Non-vector borne  

Avian Influenza Update Information

Avian Influenza (Bird Flu): Implications for Human Disease
May 16th, 2007
Source: CIDRAP

Avian Influenza, human cases in Indonesia
May 16th, 2007
Source: World Health Organization (WHO), CSR, Disease Outbreak News

As of Wed 16 May 2007, WHO can now confirm 15 additional cases, including 13 deaths, of human infection with H5N1 avian influenza that occurred in Indonesia from the end of January 2007 up to the present and has updated its table of confirmed human cases accordingly. Testing for H5N1 influenza virus infections is not done routinely by many laboratories, and among the laboratories that do test for H5N1, experience and levels of diagnostic capacities can vary (see WHO criteria). WHO had previously required external confirmation of laboratory results from Indonesia, but following a formal on-site assessment of the capacity of the national laboratory in Jakarta to diagnose H5 avian influenza viruses, WHO will now accept the results from the national laboratory, in collaboration with the Eijkman Institute, without further external confirmation.

The assessment was carried out by a WHO team of virologists and laboratory scientists from the WHO Collaborating Centre in Tokyo, Japan, the national influenza centres of India and Thailand, the WHO Regional Office for South-East Asia and the WHO Country Office of Indonesia. The following additional cases of human infection with H5N1 avian influenza have been confirmed. Seven of these cases had exposure to sick or dead poultry; the source of infection is unknown for 8 cases.

Sex / Age / Location / Onset date / Hospitalized / Outcome

M / 30 / West Java / 25 Jan 2007 / 31 Jan 2007 / Recovered
F / 16 / Central Jakarta / 31 Jan 2007 / 5 Feb 2007 / Recovered
F / 20 / West Java / 2 Feb 2007 / 9 Feb 2007 / Died 11 Feb 2007
F / 20 / East Java / 28 Feb 2007 / 8 Mar 2007 / Died 19 Mar 2007
M / 32 / East Jakarta / 9 Mar 2007 / 13 Mar 2007 / Died 14 Mar 2007
F / 22 / South Sumatra / 10 Mar 2007 / 23 Mar 2007 / Died 24 Mar 2007
M / 16 / West Java / 4 Mar 2007 / 24 Mar 2007 / Died 25 Mar 2007
M / 39 / East Java / 19 Mar 2007 / 24 Mar 2007 / Died 28 Mar 2007
M / 14 / West Sumatra / 15 Mar 2007 / 22 Mar 2007 / Died 24 Mar 2007
F / 29 / Jakarta / 20 Mar 2007 / 23 Mar 2007 / Died 28 Mar 2007
F / 23 / Jakarta / 28 Mar 2007 / 31 Mar 2007 / Died 1 Apr 2007
F / 15 / Jakarta / 28 Mar 2007 / 30 Mar 2007 / Died 5 Apr 2007
M / 29 / Central Java / 24 Mar 2007 / 30 Mar 2007 / Died 5 Apr 2007
F / 29 / Riau / 27 Apr 2007 / 28 Apr 2007 / Died 3 May 2007
F / 26 / North Sumatra / 3 May 2007 / 8 May 2007 / Died 12 May 2007

Publication of these data removes the discrepancy between the number of human cases of avian H5N1 influenza recognized by the Indonesian Ministry of Health and the number confirmed by the World Health Organization, a development to be welcomed. The number of confirmed human cases of avian H5N1 influenza in Indonesia is now accepted as 96, which includes 76 deaths. The global total of confirmed cases is now computed as 306, including 185 deaths. The adjusted WHO cumulative table of confirmed human cases of avian H5N1 influenza can be viewed here.

See also:
Avian influenza, human (78): Indonesia 20070514.1539
Avian influenza, human (77): Indonesia 20070513.1527
Avian influenza, human (76): Indonesia 20070509.1493
Avian influenza, human (75): Indonesia 2007052007.1476
Avian influenza, human (74): WHO 20070421.1306
Avian influenza, human (69): Indonesia 2007042007.1173
Avian influenza, human (68): Cambodia, Indonesia 20070406.1161
Avian influenza, human (67): Indonesia, Kuwait NOT 20070405.1152
Avian influenza, human (66): Indonesia, Kuwait 20070404.1145
Avian influenza, human (65): Egypt, Indonesia 20070403.1134
Avian influenza, human (61): China, Indonesia 20070329.1080
Avian influenza, human (60): Egypt, Indonesia, WHO 20070328.1067
Avian influenza, human (59): Egypt, Indonesia, WHO 20070327.1061
Avian influenza, human (56): Egypt, Indonesia, WHO 20070320.0985
Avian influenza, human (19): Egypt, Indonesia 20070123.0305
Avian influenza, human (17): Egypt, Indonesia 20070120.0271
Avian influenza, human (13): Egypt, Indonesia 20070115.0198]

Avian Influenza, human: Food and Drug Administration-approved vaccine
April 18th, 2007

The U.S. Food and Drug Administration on April 17th, 2007 approved a human vaccine against the H5N1 influenza virus, marking the first such approval in the U.S. In a press release the agency said that, should H5N1 develop the ability to spread readily from person to person: "The vaccine may provide early limited protection in the months before a vaccine tailored to the pandemic strain of the virus could be developed and produced." The vaccine will be kept in a federal stockpile and available only through public health officials; it is approved for those 18 to 64 who are at increased risk for H5N1 exposure.

Press release:
The U.S. Food and Drug Administration (FDA) today announced the first approval in the United States of a vaccine for humans against the H5N1 influenza virus, commonly known as avian or bird flu. The vaccine could be used in the event the current H5N1 avian virus were to develop the capability to efficiently spread from human to human, resulting in the rapid spread of the disease across the globe. Should such an influenza pandemic emerge, the vaccine may provide early limited protection in the months before a vaccine tailored to the pandemic strain of the virus could be developed and produced. "The threat of an influenza pandemic is, at present, one of the most significant public health issues our nation and world faces," said Andrew C. von Eschenbach, M.D., Commissioner of Food and Drugs. "The approval of this vaccine is an important step forward in our protection against a pandemic." The H5N1 virus is one version of the influenza A virus commonly found in birds. Unlike seasonal influenza, where infection ranges from mild to serious symptoms in most people, the disease caused by H5N1 is far more severe and happens quickly, with pneumonia and multi-organ failure commonly seen.

While there have been no reported human cases of H5N1 infection in the United States, almost 300 people worldwide have been infected with this virus since 2003 and more than half of them have died. To date, H5N1 influenza has remained primarily an animal disease but should the virus acquire the ability for sustained transmission among humans, people will have little immunity to this virus and the potential for an influenza pandemic would have grave consequences for global public health.

"The timing and severity of an influenza pandemic is uncertain, but the danger remains very real," said Jesse L. Goodman, M.D., M.P.H., Director of FDA's Center for Biologics Evaluation and Research. "We are working closely with other government agencies, global partners
and the vaccine industry to facilitate the development, licensure and availability of needed supplies of safe and effective vaccines to protect against the pandemic threat."

The vaccine was obtained from a human strain and is intended for immunizing people 18 through 64 years of age who could be at increased risk of exposure to the H5N1 influenza virus contained in the vaccine. H5N1 influenza vaccine immunization consists of two intramuscular injections, given approximately one month apart. The manufacturer, Sanofi Pasteur Inc., will not sell the vaccine commercially. Instead, the vaccine has been purchased by the federal government for inclusion within the U.S. Strategic National Stockpile for distribution by public health officials if needed. The vaccine will be manufactured at Sanofi Pasteur's Swiftwater, Pa., facility.
A clinical study was conducted to collect safety information and information on recipient's immune responses and to determine the appropriate vaccine dose. A total of 103 healthy adults received a 90 microgram dose of the vaccine by injection followed by another 90
microgram dose 28 days later. In addition, there were approximately 300 healthy adults who received the vaccine at doses lower than 90 micrograms and a total of 48 who received a placebo injection.

The vaccine was generally well tolerated, with the most common side effects reported as pain at the injection site, headache, general ill
feeling and muscle pain. The study showed that 45 percent of individuals who received the 90 microgram, two-dose regimen developed
antibodies at a level that is expected to reduce the risk of getting influenza. Although the level of antibodies seen in the remaining individuals did not reach that level, current scientific information on other influenza vaccines suggests that less than optimal antibody levels may still have the potential to help reduce disease severity and influenza-related hospitalizations and deaths. Additional information on this H5N1 influenza vaccine is being collected on safety and effectiveness in other age groups and will be available to the FDA in the near future.

