Clova realpolitik

Fourth 'bird flu' death in Turkey

Despite the panic in Turkey, there is still no evidence of the all important person to person transmission that would signify the beginning of a pandemic.

BBC NEWS | World | Europe | Fourth 'bird flu' death in Turkey

Turkish authorities are doing further tests to determine whether a girl of 12 is the fourth victim of bird flu.

Fatma Ozcan died in hospital in the eastern city of Van on Sunday. Although preliminary tests for bird flu were negative, doctors want confirmation.

Fatma's brother, who is in hospital, became the 19th person to be confirmed with the H5N1 virus. All came after contact with infected birds.

More than 70 people, most in Asia, have died since the outbreak began in 2003.

The disease reached Turkey in recent months. Many parts of the country have now been affected.

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Bird flu

Fatma Ozcan died at 1350 (1150 GMT), authorities in the Van hospital said.

She became ill 10 days ago after slaughtering a sick chicken. Her five-year-old brother, Mohammed, also became infected.

A doctor treating him told the BBC he is not on a respirator, and his condition is stable.

The two children are from Dogubeyazit, the remote, rural town where three siblings have already died of bird flu.

Doctors believe Fatma's initial negative test may have been due to a poor quality sample, says the BBC's Sarah Rainsford in Istanbul.

At least 20 other patients are still being treated for suspected bird flu in Van.

A mass cull of poultry is underway in almost one third of all provinces to try to stop the virus spreading any further.

A national awareness campaign has also been launched to warn people of the danger.

No mutation

Scientists analysing the virus in Turkey say it is a particularly nasty form, but one which has been seen elsewhere.

CONFIRMED TURKISH H5N1 CASES
Van: 9, including 3 deaths
Ankara: 3
Kastamonu: 2
Corum: 1
Samsun: 1
Sivas: 1
Siirt: 1
Sanliurfa: 1

Q&A: Your concerns
Anguish in rural Turkey

The analysis of a sample from one Turkish case has shown a genetic change which has been seen in previous human cases in Hong Kong and Vietnam.

However, the scientists have said the alteration does not make the virus more likely to pass between humans.

The UN says it hopes an international donors' summit in Beijing on 17 and 18 January will raise pledges for the $1.5bn (£850m) needed to help countries implement programmes to stop bird flu.

January 15, 2006 at 07:37 PM in Flu pandemic watch | Permalink | Top of page | Blog Home

Britain at highest risk from avian flu pandemic

Britain at highest risk from avian flu pandemic - World - Times Online

Mark Henderson
Widespread urbanisation, high population density and a large number of foreign visitors increase the country’s vulnerability
BRITAIN is at highest risk of an H5N1 flu outbreak if the avian virus starts passing from person to person, according to a map of the probable global impact of a pandemic, The Times has learnt.

Although a pandemic strain of flu is more likely to emerge elsewhere in the world, Britain is the country to which it is most likely to spread once the disease evolves the ability readily to infect humans, the research suggests.

High population density, widespread urbanisation and large number of tourists and business visitors make it particularly vulnerable to a new virus, the study by Maplecroft, a risk consultancy, finds.

As well as topping the league table of countries to which human H5N1 flu is likely to spread, Britain is also the only Western country considered at “extreme risk” from the general impact of a pandemic.

The alarming figures are from a global survey that uses World Health Organisation (WHO) data to calculate the hazards that a pandemic of flu or another new infectious disease would pose to individual countries and regions.

Maplecroft assessed the likelihood of a new human disease emerging in each of 161 countries; the chances of each country being affected by a new disease that arises elsewhere; and national capacity to cope with such an outbreak. These three factors were been combined to create a general pandemic risk index, which estimates the overall hazard that an emerging disease would pose to each nation.

Although the Government’s contingency plans and a good public health system mean that Britain was judged among those that would best be able to contain an avian flu outbreak, it heads the league table of those to which the disease is most likely to spread. It is also the ninth most likely country in which a pandemic might emerge.

Overall, Britain is the 25th most vulnerable nation to the overall effects of a pandemic, largely because of its peculiar susceptibility to the arrival of a new disease.

“We were surprised and concerned that the UK came out first for spread, but it is understandable,” said Alyson Warhurst, Professor of Strategy and International Development at Warwick Business School and a director of Maplecroft.

“The openness of our economy, the high population density, the high urban density and the heavy traffic of tourists and immigrants all combine to add to the risk. This all means we have to be very stringent in putting together contingency plans.”

All the countries that have reported human cases of bird flu — Vietnam, Thailand, Cambodia, Indonesia, China and Turkey — are classed as being at high or extreme risk.

Andy Thow, principal researcher for Maplecroft’s global map of pandemic risk, said that it had been compiled with data from the WHO, the UN Food and Agriculture Organisation and the World Resources Institute. “We then replicated the methodology that the WHO uses to work out detailed risk on a regional basis, as in China at the moment, and applied this on a national basis,” Dr Thow said.

“We used 32 indicators in total, each of which measures a different aspect of risk for a pandemic, or which is a proxy for the conditions that influence disease.”

The likelihood of a new pandemic disease strain emerging in any country considered variables such as its population density, the proportion of agricultural workers in the labour force, live animal imports and exports and the density of poultry, pigs and other livestock.

The risk of a new disease spreading to a country also took into account its population density, as well as factors such as the urban population, tourist numbers, local environmental conditions such as temperature and humidity, and the prevalence of existing pan- demic diseases such as tuberculosis and HIV.

www.timesonline.co.uk/birdflu

View interactive pandemic risk map

January 11, 2006 at 07:41 PM in Flu pandemic watch | Permalink | Top of page | Blog Home

Business told to prepare itself for outbreak of flu

Business told to prepare itself for outbreak of flu - World - Times Online

BY Tom Bawden and Caroline Merrell
Soldiers will not be riding to the rescue in the event of a pandemic so companies should make contingency plans of their own
BUSINESSES have been given a stark warning that the Government will not bail them out if the feared flu pandemic hits Britain.

The Cabinet Office, which is co-ordinating contingency planning for the flu threat, said that some companies wrongly expected the Government or the Army to protect them from the worst of the potential outbreak. Bruce Mann, the head of the Civil Contingencies Secretariat at the Cabinet Office, said: “There are not that many heavy goods vehicle drivers in the Army, and most of them are in Afghanistan or Iraq.”

A source close to the Cabinet Office added: “Some companies take the view that other people will bail them out, but the Government doesn’t have the capacity to do that any more, if it ever did. We are not going to take the haulage industry and stuff it with soldiers.”

The warning came as HSBC, the world’s third-largest bank, estimated that half its staff could be absent from work if the H5N1 bird flu virus mutates so as to be transmitted between human beings. All human cases of the virus so far have been caught from contact with birds, and the flu will have the potential to become a pandemic only when it can be passed from person to person.

HSBC’s estimate is double that drawn up by the World Health Organisation in draft guidelines for businesses. But the Department of Health also envisages a more pessimistic situation, and has forecast that as many as half of the Britain’s 60 million population could be infected.

But the World Health Organisation and the Government agree that 15 million is the most likely number of casualties if the virus mutates, over a period of about six months. This means that about 10 per cent of a company’s staff would be absent from work, although the figure could be higher as uninfected parents take time off work to care for sick children.

Although some companies were being complacent, many more were drawing up detailed contingency plans, the Cabinet Office said. AstraZeneca, the manufacturer of drugs such as Losec for gastrointestinal problems, expects at least 6,400 of its staff to be absent in the event of a pandemic and has set up a taskforce to combat the problem.

“We are also making sure that our principal contractors, such as IBM, have their own arrangements in place so that anything that may affect them doesn’t affect us,” a spokesman for the company said.

Many companies are publicly seeking to play down the threat and are refusing to give detailed estimates of how they might be affected.

A spokesperson for BP, Europe’s biggest oil company, said: “We are working out how to protect people, but we don’t want to generate alarm among our staff and those who rely on us for heating and lighting.”

Apart from the damage to families and businesses, a serious flu outbreak would strain Britain’s infrastructure and supplies. “It would be like August for about six months,” the Cabinet Office source said. “Supermarkets would be short of the staples, although they would be available.”

Many companies had even failed to prepare a contingency plan in the event that their boss falls victim to the virus, Mr Mann added. “Senior executives are not immune. How would the company cope if one of them falls ill?” If Britain escapes unscathed it will be the sixth consecutive year without serious levels of the disease. The flu circulating has changed relatively little from year to year and is in general well matched by vaccines.

The number of deaths in a pandemic can vary considerably. The 1918-19 outbreak was exceptionally virulent and killed more than 20 million people. In America, 2.5 per cent of the population died. The threat of a pandemic has grown after human cases of the H5N1 flu virus emerged in Turkey.

Two people in China were last night reported to have died of bird flu, raising the global toll to at least 78 people.

The virus is most prevalent in Asia, particularly in Vietnam, Thailand, Indonesia and China, where a new outbreak was detected among quails in the southwestern city of Guiyang.

January 11, 2006 at 07:40 PM in Flu pandemic watch | Permalink | Top of page | Blog Home

UN in two minds about Turkish bird flu outbreak

UN getting into a tither now that bird flu is impacting close to the EU.

UN in two minds about Turkish bird flu outbreak - World - Times Online

By Philippe Naughton and agencies

To panic or not to panic? Two United Nations agencies gave out conflicting messages on the today on the risk posed by the Turkish bird flu crisis.

So far 15 Turks have been infected by what appears to be the lethal H5N1 variant of the virus, which doctors and public health experts fear could mutate into a strain transmissible between humans to cause a global pandemic.

The number of infections has puzzled health experts, but a senior official of the World Health Organisation said today that there was no sign of any human-to-human transmission and he was confident that Turkey was doing everything it could to manage the outbreaks.

"The worst situation is a panic situation. There is no reason to panic," Dr Marc Danzon, the WHO's regional director for Europe, told a press conference in Ankara. "The risk is global ... We need to exercise solidarity."

But in Rome, the message from the Food and Agriculture Organisation (FAO) was that Turkey should avoid any complacency and step up its campaign against the virus to stop it become endemic. The FAO warned Turkey's neighbours, including Armenia, Azerbaijan, Georgia, Iraq, Iran and Syria, to put control and surveillance measures in place immediately.

"The virus may be spreading despite the control measures already taken," said Juan Lubroth, the FAO's senior animal health officer. "Far more human and animal exposure to the virus will occur if strict containment does not isolate all known and unknown locations where the bird flu virus is currently present."

In a statement, the FAO said that it had sent a team of experts to Turkey. It urged Ankara to apply a nationwide control campaign and said that poultry in outbreak areas should only be moved with the permission of veterinarians.

Mr Lubroth said control measures in the outbreak areas should include "humane culling, strict isolation and, if and when appropriate, vaccination".

Turkey’s 15 suspected cases in one week is a record for the current bird flu outbreak. The WHO has so far confirmed only four of the cases as H5N1, but said it is confident the remaining samples would be positive. Three people died of the virus last week, including two children.

Asked about whether countries should ban or restrict their citizens from travelling to Turkey, Dr Danzon called it "a non-story" and said there was no reason to take such measures.

All of the cases in Turkey appeared to have involved adults or children who touched or played with infected birds - including a girl who hugged and kissed dead chickens.

"The people of the country need to perfectly understand that the danger is contact between sick or dead poultry and a human being, especially a child," Dr Danzon said. "This is the key point for the future. This is where we need to pass messages to the population and inform local leaders."

But European governments are scrambling to halt the westward spread of the virus and are taking their own measures to prevent it crossing the borders from Turkey.

