With its focus on health maintenance and disease prevention, demand for greater knowledge and use of Traditional Chinese Medicine (TCM) throughout the world continues to increase.

Facts About Bird Flu - Avian Flu 

WHO has warned several times over the past year of the potential evolution of the virus into a human pandemic which, in a worst-case scenario, could have devastatingly deadly consequences.

We all certainly hope that a serious worldwide influenza pandemic will not occur.

We all certainly hope that a serious worldwide influenza pandemic will not occur. Although we cannot ignore the possibility, and we cannot expect that governments and authorities will have all the answers. If it does occur it is likely to have a major impact on each of our lives.

I have chosen to contribute to be part of the solution and perhaps my efforts may help others, and maybe even save some lives. I hope the information I provide here to you on this web page, and attempt to keep current,  will keep you informed of the situation and provide you with the materials you need to educate and prepare yourself, your family and your community. Please help by spreading the word.

Pandemic Influenza A Global Threat - a short film by European Scientific Working Group on Influenza

WHO Latest Analysis of Bird Flu Prevalence and Cases

Frequently Asked Questions About Bird Flu

Reported Worldwide Bird Flu Case Count from Center for Infectious Disease Research & Policy (CIDRAP)

Reported Worldwide Bird Flu Case Count from Hong Kong Government

Graph from World Organisation for Animal Health Showing H5N1 Outbreaks in the Avian Population 

Comments from Mayo Clinic on Bird Flu
 

Comments and observations from myself:

• Despite our 21st century communications capabilities it is evident that many countries have a strong incentive to 'play-down' anything to do with H5N1, to protect their own economic interests. As Recombinomics points out "India claims to have never had H5N1 in poultry or people, although, poultry workers in India have H5N1 antibodies.  Thailand claims to have had no H5N1 cases in 2005 although the H5N1 isolated from birds closely matches the H5N1 in northern Vietnam isolated from patients.  Indonesia claim their H5N1 infections in 2003 were due to New Castle Disease and the H5N1 in a Jakarta suburban family was a fatal bacterial infection. China has denied any human cases of H5N1, including the large number of cases reported by Boxun in Qinghai and the pneumonia isolation wards in Tacheng, Xinjiang."
• China seems once again to be limiting the worlds ability to look into the details and prevalence of H5N1 in China. It seems to be repeating its handling of  SARS by keeping everything to itself and not allowing the rest of the world to know the real facts. It is clear that the rest of the world can have no expectation or reliance on China to help anyone but themselves. Concern for others, and a desire to help humanity, is evidently not part of the culture. 
• While most governments and their departments are getting together bird flu preparedness plans, so should many businesses that could be deemed to be essential community services. These would include those businesses in the community that are part of the supply chain for money & finance, food, health & medicines, utilities, communications, etc. Now is the time to act - not wait until a potential pandemic is on our doorstep. Governments have considered this important enough to spend millions of dollars of taxpayers money on right now. Why should preparedness stop there. And what should the average person in the community do to prepare themselves and their families for what may be about to occur? Governments are not likely to initiate this for fear of public unrest, and adverse political consequences. Bt that does not mean it is not necessary to do so.
• Surely it is time that governments of all countries started to encourage and educate people to exercise personal and environmental hygiene as an effective measure against contracting all types of influenza. With all our advancements in science, medicine, technology, and education it would appear from everyday observed practices in many countries (included developed countries in the west) that the human race has learnt very little about common hygiene. Common-sense hygienic practices alone could help prevent widespread infections.
• The apparent 'cover-up' by countries such as China on accurate and timely reporting of bird flu spread and infection, would seem to indicate their concern with their own image, 'face', politics, and international trade rather than any concern about the toll such a disease may have on humanity. Yes, we have progressed quite a lot from 1918 in many ways, but the characteristics being displayed by countries such as China in the face of a potential worldwide pandemic did not seem to be present in 1918, and today could be the biggest single factor that facilitates the worldwide spread of bird flu. In the past, Chinese authorities denied that there were cases of SARS in Beijing when it later transpired there had been.
• A problem during the 1918 influenza pandemic, which is now believed to have begun in the USA, was the lack of adequate testing equipment, facilities and knowledge available to confirm proper diagnoses. Fortunately today in the USA there exists considerable knowledge and facilities to prevent a similar occurrence there of the 1918 influenza pandemic. 
  However, it would seem from reports that many Asian countries today in which H5N1 is present severely lack adequate testing equipment, facilities and knowledge. Yet it is in these very Asian countries that H5N1 may be evolving into a serious worldwide threat. 
• At the early stages of the 1918 pandemic, before it was known to be of pandemic proportions, there were many unexplainable reports across the USA and other European countries of people becoming fatally ill with influenza, pneumonia and meningitis. It was not until some time later that these seemingly unrelated instances were recognised as the early stages of the worldwide pandemic.
  Today in several Asian countries there are seemingly unrelated instances of unexplained outbreaks of influenza, meningitis and pneumonia.
• During the 1918 influenza pandemic it was not uncommon for those infected by the pandemic to be diagnosed as having meningitis or pneumonia, both of which were found later to be secondary bacterial infections from the pandemic viral influenza.
  It seems during the first few months of 2005, there have been reported unusual outbreaks of meningitis in several countries, such as Philippines, India, Vietnam, and China.

The Independent August 21, 2005: Migratory ducks and waders could bring bird flu to Britain this winter, experts have warned, after the disease was found in wild flocks in Russia. The potentially lethal avian flu virus, H5N1, is now spreading westwards after health experts in Siberia and Kazakhstan discovered outbreaks of the virus in birds that will soon enter Europe. Yesterday, as the total number of confirmed cases in Russia hit 40, the authorities revealed the first suspected case of the virus at a commercial chicken farm in the western Siberian region of Omsk. Another 78 villages have suspected cases. Although the chances of the virus spreading from birds to humans within Britain is thought to be very low, the Cabinet's civil disasters committee, Cobra, is to stage its own emergency exercise next month.

MediaCorp August 20, 2005: The Rome-Fiumicino international airport has begun implementing precautionary measures involving passengers and merchandise originating from regions affected by bird flu. Passengers traveling to the Rome airport from China or Russia may be immediately hospitalized in an infectious diseases clinic if they shows signs of respiratory problems, airport authorities said Saturday.

SciDev August 18, 2005: The World Health Organization (WHO) has called on its offices worldwide to stockpile drugs to protect at least one-third of staff and their families from a potential bird flu pandemic. The call comes after news that the bird flu virus H5N1 has spread from South-East Asia to Kazakhstan and Russia. The WHO also advises their offices to stockpile medical equipment such as syringes, antibiotics and face-masks, and is giving advice on how to convert large areas, such as gymnasiums, into temporary wards.

Recombinomics August 13, 2005: Reports indicate H5N1 wild bird flu is expanding dramatically in Novosibirsk and points west along Russia's southern border (see map).  The leading edge of the advance now appears to be entering the province of Chelyabinsk.  The large number of additional points under suspicion suggests that there are additional unreported locations in northern Kazakhstan and the advance of the H5N1 has probably already entered European Russia. As the weather cools more migration into Europe is expected.

Bloomberg August 12, 2005: GlaxoSmithKline Plc's Relenza may be as effective as Roche Holding AG's Tamiflu in the treatment of bird flu, and should be included in government stockpiles against the potentially fatal illness, researchers said in this week's Lancet medical journal. Relenza, also known as zanamivir, causes fewer adverse reactions than Tamiflu and has a favorable resistance profile, according to Kenneth Tsang, a researcher at Queen Mary Hospital in Hong Kong. Tsang's study showed both drugs have similar efficacy.

Recombinomics August 11, 2005: The report of 20 meningitis cases in and around the village of Rybalovo in the Tomsk region is cause for concern.  The village is just northwest of Chany Lake in Novosibirsk where there have been at least 14 outbreaks of H5N1 bird flu (see map). Meningitis can also be due to secondary infections after the flu, so testing of the meningitis patients ffor influenza A is warranted.

Canadian Press 11, 2005: Enthusiasm over the news that U.S. researchers have proven a vaccine is effective against the H5N1 avian flu strain was tempered Monday with word that it took massive doses - roughly 12 times the normal amount - to produce a protective response in humans. Given that manufacturers can only make enough vaccine for a fraction of the world's population in normal times with regular dosing schedules, experts said the findings underscore the urgent need to find ways to produce the same response with smaller doses of vaccine. "I think these results suggest the world is even less prepared than more prepared," said Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. "And unfortunately many policy makers might take this announcement as being 'We've hit the gold mine' - when in fact I would suggest we are having a hard time even finding water." 

Xinhua August 9, 2005: A 35-year-old man from Vietnam's southern Ben Tre, has just been confirmed to die of bird flu, lifting the total fatal cases in the country to 41 since late 2003,local newspaper Young People reported Tuesday. Tests by the Pasteur Institute in southern Ho Chi Minh City showed that the man from the Ba Tri district named Phan Van Lu was infected with the virus strain H5N1. He died at a provincial hospital on July 31, one day after being hospitalized. 

Times Online August 7, 2005: THE government is to mount an exercise to help emergency services prepare for any potential bird flu pandemic that could kill thousands of people in Britain. Sir Liam Donaldson, the chief medical officer, has said that the question “is not if the pandemic comes, but when”. The exercise in September — a table-top simulation in a bunker beneath Whitehall — will be co-ordinated by Cobra, the cabinet civil emergencies committee, and will involve the army, police, health department and other key government organisations. According to the health department’s contingency plan, the healthcare system could be overwhelmed. Estimates of deaths in the first six weeks of the outbreak range from 20,000 up to 710,000, after which the disease would begin to subside. About 20m people could suffer serious breathing problems.

Bloomberg August 6, 2005: Preliminary human tests show an experimental vaccine made by Sanofi-Aventis SA is effective against a bird flu virus feared capable of starting a lethal worldwide outbreak of the disease, the National Institutes of Health said. Results from 113 people showed that protective proteins, called neutralizing antibodies, rose to an effective level after the shots, said Anthony Fauci, director of the NIH's National Institute for Allergy and Infectious Diseases. The full study will include results from more than 450 subjects, he said. An effective vaccine would provide a line of defense against the threat of the H5N1 bird flu that has killed at least 57 people and millions of birds in Asia. It might help health officials head off a repeat of the 1918 outbreak of deadly flu that may have killed as many as 50 million people worldwide.

Recombinomics August 6 2005: An earlier human vaccine against A(H5N1) avian influenza virus was prepared after it first appeared in the world, in Hong Kong in 1997. That vaccine was never fully developed or used, and the strain has mutated since then. In interviews over recent days, Dr. Fauci has said that tests so far have shown that the new vaccine produced a strong immune response among the small group of healthy adults under age 65 who volunteered to receive it, although the doses needed were higher than in the standard influenza vaccine offered each year.  The above comments on the development of a pandemic vaccine are overshadowed somewhat by the rapid spread of H5N1 across Russia, Kazakhstan, and Mongolia.  Although the sequence of the rapidly spreading H5N1 has not been published, descriptions of  the sequence sound much like the recently published H5N1 sequences from Qinghai Lake.  Those sequences suggest that the current pandemic vaccine being tested worldwide will not be effective against the H5N1 expected to spread throughout Asia and Europe in the upcoming weeks.

Recombinomics August 6, 2005: H5N1 bird flu has migrated to Mongolia.  Mongolia's proximity to Qinghai Lake, Russia, and Kazakhstan, all of which have confirmed H5N1 bird flu, predicted that bird flu would also reach Mongolia. Prior H5 isolates from Chnay Lake and Primorie had shown related to each other as well as H5 in Europe, indicting migratory bird transmit H5 from Chany Lake to Primorie or vice versa.  Either direction however would likely include flights over Mongolia. The H5N1 detected in China, Russia and Kazakhstan kills geese, which is unusual.  The dead geese in Mongolia strongly suggest that the H5N1 in the three adjacent countries has migrated to Mongolia also.  The dead geese in Mongolia also suggest H5N1 will be detected in Primorie also. The appearance of the Asian version of H5N1 has not been previously reported in Russia, Kazakhstan, or Mongolia.  Thus, H5N1 has expanded its geographical range as well as its host range.  After migrating from Russian and northern China, it seems likely that most of Asia and Europe will be H5N1 positive in the upcoming flu season in the northern hemisphere.

Times Online August 3, 2005: Scientists Warn Over Bird Flu Threat: Only decisive action within days of the first human to human cases of avian flu could prevent the triggering of a pandemic that would kill millions, scientists said today. If the H5N1 virus currently circulating among birds in Asia evolves the ability to pass easily from person to person, health authorities will have just three weeks to contain it with drugs before it becomes a global threat, according to two sophisticated computer models. Should this opportunity be missed, the result could be a pandemic that infects half the world’s population and kills even more than the 20 to 50 million who died in the "Spanish flu" of 1918-19. Countries worldwide, including Britain, would be powerless to protect themselves against the virus, though judicious use of drugs and vaccination might reduce the death toll. The findings, from two independent international research teams, show the urgency of building up a "mobile stockpile" of three million courses of the antiviral drug Tamiflu, that can be deployed anywhere in the world within three days. The World Health Organisation has just 120,000. The models suggest that swift preventive use of the drug to treat people who come into contact with sick patients could contain an outbreak before it turns into a pandemic. They also point to the importance of thorough disease surveillance in the Asian nations in which a human H5N1 outbreak is most likely. If the first cases and clusters are missed, vital time will be lost and containment efforts could become futile. "Control of a human outbreak is potentially possible but only when it is in its early stages," said Neil Ferguson, Professor of Mathematical Biology at Imperial College, London, who led the first study. "Once it is beyond this, once it reaches the UK, there is no chance of stopping it, only of mitigating its impact. We need to act quickly, detect cases quickly and treat people quickly. The challenges are great but the potential benefits are saving millions of lives. "This is our only option for making a big difference to a pandemic outcome. If we let it spread we’ll at best be able to prevent the deaths of perhaps half those infected in the UK." Ira Longini, Professor of Biostatistics at Emory University in Atlanta and the leader of the second team, said: "If detection and containment starts within three weeks or so, we have a good chance. Once the response takes more than a month there is a very poor chance of containment." Both teams said the World Health Organisation (WHO) should buy three million doses of Tamiflu, which could be sent within three days to contain an outbreak anywhere in the world. WHO is currently negotiating over a large stockpile with the manufacturers, Roche, which is understood to be considering donating the drugs. While there is an experimental vaccine against H5N1, a pandemic strain is likely to be genetically different from the present one, making it less effective. Tamiflu is considered the best option, as it can be used prophylactically to prevent infection.

Associated Press August 3, 2005: Rapid quarantines, travel restrictions and plenty of medicine quickly distributed could prevent millions of deaths in a bird flu outbreak in Southeast Asia, public health scientists said in a pair of studies examining the threat. Such an emergency plan would have to be enacted within two days and the spread of the virus limited to a few dozen cases – a challenge for an area where communications are often rudimentary and entire economies and transportation networks could be disrupted. "Containment is challenging," said Neil Ferguson of Imperial College in London and lead author of one of the two studies examining avian flu control measures. "We just can't cherry-pick the more easily implemented solutions." Once the virus spreads to mobile, urban nations like the United States or Great Britain, "chances of stamping out the pandemic are poor," he said in a news conference Wednesday. 

The Register August 3, 2005: Russia's Emergencies Ministry is warning that the H5N1 strain of the bird-flu virus, the strain dangerous to humans and responsible for the deaths of more than 50 people in Asia, could spread into mainland Europe from farms in Siberia. The Ministry issued a statement saying that the autumnal migration of birds from Siberia to the Caspian and Black Sea regions could increase the risk of new outbreaks, Reuters reports. "Human infection, especially among workers at poultry farms, cannot be ruled out," the statement warned. In the Novosibirsk region, where the virus has claimed nearly 3,000 head of domestic poultry, farmers have already begun slaughtering birds - a program that could last for at least a week, or even for 10 days. The H5N1 strain of the bird-flu virus can be passed from bird to human, but in Russia no cases of human infection have been officially registered. The greatest fear is that the virus will mutate and a strain will emerge that can be passed from human, to human, triggering a global epidemic.

myDNA August 2, 2005: A British pharmaceutical firm states that they have developed a vaccine for the deadly H5N1 virus, commonly known as the avian bird flu.

The vaccine is unique in that it is DNA-based, as other bird flu vaccines are derived from a developing egg. This proves beneficial, as egg-produced vaccines can take up to six months to produce, while the latest DNA vaccine can be produced at a much faster rate. Dr Clive Dix, CEO of PowerMed, the manufacturer of the vaccine, believes that if necessary, 150 million vaccines could be produced in three months. Dix also states that another advantage of the vaccine is its ability to adjust to any mutations present in the bird flu, as it would take a simple alteration in the genetic code to adapt the vaccine.

Associated Press August 2, 2005: Russian veterinary officials said Tuesday that an outbreak of an avian flu strain that can infect humans has spread to another region in Siberia, while authorities were struggling to contain the virus. Gennady Onishchenko, Russia's chief epidemiologist, sought to assuage public fears during an inspection trip to the Novosibirsk region Tuesday, saying the outbreak was being successfully contained. Almost all the humans who have been killed contracted the virus from poultry, but experts worry it could mutate into a more deadly virus that could spread from person to person.

Recombinomics August 2, 2005: Three Villages Razed In Qinghai After H5N1 Bird Flu Riots. According to the Qinghai Bulletin Board Service (BBS), the state of emergency imposed on the farming community and its surroundings in the Northwestern Qinghai City / Town of Yushu was lifted on the night of 28th July. When natives living further from the area made a trip to the farming community, they discovered that it had "vanished" together with 3 of its surrounding villages. Only some ruins, blocks from collapsed walls, remained. Apparently, the farms and villages had been flattened and there were signs that they had been razed. It is believed that some inhabitants from those 3 villages were workers in the farm. Around 200 people were estimated to have inhabited or worked in those 3 villages and the farm. There whereabouts are, as yet, unknown. The above translation of a boxun report suggest that three villages were razed in response to unrest linked to a forced bird flu quarantine in Yushu in northwestern Qinghai in China.  China has imposed news blackouts and arrested reporters in the past, so verifiable news from the area is difficult to obtain.

ThanHnien News August 2, 2005: Vietnam's northern Ha Tay province reported a local woman tested positive for the deadly bird flu virus that has killed over 41 people in the country since late 2003, said local Lao Dong newspaper Tuesday. Specimens from Nguyen Thi Them, a 49-year-old woman from Quoc Oai district, tested positive for the bird flu virus strain H5N1, a source told the newspaper. Although she no longer has an elevated temperature, she continues to require respiratory assistance at the Institute of Tropical Diseases in Vietnam’s capital Hanoi.

Interfax July 31, 2005: A 20-year-old man showing bird flu symptoms has been hospitalized in Kazakhstan's Pavlodar region, where 600 domestic geese died between July 20 and July 30 as a result of an outbreak of the disease in the area. The patient, a poultry farm worker from the village of Golubovka, was later diagnosed with double pneumonia and taken to the intensive care unit of Pavlodar's regional infectious diseases hospital in a critical condition, sources in the region's emergency medicine center told Interfax. The first deaths of birds in Golubovka were registered a week ago, Yersain Aitzhanov, chief of the Irtysh district's emergency situations department, told Interfax. A quarantine order has been imposed in the village. "All necessary measures are being taken: the territory is being ploughed, additional fences have been built around the farm and a ban has been introduced on the delivery of poultry products and eggs from the village," Aitzhanov said.

Chicago Tribune July 31, 2005: Hundreds of fowl in Siberia have died of the same strain of bird flu that has infected humans across Asia, the Russian government said Friday. No human infections have been reported from the Siberian outbreak, Russia's Agriculture Ministry said in identifying the virus as avian flu type H5N1. The outbreak in Russia's Novosibirsk region in central Siberia apparently started about two weeks ago when large numbers of chicken, geese, ducks and turkeys began dying. An expert at the United Nations said it was still not known how many birds have been exposed. 

Reuters July 29, 2005: Bird flu has killed two more Vietnamese, taking the country's toll to 42, nearly half of them killed since the H5N1 virus returned in December, state-run media said on Friday. A 26-year-old who died in Ho Chi Minh City on Wednesday tested positive for the H5 component of the deadly H5N1 virus, the Tuoi Tre newspaper reported without disclosing the sex of the victim. A 24-year-old man from the southern province of Tra Vinh died on Monday in a provincial hospital and tests showed he had the deadly H5N1 virus which has also killed 12 people in Thailand, four in Cambodia and three in Indonesia, it said. Both had eaten sick chicken before falling ill.

Recombinomics July 26, 2005: A laboratory jointly run by universities in Hong and China said on Tuesday it had suspended studies into the H5N1 bird flu virus after Beijing issued new guidelines which triggered fears of a crackdown on academic freedom and independent research into the deadly disease. The new rules were issued on May 30, five days after the Joint Influenza Research Centre sent an article to the international journal Nature which said that infected wild birds in western China might have picked up the virus from poultry farms in southern China. A day after the article was published, Jia Youling, director general of the Ministry of Agriculture's Veterinary Bureau, criticised the findings and said no bird flu had broken out in southern China this year. The closing of an independent lab in China is cause for concern.  The lab has been doing H5N1 research in collaboration with Yi Guan's lab at Hong Kong University.  The publication in Nature clearly demonstrated that H5N1 was present in 2005 in eastern China, even though China had filed no OIE reports in 2005 prior to the May 21 report on Qinghai Lake.  Subsequent reports were filed on outbreaks in Xinjiang province, but there are still no reports of H5N1 in China in 2005 east of Qinhai Lake. China's actions strongly suggest they want to control and withhold vital information regarding H5N1 in China. The timing of the new announcement, in view of the 20 isolates deposited at GenBank and Los Alamos (which included all 12 isolates collected at Qinghai Lake), as well as the virulence of the Qinghai isolates, increases concerns that there is a raging pandemic in China and information  on H5N1 is being withheld.

Reuters July 26, 2005: A laboratory jointly run by universities in Hong and China said on Tuesday it had suspended studies into the H5N1 bird flu virus after Beijing issued new guidelines which triggered fears of a crackdown on academic freedom and independent research into the deadly disease. The new regulations require laboratories to obtain permission from the ministry before they can carry out research on deadly pathogens and restrict studies into H5N1 to three government laboratories.

CNN July 26, 2005: Three family members who died of bird flu earlier this month were infected by chicken droppings that contained the deadly H5N1 strain of the virus, Indonesia's agriculture ministry has said. Authorities earlier said they had no known contact with poultry but since found chicken feces in their backyard that "positively contained the bird flu virus," said Hari Priyono, an agriculture ministry spokesman.

LA Times July 25, 2005: Indonesia became the first known country to destroy pigs in an effort to contain the rapid spread of bird flu, which has killed at least 57 people across Asia since 2003 and devastated poultry stocks. Plans to kill 200 swine, however, were sharply reduced as authorities wrangled over the best way to battle the disease. Eighteen pigs that tested positive for the H5N1 strain of the virus were killed on a farm in Tangerang, about 25 miles west of Jakarta. 