With the support of the FDA, the U.S. National Institutes of Health and other government agencies, Sanofi Pasteur and other manufacturers are working to develop a next generation of influenza vaccines for enhanced immune responses at lower doses, using technologies intended to boost the immune response. Meanwhile, the approval and availability of this vaccine will enhance national readiness and the nation's ability to protect those at increased risk of exposure. The U.S. Strategic National Stockpile is maintained by the U.S. Centers for Disease Control and Prevention. It contains large quantities of medicine and medical supplies to protect the American public if there is a public health emergency, which can be delivered to any state in the United States within 12 hours. For more information on the government's preparedness efforts, visit: <>.

See also:
Avian influenza, human (188): WHO recombinant vaccine 20061224.3601
Avian influenza, human (123): Thailand, vaccine update 20060818.2315
Avian influenza - Eurasia (110): China, live vaccine 20051226.3685
Avian influenza A (H5N1) virus, human vaccine prospects 20050807.2299
Avian influenza, human - East Asia (109): vaccine prototypes 20050801.2234
Avian influenza A (H5N1) virus, human vaccine (06) 20040410.0975
Avian influenza A (H5N1) virus, human vaccine (05) 20040403.0917
Avian influenza A (H5N1) virus, h

Human vaccine (04) 20040401.0889
Avian influenza A (H5N1) virus, human vaccine (03) 20040130.0349
Avian influenza A (H5N1) virus, human vaccine (02) 20040129.0342
Avian influenza A (H5N1) virus, human vaccine prospects 20040125.0300]

Egypt - confirmation of 24th human case
March 17th, 2007
World Health Organization (WHO), CSR, Disease Outbreak News

As of March 12th, 2007, the Egyptian Ministry of Health and Population has announced a new human case of avian influenza A(H5N1) virus infection. The case was confirmed by the Egyptian Central Public Health Laboratory and by the US Naval Medical Research Unit No. 3 (NAMRU-3). The 4-year-old boy was from Ad Daqahliyah Governorate. He developed  symptoms on Wed 7 Mar 2007, was admitted to hospital on March 8th, 2007, and his condition remains stable. The boy was exposed to sick birds during the 1st 3 days of March, 2007, Contacts of the boy remain healthy and are being closely monitored. Of the 24 cases confirmed to date in Egypt, 13 have been fatal.

Worldwide - Cumulative number of confirmed cases and fatalities March 12th, 2007 World Health Organization, Cumulative number of human cases of avian influenza A/(H5N1) [Link]

As of March 12th, 2007, the number of countries with confirmed human cases of H5N1 avian influenza has increased to 12. The ollowing are the cumulative numbers of confirmed human cases of avian influenza A/(H5N1) reported to WHO:

Country and year
2003 / 2004 / 2005 / 2006 / 2007 / Total

cases: 0 / 0 / 0 / 8 / 0 / 8
deaths: 0 / 0 / 0 / 5 / 0 / 5

cases: 0 / 0 / 4 / 2 / 0 / 6
deaths: 0 / 0 / 4 / 2 / 0 / 6

cases: 1 / 0 / 8 / 13 / 1 / 23
deaths: 1 / 0 / 5 / 8 / 0 / 14

cases: 0 / 0 / 0 / 1 / 0 / 1
deaths: 0 / 0 / 0 / 0 / 0 / 0

cases: 0 / 0 / 0 / 18 / 6 / 24
deaths: 0 / 0 / 0 / 10 / 3 / 13

cases: 0 / 0 / 19 / 56 / 6 / 81
deaths: 0 / 0 / 12 / 46 / 5 / 63

cases: 0 / 0 / 0 / 3 / 0 / 3
deaths: 0 / 0 / 0 / 2 / 0 / 2

cases: 0 / 0 / 0 / 0 / 1 / 1
deaths: 0 / 0 / 0 / 0 / 1 / 1

cases: 0 / 0 / 0 / 0 / 1 / 1
deaths: 0 / 0 / 0 / 0 / 1 / 1

cases: 0 / 17 / 5 / 3 / 0 / 25
deaths: 0 / 12 / 2 / 3 / 0 / 17

cases: 0 / 0 / 0 / 12 / 0 / 12
deaths: 0 / 0 / 0 / 4 / 0 / 4

Viet Nam
cases: 3 / 29 / 61 / 0 / 0 / 93
deaths: 3 / 20 / 19 / 0 / 0 / 42

cases: 4 / 46 / 97 / 116 / 15 / 278
deaths: 4 / 32 / 42 / 80 / 10 / 168

The total number of cases includes the number of deaths. WHO reports only laboratory-confirmed cases.

No human cases of avian A/(H5N1) influenza have been reported since the beginning of the year (2007) from Azerbaijan, Cambodia, Djibouti, Iraq, Thailand, Turkey and Viet Nam.

See also:
Avian influenza, human (49): Egypt 20070311.0860
Avian influenza, human (44): China, Egypt, WHO 20070301.0732
Avian influenza, human (43): China, Egypt 20070228.0718
Avian influenza, human (38): Egypt, WHO 20070216.0584
Avian influenza, human (37): Egypt 20070214.0557
Avian influenza, human (34): Egypt, WHO 20070207.0481
Avian influenza, human (31): Egypt 20070206.0469
Avian influenza, human (19): Egypt, Indonesia 20070123.0305
Avian influenza, human (17): Egypt, Indonesia 20070120.0271
Avian influenza, human (15): Egypt, drug resistance, correction 20070119.0253
Avian influenza, human (15): Egypt, drug resistance 20070118.0238
Avian influenza, human (13): Egypt, Indonesia 20070115.0198]


Date: March 12th, 2007
From: ProMED-mail
Source: Xinhua News Agency

The Indonesia Health Ministry reported on March 12th that 85 human bird flu cases have been recorded in the country after confirmation of infection of a 20-year-old woman by the avian influenza virus.

The woman, from East Java province, had a history of contact with chicken, an anti-bird flu official of the Ministry, Joko Sugiyono, said. "She was positive for bird flu," he told Xinhua. "The woman cleaned a spot where her neighbors threw some dead chickens," said Sugiyono. The [patient] was hospitalized in the Mojokerto Regency Hospital of the province on 28 Feb 2007, and on 8 Mar 2007, she was transferred to a hospital in Surabaya, the capital city of the province.

Indonesia has recorded 64 fatalities among the 85 people who have contracted the disease, Sugiyono said.

The number of bird flu cases in the country has increased recently after months of absence of new cases. The Indonesian health authorities have imposed a firm policy separating fowls from humans and surveillance on the viruses, the official said, adding that the authorities forbid raising fowls in residential areas. Over 32 million families in Indonesia's vast archipelago have been raising chickens in their back yards, Indonesian Agriculture Minister, Anton Apriantono, has said.

Byline: Liu Dan

There is now a discrepancy between the number of cases confirmed as H5N1 virus positive by the Indonesia Ministry and the number recognized by the World Health Organization (WHO). As of Mon 12 Mar 2007, the WHO list gives the number of confirmed cases as 81 and the number of deaths as 63.

see also:
Avian influenza, human (40): Indonesia  20070224.0677
Avian influenza, human (36): Indonesia  20070211.0524
Avian influenza, human (33): Indonesia  20070208.0496
Avian influenza, human (32): Indonesia  20070207.0476"
Avian influenza, human (25): Indonesia, WHO  20070129.0382
Avian influenza, human (22): Indonesia  20070125.0336
Avian influenza, human (21): Indonesia, susp.  20070124.0316
Avian influenza, human (19): Egypt, Indonesia  20070123.0305
Avian influenza, human (17): Egypt, Indonesia  20070120.0271
Avian influenza, human (15): Egypt, drug resistance, correction  20070119.0253
Avian influenza, human (15): Egypt, drug resistance  20070118.0238
Avian influenza, human (19): Egypt, Indonesia  20070123.0305
Avian influenza, human (17): Egypt, Indonesia  20070120.0271
Avian influenza, human (15): Egypt, drug resistance, correction  20070119.0253
Avian influenza, human (15): Egypt, drug resistance  20070118.0238
Avian influenza, human (14): Indonesia, WHO  20070116.0204
Avian influenza, human (13): Egypt, Indonesia  20070115.0198
Avian influenza, human (12): Indonesia  20070114.0187
Avian influenza, human (11): Indonesia, WHO  20070113.0173
Avian influenza, human (10): Indonesia, WHO  20070112.0161
Avian influenza, human (09): Indonesia  20070111.0133
Avian influenza, human (07): Indonesia, China WHO  20070110.0109
Avian influenza, human (05): Indonesia, WHO  20070109.0090
Avian influenza, human (04): Indonesia  20070108.0080]


Date: March 12th, 2007
From: ProMED-mail
Source: Xinhua News Agency

The Indonesia Health Ministry reported on March 12th that 85 human bird flu cases have been recorded in the country after confirmation of infection of a 20-year-old woman by the avian influenza virus.