In Italy, a consumer group urged the government to impose a ban on travel to Turkey, and in Greece, veterinary inspectors stepped up border checks. Serbia has stepped up inspection of people, vehicles and luggage coming from Turkey and told citizens who have recently visited Turkey to report to hospital in case of any bird flu symptoms.

In Germany, Horst Seehofer, the Agriculture Minister, said that the Government was set to insist that all poultry be kept indoors to prevent bird flu outbreaks. Several of Germany's 16 states have already increased controls of travellers entering the country from Turkey.

Anxious to demonstrate to its citizens and the European Union that it was taking decisive action, Turkey today ordered more than 300,000 fowl destroyed as a precaution, doubling the number already culled.

"The situation has been taken seriously from the beginning; in Turkey," Dr Danzon said. "The action in the country has been appropriate and the management of this crisis is at the level where it should be and we are satisfied both by the type of action taken by the Ministry of Health and by the possibility of our team to act independently and with transparency."

But WHO officials admitted that they were baffled by the number of humans infected in Turkey, which they said might only be explained by the behaviour of poultry farming families. Authorities distributed leaflets in eastern regions most affected by the outbreak, cautioning people not to touch fowl, while television spots urged people to wash their hands after contact with poultry.

Dr. Guenael Rodier, who heads the WHO team in Turkey, said: "In the future we will probably see some other cases in humans but then we will see less and less cases."

January 11, 2006 at 07:39 PM in Flu pandemic watch | Permalink | Top of page | Blog Home

Human bird flu spreads in Turkey

More ,,,

BBC NEWS | World | Europe | Human bird flu spreads in Turkey

Five new human cases of bird flu have been confirmed in several Turkish provinces, pushing the number of people infected up to 14, officials say.

The cases, identified as being of the deadly H5N1 strain, mean the virus is now present in the east, north and centre of the country.

At least two Turkish children have died, and correspondents say fear is spreading rapidly across the country.

Health experts say there is no sign the virus is passing from human to human.

The two siblings confirmed to have died of bird flu in the eastern town of Dogubeyazit, in the province of Van, had close contact with poultry.

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Bird flu

Tests are still being carried out on their 11-year-old sister, who also died, to see if she was also infected with H5N1.

Their brother, the sole surviving sibling of the family, was released from hospital on Monday. Tests indicated six-year-old Ali Hasan Kocyigit did not have the virus.

The World Health Organization (WHO) has confirmed only two cases of H5N1 through its own laboratory tests in the UK, but says it considers the Turkish results reliable.

"We're certainly considering these 14 as cases and are treating them as such," the WHO's Christine McNab told the BBC News website.

She said the third death had not been added to official figures because there was still no confirmation from Turkey, but that it was being treated as a "probable additional [ie 15th] case".

'Under control'

International experts have gone to the region, where a mass cull of poultry is under way, to try to find out how quickly the deadly strain is spreading.

CONFIRMED TURKISH H5N1 CASES
Van - 7, including 2 deaths
Ankara - 3
Kastamonu - 2
Corum - 1
Samsun - 1
A third death is being treated as a "probable" case

But the head of the Turkey mission of the WHO, Guenael Rodier, said there was "no element in this village indicating human-to-human transmission".

The latest five cases to be reported are in the Black Sea provinces of Kastamonu, Corum and Samsun, and the eastern province of Van.

Forty-eight cases are said to be under investigation in Turkey.

The fact that the virus is now present along the Black Sea coast and central Turkey, as well as in the east, is seen as worrying.

The main concern is that the virus will mutate into a form easily transmissible between humans.

Turkish television has begun broadcasting a public health warning telling people how to protect themselves from the virus.

Chicken captured for slaughter

Outrage in Turkish press
Anguish in rural Turkey

But Turkish Health Minister Recep Akdag - who has been visiting Van - said the problem was under control.

"There's no disease in urban areas, the only human cases are from people who've been in direct contact with poultry," he told the BBC.

The two deaths in Van last week were the first outside South East Asia, where about 70 people have been killed by the virus in the past two years.

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The EU already bans imports of live birds and poultry products, including feathers, from Turkey.

On Monday, it announced a ban on feather imports from six of Turkey's neighbours: Armenia, Azerbaijan, Georgia, Iran, Iraq and Syria.

In other new cases:

* Indonesian officials confirm a 39-year-old man died of bird flu on 1 January. If confirmed by the WHO as a victim of H5N1, he would be the country's 12th fatality.

* China confirms its eight case of bird flu after a six-year-old boy in central Hunan province is treated for the H5N1 strain, Xinhua news agency says

January 9, 2006 at 09:49 PM in Flu pandemic watch | Permalink | Top of page | Blog Home

Bird flu status

There has not been much news on bird flu lately.  This makes sense, because birds dont migrate in the middle of winter.  The last bout of finds located in the summer /autumn time, and I would expect that the next bunch will show up in the March/June timeframe this year.

At the moment, reported human cases are listed on the BBC at 144 cases and 76 deaths:
                Cases   Deaths
Turkey             2             2
Thailand         22           14
Cambodia         4             4
Indonesia       16            11
China               7             3
Vietnam         93            42

China is particularly the one to watch, since their reporting is reportedly sketchy, and the 2008 Olympics are coming soon.

January 5, 2006 at 12:29 PM in Flu pandemic watch | Permalink | Top of page | Blog Home

Mutated strain of bird flu found in Cambodia

Mutated strain of bird flu found in Cambodia - Yahoo! News

Thu Nov 24, 2:34 AM ET

PHNOM PENH, (AFP) - A mutated strain of bird flu has been found in samples taken in Cambodia, but it is not known if the new strain is more lethal than that which has killed four people here, health officials said.

Testing on the samples, which were collected in April, is continuing, said Philippe Buchy, head of the Virology Department at the Pasteur Institute office in the Cambodian capital Phnom Penh.

"We don't know yet if it has any significance for the transmission from humans to humans, or from birds to humans," Buchy said, adding that mutations of the H5 virus are common.

"I'm really not concerned about this. The strains have been seen by H5 experts from the (World Health Organisation's) networks and they didn't say anything."

Buchy said it was likely the strain found in Cambodia was similar, if not the same as a mutation reported earlier this month in southern Vietnam, where officials sought to ease fears that a deadlier form of bird flu had erupted.

No new cases of bird flu have been reported in either humans or animals in Cambodia since March, said Ly Sovann, head of the health ministry's infectious disease department.

But he also said the impoverished country does not have the means to test new strains of bird flu, making it more difficult to control future outbreaks.

Cambodia is located between Vietnam, where 42 bird flu deaths have occurred, and Thailand, which has seen 13 fatalities, according to the World Health Organisation's official figures since late 2003.

Two of the four bird flu victims from Cambodia, whose nationals regularly cross the porous border in the densely populated Mekong delta, died in southern Vietnam after being hospitalized in a Kien Giang hospital.

Scientists warn that the H5N1 virus, which has killed more than 60 people in Asia since late 2003, could mutate and combine with human flu variants, making it easily transmissible among humans and creating a global pandemic.

November 28, 2005 at 01:45 PM in Flu pandemic watch | Permalink | Top of page | Blog Home

Report: Bird flu on migration path

CNN.com - Report: Bird flu on migration path - Nov 6, 2005

China can't rule out bird flu in death of human

Sunday, November 6, 2005; Posted: 4:15 a.m. EST (09:15 GMT)
BEIJING, China (AP) -- A bird flu outbreak in northern China that sparked the culling of about 370,000 birds lies along a migration route that spans from East Asia to Australia, a media report said Sunday, as officials continued killing thousands of birds east of Beijing.

China, meanwhile, said Sunday it can't rule out bird flu in the death of a 12-year-old girl last month and has called on the World Health Organization to help with diagnosis.

Three people living in central China's Hunan province came down with pneumonia last month following an outbreak of the deadly H5N1 bird flu among local poultry, the official Xinhua News Agency said.

Of those, a 12-year-old girl died. Her nine-year-old brother and a 36-year-old school teacher recovered from the illness. Chinese officials initially said that the girl and her brother had tested negative for the virus.

But on Sunday, Xinhua reported that experts "cannot rule out the possibility of human transmission of H5N1 bird flu. The specific cause needs further laboratory tests."

Xinhua also said that China has asked the World Health Organization for help in testing the blood and throat swabs from the three victims.

As Indonesia confirmed its fifth fatality from the H5N1 strain of bird flu, and jitters mounted across Asia, Japan was reportedly considering a plan to nearly double its annual contribution to the World Health Organization to help combat the deadly virus.

Around 1,700 Chinese officials and armed police were expected to complete by Sunday the culling of poultry in Liaoning province's Badaohao village, close to the border with North Korea, the official Xinhua News Agency reported.

The Badaohao outbreak of the H5N1 bird flu strain -- the fourth in China in three weeks -- killed 8,940 chickens and prompted authorities to destroy 369,900 other birds, the government has said.

More than 20 magpies and other migratory birds were spotted in the area, Xinhua said without giving further details.

Chinese authorities have said they are concerned that wild birds might spread the virus, particularly following an outbreak last spring that killed more than 6,000 migratory geese and gulls at northwestern China's Qinghai Lake. (Global bird migration paths)

The State Forestry Bureau said last month it was activating a reporting network to detect outbreaks among wild birds.

Meanwhile in Beijing, new regulations went into effect Sunday that allow detention for up to 15 days and fines of up to 200 yuan (US$25; euro21) for anyone who fails to immunize their birds, the Beijing Morning Post reported.

The rules, announced jointly by the Beijing Agricultural Bureau and the Beijing Public Security Bureau, are aimed at ensuring a 100 percent bird vaccination rate in the capital, the newspaper said.

No human cases have been reported in China, but authorities warn they are inevitable if the government cannot stop repeated outbreaks in poultry.

Meanwhile, Japan was mulling a plan to give 300 million yen (US$2.6 million; euro2.1 million) to the WHO to help combat bird flu and other infectious outbreaks in developing countries, the national newspaper Yomiuri Shimbun reported Sunday, citing unnamed government sources.

Tokyo, which gave around 160 million yen (US$1.36 million; euro1.1 million) to the global health agency for 2005, said the money would be used to improve surveillance of infection routes of bird flu and SARS, or severe acute respiratory syndrome, the report said.

The government was also planning to invite influenza experts from Vietnam, Indonesia and other countries early next year for training at the National Institute of Infectious Disease in Tokyo, Yomiuri Shimbun reported.

Officials at the Health and Agricultural Ministries were not available for comment Sunday.

The response comes a day after Indonesian officials confirmed that a 19-year-old woman died of bird flu, bringing the number of people killed by the disease in Indonesia to five.

The woman, from the town of Tangerang on the outskirts of the capital, Jakarta, was believed to have contracted the virus from infected dead chickens in her neighborhood, Ministry of Health official Hariadi Wibisono said Saturday.

An 8-year-old boy from her family was hospitalized with the virus, but it was not immediately clear how the young boy contracted the disease.

Since late 2003, the virulent H5N1 strain of bird flu has ravaged poultry stocks and killed more than 60 people in Southeast Asia.

Most of the human deaths have been linked to close contact with infected birds. But experts fear the virus could mutate into a form easily passed among humans, and possibly trigger a worldwide pandemic.

Copyright 2005 The Associated Press. All rights reserved.This material may not be published, broadcast, rewritten, or redistributed.

November 6, 2005 at 10:41 AM in Flu pandemic watch | Permalink | Top of page | Blog Home

Ministers 'not grasping seriousness of bird flu'

Political considerations are creeping in on the flu watch - not necessarily helpful or useful.

ePolitix.com - Ministers 'not grasping seriousness of bird flu'

The Opposition warned on Monday that lax quarantine procedures could be putting Britain at risk of an avian influenza epidemic.