Science Daily July 24, 2005: A strange illness has killed 17 farmers and 12 others were in critical condition Sunday in China's Sichuan province. Health Department officials believe the illness is caused by streptococcus suis, a bacteria typically spread by pigs, Red Nova.com is reporting from a China Daily story. Officials are denying the disease is SARS or avian flu, which have attacked Asia in recent years.

New Scientist July 16, 2005: In the spirit of the 1930s Soviet biologist Trofim Lysenko, China is ignoring science it finds inconvenient. The head of the ministry of agriculture's veterinary bureau, Jia Youling, has rejected research on bird flu published in the journal Nature last week by Yi Guan and his colleagues at the universities of Hong Kong and Shantou. The paper concluded from genetic analysis that the H5N1 bird flu killing migratory birds at Qinghai Lake in north-west China had come from southern China. An independent team in Beijing reported similar findings. Chinese officials had claimed that the virus came from another country. Last week Jia told the official Xinhua news service that Guan's paper "made the wrong conclusion" and "lacks credibility" because birds do not fly to Qinghai from southern China - even though this is a well-known migratory route. Ominously, Jia added that Guan's group did not even go to Qinghai or have permission to do the research, and that his lab does not meet safety standards. Yet Guan's BSL3 lab complies with international standards, and his team collected samples from Qinghai before the government introduced rules last month saying no one could study dead animals or bird flu, or even report an outbreak of animal disease, without permission. "They are trying to close everyone's lab," Guan told reporters. 

Daily Telepraph July 8, 2005: Asia's bird flu may be poised to spread through migrating birds to India, Australia, New Zealand and eventually on to Europe, scientists warned yesterday. If birds carry the H5N1 flu virus beyond its stronghold in South-East Asia, it could devastate poultry farms and raise the risk of a deadly flu pandemic in people, experts said. "They're going to spread this . . . thing further and further across central Asia and Europe and who knows where," said Robert Webster of the St Jude Children's Research Hospital in Tennessee, an author of a report released by the journal Nature.

Manila Times July 7, 2005: World Health Organization scientist Hitoshi Oshitani spends his days planning for a nightmare scenario—a bird-flu pandemic among humans that would kill millions and bring nations to their knees. There is much that experts still do not know about the deadly H5N1 strain of avian influenza—exactly how humans contract it from infected poultry, and why so many of its victims are healthy youngsters. But Oshitani says they do know vulnerable countries are ill-prepared and that if the virus mutates and erupts among humans in one of Asia’s crowded mega-cities, it will be impossible to prevent it from becoming a pandemic. “If a pandemic starts we cannot do anything to stop it. What we can do, once a pandemic starts, is just to reduce the negative impact by being better prepared,” said the Manila-based WHO policy-maker. “It’s probably just a matter of time. Every 30 to 40 years we have had a pandemic,” he told AFP on the sidelines of an international conference on bird flu held this week in the Malaysian capital. “Usually for influenza, it’s almost impossible to control. That’s why we have huge outbreaks every year.” To date, most bird flu victims have caught the disease from animals, but the fear is it will mutate into a form that can spread easily among humans, triggering a contagion that could kill tens of millions of people. “Our window of opportunity will be just two or three weeks,” he says. After that the virus would almost certainly have moved on. And in teeming cities like the Thai capital Bangkok or Vietnam’s Ho Chi Minh City, the sheer mass and movement of people would mean the virus would have to be allowed to run its course through the population. “There are no other alternative tools to stop the spread,” Oshitani said. What would happen then is the stuff of nightmares. Water and electricity supplies could be disrupted because utility workers are too sick to maintain them, the public transportation system could be abandoned for fear of infection, and those who cannot afford drugs would succumb in huge numbers. “If more than 20 percent of the population is affected, it could affect a whole range of social activities,” Oshitani said, adding the crisis would no longer be just a health issue, but one which could damage entire economies. “People do not want to get infected in a bus or the train. People may not want to go to the supermarket. So how to maintain that social life is a big challenge, particularly in urban areas.” Oshitani said there were worrying signs a mutation is looming. Growing numbers of people are being infected with bird flu—64 cases have emerged in Asia so far this year, compared with 44 for the whole of 2004. The disease is still circulating widely in the region, and the virus has continued to change and mutate since jumping to humans in 1997, when it killed six people in Hong Kong. Since resurfacing in 2003, it has killed 55 people in Asia including 39 in Vietnam, 12 in Thailand and four in Cambodia. “These are all bad indicators in terms of the risk of a pandemic,” he said.“If you start thinking of what you should do after a pandemic starts, it will be too late,” he warned.

Scotsman July 7, 2005: UNITED Nations agencies and health experts yesterday unveiled a multi-pronged strategy against bird flu, calling for Asian governments to overhaul backyard farming practices and vaccinate poultry to prevent the disease from becoming a human pandemic. The plan, hammered out after three days of deliberations, "gives us a real chance to make a mark on history as long as we work together with maximum energy and commitment", Mr Omi said. The UN plan focuses on educating small-time farmers and their families about the risk of living in close proximity with animals, and of combining various species such as chickens, ducks and pigs in one enclosure. Health experts say such practices increase the danger of the avian flu virus moving from one species to another and possibly mutating into a new strain more easily transmitted between humans than the current H5N1 virus. The virus currently appears to spread to people mainly when they come into close contact with sick poultry. Medical experts fear a mutated form could trigger a global pandemic. Delegates also expressed concern about the open vegetable and meat markets of Asia, where animals are often slaughtered in unsanitary conditions. This threatens the health of humans who are exposed to contaminated blood, faeces, feathers and carcases, the statement said. "The meeting agreed that the avian influenza situation in Asia is extremely serious, but determined that there was still a window of opportunity to ward off a pandemic," it said. 

CBC News June 30, 2005: A 73-year-old man has become the 39th victim of bird flu in Vietnam since the end of last year. Reports say the man, a Hanoi resident, was one of four people being treated in hospital for the H5N1 strain of the virus. 

IntlHeraldTribune June 29, 2005: Lack of information slows bird flu investigation in China. World Health Organization officials said Tuesday that efforts to determine the extent of a bird flu outbreak in western China were being hampered by a lack of information from the Chinese government. Julie Hall, a WHO expert investigating the outbreak, said that a Chinese government lab had analyzed virus samples from infected birds in Qinghai Province, but that the Chinese government had yet to share that information with the organization or with other countries. "Our understanding is that the virus has been isolated and sequenced," she said. "However, at this stage we do not have access to the sequencing information, so we don't know if the virus has changed." WHO officials also suggested that with migratory birds acting as infectious couriers, analyzing the virus and limiting its spread will be a daunting task that could be slowed by lack of information from China.

WHO June 28, 2005: The Ministry of Health in Viet Nam has confirmed an additional case of human infection with H5N1 avian influenza. The case occurred in the

northern province of Ha Tay in May 2005. The newly confirmed case brings the total, in Viet Nam, since mid-December 2004 to 60 cases, of which 18 were fatal. Four patients are undergoing treatment at a hospital in Hanoi.

Epoch Times June 28, 2005: An influenza pandemic is coming- public health experts worldwide agree. The main questions remaining are, when it will happen, and how effectively our health care systems will respond to it. There’s no way to nip this thing in the bud, it will happen. It’s just a question of when,” said Dr. Trevor Corneil, Clinical Associate Professor at Canada’s University of British Columbia and part of the province’s avian flu pandemic planning team. Now there is mounting evidence of human-to-human transfer, an essential precondition for a pandemic to emerge. According to a recent World Health Organization (WHO) report, although no human-to-human infection has been confirmed, in Vietnam “the pattern of disease appear[s] to have changed in a manner consistent with this possibility.” Another cause for concern is the high fatality rate of those already infected. Of the 100 H5N1 human cases recorded by the WHO in Vietnam, Thailand and Cambodia, 55 have died. “An H5N1 virus with this ability could lead to a global pandemic and many millions of deaths worldwide,” warns the WHO report. Australian Health Minister, Tony Abbott, estimates his country could see “2.6 million Australians seeking medical attention, 58,000 needing hospitalization and 13,000 deaths.” The American Center for Disease Control and Prevention predicts that even a “medium-level pandemic” would affect “between 15 percent and 35 percent of the US population” and 2 to 7.4 million would die worldwide. “There is a question about China,” says Corneil, describing the situation there as “a big mystery.” Until recently, during the extensive bird flu outbreaks in eight Asian countries, China admitted to only 50 cases which it “successfully…brought under control,” according to China’s state-controlled media. On May 21 of this year, the Chinese media confirmed the Qinghai province deaths of 178 wild geese as a result of infection from the H5N1 virus. On May 24, the independent US-based Chinese website Boxun News reported that 121 people in 18 villages had died in Qinghai due to “bird flu infection.” Another 1,300 people were reportedly in isolation. According to the report, “some of the family members of the victims have received warnings. If they keep the secret, the authorities will compensate the family members. Otherwise, they will be punished with the charge of ‘deliberately spreading rumors to harm public security’.” The WHO highlights the need for the world to take action well before “there is unmistakable evidence that the virus has become sufficiently transmissible among people to allow a pandemic to develop.” To head off a worst-case scenario, honest and timely disclosure of human H5N1 infections in China is not only beneficial, but absolutely essential.

Daily Telegraph June 28, 2005: An outbreak of avian flu in China is more lethal than previously thought, UN experts warned today as they called for an immediate and thorough study of the birds before it is too late. A total of 5000 birds have died on an island in Qinghai province, north-west China, according to officials from the World Health Organisation (WHO) and the Food and Agriculture Organisation (FAO) who visited the area. "This is the first time we've seen large numbers of migratory birds dying from bird flu," Julie Hall, the WHO official in charge of communicable diseases in China, said. "So the virus has obviously changed to be more pathogenic to animals. What it means to humans we don't know." 

Recombinomics June 25, 2005: "Everything suggests, that the situation we are in now, there is a greater risk for a pandemic than for many decades," said Dr. Peter Horby, a medical officer and epidemiologist for the World Health Organization in Hanoi. "The situation is much more complex than a year ago." "This year, there doesn't appear to be a stop," said Klaus Stöhr, head of WHO's global influenza program in Geneva. "Every human case is worrisome because there is another chance for the virus to [mutate] and a higher chance for a pandemic to occur." Stöhr said it was unclear why human cases have not receded this summer. It could be better surveillance or more instances of bird-to-human transmission. Or perhaps the virus has become more adept at infecting people. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, sees the developments in Asia as more reason to worry. He doubts the past will predict the virus' future. Unlike previous pandemics, where a virus underwent a major genetic overhaul all at once, Osterholm said the avian strain has been changing gradually since it was first identified in 1997. He believes the virus will continue to transform, increasing the likelihood it will ultimately lead to a pandemic. "We haven't done much to eliminate the source in Asia," said Osterholm, a former bioterrorism special adviser to the current Bush administration. "And there is a dynamic mutation laboratory over there. I see nothing to slow down the mutations." The above comments reinforce the notion that H5N1 is changing and becoming more genetically complex.

Reuters June 25, 2005: Vietnam's agriculture ministry was quoted as saying on Saturday that the mutation of a bird flu virus was increasing the infection possibility between humans. State-run media cited a ministry report as saying laboratory test results overseas and at home showed the antigen structure of virus is changing. "The ministry warned in the report that the mutation of the H5N1 virus is raising the possibility of infections on humans, because the test results of international and domestic laboratories showed the virus's antigen structure contained a change," the Saigon Giai Phong (Liberation Saigon) daily said. The mutation of the virus explains why Vietnam did not detect major outbreaks in poultry in recent months but people still fell sick of avian influenza, it said.

TodayOnline June 24, 2005: An international team of experts arrived in Vietnam to study the likelihood of greater human-to-human transmission of the bird flu virus. The top virologists and epidemiologists from Britain, Hong Kong, Japan and the United States were scheduled to work with Vietnamese scientists until the middle of next week. "These experts will be further studying issues first raised at a WHO meeting in Manila in May 2005, including the possibility of more widespread H5N1 human transmission, changes in the H5N1 virus, and the likelihood of increased human-to-human transmission," the World Health Organisation (WHO) said Friday. Neighbouring China has had three bird flu outbreaks in the past two months, leading authorities to cull thousands of infected birds.

Recombinomics June 21, 2005: China today reported a new outbreak of deadly bird flu which has infected 128 geese and ducks in the northwestern Xinjiang region, killing 63 of them, the UN Food and Agriculture Organization (FAO) told Agence France-Presse. The outbreak -- the third reported by the Chinese government in the past two months -- occurred in Changji city near Urumqi, the capital of Xinjiang, the FAO said citing Chinese government information. The latest outbreak is also in Xinjiang Province in northwestern China.  It is about 30 miles northwest of the capital; city of Urumqi, which lies between the early outbreak in water fowl, including migrating bar headed geese, and Tacheng, located near the border with Kasakhstan and about 100 miles south of China's border with Russia. The latest outbreak is similar to the outbreak near Tacheng, with about half of the infected geese reported as dead.  H5N1 usually does not kill geese, so the finding of the three outbreaks close in time and location suggests they are due to the same version of H5N1 and are being transported by migrating birds.  The latest report, like the two preceding reports, has noted the lack of human infections.  However, third party reports have described human infections and fatalities in the Qinghai Lake area as well as a pneumonia isolation ward in Tacheng. WHO has requested on site visits to Qinghai and Xinjiang.  The request to vist Tacheng in Xinjuiang has been denied, fueling speculation that the patients and health care workers in the isolation unit are infected with H5N1. third party reports have described human infections and fatalities in the Qinghai Lake area as well as a pneumonia isolation ward in Tacheng. WHO has requested on site visits to Qinghai and Xinjiang.  The request to vist Tacheng in Xinjuiang has been denied, fueling speculation that the patients and health care workers in the isolation unit are infected with H5N1.

ABC June 21, 2005: Vietnam has experienced its first outbreak of bird flu in two months, with more than 6-thousand chickens contracting the deadly virus in the country's south. The discovery has prompted a warning for "very high vigilance" from the Director of Animal Health at the Agriculture Ministry. He's accused some provinces of not paying serious attention to the situation.

US Embassy Japan June 20, 2005: "A pandemic of influenza could result in 350 million deaths globally,” said Michael Osterholm of the U.S. Department of Homeland Security, “and would cripple the global economy with the suspension of international trade." Osterholm, associate director for the National Center for Food Protection and Defense, spoke at a Council on Foreign Relations meeting June 16. Osterholm characterized a pandemic influenza as "the perfect storm" for the global economy because of its potential effect on countries that depend on overnight international trade for critical services. "Collateral damage from the pandemic would also be significant because a suspension in trade would mean that countries will not have access to imported products used for manufacturing, life-saving medications and other consumer items," Osterholm said. According to Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, mortality rates would be highest among healthy adults between the ages of 20 and 40, a grave consequence that would also result in a severe depletion of labor in some countries. "One of the problems of bird flu is that there are no naturally immune humans from this type of virus," Fauci said. "In the past pandemics, there have been reservoirs of people with immunity from the outbreak," he added. "We have every reason to believe that the H5N1 virus in Southeast Asia has the potential for a pandemic type of infection," Fauci said. Osterholm noted it would take five to seven years to develop the capacity for global influenza vaccinations.

Kazinform June 20, 2005: In the Chinese People’s Republic 25 km from the border with East Kazakhstan is registered large outbreak of bird flu among birds. According to WHO, 1042 ducks were detected with symptoms of bird flu, and 406 of them died. It has been said by deputy Healthcare Minister, chief state sanitary inspector of Kazakhstan Anatoliy Belonog. According to the Chinese veterinary services, at one of the private farms of Chuguchak (Tacheng) in SUAR province have been destroyed 13 000 birds, as well as other measures taken including isolation and disinfection. Besides, urgent poultry immunization was carried out at all neighboring fowl-farms.In the Chinese experts’ view, bird flu virus uprise at the west of China is connected with its carry-over by migrating birds from the South Asia via Tibet and the Himalaya.

Canada June 20, 2005: In a soon-to-be-released issue of a scientific journal, researchers from Thailand and Hong Kong will report the findings of an autopsy of a six-year-old Thai boy who died from avian influenza. Slated for publication in the July issue of Emerging Infectious Diseases, their findings of an atypical pattern of infection - deep in the lungs, away from the tracheal lining where virus could easily be coughed out at others - may help explain why H5N1 influenza doesn't yet spread easily among people. While at least 54 people have died from H5N1 infections since December 2003, autopsies have been performed on fewer than a handful of cases. For cultural and other reasons, body after body has been buried or cremated, robbing pathologists of the precious chance to chart the havoc the virus wrecks on its victims. "That's one of the reasons why it's so difficult to understand what the virus does in the body," says Dr. Klaus Stohr, who heads the World Health Organization's global flu program.

ABC June 20, 2005: Two more people from northern Vietnam have been sickened with bird flu, and thousands of chickens have dropped dead in the south, officials said Monday. The poultry outbreak is the country's first in three months. The two new victims tested positive for the virus after being admitted to Bach Mai Hospital in Hanoi over the weekend, said hospital director Tran Quy. 

VOA June 20, 2005: The World Health Organization and other international agencies are looking into reports that Chinese farmers have been using a human anti-viral drug to suppress bird flu. Some experts say such use may make the virus resistant to the drug. Chinese officials had no immediate comment on the report, which first appeared in the U.S. newspaper The Washington Post. The newspaper said that Chinese farmers, with the encouragement of the government, violated international livestock guidelines by feeding the drug Amantadine - intended for humans - to chickens during the past several years. That has experts concerned the drug would no longer help humans fight off the disease in the event of a worldwide avian-influenza epidemic.

Sun Star June 20, 2005: IT IS GETTING real and imminent! World Health Organization (WHO) scientists and health experts are calling for stepped-up surveillance of avian influenza in Southeast Asia and that includes the Philippines, after reports surfacing from northern Vietnam suggest that the deadly virus may be evolving into something more easily transmitted to humans. scientists who met five weeks ago in Manila concluded there are numerous signs that the virus is undergoing an evolutionary change. "If action is delayed until there is unmistakable evidence that the virus has become sufficiently transmissible among people to allow a pandemic to develop, then it most likely be too late to implement effective focal, national or regional response," - a warning statement from the Manila WHO summit.

Telegraph June 19, 2005: China ruins best chance of beating bird flu epidemic. China has been trying to suppress a bird flu outbreak by feeding poultry a human antiviral drug, threatening public safety in the event of a global pandemic. China first reported an avian flu outbreak in February last year. Yet for more than eight years, according to drug company officials in Beijing quoted in the US media, the agriculture ministry has been urging farmers to use the drug, amantadine, on infected birds, in breach of international guidelines. It explains why scientists discovered late last year that the virus had grown resistant to amantadine, which cannot now be used to fight it in humans. Dick Thompson, a spokesman for the World Health Organisation in Geneva, said last night that the UN body had long suspected China of using amantadine on poultry. Mr Thompson said that the drug, which is now ineffective against the H5N1 strain of the virus found in Asia, should have been a key part of the fight against a global outbreak. "It would have been important in a pandemic and it is a disappointment that it may have been lost to us." Chinese farmers and officials from pharmaceutical companies confirmed that the drug had been used since the late 1990s to treat sickly chickens and prevent healthy birds from catching it. A farmer from Hebei province, near Beijing, confirmed that he had been giving his chickens the drug for several years. "Local government vets have always recommended it," he said. Three years ago China was condemned internationally for trying to hide the extent of the SARS outbreak, which ultimately infected 8,000 people and killed about 800.

Recombinomics June 17, 2005: The treatment of 23 bird flu cases [in Vietnam] represents an all time high for confirmed or suspected bird flu cases.  An earlier report described nine patients, which was followed by another report with two confirmed patients and 5 patients positive for influenza A.  Those five were awaiting H5N1 test results.  Thus it would appear that two patients were admitted in the first week of June, 13 in the second week, and 8 more so far this week. Although most of these cases are described as mild, the positive result in the physician is a strong indication of human-to-human transmission.  The large number of admissions this month clearly move the phase of the pandemic to 5.  Since these cases are mild, the number of unreported cases may be markedly higher, indicating the pandemic in northern Vietnam has already moved to phase 6. Similarly, the unofficial reports on human cases in Qinghai and Xinjiang provinces in China suggest that region is also experiencing phase 6 pandemic conditions, but with a strain that is markedly more lethal than northern Vietnam. The major outbreaks demand a rapid response, yet there are no publicly available 2005 H5N1 sequences at GenBank.  Moreover, many suspect countries like India and Bangladesh have yet to be H5N1 tested. As the pandemic of 2005 begins to spin out of control, the monitoring of H5N1 reamins scandalously poor.

VNA June 17, 2005: Four individuals were confirmed infected with the H5N1 virus [in Vietnam], which causes the avian flu, between June 1-17, raising those diagnosed with avian flu so far to nationwide 86, 38 of whom have died, according to the Health Ministry. The ministry said that it is striving to discover how the virus is transmitted and that almost all patients have had direct contacts with infected poultry. The ministry has failed to explain why no one was infected with the H5N1 virus in the 50 days prior to May 31. In addition, the Ministry of Agriculture and Rural Development has affirmed that there has been no bird flu outbreak nationwide for more than one month. However, the ministry stressed that thus far all people contracting influenza type A from the H5N1 virus came from bird flu-stricken areas.

ABC June 17, 2005: Hard on the news of Indonesia recording its first human case of bird flu, comes reports that six new human infections have been recorded in Vietnam. The World Health Organisation says it's trying to confirm the situation with the Vietnamese Government, but says it believes they are accurate. The six people are being treated for the H5N1 strain of the virus in a Hanoi hospital. 

Recombinomics June 17, 2005: A directive issued in China appears to be restricting information on the current H5N1 bird flu outbreak at all levels.  The latest outbreak began with a report on 180 dead bar headed geese in Qinghai Lake Nature Reserve.  All reserves in China were closed when China announced that 519 birds had died and were positive for H5N1.  A follow-up news conference indicated over 1000 birds had died, which was unprecedented for H5N1, which usually is not lethal in ducks or geese.  Reports by nine students through Abundant News at boxun.com indicated that over 8000 birds had died.  Reports indicated that 6 tourists and 121 residents in the area also died.  The government denied that there were human cases and reports indicated that at least 8 of the 9 students had been arrested. These reports were followed by reports of another outbreak near Tacheng City in Xinjiang province.  Geese on a backyard farm began to die an they too were H5N1 positive.  All of the poultry in the area was culled and the outbreak was said to be contained. However, reliable source indicated that a pneumonia cluster had developed at Tacheng Hospital.  Both patients and health care workers had been placed in isolation.  These reports fueled speculation that there were significant numbers of human H5N1 infections and deaths in Qinghai and Xinjiang provinces. Now China has announced limits on movement of samples out of China, which is another indication that speculation about widespread efficiently transmitted human infections were being covered up by the government and the dead and infected patients signaled the beginning of phase 6 of the 2005 flu pandemic.