The woman, from East Java province, had a history of contact with chicken, an anti-bird flu official of the Ministry, Joko Sugiyono,
said. "She was positive for bird flu," he told Xinhua. "The woman cleaned a spot where her neighbors threw some dead chickens," said Sugiyono. The [patient] was hospitalized in the Mojokerto Regency Hospital of the province on 28 Feb 2007, and on 8 Mar 2007, she was transferred to a hospital in Surabaya, the capital city of the province.

Indonesia has recorded 64 fatalities among the 85 people who have contracted the disease, Sugiyono said.

The number of bird flu cases in the country has increased recently after months of absence of new cases. The Indonesian health
authorities have imposed a firm policy separating fowls from humans and surveillance on the viruses, the official said, adding that the authorities forbid raising fowls in residential areas. Over 32 million families in Indonesia's vast archipelago have been raising chickens in their back yards, Indonesian Agriculture Minister, Anton Apriantono, has said.

Byline: Liu Dan

There is now a discrepancy between the number of cases confirmed as H5N1 virus positive by the Indonesia Ministry and the number recognized by the World Health Organization (WHO). As of Mon 12 Mar 2007, the WHO list gives the number of confirmed cases as 81 and the number of deaths as 63.

see also:
Avian influenza, human (40): Indonesia  20070224.0677
Avian influenza, human (36): Indonesia  20070211.0524
Avian influenza, human (33): Indonesia  20070208.0496
Avian influenza, human (32): Indonesia  20070207.0476"
Avian influenza, human (25): Indonesia, WHO  20070129.0382
Avian influenza, human (22): Indonesia  20070125.0336
Avian influenza, human (21): Indonesia, susp.  20070124.0316
Avian influenza, human (19): Egypt, Indonesia  20070123.0305
Avian influenza, human (17): Egypt, Indonesia  20070120.0271
Avian influenza, human (15): Egypt, drug resistance, correction  20070119.0253
Avian influenza, human (15): Egypt, drug resistance  20070118.0238
Avian influenza, human (19): Egypt, Indonesia  20070123.0305
Avian influenza, human (17): Egypt, Indonesia  20070120.0271
Avian influenza, human (15): Egypt, drug resistance, correction  20070119.0253
Avian influenza, human (15): Egypt, drug resistance  20070118.0238
Avian influenza, human (14): Indonesia, WHO  20070116.0204
Avian influenza, human (13): Egypt, Indonesia  20070115.0198
Avian influenza, human (12): Indonesia  20070114.0187
Avian influenza, human (11): Indonesia, WHO  20070113.0173
Avian influenza, human (10): Indonesia, WHO  20070112.0161
Avian influenza, human (09): Indonesia  20070111.0133
Avian influenza, human (07): Indonesia, China WHO  20070110.0109
Avian influenza, human (05): Indonesia, WHO  20070109.0090
Avian influenza, human (04): Indonesia  20070108.0080]

1/25/2007 Update: Avian Influenza, Poultry vs. Migratory Birds

A. Marm Kilpatrick*, Aleksei A. Chmura*, David W. Gibbons, Robert C. Fleischer, Peter P. Marra, and Peter Daszak* * Predicting the global spread of H5N1 avian influenza. Consortium for Conservation Medicine, New York, NY 10001; Royal Society for the Protection of Birds, Sandy, Bedfordshire SG19 2DL, United Kingdom; and National Museum

The spread of highly pathogenic H5N1 avian influenza into Asia, Europe, and Africa has resulted in enormous impacts on the poultry industry and presents an important threat to human health. The pathways by which the virus has and will spread between countries have been debated extensively, but have yet to be analyzed comprehensively and quantitatively. We integrated data on phylogenetic relationships of virus isolates, migratory bird movements, and trade in poultry and wild birds to determine the pathway for 52 individual introduction events into countries and predict future spread. We show that 9 of 21 of H5N1 introductions to countries in Asia were most likely through poultry, and 3 of 21 were most likely through migrating birds. In contrast, spread to most (20/23) countries in Europe was most likely through migratory birds. Spread in Africa was likely partly by poultry (2/8 introductions) and partly by migrating birds (3/8). Our analyses predict that H5N1 is more likely to be introduced into the Western Hemisphere through infected poultry and into the mainland United States by subsequent movement of migrating birds from neighboring countries, rather than from eastern Siberia. These results highlight the potential synergism between trade and wild animal movement in the emergence and pandemic spread of pathogens and demonstrate the value of predictive models for disease control.

<< PNAS Article - Predicting the global spread of H5N1 avian influenza >>

Katinka de Balogh
International Project Coordinator - Avian Influenza
Emergency Centre for Transboundary Animal Diseases
Food and Agriculture Organization (FAO)

5/25/2006 Update: HPAI H5N1 Virus Infection in Animals (ProMED)

A. H5N1 infections in European Union countries

During the first few months of 2006, 13 of the 26 European Union (EU) countries have already reported confirmed cases of avian influenza H5N1 almost entirely in wild birds. These are Austria, Czech Republic, Denmark, France, Germany, Greece, Hungary, Italy, Poland, Slovakia, Slovenia, Sweden and United Kingdom. All of these are in wild birds apart from France, Germany, Sweden and Denmark. In Germany, at least 3 cats and one stone-marten were confirmed infected with the H5N1 strain of avian influenza last March.

This rate of infection in wild birds in Europe in the early spring was associated with infected wild birds that travelled west from Russia and Central Asia. This seems to have passed. There was a steep decline towards the end of April, but unfortunately, as OIE reports, there was the first case of H5 bird flu virus in poultry in Denmark. The virus was found in a farm in Hundslev, on Fyn Island in the centre of the country. According to the Danish Veterinary and Food Administration (DFVA), all the birds have been destroyed and zones of protection (3 km) and surveillance (10 km) have been set up around the area where the infected birds were found. A very few people could have been exposed; however there is no sign of infection in any of these though they were offered anti-virals. Denmark had reported a number of cases of H5N1 avian flu in wild birds, but this is the first report of the H5 virus in poultry.

Concern had been expressed that more infections could come north from Africa. The decline in the reports in Europe is casting doubts on this and [on] the role that the northward spring migration may play in the arrival of infected birds to the EU. This will be discussed during a meeting in Rome next week, organised by FAO, OIE, and their partners. The next period of vulnerability may be in the autumn and winter as birds move out of the areas where birds are known to be infected in Russia.

B. H5N1 infections in non-European Union Countries

Countries with wild birds infected with H5N1, with the date of latest reports to OIE in brackets, are Bulgaria (February 12, 2006), Croatia (April 12) and Switzerland (May 16). Affected countries with poultry positive to H5N1, with date of latest reports to OIE in brackets, include Serbia-Montenegro (15 Mar), Kazakhstan (March 21), Georgia (March 27), Israel (April 4) Azerbaijan (April 10), Albania (April 12), Jordan (April 16), Turkey (April 20) and Romania (May 16).

Romania, after having declared eradicated the disease on April 21, 2006, reported new outbreaks affecting poultry on May 16 in the district of Brasov, where for the first time in Romania, an industrial farm was affected. An unspecified amount of poultry meat, already distributed, is being recalled from the market. Media reports cases in 14 villages, and nearby districts: one million domestic birds might be culled to avoid the spread of the disease. Quarantine measures were taken in Bucharest, where outbreaks were reported in the eastern part of the city. The Romanian authorities have now asked for assistance and a multidisciplinary team is being assembled to travel to Romania to assist on both the animal and human sides. Though some people have been investigated for possible human infections none have been detected to date (May 24, 2006).

In Russia, an outbreak has been reported in a production farm in Novosibirsk (Western Siberia), for the first time in 2006; though as specimens are not shared with external laboratories, these infections cannot be regarded as confirmed. Other outbreaks reported in the Siberian region have been reported but not confirmed by external laboratories.

Afghanistan, Pakistan, Malaysia, India, China, Cambodia, Burma and Vietnam are among the countries where there have been confirmed infections in the past but there are no recent reports. In Indonesia, in the same village of Northern Sumatra where this week 6 human deaths have been confirmed in a single family, 10 of 11 pigs samples have tested positive for avian influenza according to media reports. These animals are apparently seropositive to H5 antigen on HI testing but these results need to be verified. Serology in animals is difficult and even if positive do not provide information on whether these animals actually
carried the virus or infected people. The latest report to OIE of positive birds dates back to April 20, 2006.

In Laos, a duck has been tested positive to H5N1 in a farm located at 20 km to the South of Vientiane. It is the first isolation after the reports of 2004.

A total of 8 African countries (Burkina Faso, Cameroon, Egypt, Niger, Nigeria, Sudan, Cote d'Ivoire and Djibouti) have been reporting infections in poultry to OIE.