Shadow agriculture minister Jim Paice welcomed plans for a review of avian quarantine arrangements and procedures for captive birds.

But he said that the Essex centre at the heart of the latest fears had prompted wider questions over whether other birds may have been infected.

"Whilst a review of quarantine rules and procedures is necessary it must not obscure the urgent questions surrounding birds which may have been in the quarantine centre in Essex," he said.

"The fact that Margaret Beckett has not taken this opportunity to provide further information or answers shows that Defra really does not understand how serious the situation is."

Paice urged the government to "explain if any birds shared the premises whilst the parrots and the birds from Taiwan were present".

"If they did, what efforts are being made to trace them?" he asked.

"Has contact been made with cage bird clubs, societies; show and fair organisers, magazines and journals?

"Have Defra contacted environmental health officers in local authorities?

"Has Defra considered offering amnesty if necessary to encourage anyone to report buying or selling these birds?

"If the stories that other birds went through the quarantine centre at the same time are untrue, then the government should say so."

The environment secretary, meanwhile, detailed the terms of reference for the independent review of avian quarantine arrangements.

Beckett said: "I recognise that the public is concerned about avian flu. As a result of existing quarantine procedures disease was identified and eradicated in a quarantine facility in Essex.

"However, we want to ensure that in this evolving disease situation our quarantine rules and procedures are as secure as possible.

"That is why we want an independent assessment of the quarantine system's effectiveness against avian flu.

"The importation of wild birds is currently suspended and all birds currently in quarantine are being assessed on a case by case basis. This review will be carried out during that suspension."

October 31, 2005 at 01:14 PM in Flu pandemic watch | Permalink | Top of page | Blog Home

MDs reveal worst-case scenario

And here Toronto predicts the impact of the pandemic.

TheStar.com - MDs reveal worst-case scenario

When the next pandemic hits Toronto, more than 900,000 people will fall ill and 5,000 residents will probably die despite today's arsenal of antivirals and antibiotics

RITA DALY STAFF REPORTER

A 70-year-old man arrives in an emergency room vomiting.

Across town, a three-month-old girl suffering from a soaring fever is brought to a walk-in clinic. And downtown, a lab technician, peering at a microscopic viral sample from a recent traveller who died of pneumonia, sounds the alarm. The flu pandemic has arrived in Toronto.

That's a likely scenario when a medical disaster strikes this city. No one knows when that will be, but health experts say the world is overdue for a pandemic.

Southeast Asia is expected to be the epicentre when the next pandemic strikes, but cases will start showing up in places around the world, including our city, in a few weeks or even days.

The Spanish flu, which killed up to 40 million people worldwide, hit Toronto in September 1918. Hospitals were soon teeming with the sick, morgues overflowing with the dead.

What can we expect next time around?

"It depends how serious the illness is," says Dr. Barbara Yaffe, Toronto's associate medical officer of health. "There have been pandemics that were extremely serious, like the 1918-1919 pandemic, and others less serious."

The first hospital patients will be put in isolation and their families and close contacts quarantined at home. But quarantine methods won't be used for long. Experts know the virus will spread regardless, and it will move quickly.

As germs multiply in subway trains, offices and classrooms, it is expected that thousands of Torontonians will fall ill with the highly infectious flu strain within days. Officials say they are preparing for the worst — in which case, schools, churches and day cares could close. (An entire high school was shut down during SARS in 2003 when one student became infected.)

But whereas influenza was not a reportable disease in 1918, today's sophisticated tracking will quickly show who is getting sick and where, and will indicate the best ways to contain it.

"If it's affecting school-aged children the most, then it might make sense to close schools," says Yaffe. "If it's affecting mostly seniors, that may involve a different approach."

Theatre performances, sporting contests and other events could also be cancelled to curb social contact. (Four major conventions were cancelled with SARS.)

But buses, subways, grocery stores, banks and other businesses will attempt to keep going. In some cases, hours of operation may be scaled back as high numbers of employees remain at home sick or caring for the sick. In other cases, however, the Internet will allow people to do their jobs from home.

"In a pandemic, there are two major goals — to reduce illness and death, and to reduce and minimize societal disruption," says Yaffe. "We don't want society to grind to a complete halt. People still have to eat, they have to keep going."

With the city set to release its pandemic plan next month, medical and emergency officials have been scrambling to prepare for a worst-case scenario.

It is expected that more than 5,000 people could die in Toronto, despite today's arsenal of antivirals and antibiotics. More than 900,000 could fall ill.

"You can imagine how quickly this will take off. Most people talk about it taking three weeks," says Dr. Michael Gardam, director of infection control at the University Health Network and a member of the Toronto pandemic planning committee.

About 65,000 people could be hospitalized. Needless to say, private rooms will be out of the question. At the pandemic's peak, the University Health Network, the largest hospital system in the country, expects half of all admitted patients to be flu victims.

Doctors, nurses and ambulance attendants will be run off their feet as flu-stricken patients cram emergency departments. As was the case in 1918, non-urgent surgeries will be cancelled. Hospitals are already drawing up plans to redeploy staff to flu detail as colleagues fall ill despite their best defences — antiviral drugs, mandatory masks and gowns.

Hospitals will also employ "battlefront triage" as doctors make painful choices on which patients to save and which to let die. "That is a very hard message in health care to wrap our head around," Gardam says.

As the death toll rises, morgues, crematoriums and funeral homes will overflow. Refrigerated trucks will be turned into temporary morgues.

More people will stay home as a Toronto hotline and website deliver up-to-date information on the pandemic in a multitude of languages. Daily media briefings will be the order of the day.

Heather MacDougall, a medical historian at the University of Waterloo, says experiences like the 1918 pandemic and SARS are often good lessons, but there is always the new and unexpected to consider.

"The real question is: Do you take what worked from the past and replicate it or decide you need to do something different?" she says.

In 1918, for instance, there was a strong volunteer ethic in the community. Ordinary folk lined up to get on-the-spot training to care for the sick and charitable groups played a major role.

But relying so heavily on the community might not work next time. Nowadays, people like to get paid for what they do.

If schools shut, however, a lot of teachers would be available for volunteer duty, MacDougall notes.

Retired doctors and nurses could be asked to pitch in, but Yaffe says most Toronto residents won't rely on medical care, at least until a pandemic vaccine is produced six months later and mass inoculations are delivered.

"A lot of times, people will just basically have to care for themselves and others unless they're severely ill."

That's a message worth repeating, especially in a society that depends so heavily on hospital and medical care. In that sense, says MacDougall, Toronto's experiences with the next pandemic may not be so different from those of 1918.

October 30, 2005 at 09:43 AM in Flu pandemic watch | Permalink | Top of page | Blog Home

The Great Spanish Flu of 1919

Bit of history here - Toronto, Canada and the last pandemic.

TheStar.com - The Great Spanish Flu of 1919

LOUISA TAYLOR AND KIRSTY DUNCAN
STAFF REPORTERS

Toronto in 1918 was a city of almost half a million people, 90 per cent of them of Canadian or British origin. An intensely imperialistic city, it had sent 70,000 men to war. Those left behind supported the war effort in any way possible — growing victory gardens, buying war bonds, knitting scarves for soldiers.

By the fall of 1918, the war was in its final stages and soldiers were starting to come home. But thousands were still abroad, fighting in the bloody final push to defeat the Germans. The First World War left six to nine million dead or wounded — but a new enemy was on its way, one that would kill four times that many around the world.

SPRING, 1918

The first known case of the avian influenza that the world comes to call the Spanish flu is reported on March 4 at Camp Funston, in Kansas. Hundreds of soldiers fall ill.

AUGUST

A second wave begins as American troops move through the port of Brest. The virus spreads across Europe within a few weeks, then back to North America with the troops.

SEPTEMBER 19

Toronto newspapers report an influenza outbreak at one of several military camps in the city. The camps are quarantined, and authorities aren't overly concerned. The front pages of the newspapers are crammed with news of troop movements and battle victories, but say little about the flu, as they do throughout the crisis.

SEPTEMBER 29

It is not clear exactly when the flu leaps beyond the soldier population, as doctors are not legally required to report the flu cases to authorities, but reports claim the first civilian victim is a schoolgirl who dies on this day at Toronto General Hospital.

OCTOBER 1

Influenza peaks in Boston, and local doctors have begun reporting what they think are cases of Spanish influenza. Dr. Charles Hastings, Toronto's medical officer of health, says no cases have been confirmed beyond the outbreak at the military camp. "Just tell the people to keep as fit as possible, to avoid anything which might give them colds, and not to worry any more about it," Hastings tells the press.

Dr. Hastings led a high-profile campaign to improve the city's hygiene and public health from 1910 to 1914; by 1915 Toronto was considered one of North America's cleanest cities. He expanded the public health department, creating an army of public health nurses responsible for specific neighbourhoods, who act as the "guides and friends" to women and children. These nurses would prove indispensable in the epidemic.

OCTOBER 2

"It is here in Toronto without a doubt," says Dr. Hastings, commenting on the death of 32-year-old James Hamilton, one of the first confirmed victims. A mother and her four children are also reported to be ill.

OCTOBER 3

The military reports 500 cases of flu at the Base Hospital on Gerrard St. The hospital's commanding officer says "there have been no serious cases reported so far," but some new recruits have their deployment overseas delayed as a result, prompting The Toronto Daily Star to wonder if "the way to stay out of a draft is to stay in one."

OCTOBER 4

The provincial medical officer of health, Col. J.W.S. McCullough, reports outbreaks of the flu in several parts of the province. The worst hit is Renfrew, with 500 cases. The Ottawa Valley town asks McCullough for "four or five doctors and about a dozen nurses."

OCTOBER 5

The Star begins running a roundup of flu stories from around North America: "Pool rooms, billiard halls and soda fountains" are closed in Boston; schools and meeting halls are shut down in Ottawa; an undertaker in Sherbrooke, Que., reports having to do 15 funerals. Dr. Hastings starts a tour of cities hard hit by the flu, including Washington, New York and Boston.

OCTOBER 7

Local doctors begin reporting influenza cases more regularly; 17 new cases are reported today, along with nine deaths, including that of 17-year-old Florence Coltman, ill for two days.

Police officers fall sick and replacement teachers are in high demand. City leaders begin debating quarantine and closing schools and "places of amusement." Unhappy with Dr. Hastings' departure for the U.S., Mayor Thomas L. Church suggests Hastings would do more to stop the flu if he got warmer tents for the hundreds of soldiers staying in camps. A brief item about the flu makes the front page: "Flu sweeps Hun Armies."

OCTOBER 8

The department of health scrambles to co-ordinate medical institutions. Hospital beds are filling up with influenza cases — 80 at the Toronto General, 27 at the Western. School authorities estimate that nearly 260 teachers and 10,000 students are absent this day but have no way of knowing how many are sick. The mayor calls for quarantine of flu patients, but Hastings refuses, saying it would be ineffective given the number of cases through the city. The papers print extensive briefs on influenza, describing its spread through coughing and sneezing, and advising sick people to stay home.

Local military officials estimate 1,042 cases in the Base Hospital and various camps in the Toronto area. Among them is future Governor General Roland Michener, then an 18-year-old soldier in basic training.

Before briefly falling ill, Michener spends days working as an orderly, "stretcher-bearing the sick and carrying out the dead ... the toll one day in October was as many as twelve."

City council discusses the need to spend money to fight the flu, while Dr. Hastings organizes temporary hospitals and reassigns sanitary inspectors to help care for the sick in their homes. He also battles for more coal to be distributed, to keep the sick warm in the cold, wet weather.