WebMD June 16, 2005: U.S. health officials and infectious disease experts have been sounding the alarm for more than a year on the deadly potential of a widespread pandemic of the bird flu troubling Southeast Asia. But their warnings have become unmistakably ominous as they struggle to convince the public and policy makers of the need to prepare for the mass casualties, chaos, and devastation that will likely result if the disease spreads across the world. In congressional hearings and on television, officials have repeatedly advised the public of the potential for millions of casualties if bird flu gains the ability to easily spread from birds to people or between humans themselves. But the warnings have now become decidedly darker as officials warn of a catastrophic economic shutdown and a global political crisis if bird flu strikes an unprepared world. "This is much larger than a public health threat. The vast majority of the world just doesn't get how vulnerable we are," says Michael Osterholm, MD, associate director of the National Center for Food Protection and Defense in the Department of Homeland Security and a former bioterrorism advisor to the Bush administration. Osterholm complains that U.S. officials and companies have not planned for the widespread logistical disruptions that would result if bird flu were to spread within the next couple of years. Local and federal agencies have not planned for widespread disruptions to schools and workplaces as the public is told to stay home and gymnasiums are converted to emergency medical facilities, he says. Travel restrictions and a run on vital supplies, such as masks able to filter flu viruses, would "no doubt" lead to an economic shutdown, he adds. What can the U.S. do to prevent the continued spread of flu from billions of Asian chickens and ducks? "The bottom line message is: almost nothing," says Osterholm, who is also a professor at the University of Minnesota. 

Washington Post June 16, 2005: An Indonesian poultry worker has tested positive for bird flu, in the country's first human case of the disease that has so far killed 54 people in Southeast Asia, health officials said Thursday. The worker on the island of Sulawesi is showing no symptoms of the disease, but blood tests show he was exposed to the H5N1 strain of the disease and has produced antibodies to it, said Hariadi Wibisono, director for the eradication of diseases transmitted by animals at the health ministry. "This is the first case found," Dr. Georg Petersen, WHO's representative in Indonesia, told The Associated Press. The Indonesian case is an ominous development in the global battle to prevent the bird flu strain from mutating into a form that passes easily between people and spawn a pandemic. Health experts have warned that Indonesia _ which allocates only a tiny percentage of its gross domestic product to the health sector _ may struggle to contain a major outbreak. Indonesia has reported scores of outbreaks of bird flu at poultry farms across the country. "We have to raise our guard once again," Wibisono told The AP. "There is a possibility we will find more cases, but we hope that this does not transpire."

Recombinomics June 14, 2005: Comments from the latest WHO update on Vietnam describes three more milder H5N1 cases in northern Vietnam.  More geographical or familial relationships were not provided, but the trend in northern Vietnam has been set since the beginning of the year.  The clusters are larger and more frequent and the cases are milder.  These milder cases are similar to severe cases of human flu and therefore many H5N1 human infections in northern Vietnam may go undetected. Sequence data from northern Vietnam included an HA cleavage site missing an ARG.  This missing basic amino acid matches the cleavage site from 2003 and 2004 isolates in Hong Kong and southeastern China, raising the possibility that mild human H5N1 cases are also in China.  The homology with 2005 Thailand isolates also raises the possibility of more human infections there also. Recent comments on the sequence of H5N1 from bar headed geese at Qinghai Lake also linked bird flu there to H5N1 in southeastern China.  The bar headed geese winter in India and Bangladesh and fly over Tibet to nest at Qinghai Lake in May and June.  Recently there have been meningitis outbreaks in northern India, which coincide in time and location with the bar headed geese migration.  Interestingly, the crested eagles smuggled into Belgium from Thailand had sequences matching those in Thialand, but the eagles originated in Tibet. The linkage by time location and sequence of H5N1 cases throughout southern and eastern Asia raise serious questions about H5N1 monitoring of birds and people.  The scandalously poor monitoring significantly compromises flu pandemic containment strategies.

The Standard June 14, 2005: Vietnamese health authorities say a test of a homegrown bird flu vaccine on chickens has been successful and they are awaiting a green light to test it on humans. ``The chickens that were given the vaccine have produced immunity,'' said Nguyen Tran Hien, director of the National Institute of Hygiene and Epidemiology in Hanoi. The World Health Organization had warned Vietnam of the dangers of not adhering to WHO standards when developing the vaccine. The UN health agency is concerned that the virus will mutate and jump the species barrier to humans, causing a world pandemic. 

Recombinomics June 14, 2005: South Korea has halted the import of poultry products from New York state after the United States reported a suspicious case of bird flu in the region, the Ministry of Agriculture and Forestry said on Tuesday. The U.S. Agriculture Department informed the World Organization for Animal Health on June 10 of the outbreak of a low-pathogenic bird flu case on a duck farm in Sullivan, New York, the ministry said. The virus is known as the H7N2 strain, but it can develop into a high-pathogenic one and infect humans, the ministry said, adding the U.S. farm authorities are conducting further tests. Additional testing of H7N2 in New York will be of interest.  The two avian sero-types that have produced reported fatalities in humans are H5N1 and H7N7.

Deutsche Welle June 12, 2005: Although at the moment H5N1 cannot be easily transmitted from human to human, scientists say it is only a matter of time until this happens. They also worry that migratory birds could carry the virus around the planet and thus spread the epidemic. Last month, more than 1,000 migratory geese were found dead from the strain of avian flu in China, an early warning sign of the virus' ability to spread, said German virologist Robert Webster.

The Independent June 12, 2005: International experts fear that bird flu is mutating into a strain that will cause a worldwide pandemic, killing many millions of people after the mass deaths of wild birds in China. Unconfirmed reports say that more than 100 people have also died, suggesting that the virus may have evolved to pass from person to person, breaking the final barrier preventing a worldwide catastrophe. The Chinese government, while denying the reports of human deaths, has adopted emergency measures in Xinjiang, its remote north-western province, and has sealed off affected areas with roadblocks and closed all nature reserves. "We are worried," says Noureddin Mona, of the UN Food and Agriculture Organisation's representatives in Beijing. "We should be prepared for the worst." Shigeru Omi, of the World Health Organisation's regional director for the western Pacific, says "the virus has become highly pathogenic to more and more species". "It remains unstable, unpredictable, and very versatile. "Anything can happen. Judging from the way the virus has behaved, it may have new and unpleasant surprises in store for us."

AsiaNews June 11, 2005: Greater vigilance and more transparency to monitor the unpredictable evolution of bird flu… this is what Shigeru Omi, director of the Pacific section of the World Health Organisation (WHO) said: “With bird flu, anything could happen.” The H5N1 virus has now contaminated all Asia: according to WHO sources, it is unstable and could evolve to the point of reaching a high pathogenic rate [capable of affecting genes of different NDR types]. WHO said that – compared to Vietnam – the virus has appeared at its most pathogenic in China: its spread in Qinghai and in Xinjiang [central-northern regions of the country] has killed several species of flying creatures which had seemed immune to infection at first. The virus therefore made a shift of species, and after recent cases of infection, WHO fears it could pass to a phase of direct human contagion. In Vietnam, the H5N1 appears even more unstable: although the mortality rate dropped from 70% in 2004 to 20% in 2005, there have been cases of people infected with the virus who have not shown any symptoms. “Information must be circulated in real time and with total transparency,” said Omi. He called on the Chinese government to allow WHO to carry out analysis of virus samples and on all Asian countries to develop vaccines and to create antiviral medicines “in expectation of a possible pandemic”. Hend Bekedam – director of WHO’s China section - said Beijing had not yet given the go-ahead for an inspection of its territory.

TechNewsWorld June 10, 2005: A top World Health Organization official Friday warned that the avian flu virus is evolving quickly and urged heightened vigilance because the strain in China appears to have increased in virulence. Shigeru Omi, the WHO's Western Pacific regional director, said two outbreaks in China's remote west in the past month have killed large numbers of species of birds that had previously been relatively resilient to the disease. "The outbreaks indicate that the virus has become highly pathogenic to more and more species," he told a news conference. "The virus remains unstable, unpredictable and very versatile," he said. Omi said the H5N1 virus is behaving differently in China and Vietnam. China has reported no human cases of bird flu; Vietnam has had 38 of Asia's 54 human deaths. But the cases in Vietnam appear to be becoming less deadly, with fatality rates dropping from 60 to 70 percent last year, to about 10 to 20 percent in 2005, Omi said. Vietnam has also seen more cases where people are infected but don't develop symptoms. "Anything could happen," he said. "Judging from the way the virus has behaved, it may have new and unpleasant surprises in store for us." The only way to safeguard against further outbreaks or worse -- a mutation of the virus into a form easily passed between humans -- is "heightened vigilance," he said. "Our work remains urgent," Omi said. That means it's imperative for countries to share information, research and samples from their outbreaks with international agencies to strengthen efforts to fight the disease, he said. Beijing has in the past been criticized for its reluctance to release information on its outbreaks. Omi said the WHO is looking forward to getting samples from China because "sharing samples is very critical." WHO officials said they were waiting for Beijing to approve a trip with Chinese health officials to Qinghai province, where more than 1,000 wild birds, including geese and gulls, were killed by the H5N1 flu strain in late May. Gao Qiang, China's health minister, told reporters in Hong Kong that WHO teams would be free to visit infected areas. "During the 2003 SARS outbreak, WHO experts were able to go wherever they wanted. And with bird flu, there's no place they can't go," Gao said. On Thursday, the Agriculture Ministry confirmed a second outbreak of bird flu in the Xinjiang region. It said it had culled more than 13,000 geese at a farm after discovering that about 460 had died from the virus. China said both outbreaks appeared to be isolated incidents, with the case in Qinghai possibly carried there by migrating birds.

Recombinomics June 10, 2005: WHO comments that the H5N1 virus "remains unstable, unpredictable and very versatile" highlight the need to gather additional data.  H5N1 evolves via recombination within hosts that are infected with two viruses.  As the number of hosts infected with H5N1 increase, the number of possible new recombinants also increase.  New emerging strains can be predicted based on the current gene pool, but the holes in the database are substantial.  WHO and FAO should be encouraging affected countries to get more serious about collecting and sharing data. The two most glaring examples are China and India.  China has almost certainly generated sequence data for the Qinghai Lake isolates.  This data should be publicly available via deposits at GenBank.  Currently there are no 2005 H5N1 sequences.  China, Vietnam, Thailand, and Indonesia certainly have sequences data, even if only from birds.  The 2004 H5N1 bird sequences are virtually identical to the human sequences, so bird sequences will be quite useful. The initial reports from Qinghai Lake described bar headed geese as the only bird flu victims.  Although the number of species expanded, the bar headed geese are key.  They winter in northern India and can fly 1000 miles in 24 hours (the distance from northern India to Qinghai Lake).  There are almost certainly H5N1 sequences in India.  Although India has claimed to lack facilities to isolate and sequence H5N1 they can simply pack up bird dropping and ship them off if they can't come up with the appropriate resources. Similarly the meningitis cases in northern India as well as the dying crows in western India should be tested for H5N1.  WHO has previously indicated they will test unexplained deaths for H5N1.  So far there is little evidence that Meningitis / meningococcal deaths in the Philippines and India have been tested for H5N1. Like China's blanket denials of human H5N1 cases, WHO blanket calls for vigilance are inadequate.  Media reports quote Chinese official as saying WHO is welcome to visit all areas of China.  Similarly, India has not told WHO or FAO to stay out. It is time for WHO to get off the phone and get on the ground in China and India to get real data on increasingly ominous developments. 

Radio Australia June 9, 2005: Hundreds of geese in China's north-western Xinjiang region have reportedly died from bird flu in a new outbreak. Chinese authorities say the disease has been detected in around 1,040 geese, of which 460 have died. They say around 13,000 birds have been culled. Authorities say the situation has been brought under control. The outbreak in Xinjiang follows the deaths from H5N1 of more than 1,000 migratory birds last month in Qinghai southeast of Xinjiang. It was the first confirmed outbreak in China in nearly a year from the virus. 

XinHua June 9, 2005: France has done a lot of work to prevent a possible massive spread of bird flu to human beings, French government health consultant Didier Houssin said on Wednesday. According to the W orld Health Organization (WHO), the bird flu virus has acquired the capacity to be transmitted to human beings, although its animal-to-human and human-to-human transmission capacity is still limited at the current stage, said Houssin. Hospitals across France are now well-prepared to host a 10- to 46-percent increase in patients in case of a possible outbreak of the virus among humans and a large team of medical personnel is ready to render home services, he said. France currently has a reserve of 13.8 million doses of antiviral drugs and more is under production, he added. Moreover, the country has purchased about 40 million doses of vaccine and more than 10 million masks, which will be ready for use by 2006, when maneuvers against a massive bird-flu outbreak among humans will be staged, he said.

The Standard June 4, 2005: Taking anti-influenza medicine needlessly may hasten the spread of bird flu by decreasing the drug's force against the virus, a doctor warned. Public awareness of bird flu - which the World Health Organization predicts could infect 30 million and kill 7.5 million people worldwide - has been lowering in the past few months while the risks remain just as high, Center for Health Protection controller Leung Pak-yin said Friday. He warned against taking Tamiflu, which is seen as the last defense against the H5N1 virus, as a preventive medication for common flu. ``If people take Tamiflu whenever they catch common flu, when a flu pandemic comes the virus may already be drug-resistant, and that will affect the whole picture of infection control,'' Leung said. ``When a flu pandemic hits, there will usually be a second or third wave attack,'' Leung said. ``If we used up most of our stock even before the pandemic, we would have no defense when the virus launched its next round of attacks.'' ``Unlike Sars, we can hardly avoid contacting the flu virus when the pandemic hits.`` 

Recombinomics June 1, 2005: The information on the over than 1000 dead birds near Qinghai Lake comes from many sources.  Initial wire service reports described the deaths of 178 bar headed geese.  These initial reports clearly indicated that the deaths were not linked to bird flu. Follow-up reports indicated dead birds had tested positive for H5N1, although the number and relationship to the 178 previously reported deaths was unclear.  Clarification came from the initial report filed by China to the OIE, which described 519 dead birds representing 5 species in Gangcha Province, Qingahia Province.  These deaths were laboratory confirmed.  In the weekly OIE report the 519 were again listed but the report indicated that the virus isolated from the birds was H5N1 and was highly pathogenic in laboratory infected chickens. The official report was followed by a news conference, which was widely reported.  At the news conference the deaths of over 1000 birds were reported and one media report indicated most were in Qinghai Province, suggesting the bird deaths might be widespread. For the human cases, the initial report came from Promed, who had translated the Abundant News story.  That report indicated six tourists had died.  Four were named and three of the four were from Chengdu, Sichuan Province (about 400 miles southeast of Qinghai Lake).  The clustering of three deaths of three tourists from the same location would be cause for concern.  These initial reports were followed by a report of 121 deaths in 18 communities in Gangcha Province, along with 79 infections generating a case fatality rate of over 60%. Follow-up reports included a smaller number of cases in more distant communities as well as a news blackout, checks of computer, difficulties connecting to the Internet, and related issues centered on limiting news. All of the reports linked to the human cases come from the same source and have not been independently verified.  However, these reports are quite specific and the severity of the reported events is quite clear and not lost in translation.  If verified, these reports would dwarf prior reports on human H5N1 cases and move the 2005 flu pandemic from phase 5, which involve an increase in human-to-human transmission, to the final phase 6, which is sustained and widespread human-to-human transmission. Although not verified, the reports via Abundant News are quite specific and consistent. The disease described is somewhat atypical, involving fever and vomiting, but not respiratory illness.  The specifics in the series of reports are not adequately addressed with blanket denials by official sources in China.  

Medical News Today May 31, 2005: While the Indonesian government talks about eradicating bird (avian) flu by the year 2007, WHO has stated that bird flu is endemic in the country. Agriculture minister, Anton Apriyantono, expressed disappointment at WHO's (animal health dept) declaration, saying cases of bird flu have been declining in Indonesia since last year.

Forbes May 29, 2005: Roche Holding AG confirmed that huge demand for Tamiflu -- the only drug deemed efficient against Asian bird flu -- is causing a production bottleneck, with new customers likely to face waiting time of up to two years. 'This is clearly a challenge for us,' the Swiss pharmaceuticals group said. The sharp increase in new orders was triggered by warnings by the World Health Organization (WHO) about a new bird flu pandemic, which according to conservative estimates could lead to 28 mln infections and up to 7 mln deaths. Tamiflu is the only drug that is able to stop the massive reproduction of the H5N1 bird virus at an early stage of infection. Moreover, the treatment works preemptively. According to Roche, 25 countries have already followed WHO warnings and have placed orders with Roche or have signed a memorandum of understanding to build-up stockpiles of the drug. In order to satisfy US demand, Roche plans to open a new production plant in North America during the second half of the year. Major orders have also been placed by the governments of the UK, France, Switzerland, Finland and Germany.

Medical News Today May 28, 2005: An official from China's agricultural department said the death toll from bird flu in the West of China is five times greater than official reports had stated. The number of migratory birds killed was much larger than people had thought, he said. He added that the reports refer only to the death of birds and that no humans have died. Rumours are rife among experts and throughout the internet that there has been a massive cover-up. People are saying nobody really knows how bad the situation really is/was. Rumours abound that many humans have perished. Officials now say more than 1,000 migratory birds have died after being infected with the H5N1 strain of bird flu. The H5N1 is the most lethal one. Official reports had talked about just 178 birds, all of them geese, perishing in Qinghai Lake - now, they say the real number is over 500. China has not reported one human death from bird flu - even though nearby countries such as Vietnam have had 38 deaths. In total, the number of human deaths from bird flu in South East Asia has totalled 54. Health experts say that in order to tackle a possible pandemic which could spread to humans and become a human-to-human transmissible disease, we need accurate, reliable information. If authorities are not able to provide reliable figures it is virtually impossible to know what to do and when and where to do it. A pandemic could kill millions and millions of people throughout the globe.

SciDev May 27, 2005: Genetic analyses of samples from patients recently infected with the H5N1 bird flu virus suggest that new strains are emerging in the north of Vietnam. The report, posted on the World Health Organization (WHO) website last week, says the data are limited and that more studies are needed, but cautions against complacency in the face of the growing pandemic threat (see Time to prepare for bird flu pandemic 'running out'). At a WHO meeting in the Philippines in early May, scientists also concluded that the transmission of the virus from person to person could be more common than previously thought. The data — from the Centers for Disease Control and Prevention in Atlanta, United States, and Japan's National Institute of Infectious Diseases — could signify changes in the virus because clusters of infection are larger and more numerous than seen recently, and in some cases exposure to poultry could not be traced. 

ChannelNewsAsia May 26, 2005: China remains woefully ill-equipped for tackling avian flu, a top scientist said, as other experts spelt out fears that hundreds of millions of people may die or fall sick if the virus triggers a global pandemic. David Ho, an internationally-renowned US researcher, said China had received a wakeup call in 2003 after its initially tardy and secretive response to Severe Acute Respiratory Syndrome (SARS). But the new political will to strengthen China's rickety medical infrastructure had yet to be matched on the ground, and this has left the country dangerously exposed to avian influenza, Ho said. "There is little doubt that China will be in deep trouble if the flu pandemic were to strike in the next few years," Ho, who works at the Aaron Diamond AIDS Research Center in New York, said in a commentary published by the British science journal Nature. "It has a moral obligation to its own people, and to the world, to rectify the situation as soon as possible." The problems highlighted by Ho include a "grossly underfunded" epidemiological system to spot disease outbreaks; an inefficient alert system to warn and advise hospitals, doctors, officials and the public; and decrepit healthcare infrastructure and poorly trained physicians. 

AgricultureOnline May 25, 2005: The Director General of the World Health Organization last week referred to avian influenza (bird flu) as the "most serious known health threat the world is facing today." Dr. Lee Jong-wook made the statement as he concluded his opening remarks to the 58th World Health Assembly in Geneva, Switzerland last Monday. The Assembly ended today after adopting revised International Health Regulations that govern national and international response to disease outbreaks. "The timing cannot be predicted, but rapid international spread is certain once the pandemic virus appears," Jong-wook said about avian influenza. "This is a grave danger for all people in all countries." 

Time May 23, 2005: The most frightening aspect of avian flu has always been its astonishing virulence, but the human death rate in hard-hit northern Vietnam has fallen to 34% this year, down from almost 80% for the entire country in 2004. Good news? Not if you're an epidemiologist. Investigators for the World Health Organization (WHO) have raised concerns that even though the H5N1 bird-flu virus appears to be weakening, it may be adapting better to human beings potentially opening the door to a flu pandemic. Researchers have found that as the fatality rate dropped in northern Vietnam, there has been an increase in the number of cases clustered close together and in the age of those infected signs that the virus may be finding more efficient ways to infect people, including human-to-human transmission, the principal barrier to a pandemic. The falling death rate could mean that this process of adaptation is accelerating. "In gaining the ability to go from one person to another, a virus may well lose its virulence," says Dr. Jeremy Farrar, director of the Oxford University Clinical Research Unit at the Hospital for Tropical Diseases in Ho Chi Minh City. The 1918 Spanish flu, for example, the worst pandemic in history, had a fatality rate of 2.5%. But it was extremely contagious, infecting hundreds of millions. The data from Vietnam is still far from conclusive, and the reduced fatality rate may be due to more experienced investigators detecting the sort of mild cases they might have missed last year. But that wouldn't explain the difference between situations in Vietnam's north and in the south, where the death rate has remained high and infections have remained comparatively low. Either way, public-health experts are preparing for the worst. Says Dr. Peter Brown, a WHO epidemiologist: "If we wait until we definitely know there is a problem, it may be too late."

Reuters May 23, 2005: Bird flu may have claimed the life of a Vietnamese man in the past week, bringing the country's toll to 18 since the latest outbreak in late December, health officials said on Monday. A provincial health official told Reuters preliminary tests by the Hanoi-based National Institute of Hygiene and Epidemiology had confirmed the 46-year-old man from the northern province of Hung Yen died last Thursday at a Hanoi hospital from bird flu. The official said by telephone from Hung Yen, 64 km (40 miles) southeast of Hanoi, that the man was admitted to hospital a week ago with a high fever and coughing. A Health Ministry spokesman said the man's death was still not officially recognised as being caused by the H5N1 virus.

WebMD May 20, 2005: The world is one step closer to a devastating killer flu pandemic, World Health Organization (WHO) experts suspect. Two developments in northern Vietnam spur the renewed concern: 

Deadly bird flu infections are being seen in larger clusters of people -- with a much wider age range -- than ever before. 

The virus is changing in ways that suggest it may be adapting to humans. 

Also of concern is the revelation that one virus isolate was partially resistant to TamiFlu, the only effective treatment for human infection with type H5N1 bird flu.

Because of these developments, the WHO urgently convened a panel of experts that met earlier this month in Manila, Philippines. The panel's report, written on May 11, was released yesterday. "All countries, both those affected and unaffected by avian H5N1 … should move ahead as quickly as possible and develop or finalize practical operational pandemic preparedness plans," the panel advised. 