For Cote d'Ivoire, confirmation of the OIE reference laboratory in Padua, Italy is still awaited. In Nigeria, a new outbreak has been confirmed in an industrial farm of Kano.

In Djibouti, 3 chickens have been confirmed as H5N1 by the laboratory of NAMRU in Cairo. The avian cases in Djibouti have not yet been notified to the OIE. It is reported that farmers are hampering the process of culling, because they are not satisfied that they will be compensated immediately.

It is suspected by some authorities that trade (legal or otherwise) of infected poultry and poultry products, combined with weak biosecurity and veterinary infrastructures, rather than wild birds, have been mostly responsible for either the appearance or at least the spread of the infection in Africa. This would be a similar picture to the early phases of the H5N1 epidemics in some South East Asia countries.

see also:
Avian influenza (123) - Romania                        20060523.1454
Avian influenza (122) - Romania (Bucharest), poultry   20060522.1443
Avian influenza (121) - Burkina Faso                   20060521.1442
Avian influenza (120) - Russia, Czech Republic         20060520.1433
Avian influenza (119) - Denmark, poultry, OIE          20060520.1417
Avian influenza (118) - Indonesia (pigs: not)          20060519.1413
Avian influenza (117) - Indonesia (pigs: susp)         20060518.1401
Avian influenza (116) - Denmark (poultry)              20060518.1400
Avian influenza (115) - Indonesia (Irian Jawa Barat)   20060518.1398
Avian influenza (114) - China, Laos                    20060518.1394
Avian influenza (113) - Egypt, Europe, Indonesia, ...  20060517.1387
Avian influenza (112) - Sudan, OIE                     20060517.1386]

5/4/2006 Update: 10 Key Facts About Avian Influenza (available in 20 languages)

Influenza Update May 4, 2006
10 Key Facts About Avian Influenza (available in 20 languages)

A. Core messages

  1. Avian influenza type H5N1 is a disease currently affecting birds in several parts of the world. For the moment, in the EU, most of the affected birds are wild waterfowl such as swans and ducks.
  2. The H5N1 virus, which is responsible for this animal disease, does not easily cross from birds to humans.
  3. People that have been infected in other parts of the world had been in close contact with live or dead infected birds, principally domestic poultry.
  4. As the epidemic affects wild birds, it can be expected to continue to affect various regions of the EU in the coming months and so we will have to learn to live with periodic cases in birds.
  5. The disease may occasionally spread from birds to other animals such as cats. If ordinary precautions are taken in areas where infected birds were found, this does not lead to any significant increase in the risk to humans.
  6. Very stringent veterinary measures are in place in the EU. These seek to prevent the spread of the virus from wild birds to poultry and to contain any outbreaks in poultry.
  7. Temporary protection and surveillance zones are established in areas where infected birds are found. In these zones, movement of live animals is restricted, poultry is confined indoors and closely monitored, and disinfection measures are strictly applied.
  8. Very specific measures are also in place to protect domestic poultry and to prevent infected birds entering the food chain.
  9. In any case, thorough cooking ensures that meat and eggs are free of any virus.
  10. The risk to the public of catching the H5N1 virus from live animals or from poultry products is very low and there is no need to
    change food consumption habits or travel plans.

B. Consumption of poultry products

  1. It is safe to eat poultry -- meat or eggs that you buy in shops in the EU. This is because strict food safety and veterinary measures are in place to prevent meat or eggs from unhealthy animals entering into the food chain.
  2. Trade from protection and surveillance zones within the EU (where infected birds have been found) is only allowed under strict veterinary controls and imports from affected 3rd countries are banned.
  3. In case of an outbreak in a poultry farm, the entire flock would be culled and disposed of immediately. Poultry meat and eggs produced in these farms are also destroyed.
  4. Even in the very unlikely event of the virus being present in meat or eggs sold in the EU, thorough cooking destroys the virus, so well-cooked meat and eggs pose no risk.
  5. Meat from vaccinated poultry is not harmful for human health as the virus included in the vaccine is killed and cannot multiply.

C. Groups at risk

  1. People who keep birds such as chickens, ducks and geese near where they live need not be overly alarmed, but they should be aware of the risks. In particular, they should:
  • Follow instructions from local veterinary authorities, especially on the need to feed and water poultry indoors and to keep poultry
    indoors in risk areas.
  • Notify the authorities if unusually high numbers of dead wild birds are seen, or if unusually high numbers of their birds die. In this
    case, people are not to touch dead or sick birds themselves
  • Keep the birds out of their home and follow good hygiene rules in particular, hand washing with soap when in contact with birds or bird excrement.
  • Discourage their children from playing with the birds and teach them to tell an adult if they see sick or dead birds.
  • Make sure children in particular understand the rules of basic hygiene.
  • Never slaughter or eat sick or dying birds, as this could carry greater risk.

2. Other people who come into regular contact with poultry (e.g. farm workers, vets) or wild birds (e.g. hunters, bird watchers) also need to be aware of the risks and take precautions.

3. ECDC has produced detailed guidance on the protection of people at risk and those living or travelling to areas where infected birds have been found. National authorities are there to advise on any questions.

4. Other members of the public

It is very unlikely that other members of the public would be in contact with infected birds.

The following good-sense precautions are sufficient:

  • Don't touch sick or dead wild birds or poultry and inform your local veterinary authorities if you find any suspicious numbers of
    dead or ill birds.
  • Follow the normal rules of good hygiene -- i.e. wash your hands with soap after contact with birds or their droppings
  • If there is an outbreak of highly pathogenic avian influenza among birds in your area:
    a. Your national authorities may impose temporary restrictions on the movement of poultry and declare certain places off-limit to people.
    It is important that you follow these instructions as they are designed to stop the virus spreading.
    b. In these areas, pet cats should be kept indoors to prevent them from coming into contact with wild infected birds or their droppings,
    and to prevent them transporting the virus on their paws and becoming infected themselves.

D. Travel

1. There is little or no risk from travelling to countries outside the EU or areas inside the EU where avian flu has been detected,
provided you avoid visiting poultry farms or bird markets and follow the precautions outlined above, as indicated in the ECDC guidance.

E. Human flu pandemic

1. We do not know when the next pandemic (i.e. a large and severe world-wide epidemic of a new human influenza virus) will happen or which virus will cause it. H5N1 avian influenza evolving or mutating into a form of human influenza is one possible scenario.

2. At the moment the virus responsible for Avian flu (H5N1), does not transmit easily from human to human.

3. During the 20th century, 3 pandemics occurred: in 1918-1920, in 1957 and 1968. Experts warn that another pandemic could occur at any time. Therefore the EU and its governments, World Health Organisation and other UN bodies are preparing for this eventuality.

4. Vaccination against seasonal flu will not protect people from the possible new (yet unknown) pandemic virus as each flu vaccine is
specific to a virus.

5. EU and national public authorities have prepared contingency plans in case of a human flu pandemic, in order to be able to respond to
the health consequences very rapidly. These plans foresee measures such as advice on public health (early isolation and mask-wearing),
the provision of anti-virals, development of vaccines, emergency measures in healthcare systems, international co-ordination, etc.


May 4, 2006
By George Robertson <>

People who have been infected with the H5N1 avian influenza virus might be especially susceptible to avian viruses because they are
genetically predisposed to them, leading disease experts suggested on Thu 4 May 2006. Of the 205 [now 206 - Mod.CP] reported cases of human infections since late 2003, there have been many family clusters involving blood relatives, such as father and children, mothers and daughters. Of the total infections, 113 people died in 9 countries.

"There have been family clusters. So there has to be certainly a genetic aspect to it," Robert Webster of the St Jude Children's Research Hospital told a bird flu conference organized by the Lancet medical journal in Singapore.

Another leading expert, Hiroshi Kida, who has spent more than 3 decades working on viruses, has long harbored the same theory. "There has not been a single case of infection involving husband and wife [i.e. family members not related by blood] ," Kida said told the
Reuters News Agency in an interview. Kida is with the Department of Diseases Control at Hokkaido University in Japan. Kida explained that people infected with H5N1 have a carbohydrate receptor on cells lining their throats. The receptor -- called alpha 2,3 -- is predominantly found in birds and avian influenza viruses like to bind to this class of receptors to replicate and cause disease.

Human influenza viruses, however, prefer to bind to another receptor called alpha 2,6, which is dominant in humans. "I think people who are infected with avian strains are special. They must have alpha 2,3 receptors," Kida said. Although humans have some amount of alpha 2,3, Kida said alpha 2,6 was by far more "dominant" in most people. [For a more precise discussion, see ProMED-mail post archived as "Avian influenza virus (03): virus receptor distribution 20060322.0893". - Mod.CP]

Kida is now trying to look for H5N1 survivors in Viet Nam and Thailand to verify his theory, and if it proves to be true, it could mean that most people simply cannot catch H5N1 easily -- unless the virus mutates. "If it changes receptor specificity, then it must be dangerous," Kida said.