Among the deaths reported on this day are Eva Williamson, 24; Margaret Kemp, 23, and George Clements, 41. Local medical staff dismiss a suggestion "emanating from Ottawa" that the prohibition laws be relaxed. "The use of whiskey does not seem to have been of much avail" in parts of the U.S. without prohibition. In South Africa, public services are severely disrupted, and mining industries are at a standstill. "A terrible toll has been taken among the native workers, and the dead are being buried in batches hourly." The Star calls for schools to be closed. "While there is no occasion for panic, there is clearly necessity for precaution."

OCTOBER 9

The flu reaches epidemic proportions. Public health nurses are busy tending to the sick in their homes, working "to the point of exhaustion." Most of the deaths result from complications, particularly pneumonia. Undertakers report difficulty keeping up with demand.

OCTOBER 10

"The experience of Europe and America shows that 40 per cent of the inhabitants have been affected by the epidemic," says Dr. Hastings, "and there is no reason for Toronto's citizens to believe that this city will be the one exception." The department of health decides to keep branch offices open day and night until the epidemic passes. The Star calls on the mayor to apologize for his public attacks on Dr. Hastings. "A weakling would have stayed home, safe in his own assurance that nobody could tell him anything. Dr. Hastings also did the right thing in using the press to enlighten the public."

OCTOBER 11

New civilian cases reported today hover around 300 in the hospitals, another 170 at homes. Among the more than 40 deaths in the previous 24 hours are Jung Lom, 38, Elsie Brennan, 11, and William J. Foster, 54. "The dove of peace hovered over the local board of health," The Star reports, as the mayor apologizes to Dr. Hastings. "There are people in the city who are almost hysterical for fear they will contract the disease," says Dr. Hastings. "For goodness sake, let everyone keep cool." His own daughter is recovering after falling ill the previous day. A baker puts an ad in The Star notifying customers half his delivery staff is down with the flu.

OCTOBER 12

While warning that Toronto had not yet reached the crest of the epidemic, Dr. Hastings pointed out that the mortality rate in Toronto is lower than that of other stricken cities. He warns the public to "beware of the fakirs" offering false remedies. The former Mossop Hotel on Yonge St. will open as an emergency hospital in a few days, with a capacity of 200. Forty-six of the 211 nurses at the General Hospital are ill.

OCTOBER 13

Fred Jenkins, a 27-year-old driver for New Method Laundry, comes home feeling ill. The next day he is admitted to the General Hospital with pneumonia. That night his wife Edith begins to feel ill; two days later, word comes that Fred has died in hospital. By then, Edith is seriously ill herself and her aunt doesn't pass on the news. Edith dies the next day, leaving their two-year-old daughter Dorothy.

OCTOBER 16

The Star reports the tale of Mrs. Ellen Neilson, who survived a severe attack of the flu only to have her husband fall ill. "Neighbours first learned of trouble when the delirious husband climbed from an upper bedroom window and asked for news of his wife and children."

The neighbours called police, who entered the kitchen and found the body of Mrs. Neilson, who had drowned herself after suffocating one of her two young sons and drowning another.

Neighbours say she was "crazed by worry over her husband's illness and the strain of nursing him."

OCTOBER 17

The Star reports that while the epidemic is waning in American cities, it is picking up steam in Toronto. About 50,000 people have been ill with the flu in the past month, marked by a big increase in the previous 24 hours. Nurses returning from Boston say Toronto is better off, and things are much worse south of the border, where, according to a Miss McMaster, the lowest death rate for a single day while she was there was 124.

Hundreds of women respond to the city's call for volunteer Sisters of Service. They receive three hours of training and a blue and white satin SOS badge, before heading out into the neighbourhoods to backstop the overtaxed public health nurses. The library stops circulating books but stays open. Salvation Army cadets help the sick in their homes, while other church groups set up soup kitchens. The University of Toronto closes and urges students to volunteer to help the sick.

OCTOBER 18

About 50 people a day are dying of influenza in Toronto now. The Neighbourhood Workers Association calls for donations of food and labour. Dozens of depots are set up around the city, and Scouts and Guides help with distribution to the sick. Cemeteries are ordered to stay open for Sunday burials. Hastings says only medical personnel need to wear masks.

OCTOBER 19

With schools already closed, the city orders theatres and movie halls and sporting events shut down or halted. The papers report a trend in women wearing the Spanish veil, a chiffon veil to ward off germs. In New York, laws against coughing in public lead to the arrest of more than 500 people this month.

OCTOBER 20

Montreal is devastated by the flu; on this, its worst day, 201 people die.

OCTOBER 21

The flu is particularly fatal among 20 to 40 year olds. Many of the dead, like Wesley Lamb, were soldiers who survived the war but not the plague: "After 10 days' illness from influenza and pneumonia, Wesley Lamb died Monday, October 21. He had just recently returned from France. He enlisted before his sixteenth birthday, was wounded, gassed, and shell-shocked, and returned four days before his eighteenth birthday." In Riverdale, pneumonia robs the Hampton family of mother and father, leaving three small children in the care of a kind neighbour "who was for a time the only friend and nurse the stricken family had."

OCTOBER 22

Prohibition is little obstacle to those eager to try the "alcohol cure." Papers report line-ups down the block at pharmacies, where people are filling prescriptions for alcohol. "There's a little list, and on it are names of doctors specializing in `alcohol' prescriptions," The Star reports. "The queues that draw attention to the official liquor dispensaries at 110 Church Street and 1271 Dundas Street bloomed vigorously as ever this afternoon. The waiting line at the Church Street address hovered around the 70 mark, and the Dundas delegation wasn't much smaller." The Star reports that "goose-grease poultices, bran poultices, lard and turpentine poultices and compresses of fir-tree spills, mutton tallow and mustard were among the concoctions applied to the chests of the sick; drinks of warm milk, ginger, sugar, pepper and soda were given to soothe the ill; and cough elixirs were administered to strengthen, heal, and make the flu-stricken well; one wholesale drug company that normally sold 6,000 bottles of cough medicine per week now faced a demand of 3,000 bottles per day." With everyone being urged to stay at home, the demand for phone service soars. Bell Telephone Co. places ads asking people to be patient — their technicians are sick.

OCTOBER 23

In the public health department, 54 of the 319 staff members are sick with the flu, including 22 nurses.

The Jewish community's services for the sick get some coverage in the paper. "Volunteer workers, both men and women, receive information concerning needy cases, and a member of the investigating committee, supplied with an automobile, makes a personal call at once ... If a doctor is not already in attendance, one is called and the fee paid by the committee provided the patient cannot afford to pay the fee himself. If there is no one in the house to look after the patient, one of a number of Jewish sisters of service is called in. The committee, in needy cases, is also supplying coal, groceries, underwear, pillow-cases, pillow-sheets, towels."

OCTOBER 24

Dr. Hastings asks for money to help families rebuild their lives. The Board of Trade soon launches a campaign to raise money to meet the emergency.

OCTOBER 25

"Rev. P. Bryce and Rev. E.C. Hunter of the Earlscourt Central Methodist Church are officiating today at no less than four funerals, all the victims of pneumonia." The dead include Mrs. Minnie Clarke, James Notley, 39, and Isabel Phillip, 22.

OCTOBER 26

Cemeteries report a gravedigger shortage, and families must dig the graves themselves. Churches in Quebec are closed, but in Toronto they are asked to reduce to one service, something that doesn't sit well with Rev. A.J. Fidler of St. Clement's Church in North Toronto. "If the Rev. A.J. Fidler cannot get near to God in any place but a church, he had better get converted," says Dr. Hastings. "He needs a truer conception of God's relationship to man and of man's humanity to man."

OCTOBER 28

The list of local dead includes many athletes. "Harry McGavin, the Broadview YMCA sprinter, was only 27 years of age. He leaves a wife and one child. Mrs. McGavin is dangerously ill from the flu and will not be able to see her husband before the remains are buried." Connaught Labs of Toronto scrambles to introduce a flu vaccine, which ultimately proves ineffective. Thousands of railway workers across Canada are sick, exacerbating the coal shortage.

OCTOBER 29

"Figures available today from the various city hospitals show conclusively that the epidemic is on the wane. Admissions in the past 24 hours have fallen off considerably and the death rate has been reduced from an average of 22 to 9," The Star reports. "We have it on the run, and victory is in sight," says Dr. Hastings, but "we must expect isolated cases, or perhaps outbreaks in certain small areas, for some time to come." Hastings urges parents to cancel Halloween parties. But tragic stories continue to flow in. "Last week Mrs. Elizabeth Duggan Howes died from pneumonia after nursing her mother, Mrs. Mary Duggan, who died one week previously ... on Sunday Mrs. Duggan's second daughter, Miss Helen, succumbed."

OCTOBER 30

"Though the total number of patients in the eight hospitals is 904, including 129 nurses, the deaths during the 24 hours ending at noon today were only 15," The Star reports. There were 1,100 more burials in October than in September.

OCTOBER 31

"The duration of the epidemic in Toronto was at least one week less than that of any other city of the same size on the continent," says Dr. Hastings, "and the mortality decidedly lower," which he attributes to Toronto's well-organized public health system.

NOVEMBER 5

School re-openings are postponed a week due to the fuel shortage. Sports events and public meetings resume. Dental college reopens.

NOVEMBER 10

Arlington temporary hospital closes.

NOVEMBER 11

Armistice Day. People pour into the streets to celebrate, prompting fears of a second wave of the flu, which doesn't materialize.

NOVEMBER 18

Dr. Hastings reports to the Board of Health, likening the flu epidemic to a "cyclone." The final tally: 1,750 deaths — now considered an underestimate, given the poor reporting practices. A nurse says in a memoir that the flu epidemic was an "unforgettable experience."

DECEMBER

Dr. Hastings makes a speech calling for a "single command" in the fight against disease — clearly a call for federal co-ordination of health matters. As a direct result of the flu epidemic, a federal department is created the following spring.

Research: Kirsty Duncan, Louisa Taylor, Toronto Star Library staff: Peggy MacKenzie, Marian Traynor, Rick Sznajder and Astrid Lange.

Sources: The Toronto Daily Star; Silent Enemy: Canada and the Deadly Flu of 1918 (Pettigrew, 1982); Toronto's Health Department in Action: Influenza in 1918 and SARS in 2003 (MacDougall); The Dead Zone (Malcolm Gladwell, The New Yorker, Sept. 29, 1997).

October 30, 2005 at 09:41 AM in Flu pandemic watch | Permalink | Top of page | Blog Home

Village at heart of bird flu scare was where foot-and-mouth began

Perhaps co-incidental link between the dead parrot, and the last outbreak of foot and mouth.

Britain, UK news from The Times and The Sunday Times - Times Online

By David Rose and Valerie Elliott
The quarantine centre where parrots died is opposite abattoir

Picture gallery

A VILLAGE sparked its second national public health scare in five years yesterday as the first case of the deadly avian flu virus found in Britain was traced to a private bird importer.

Little Warley, Essex, is home to Pegasus Birds, a tropical bird specialist which is thought to be linked to the quarantine centre where a parrot carrying the lethal H5N1 strain of the disease died on October 16.

The shop is opposite the abattoir that reported the first case of foot-and-mouth disease in the 2001 outbreak.

Brett Hammond, the owner of Pegasus Birds, was convicted of VAT fraud and jailed for 18 months at Knightsbridge Crown Court in February 1997. The sentence was reduced to 12 months on appeal. He also featured in a BBC Radio 4 investigation about the importation of wild cockatoos from Indonesia that were sold in Britain as captive reared birds, which command higher prices.

Last night government vets confirmed they are investigating the possibility that H5N1 was present at the facility much earlier than thought.

On Sunday it announced its “working hypothesis” was that the bird had been infected by a batch of birds from Taiwan.

