and the BBC reports their deputy chief vet BBC saying he believes that wild birds have carried the virus to the UK. He did acknowledge the suspicion that the trail led back to Hungary.

Last week, almost 160,000 turkeys were culled at a Bernard Mathews turkey plant after the discovery of the H5N1 virus. The Bernrad mathews company also owns Saga Foods in Hungary and evidence has emerged of a traffic in partly processed poultry meat between Hungary and the UK.

Last month bird flu was discovered at geese farms in the south east of Hungary.

THe UK outbreak led to two men who suffered respiratory symptoms being tested for Bird Flu after they were involved in the clean up operation. The tests proved negative. So far there have been no other outbreaks of Bird Flu in the UK this winter. However it is increasingly clear that the extent of the traffic in poutry and poultry products between coutries is more extensive than many had realised and that this may itself pose a bio-security hazard in controlling teh spread of Avian Flu. These two outbreaks have also emboldened thos who argue that intensive poutry farming systems are connected with the rise and spread of H5N1.

South Korea bird flu outbreak

South Korea
A cull of thousands of chickens has begun near the capital Seoul in South Korea after a new bird flu outbreak was discovered. Avian influenza reemerged in South Korea three months ago after a three-year absence and this is the sixth outbreak since then

THe outbreak was identified on Tuesday at a poultry farm, housing more than 130,000 chickens, near Ansung near Seoul, officials said. Tests have yet to confirm if it is the H5N1 strain which is potentially fatal to humans. The agriculture ministry released a statement confirming that breeding chickens at a farm in Iljuk village had been infected with the highly contagious bird flu virus.

In addition to culling the birds at the farm where the outbreak occurred officials have ordered a cull of another 107,000 on nearby farms.

More than two million birds will have been slaughtered in the country since bird flu reappeared there in November 2006.

Given the numbers of birds at the farm involved in this latest outbreak this will fuel the arguments of those who claim that avian influenza, or to be more specific, the H5N1 strain, is intimately connected with intensive poutry systems. It has been suggested that the virus may have indeed arisn in such intensive production systems and spread from there to wild birds rather than the transmission route being the other way. Such speculation is as yet unproved.

Bird Flu-Indonesia deaths and Pakistan outbreak.

JAKARTA, Feb 6 - On Tuesday two more Indonesians were confirmed to have bird flu and Pakistan reported its first case in a year after finding the deadly virus was found in a small flock of chickens near the capital Islamabad.

The H5N1 virus has surfaced again in Asia in recent months, and has been found in poultry flocks in South Korea, Japan, Thailand and Vietnam.
The H5N1 virus has also spread into the Middle East, Africa and Europe since it reemerged in 2003 and outbreaks have been detected in birds in around 50 countries.

Indonesia has the highest human bird flu death toll and the latest human case was a girl from Jakarta who had caught a wild bird which died two days later.

The other was a West Java man who lived in an area where many poultry had died.
Indonesia has had 63 human deaths from the highly pathogenic H5N1 bird flu virus, six of them this year. The virus is endemic in poultry in most of the provinces in the country of 17,000 islands.

The two new cases came as Indonesia stopped sharing human genetic samples of the most deadly strain of bird flu with foreign laboratories. It wants to keep control of the intellectual property rights of the H5N1 strain.
"We can't share samples for free. There should be rules of the game for it," said the health ministry's spokeswoman, Lily Sulistyowati. "Just imagine they could research, use and patent the Indonesia strain. We can't give the samples but we can share data in the gene bank."

Sulistyowati said Indonesia would sign a Memorandum of Understanding with U.S. medical products maker Baxter International on Wednesday to collaborate on making a human bird flu vaccine. "The vaccine is to prevent poultry-to-human infection. That's what we need for the current situation and not for the future pandemic," she said. Baxter has confirmed it expected to conclude a "framework for future collaboration" with Indonesia, but said it would still abide by World Health Organisation rules on sharing virus samples, the Financial Times newspaper said.
Pakistan

Mohammad Afzal, Livestock Commissioner at the Ministry of Agriculture in Pakistan, said all the chickens in a flock of about 40 birds in Rawalpindi, a city near Islamabad, had died or been culled due to H5N1.
"It has been contained and there is no danger of the spread of this virus because there are no poultry farms near this house," he told Reuters.
Pakistan's first reported cases were found in chickens in February last year in North West Frontier Province and this resulted in about 40,000 chickens being culled. Fortunately, there have been no human cases in Pakistan.
(Reuters)

England Bird flu outbreak update

After the slaughter of around 159,000 turkeys after a bird flu outbreak. at a Suffolk farm a cleaning operation of the site has now begun.
The sheds which housed the birds at the Bernard Matthews plant will now be disinfected.
More than 320 farm workers have now taken the antiviral drug Tamiflu and so far no-one has been reported being ill.