Many experts see H5N1 [virus] as possibly triggering an influenza pandemic that is long overdue. But that could happen only if it mutates sufficiently to become easily passed among people. Most of its victims contracted the virus directly from sick birds. And there have not been any proven cases of human-to-human transmission.

Although very little is known about the virus, much work has been done to find out how it is transmitted, why so few people have been infected, and why it hasn't yet become infectious among people. A group of researchers recently postulated that the virus lodges itself deep in the lungs, and not in the upper respiratory tract where it could more easily dislodge itself, get out of the body and spread.
But while Kida does not dismiss this theory, he thinks it is not the only one.

George A. Robertson, PhD
Vice President, Maunfacturing
351 Phoenixville Pike
Malvern, PA 19355

It could be reasonably inferred from this type of analysis that evolution of the H5N1 avian pathogen into a form capable of sustaining a human pandemic may require progressive changes affecting several virus properties rather than simply one change in a single phenotypic property of the virus.

[see also:
Avian influenza, human - worldwide (07): genetic risk? 20060216.0512
Avian influenza virus (03): virus receptor distrib...  20060322.0893]

3/23/2006 Update: Two Different Clads of H5N1 Virus In Humans

Source: Reuters Foundation AlertNet, Mon 20 Mar 2006 [edited by ProMed]

The H5N1 avian influenza virus in humans has evolved into 2 separate strains, a development that will complicate the search for a vaccine and the prevention of a pandemic, U.S. researchers reported on Mon (20 Mar 2006). The genetic diversification of the pool of H5N1 avian influenza viruses with the potential to cause a human influenza pandemic heightens the need for careful surveillance, researchers said at the International Conference on Emerging Infectious Diseases in Atlanta. "Back in 2003 we only had one genetically distinct population of H5N1 with the potential to cause a human pandemic. Now we have 2," said Rebecca Garten of the U.S. Centers for Disease Control and Prevention (CDC), who helped conduct the study. One of the 2 strains, or clades, made people sick in Vietnam, Cambodia and Thailand in 2003 and 2004 and the 2nd, a cousin of the 1st, caused the disease in people in Indonesia in 2005.

Two clades may share the same ancestor but are genetically distinct -- as are different clades, or strains, of the AIDS virus, the team from the CDC found. "This does complicate vaccine development. But we are moving very swiftly to develop vaccines against this new group of viruses," said Dr. Nancy Cox, chief of the CDC's influenza branch. The H5N1 strain of bird flu has spread across Europe, Africa and parts of Asia and killed nearly 100 people worldwide and infected about 180 since it re-emerged in 2003. Although it is difficult to catch bird flu, people can become infected if they come into close contact with infected birds. Scientists fear the virus could mutate into a form that could pass easily between humans, triggering a pandemic in which millions could die. All influenza viruses mutate easily, and H5N1 appears to be no exception. But Cox said the evolution of a 2nd clade does not move the virus closer to human-to-human transmission. "Like the group 1 or clade 1 viruses, the group 2 or clade 2 viruses are not easily transmitted from person to person," she said. "It really doesn't take us closer to a pandemic. It simply makes preparing for the pandemic a bit more difficult."

The U.S. Health and Human Services Department has already recognized the 2 strains and approved the development of a 2nd H5N1 vaccine based on the 2nd clade. Several companies are working on H5N1 vaccines experimentally, although current formulations are not expected to protect very well, if at all, against any pandemic strain. A vaccine against a pandemic flu strain would have to be formulated using the actual virus passing from person to person.

Researchers said while vaccines were needed against different strains of the virus, a vaccination against one clade could provide partial protection against another. "We would expect the priming (of a patient) with a clade one (vaccine) could potentially reduce the severity of disease," Cox said. For their study, Garten and colleagues analyzed more than 300 H5N1 virus samples taken from both infected birds and people from 2003 through the summer of 2005. Garten said the bird flu strains being detected in Europe were generally clade 2 strains.

Byline: Jim Loney and Maggie Fox
Mary Marshall

ProMed Footnote:
The term "clade" is derived from the style of presentation of phylogenetic data, which are most conveniently presented in the form of trees consisting of 2 elements; nodes and branches. A branch is a line that connects 2 nodes. Nodes can be external (the tips of the branches) or internal (representing the common ancestor of 2 nodes) A cladogram shows only the branching order of nodes, and the lengths of the branches contain no information. All of the descendents of a common ancestor represented by a common node belong to the same clade. A clade is a monphyletic group. A phylogram, on the other hand, displays both branching order and distance information, where distance provides an indication of the number of amino acid changes (or nucleotide substitutions) from the ancestral node (i.e. giving an indication of the extent of relative evolution from a common node).

Avian Influenza Articles (Added 3/20/2006)

Influenza Up-date March 6, 2006 (modified from ProMed)

Russia (Astrakhan), H5, poultry
Bird flu suspected in southern Russian region

A suspected outbreak of bird flu has hit another region in Russia, a regional Emergency Situation Ministry official said Monday (6 Mar 2006). The official said that provisional laboratory tests of fowl that died on 2 Mar 2006 in the southern Astrakhan Region, home to more than a million people, had found "antibodies specific for both the H5 bird flu strain and Newcastle disease," which means that "birds were infected either with one virus or both of them." Newcastle disease is an acute, highly contagious viral disease found  in birds, especially poultry. The human form of the virus is not  thought to be life-threatening, but symptoms include conjunctivitis. Local health officials said that measures were being taken to prevent the disease from spreading from a village about 1000 miles southeast of Moscow, where the dead birds had been found. According to the ministry, with the disease now having reached the heart of Europe, almost 800 000 birds in southern Russia have died of bird flu or been culled in the last month.

"A total of 768 533 have died or been culled since 3 Feb 2006, including 16 287 in the last 24 hours," a ministry official said. "The authorities have been taking measures to address the epidemic."

The Agriculture Ministry said earlier that cases of bird flu had been registered in 7 regions in the Southern Federal District, a major stopover area for migrating birds. Areas hit included the republics of Kabardino-Balkaria, Daghestan, Chechnya, Kalmykia and Adygea, and
the Krasnodar and Stavropol territories. Over 1.3 million birds have died or been slaughtered in 3 outbreaks of bird flu since July 2005, the ministry said. The figure includes more than 416 000 birds that died from the virus. No human cases of bird flu have yet been reported in Russia.

 Austria, cats
Austrian Cats Test Positive for Bird Flu

Three cats have tested positive for the deadly strain of bird flu in Austria's first reported case of the disease spreading to an animal other than a bird, state authorities said Monday. The sick cats were among 170 living at an animal shelter where the disease was detected in chickens last month, authorities said. In Austria, all the cats from the affected shelter have been moved to a location where they will remain under observation. The shelter has been closed, Health Minister Maria Rauch-Kallat told reporters in Vienna.

"We have decided to put all the cats in quarantine," Rauch-Kallat said. "Here they will be observed by veterinarians and experts in the
coming days and weeks." German authorities last month confirmed that a cat on the Baltic Sea island of Ruegen had succumbed to the deadly virus, which it is believed to have caught by eating an infected bird. That would be consistent with a pattern of disease transmission seen in wild cats in Asia.

German officials have warned pet owners to keep their cats indoors and dogs on a leash in areas where the disease has been detected
Austria confirmed the nation's first case of H5N1 in a wild bird last month and has since detected several dozen cases in birds, including 29 in Styria.

According to WHO, several tigers and snow leopards in a zoo and several house cats were infected with H5N1 during outbreaks in Asia
in 2003 and 2004.

Poland: swans, H5N1 confirmed
Poland confirms 1st case of deadly H5N1 virus

2 dead swans found in northern Poland had the deadly H5N1 strain of bird flu, the Polish veterinary institute was quoted as saying by the PAP news agency on Monday [6 Mar 2006]."It was the H5N1 strain. It's certain," the institute's Jan Zmudzinski said. "The test specifically for the H5N1 strain was positive."

The findings confirm the 1st case of the deadly virus in Poland after 2 swans were found on Sunday [5 Mar 2006] infected with the H5 bird flu virus on the banks of the Vistula river in the northern city of Torun. Preliminary tests for bird flu are routinely conducted in Poland's veterinary research institute in the city of Pulawy. If the presence of a bird flu virus is confirmed, special tests for the deadly H5H1 strain are carried out in Britain.

The government confirmed that the samples will now be sent to the Community Reference Laboratory for avian influenza in Weybridge in the United Kingdom for further tests to confirm they had the more deadly H5N1 virus.