But yesterday authorities in Taiwan said there had been no reports of cases of H5N1 on the island and the British Government’s theory had no “solid evidence” to back it up.

An alternative possibility is that birds in an earlier batch delivered to the facility could have had a “subclinical” infection and began secreting virus only after the stresses of quarantine. Contaminated droppings could have released the airborne virus that may have infected subsequent batches of birds from Taiwan and South America.

The Department for Environment, Food and Rural Affairs is now looking at what went into the quarantine before the parrot’s arrival.

Although Defra refused to disclose the location of the avian flu case, the commuter belt village came under suspicion. Little Warley, just east of the M25, is home to numerous pet centres, kennels, catteries and aquariums, as well as farms and expensive gated homes.

Mr Hammond could not be contacted at his home in Upminster, near the centre, yesterday. Katrin Geller, his partner, said he was not in the house when The Times called.

She subsequently denied that Mr Hammond lived in the house. When asked if she could confirm that the parrot had died at Pegasus Birds, however, she said: “Defra have told us not to say anything to you about that.”

Staff at the Pegasus Centre, which is the biggest importer of birds and reptiles in Essex, denied that the parrot had died there after a transfer from Heathrow. The bird originated from Surinam, South America, and entered the country in a consignment of 148 birds on September 16.

Eleven days later a batch of 218 birds from Taiwan were also moved into the quarantine premises and two parrots were found dead last Thursday. Only one was found to contain the suspect H5 strain, though further tests on tissue samples from both birds confirmed the H5N1 strain.

Debby Reynolds, the Government’s chief veterinary adviser, confirmed that the birds had been kept in Essex and had shared air space.

The Times was told that there were no quarantine facilities at the Pegasus Centre, and was then repeatedly asked by a man who would not give his name to leave the premises.

Mr Hammond, who was later contacted by telephone, initially denied that he owned the company. “You must have the wrong Brett Hammond, a wrong number,” he said. When it was put to him that he was listed as the director of Pegasus Birds at Companies House, he put the phone down.

Defra declined to confirm or deny that Pegasus Birds was at the centre of the bird flu scare. A spokesman said: “As a matter of course we always discourage people from approaching any disease sites and will therefore not be naming the facility. It is not our practice to release personal information of the owner. Investigations continue into the circumstances surrounding the death of these birds.”

It was a routine inspection at the formerly named Cheale Meats abattoir in Little Warley on February 19, 2001, that triggered the world’s worst foot-and-mouth outbreak.

www.timesonline.co.uk/europe
Latest developments on bird flu

October 25, 2005 at 08:58 AM in Flu pandemic watch | Permalink | Top of page | Blog Home

Avian flu in Europe does not affect the possibility of a human influenza pandemic

Interesting choice of words from European Health Commissioner Markos Kyprianou. One would assume that the more birds with flu, then the greater probability of the anticipated mutation to human transfer, for no other reason than sheer volume of birds. Perhaps he knows something we don't, or at least we can hope he does.

Top News Article | Reuters.com

LUXEMBOURG (Reuters) - The presence of bird flu in southeastern Europe does not increase the risk of a human influenza pandemic, the European Union's health chief said on Tuesday.

European Health Commissioner Markos Kyprianou said after briefing EU foreign ministers at an emergency meeting that Brussels did not yet know what strain of bird flu had been detected on the Greek island of Chios.

The virulent H5N1 strain of the virus, which has killed more than 60 people in Asia since 2003, was found last week in Turkey and Romania.

"The fact we have avian flu in Europe does not affect the possibility of a human influenza pandemic," Kyprianou told a news conference.

October 18, 2005 at 08:31 AM in Flu pandemic watch | Permalink | Top of page | Blog Home

Bird flu reaches EU as Greece finds virus

Its no longer a question of "when". Avian flu are reached the EU.

Top News Article | Reuters.com

ATHENS (Reuters) - Greece said on Monday it had detected one turkey with bird flu on the eastern Aegean island of Chios, becoming the first EU country where the virus has spread to.

"The Center for Veterinary Institutes has informed us that one of nine poultry samples has tested positive to bird flu (H5) antibodies," the agriculture ministry said in a statement.

The ministry said the turkey came from a small private poultry farm of about 20 turkeys on the tiny island of Inousses off Chios which belongs to the Chios prefecture.

It said it was running further tests to "to verify the correctness of the analysis".

Government officials said there was no need to cull any of the other birds.

"There has been no order for the culling of birds in the area," a high-level government official told Reuters.

"It was a small farm with about 20 turkeys. But any transport of birds, people, vehicles and eggs has been forbidden."

"The final confirmation will be made by the special laboratory in Thessaloniki (northern Greece) where special tests will take place."

The official said the government's emergency response plan had been activated.

Neighboring Turkey, only a few miles off Chios, has also detected cases of bird flu as well as Romania, both of which have culled thousands of birds in the past days.

(Additional reporting by George Georgiopoulos and Lefteris Papadimas)

October 17, 2005 at 01:48 PM in Flu pandemic watch | Permalink | Top of page | Blog Home

'Different times'

Words of calm from the chief UK health official.

Sir Liam said flu pandemics were things which came in "natural cycles" every 10 to 40 years, with the last taking place in 1968/69.
However he said that three decades ago there were no anti-viral drugs to combat the virus in its initial stages, as there are now.
He also said the situation was not comparable to the Spanish flu pandemic of 1918 which killed millions around the world, as we now lived in "different times" with great advances in hospitals and medical science.

October 16, 2005 at 02:31 PM in Flu pandemic watch | Permalink | Top of page | Blog Home

Are We Ready for the Bird Flu?

ABC News: Are We Ready for the Bird Flu?

What We Can Do if the Avian Flu Reaches the United States

Sept. 29, 2005 — ANNOUNCER: Thursday night, Sept. 15, 2005. It's time for "Primetime." Katrina's barely over. Is the worst disaster ever finally behind us? Not on your life. Tonight, "Primetime" puts you in the hot zone. But it's not just what can go wrong. It's what you can do right to save yourself in the next three big disasters experts say are just waiting to happen. A catastrophic earthquake.

FIRE AND RESCUE WORKER, MALE: Prepare yourselves. Shut off the gas and shut off electricity.

ANNOUNCER: An epidemic of avian flu, the whole world over.

MICHAEL OSTERHOLM, CENTER FOR INFECTIOUS DISEASE RESEARCH AND POLICY: I can't imagine anything that would be closer to a living hell.

ANNOUNCER: And a nuclear bomb in an American city.

CHRIS CUOMO, ABC NEWS: I get in my car, if I have one, and I take off.

ANNOUNCER: But what if we told you your first instincts to save yourself are wrong? Tonight, the warnings are here, and so are the answers. Ready or not? The next big one. Here now, Chris Cuomo.

CHRIS CUOMO: Good evening and welcome to "Primetime." Imagine a huge bridge like the one behind me being the only way out of your town and it's crammed with desperate drivers trying to evacuate. Now, we saw something like it during Hurricane Katrina, and the problem may well arise again during the now unthinkable next big disaster. It's a subject the president addressed in his speech tonight.

PRESIDENT BUSH: I consider detailed emergency planning to be a national security priority.

CHRIS CUOMO: So what does that mean to you? What would you do in a hurricane or a manmade catastrophe like a nuclear or biological attack? These are frightening thoughts, of course they are. But tonight is not just about what can go wrong. It's about what you can do right.

We start with a virus poised to create a global epidemic. Are we ready? Here's ABC News chief investigative correspondent Brian Ross.

BRIAN ROSS, ABC NEWS: It has the potential to turn parts of major cities into ghost towns.

MICHAEL OSTERHOLM: We would expect between 1.5 and 1.7 million Americans to die.

BRIAN ROSS: Officials in London are already quietly looking for extra morgue space.

DR. IRWIN REDLENER, COLUMBIA UNIVERSITY: We could have a billion people dying worldwide.

BRIAN ROSS: It could hit as early as this winter, and there's no vaccine and not enough medicine to fight it.

DOCTOR, MALE: There is very much a sense of a race against time.

BRIAN ROSS: Against this, a microscopic view of a never before seen strain of the flu that scientists say could pose a much more real and greater threat than smallpox, AIDS or anthrax. Known to scientists as H5N1.

LAURIE GARRETT, COUNCIL ON FOREIGN RELATIONS: Right now in human beings, it kills 55 percent of the people it infects. That makes it the most lethal flu we know of that has ever been on planet Earth affecting human beings.

BRIAN ROSS: Laurie Garrett is a senior fellow for global health at the Council on Foreign Relations. The most recent issue of its prestigious Foreign Affairs journal contains a special report on what it calls the coming global epidemic, a pandemic.

LAURIE GARRETT: Each year different flues come, but your immune says, I've seen that guy before, no problem, crank out some antibodies. Might not feel great for a couple of days, but I'll recover. Now what's scaring us is that this constellation of H number 5 and N number 1, to our knowledge has never in history been in our species. So absolutely nobody watching this has any natural immunity to this form of flu.

BRIAN ROSS: This form of the flu started as do almost all flu viruses, in wild birds in Asia.

BILL KARESH, WILDLIFE CONSERVATION SOCIETY: They die of pneumonia just like people. When you open them up, you do a post-mortem exam, their lungs are just full of fluid and full of blood.

BRIAN ROSS: Bill Karesh, the lead veterinarian for the Wildlife Conservation Society, has been tracking this rare flu strain since it first emerged in the 1990s, and has watched it as it's gained strength going from wild birds to chickens to humans.

BILL KARESH: The last outbreak in July that was reported was this part of China. It started in a market somewhere in the Guangdong Province. It's just packed with cages. you'll have chickens, you'll have ducks, cats, dogs, turtles, snakes. And they're all stacked in cages and they're all spreading their germs to each other.

BRIAN ROSS: Asian governments have killed millions of chickens in a futile attempt to stop the flu's spread. Dr. Irwin Redlener heads Columbia University's Center for Disaster Preparedness.

DR. IRWIN REDLENER: The tipping point, the place where it becomes something of immediate concern is when that virus mutates to something that is able to go from human to human.

BRIAN ROSS: So now, scientists in Asia and around the world, on a literally hour-to-hour basis, are watching for that tipping point to occur.

DR. MALIK PEIRIS, RESEARCH SCIENTIST: This virus is a pretty nasty piece of work.

BRIAN ROSS: Dr. Malik Peiris is the scientist who first identified the so- called SARS virus two years ago, which killed more than 700 people and triggered a worldwide scare. This, he says, is much worse.

DR. MALIK PEIRIS: Unlike the normal human flu where the virus is predominantly in the upper respiratory tract, so you get a runny nose, sore throat, the H5N1 virus seems to go directly deep into the lungs. So it goes down into the lung tissue, causes a severe pneumonia.

BRIAN ROSS: To date, there have been 57 confirmed human deaths and another suspected one just last week in Indonesia. Scientists say the humans who have been infected so far have been infected by birds, but that every infected person represents one step closer to the tipping point.

DR. IRWIN REDLENER: Once that virus is capable of not needing the bird to infect humans, so in other words, you have it, I can get it from being in contact with you, then we have the beginnings of what can turn out to be this worldwide epidemic problem that the experts call pandemics.

BRIAN ROSS: That's what happened in 1918. A shocking reminder of the worst-case scenario. It was known as the Spanish flu.

DOCTOR: It was the most horrible time. By the hundreds they were dying, and no doctor could stop the epidemic.

DOCTOR: We had little caskets for the little babies that stretched for four and five blocks.

BILL KARESH: The Spanish flu was killing people in two or three days once they got sick. It started at the end of World War I. It actually came to America with returning soldiers from Europe and then spread through the United States.