The WHO lists six stages leading from the detection of a new flu virus in animals to a global human flu pandemic. So far, the H5N1 bird flu has been at stage 4: small, highly localized clusters of human infections. At this stage, the virus cannot spread easily from person to person. The new evidence suggests -- but does not yet prove -- that bird flu may be moving to stage 5. That would mean the virus is becoming increasingly better at person-to-person spread. When stage 6 is reached, there will be rapid human-to-human flu spread and pandemic flu. It's only a matter of time, says virologist Klaus Stöhr, PhD, DVM, project leader for the WHO Global Influenza Program. "We are in a situation where we simply have to deal with uncertainties on when this will happen -- not whether this will happen or not," Stöhr said yesterday in a news conference. "We believe a pandemic will happen, but we don't know when and also [we don't know] the severity of the event." The last flu pandemic was in 1968. That means that this is the first time the world has had the tools in place to track a flu pandemic as it develops. Guénaël Rodier, MD, MSc, director of the WHO Department of Communicable Disease Surveillance and Response, says it's becoming clear that there are many small steps -- rather than alarming leaps -- that lead to a flu pandemic. "There is no evidence of a big crisis," Rodier said at the news conference. "But there are enough elements to say there may be something going on. … We have enough data to be concerned. At the same time we don't have enough data to be sure." "In the last 18 months, we have seen an incremental increase in our concern," Stöhr said. "We do not know if a pandemic can occur next week or next year."

LA Times May 14, 2005: Indonesian researchers have found a strain of bird flu in pigs on the densely populated island of Java, raising fears the virus could more easily spread to humans, the government and scientists said Saturday. The scientist who made the discovery identified the strain found in the pigs as H5N1, the same version of the virus that has jumped from chickens to humans elsewhere in Southeast Asia, killing 36 in Vietnam, 12 in Thailand and four from Cambodia. Until now, human infections have been traced to direct contact with infected poultry or poultry waste, and millions of chickens and other fowl have been slaughtered in attempts to stem the disease. But last fall, the World Health Organization urged scientists to examine other mammals, in particular pigs. Pigs, which are genetically similar to people, often carry the human influenza virus. Experts worry that pigs infected with both bird flu and its human equivalent could act as a "mixing bowl," resulting in a more dangerous, mutant virus that might spread to people more easily -- and then from person to person. Indonesia has yet to report any case of humans contracting bird flu, but has reported scores of outbreaks at chicken farms around the sprawling archipelago.

Canadian Press May 13, 2005: It's impossible to say whether recent changes in both the pattern of human cases of avian influenza and in the genetic makeup of the circulating viruses mean the risk of a flu pandemic has risen, the head of the World Health Organization's influenza program said Wednesday. Dr. Klaus Stohr said experts can't make that judgment, because too little scientific informa  tion is flowing out of Southeast Asia to the WHO's network of reference laboratories. "The data in humans is inconclusive and is too incomplete to draw any profound conclusions," Stohr said from Hanoi, Vietnam, where he is attending a second meeting of experts in as many weeks on the H5N1 problem. The agency has recently acquired some new genetic information that may help it in efforts to reassess the risk posed by the H5N1 virus, he suggested. Analysis of the new data confirms the virus is changing. But what that signifies remains a mystery, Stohr said. 

Recombinomics May 13, 2005: [In India] Two more people died of meningococcemia in the capital yesterday. The disease is displaying characteristics never seen before. It is supposed to occur among children aged between 1-5, but the worst hit are adult males in the 15-30 age group..... There have been 260 suspected cases and 20 deaths in the space of one month. Though these figures have alarmed some people, the government maintains the situation is well under control. 

The meningococcemia / meningitis outbreak in India has some striking parallels with the outbreak in the Philippines.  There have been no reports on bird flu tests on these patients, even though the infections are clustered, spreading rapidly, and affecting an unusual age group.  Previously, WHO had said that clusters of unusual deaths would be tested for H5N1.  There is little evidence for such tests and there are significant concerns about the sensitivity of such tests.  Moreover, menigococcemia is a known secondary infection of influenza. Recent reports of H5N1 antibodies in poultry workers in India raise a red flag on bird flu.  The sera were from 2002, but the monitoring of bird flu in India has been minimal, and there have been no attempts to isolate or sequence the virus.  Thus, the current bird flu situation in India is not well understood. In Vietnam a high percentage of ducks are asymptomatically infected with H5N1, and an increasing percentage of chickens are also asymptomatically infected.  False negatives in humans are frequent in both northern and southern Vietnam, so the distribution of the virus in endemic areas is not monitored well, and the evolving virus is becoming increasingly difficult to detect with probes directed against earlier isolates. Similarly, the probes being used to detect WSN/33 H1N1 in Korean pigs also yield false negatives, as the number of fatal swine infections increases and spreads. Bird flu appears to be spreading in greyhounds in the United States leading to unprecedented levels of fatal infections which are being diagnosed as an unusually aggressive form of kennel cough, although the descriptions match the fatal H3N8 infections in Florida last year. Although WHO has complained about a lack of samples, they have indicated that the were too busy to verify the fatal swine infections in Korea.  Moreover, the WHO makes pronouncements about the absence of reassortment in Vietnam H5N1 isolates, although they have very limited data.  Likewise, there has been no announcement on the fatal infections in dogs in the Untied States.  Explanations for the meningitis outbreaks in the Philippines and India have also been lacking. The recent infections of people, birds, pigs, and dogs create striking parallels with the 1918 flu pandemic.  The fatal infections in the fall were preceded by mild but unusually widespread reports of atypical infections in the spring. Although it is 87 years later and the number of scientific and medical advances has been significant, simple monitoring of various influenzas, including H5N1 is scandalously poor.
China Post May 13, 2005: A young Cambodian woman suffering from bird flu symptoms has been hospitalized in a serious but stable condition in southern Vietnam, a doctor said Friday. The 20-year-old woman from Kampot province has been on a respirator since she was admitted Wednesday to the General Hospital in Kien Giang province that borders Cambodia, Dr. Do Thanh Binh said. Her high fever and coughing have almost disappeared, but two X-rays of her lungs showed serious damage, he said. Binh said the woman first developed symptoms two weeks ago and was treated at a private clinic in Cambodia before being transferred to Vietnam. 

ABC Radio May 13, 2005: Initial tests have found a man in northern Vietnam is contaminated by the bird flu virus, the first human case in more than three weeks.
 Doctors from the Institute of Tropical Diseases in Hanoi say the tests indicate the 55-year-old man from Vinh Phuc province is positive to the deadly H5N1 virus. The case comes one day after government officials said the country had reported no poultry or human bird flu cases for at least 21 days. In another development a young Cambodian woman has been hospitalised in Vietnam after showing symptoms of bird flu. The woman is from Cambodia's Kampot province, the same area where four people have died this year from bird flu.
ABC News May 12, 2005: International efforts to prepare for a human pandemic of the avian flu virus could be under threat because samples of the virus are not getting to World Health Organisation (WHO) laboratories. An international science journal says a lack of cooperation between international animal and human health authorities could hamper efforts to contain a major human outbreak. It is nearly eight months since since the WHO received data on avian flu in Asian poultry, according to Nature, and it only has six samples of the most recent human infection. Curtin University's Professor John Mackenzie says that is enormously concerning. "The only way we can tell whether the virus has mutated or changed to become more able to transmit between people is by being able to sequence strains on a regular basis, so the we can make vaccine quickly," he said.

The Indian Express May 12, 2005: Taking note of The Indian Express’s report on Tuesday that bird flu strains were detected in three poultry workers near Chennai three years ago, the Tamil Nadu Government on Wednesday said the matter would be investigated. The H5N1 strains of Avian Influenza virus were spotted at ICMR’s referral laboratory in Chennai’s King Institute of Preventive Medicine in 2002. It had been confirmed by the Centre for Disease Control and Prevention (CDC), Atlanta, late last year. Health Secretary Sheela Rani Chunkath said on Wednesday that the Director of Medical Education Vijayalakshmi has been asked to look into the issue and submit a report. Chunkath, however, assured that there was nothing alarming about the findings as the strain never caused an epidemic.

Reuters May 11, 2005: Lack of cooperation among international agencies and a reluctance by countries to provide samples are frustrating global efforts to monitor bird flu in Asia, the science journal Nature said on Wednesday. The World Health Organisation (WHO) has obtained only six human samples of the virus and no infected poultry samples in eight months. Although they are supposed to be working together, Michael Perdue, of the WHO's flu programme, told Nature that the UN Food and Agriculture Organisation (FAO) "hasn't been sharing" the samples it has. "It's as if you hear a noise in your car engine but you keep driving, not knowing whether it's serious," said Klaus Stohr, coordinator of the WHO flu programme. Studying samples of the H5N1 bird flu virus that has killed more than 50 people in Asia since 2003 and tracking genetic changes is essential, scientists say. They fear the virus could mutate and develop into a worldwide pandemic with the potential to kill millions of people. The journal said the FAO should be collecting samples but it has not been receiving any, so the WHO does not know how the virus is changing. Joseph Domenech, of the FAO headquarters in Rome, said some infected countries do not have the resources to collect and export samples. "But things that should be happening are not," he said. "Samples sometimes sit in labs." Infected nations are also worried about losing control and negative publicity. "They don't want outside groups making pronouncements and these getting into the press without being vetted by the ministries of health and agriculture," Domenech told Nature. 

Recombinomics May 11, 2005: .  The database for 2004 isolates from Vietnam, Thailand, and several other countries in Asia is large, and it is reinforced with a large number of H5N1 sequences from isolates of this decade. The main problem is not the amount of data, but the interpretation of data.  The existing database has ample evidence for recombination as the principle driver of H5N1 evolution.  However, the WHO is still talking about mutations and reassortment, when the real genetic change is driven by recombination. As noted above, the 2005 genes have changed.  Genes do not change via reassortment, which merely shuffles existing genes.  The Z genotype is defined by reassortment, and the vast majority of the current H5N1 isolates are the Z genotype, including isolates from Japan, Korea, Indonesia and many provinces in China.  These H5N1 isolates have not been reported to cause fatal human infections.  However, the Z genotypes in Vietnam and Thailand have caused infections with a high case fatality rate.  It is the region-specific differences in the genes that are associated with the reported fatal infections in humans. These differences are generated via recombination.  The new 2005 isolates missing one amino acid are almost certainly recombinants between H5N1 isolates from Vietnam and China. More data would be useful, but widespread infections of diverse H5N1 that are continually changing via recombination are serious, no car mechanic required.
Globe and Mail May 10, 2005: A possible global influenza pandemic could sicken more than 900,000 people in Toronto, send as many as 12,000 to hospital and kill up to 5,000, Toronto public health officials warned yesterday. Spurred by the 2003 outbreak of severe acute respiratory syndrome, officials have been working on a pandemic influenza plan, a draft of which is due next month, in the hopes of preparing for a global flu outbreak like those in 1918, 1957 and 1968, which killed millions worldwide. The board voted to urge the provincial and federal governments to accelerate their influenza pandemic plans. And it urged the city to make plans to ensure that essential services would be available in the event of an outbreak. Dr. Yaffe said that in the event of an outbreak, not only could hundreds of thousands of Torontonians potentially fall ill, but also hundreds of thousands more would have to skip work to care for them. This would leave as much as 35 per cent of the city's work force off -- either sick or caring for a sick relative. There will be issues around continuing the functioning of society, the delivering of essential services," she said. Unlike SARS, the report says, when transmission was largely limited to hospitals, an influenza pandemic would spread in workplaces, schools and homes.

Effect Measure May 10, 2005: Last week we noted Thailand's efforts to bring bird flu under control and expressed some skepticism about their claim that the country was "bird fu free." Now a strongly worded Editorial in Thailand's national paper (The Nation) has come to the same conclusion. Taking notice of a recent ban on all animal products from Thailand by the Central Asian State of Kyrgyszstan, the paper also doubts the virus has been banished: 

Dr Robert Webster, a bird-flu expert from the United States who has visited Thailand, rightly points out that in the government’s haste to declare the country bird-flu free, it has completely overlooked the fact that H5N1 is now endemic to the region and not only is likely to return to domestic poultry stocks but could also transform Thailand into ground zero for an influenza pandemic.

The Times of India May 8, 2005: More than 10,000 people, mostly children, have been suffering from flu symptoms during an outbreak in southern China during the weeklong Labor Day holiday according to media reports. The victims had symptoms including runny noses, cough and fever. More than half of the 10,000 people who contracted the virus were children, the report said, adding that a hospital in the city of Shenzhen had to set up temporary beds to accommodate nearly 700 children admitted daily during last week's holiday. A man surnamed Shen who answered the phone at Shenzhen's health department said he didn't have information on the outbreak.

British Medical Journal May 7, 2005: Gottlieb's report that research confirms human to human transmission of avian flu highlights what is now a true threat to the world's population. The tsunami in Asia illustrated one acute natural trauma with thousands of deaths. That catastrophe pales into insignificance when compared with an influenza pandemic. Hundreds of millions will die if the world does not act to prevent this developing pandemic. Development of vaccines against H5N1 needs government pump priming, as will the stockpiling of neuraminidase inhibitors, which should be effective against avian flu. General practitioners and other prescribing practitioners must learn the practicalities of treating epidemic or pandemic influenza and be prepared to prescribe appropriately in all cases of true influenza, to gain experience with the available drugs as well as encouraging increased pharmaceutical company capacity. It is many years since a pandemic struck, and people have become complacent in that time. For governments to bury their heads in the sand may have some benefits in many political areas but it will be disastrous in terms of pandemic planning.

Recombinomics May 6, 2005: The ministry has provided WHO with official confirmation of an additional eight human cases of H5N1 avian influenza, the organization said, noting that two of the cases were recently detected, between April 2 and April 8, in the northern provinces of Hung Yen and Ha Tay, respectively. Both patients are alive. The other six cases are thought to have been detected prior to April 2. Since it is May 6, cases detected between April 2 and April 8 would not qualify as "recent".  Lack of information of the six cases prior to April 2 is not helpful.  It seems likely that the 34-year old physician from Vietnam Sweden hospital in Thai Ninh would be among the H5N1 positive cases.  He developed symptoms on April 1 and died April 3, so it is unclear if he would be among the six detected prior to April 2.  He could be the fatality announced last month that had no associated age or gender. The delay in announcing these cases hinders monitoring or treating contacts.  Moreover, the results on the 1000 samples collected in March, and sent to the CDC, have not been made public.  These samples would have included commune members in Quang Binh.  The delay in reporting cases and lack of transparency in most of the cases tested, reduces the potential of any intervention to control efficient human-to-human transmission, which would appear to be happening at a high but unreported level.

Bloomberg May 5, 2005: Cambodia recorded its fourth human death from bird flu after confirming a 20-year-old woman died last month from the virus, the Cambodian government and the World Health Organization said in a joint statement today. The woman, from Kompong Trach district in Kampot province, was a secondary school student and part-time poultry seller. She died April 19 in Vietnam after contracting a fatal variant of bird flu probably in the village of her school, the e-mailed statement said.

Globe and Mail May 3, 2005: Three months ago, Vietnam announced a strict ban on the raising of ducks, which are believed to be the primary reservoir of the bird-flu virus. Yet all of the 8,200 ducks on one particular farm were born after the ban. The farm is hardly a secret. The ducks are clearly visible from the nearest road, but the owner is not worried by the possibility of government inspectors. Some Vietnamese suspect that he simply bribed the inspectors to ignore the ducks. Similar evidence of corruption and illegality can be easily spotted in Vietnam's biggest city, Ho Chi Minh City. Live poultry sales have been prohibited in the city since February, yet a visit to a traditional poultry market soon reveals a shop where a man is carrying 20 chickens in baskets on his motorcycle. The man flees when a journalist arrives, but nearby vendors confirm the shop is still routinely selling live chickens, despite the ban. Vietnam's inability to enforce its own health rules helps explain why the bird-flu threat is so persistent. Health experts fear that the bird-flu outbreak in Southeastern Asia could trigger a human pandemic and a global health disaster with millions of human deaths. Even the strict Communist regime that has ruled Vietnam with an iron fist for 30 years has been unable to stamp out the poultry practices that nurture the bird-flu virus.

The Independent May 1, 2005: Deadly bird flu is mutating to spread from person to person, bringing a disastrous global pandemic closer, experts fear. Evidence from Southeast Asia suggests that the virus, which could kill tens of millions of people worldwide, is becoming less virulent, but at the same time more infectious to people. Death rates from the virus have plunged in northern Vietnam, says the World Health Organisation (WHO), though it is still killing more of its victims than any previous outbreak. The instances where it appears to have spread from person to person are rising. Flu pandemics occur when three developments take place: a virus emerges to which humans have little or no immunity; it is able to infect people, and it mutates to spread efficiently among them. The bird flu virus - codenamed H5NI - has crossed the first two barriers, and experts fear it is now about to breach the third. "Suddenly it's a very different virus that might suddenly become extremely transmissible," said Peter Horby, of the WHO office in Hanoi. He said that it was impossible to predict when that might happen, but there were "a number of indications" that the virus was already becoming more dangerous. Ironically, one of the main ones is that the virus is becoming a less ruthless killer. By allowing more of its victims to survive, it enables them to live to infect other people. Up to now about 70 per cent of those infected have died. But the WHO reports that the death rate in northern Vietnam has now fallen to 20 per cent, though it has remained the same in the south. Even the reduced level would make it much the worst flu pandemic to hit the world. "Spanish flu", which killed 40 million people in 1918, had a mortality rate of just 5 per cent. A second ominous indication is that the flu has been widening its targets in northern Vietnam. Previously it mainly attacked children and young adults, but now it is affecting all age groups. Then, while almost all previous victims have been infected directly by chickens or ducks, there is a steadily increasing number of clusters of disease, where it appears to have spread between people. There are now at least seven of these, almost all in the northern province of Haiphong. WHO officials say this is unprecedented. Finally, the virus itself seems to have changed physically. Vietnamese health experts say it has evolved in the north of the country by dropping an amino acid. The US Government Centers for Disease Control and Prevention, which has analysed many specimens of the virus from Vietnam, adds that new strains of it "are becoming more capable of causing disease for mammals". It and the WHO stress that there is no conclusive proof yet that the virus is spreading efficiently between people. But scientists are agreed that it is only a matter of time before it does and that, then, jet travel will spread it rapidly around the globe.

Channel NewsAsia April 28, 2005: There was likely to be another full-blown outbreak of bird flu this year in Vietnam, where 36 people have died from the disease since late 2003, a health expert warned in state media Thursday. The deadly H5N1 virus could be dormant and resurface as the weather warmed, Central Institute of Hygiene and Epidemiology deputy director Pham Ngoc Dinh told the official English-language daily, Vietnam News. The virus "is still in faeces, ash and other waste, not to mention the poultry carrying the disease," Dinh said. "We predict that by the end of the year, the epidemic might break out again if we do not have positive solutions such as vaccines for poultry, as well as disinfecting the environment when the weather is warmer," he said. It might take one or two more years to eradicate the disease, Dinh said, adding, "if we cannot extinguish the epidemic fully, the virus might change its genetic structure and cause a bigger epidemic." Health experts have warned the H5N1 virus could lead to a pandemic if it mutates into a form that can be easily transmitted between humans.

The Standard April 25, 2005: As scientists increasingly worry about an "imminent'' bird flu pandemic which they say will kill millions around the globe, a local respiratory specialist says it is Hong Kong's' "scientific and moral responsibility'' to conduct clinical trials on anti-viral drugs if avian flu breaks out in the SAR. The suggestion comes from Dr Kenneth Tsang, a respiratory specialist at Hong Kong University. He spoke recently on an unpublished study about the possible use of clinical trials on avian flu patients in the light of discussion about the efficacy of the drug under consideration by health authorities here, Tamiflu. Hong Kong has 1.7 million Tamiflu tablets and plans to stockpile at least 20 million doses of the drug by next year for health-care workers who will be on the frontline should an outbreak occur. The number of doses to be stockpiled is determined by using a 15 per cent ``attack rate'' of the virus as well as calculations used by the United Kingdom and Australia, Leung said. Those countries stockpile pandemic drugs for about 20-30 per cent of the general population.

Washington Post April 24, 2005: More than a year after avian influenza emerged in East Asia, killing more than two-thirds of the people with confirmed cases, Vietnamese doctors are reporting that the mortality rate in their country has dropped substantially. But while this is good news for survivors, it could mean the outbreak of bird flu in Southeast Asia is taking an ominous turn. If a disease quickly kills almost everyone it infects, it has little chance of spreading very far, according to international health experts. The less lethal bird flu becomes, they say, the more likely it is to develop into the global pandemic they fear, potentially killing tens of millions of people. "The virus could be adapting to humans," said Peter Horby, an epidemiologist with the World Health Organization (WHO) in Hanoi, the Vietnamese capital. "There's a number of indications it could be moving toward a more dangerous virus." Officials said the drop in the bird-flu mortality rate was more marked in northern Vietnam than in the south. While the virus in southern Vietnam is still killing at the same pace as last year, the rate in the area around Hanoi and elsewhere in the north has dropped from that level to as low as 20 percent. Vietnamese health experts said their suspicion that the disease is shifting is further supported by preliminary research showing a genetic change in the virus in the north resulting in the production of a protein with one less amino acid than in the south. Health researchers believe that nearly all the 52 people known to have died of bird flu in Southeast Asia caught the virus from infected poultry. But with more clusters of cases among families reported in Vietnam this year, experts say they are growing increasingly suspicious that the disease has begun passing from one human to another. Also worrying is the discovery of at least five cases in which people tested positive for bird flu but showed no symptoms. This could make it more difficult to contain an epidemic because people could transmit the disease without anyone realizing it. Moreover, the existing virus strain is not the only threat. Each human case also presents a chance for the bird-flu virus to swap genetic material with an ordinary flu bug — if the person becomes infected with both strains at the same time — potentially creating a new hybrid that is highly lethal and even easier to catch. "We are concerned that if the virus is changing, maybe a new virus is coming in the future," Hien said. WHO officials have complained, however, that Vietnam is reluctant to provide detailed information about human cases. Senior Health Ministry officials respond that reports are provided in accord with national regulations. The question now is whether bird flu in Vietnam has begun passing among humans.

Recombinomics April 23, 2005: Media reports are now providing more detail on specific human-to-human cases that signaled the more efficient H5N1 transmission, particularly in northern Vietnam.  One case provides detail about the first reported transmission from patient to health care worker, a very big red flag for human-to-human transmission.  The transmission at the time was the longest transmission chain, and symptoms in a second nurse would have extended the chain further. The travel of the index case to Haiphong prior to developing symptoms may have also been relevant.  That is where a family of five were hospitalized on the same day, and a few days later neighbors showed symptoms.  Thus, the version of H5N1 in the north has been circulating for some time.  Co-circulation of this northern strain with the more lethal southern strain creates conditions for rapid evolution via recombination. The increased efficiency of human-to-human transmission was clear earlier this year, and familial clusters account for over one third of reported cases.  These frequent human-to-human transmissions have been less obvious to the public because of intense efforts to attribute the human-to-human transmissions to poultry. The failure of WHO to issue alerts on these clear signals of the emerging pandemic remain scandalous.
Reuters April 22, 2005: A 20-year-old Cambodian woman who died in Vietnam this week was killed by bird flu, taking the death toll in Asia to 52, a health official said on Friday. The woman died just hours after being rushed to hospital on Tuesday in Vietnam's southern province of Kien Giang, suffering from high fever and respiratory problems, a doctor who treated the woman told Reuters. "This case has tested positive," said a Ho Chi Minh City official, who declined to be identified, following tests on samples from the woman at the city's Pasteur Institute. Four Cambodians have now died of bird flu, all of them from Kampot province, which borders Vietnam. The H5N1 virus has also killed 36 Vietnamese and 12 Thais. 