Uganda: suspected
The Uganda Media Centre director, Robert Kabushenga, said tests

carried out in Nairobi, Kenya had established that there was no avian influenza in Uganda. The center, in a statement issued on Saturday [4 Mar 2006], said, "since its formation, the National Task Force has developed an emergency preparedness and response plan. A surveillance plan has been put in place to monitor migratory birds and domestic poultry."

The statement quoted the task force as saying, "in the process of monitoring, samples were collected from dead wild birds and chickens
on farms experiencing unusual death rates. These were sent to the Centre for Disease Prevention and Control (CDC) at KEMRI, Nairobi, for testing."

"As of 3 Mar 2006 at 6:00 p.m., CDC was unable to confirm the presence of avian influenza in the samples. Further research is being undertaken at more specialized laboratories," it said. It said the main carriers are wild birds, although domestic poultry suffered most, and the virus is carried mainly in bird excreta. It said the disease is not easily transmitted to humans. However, the statement advised the public to limit interaction with sick birds. It said Ugandan chicken was free of bird flu and posed no health threat. "It is safe to eat chicken, eggs and other poultry products," it said.

See additional ProMed listings:
Avian influenza, cats: H5N1 systemic infection 20060114.0140
Avian influenza - worldwide (43): Africa, Europe 20060305.0719
Avian influenza - worldwide (42): OIE 20060304.0705
Avian influenza - worldwide (41): Africa, Europe 20060304.0696
Avian influenza - worldwide (40): Africa, Europe 20060302.0665
Avian influenza - worldwide (39): Europe 20060301.0657
Avian influenza - worldwide (38): Africa, Asia, Europe 20060301.0656
Avian influenza - worldwide (37): Europe 20060228.0646, 20060301.0649
Avian influenza - worldwide (36): France, OIE 20060227.0640
Avian influenza - worldwide (35): Europe, Asia, Africa 20060227.0637
Avian influenza - worldwide (34): Africa, Asia, Europe, OIE 20060227.0636
Avian influenza - worldwide (33): Switzerland, duc... 20060226.0633
Avian influenza - worldwide (32): Europe, Asia 20060226.0625
Avian influenza - worldwide (31): Europe, Asia 20060225.0617
Avian influenza - worldwide (30): Europe, Asia, Africa 20060224.0600
Avian influenza - worldwide (29): Europe, Asia, Africa 20060223.0589
Avian influenza - worldwide (28): Europe, Asia, Africa 20060222.0569
Avian influenza - worldwide (27): Europe, Asia, Africa 20060221.0565
Avian influenza - worldwide (25): Europe, Asia, OIE 20060220.0558
Avian influenza - worldwide (24): Europe, Asia, Africa 20060220.0550
Avian influenza - worldwide (23): Europe, Asia, Africa 20060219.0541
Avian influenza - worldwide (22): Europe, Asia, Africa 20060218.0526
Avian influenza - worldwide (17): Hungary 20060215.0495
Avian influenza - worldwide (16): Austria, suspected 20060214.0486
Avian influenza - worldwide (16): Asia, Europe, Africa 20060214.0489
Avian influenza - worldwide (14): Europe, Africa 20060213.0478
Avian influenza - worldwide (11): Europe 20060212.0466
Avian influenza - worldwide (10): Nigeria, Greece,... 20060211.0461
Avian influenza - Worldwide (07): International Re... 20060211.0451]

Avian Influenza, Poultry vs. Migratory Birds (Updated 3/1/2006)

Date: 27 Feb 2006 <>

Report says global poultry industry is the root of the bird flu crisis. Small-scale poultry farming and wild birds are being unfairly blamed for the bird flu crisis now affecting large parts of the world. A new report from GRAIN shows how the transnational poultry industry is the root of the problem and must be the focus of efforts to control the virus. (1) The spread of industrial poultry production and trade networks has created ideal conditions for the emergence and transmission of lethal viruses like the H5N1 strain of bird flu. Once inside densely populated factory farms, viruses can rapidly become lethal and amplify. Air thick with viral load from infected farms is carried for kilometers, while integrated trade networks spread the disease through many carriers: live birds, day-old chicks, meat, feathers, hatching eggs, eggs, chicken manure and animal feed. (2) "Everyone is focused on migratory birds and backyard chickens as the problem," says Devlin Kuyek of GRAIN. "But they are not effective vectors of highly pathogenic bird flu. The virus kills them, but is unlikely to be spread by them."

For example, in Malaysia, the mortality rate from H5N1 among village chickens is only 5 per cent, indicating that the virus has a hard time spreading among small scale chicken flocks. H5N1 outbreaks in Laos, which is surrounded by infected countries, have only occurred in he nation's few factory farms, which are supplied by Thai hatcheries. The only cases of bird flu in backyard poultry, which account for over 90 per cent of Laos' production, occurred next to the factory farms.

"The evidence we see over and over again, from the Netherlands in 2003 to Japan in 2004 to Egypt in 2006, is that lethal bird flu reaks out in large scale industrial chicken farms and then spreads," Kuyek explains. The Nigerian outbreak earlier this year [2006] began at a single factory farm, owned by a cabinet minister, distant from hotspots for migratory birds but known for importing unregulated hatchable eggs. In India, local authorities say that H5N1 emerged and spread from a factory farm owned by the country's largest poultry company, Venkateshwara Hatcheries. A burning question is why governments and international agencies, like the UN Food and griculture Organization, are doing nothing to investigate how the factory farms and their byproducts, such as animal feed and manure, spread the virus. Instead, they are using the crisis as an opportunity to further industrialize the poultry sector. Initiatives are multiplying to ban outdoor poultry, squeeze out small producers and restock farms with genetically-modified chickens. The web of complicity with an industry engaged in a string of denials and cover-ups seems complete. "Farmers are losing their livelihoods, native chickens are being wiped out, and some experts say that we're on the verge of a human pandemic that could kill millions of people," Kuyek concludes. "When will governments realize that to protect poultry and people from bird flu, we need to protect them from the global poultry industry?"

(1) The full briefing, "Fowl play: The poultry industry's central role in the bird flu crisis," is available at <>.
Spanish and French translations will be posted shortly.
(2) Chicken feces and bedding from poultry factory floors are common ingredients in animal feed.


Date: 27 Feb 2006
From: Mary Marshall <>

Import bans are overreaction to bird flu.

Countries that are banning imports of poultry from bird flu-affected areas are overreacting, because the meat is safe to eat, an international animal health group said on Monday [27 Feb 2006]. And while wild birds may play a role in spreading the virus, they are not the key to controlling its spread, said Alex Thiermann, president of the standard-setting committee for the World Animal Health Organization. Thiermann said sensible precautions, such as quickly culling birds in affected areas, can work to control outbreaks of H5N1 avian influenza. "Countries have far exceeded what is science-based, and they have further complicated the losses to the industry," Thiermann told the New-Fields' Bird Flu Summit, a meeting of avian influenza experts. "Eating chicken is not what is going to kill you."

French trade minister Christine Lagarde said 20 countries had imposed curbs on imports of French poultry after an outbreak of H5N1 at a turkey farm in the east of the country last week. The World Health Organization stressed again on Monday [27 Feb 2006] that properly cooked poultry does not spread bird flu. No one seems to have become infected merely through handling chicken meat, WHO added. But poultry sales have plunged, and many countries have moved to block imports as the virus spreads among flocks. As many as 19 new countries have reported outbreaks in birds over the past month. "A lot has to do with the trust level between the public and government," Thiermann said. Thiermann said countries were now beginning to respond in the proper manner, doing the right surveillance to watch the virus as soon as it begins to infect birds, culling poultry right away and sealing off the movement of poultry within affected areas. "A timely response and proper resources in 2004 would have reduced the pandemic risk," Thiermann said. "Culling or stamping out is the number one measure to be taken. The tools are available."

Watching wild birds for signs of the virus is important, but it would be impossible to try to control the spreading virus in wildfowl, Thiermann said. "Once the disease gets into a country, it really doesn't matter whether it is carried by wildlife, because it is going to get into the poultry," he said. Mute swans have been the latest sentinels in Europe, he said, and there is some evidence that wild mallards may be carrying the virus. But control has to take place in poultry. Developing countries are more at risk than richer nations, because they lack a good veterinary system, Thiermann said.

"We must improve the veterinary infrastructure," he said. "We can look at Croatia, Romania, Japan, Malaysia and South Korea as good examples," he added. "We can look at Nigeria, at Indonesia and other places where we see existing problems, in my opinion, having to do with lack of veterinary infrastructure."