LAURIE GARRETT: In 1918, my now quite elderly uncle was a young boy, and the flu came through. And his family insisted that he could not go outside for any reason until the whole epidemic was over. He spent his afternoons looking out the window and counting the hearses going up and down the neighborhood and trying to guess which of his schoolmates had died and keeping a little scorecard.

BRIAN ROSS: That was before the international air travel routes of today with non-stop flights from flu ground zero to the United States.

BILL KARESH: So it's going to come out of Bangkok or Hanoi or Hong Kong or Shanghai, get into Japan. It'll get to New York. It'll get to San Francisco. It'll get to Vancouver. It'll get to Paris and London, all within a matter of the first week.

LAURIE GARRETT: It's on people's hands. You shake hands. You touch a doorknob that somebody recently touched.

BRIAN ROSS: And that's how this particular strain, never seen before, could spread?

LAURIE GARRETT: Absolutely. There's no reason to believe that if H5N1 manages to make that crucial punch through genetically, it won't spread like every other flu.

BRIAN ROSS: And once it hits a city like New York ...

DR. IRWIN REDLENER: It's extremely possible we'd have to quarantine hospitals, we'd have to quarantine sections of the city.

BRIAN ROSS: Dr. Redlener has been working with New York City officials to get ready for the deadly epidemic.

DR. IRWIN REDLENER: The city would look like a science fiction movie. This would look like an armed camp, basically.

BRIAN ROSS: You would ring a neighborhood in New York City with armed officers to keep people from leaving or going in?

DR. IRWIN REDLENER: Yes.

BRIAN ROSS: Actually shut down parts of New York City?

DR. IRWIN REDLENER: We might have to do that, correct.

LAURIE GARRETT: I could imagine that you would look at Grand Central Station and not see much of anybody wandering around at all. People would be afraid to take the subways because who wants to be in an enclosed airspace with a whole lot of other strangers never knowing which ones are carrying flu?

DR. IRWIN REDLENER: We might be seeing 200 to 350 people every single day dying from the flu in New York City.

BRIAN ROSS: Every single day?

DR. IRWIN REDLENER: Every single day. And a quarter to a third of those might be children.

BRIAN ROSS: And for hospitals, there would be scenes like the ones this month in Houston and New Orleans. Except the cots would be full of dying people.

LAURIE GARRETT: There wouldn't be equipment and personnel to staff them adequately that you could really call them a hospital. You might more or less call them warehouses for the ailing.

BRIAN ROSS: And as happened in New Orleans, there would be no place for the dead.

MICHAEL OSTERHOLM: If you look at the expected number of deaths that could occur in cities across the United States, we are wholly unprepared to process those bodies in a dignified and respectful way. We will run out of caskets literally within days.

BRIAN ROSS: University of Minnesota Professor Michael Osterholm is the director of the Center for Infectious Disease Research.

MICHAEL OSTERHOLM: That's the kind of realities that we have to start planning for now that unfortunately in most communities in this country we just haven't even begun to think about.

BRIAN ROSS: The prospects have been so bleak that in planning sessions held in New York City, some veteran emergency preparedness officials have been overwhelmed.

MICHAEL OSTERHOLM: If we have a repeat of a 1918-like experience, I can't imagine anything to be closer to a living hell than that experience of 12 to 24 months of pandemic influenza.

ANNOUNCER: Up next, some good news. There is a medicine that can help you survive. But can you get it in time? When we come back.

ANNOUNCER: "Primetime." Once again, Brian Ross.

EMCEE, MALE: Mr. George W. Bush, president of the United States of America.

BRIAN ROSS: On the same stage where he has warned the world of terrorism and weapons of mass destruction, President Bush this week warned the world must prepare for a new weapon of mass destruction, a global epidemic of killer flu.

PRESIDENT BUSH: If left unchallenged, this virus could become the first pandemic of the 21st century.

BRIAN ROSS: Are we prepared in this country today?

DR. IRWIN REDLENER: We're not even close to being prepared in this country. I mean, the short answer to the question are we prepared is absolutely not.

BRIAN ROSS: If that flu were to hit this country this winter, how bad?

DR. IRWIN REDLENER: If we had a significant worldwide epidemic of this particular avian flu, the H5N1 virus, I think we would see outcomes that would be virtually impossible to imagine, even to a world that has just witnessed some of the most horrible scenes of a natural disaster that any of us will ever see in our lifetimes.

BRIAN ROSS: For the victims, they at first wouldn't know if it's the kind of routine flu that comes every year or the killer flu called H5N1. If it's the killer flu, the world will stop, too.

MICHAEL LEAVITT, SECRETARY OF HEALTH AND HUMAN SERVICES: We'd do all we could to quarantine. We'd do all we could -- it's not a happy thought. It's something that keeps the president of the United States awake. It keeps me awake.

BRIAN ROSS: The man in charge of making sure this country is prepared for a killer flu epidemic is Secretary of Health and Human Services Michael Leavitt, who took office just this January. The plan calls for him to run operations out of this crisis center in Washington.

MICHAEL LEAVITT: This is a very serious version of a disease that can literally take lives by the millions.

BRIAN ROSS: Is this country prepared today for this epidemic?

MICHAEL LEAVITT: Not as prepared as we need to be. We're better prepared today than we were yesterday. We'll be better prepared tomorrow than we are today. But no one in the world is prepared enough yet.

BRIAN ROSS: So the answer is, no, we are not prepared?

MICHAEL LEAVITT: Not as prepared as we need to be.

BRIAN ROSS: The draft report of the Federal government's own emergency plan, examined by "Primetime," predicts as many as 200,000 Americans will die within a few months, considered a conservative estimate.

LAURIE GARRETT: Well, the first thing is everybody in America is going to say, where's a vaccine? And they're going to find out that it's really darn hard to make vaccine. It takes a really long time, and they may queue up in demand, but it's not there for them.

BRIAN ROSS: In fact, the draft report says it won't be until six months after the first outbreak that any vaccine will be available, and then only in limited supply.

LAURIE GARRETT: And even that's optimistic.

BRIAN ROSS: So if we're hit by this epidemic, there's not going to be vaccine for everybody.

LAURIE GARRETT: No.

BRIAN ROSS: But while there's no vaccine to stop the flu, there is one medicine to treat it and only one. Made at this plant in Switzerland by the Roche pharmaceutical company, it's called Tamiflu.

ADVERTISEMENT VOICE, MALE: If you feel flu-ish, see your doctor early.

BRIAN ROSS: Roche has been selling Tamiflu for years, but it was only recently that scientists realized it is the one medicine so far proven effective against the killer flu, H5N1. And that has created a huge demand and a critical shortage.

BRIAN ROSS: The whole world wants what's coming out of that one plant in Switzerland.

LAURIE GARRETT: Exactly.

BRIAN ROSS: Can they supply the whole world?

LAURIE GARRETT: No. All of the wealthiest countries in the world are trying to purchase stockpiles of Tamiflu. Our stockpile is around 2.5 million courses of treatment.

BRIAN ROSS: And the government knows that at least, or predicts, 200 million people would be infected?

LAURIE GARRETT: Looks like we have a shortage.

BRIAN ROSS: How many doses do we have of Tamiflu?

MICHAEL LEAVITT: Our objective is to have 20 million doses of Tamiflu, or enough for 20 million people.

BRIAN ROSS: Today?

MICHAEL LEAVITT: No, we don't have that today, but most ...

BRIAN ROSS: How much do we have today?

MICHAEL LEAVITT: Currently, we have about 6 million that have been both ordered and will be delivered this year.

BRIAN ROSS: On hand today?

MICHAEL LEAVITT: No, we have 2 million that are on hand today.

BRIAN ROSS: How is it that we don't have more?

MICHAEL LEAVITT: Well, first of all, no one does.

BRIAN ROSS: But officials in Australia say they do have more. And in Great Britain, officials say they will soon have enough for 1/4 of the population.

PROFESSOR JOHN OXFORD, ROYAL LONDON HOSPITAL: I think at the moment, with 2.5 million doses, it -you're pretty vulnerable.

BRIAN ROSS: European health officials at a conference this week in Malta said they were astonished at the U.S. lack of planning. Professor John Oxford of the Royal London Hospital.

PREOFESSOR JOHN OXFORD: The lack of advanced planning up to the moment in the United States in the sense of not having a huge stockpile, which I think your citizens deserve, has surprised me and I've been rather dismayed about it.

BRIAN ROSS: Faced with worldwide demand, the Roche company, which makes Tamiflu, has set up a first come, first serve waiting list with the United States nowhere near the top.

MICHAEL LEAVITT: Do we wish we had ordered it sooner and more of it? I suspect one could say, yes. Are we moving rapidly to assure that we have it? The answer to that is also yes.

BRIAN ROSS: Why didn't the U.S. order it sooner?

MICHAEL LEAVITT: I can't answer that. I don't know the answer.

BRIAN ROSS: It once again, just two weeks after Hurricane Katrina, raises questions about the Bush administration and its ability to plan for a predictable natural disaster.

DR. IRWIN REDLENER: We can't just wing it. When we wing it, we get New Orleans.

BRIAN ROSS: Even the president's closest ally on Capitol Hill, the Republican leader of the Senate, Bill Frist, is now sounding the alarm about the country's lack of Tamiflu.

SEN. BILL FRIST, MAJORITY LEADER: We are way under-prepared. What if it does break out? And it could, it could be tomorrow here in the United States. So the Tamiflu is what people would go after. It's what you're going to ask for, I'm going to ask for immediately.

BRIAN ROSS: Tamiflu is already in short supply for the public, and officials of the Roche company say there could well be a run on the medicine before this winter's flu season.

BRIAN ROSS: How will it work? Who will get the lifesaving drug? Who won't?

LAURIE GARRETT: As far as I know, there is no coherent plan for who will get the meager supplies.

BRIAN ROSS: With 300 million people, how do you decide who gets the 2.5 million doses?

MICHAEL LEAVITT: Well, that's part of our planning process.

BRIAN ROSS: Won't everyone want Tamiflu for themselves, for their families, if this hits? And you're going to have to say we don't have enough.

MICHAEL LEAVITT: Well, that's not something I want to say, and that's the reason we're moving so rapidly.

BRIAN ROSS: But you're going to have to, aren't you?

MICHAEL LEAVITT: Well, it isn't going to happen tomorrow. But if it happened the day after that, we would not be in as good a position as we -- as we will be in six months.

BRIAN ROSS: So for at least this coming winter, this country will be in much the same situation as it was in 1918.

DR. IRWIN REDLENER: We didn't have Tamiflu then and we didn't have the vaccine then. And we struggled to try to save people through the medical care that we had, which was pretty good. And we had a pretty sophisticated public health system. But the fact is, a lot of people died then.

BRIAN ROSS: And this time?

DR. IRWIN REDLENER: A lot of people will die.

This "Primetime" segment aired on Sept. 15, 2005.

Copyright © 2005 ABC News Internet Ventures

October 16, 2005 at 12:50 PM in Flu pandemic watch | Permalink | Top of page | Blog Home

Brussels says EU unprepared for bird flu

Preparedness for the flu is complicated by the fact that we don't know which vaccine is appropriate.

However, a study in the scientific journal Nature next week says resistance to Tamiflu has appeared in a girl with the H5N1 bird flu strain.

Another complication is short shelf life of the vaccine. Here is the latest from FT on the EU situation.

FT.com / Europe / Brussels briefing - Brussels says EU unprepared for bird flu

By Andrew Bounds and Tobias Buck in Brussels and Andrew Jack and Vincent Boland in Ankara
Published: October 14 2005 22:01 | Last updated: October 14 2005 22:01

Europe is not properly prepared for a flu pandemic and has inadequate supplies of vaccines and antiviral drugs, says an internal European Commission document obtained by the Financial Times.