There are strict controls in place around the farm near Lowestoft, but the risk to humans is "negligible" according to experts.

A Staffordshire MP raised concerns, however, about the safety of driving the culled turkeys across England. Bill Cash, the member for Stone, has said people living in Stone were "deeply concerned" about trucks carrying the dead birds through the area.

The workers who have taken Tamiflu include those who may have handled more than 2,000 birds who died from the virus.
While the outrbreak has so far not had implications for human health in England it is having economic consequences. South Africa, South Korea, Japan and Hong Kong have blocked all UK poultry imports. Russia however, is still allowing the importation of cooked meats. Britain is Europe's second-largest poultry producer with annual poultry exports of around £300m.

A 3km (1.9 miles) protection zone and a 10km (6.2 miles) surveillance zone are in place around the farm where the outbreak occurred.
Poultry owners in a wider restricted zone, covering 2,090 sq km (807 sq miles) around Holton, must keep their flocks isolated from wild birds.
The source of the outbreak is currently unknown and there is speculation that it may prove to be impossible to trace the source. This causes some concern as if the source remains unknown then lessons can not be learned that would help prevent further outbreaks.

Egypt, 17 yr old girl dies of avian flu

In Egypt the number of confirmed deaths from avian flu has risen to 12 with the death of a 17-year-old Egyptian girl, Nouri Nadi, from Fayyoum Shewas admitted to hospital a week ago after being initially diagnosed with human flu.
As with most other cases so far, it is thought she became infected with avian influenza after coming into contact with sick and infected birds.
This death brings the number of known infections in Egypt to 20 which is the largest human cluster outside Asia. The virus has been found in 19 of the 26 provinces in the country.
Of the 12 people who have died from the illness in Egypt, 11 have been women - a pattern thought to be related to the fact that women and girls often look after poultry in Egypt.

Several weeks ago, the WHO announced that two of those who had died had been infected with a strain of the virus that showed moderate resistance to the antiviral drug, Tamiflu. This is a clearly worrying development.

First Russian Bird Flu Outbreak 2007

Russia has reported its first H5N1 avian influenza outbreak of the season.

Rosselkhoznadzor, the Russian government’s agricultural watchdog, announced today that poultry deaths were reported at three farmsteads in Krasnodar. A Spokesman said that samples from the birds tested positive for H5N1 avian influenza (bird flu).
Krasnodar is in southwest Russia near the Black Sea. The outbreaks occurred at three different settlements. Further tests on the samples will be conducted in Moscow.
Russia’s last confirmed outbreak was in July 2006, . The country had its first major poultry outbreak in 2005 but no human cases have been reported .

Story Link

Third Bird flu outbreak in Japan

Japan - Officials confirm a third outbreak of bird flu on a farm in Takahashi - although it is unclear if it is the H5N1 strain dangerous to humans.
About 40 chickens died and all poultry there are to be culled, and the movement of people and goods restricted.
Two H5N1 bird flu outbreaks were confirmed earlier this month in the southern prefecture of Miyazaki.
Tests have already determined that the new case of bird flu belongs to the H5 family of the virus, but further tests are to be made to find out if it is the strain potentially deadly to humans.
H5N1.
Officials are taking no chances and will cull all 12,000 birds at the affected Takahashi farm as early as Tuesday.
Other farms in a 10 km (six-mile) radius have been banned from transporting chickens and eggs, a ministry official said.

There have been a number of H5N1 outbreaks in Japan since early 2004, but no human deaths from the virus.
Across Asia health officials are on alert as a growing number of countries have reported cases in birds and humans in recent weeks.
Since the H5N1 virus emerged in South East Asia in 2003, it has claimed more than 150 lives around the world.