Avian Influenza Update - Europe, Asia, Africa (2/15/2006)

Modified from ProMed Feb. 15th, 2006

Date: Tue, 14 Feb 2006
5 more countries have found the H5N1 bird flu virus in birds in the last 3 days. Its spread remains consistent with the movements of wild
birds, although certain wild species are also becoming major victims of the virus, which is leaving a trail of dead swans across Eurasia. On Friday, Azerbaijan reported that H5N1 had been confirmed in dead wild birds, including swans, from the Caspian Sea coast. The coast is a major wintering spot for migrants, including some duck species that summer in Siberia, where there were H5N1 outbreaks in summer 2005, and winter from the Caspian and Black Seas through Turkey and the Mediterranean down to northern Nigeria. The virus has appeared now in all those areas.

Large numbers of dead wild birds were reported along the Caspian coasts of Azerbaijan and neighbouring Iran in autumn. Iran announced in October 2005 that their dead ducks tested negative for avian flu. But die-offs continued in Azerbaijan until February 2006, according to press reports, and under foreign pressure Azeri officials finally sent samples to the flu reference lab in Weybridge, UK, says Juan Lubroth, head of animal diseases at the UN Food and Agriculture Organization in Rome.

Then on Sat, 11 Feb 2006, Greece confirmed that it had found H5N1 in 3 dead swans on Thermaikos Gulf near the northern city of Thessaloniki. Greece is also expected to announce Monday that it found H5N1 on the Aegean Island of Skiros in a dead red-breasted goose ( Branta ruficollis – see picture at< which conservation organisation Bird Life International describes as"globally endangered".

Also on Sat, 11 Feb 2006, Italy confirmed H5N1 in dead swans from the southern provinces of Puglia, Sicily and Calabria, where birds wintering near Venice had flown to escape a cold snap. Bulgaria confirmed H5N1 in dead swans from the Danube delta. "From what I have seen of the genetic sequence, the Italian virus is identical to the one from Qinghai," a strain first found in wild birds at Qinghai Lake in northwest China in spring 2004, says Lubroth. This strain has since appeared across Siberia, and in Mongolia, Turkey, Romania, Ukraine and Nigeria. Meanwhile, Slovenia has found an H5 flu strain in a dead swan near the Austrian border. It is expected to be confirmed as H5N1. Bird deaths in Armenia are also under suspicion. "In Greece and Italy it is very clear wildlife introduced the virus," says Lubroth. Without better understanding of which species carry it, and where, it is hard to be certain in other cases, he says. "We asked for money for this research 2 years ago." Now the FAO hopes to radio-track birds and test water from bird habitats for the virus. Meanwhile, H5N1 continues to spread in Nigeria, with reports of outbreaks in poultry now from 8 states, possibly including the megacity of Lagos. People in Nigeria who had flu symptoms and were near dead birds are being tested, while in Greece several people who contacted dead wild birds are being tested.

H5N1 bird flu found in dead swans in Germany 2 dead swans in Germany have tested positive for the deadly H5N1 strain of bird flu, the Agriculture and Consumer Protection Ministry said on Tuesday. A spokeswoman for the ministry told Reuters 2 of 4 dead swans found on the Baltic Sea island of Ruegen had registered positive in an initial test for the virus -- the first such positive result in Germany. The spokeswoman added that Agriculture and Consumer Protection Minister Horst Seehofer was due to make a statement in Berlin on the
matter at 2045 GMT.

"Our emergency committee is meeting right now," the spokeswoman said, adding that samples were on the way to the reference laboratory in Great Britain for further testing. Earlier on Tuesday, neighbouring Austria [see ProMED-mail posting Avian influenza - Worldwide (16): Austria, suspected 20060214.0486) as well as Iran said it had detected the virus in dead birds (see below). The deadly strain of bird flu has so far killed 91 people worldwide.

A dead pelican was found in the area near to Kozloduy nuclear power plant, Bulgarian media reported. The bird was retrieved by the municipal authorities and immediately sent for initial tests in Sofia. Results on the possible detection of bird flu in the pelican are expected within a week, local veterinaries said. Kozloduy, situated in the upper part of the Bulgarian stretch of the Danube, has added to Vidin, Durankulak, Shabla and Burgas as a place where dead birds possible killed by avian flu were found. On Monday the European Commission confirmed that samples sent to the EU reference laboratory in England after a first analysis by local research institutes confirmed the H5N1 strain of bird flu in Slovenia, Bulgaria and Greece.

The Commission said that imports of poultry and poultry products from non-EU member Bulgaria were already banned and that the restrictions would be further extended to cover live poultry and birds as well as eggs and unprocessed feathers from the affected areas.
The EU's top veterinary experts are set to meet in Brussels on 16 Feb [2006] to analyse the situation.

Chicken consumption has already fallen in Bulgaria since reports on the imminent bird flu started circulating in the country. Bulgarian
poultry producers said Monday they were concerned that the spread could cause serious damage to a business worth millions of euros and which employs more than 20,000 people.

Elsewhere, authorities in Bosnia-Herzegovina on Monday announced a ban on the import of live poultry, poultry meat and poultry products from Bulgaria, Greece, Italy and Slovenia.

Macedonia also suspended the import of live poultry and poultry meat from Bulgaria, Greece and Italy. The same restriction measure would be imposed for Slovenia, should H5N1 is confirmed on its territory.

Swans, OIE
On 30 Jan 2006, in the sea area of Paralia-Katerini [40 deg 16 min N, 22 deg 35 min E], a fisherman found a dead swan and brought it at the seashore. The veterinary authorities collected the swan and sent it to the NRL immediately. The swan belongs to a flock that arrived some 20 days ago, probably from North due to bad weather conditions. No anatomical pathology was observed. In addition, the Veterinary Authority of Pieria has been conducting an epizootic survey, since 9 Feb 2006 over the whole area of the Prefecture, far wider than the circle of 10 km around the point of collection. According to this survey, there are no findings of Avian Influenza in the area, while strict biosecurity measures have been applied to all poultry farms, especially to backyard flocks kept at the villages of the whole Prefecture.

On 31 Jan 2006, in the area of the village of Stavros [40 deg 40 min N, 23 deg 41 min E], people informed the veterinary authorities about the presence of one swan found dead on the coast. The veterinary authorities collected the swan and sent it to the NRL immediately. The swan belongs to a flock that arrived some 20 days ago, probably from North due to bad weather conditions. No pathological signs were observed. In addition, the Veterinary Authority of Thessaloniki has been applying an epizootic survey, since 9 Feb 2006, at the whole area of the Prefecture, far wider than the circle of 10 km around the point of collection. According to this survey, there are no findings of Avian Influenza in the area, while strict biosecurity measures have been applied to all poultry farms, especially to backyard flocks kept at the villages of the whole Prefecture. On 1 Feb 2006, in the area of the village of Nei Epivates [40 deg 30 min N, 22 deg 54 min E], people informed the veterinary authorities about the presence of one swan found dead on the coast. The veterinary authorities collected the swan and sent it to the NRL immediately.

Greece confirmed a 2nd outbreak of the H5N1 avian flu virus, after tests on a dead goose from the Aegean Sea Island of Skyros returned positive from an EU laboratory near London. The announcement comes 2 days after 3 dead migratory swans in northern Greece were also found to be carrying the virus, leading local authorities to impose zones of protection around the areas in question. On Skyros, an island of about 2900 inhabitants in the Central Aegean Sea, the necessary precautions have already been taken, Mayor Miltiadis Hadjiyannakis told the media.

"A veterinary squad from the local prefecture is already here, we have vaccinated a number of municipal staff for house calls, and our citizens have been briefed on the issue," he said. Skyros has no major poultry farms, but a 3-km zone around the area of the dead bird's discovery has been imposed regardless, Hadjiyannakis noted. A Greek airman who found the goose at the island's airport on 2 Feb 2006 has already been tested, and has displayed no worrying signs, he added.

The virus strain, confirmed today by the EU reference laboratory for avian influenza in Weybridge, England, was the highly pathogenic H5N1 type also found in the wild swans in northern Greece on Saturday, an agriculture ministry official said. Bird hunting has already been banned on Skyros and the prefecture of Salonika, while owners of poultry in both areas have been ordered to shut their flocks indoors.

There was information on: "more dead birds cropped up with the H5 strain in the north of the country." It further stated that "The agriculture ministry on Tuesday [14 Feb 2006] announced that the broad H5 virus category had been isolated on 2 more dead swans in northern Greece. The samples, found in coastal areas, have been sent to an EU-certified laboratory in Weybridge, England for H5N1 confirmation tests. Protection zones have been created around the airport of Skyros, and 3 beaches near the northern city of Salonika, where the 1st dead birds were discovered. 2 more dead birds found on Skyros have been sent to an EU-certified laboratory in Salonika for tests." - Mods. MPP/AS]

Russia (Krasnodar, Dagestan):
Russia has found new cases of H5N1 bird flu in wild fowl in 2 regions in the south of the country, the Agriculture Ministry said on Monday
13 Feb 2006. The virus was found in wild swans and ducks in 2 regions bordering the Black Sea and the Caspian Sea, the ministry said."Cold weather forces wild fowl to migrate over short distances, spreading the (bird) flu virus of group A, H5N1 strain," the ministry said in a statement. "Recently, the virus has been found in wild swans and wild ducks in the littoral zone of the Krasnodar region and Dagestan."