Reuters April 21, 2005: Australia has survived the most dangerous time of year for the spread of the H5N1 infection. The end-of-summer departure of millions of migratory birds had greatly reduced the risk of them introducing the deadly virus from Asia, spreading it to native birds and eventually into the human food chain, government officials said on Wednesday. "The risk of migratory birds is much reduced by the fact that they're now flying north," Howard Conkey, spokesman for the federal Department of Agricutlure, told Reuters. Migratory birds, mainly shore birds and sea birds, fly into Australia for the southern summer each year. They arrive around September and leave in autumn, which begins in March. Many travel through countries of Southeast Asia and East Asia that have had bird flu outbreaks, and that means they can carry it back when they return. But there is little Australia can do to stop birds flying into the vast, empty spaces of its tropical north. "I would never say we're safe," said Carson Creagh, spokesman for the chief control agency the Australian Quarantine and Inspection Service (AQIS). "It's always a risk." The passing of the period of greatest risk leaves Australia still free of the H5N1 strain, even though it has reached its doorstep, in northern neighbour Indonesia. "But we're very aware that this disease is still sweeping through parts of Asia," Conkey said, pointing to recent warnings by the World Health Organisation that H5N1 could mutate to be more easily spread from person to person, causing a global pandemic. Australia has had five previous outbreaks of bird flu, most recently in 1997, with the infection brought in by migratory birds that defecate into water, passing the flu onto wild birds.

Reuters April 20, 2005: A 20-year-old Cambodian girl has been rushed to a Vietnamese hospital with suspected bird flu, state media said on Wednesday. The schoolgirl from Kampot province was taken across the nearby Vietnamese border suffering a high fever and respiratory problems, symptoms of the H5N1 virus that has killed 51 people in Asia, the Tuoi Tre newspaper said. Doctors at the Kien Giang provincial hospital took samples for tests after isolating the girl and putting her on a respirator. The samples will be sent to Ho Chi Minh City's Pasteur Institute, 250 km (155 miles) away. Three Cambodians from Kampot province have already died of the bird flu virus, along with 12 Thais and 36 Vietnamese. The newspaper quoted the girl's relatives as saying chickens had died of unknown causes near her home.

Bangkok Post April 20, 2005: Asean countries have not done enough in stockpiling anti-viral drugs for protecting their people from avian influenza and a possible virus pandemic in the region, say health experts Robert G Webster, professor at St Jude Children's Research Hospital, said Southeast Asian nations had not stockpiled sufficient doses of the anti-viral drug oseltamivir for their population. Many countries were stockpiling anti-viral drugs for their population. Hong Kong had already announced plans to beef up its stocks of the drugs and other countries such as France, Britain, New Zealand, Sweden and Canada have also placed significant orders. However, very little information of drug stockpiling had been reported from countries in the Asean region despite Asean being pointed out as a virus ground-zero, he said. Oseltamivir, made by Switzerland's Roche Ag and also known as Tamiflu, has been singled out by the World Health Organisation as its drug of choice to restrict the spread of bird flu in case of a human flu pandemic. Dr Webster pointed out that bird flu could remain widespread because it stemmed from free-range ducks farming, which was evident across the region, especially in Thailand and Vietnam. The only solution left was to cull all the country's infected ducks, which was almost impossible. Ducks have become the reservoir of H5N1 strain of the avian flu. Thailand only has a stockpile of 30,000 doses of oseltamivir for its 60 million-strong population.

The Standard April 18, 2005: While Hong Kong's surveillance system against the deadly bird flu has been praised, a leading microbiologist warns the threat of the virus must be viewed as part of a bigger picture. University of Hong Kong microbiology professor Malik Peiris says the weakest link in the region could have a dramatic impact. We are dealing with something that is affecting the region. It cannot be dealt with in isolation. ``Sooner or later, there is going to be a pandemic. Whatever preparations are made will not [have been] in vain,'' he said. If H5N1 does mutate - and the world has no adequate immunity to such a threat - as many scientists suggest the virus is trying to do in developing countries such as Vietnam, Thailand and Cambodia, the result could be the end of life as the developed world knows it. However, some of the brightest minds in microbiology and emerging disease research and treatment say that the world is in a better position now to mount a rational and effective response to such an event. 

Thanh Nien News April 18, 2005: The government aimed to contain the H5N1 virus by next year or 2007 and eliminate it by 2010, Deputy Agriculture Minister Bui Ba Bong told a conference reviewing the fight against bird flu in Vietnam, the country hit hardest by the epidemic. Other senior officials said current knowledge about the virus, which has been at its worst during the cool season between December and March in each of the last two years, meant the fight would be a tough one. "This is a new, extremely dangerous disease which contemporary knowledge in our country and internationally has not been able to explain properly," Deputy Prime Minister Nguyen Tan Dung said. He told health and agriculture officials and foreign experts it was still not known for sure how the virus was transmitted from water fowl, which can carry it without getting sick, to poultry and then to people. "There are cases where a healthy person carries the virus without showing clinical symptoms, which has made the risk of spreading the virus in the community greater," Deputy Health Minister Tran Chi Liem said. What the World Health Organization fears is that the virus will mutate into a form which can pass easily between people and kill millions in a global pandemic.

Recombinomics April 17, 2005: Peter Horby, the WHO medical epidemiologist in Hanoi, said that while the mortality rate from H5N1 infections was falling, the virus appeared to be adapting to human hosts, which was taken to be an indication that transmission between humans would become easier. Dr Klaus Stohr, the WHO global influenza programme chief, reported an increase in the number of cluster cases reported recently, with the biggest a family of five cases.  No relative has been proved to have passed the disease to another, but Dr Horby said: "The onset dates could be consistent with human to human transmission." The above comments by Peter Horby and Klaus Stohr dance around the human-to-human transmission issue. They cite evidence for more efficient human-to-human transmission, but then try to limit the implications by saying that the proven transmissions are not proven. The most straightforward proof of human-to-human transmission is bimodal distribution of onset dates.  When two people who have contact with each other develop symptoms at different times, the simplest explanation is that the patient who developed symptoms at an earlier date transmitted bird flu to the contact that developed symptoms at a later date. All of the relevant facts are acknowledged.  The number of clusters has increased, as have their size.  The relevance of the bimodal distribution is acknowledged by the statement that "onset dates could be consistent with human-to-human transmission". Use of "could" was appropriate last year, when the number of clusters was smaller.  However, now the number of familial clusters has grown to more than double the seven acknowledged above and virtually all have bimodal distributions, which as an aggregate provide overwhelming evidence for human-to-human transmission. It is misleading to continue to use "could".  The onset dates in virtually all of the familial clusters PROVE human-to-human transmission. Moreover, the statement that the cluster cases are all within single families is simply false.  The cluster in Thai Binh involving the two nurses extended beyond a single family.  The brother, sister and their nurse were all confirmed to be H5N1 positive, and the negative tests on the second nurse remain suspect. When top WHO representatives define evidence for human-to-human transmission, but fail to acknowledge the existence of human-to-human transmissions proven by the clear evidence, the number of reasons why the monitoring and control of avian influenza in Asia is scandalous, increase. 

Telegraph April 16, 2005: The threat of a killer flu pandemic is greater than ever because of the spread of the bird flu virus in south-east Asia, the World Health Organisation said yesterday. Avian influenza is still spreading, despite countermeasures, and the possibility of a global epidemic that could kill millions is said to be more likely than not. More than 50 people have died from the H5N1 virus in south-east Asia, most of them in Vietnam, where tens of thousands raise poultry in small back-yard farms. In its current form, the virus is difficult for humans to contract, but if it changes its genetic make-up, it could spread rapidly. Peter Horby, the WHO medical epidemiologist in Hanoi, said that while the mortality rate from H5N1 infections was falling, the virus appeared to be adapting to human hosts, which was taken to be an indication that transmission between humans would become easier. "The fact that it's been around for a year and we haven't seen a pandemic is no reason to be complacent," he said. "I'm more concerned than I was a year ago." He estimated the probability of a pandemic at "more than 50 per cent". To date, there has been human-to-human transmission but none beyond "one or two links in the chain", following close contact with a terminally ill patient. 

UN News Centre April 15, 2005: Eight more human cases of bird flu have been reported in Viet Nam, according to the United Nations health agency, bringing the total since mid-December to 41, 16 of them fatal, in the latest outbreak of a disease that in a worst-case scenario could kill tens of millions people worldwide. The World Health Organization (WHO) is seeking further details from the authorities. Earlier this month the agency said there was currently no evidence that the virus was spreading easily from person to person. Three additional cases of the H5N1 virus strain have been reported from neighbouring Cambodia WHO has stressed the need for scientists to share the viruses from recent clusters of cases and determine possible changes in the behaviour of the H5N1 to assess the risk of an influenza pandemic.

New Scientist April 14, 2005: Indonesian scientists have found the H5N1 bird flu virus in a pig. The strain has infected poultry across east Asia, and killed at least 51 people so far. Scientists fear pigs could act as a “mixing vessel” in which a human pandemic strain could evolve, because the animals can harbour both human and avian flu viruses. But while suspected, such hybridisation has never been proven. Furthermore, New Scientist has learned of preliminary results from scientists in the US that suggest pigs might not be able to transmit H5N1 flu to one another.

Nature April 14, 2005: Mass culling of poultry to limit the spread of bird flu is not an acceptable method of control, said the UN Food and Agriculture Organization and the World Organisation for Animal Health (OIE) at a meeting in Paris, France, last week (7-8 April). Instead, the two organisations are urging governments and farmers to vaccinate birds against the disease. Their previous calls for vaccination were not as strong as this one. The insistence follows a realisation that killing large numbers of birds is unlikely to eliminate the lethal H5N1 bird flu virus. The virus is widespread in wild and domestic bird populations, meaning it will continue to re-emerge no matter how many birds are killed. The organisations say that "for ethical, ecological and economical reasons", culling should no longer be used as a primary means of control.

Recombinomics April 11, 2005: Hospitals in Ho Chi Minh City have been filled with thousands of children who have caught respiratory and digestive illnesses due to the hot weather. Pediatric Hospital I reported that it had examined nearly 4,000 children patients a day with some 85 per cent of them suffering from respiratory problems, said a hospital doctor. Meanwhile, more than 3,000 children were brought into Pediatric Hospital II on Monday.  One-third of the children had respiratory problems and 300 others had digestive problems. The deafening dearth of data in Vietnam may have ended. The number of children alone would be cause for concern, but large numbers of patients with respiratory and digestive illness, and  "brain diseases" in Vietnam ring alarm bells very loudly. Serious H5N1 testing is indicated, although results from Quang Binh, Haiphong, and Quang Ninh have not been reported.  Bird flu monitoring in Vietnam is well beyond scandalous.

Vietnam News Agency April 10, 2005: Cambodian Health Minister Nuth Sokhom has confirmed a new case of bird flu in an 8-year-old girl who died on April 9, bringing the death toll of avian flu in the country to three. The minister said the patient, who had suffered a high fever since March 31, died at Kanthabopha hospital in Phnom Penh shortly after being sent from a hospital in her native province of Kampot, about 170 km from the capital city.

AsiaNews April 8, 2005: United Nations representatives and the central government of Hanoi have released a document about the situation of bird flu in Vietnam. In the text, Anton Rychener, representative of the Food and Agriculture Organization of United Nations (FAO), charges: “Besides the extremely high mortality rate of H5N1 – higher than that of Ebola – there is a serious problem of internal communication. Local people do not understand that the authorities, both local and international, can do little to defeat the disease if they are not informed in good time about cases of infection.” Nguyen Duy Long, head of the veterinary department of Long An province, confirms the charges and explains that many deaths among both animals and humans could easily be avoided. “Villages must send information about real or supposed infection as quickly as possible, to allow central bodies to intervene in the best way,” he said, adding: “However, in many regions of the country, monitoring and information networks are non-existent.” 

Recombinomics April 7, 2005: "The potential for the disease to spread to other continents is real and the international scientific community cannot remain insensitive to the challenge of preventing this happening," OIE Director-General Bernard Vallat told a conference in Paris on Thursday. Although the potential for H5N1 bird flu to spread to other continents is real, the possibility that it has already spread to other continents is high.  Reports of bird flu in the three northeastern provinces of Vietnam, Thai Binh, Haiphong, and Quang Ninh, show clear patterns of human-to-human transmissions. The evidence for human-to-human transmission within the clusters is overwhelming, and the clustering of these clusters leaves little doubt that the transmission to humans is becoming increasingly efficient, as transmission chains grow longer and clusters grow larger. However, many of the cases have been much milder than those reported in the south, where the case fatality remains at 100%.  In the north, many of the patients improve within days after hospitalization and are released after 1-2 weeks.  This mild course suggests many H5N1 patients simply recover at home, assuming that they have a bad case of human flu. As the number of the milder cases increases, so does the likelihood that some H5N1 infected people will travel outside of Asia and transmit H5N1 to contacts in other continents. These milder cases will go unnoticed unless the symptoms worsen to a point where testing is ordered.  However, milder cases will not be tested, so the flow of H5N1 outside of Asia will remain undetected.

Financial Review April 7, 2005: Investment banks are starting to issue warnings on the risks avian influenza poses to the economies and financial markets of East Asia, as health experts struggle to assess whether the disease has the potential to cause a pandemic at all. With Asia, and particularly China, now the main area of global economic growth along with the United States, economists are considering any factors that could derail the region's expansion. Many such risks are familiar ones - an earthquake in Japan, a banking crisis, civil unrest in China or a conflict in the Taiwan Strait. CLSA Asia-Pacific Markets, the Asian investment banking arm of Credit Agricole of France, estimated in a report issued this week that the disease had already cost Asian countries $US8billion to $US12billion ($10.4billion to $15.6billion) , mostly from the deaths or destruction of 140million chickens and other poultry. But the cost would be greater if the disease gained the ability to spread easily from person to person, a possibility not factored into stock and other asset prices, CLSA's chief equity strategist, Christopher Wood, said. "It would be a regional panic and potentially a global panic," he said. "There's no way markets can discount this."

WebMD April 6, 2005: Federal health officials say they are stepping up efforts to protect the nation against influenza, amid concerns that bird flu could enter the U.S. from Asia and cause a pandemic. CDC officials told lawmakers Wednesday that they are moving to more than double the number of quarantine stations used to evaluate and detain travelers from overseas who enter the country ill with potentially dangerous contagious illnesses. Officials said the expansion is part of an effort to increase the government's ability to respond to a potential influenza pandemic. Concerns over the potential impact of the flu were heightened this winter amid a widespread shortage of vaccines that left the U.S. with just over half of its expected supply. Unease has also increased among health officials as bird flu continues to spread among millions of chickens and ducks in Southeast Asia. Wild birds worldwide carry the bird flu virus in their intestines but usually do not get sick from them. However, bird flu is very contagious among birds and can make some domesticated birds, including chickens, ducks, and turkeys, very sick and kill them.

CBC News April 6, 2005: A 10-year-old girl has become the latest victim of bird flu in Vietnam. Her death in Hanoi takes the number of bird flu deaths in Vietnam to 34 and 50 Asia-wide. Vietnamese authorities earlier confirmed another death, but details have not been released. The UN says the new strain of bird flu that has emerged in North Korea is probably H7, which experts say is not capable of being transmitted to humans.

Bloomberg April 6, 2005: Another human fatality in Vietnam has been attributed to avian influenza, while health officials investigate the death last weekend of a doctor who worked in a hospital where bird-flu patients have been treated. Test results showed that a 10-year-old girl who died on March 27 in a hospital in the Vietnamese capital of Hanoi was infected with the H5N1 bird-flu virus, according to Le Van Diem, director of St. Paul's Hospital in Hanoi. If the doctor's samples test positive for avian influenza, it would mark the second known case of bird flu in a health-care worker. A male nurse from the northern province of Thai Binh tested positive for the H5N1 virus last month. 

Taipei Times April 5, 2005: If a bird flu pandemic ever strikes, Thailand, Vietnam and China would likely be the epicenters and the hardest-hit economies would probably be Hong Kong, Singapore and China, a research report said yesterday. The report issued by CLSA -- a Hong Kong-based brokerage, investment banking and private equity group -- said that the public and investors were not focused on bird flu, even though it has devastated the poultry industries in some Asian nations. ``The epicenter for emergence of a pandemic strain, if it occurs, is most likely to be in Thailand, Vietnam or China,'' the report said. Hong Kong, Singapore and China face the greatest economic risk from any pandemic, said CLSA, a unit of France's Credit Agricole.

Reuters April 1, 2005: President Bush issued a directive on Friday allowing authorities to detain or isolate any passenger suspected of having avian flu when arriving in the United States aboard an international flight. White House spokesman Trent Duffy called the directive a precautionary measure. "There's no evidence of any risk of avian flu to the American people at this time. But in an abundance of caution, this is a pragmatic step to ensure the government has the authority it needs to protect the American people as best it can," Duffy said. The Bush order added pandemic influenza to the list of diseases for which quarantine is authorized. Pandemic flu is considered a novel or re-emergent strain to which there is little or no population immunity.

The Standard April 1, 2005: Hong Kong Stadium could be turned into a huge outpatient clinic in the event of a major outbreak of bird flu, health authorities said. The plan is the latest in a series of defensive measures Hong Kong is taking against the H5N1 avian flu virus that has killed dozens of people in Vietnam, Thailand and Cambodia. While the World Health Organization has said that Hong Kong is one of the safest places to be if there is an outbreak because of existing safety measures, local health chiefs said Thursday that resources in public hospitals would be overwhelmed if the city were hit by a large-scale avian flu epidemic. The 40,000-seat stadium in Causeway Bay is an option because it could house hundreds of doctors, nurses and other medical personnel in one location.

ABC News March 31, 2005: A top Vietnamese health official on Thursday blamed public ignorance about bird flu, weak surveillance systems, and small-scale farming activities for the re-emergence of the disease, which has killed 48 people in the region. "The risk of bird flu recurrence is unavoidable because of people's limited awareness and poor poultry farming conditions," the Tuoi Tre (Youth) newspaper quoted Vice Minister of Health Tran Chi Liem as saying. "In many places, the epidemic surveillance network is largely nonexistent." Another health official was quoted by the newspaper as saying bird flu would continue to infect people as long as the country fails to control outbreaks among poultry. "The most important thing now is to wipe out bird flu outbreaks among poultry, and bird flu among humans can only be eradicated after this is done," said Trinh Quan Huan, director of the Ministry of Health's Preventive Medicine Department.

Reuters March 29, 2005: Vietnam has four more suspected human cases of the bird flu which has killed 49 people in Asia since the end of 2003, medical officials and a doctor said on Wednesday. Tests for the H5N1 virus were under way on a 25-year-old woman who was taken to Ho Chi Minh City's Hospital for Tropical Diseases on Tuesday with coughing and fever after returning from Cambodia, a hospital official told Reuters.

Reuters March 29, 2005: A bird flu outbreak in North Korea is probably extensive, South Korean officials said on Tuesday, but Pyongyang has yet to request Seoul's help to contain the virus. North Korea officially confirmed on Sunday an outbreak of bird flu at two chicken farms in the capital Pyongyang. It said hundreds of thousands of birds had been culled in the secretive state, which suffers from severe food shortages. "We suspect that it has spread quite extensively looking from the way North Korea disclosed this," said Unification Ministry official Kim Chun-sik, who oversees exchanges with the North. 

VOA News March 29, 2005: A family of Vietnamese poultry farmers has tested positive for bird flu. Officials in Haiphong say a couple and their three daughters became ill after eating sick chickens. About half of the family's 400 chickens reportedly died of bird flu. Initial tests show the five have the deadly H5N1 form of the disease. A neighbor of the family is also hospitalized with bird flu symptoms. 

Recombinomics March 28, 2005: A 41-year-old woman from Vietnam's northern Hai Phong city has been hospitalized for being suspected to contract bird flu virus strain H5N1. The new case expands the bird flu Haiphong five to six. The symptoms are similar to those of the five member family, although they had fevers at the time of admission.  Although doctors had indicated an Friday and Saturday that the family were admitted last Tuesday because they were bird flu cases, the H5N1 test results have not yet been reported.

XinHua March 27, 2005: The Democratic People's Republic of Korea (DPRK) on Sunday confirmed an outbreak of bird flu in the country for the first time. "Bird flu has recently broken out at a few chicken farms including the Hadang Chicken Farm, hundreds of thousands of infected chickens have been burned before their burial at the relevant chicken farms. No one is reported to have been infected with this bird flu from among breeders of those farms," the Korean Central News Agency (KCNA) quoted the State Emergency Veterinary and Anti-Epizootic Committee as saying.

Japan Today March 26, 2005: Vietnam's Health Ministry confirmed Saturday three more cases of bird flu in humans, one of whom has died, bringing the total number of infections in the country to 28 since the epidemic's resurgence late December. Test results revealed this week that a 5-year-old boy in the central province of Quang Binh and two girls from the northern provinces of Quang Ninh and Nam Dinh contracted the virus.

Recombinomics March 25, 2005: In Vietnam, the afternoon edition of the state-run Hanoi Moi (New Hanoi) daily said five members of one family were hospitalized on Wednesday in the northern port city of Haiphong with coughing and breathing difficulties. Doctors suspected they had bird flu, the paper said. It quoted Nguyen Van Vy, director of Haiphong's Health Department, as saying poultry at the family's house had been slaughtered earlier to stop bird flu outbreaks. The hospitalization of five members of one family would represent the largest familial cluster reported to date.  Although many of the index cases in the clusters are exposed to sick poultry, transmission to other family members is limited to one or two.  Similarly, there is usually just one index case.  The onset dates are bimodal, indicating human-to-human transmission, but such transmissions are limited. March 26, 2005: If all family members developed symptoms at the same time, it will also represent the most efficient transmission of H5N1 to humans, which is why this cluster has been a major cause for concern.

Bloomberg March 25, 2005: Two more Vietnamese have caught bird flu, one of whom who has died, local health officials said, as the World Health Organization met with the government to discuss reports of a flu-like illness in central Vietnam. 

Reuters March 25, 2005: A 17-year-old girl and a 40-year-old woman have been infected by Asia's bird flu in Vietnam -- the hardest-hit country, with 34 deaths so far, 13 since December -- officials said on Friday. "They have been here for a week and the positive test results just came out this week," the official at the National Institute for Clinical Research of Tropical Medicine in Hanoi told Reuters. The girl came from Nam Dinh province, 56 miles south of Hanoi, while the woman was from Quang Ninh province which borders China, the official said. The World Health Organization says it has seen no evidence so far to suggest the virus is changing into a form that could be transmitted easily from one human to another.