Bird flu outbreaks in Japan

The Japanese agriculture ministry on Thursday confirmed that the virus detected in the second case in a month of birds' mass death in Miyazaki Prefecture is the virulent H5 strain of the bird flu virus.
The National Institute of Animal Health in Tsukuba, Ibaraki Prefecture will further analyze the virus sample to determine if it was the lethal H5N1 type, Kyodo News reported.
About 1,300 birds died from Monday to Wednesday at a farm in the city of Hyuga. This is the second bird flu case in a month in Ibaraki prefecture and the sixth in Japan since 2004.
Earlier this month at a farm in the town of Kiyotake, 60 kilometers away from Hyuga 3,500 birds were killed by the H5N1 strain and all of the 12,000 birds incinerated.
Bird flu infections hit dozens of farms in central Japan's Ibaraki prefecture in 2005 and 2006, resulting in the destruction of at least 5.8 million poultry.

US Senate hears bird flu threat continues

(Reuters) - Bird flu poses as big a threat to the world as ever, and people need to worry about it more, U.S. senators and health leaders agreed at a meeting on Wednesday.

The Senate hearing was told that the H5N1 avian flu virus could cause a human pandemic at any time, killing perhaps millions, yet preparations are slow

Federal health officials said they were working to raise preparedness but progress has been slowed by budget limitations and the generally poor state of public health in the United States.

"I am concerned that there is not as much public awareness or concern today as there was a year ago ....You don't want to unduly alarm people. (But) I think people are unconcerned."
Pennsylvania Republican Sen. Arlen Specter told the Senate Appropriations subcommittee on health.

Firt european bird flu outbreak of winter

Jan 24, 2007 – Hungary announced today that it had a H5N1 avian influenza outbreak at a goose farm - the first appearance of the disease in Europe this winter.

A European Union statement said Hungarian authorities notified the EU of an H5N1 avian flu outbreak in Csongrad County (southeastern Hungary) , Reuters reported. The EU said vets tested some geese after several deaths were reported in a 3,000-bird flock; all the remaining geese were culled.

Hungarian veterinary officials told Bloomberg News they will send samples tomorrow to an EU lab in the UK to confirm the results.

Chief veterinarian Miklos Suth, in a tv appearance, said a surveillance zone had been set up around the farm. The farm is said to be in an isolated location, making spread of the disease less likely.

Hungary's first H5N1 outbreaks involved mute swans in Bács-Kiskun County in April 2006, according to the World Organization for Animal Health (OIE). The following June, the disease was found in several goose farms in the same county.

The last previous outbreak in Europe was in Germany last August, according to the United Nations Food and Agriculture Organization (FAO).

Egypt bird flu deaths rise to 11

The Egyptian Ministry of Health and Population has announced a new human case of avian influenza A(H5N1) virus infection. The case was confirmed by the Egyptian Central Public Health Laboratory and by the US Naval Medical Research Unit No.3 (NAMRU-3).

The 27-year-old woman from Beni Sweif Governate developed symptoms on 9 January 2007 and died in hospital on 19 January.

Initial investigations indicate the presence of sick and dead poultry at her residence in the days prior to the onset of illness.

Of the 19 cases confirmed to date in Egypt, 11 have been fatal.

The world total deaths from avian influenza now stands at 163

Source : World Health organisation

New WHO Director speaks of Avian flu

Dr Margaret Chan, the new director general of the World Health Organisation, addressed the subject of avian flu in her address to the 120th Executive Board session of the WHO on 22nd January 2007.

"The message is straightforward: we must not let down our guard. The whole world has lived under the imminent threat of an influenza pandemic for more than three years. These years of experience have taught us just how tenacious this H5N1 virus is in birds.
Countries have made heroic efforts, yet the virus stays put or comes back, again and again. Almost no country with large outbreaks in commercial or backyard flocks has successfully eliminated this virus from its territory.
As long as the virus continues to circulate in birds, the threat of a pandemic will persist. The world is years away from control in the agricultural sector.
This may mean that we have some more years in which to improve preparedness, or it may not. Influenza viruses are notoriously sloppy, unstable, and capricious. It is impossible to predict their behaviour.
But we do know some things. The virus does not, at present, transmit easily from birds to humans. H5N1 avian influenza is still essentially a disease of birds.
For humans, we also know that this virus has lost none of its virulence. As of today, 267 cases have been confirmed, of which 161 were fatal, representing a case fatality rate of 60%. More deaths occurred in 2006 than in the previous years combined. For 2006, the case fatality rate was 70%.
We are clearly much better prepared than three years ago, but have every reason to continue these efforts. The revised International Health Regulations come into force in June. That will help. You have a resolution before you that calls for routine and timely sharing of biological materials related to novel influenza viruses. That will help as well."