With avian flu on its borders, the human vaccine situation in the EU is “far from satisfactory”, according to a note presented last Wednesday by Markos Kyprianou, health and consumer protection commissioner, to his colleagues ahead of a meeting of EU health ministers on October 20.

Some member states have reserved all available antiviral drug supplies for years to come, leaving countries that may be first hit by the disease without any access to drugs, it adds.

The news comes as the EU sent veterinary experts and scientists to Turkey and Romania, the first two European countries to register an outbreak. At an emergency meeting of national vets in Brussels on Friday, member states were advised to keep poultry isolated from migrating birds.

The internal EU document says 16 of the 25 members have informed Brussels about their supplies of antiviral drugs, to be used if avian flu jumps to humans. There are 10m doses in the EU and European Economic Area (Norway, Iceland and Liechtenstein), and a further 36m to be delivered by the end of 2007 enough for about 10 per cent of the EU population, against World Health Organisation recommendations for 25 per cent coverage.

The report said: “There are complaints from member states (and third countries) that orders from some countries have reserved all manufacturing capacity for several years to come, leaving no possibilities for others who may be hit first.”

It also said the situation was “far from satisfactory”, for pandemic vaccines. “Some member states have concluded advanced purchase agreements for the H5N1 virus vaccine”.

The EU warnings of capacity shortfalls will increase pressure on Roche, sole distributor of Tamiflu the principal flu antiviral drug as Cipla, an Indian drugs company, has said it is beginning to make a generic version in defiance of patent laws.

However, a study in the scientific journal Nature next week says resistance to Tamiflu has appeared in a girl with the H5N1 bird flu strain.

October 15, 2005 at 12:22 PM in Flu pandemic watch | Permalink | Top of page | Blog Home

Bird flu confirmed as deadly H5N1 strain

The H5N1 virus moves towards Europe proper. Still no evidence it has jumped from human to human.

Telegraph | News

(Filed: 15/10/2005)
The outbreak of bird flu in Romania has been confirmed as the strain that is potentially lethal in humans.

The Department for Environment, Food and Rural Affairs (Defra) has confirmed that that tests in Britain have shown that three ducks found dead in the Danube delta last week had the H5N1 strain of the disease.

Turkey has also reported an outbreak of bird flu, as fears grow in Europe over a potentially deadly outbreak.

Experts fear that the H5N1 strain might mutate into a virus which would then spread easily in the human population. Millions of people could be infected.

More than 60 people in Asia have died since 2003.

But Defra said more tests were needed in order to discover how similar it is to the viruses found in Turkey and Asia.

A spokesman for the department said: "The results are that it is H5N1 but further laboratory results are required in order to confirm the origin of the virus and the relationship of that with Turkey."

He added: "We have been working on the assumption that it would be H5N1 any way. It does not necessarily change our approach to preparedness. We believe that we are prepared and we urge all poultry farmers to keep vigilant."

The Danube delta in Romania is Europe's largest wetlands; playing host to many wild birds migrating from Russia, Poland and Scandinavia.

Romania has announced plans to slaughter thousands of birds to prevent the disease from spreading.

October 15, 2005 at 11:12 AM in Flu pandemic watch | Permalink | Top of page | Blog Home

Looking for the next outbreak

TheStar.com - Looking for the next outbreak

FluWatch a national system to detect early signs
RITA DALY
STAFF REPORTER
As one of Canada's physicians on the lookout for signs of human outbreaks of flu, Dr. Claire Nunes-Vaz holds more than a passing interest in the deadly bird flu sweeping through Southeast Asia.

Recruited as a "sentinel" physician by the College of Family Physicians of Canada, she is one of about 175 family doctors and nurses that form part of a national warning system called FluWatch that detects early signs of influenza outbreaks. Ontario has 75 sentinel physicians, half of whom practise in small towns and rural areas. While there's a slim chance any of them will see the first Canadian case of a pandemic flu, they are nonetheless the country's front-line defence against garden-variety flu and a highly pathogenic pandemic flu.

Efforts to combat the next flu pandemic have intensified in recent weeks. Officials from 80 countries, including Canada, met in Washington yesterday to discuss how to bolster surveillance. And U.S. President George W. Bush has urged drug companies to beef up vaccine production against the H5N1 bird flu virus.

Experts warn it's now the biggest health threat in the world.

"You always have to keep your radar out for something that doesn't quite fit," Nunes-Vaz said during an interview in her Lawrence Ave. office in North York. "If we get this mutated avian flu, some people will become very sick with respiratory distress and need support."

The recent outbreak at a Scarborough nursing home has driven home the challenges wrought by mysterious bugs and viruses that can't be quickly identified.

It took public health officials a week to figure out that 16 residents from the Seven Oaks Home for the Aged died from Legionnaires' disease, caused by a bacterium that often spreads through ventilation and plumbing systems. Until Thursday, lab experts were scrambling to identify the illness marked by typical flu-like symptoms of fever, chills, cough and fatigue.

With SARS still fresh in people's minds, bird flu spreading in Southeast Asia, a pandemic looming on the horizon and the latest nursing home outbreak, the role of sentinel physicians gearing up for the regular late fall flu season starting has taken on a new level of concern.

Once a week, the sentinel physicians fill out a special form noting patients who arrive in their office with flu-like illness and report to the Public Health Agency of Canada's immunization and respiratory infectious diseases division.

Some, like Nunes-Vaz, also take a viral swab from a feverish patient's nostril and send the sample to public health officials. Virus samples from sentinels, hospitals and clinics are sent to provincial, territorial and federal labs, whose findings are forwarded to Ottawa.

Their data is combined with epidemiologists who report absenteeism rates of 10 per cent or more from schools and workplaces, as well as flu outbreaks in hospitals and nursing homes in each region.

Based on these and other reports of virus strains circulating the globe, the World Health Organization's Global Influenza Surveillance Network decides on the best strains for the next year's flu vaccine.

That vaccine won't be effective against a pandemic, and there continues to be controversy about the efficacy of shots against regular flu. A recent study published in the Lancet, a prominent medical journal, suggested flu shots aren't that effective in the elderly.

Dr. Allison McGeer, director of infection control at Mount Sinai Hospital and a major player in the SARS crisis, said flu shots are "reasonably" effective — 30 to 70 per cent depending on the vaccine's efficacy that year — at preventing people from landing in hospital or dying.

"It would be very nice if we had a better vaccine. But the fact that we don't doesn't mean it is not cost-effective and doesn't save lives," she said.

This year's vaccine strain protects against three types — influenza A New Caledonia-like, A California-like, and B Shanghai-like virus strains. The federal government has ordered 11 million doses, which will arrive in doctor's offices, hospitals and public health clinics in the coming weeks.

Every flu season is a surprise. There is no way of knowing what strain of flu this year is going to hit. Or how widespread the season will be. And the problem with the influenza virus is that it is most infectious before symptoms show.

"If every sentinel in our area suddenly sent in a report one week that doubled or tripled our numbers, the flashing red warning lights would be going off," said Dr. Donald Collins-Williams, a sentinel physician in Mississauga. "It may just be a regular flu that's worse this year, or it may be something new."

The regular flu kills between 500 and 2,000 Canadians every year. Canada's pandemic plan warns that a pandemic flu — caused by an entirely new virus strain that humans will have no immunity to — could kill 11,000 to 58,000 people. Globally, it will kill millions.

The FluWatch program began in 1996, long before pandemic planning began. It was designed to monitor each year's flu season. SARS, and now the threat of a pandemic, has since led to year-round reporting.

McGeer says the program works well for monitoring regular flu, but it won't help much in detecting a pandemic.

Health experts predict the next pandemic will likely originate in Southeast Asia, where the highly pathogenic H5N1 virus is threatening to mutate and spark human-to-human transmission. It has resulted in the deaths of tens of millions of birds and has made the jump to humans, killing at least 60 people.

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October 8, 2005 at 05:48 PM in Flu pandemic watch | Permalink | Top of page | Blog Home

Bird flu strikes in Danube delta

Bird flu edges closer to Europe.

BBC NEWS | Europe | Bird flu strikes in Danube delta

Romania has reported its first bird flu cases but it is unclear if the strain found in the Danube delta is the deadly H5N1 virus which hit parts of Asia.

Scientists in Bucharest discovered flu antibodies in three domestic ducks found dead in a remote village late last month, the government said.

The exact strain is to be determined by a lab in the UK in the next few days.

According to an unconfirmed report, three more cases of bird flu have since been found and a cull has begun.

The first three cases were found in the village of Ceamurlia de Jos, Agriculture Minister Gheorghe Flutur said.

Access to the village near the Black Sea has been restricted.

Analysts say the Danube delta is particularly vulnerable because it lies along a route taken by migratory birds, which often mix with domestic ducks and geese.

Romanian monitors had been collecting samples for months and planning for such an eventuality, the minister said.

At least 60 people died after contracting H5N1 bird flu across Asia in the last two years although there is no evidence so far of the strain being passed between humans.

Fears rose that it was travelling west after poultry farms in eastern Russia reported numerous cases of bird flu in the summer.

'Second village'

Reuters news agency reported on Saturday that three more cases had been discovered in a different Danube delta village, Smardan.

Ion Agafitei, a senior veterinarian, was quoted by the agency as saying that the birds had tested positive for a flu virus.

In Ceamurlia de Jos, he said, 220 domestic birds had been culled in a bid to stamp out the virus.

Ceamurlia de Jos, Smardan and five other villages had been placed under quarantines, he added.

"The process is ongoing and will continue," he told Reuters.

Local farmers have been telling Romanian media that they recorded dozens of poultry dying in recent days.

October 8, 2005 at 02:53 PM in Flu pandemic watch | Permalink | Top of page | Blog Home

Mystery virus kills another 6

The local authorities in Toronto, Canada, assure everyone this is not Avian Flu, nor SARS, and that respitory illness is normal in Nursing Homes. However they also note that "normal" respitory illnessness result in almost no deaths.

The handling of this situation given the international concerns about flu, leaves a lot to be desired. As a minimum one would assume that a quarantine would be required, and that has not yet happened.

We should all note that all situations of epidemic (let alone pandemic which hasn't happened yet) always begin innocently with assumptions of localisation, and remonstrations to "not be concerned".

TheStar.com - Mystery virus kills another 6

Nursing home illness not SARS
But global media quick to condemn

ISABEL TEOTONIO AND ROB FERGUSON
STAFF REPORTERS

Six more residents of a Scarborough nursing home are dead from a mysterious flu-like virus, raising the death toll to 16, health officials said yesterday.

The cause of the outbreak at the Seven Oaks Home for the Aged remains unknown, but the outbreak has already garnered international headlines, evoking memories of the deadly SARS outbreak that crippled the city two years ago.

Despite the rising death toll, making it the city's worst respiratory outbreak at a long-term care facility in five years, Toronto's medical officer of health said the outbreak is under control. As of yesterday afternoon, he said, there had been no new cases reported in the previous 24 hours.

"The trend is in the right direction," said Dr. David McKeown at a news conference. "The outbreak is confined to residents and staff and people closely associated with this one facility. It's not a general health risk but it is a problem for these populations."

Since the illness was discovered on Sept. 25, five visitors, 13 employees and 70 residents have been affected. Thirty-four residents, two staff and two visitors are in seven hospitals in the city. All are in isolation.

The latest fatalities are three women aged 85, 92 and 96, and three men, 75, 84 and 89. All had underlying medical conditions that made them more susceptible to contracting the virus.

Officials have spoken with 170 people who had been in the facility, such as volunteers, visitors and staff. But because there's been no evidence of transmission, McKeown said he's not worried about contacts any of those individuals may have had with others.