EffectMeasure March 24, 2005: Hong Kong certainly seems to be taking the situation in Vietnam seriously, and in particular the possibility of a flu outbreak in Quang Binh. Hong Kong authorities have set up a telephone hotline for travelers to Vietnam who feel unwell after visiting, have established a special liaison with WHO and the Vietnamese Consulate in Hong Kong to get the latest information and are setting up temperature screening at the airport with informational leaflets on all in-bound flights from Vietnam. Hong Kong is just entering peak flu season, and unlike last year when most strains were H3N2, this year they are seeing a mixture of H3N2, H1N1 and influenza B virus. Reports from public clinics of influenza-like illness were up 78% from the previous week. Tsang said Taiwan and Japan were also seeing a high number of flu cases. Meanwhile, reports from Cambodia and Vietnam indicate that the H5N1 strain may be changing once again. So while we wait for the other shoe to drop with bird flu, the "garden variety" viruses are still with us, causing serious illness and death in Asia, and co-circulating with H5N1, with the obvious increase in chances for reassortment and recombination.

Recombinomics March 24, 2005: The man from Kampot province died at a hospital in the capital, Phnom Penh, late Tuesday after falling ill early this week, said Health Minister Nuth Sokhom. Megge Miller, an epidemiologist for the U.N. World Health Organization office in Cambodia, said that tests done by the Pasteur Institute in Phnom Penh showed he had bird flu. The victim is the third reported bird flu death in Kampot, Cambodia.  The first two formed a familial cluster.  The index case died after collecting dead birds, and his sister developed symptoms shortly after his funeral.  Although there had been dead poultry in the village, they were not reported and follow-up tests failed to detect H5N1 in poultry or family members. However, the latest case is from Tam Sasor, which is just 20 km from the home of the familial cluster.  There are reports of dead poultry in the area as well as reports of villagers eating the dead poultry. These data suggests there are additional unreported cases which are not limited to Kampot province in Cambodia, adjacent Kien Giang province in Vietnam, or Quang Binh in Vietnam's Central Highlands.  There are 37 suspect cases who are from the commune in Quang Binh, where dead poultry was eaten. The likelihood of other outbreaks is high since H5N1 is endemic to the area.

WorldPeace Herald March 24, 2005: The U.S. Centers for Disease Control and Prevention has begun a series of experiments to see how likely the bird flu virus could result in a human pandemic. The six-month series of experiments seeks to simulate the mixing and matching of genes from the H5N1 avian flu virus that has plagued Asia and a common human flu virus that public-health experts fear could turn avian flu into a pandemic, the Wall Street Journal reported Thursday. CDC scientists inside an ultra-secure laboratory have started swapping the genes of the H5N1 avian virus with the genes of an H3N2 virus, the strain behind most recent human flu outbreaks. The goal is to substitute the eight genes of each virus, one by one, with the eight genes from the other virus to see which of more than 250 possible combinations create flu viruses that could spread easily among humans.

Agence France-Presse March 24, 2005: A 28-year-old Cambodian man has died of bird flu at a hospital in the capital becoming the country's second victim of the virus, the health minister said Thursday. The victim, Meas Ran, came from Kampot province, which borders Vietnam and his village Tram Sasor is 20 kilometers away from the home of the first victim, who died in January after traveling for treatment to Vietnam. The minister said between 400 and 500 chickens and ducks had died in the village but it was not known if Meas Ran, who worked as a traveling businessman and occasionally went to Vietnam, had been in contact with them.

ChannelNewsAsia March 24, 2005: Veterinarians fighting the threat in Vietnam have launched a public awareness campaign to teach farmers there safe practices. But the rural lifestyle, where poultry, animals and people mingle freely, may be creating conditions for a bird flu pandemic. This does not look like one of the most dangerous places on earth, but health officials, worried about a global bird flu outbreak, say that is just what it is. Villagers here have a hand in everything, from rice and pineapple farming to duck and pig rearing -- often on the same farm. Experts say if there is going to be a pandemic it will start in villages where pigs, ducks, chickens and humans are mixing together. It is a seemingly idyllic scene: a woman cooks lunch, fat pigs lounge by the river, chickens run free and ducks swim in the river. But look at it from a veterinary standpoint and this place is an ideal breeding ground for a bird flu pandemic. 

The Standard March 24, 2005: Vietnamese travelers could be banned from entering Hong Kong and other travelers returning to the SAR from Vietnam may face compulsory screening should a human-transmittable strain of bird flu be found in that country, the government said Wednesday. Centre for Health Protection consultant Thomas Tsang said different options are being considered including the scale of the outbreak, but if the World Health Organization (WHO) confirms such an occurrence, tougher entry measures will ensue. News reports from Vietnam suggest about 200 people in a village in the center of the country are suspected to be suffering from bird flu. ``Up to [Wednesday] morning, the WHO tells us they are still investigating the reported outbreak,'' Tsang said. ``The situation in Vietnam is changing fast but if the WHO confirms that bird flu is being transmitted from humans to humans, we do not rule out endorsing further measures, including issuing a travel warning.''

XinHua March 24, 2005: A 16-month-old boy from Vietnam's central Quang Binh province has been hospitalized for being suspected of contracting bird flu virus strain H5N1, according to local newspaper Pioneer on Thursday. 

Jakarta Post March 24, 2005: As of Wednesday, bird flu was continuing to spread in South Sulawesi, affecting around 128,000 chickens so far in four regencies: Sidenreng Rappang (Sidrap), Wajo, Soppeng and Maros. The biggest outbreak occurred in Sidrap regency, some 200 kilometers north of Makassar, where the virus has infected 101,400 chickens. Bird flu in Indonesia has not resulted in bird-to-human transmission.

WashingtonPost March 23, 2005: Cambodia's chief of disease surveillance, Ly Sovann is responsible for spotting the stirrings of an epidemic in a country where the public health and veterinary systems are so impoverished that experts acknowledge they are probably failing to detect most of the human cases and have no idea how rampant the virus is among poultry. So far, international health specialists report that the disease is less prevalent in Cambodia than in Vietnam and Thailand. But health specialists are concerned about the rudimentary level of medical and veterinary care in Cambodia and its destitute neighbor Laos. They fear that those countries' primitive health care systems may not be able to diagnose or report human cases of bird flu, allowing the virus to spread. "The chain is as strong as the weakest link," said Klaus Stohr, director of the World Health Organization's global influenza program. "Cambodia and Laos are certainly the ones that need beefing up."

Thanh Nien News March 21, 2005: Authorities in central Quang Binh province became aware of a serious bird flu outbreak only after media recently uncovered a bird flu death and hundreds of suspected cases in one of the province’s communes. An interagency task force has now arrived at the commune to take immediate necessary actions to stabilize the situation and fend off the spread of the epidemic, a Thanh Nien source said. Tests are being carried out with all 195 suspected patients to determine whether they are infected with bird flu.

VNA March 21, 2005: Two bird flu outbreaks have occurred at two duck breeding households in Vinh Hoa and Tan Xuan communes in Ba Tri district, the Mekong Delta province of Ben Tre on Mar. 19-20, announced the Veterinary Department. 

DVB Burma March 20, 2005: During last week, thousands of chickens died suddenly at Moulmein, Mon State in southern Burma and local worried residents suspect that there could be an outbreak of bird flu. The chickens are said to be from a farm at 6-mile Hill near Moulmein University, but Veterinary Department of Mon State said these chickens died from ordinary diseases. There have been reports that the state authorities have been trying to cover up the news making the people suspect that these chickens died from avian flu.

Recombinomics March 20, 2005: There are now over a dozen familial clusters which have virtually identical bimodal distributions.  The secondary patients cared for the index case, or had contact at hospital visits and/ or the funeral.  The onset dates are 1-2 weeks after the index case, and are inconsistent with a common exposure by the index case and secondary case(s). Examples clearly demonstrate human-to-human transmission in Vietnam and Thailand, and highlight the gross deficiencies in the testing program which the WHO uses to exclude clear-cut H5N1 positive cases and clusters.

Thanh Nien News March 20, 2005: A commune in central Vietnam has been severely hit by the bird flu, with 195 patients showing symptoms and two children testing positive with the virus, reported a top provincial official. Two siblings from the province’s Chau Hoa commune of Quang Binh province had tested positive for the H5N1 strain of bird flu, said Mai Xuan Thu, vice chairman of the provincial People’s Committee on March 20. The older sister, Hoang Lan Huong, 13, died from the bird flu on March 9, while the brother, Hoang Trong Duong, 5, is in serious condition at the Hue Central Hospital. Meanwhile, there are 195 other local residents who have shown symptoms of the flu, said Ms. Thu. It is not yet clear whether these people, some of who had reportedly eaten sick chickens, have the symptoms of the deadly bird flu or the normal flu. 

Houston Chronicle March 19, 2005: After more than a year of watching patients sicken and die of bird flu, Dr. Tran Tinh Hien of the Hospital for Tropical Diseases here thought he understood the illness. Then last month, he learned of an unsettling study. Japanese researchers retested samples from 30 Vietnamese patients whose lab tests showed no signs of the disease. They discovered that seven had actually been infected. "We are especially worried because it may mean we missed some patients," said Tran, the hospital's deputy director. Tran is part of a growing consensus that the extent of human bird-flu infection in Southeast Asia may have been significantly underestimated.

LA Times March 17, 2005: After more than a year of watching patients sicken and die of bird flu, Dr. Tran Tinh Hien of the Hospital for Tropical Diseases here thought he understood the illness. Tran is part of a growing consensus that the extent of human bird flu infection in Southeast Asia may have been significantly underestimated. In the last few months, scientists have begun to believe that the inaccuracy of laboratory tests, the wide variation of symptoms and the inability of public health agencies to combat the disease may have created the erroneous perception that bird flu is still rare among humans. The number of infections is key. The more there are, the greater the chance the virus will mutate into a form that can easily be passed between people, who would have little immunity to the new disease. Doctors and public health officials point to a glaring oddity in the statistics that underscores the belief that the case count is too low to be true.  Vietnam and Thailand have reported the overwhelming majority of recent cases. Yet Laos, which is sandwiched between the countries, has reported no cases among people or birds this year. Cambodia, which is also flanked by Vietnam and Thailand, has confirmed only a single human case. "People are not trying to cover it up, but given how widespread the infection is in poultry in Southeast Asia, it's hard to believe people have gotten ill in only [three] countries," said Jeremy Farrar, a University of Oxford flu researcher at the Hospital for Tropical Diseases. Philippe Buchy, head of virology at the Pasteur Institute, the only testing center in Cambodia, added, "The best way not to find something is not to look for it." The recent discovery of mild cases debunks the widely accepted idea that bird flu kills about 70 percent of its victims, which would make it one of the most lethal infectious diseases. But that seemingly good news has a disturbing implication. "In global health terms, people who don't die can be more of a problem," Farrar said, because they provide havens for the virus and may help it circulate in their communities and beyond. "We've always thought it's more widespread than reported. That's traditional for any infectious disease," said Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. "The question is, are we missing many fatal cases, and what part of the iceberg do they represent?"

Recombinomics March 16, 2005: A five-year-old boy from the northern province of Quang Binh is suspected of contracting the avian flu, reported newswire VietnamNet Wednesday. X-rays showed pneumonia in both lungs, while clinical diagnostics and tests indicated signs of acute inflammation of the respiratory system…… Duong's family was reported to have eaten a dead chicken three weeks ago. His 13-year-old sister had died 10 days after eating the dead chicken. The above cases form another familial cluster with a bimodal distribution.  The clinical presentation is consistent with bird flu.  These clinical presentations appear to be far more accurate than the PCR tests in Vietnam, which appear to give false negatives for approximately 80% of H5N1 positive patients.  The high false negative rate appears to be true of atypical patients, as well as those with classical bird flu symptoms, such as the case described above. Therefore, both of the victims are assumed to be H5N1 positive, with transmission from the index case to the family member.  Earlier clusters showed a gender difference between index cases and secondary cases within families.  The secondary cases were predominantly female.  Two of the three male secondary cases described previously were young boys ages 5 or 6 whose older sister had died.  This cluster extends the sister to younger brother type of transmission to three. Failure of WHO to issue warnings of such human-to-human familial transmission after 12 bimodal clusters goes beyond scandalous.

The Age March 16, 2005: A bird flu scare sparked an emergency services callout to Wellington airport after two Chinese children became violently ill during a flight from Melbourne. Some passengers had originally travelled from Asia. It is understood authorities held grave fears that the children could be sick with the bird flu. The children, believed aged about four and seven, were vomiting during the NZ152 flight. The captain told travellers the delay was due to precautionary action after a bird flu scare, one of the passengers said.

EffectMeasure March 15, 2005: Vietnam is looking more and more like the launch-pad for the pandemic (doesn't mean that it has to be though; there is plenty going on in other places, too). The latest familial cluster in the Thai Binh Province area (assuming the female nurse proves positive for H5N1, and the isolate is identified as essentially identical to the others that comprise the cluster) is the latest example of the pathogen's rapidly advancing adaptability to human beings. Zero human flu genes are involved here, so it should now be assumed that this can no longer be considered as an absolutely necessary component of a potential pandemic flu strain, as had previously been thought to be the case. It's doing things that we haven't figured out, yet. On the other hand, H5N1 is doing an enviable job of figuring us out, even though this may have required a (temporary?) suspension of its extremely high level of lethality (all four people in the largest cluster are still alive, but none of them are out of the hospital yet, either, so lethality here remains an open question). I mention "temporary" here because a signature of H5N1 in many early poultry infections was an initial low pathogenicity that spiraled into high pathogenicity that ultimately raged through a flock of birds like a firestorm, and resulted in lethality levels approaching 100%. And this current intensified infectiousness of pure avian H5N1 doesn't in any way alter the fact that H5N1 could still mate up with something like H3N2/California, for instance, and undergo an antigenic shift; it just suggests that there are far more options on the table for H5N1 to pursue than could have been considered feasible even a few short months ago. We are orders of magnitude beyond where this thing was at the beginning of 2004, and light years beyond the state represented by the first expression of H5N1 in human beings in Hong Kong, in 1997. We have gone from a state where there was absolutely no evidence whatsoever of transmissibility between human beings, to a state where not only is that apparently a common component, but the evidence increasingly suggests that transmission through casual contact is now occurring. The overall state of affairs being what it is right now, I find myself thoroughly ensconced in the camp of those who insist that we will be dealing with a full-fledged pandemic before the end of next winter. To qualify as alarmist these days, one would have to insist that the pandemic has already begun, and we're all just in a state of global denial. Alarms are sounding all over, and unfortunately our Government seems to be one of the few that is virtually deaf to all of them. Maybe the same in-house scientists who are advising the Administration on the causes of global warming are providing the advice on this issue, too?
Sydney Morning Herald March 14, 2005: The World Health Organisation says bird flu poses the single biggest threat to the world, and there are doubts as to whether we possess the tools to confront it adequately. The Australian Government's 2004 budget earmarked $123.8 million to buy antiviral drugs to protect the population from influenza and bird flu, and the Government has recently been buying a lot of antiviral drugs - although just how much is stockpiled is secret. The Australian action plan for pandemic influenza states immunisation and antiviral drugs would be delivered to "priority groups" - those most at risk, as well as to key health and essential services personnel. With about 2.8 million Australians aged over 65 and more than 1 million under five, together with those suffering chronic illnesses, few drugs would be left. Other action measures include surveillance, decentralised quarantine - with the sick urged to stay home, closing schools, universities and child-care centres, cancelling public events, restricting travel and establishing temporary hospitals. In most states, the government would identify isolation and acute-care beds in suitable hospitals to handle severe cases. Whether this would be able to cope with a fully fledged epidemic is doubtful. Effort would also be needed to ensure a co-ordinated medical response and that essential services are maintained. Vaccine supplies would need to be developed and/or obtained, but this would be delayed until the virus strain was identified and it would probably take six to eight months before supplies became available, by which time millions could have become infected. A communications strategy would be needed to disseminate information to the media and the public, including a freecall hotline and national advertisements to raise public awareness. The pandemic action plan raises other problems. How easy would it be to get people to go home and stay there? This form of quarantine requires more community resources and support than the centralised method. Could we reasonably expect people to deliver food, medicine and mail to quarantined areas? Would there be enough healthy people to conduct these services? And would people respect home quarantine? Finally, while the Australian action plan stresses the need for close relations with the media and the speedy dissemination of information, it is ominously silent on how to manage the panic and hysteria. SARS demonstrated how deep-seated fears about contagion and a lack of confidence in the authorities can lead to an outpouring of fear and anxiety in many countries.

Reuters March 14, 2005:  A cluster of human bird flu cases among relatives and possibly health workers in Vietnam may show the virus is changing into a form that can be passed on by humans, the World Health Organization said. "Such cases can provide the first signal that the virus is altering its behavior in human populations and thus alert authorities to the need to intervene quickly," the WHO said in a statement seen on Monday. The main concern of the WHO was a series of cases of the deadly H5N1 bird flu virus in a family in the northern Vietnam province of Thai Binh and the possible infection of two nurses who cared for one of the patients. Earlier, there had only been one probable case of human-to-human transmission of the virus, that of a Thai woman who cradled her infected and dying daughter in her arms for hours. Now, medical experts are investigating whether two nurses who treated a bird flu victim in Thai Binh caught it from their patient.

Reuters March 13, 2005: A leading British scientist attacked the government on Sunday over its contingency plans to deal with a human bird flu pandemic, saying over two million Britons could die. Professor Hugh Pennington, president of the Society for General Microbiology, told the Independent on Sunday a pandemic was both imminent and inevitable. "They (the government) hope that by the time they have to spend money the problem will have gone away," he said. Britain has ordered enough drugs to treat about one quarter of the population and they will be delivered over the next two years. They would not prevent a pandemic but could mitigate its effects.

The Times March 13, 2005: Health experts are watching the spread of deadly bird flu among humans with increasing concern after doctors reported a second suspected case yesterday among medical staff treating a victim. The World Health Organisation (WHO) has given a warning that the flu, which has killed 47 people in Asia, could mutate into a form that spreads quickly between humans and trigger a global pandemic. So far there have been five suspected instances of bird flu among poultry in Britain, but no human cases.

Recombinomics March 12, 2005: Efficient Feline to Feline Transmission of Bird Flu - this article  will be published in the May issue of Emerging and Infectious Diseases. The article describes the bird flu epidemic among tigers at the Sri Racha Tiger Zoo in Thailand last summer. The epidemic provides a sobering picture of how well H5N1 transmits and how ineffective the control measures are. Although the details have not been published, the sequences of isolates from tigers have been published. These sequences do not contain human reassorted genes, yet the H5N1 was very efficiently transmitted to a large number of tigers quarantined in the zoo. However, the sequences are also closely related to other avian isolates in Thailand as well as the sequences from the mother of the index case frequently cited as the best example of human-to-human transmission of H5N1.  The sequences are also closely related to other human isolates from Thailand and Vietnam. Thus, feline isolates closely related to human isolates are efficiently transmitted cat to cat, domestic and wild, and do not require additional genetic changes or human reassorted genes.  Reassurances that human isolates do not contain human influenza genes do not address efficient mammal-to-mammal transmission seen at the zoo and lab.The recent clustering of human bird flu cases in Thai Binh is cause for concern.  The familial clusters are bimodal, a strong indicator of human-to-human transmission.  Moreover, the extended transmission chain involving both family members and health care workers are indications that human-to-human transmission is becoming more efficient.  There is no evidence that human reassortants are required for improved efficiencies. H5N1 has evolved over the years to broaden both host ranges and tissue tropism in the absence of any reported human reassortment.  Thus, repeated assurances on the lack of human reassortment or failure to acquire a human receptor binding domain means little. 

Reuters March 12, 2005: A Vietnamese nurse who tended a bird flu patient with a colleague who has since tested positive for the deadly virus has been hospitalised after showing symptoms of the disease, health officials said on Saturday. It was not clear yet if the 41-year-old female nurse caught the sickness from the patient or in another way, said an official at the health centre of Thuy Luong commune, northern Thai Binh province, 110 km (70 miles) southeast of Hanoi.

Medical News HK March 12, 2005: The Ministry of Health in Viet Nam has today confirmed an additional 10 cases of human infection with H5N1 avian influenza. Today's report is an official notification to WHO of some recent cases, whose infection was detected in March, combined with retrospective notification of older cases, some of which date back to late January. Of these newly reported cases, three have been fatal. Human cases have occurred in three phases: from January through March 2004 (35 cases, 24 deaths), from August through October 2004 (9 cases, 8 deaths), and from December 2004 to the present (25 cases, 14 deaths). In the present phase, the total includes a single case in Cambodia, which was fatal, in addition to those in Viet Nam.

Weekend Standard HK March 12, 2005: Two hundred million subsistence farmers in East Asia are in daily close contact with the potential conduits of a human bird flu pandemic - domestic fowl. Each of them keeps a small clutch of ducks, geese, chickens or turkeys, says the United Nation's Food and Agriculture Organization. It's a statistic that terrifies the UN agency's sister, the World Health Organization (WHO). East Asia is the frontline in an intensifying battle to prevent a global pandemic - defined by WHO as a disease which spreads to all parts of the world quickly and infects 25 percent of the population. But despite their dedication, both in the Geneva headquarters ``war room'' and on the battlefields of rural Vietnam, Cambodia, Laos, Thailand, Indonesia and China, the WHO warriors are hopelessly outnumbered. They admit they have insufficient weapons, logistics and money. while the WHO and other health agencies watch and wait, the level of preparedness varies enormously. ``Only a few countries in the region - Australia, New Zealand, Japan and Hong Kong - have a pandemic preparedness plan,'' reports WHO's Cordingley. ``Other countries are developing a plan, or already have a draft. Many countries don't have enough resources.'' 

FuturePundit March 10, 2005: The World Health Organization is reporting cases where multiple members of families are testing positive for bird flu. When multiple infections occur in the same family that raises the threatening possibility that the bird flu is mutating into a form that is more capable of human-to-human transmission. Extremely virulent diseases can "burn-out" their available hosts. What would be scary would be if the Bird Flu becomes more transmissible and less virulent. I would say the reason normal flu is so common is that the symptoms are not debilitating enough to keep the host bedridden. They don't feel "bad enough" to stay home or not work, so they go forth and spread the virus. With the Bird Flu... people stop, drop and/or die or recover. As long as it's this deadly, it's not going to spread much.

Designerz March 10, 2005: Vietnam's northern province of Thai Binh has become the frontline in the country's war against deadly bird flu, but with fresh cases day after day authorities are baffled as to how the virus is spreading.  

Chicago Tribune March 9, 2005: Compared with other major diseases that menace humanity, bird flu can seem out of place: Only 60 known human cases have appeared in the last year. Yet public health officials now say the disease is a global threat. That conclusion is based on a new understanding of influenza's unprecedented attack on birds in Asia over the last year, and the lethal risk that will pose to humans for years to come. Even after widespread culling meant to stamp out the outbreak, avian flu has returned in force to Asian flocks this year, officials say. Many experts believe the disease is now endemic in the region. That raises the risk to humans, who have no natural immunity to the bird flu strain. The longer the virus circulates, the greater the chances it will mutate into a form that can spread widely among people all around the world. "We have more avian virus sitting in poultry in Asia than we could have ever imagined possible," said Dr. Julie Gerberding, director of the federal Centers for Disease Control and Prevention. "We have to be prepared for the possibility that somewhere along that line we're going to see strains emerge that could be more infectious for people."