Nutritional status and preparing for Bird Flu

BARRY W. RITZ, MS, researcher, was on the team of immunologists from DREXEL UNIVERSITY'S Department of Bioscience & Biotechnology which has just had a study published: Quote "An important consideration in preparing oneself for a possible influenza pandemic is nutritional status. Malnutrition is the leading cause of immunosuppression worldwide, and nearly any nutrient deficiency results in impaired immunity and an increased incidence of infection. Further, specific nutrients show great promise in enhancing immune function. In a study recently published in the Journal of Nutrition, we (the team of researchers at Drexel University) showed that a novel nutrient compound marketed under the brand name Immpower effectively enhanced the immune response to influenza infection, decreasing the severity of infection and expediting viral clearance."

bulgaria flu epidemic

Bulgaria is in the grip of a serious flu epidemic and the virus continues to spread. The outbreak is forcing hospitals to cancel hundreds of operations and there is significant overcrowding in majors hospitals across the country. The bug is due to peak this week according to experts from the National Center for Infectious Diseases. A flu epidemic was declared in the capital yesterday and several other cities did so earlier this week.

bird flu deaths

An Egyptian woman died in hospital on 19/01/2006 from the human form of bird flu. Warda Eid Ahmad, 27, from Beni Suef province, south of Cairo, was transferred to hospital in the capital on January 13 suffering from pneumonia.

An Indonesian woman has died of bird flu, raising the country's death toll to 62, while South Korea was set to slaughter 273,000 poultry after an outbreak of the deadly H5N1 strain at a chicken farm, officials said Saturday. The 19-year-old woman died on Friday after three days in hospital said health ministry official Nyoman Kandun. "She had contact with dead poultry six days before hospitalized," Kandun said. This is the fifth human bird flu fatality in Indonesia since Jan. 9. Before that, Indonesia had not recorded any cases for six weeks – a lull that led some Indonesian officials to say they were succeeding in beating the disease.

Developing technology for flu protection

18/01/2007 - The major drug companies Novartis and GlaxoSmithKline (GSK) have been awarded contracts with the US government to develop adjuvant technology for pandemic influenza, to potentially increase the number of doses to be distributed among US citizens.

Recent figures imply that pandemic flu vaccine production, even at peak capacity, will only make vaccines available to 10 per cent of the US population. This prompted the US Department of Health and Human services (DHHS) to call for proposals to 'stretch the domestic influenza vaccine supply in the event of an influenza pandemic.'
The DHHS has invested into research on adjuvant technology – a substance added to a vaccine to improve the body's immune response – used in combination with a vaccine's active ingedient, the antigen. This has potential to lower the amount of antigen used per dose of H5N1 influenza vaccine.
A third contract has been awarded to Iomai to develop an immune-boosting skin patch, used in combination with an injectable influenza vaccine, which requires 10- to 100-times less vaccine.