While the deaths have shocked a city still reeling from the outbreak of severe acute respiratory syndrome in 2003, respiratory outbreaks in long-term care facilities are common, said Dr. Barbara Yaffe, director of communicable disease control with the city's public health department.

In Toronto each year, there are up to 200 respiratory outbreaks in long-term care facilities, she said, adding that over the past five years the city has experienced 500. The average death per outbreak has been fewer than one. Until this, the highest number of deaths had been 15.

While the death rate in Toronto is low, provincial rates show that in 4 per cent of these outbreaks, 20 per cent or more of those affected die.

While such outbreaks are common, the response to this one has been anything but routine, she said. "We are taking this as the highest priority and putting many, many staff hours into the investigation, control and management of this outbreak."

Although the deadly virus may never be determined, health officials have ruled out avian flu and influenza. They've also confirmed it is not SARS, which killed 44 people in 2003.

"The outbreak is confined to residents and staff and people closely associated with this one facility."

Dr. David McKeown, Toronto medical officer of health

Nonetheless, Toronto's image has been unjustly tarnished in international news reports, Health Minister George Smitherman said yesterday. "This is not SARS, this is not the beginning of a new pandemic."

News reports have shown up on CNN and the Australian Broadcasting Corporation, been picked up by news services including The Associated Press, Bloomberg, Pravda in Russia and a Chinese agency, and appeared in major newspapers in New York, Florida and Seattle.

The Australian story notes the Scarborough bug is "similar to SARS but which officials insist is not" and adds, "this ailment develops more quickly than SARS, as patients go from healthy to dead in just a few days." It also notes there was no quarantine at the nursing home and "Canadian authorities had been criticized during the SARS outbreak for being too slow to impose quarantine."

SARS hit Toronto in two waves during the spring of 2003, leading to warnings from the World Health Organization for people to avoid travel to the city, hurting tourism and convention bookings.

The government must closely monitor the tone of coverage, said a Progressive Conservative MPP who was tourism minister in the aftermath of the Sept. 11, 2001 terrorist attacks.

"I know how much of an impact international perceptions can have on our economy," said Tim Hudak (Erie-Lincoln).

"Information travels internationally very quickly, particularly to people considering travel to another jurisdiction," he said, calling on Smitherman to concentrate on "solving the problem here at home and perceptions internationally."

New Democrat MPP Marilyn Churley said it is "worrisome" how the Scarborough outbreak has grown despite the precautions in place.

Smitherman said any fears of a SARS-like outbreak are unwarranted because there is "no evidence" the flu outbreak has spread beyond the nursing home, thanks to precautions taken to isolate patients and the medical staff treating them.

"I can't take responsibility for how the media characterizes a story," he said. "Lessons that have been learned from SARS have been well applied here ... I'm very, very confident that the steps that have been taken are appropriate ones."

He noted deadly flu outbreaks in nursing homes are "regrettably not a new story."

Asked if the province needs to do a better job of getting that message out beyond Canada's borders, Smitherman said, "I'm conveying this to Ontarians. This is, I think, our primary responsibility."

"We're sticking to our knitting and doing all of those things locally that are prudent in the circumstances with city officials, through the public health unit and my ministry working together."

The outbreak shows the importance of getting a flu shot, which the government will again provide free to all residents starting in the next few weeks, and frequent hand washing in fall and winter to stop flu from spreading, he said.

October 6, 2005 at 08:50 AM in Flu pandemic watch | Permalink | Top of page | Blog Home

British flu pandemic 'will kill 50,000'

UK estimates 50,000 dead when the pandemic hits.

Britain, UK news from The Times and The Sunday Times - Times Online

By David Sanderson

A British flu pandemic is inevitable and will put the lives of tens of thousands of people at risk, according to the country’s top medical officer.

Sir Liam Donaldson said today that it was a "biological inevitability" that when the pandemic arrives, it would have a "serious impact".

The Chief Medical Officer for England said that the government’s contingency plans were looking at 50,000 deaths in the UK from the pandemic. He added that a pandemic could arrive at any time and that it was impossible to state that Britain was ready to cope.

Experts have said that avian flu will eventually mutate so that it can spread easily between humans, leading to a pandemic strain.

The H5N1 strain of Avian flu has killed over 60 people in south-east Asia in the last two years including, it is believed, five people in Indonesia who came into contact with affected poultry in the last month. The disease is believed to have been transmitted through the droppings or saliva of sick birds.

Dr David Nabarro of the World Health Organisation - which has already said a pandemic is only a matter of time - said today that a pandemic could kill between five million and 150 million people worldwide, depending on action taken now.

Questioned on what Britain was doing to prepare for the pandemic, Sir Liam Donaldson told BBC Radio 4’s The World at One that anti-viral drugs were being stockpiled. It is understood that about 14.6 million courses of Tamiflu - enough to protect a quarter of the population - have been stored.

Sir Liam added however: "Those won’t eliminate the problem but for people who get it, it should reduce the severity of the attack and it should prevent many people from dying."

Asked if he thought Britain was ready to face a pandemic he replied: "I don’t think I would ever want to be as bold as to claim that.

"It’s inevitable that when the flu pandemic comes, and we don’t know whether that will be next winter or even in five or 10 years’ time, that it will have a serious impact on the health of our country. That’s a biological inevitability."

Health authorities believe that if the bird flu virus mutates in Asia and cases start spreading, Britain will only have weeks - if not days - to prepare.

Travel restrictions, airport screening and other strategies would be of little use to stop cases multiplying rapidly, according to statistical models carried out by the Health Protection Agency.

Last month the experts from the European Union’s 25 member states met in Brussels to coordinate contingency plans to combat the threat. Their worries had mounted after the H5N1 strain was found to be moving westwards and had reached Siberia.

Amid fears that migrating birds arriving from the east could be carrying the virus, German and Dutch poultry farmers complied with government orders to move all their birds indoors.

After the recent outbreak in Indonesia, the United Nations warned its government to start a mass slaughter of poultry in affected areas.

Indonesian health minister Siti Fadilah Supari said last week it was an epidemic adding that there would be more deaths unless they could pinpoint the source. She later toned down her comments but the government has declared it an "extraordinary situation". It has given itself the powers to confine and forcibly treat anyone showing bird flu symptoms.

Australia has given the government 10,000 doses of Tamiflu but there are concerns there is not enough of the drug being produced.

About 300 million doses of vaccine are produced annually, but demand still exceeds supply. Flu affects between 5 per cent and 15 per cent of the world's population, resulting in between 3 million and 5 million cases of severe illness and 250,000 to 500,000 deaths each year.

First discovered in China in 1997, bird flu has infected more than 100 humans since 2003. It has a high mortality rate, with more than 60 dead in Vietnam, Thailand, Cambodia and Indonesia.

October 5, 2005 at 10:43 PM in Flu pandemic watch | Permalink | Top of page | Blog Home

Bird flu reminds scientists of virus that killed 50m people

An analysis of the re-created pathogen has shown that, like its modern cousin, it began as a bird virus and jumped species into humans with mutations that made it peculiarly virulent and lethal.

World news from The Times and the Sunday Times - Times Online

By Mark Henderson
It is mutating in the same way as the germ that cause the 1918 pandemic
FEARS that avian flu will trigger a global pandemic that could kill up to 150 million people intensified yesterday after research revealed similarities between the virus and possibly the deadliest germ in history.

Scientists have re-created the “Spanish flu” virus that killed up to 50 million people in 1918-19 and shown that it shared traits with the H5N1 strain of avian flu.

An analysis of the re-created pathogen has shown that, like its modern cousin, it began as a bird virus and jumped species into humans with mutations that made it peculiarly virulent and lethal.

A related study has identified that several of these mutations are also present in the H5N1 strain that has killed at least 60 people in Thailand, Vietnam, Cambodia and Indonesia. This could mean that the contemporary strain is starting along the evolutionary pathway that transformed a bird virus into a human-killer in 1918.

Jeffrey Taubenberger, of the US Armed Forces Institute of Pathology, who contributed to both studies, said: “This suggests that these H5N1 viruses might be acquiring the ability to adapt to humans, increasing their pandemic risk.” Insights from the work promise to assist the development of drugs against highly virulent forms of flu, and could provide a “checklist” of dangerous genetic traits that would improve surveillance of hazardous strains.

The research also indicates that the Spanish flu jumped species directly from birds to humans. The less serious pandemics of 1957 and 1968 began when an avian virus first mingled its genes with those of a flu strain that could already infect people, either in a human or in animals such as pigs that can harbour both varieties.

If a direct jump has occurred once, it could occur again, providing a fresh route by which modern avian flu could evolve. “For H5N1, it could go either way,” Dr Taubenberger said. “There is still a risk that H5N1 could become pandemic through reassortment with a contemporary human flu strain, but it’s also possible that it could completely adapt to humans like the virus did in 1918.”

The discoveries come a week after David Nabarro, who was appointed last Thursday as the UN co-ordinator for avian and human influenza, said that avian flu had the potential to kill 150 million people.

Sir Liam Donaldson, Britain’s chief medical officer, then said that this country’s contingency plans assume that at least 50,000 people would die here in such an outbreak.

Indonesia, the fourth country to suffer human cases of H5N1 flu, reported a seventh death yesterday, of a 23-year-old man, though only three of these are confirmed to have been caused by the virus.

Dr Taubenberger’s study, published in the journal Nature, has mapped the genetic code of the H1N1 Spanish flu strain, using viral material from a female victim preserved in permafrost in Alaska. Another group, led by Terrence Tumpey, of the US Centres for Disease Control (CDC), advised by Dr Taubenberger, used this information to reconstruct the H1N1 virus. These results are published in the journal Science.

Vials of the re-created virus are stored in a secure CDC laboratory. Julie Geberding, director of the CDC, said that producing the virus carries little risk to the public as human populations have a residual immunity to the H1N1 strain, making it unlikely that an accidental release could itself start a pandemic.

Dr Taubenberger said: “In the case of the H5N1 viruses we do find some parallels. This suggests the possibility that the H5 viruses are being exposed to some human adaptive process and might be acquiring these changes, in the sense that they might be going down a similar pathway that led to 1918.”

PANDEMICS PAST

# “Spanish flu” is thought to have killed as many as 50 million people

# It began early in 1918, and reached its peak towards the end of that year. The pandemic subsided in 1919

# The pathogen that caused the virus was not known at the time. The influenza virus was identified in 1933, and the Spanish flu strain is now known to have been the H1N1 variety

# Particularly virulent, it caused lung inflammation and haemorrhaging, and an exceptionally high number of deaths among adults aged between 18 and 34

# Other flu pandemics struck in 1957 (the “Asian flu”) which killed about four million, and in 1968 (the “Hong Kong flu”) which killed about one million

October 5, 2005 at 10:41 PM in Flu pandemic watch | Permalink | Top of page | Blog Home

1918 killer flu 'came from birds'

Its appears birds have been the culprits before in the incidence of Flu pandemics.

BBC NEWS | Health | 1918 killer flu 'came from birds'

The Spanish flu virus that killed 50 million people in 1918-19 was probably a strain that originated in birds, research has shown.

US scientists have found the 1918 virus shares genetic mutations with the bird flu virus now circulating in Asia.

Writing in Nature, they say their work underlines the threat the current strain poses to humans worldwide.

A second paper in Science reveals another US team has successfully recreated the 1918 virus in mice.

The virus is contained at the US Centers for Disease Control and Prevention under stringent safety conditions.

It is hoped to carry out experiments to further understand the biological properties that made the virus so virulent.

The virus was recreated from data produced by painstaking research by a team from the US Armed Forces Institute of Pathology.

Lung tissue samples

Working on virus samples from the remains of victims of the 1918 pandemic,