Reuters March 9, 2005: Two elderly Vietnamese relatives of people who died of bird flu have tested positive for the deadly virus despite showing no symptoms, health officials said Wednesday. Both lived in the northern province of Thai Binh, where a cluster of cases is causing great concern about the possibility of human-to-human transmission of the H5N1 virus, which experts fear could mutate into a form which could cause a pandemic. For one of the symptom-free carriers of the virus, a 61-year-old woman, the only link established to the disease was her husband, who died of bird flu on Feb. 24. "She took care of her husband when he was sick. Other than that, she said she ate only pork and all four chickens raised in her house tested negative for bird flu." The other, the 81-year-old grandfather of a brother and sister who contracted the disease, drank raw duck blood during the Tet Lunar New Year festivities last month, health officials in his village said. is really strange that he carries the virus for a month and did not get sick," said one health official in the Thuy Luong commune of Thai Thuy district of a virus which usually takes three to 10 days to show symptoms.

BBC March 8, 2005: Seven Vietnamese who initially tested negative for bird flu have now been found to have carried the virus, the World Health Organization has said. A WHO scientist in Hanoi, Peter Horby, said further support for Vietnam's laboratories was needed in order to "make sure quality control is good".

The Citizen March 8, 2005: Experts fear lethal bird flu can now jump from human to human. The first possible human-to-human transmission of bird flu between two unrelated people has raised the spectre the lethal virus could be changing to become more easily spread between humans, a Canadian influenza expert warns. A 26-year-old nurse from northern Vietnam who provided bedside care for a 21-year-old bird flu patient now in critical condition has himself tested positive for H5N1 avian influenza. The nurse reportedly visited his girlfriend, who lives in a village hit by bird flu, in mid-February. While there, they shared several meals, during which he may have been infected. However, the incubation period for H5NI is believed to last no more than 10 to 14 days -- meaning he probably would have shown symptoms much earlier if infected by poultry. A spokesman for the World Health Organization said in an interview yesterday that the international agency is watching the case closely to determine if it has the potential to spawn an influenza pandemic. There have been at least two probable cases of human-to-human transmission so far in Southeast Asia. If the nurse contracted the virus from his patient, it would be the first known case involving a patient infecting a hospital worker.

Chosunilbo March 8, 2005: Research Shows Kimchi May Be Effective Against Bird Flu. Kimchi, a traditional Korean vegetable dish, has been found to be effective in treating avian influenza and other viral diseases affecting poultry. A research team at Seoul National University said their findings show that a lactic enzyme in kimchi has remedial effects on chicken and other types of poultry, which had been infected with avian flu, Newcastle's disease and bronchitis. The experiment was conducted on three groups of 13 chickens infected with the bird flu virus. The first group was given only water, while the other two groups were given either a concentrated or diluted fluid containing kimchi's lactic enzyme. A week later, all chickens in the first group died, but 11 chickens each in the second and third group survived. "Kimchi is already known to have antibacterial powers. But this is the first time kimchi's effectiveness in curing viral diseases has been proven," said one researcher.

WHO March 7, 2005: WHO reports four additional cases of human infection with H5N1 avian influenza in Vietnam - a 21-year-old man from Thai Binh Province; his 14-year-old sister, also from Thai Binh Province; a 69-year-old man, also from Thai Binh Province; and a 35-year-old woman from Hanoi. One additional case in Viet Nam, dating back to February 2004, has been identified retrospectively from specimens stored as part of a study of encephalitis.

Bloomberg March 7, 2005: A Vietnamese nurse who tested positive for the H5N1 bird-flu virus may be the first health-care worker to contract the illness that is spread by infected poultry, a World Health Organization official said. The 26-year-old man from the northern province of Thai Binh had exposure to an avian influenza patient. The man's case, if confirmed, would be the first known instance of bird flu in a health-care worker, said Peter Cordingley, a WHO spokesman based in Manila. 

Independent March 6, 2005: Indecision and delay exposes Britons to the full risk of the bird flu virus. Britain will be largely defenceless against a devastating and "imminent" pandemic of bird flu for more than a year. Stocks of flu-busting drugs, ordered by the Government in a blaze of publicity last week, will take up to two years to build up. Even in a year's time, Britain will have less than half of what it needs. And ministers have dismissed a call from the World Health Organisation (WHO) to stockpile vaccines that might give protection against the worst effects of the disease, which - experts say - could kill 500,000 Britons. The facts undermine assurances by ministers and top officials last week that Britain was "well prepared" for a pandemic, which the WHO describes as "imminent" and "knocking at our door". The Secretary of State for Health, John Reid, boasted that the announcement of the order for 14.6 million courses of the drug Tamiflu put the country "in the forefront of international preparedness". But, in fact, it is well back in the queue for limited supplies behind other countries - from France to New Zealand - that put their orders in earlier. And it has not yet even joined the queue for vaccines, although countries such as the United States, Italy and France have already taken steps to assure supplies. Last week's announcement followed weeks of dithering and was hurriedly brought forward following intense press and political pressure. Until about 10 days ago the Department of Health was insisting that it would only make its mind up about ordering the drugs "some time in the spring", despite repeated warnings of increasing danger from international authorities. The WHO warns that "the world is now in the gravest possible danger of a pandemic", while the UN's Food and Agriculture Organisation calls it "a sword of Damocles" hanging over the globe. Present flu vaccine offers no protection against it, and a fully effective one cannot be developed until after the emergence of the particular strain that spreads rapidly among people. Even then, it will take many months to produce enough of it to make a major impact on the pandemic. In the meantime, the world has two defences. The first are vaccines based on the strain of the flu now infecting chickens. While not giving full protection, these may blunt its effects; they would not stop people catching the flu, but might prevent them dying from it. The second defence is the anti-viral drug oseltamavir - marketed by the Swiss chemical giant Roche under the name Tamiflu - which has been specifically designed to tackle flus of this general type. Again, it would not stop people catching the disease but the Government admits that there is "impeccable evidence" that it will mitigate its worst effects. 

BBC March 5, 2005: Poultry feathers being imported from China could carry the bird flu virus, a microbiologist has warned. Poultry meat from the country has been banned, but BBC Radio 4's Farming Today reported that duck, chicken and turkey feathers were still being imported. Professor Hugh Pennington said the virus could survive in faecal material on the feathers, some of which are used in making pillows. 

Sydney Morning Herald March 5, 2005: The world is in danger from an avian flu pandemic, and tens of millions may die, the World Health Organisation has warned. After a brief remission, scientists are again sounding the alarm on the influenza A (H5N1) virus. Why this fuss for a virus that has killed about 60 people and 1.5 million chickens, and forced the culling of another 140 million? By comparison, the global human death toll for the SARS virus was 774. There are two reasons: confirmation of the first probable human to human transmission of the virus in Thailand last September and a mortality rate for infection of 75 per cent. Only ebola, with 50 per cent mortality, and rabies, slightly higher, come close. The SARS rate was 9.6 per cent. With every outbreak the fears of mutation grow. Vietnam is struggling to control the disease, and 12 people have died there since the middle of December. Dr. Scott Dowell, director of Bangkok's International Emerging Infections Program, said: "This virus is bad news in almost any way you can think of, except for [efficient human-to-human transmission] ... it's highly pathogenic in a whole range of animals including humans, it causes severe disease and death, and it affects a whole range of organs not just the lungs." "With this virus the mortality rate has been 75 per cent," Dr Dowell said. "We can't begin to get our heads around it." Other developments that have raised concerns include:  The increasing number of human cases.  The virus is resistant to most classes of antiviral drugs.  Poultry farmers say it is becoming more potent. Previous outbreaks killed 10 per cent of their flock; now up to 90 per cent are dying. WHO's spokesman for the Western Pacific region, Peter Cordingley, said the world was lucky with SARS. "When people were transmitting the virus they were already showing signs, so it could be picked up at airports with temperature controls. With [bird] flu you can be infectious before you show any signs."

Reuters March 3, 2005: The European Union executive will check whether member states are ready to fight a human pandemic sparked by bird flu, putting pressure on eight EU countries that have failed to prepare an action plan. Eight EU states have no preparedness plan in place for an influenza pandemic while the other 17 need to update their measures, he added, declining to name the countries. The European Commission will carry out an exercise to test the 25-nation bloc's readiness in the second half of this year but Tod gave no further details. Health experts from 52 European nations, including the EU 25, met in Luxembourg to determine the state of preparedness for a flu pandemic, and ways to improve readiness. Every year 100 million people are affected by influenza in Europe, Japan and the United, according to the European Commission. Influenza kills between 500,000 and 1 million people a year globally.

Xinhua March 3, 2005: Bird flu is reported Thursday to have resurfaced in Indonesia, killing at least 12,000 chickens on farms in West Java over the last two months. The head of farm animal health at the West Java Animal Husbandry Office, Musni Suatmodjo, said avian influenza, or bird flu, had spread to five regencies and municipalities in the province, according to The Jakarta Post newspaper. 

PRNewswire March 3, 2005: While the World Health Organization (WHO) is projecting an outbreak of bird flu which could affect millions of people and is urging countries to improve their vaccination preparedness, families are showing an increased interest in antiviral herbs and nutritional supplements referenced in a new report. The report, "Beat the Bird Flu Virus" (Truth Publishing 2005, http://www.truthpublishing.com) by nutritionist and author Mike Adams, offers families a "shopping list" of a dozen of the strongest antiviral herbs available for boosting immunity and beating infection. This previously unreleased list of the top 12 antiviral nutrients for beating the bird flu virus is motivating families to consider these powerful nutrients in lieu of a potential bird flu vaccine shortage. 

Scotsman March 2, 2005: A FLU pandemic that could kill between 5,000 and 50,000 people in Scotland is inevitable, the country’s chief medical officer said yesterday. Amid fears a new strain of Asian bird flu could develop into a worldwide epidemic, UK and Scottish ministers have set out contingency plans to deal with the impact of a virus spreading to Scotland. Andy Kerr, the health minister, said £15 million is to be spent over the next two years on stockpiling 1.2 million courses of the anti-viral drug Tamiflu - enough to treat a quarter of the population. Experts have outlined practical plans to slow the flu’s spread through infected people sneezing or coughing, such as advising against travel, closing schools and cancelling football matches and pop concerts. On the advice of the World Health Organisation, Scotland is planning for a quarter of the population to be affected by the new flu, with 0.37 per cent of those dying. This would mean a death toll of 5,000 people. But Dr Mac Armstrong, the chief medical officer, said Scotland must prepare for the worst - up to 50,000 deaths. "Experts believe a new pandemic strain of flu is likely to spread rapidly across the globe and around one in four people in the UK could be affected," he said.

Reuters March 2, 2005: A 35-year-old Vietnamese poultry market cleaner and a 14-year-old girl, both in the north of the country, have contracted bird flu. The Lao Dong newspaper said today the woman was taken to hospital on February 24 and tests confirmed yesterday she had the virus. The woman, from a district of the capital, Hanoi, is the latest bird flu patient detected in northern Vietnam, where fewer outbreaks have been reported in recent weeks, but where cool spring weather still favours the spread of the H5N1 virus.

MSNBC March 1, 2005: Officials in Vietnam announced Tuesday that a 35-year-old man and a 14-year-old girl had tested positive for a potentially lethal bird flu virus. "The virus is clearly going in what we call the wrong direction for us," says Dr. Anthony Fauci, director of the National Institute of Allergies and Infectious Diseases. "It absolutely dwarfs all other public health problems that we can imagine," says Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy. The United States has stockpiled about 2.3 million doses of antiviral medicine. But other countries have much more: Britain 14 million doses, France 13 million and Canada more than 8 million. But who would get the scarce drugs and vaccine in the event that a flu epidemic spread to the United States? The Centers for Disease Control and Prevention has asked a group of ethicists to try to decide.

Daily Telegraph March 2, 2005: A 21-year-old man from northern Vietnam has died of bird flu, becoming the 15th victim of the disease in the South-East Asian country in the past two months, the health ministry said yesterday. The man died at Hanoi's institute of tropical medicine after several days on a respirator battling a raging fever, said health ministry spokesman Pham Tuan Hung. The victim's 14-year-old sister has also been struck down by the deadly H5N1 strain of the bird flu virus and is currently in hospital.

Reuters March 1, 2005: Britain said on Tuesday it was buying 14.6 million courses of Roche Holding AG's <ROG.VX> antiviral drug Tamiflu as part of its contingency plan against an influenza pandemic. The anti-HIV drugs known as protease inhibitors may be effective against the bird flu virus, according to an Italian researcher. Evidence that protease inhibitors may be of use against H5N1 is indirect, suggested by findings that these agents are effective against a third virus, the severe acute respiratory syndrome (SARS) virus, which has structural similarities to H5N1.

Scotsman March 1, 2005: Vietnam’s latest bout with bird flu moved to the capital today when health officials confirmed that a 35-year-old woman in Hanoi had caught the disease, the country’s fourth case in a week. The three earlier cases in the last week – including one death – were all from Vietnam’s northern Thai Binh province. In the most recent case, the woman, who worked as a garbage collector, was the first person to be infected in Hanoi since September, health officials said.

Asia Times March 1, 2005: A year after triggering alarm bells across Asia, the lethal bird-flu virus is showing little signs of slowing down, consequently forcing health and food experts to concede that the disease will persist for years in the region. That prognosis, made at a just-concluded international meeting on bird flu in Vietnam, is also expected to shake up distinct features of Asian societies, such as the ubiquitous wet markets that abound in small towns and even major cities, like Bangkok. 

BBC News March 1, 2005: It is only a matter of time before a pandemic of bird flu hits the human population, experts say. The World Health Organisation recently urged all countries to develop or update their influenza "pandemic preparedness plans" because if the world is unequipped, between two and 50 million people could die from the virus.

Sunday Times Ireland February 27, 2005: IRISH holidaymakers suspected of catching the potentially fatal avian flu in Beijing were allowed to leave Dublin airport without being assessed by public health officials. Last week, a British Midlands flight from London to Dublin was quarantined after eight passengers, who flew to London on a chartered flight from the Chinese capital, became severely ill. Two of the passengers developed flu-like symptoms and began vomiting at London’s Heathrow airport and later boarded a flight to Dublin. The pilot, who knew 40 of his 188 passengers and eight crew had travelled together from Beijing, quarantined the plane and called ahead for medical assistance. He suspected they had contracted the deadly bird flu. However, when he landed in Dublin no public health experts were available. The passengers were allowed to leave the plane after being diagnosed with food poisoning by an airport GP. The incident exposes weaknesses in Ireland’s national flu pandemic and bio-terror plans. “There was no public health response. We could have had a serious incident on our hands,” said Paul McKeown, a specialist in public health with the National Disease Surveillance Centre. “People’s lives were placed at risk — viruses are highly tenacious. We avoided a crisis only because we were lucky; but we can’t rely on lucky escapes."

New Scientist February 26, 2005: Two children in Vietnam who died of diarrhoea and brain inflammation are found to have had bird flu - doctors had been looking for typical flu symptoms. DETECTING the start of a pandemic caused by a new form of the H5N1 bird flu virus might be even harder than experts feared. Two children in Vietnam who died of diarrhoea and brain inflammation have been discovered to have had bird flu, suggesting that doctors watching only for the fever and cough typical of normal flu may miss cases. The news is particularly worrying because diseases that cause gastrointestinal symptoms and brain inflammation (encephalitis) are common in south-east Asia. If H5N1 evolves into a form that is easily transmitted from person to person it could spread widely before anyone notices the unusual number of cases, reducing the chances of preventing a wider outbreak.

Reuters February 25, 2005: Asian countries battling a bird flu virus which threatens to create a human pandemic that could kill millions need urgent help from the wealthy West if they are to succeed. "The threat is real and the potential is very high" for a pandemic, Samuel Jutzi of the Rome-based Food and Agriculture Organization told a news conference at the end of a three-day conference on bird flu in Ho Chi Minh City. "The longer the virus continues to circulate in poultry production systems and ducks, the higher is the probability of infection of humans," he said. "All 28 countries have said there is a need for external support," he said. Vietnam is the only one to have appealed for help publicly and senior U.N. officials at the conference have complained about what one called "an alarming lack of commitment" from rich nations in the fight against the H5N1 virus. The communist nation has been hardest hit by the virus which erupted across much of Asia at the end of 2003 and has killed 46 people -- 33 Vietnamese, 12 Thais and a Cambodian. It now has another case, a 21-year-old man whose younger sister may also have caught the virus, officials said. "Now we are disinfecting his home area. It is not clear how he was infected, but during Tet people everywhere ate chickens," said Dr Pham Van Diu, referring to the Lunar New Year holiday this month when poultry is traditionally served. Almost all the people known to have caught the virus got it from contact with sick birds. It has killed more than 70 percent of people infected. But while Vietnam has borne the brunt, the H5N1 virus was now also endemic in Thailand, Indonesia and China. The experts no longer talk about eradicating the disease, but of containing it before it mutates into a form which can pass between humans and sets off a pandemic. If we want to control avian influenza there may be people who lose their livelihoods.

ChannelNewsAsia February 25, 2005: HO CHI MINH CITY : Bird flu has cost 10 billion dollars in agricultural losses and the world needs to spend hundreds of millions of dollars more to combat it, health experts said at a conference. Samuel Jutzi, the Food and Agriculture Organisation's director of animal production and health told a press briefing "the global cost of the avian epidemic to agriculture is about 10 billion dollars ... so far." "More than hundred million dollars would be needed to urgently strengthen animal health services and laboratories to improve virus detection and its ultimate eradication," he said Friday. In addition, several hundred million dollars would be required to finance the restocking of infected poultry flocks and to restructure the whole sector. A 21-year-old man has tested positive for bird flu in northern Vietnam, becoming the first human case identified in the country in more than three weeks.

New Scientist February 25, 2005: Chief veterinary officers, health officials and scientists from 28 countries issued an urgent call on Friday for a vast increase in investment to head off the threat of H5N1 bird flu. Scientists fear the H5N1 virus, which has killed three-quarters of the confirmed human cases, could evolve into a form that spreads easily among people. On Friday, Vietnamese officials confirmed yet another human case in the north of the country. The meeting in Vietnam, organised by the UN's Food and Agriculture Organization (FAO), and the World Organisation for Animal Health (OIE), called for a renewed focus on stopping the virus from circulating in poultry.

Coventry UK February 25, 2005: Health bosses in Coventry have admitted they are still waiting for national guidance about how to protect people from a possible epidemic of killer bird flu. A spokesman for Coventry Primary Care Trust said it was waiting for instructions from the Department of Heath. A Department of Health spokesman said an action plan would be released soon. She said: "As this virus mutates very quickly, one will not be able to predict what strain will form a pandemic, so we cannot stockpile vaccinations. "We can have antivirals, which limit the effects and in some cases can help people not to develop it."

Scotsman February 24, 2005: The outbreak of bird flu in Asia may lead to a human pandemic like 1918, but the government is rightly hedging its bets. Comparisons are being made with the last great worldwide human flu outbreak in 1918-19 which killed more people than were slaughtered in the First World War: the lowest estimate was 21 million; one put it as high as 100 million. These are truly appalling statistics, which if repeated today would serve as a stark reminder that no matter how technologically sophisticated we have become, we are still at the mercy of random nature. Influenza is one of the fastest mutating viruses known, and the direct transfer suggests that the avian flu H5N1 has mutated into a strain that will spread through the human population. So far, as the ratio of those infected who died suggests, it has proved highly virulent. But it is not yet highly contagious. The 1918-19 virus, H1N1, spread rapidly around the world in the era before global airline travel. The idea that it preyed on the poor and the weak, exhausted after the first ever global conflagration is a myth. It ignored the statistical nicety of the normal distribution curve and killed the strongest and healthiest in society, those aged between 25 and 45. And it brought civilised life to a halt. Hospitals were full of emaciated victims, red-faced from the effects of cyanosis caused by blood flooding into their lungs. Many literally drowned in their own blood. Morgues overflowed. The public panic forced schools, theatres, shops and offices to close. Relatives shunned each other. Thanks to modern medicine, we now know how to vaccinate people against flu (in 1918 scientists were unable to detect the virus) and have developed anti-viral drugs such as Tamiflu. But the British government is playing a high-risk game of chicken and egg over the avian flu virus. Under a deal announced yesterday between the government and drug companies, key workers, including NHS staff, police officers and firefighters, are to be given stockpiles of anti-viral drugs. Perhaps the most instructive recent episode in man’s millennium-long struggle with the influenza virus occurred in 1976, when some of America’s most distinguished scientists advised President Nixon that a new strain of flu had appeared which was as lethal as the 1918-19 virus. A vaccine was developed and given to millions. Many elderly people developed a brain condition from the vaccine and died. The pandemic never arrived.

The Independent February 24, 2005: The deadly outbreak of bird flu in Asia poses a grave danger of becoming a global pandemic that could threaten the lives of millions, United Nations officials warned yesterday. "We believe that the world is now in the gravest possible danger of a pandemic," said Dr Shigeru Omi, the World Health Organisation's Western Pacific regional director.

CTV Canada February 23, 2005: top World Health Organization official is warning the world about the imminence of a deadly bird flu pandemic if governments don't act now to fight the virus. Dr. Shigeru Omi, the WHO's Western Pacific regional director, told a conference in Vietnam Wednesday that the world's health agencies need to start drafting emergency plans for the disease. He adds that that virus would cause more death and sickness than SARS if it becomes highly contagious among humans. Experts have repeatedly warned that the virus could spark a global pandemic and kill millions if it mutates into a form that can be easily spread between humans.

Daily Mail UK 23, 2005: Health officials have confirmed they are finalising a new national plan to tackle a UK outbreak of the deadly bird flu virus, as international experts warn the world is in the "gravest possible danger" of a pandemic. The World Health Organisation has warned governments they must stockpile vaccines now in preparation for a pandemic, a move taken up by the US, French and Italian administrations. Though London Mayor Ken Livingstone announced a £1 million programme to protect key workers in the capital, the Government has been criticised for failing to quickly respond to the situation. 

Reuters February 22, 2005:  Speaking on day one of the three-day meeting in Ho Chi Minh City on Wednesday, Dr. Shigeru Omi, WHO's western Pacific regional director, urged health agencies around the world to better coordinate their fight against the virus. Asian countries have documented 55 cases in which the avian flu has jumped from birds to humans. And though only one of those cases involved human-to-human transmission, experts believe that avian flu has the potential to kill millions of people, particularly if the virus mutates. WHO officials say the so-called bird flu was identified last year in 10 countries and is currently circulating in four: Thailand, Vietnam, Cambodia and Indonesia. Many experts agree that the world is due for another such outbreak like the one in 1918 that killed millions.

Reuters February 22, 2005: Japanese researchers found flies infected with the bird flu virus after an outbreak among chickens in Japan last year, a Health Ministry official said on Tuesday, a finding that underscores the ability of the deadly virus to jump between species. While there was no risk of humans catching the bird flu virus from flies, the possibility that flies could spread the virus among birds could not be ruled out and they should be exterminated in any future bird flu outbreaks, the official said.

Reuters February 22, 2005: Bird flu experts from around Asia were gathering in Vietnam on Tuesday to figure out how to kill off a virus one leading American expert has called the world's biggest threat to human health. At the moment, we are not on top of it," said Hans Wagner of the U.N.'s Food and Agriculture Organization as he prepared for a two-day conference in Vietnam, the country worst hit by a virus which has killed 46 people since it arrived in Asia in late 2003.