Recent clinical data has shown that H5N1 pandemic vaccines require two doses to stimulate an immune response in humans and that up to 90 micrograms of antigen is used per dose, in comparison to seasonal influenza that uses 15 micrograms of antigens in a single dose.
Both Novartis and GSK have addressed this problem with their proprietary adjuvant technologies, as an example Novartis' MF59 has been included in several studies where it was found that it might reduce the amount of antigen needed for an immune response. In addition, MF59 can potentially provide cross-protection against changing flu strains.
Around two-thirds of GSK's vaccines in development are formulated with their proprietary adjuvant technology. In 2005, GSK boosted its presence in the vaccines field with the acquisition of its long-term US vaccines partner Corixa, which produced adjuvants contained in many of their vaccines. However, the pandemic flu adjuvant, details of which will not be disclosed until 3 March 2007, will be developed in a plant in Belgium, according to Graeme Hacking, GSK spokesperson.
”Novartis is committed to the development and supply of vaccines to help protect against both seasonal influenza as well as the possible emergence of pandemic influenza,” said Jörg Reinhardt, CEO of Novartis Vaccines and Diagnostics.
”The use of our proprietary adjuvant MF59 with influenza vaccines has shown to be dose sparing and to provide additional immunogenicity against a broader range of potential pandemic influenza strains, while using lower amounts of viral antigen for the vaccine.”
”A limited global supply capacity of flu antigen makes it critical that we use innovative adjuvant system technology to produce a new generation of flu pandemic vaccines,” said David Stout, president of pharmaceuticals at GSK.
In 2006, DHHS made a bulk order of $40m (€31m) of bulk H5N1 antigen – representing 800,000 doses - to GSK, that will build on the existing US stockpile of about 5.9m doses of H5N1 vaccine. GSK was also awarded $274m to develop cell-culture technology to speed the development of new cell-culture-based seasonal and pandemic influenza vaccines, and to scale-up cell culture manufacturing capability at its Pennsylvania site.
In addition, DHHS announced it had also awarded contracts to two other drugmakers – Sanofi-Pasteur and Novartis – to supply flu vaccines. The three drug firms will make enough doses to cover 2.7m people for $200m worth of vaccines against the H5N1 avian flu virus, DHHS said.
“Having a stockpile of influenza vaccine that may offer protection against the H5N1 virus is an important part of our pandemic influenza preparedness plan," said HHS secretary Michael Leavitt.

Latest Bird Flu news causes concern

BEIJING (Reuters) - Bird flu has infected a farmer in China's first human case in months, killed an Indonesian teenager and spread deeper in Vietnam in a flare-up of infections mirroring past winters.
A second Indonesian bird flu victim, a 37-year-old woman from Banten Province on Java island, was in hospital on Wednesday, the World Health Organization (WHO) said.
Most human victims of bird flu have contracted the virus from infected birds, usually chickens, ducks or geese and there is usually a surge in cases during cooler months when the virus seems to thrive.

The 37-year-old Chinese man from the eastern province of Anhui kept backyard birds, but as in other human bird flu cases in China there was no reported poultry outbreak in the area, raising questions as to how he contracted the virus.

The man developed symptoms of fever and pneumonia early last month and was discharged from hospital on Saturday, the state-run Health News said.
"In China, the challenge is now to identify where this virus is hiding and how it is circulating," Henk Bekedam, the WHO's China representative, told Reuters.
China has reported 22 human cases, including 14 deaths, since 2003 and, with the world's largest poultry population and millions of backyard birds roaming free, it is seen as a center in the fight against the virus.

Bekedam said that as vaccination rates for birds improve in China, detecting avian influenza becomes harder and harder, offering a possible explanation for why there was no reported outbreak where the farmer lived.
BOY DIES
Indonesia has the highest human death toll from bird flu of any nation, and on Wednesday that number grew to 58 when a boy, from Tangerang near Jakarta, died, said the head of the Indonesian health ministry's bird flu center Runizar Ruesin.
The boy was admitted to hospital in the capital last week and deaths among poultry in his neighborhood had recently been reported, the WHO said in a statement posted on its Web site (http://www.who.int).

Muhammad Nadirin, another official at the country's bird flu center, said hospital staff had to take extra care washing the boy's corpse because of concerns the virus might infect them.
"He was washed using special protection methods to prevent contagion," but added he didn't know if it could be transmitted from human-to-human this way.
The H5N1 virus mostly affects birds, but it has infected 263 people in 10 countries since 2003, killing 157 of them.
Scientists fear the virus could mutate and spread rapidly between people, triggering a pandemic that could sweep the globe in weeks and possibly kill millions.

An adviser to the White House said on Monday the number of people that could die in a flu pandemic that matches the 1918-19 outbreak will be "very scary" and far higher than the 62 million deaths forecast by a recent study by Harvard University.
The 1918-19 "Spanish influenza" pandemic killed anywhere from 20 million to 100 million people.
In Vietnam, bird flu has been confirmed in a fourth Vietnamese province after tests on 70 ducks showed they had died from the H5N1 virus, a government report said on Wednesday.
The results of tests on ducks found dead at the weekend prompted health workers to slaughter around 1,800 more ducks in two communes of Kien Giang province in the southern Mekong Delta, the Animal Health Department report said.

The virus that first struck the delta region in late 2003 re-emerged last month. Vietnam has had no human H5N1 cases since November 2005.