Thanh Nien Daily News February 22, 2005: Thailand will begin vaccinating millions of chickens and other fowl against bird flu within the next two months to combat the lingering disease in the kingdom. A meeting chaired by Prime Minister Thaksin Shinawatra agreed the vaccine would be administered under conditions called for by international health organisations, said deputy premier Jaturon Chaisang, who oversees the country's avian influenza fight.

AP Breaking News February 21, 2005: The Earth may be on the brink of a worldwide epidemic from a bird flu virus that may mutate to become as deadly and infectious as viruses that killed millions during three influenza pandemics of the 20th century, Dr. Julie L. Gerberding, head of the Centers for Disease Control and Prevention said today. She said scientists expect that a flu virus that has swept through chickens and other poultry in Asia will genetically change into a flu that can be transmitted from person to person. Although cases of human-to-human transmission have been rare, "our assessment is that this is a very high threat."

Financial Times February 21, 2005: The "very frightening" outbreak of virulent bird flu in Asia could lead to the most devastating human pandemic in history - or it could continue just to produce isolated deaths of people who are in close contact with poultry, the chief influenza scientist at the US Centres for Disease Control said yesterday. Dr Nancy Cox told the American Association for the Advancement of Science: "There is a real challenge in public health in mobilising people into action without trying to scare them to death. If we knew for sure that a pandemic with, say, a 10 per cent fatality rate was going to occur, we could proceed in a more deliberate way." A mutation that made the virus easily transmissible between humans could cause more deaths than the 1918-19 Spanish flu epidemic, which killed around 50m people with just a 1 per cent fatality rate, Dr Cox said. But that might not happen because "the H5N1 viruses may not be able to shuffle their genes with the human flu virus" to produce a strain that was both virulent and transmissible.  

ABC News February 20, 2005: BIRD FLU HAS PANDEMIC POTENTIAL. One of the world's top researchers investigating outbreaks of bird flu in South-East Asia says she is extremely concerned by the scientific evidence emerging about the virus. Nancy Cox is the head of the flu division of the United States Centre for Disease Control. She says research now shows that bird flu is capable of mutating into a form that can spread from humans to humans. She also says the recent spurt of human infections increases the likelihood that a mutant strain would arise that could spread between humans.

BBC February 20, 2005: The bird flu virus could mutate to pass from human to human and trigger a pandemic, latest evidence suggests, according to scientists. Outbreaks so far have been through the flu spreading from animals to humans. But Nancy Cox, of the US Center for Disease Control and Prevention, says a number of subtypes have proven their ability to jump the species barrier.

Thanh Nien Daily News February 19, 2005: Health animal authorities yesterday reported bird flu outbreaks in 19 sites of six provinces, including five in the Mekong Delta region, with more than 7,500 fowls culled.

Recombinomics February 18, 2005: The monitoring of bird flu is well into the scandalous area.  There are glaring deficiencies in deciding who to test, the testing itself, and the reporting of the results.  All of these deficiencies have lead to a gross underestimate of the incidence of avian influenza in southeast Asia, and little information on the spread of the virus throughout the world. The poor monitoring and reporting of the most obvious cases raises serious questions on the ability to monitor H5N1 infections with any reasonable degree of accuracy or confidence. Testing for H5N1 should be done for meningococcemia / meningitis cases in the Philippines and mainland China as well as for the large number of deaths of children in India.

TVNZ February 18, 2005: The Ministry of Health says New Zealand could be caught short if a major bird flu outbreak occurs in the next few months. The World Health Organisation warns that many countries are not prepared for a possible flu pandemic, triggered by bird flu.

Scotsman February 18, 2005: Bird flu could be far more prevalent and humans more susceptible than previously thought, according to new research by British scientists. A team at Oxford University, who studied a number of deaths in Vietnam, concluded that avian influenza, as it is formally known, is "progressively adapting to mammals". This finding has prompted fears that the spread and impact of avian influenza has been underestimated. The findings are published in the New England Journal of Medicine.

Massey University NZ February 18, 2005: With more than 3000 reported outbreaks of bird flu in Asia, a report from researchers in the University’s EpiCentre to Asian and Pacific countries next week in Ho Chi Minh City, Vietnam, will offer an in-depth overview of the situation. EpiCentre director Professor Roger Morris and international disease control expert Dr Ron Jackson will deliver their findings during the regional meeting on February 23 to 25. It identifies key factors which influenced the course of the epidemic, and recommends enhancements which need to be made to control programs in order to manage the current situation more effectively. Professor Morris says there is continuing concern about the possibility of the virus gaining the ability to spread between people, and although the disease has been brought under control in some countries, there has been a resurgence in others. The report was commissioned by the Food and Agriculture Organization of the United Nations several months ago, at a time when it was thought that the epidemic was over. The EpiCentre research team has been working on the report for the last few months, and visits have been made to Asian countries for a detailed examination of each affected country, and an overview of the situation.

Reuters February 18, 2005: The bird flu virus can produce a deadly encephalitis, diarrhoea and other symptoms that do not look like the classic respiratory disease, an international team of doctors said today. "Cases suggest that the clinical spectrum of influenza H5N1 is wider than previously thought, and therefore they have important implications for the clinical and public health responses to avian influenza," the researchers wrote in this week's issue of the New England Journal of Medicine.

Thanh Nien Daily News February 18, 2005: At the Association of Southeast Asian Nations (ASEAN) meeting in Bangkok to discuss emerging diseases, Thai Epidemiologist Prasert Tongcharoen said the world was ready to test three kinds of bird flu vaccines for people in March. Two vaccine types will be tested in the U.S. and the other in the UK, he said.

ABC News Australia February 17, 2005: The Australian Federal Government is ramping up efforts to prepare Australia for a possible outbreak of bird 'flu, announcing plans for a simulated outbreak later this year. Under the title Exercise Eleusis, government agriculture and health departments will fight the phoney 'flu as it moves across state borders. The Australia Chicken Meat Federation's Andreas Dubs says plans to control any outbreak are already in place, but a simulation is the only way to test if they'd work.

Xinhua News February 17, 2005: The highly pathogenic bird-flu virus very likely exists in ducks and may trigger a pandemic, a visiting US expert has warned. At the Association of Southeast Asian Nations (ASEAN) meeting on emerging diseases in Bangkok, Robert G Webster, a virus expert from St Jude Children's Research Hospital Department of Infectious Diseases in Memphis, said domestic ducks play a key role in the continued evolution of the H5N1 virus, including prolonged shedding and generation of drift variants. A recent study found H5N1 virus in faecal samples of ducks. The virus could remain stable for up to six days and live for 17 days, Webster was quoted by The Nation newspaper on Thursday. He warned regional officials to keep ducks away from other potential sources of bird flu virus to reduce the chance that H5N1in ducks can find ways to transmit from humans to humans. On Tuesday, Thai Prime Minister Thaksin Shinawatra rejected a cabinet proposal to cull 2.7 million young free-ranged ducks to eradicate the bird flu virus from the kingdom. The main challenges for ASEAN to better handle the disease include being able to rapidly deploy a trained team to the scene where a suspected case is reported, have stockpiles of antiviral medications in place, implement risk communication and trigger a pre-planned and coordinated response.

Seattle Post February 17, 2005: Bird flu symptoms may be more varied. A young Vietnamese boy who died from bird flu last spring suffered from diarrhea before slipping into a coma but did not display the severe respiratory problems typically associated with the deadly virus, according to Oxford University researchers. The findings, published in the Feb. 17 issue of the New England Journal of Medicine, suggest that avian influenza's symptoms in humans are wider and more varied than originally believed. It also suggests that the total number of infections may have been underestimated. The findings are significant, said World Health Organization spokeswoman Maria Cheng. "In the past, we've been looking for severe respiratory cases in people exposed to poultry. Maybe we should be casting a broader net. It certainly has implications for how we look for cases, how we treat them, how specimens are handled," she said. The boy's case also marked the first time that the virus was found in human feces, a major concern since it suggests a possible route for human-to-human transmission. [My note: In the 1918 flu pandemic, many patients were misdiagnosed as cholera, dengue fever, and typhoid. These are are common diseases today in eastern and southeast Asia. Some also had neurological problems.]

Vietnam News Agency February 17, 2005: Eight provinces and one city have detected no new bird flu-affected spots in their territories for 21 days, Director of the Ministry of Agriculture and Rural Development (MARD)'s Veterinary Department Bui Quang Anh said today.

New Scientist February 17, 2005: Governments should consider stockpiling vaccine against H5N1 bird flu now, before a pandemic starts, a World Health Organization report out next month will advise. The change in policy reflects growing fears that an H5 pandemic is likely, and that there will not be time to produce much vaccine once it starts. "When we realised H5N1 is not going to be eradicated in poultry in Asia for at least another couple of years, that made the risk of H5 much higher," Klaus Stöhr, head of the WHO's influenza team, told New Scientist. The US has already contracted manufacturers to make 4 million doses, while at a meeting at WHO headquarters in Geneva last week Italy and France said they plan to stockpile 2 million doses each.

Forbes February 17, 2005: Doctors in Vietnam report the troubling finding that the avian flu virus can cause potentially lethal encephalitis as well as severe respiratory infections.

Bangkok Post  February 16, 2005: Thailand Prime Minister Thaksin Shinawatra put the brakes on anti-bird flu measures tabled for cabinet approval yesterday out of concern that they could send an alarming message to the public and other countries.

Reuters February 15, 2005: Vietnam's latest bird flu epidemic, which has killed 13 people in a little more than a month, is showing sign of subsiding and no humans have caught it in the past week, the government said today. 

The Guardian February 14, 2005: Poultry has now been banned from Ho Chi Minh City, for a simple reason: the 'bird flu' virus kills three out of every four people it infects.
Luckily, the highly pathogenic avian influenza is not very virulent for a virus, and infects people only with difficulty. That could change at any time. A small variation or mutation in the virus, and bird flu could spread like the common cold: quickly and easily between cities, provinces, countries and continents.
That's the bad news. The good news is that avian flu killed only 32 people in 2004. Before we all relax, the New England Journal of Medicine has some grim warnings that, if the flu could hop the species barrier with greater ease, the medical world is poorly placed to get to deal with it. Scientists, it seems, still don't have a clue about some basic aspects of the flu, including which bird species are spreading the virus, how to pick dangerous strains such as H5N1 out from a crowd of similar flu viruses, and perhaps most crucially, its incubation period. All of these knowledge gaps could be filled with more research, but in the meantime the dangers remain. As the New Scientist has pointed out, a flu pandemic is several years overdue. Successful completion of a vaccine or other treatment is a matter of urgency - and the World Health Organisation needs to resist those governments insisting on enforcing patents in the event of a worldwide outbreak. Trials of effective vaccines are under way, but global manufacturing and storage capacity is lacking in the event of an outbreak. Until a vaccine or treatment is developed, the world's governments need to be alert to a pandemic outbreak, and swiftly ring fence the area or region that is infected. That will require rapid, coordinated action - and will also require the host country or countries to be honest about an outbreak of the flu. Even more worrying than the lack of a vaccine is the possible response of some governments, especially that of China. During the outbreak of the (unrelated) Sars virus in 2003, the Chinese government at various levels insisted on concealing and dissimulating over the extent of the problem. If the same were to happen with a bird flu pandemic, the result would be millions of deaths.

WHO February 10, 2005: The World Health Organisation (WHO) announced today a number of measures to intensify the supervision of bird flu control in Cambodia after the local government's confirmation of a H5N1 case in Kampot province. The WHO representative in Cambodia, however, maintained that raising public awareness about the disease will still play a decisive role in controlling it in the future.

Reuters February 7, 2005: Scientists in China have developed a bird flu vaccine for poultry and mammals that can fend off the deadly virus and help stop its spread, the China Daily newspaper said today. The Health Ministry said the new vaccine could "cut a key link in the transmission chain", the paper reported. Using a technique called reverse genetics, researchers at the Key Laboratory of Animal Influenza, affiliated with the Harbin Veterinary Research Institute, altered the genome sequence of the virus to create the vaccine, the newspaper said. "Laboratory tests show the vaccine enables ducks and geese to fight H5N1, the highly lethal strain of bird flu, three weeks after the flocks were vaccinated," it said, quoting a Health Ministry statement. "The new vaccine also provides at least 10 months of protection for chickens -- four months longer than the existing bird flu preventive drugs."Field tests showed that after two shots of the vaccine, ducks and geese can produce antibodies effective for 10 months and three months, respectively, it said.

February 6, 2005: The bird flu  is spreading through Vietnam at a startling rate, with 232 communes in 23 cities reporting cases of influenza strain H5N1. This is after only 25 communes reported cases of bird flu on January 7. This may indicate that poultry in neighboring countries are highly infected, though Thailand is only reporting a modest increase in bird flu reports.

Hanoi February 6, 2005: Minister of Agriculture and Rural Development Cao Duc Phat on Feb. 6  directly instructed the Red River delta provinces of Hai Duong and Nam Dinh to enhance the fight against avian flu. The ministry's Veterinary Department said that 36 new outbreaks of bird flu were reported in 26 communes of the southern provinces of Long An, Ben Tre and Bac Lieu, and the northern province of Hai Duong on Feb. 5 alone. Nearly 25,000 poultry were culled in these provinces.

Hanoi February 4, 2005: A hundred masked and gloved women mechanically slam cleavers down on thousands of chickens. Blood spills to the ground, feathers float on a draught. In operation since only two days ago, this special slaughtering zone was created to provide the people of Hanoi with safe meat ahead of the celebrations of Lunar New Year, or Tet, which starts on February 8 and traditionally features chicken dishes. Still an experiment, it operates 24 hours a day in a 2,000-square-metre (21,520-square-feet) shed. "The conditions of hygiene are acceptable for the tradesmen but they are not really good," admits Le Thi Hoa, head of the board managing the slaughterhouse as she looks at the soggy, dirty floor strewn with rubbish. The authorities want to stop people slaughtering their own poultry, a process which can lead to them becoming infected if the birds have the H5N1 flu virus that can kill humans. This is the first establishment of its kind in Hanoi and it meets 40-50 percent of the needs for poultry slaughter in the city.

BBC February 2, 2005: Cambodia has recorded its first death from the deadly bird flu virus.

Reuters February 1, 2005: The deadly bird flu virus remains endemic in parts of Asia, where it will not be eradicated soon and poultry movements following the tsunami disaster may worsen the crisis, world animal agencies say. "Recent experience shows it may be impossible to eradicate the virus soon," the U.N. Food and Agriculture Organisation (FAO) and the world animal health body OIE said in a statement today. "The disease will be present for several years in the countries that experienced outbreaks in 2004. Strict biosecurity measures need to be applied throughout the poultry production chain, from farms and smallholdings to distribution channels, markets and retailers. The international community has to realise that some poor countries in Asia living with the bird flu virus must receive more support to intensify precautionary measures," they said.

Vietnam February 1, 2005: Vietnam is instructing localities nationwide to temporarily cease the raising of poultry in bird flu-stricken areas, in a move to stop the spread of the disease. Municipal authorities in Ho Chi Minh City have decided to stop the raising of ducks in the city for one year, starting from early this month. The city will slaughter healthy ducks, changing them into frozen foodstuff, and cull all others infected with H5 by Feb 7. Regarding chickens, the municipal authorities have banned the raising of the fowls in the inner city. The city will keep closer surveillance on chicken farms, and offer interest-free loans to local companies so that they can turn live chickens into frozen meat. 

Voice of America News January 31, 2005: Continuing spread of bird flu between people is the worst fear of public health experts. The World Health Organization's representative in Hanoi, Hans Troedsson, says this would mean that the virus has genetically altered to a form much more easily transmitted. "The major concern we have is, of course, that the virus will change or alter, but we have no indication of that yet," he said. "The other concern we have would be a dramatic increase in the number of cases even if the virus has not changed, because that would put a lot of additional pressure on the existing health care services." The fact that no further human bird flu transmission occurred in Thailand suggests to experts that the virus has not mutated and is still completely avian. Yet in a New England Journal of Medicine commentary, University of Michigan School of Public Health professor Arnold Monto expresses concern that mutation is only a matter of time. He writes that, given the continued outbreaks of this disease in Asia, the question is when such changes will happen.

Times January 31, 2005: Scientists have sounded a global alert on avian flu following reports of human-to-human transmission of this virus. Comparing the patterns of avian influenza to the 1918 flu epidemic which killed millions around the world, scientists at the New England Journal of Medicine said: "The emergence of human cases of avian influenza A (H5N1) virus infection in Asia is an unprecedented warning." They urged the world to "put up safeguards while the storm is still gathering". "A virus with the potential to cause a pandemic could emerge suddenly, by way of a single reassortment event, or more gradually, by adaptive mutations during human infections, with the virus incrementally improving its transmissibility," says the NEJM. It goes on to add how the virus has been getting more lethal. It has increased environmental resistance, and is expanding its mammalian host range. "All prerequisites for the start of a pandemic have been met save one, namely, genetic changes in this virus that would allow it to achieve efficient human-to-human transmission," they say.

BBC News January 31, 2005: A 10-year-old girl has died of bird flu in Vietnam, the country's 12th confirmed victim in a month.

January 29, 2005: A 13-year-old girl has died from bird flu in Vietnam, becoming the country's 11th victim of the disease in the past month. The girl's mother, 35, died of the virus on January 21. The six-day interval between the Vietnamese mother and child developing symptoms means that human-to-human transmission can't be ruled out, the WHO said of the latest case. Bird flu has now spread to 28 of Vietnam's 64 cities and provinces.

January 29, 2005: Britain issues holidaymakers bound for South-East Asia and China a warning of renewed outbreaks of avian influenza - bird flu - and of the first suspected human-to-human transmissions of the virus.

Vietnam January 28, 2005: A man who tested positive for avian flu has died in Vietnam, becoming the country's 10th victim of the disease in the past month. The actual number may be higher as these are only the reported and confirmed cases.

BBC News January 28, 2005: Professor John Oxford, a leading UK expert, said the virus had broken down the "final door" which prevented it being spread between people. Researchers from the Thai Ministry of Public Health warn it is likely there will be more cases where the virus is passed from human-to-human.

Thailand January 27, 2005: More than 400 pigeons have been culled in central Thailand, after one of the wild birds was found infected with a strain of bird flu that can be deadly to humans. 

WHO January 20, 2005: The bird flu virus endemic in Asia appears to be evolving in ways that increasingly favor the start of a deadly human influenza outbreak, the World Health Organization (WHO) warns today. The situation "may resemble that leading to the 1918 pandemic," which killed more than 40 million people, it said in its latest report on preparedness for an influenza pandemic.

Nature January 12, 2005: In a strongly worded editorial entitled "Dangerous state of denial" the prestigious scientific journal Nature expresses the concern about a seeming lack of urgency regarding a potential pandemic from avian influenza A(H5N1). 

CNN December 8, 2004: As warnings mount that a major outbreak of bird flu is a matter of when, not if, concerns that Hong Kong will be among the hardest hit areas from such a scenario are growing. All the great flu pandemics of the last century have originated in southern China, which puts Hong Kong in a very dangerous neighborhood. In 1997, Hong Kong was ground zero -- the first place where avian flu jumped the species barrier to infect, and kill, human beings. "Hong Kong and southern China are in an area where everything comes together. It's like the perfect storm -- animals, the virus, population density," said Dr. John Nichols, a pathologist at the Hong Kong University. As fears of a pandemic grow, scientists are expressing concern at how little they actually know about the disease.

WHO November 29, 2004: Up to 100 million people around the world could be killed in a pandemic of human influenza, a World Health Organization official warned. The WHO believes the H5N1 strain of avian influenza, known as Bird Flu, could mutate and be the cause of the next global pandemic.

Dr. Shigeru Omi, regional director of WHO's Western Pacific Regional Office is warning world governments to be prepared to shut down schools, and businesses in an effort to slow down infection rates if a pandemic strikes. In a news conference, Dr. Omi said these measures may be needed if the WHO's estimates that up to 30 percent of the world's population becomes infected. In a worst case scenario, Dr. Omi said as many as 100 million people could be killed by a new form of human influenza. Dr. Omi warned a global pandemic of influenza is very likely.

Latest Analyses of Bird Flu Prevalence and Cases (Figures from WHO as at August 5, 2005)

CIDRAP Analyses of Bird Flu Cases (as at August 5, 2005)

Center for Infectious Disease Research and Policy (CIDRAP), 

University of Minnesota.

Laboratory-confirmed human cases of H5N1 avian influenza, January 2004 to present.

Hong Kong Government Statistics (as at August 4, 2005)
These differ slightly from the WHO statistics.

  The most recently detected case of human influenza was reported in Indonesia on 21 July 2005.

(Source: WHO)

Avian flu is used to describe the influenza viruses that infect birds - for example wild birds such as ducks and domestic birds such as chickens. In fact, birds appear to be a natural reservoir of flu viruses - 15 subtypes influenza A virus are known to be circulating in bird populations. Many forms of avian flu virus cause only mild symptoms in the birds, or no symptoms at all. However, some of the viruses produce a highly contagious and rapidly fatal disease, leading to severe epidemics. These virulent viruses are known as "highly pathogenic avian influenza" and it is these viruses that cause particular concern. One such avian flu virus is currently infecting chickens in Asian countries.

The three most recent global epidemics of flu (1918, 1957 and 1968) were each caused by mutant avian strains and this might happen again. The worst epidemic, in 1918, resulted in more than 40 million deaths. Avian flu is normally confined to birds, but there have now been 44 documented cases (32 fatal) of the disease spreading to humans. If a person already suffering from human flu becomes infected with an avian strain at the same time, there's a real risk of new mutant strains that might spread easily from human to human, causing a massive outbreak.

There are two circumstances in which an avian flu virus could merge with a human flu virus:

In humans - if a person who already has flu is comes into close contact with birds who have highly pathogenic avian flu, there is a chance that the person could become infected with the avian flu virus. If this happens, the person would now be carrying both the human flu virus and the avian flu virus. The two viruses could meet in the person's body and swap genes with each other. If the new virus had the avian flu's genes that made it rapidly fatal and the human flu's genes to allow it to be passed from person to person, a flu pandemic could result.

In pigs - pigs are susceptible to both human and bird flu viruses. If a pig became infected with both viruses at the same time, it could act as a "mixing vessel", allowing the two viruses to swap genes and produce a new virus.

Typical cultural practices throughout much of Asia include the habit of acquiring live food (rather than prepared frozen food) for human consumption, especially chickens and ducks. Consequently many of the food markets bring together in very close proximity humans, chickens and pigs. These are ideal circumstances for new viruses to mutate and multiply, and likely explains the precipitation of the present situation.  

Avian flu causes similar symptoms to other types of flu:

• fever

• cough

• sore throat

• muscle aches

• conjunctivitis

• in severe cases of avian flu, it can cause severe breathing problems and pneumonia, and can be fatal.

How dangerous is avian flu?

Are there any treatments available for avian flu?

Can Tamiflu save us from avian flu?

Could a 1918 influenza pandemic really happen again?

Mayo Clinic Comments on Bird Flu Virus March 3, 2005