The ministry's animal and plants health inspectorate, Rosselkhoznadzor, has sent veterinary experts to the region to monitor the situation.

Russia has been battling bird flu in poultry since July 2005, culling more than 600,000 domestic fowl. No new cases of the virus have been found in Russia since the end of 2005, but veterinarians warned that migratory birds could bring the virus back in the spring. The highly pathogenic H5N1 strain has killed at least 88 people since 2003 in Asia and the Middle East. No cases of human infection have
been registered so far in Russia.

 Europe (Ukraine), Asia, Africa:
"The virus is moving quite substantially into new locations," David Nabarro, a United Nations envoy, said yesterday before flying to Ukraine. "My attention is pretty much equally divided between Europe, the southern Balkans and Black Sea area, Africa and south Asia.''
Nigeria, with almost 140 million people, is Africa's most populous country. It borders Benin, Niger, Chad and Cameroon. Ukraine's neighbors include European Union members Hungary, Poland and Slovakia. The disease in birds creates more opportunity for human infection and increases the risk of the virus changing into a pandemic form. Since December 2003, H5N1 has sickened at least 169 people, killing 91.

"There are some quite tricky challenges facing everybody working in Crimea and I shall be engaging with various government people,'' Nabarro, who is advising UN Secretary General Kofi Annan on avian and human influenza, said in a telephone interview yesterday. He didn't say what the challenges were.

An H5 avian-flu subtype was found in 24 villages in Crimea and the village of Tsevetochnoe was quarantined, the Ukraine Health Ministry
said in a statement yesterday.

The former Soviet republic of 47 million people has reported at least 33 outbreaks of avian flu since November 2005, according to the World Organization for Animal Health.

The Paris-based organization said today more than 40 000 poultry had been culled in the Shevchenkovskiy district of Ukraine's Kharkiv
region after Newcastle disease, a type of avian virus, infected 13 346 fowl. The H5N1 avian influenza strain, which first sickened people in Hong Kong in 1997, has infected birds in more than 20 countries on 3 continents. The notification further says:"The State Veterinary Services of the Autonomous Republic of Crimea, in collaboration with local authorities, have formed 142 groups to perform clinical examination of backyard poultry throughout the territory of the Autonomous Republic of Crimea. The total number of quarantine posts on the territory of the affected districts is 3 (1 post in Feodosiya district and 2 posts in Belogorskiy district). Quarantine restrictions have been lifted in the following villages:
- Predmostnoye (Dzhankoyskiy district);
- Zolotoye Pole (Kirovskiy district)".

It will be interesting to note if surveillance in Crimean addresses the wild bird population. The outbreak of Newcastle disease in the farm "Staroverskiy" (Shevchenkovskiy district, Kharkiv region) has been notified to the OIE on 13 Feb 2006 in an alert massage, available at

Iran's veterinary organization said on Tuesday the first cases of the H5N1 strain of bird flu had been detected in wild swans in the Islamic Republic. A later newswire states "The deadly strain of bird flu has killed 135 wild swans on the Iranian part of the Caspian Sea "International laboratory results confirm that some wild swans died from bird flu," a statement from the organization said. An official from the veterinary organization, who declined to be named, confirmed the birds had died from the H5N1 strain of the disease, which is dangerous to humans.

The dead swans came from wetlands near the Caspian Sea port of Bandar-e Anzali on Iran's northern coast, a wintering spot for many wild fowl from Russia.

"Information received on 7 Feb 2006 from Dr Hossein Hassani, Head of Iran Veterinary Organization (IVO), Ministry of Jihad-e-Agriculture, Tehran: On 2 Feb 2006, within the framework of the Avian Influenza Passive Surveillance Plan in place for wild birds in Gilan province, a few deaths were reported among swans in 2 marshes (Selkeh and Espand) at Somaesara (Anzali wetland). Immediately, all the relevant activities were implemented in accordance with OIE guidelines and recommendations, and all of the indigenous birds in 6 villages considered to be epidemiological units at risk (i.e. within a 2-km radius) were destroyed and their owners compensated by the IVO. Samples taken from the indigenous birds were tested as follows: sera were tested using haemagglutination inhibition (H5 and H9 avian
influenza and Newcastle disease) and tissue samples were tested by RT-PCR, all with negative results.

Tissue samples taken from swans will be sent tomorrow morning [8 Feb 2006] to the OIE Reference Laboratory for avian influenza and
Newcastle disease in Padova, Italy, for virological tests". The control measures applied by the Iranian authorities, even before confirmation of the suspicions, are impressive.

Following the addition of Iran, Austria and Germany, there are, at present, 12 countries where swans have been found affected by H5N1. They are: Mongolia, Russia (Astrakhan region, Krasnodar region and Dagestan), Romania, Croatia, Bulgaria, Greece, Italy, Slovenia, Iran, Austria and Germany. This dramatic development might have removed the remaining doubts about the role of wild birds in the epidemiology of this unprecedented worldwide panzootic, now covering 3 continents.

Avian Influenza Update Information (1/10/2006)

New reports of animal outbreaks across Turkey were rapidly increasing, with 6 of 81 provinces now reporting ongoing disease in
birds, up from 3 just a few days ago. By this evening (8 Jan., 2006), the Agriculture Ministry said the count was up to 10.

"Things are unfolding quickly, but we do not yet know how extensive the outbreaks are," Juan Lubroth of the United Nations Food and
Animal Organization said. He added that the organization now believed that they had been occurring "for some time," starting perhaps as early as October or November (2005).

In light of the 9 human cases over the last 4 days, the failure of the Turkish officials to quickly detect and publicize animal outbreaks could have been a deadly oversight.

Humans almost always acquire bird flu through close contact with sick birds. In areas with known outbreaks, all birds are supposed to be quickly culled to contain the disease, and farming families in the surrounding area must take extreme precaution in handling poultry to prevent human infections. Because there were no reports of bird flu in the area, the patients in Van and Ankara had no way of knowing
they were at risk.

The officials said that while Turkey had responded swiftly to its 1st outbreak of bird flu, which occurred in the more developed western part of the country in October 2005, government officials had been far less efficient in dealing with the disease in impoverished eastern regions.

"The veterinary structure is weak there," said Mr. Lubroth, who added that the United Nations had offered its assistance. "I'm not sure if officials in the capital were even aware for a long time that there was a problem."

Detection of avian influenza at the earliest after its introduction into a virgin territory is essential for effective control. Unfortunately, this is not always the case.

Since the start of the H5N1 panzootic at the end of 2003, 1st in Eastern Asia and later elsewhere, situations which resemble the Turkish one have been observed several times. In Thailand, for example, the disease had been spreading in poultry for at least 2 months when diagnosed for the 1st time in humans. This was followed by its reporting in poultry. According to (unofficial, but seemingly reliable) information from Ukraine (Crimea), the disease was present there since September 2005, but reported for the 1st time (5 outbreaks in different locations) at the beginning of December 2005.

The quick and massive spread of the virus in Turkey is indeed a cause for grave concern, locally and internationally. Its true distribution must be determined with the utmost urgency. An official update is anticipated shortly.

Date: Mon 9 Jan 2006
From: Mary Marshall <>

Turkey: 5 New Suspected Human Cases of Avian Influenza
5 additional people have tested positive for avian influenza in preliminary lab tests in Turkey, the Health Ministry said on Monday [9 Jan 2006]. The announcement raised to 15 the number of suspected cases detected in Turkey since Wednesday [4 Jan 2006], including 3 deaths. It was not immediately clear whether the 5 new cases, detected in 4 separate provinces, were the deadly H5N1 strain. Health officials cautioned that the H5N1 strain so far has only been confirmed in humans who were in close and prolonged contact with fowl but said they were monitoring the virus for fear it could mutate into a form easily transmissible among humans and spark a pandemic.

On Sunday [8 Jan 2006], officials reported 3 new cases in Ankara and 2 cases in the eastern city of Van, about 600 miles away. The cases in Ankara include 2 brothers, aged 5 and 2, who tested positive for H5N1 in preliminary tests by Turkish labs, along with a 65-year-old man. They were the 1st suspected cases outside Van. The boys apparently caught the virus while playing with gloves that their father had used to handle 2 dead wild ducks outside Ankara, their doctor Metin Dogan said. The boys did not appear sick despite testing
positive for the virus, Dogan said.

A 15-year-old girl and her 14-year-old brother from the eastern town of Dogubayazit died of the disease last week [1st week January 2006], the 1st humans outside East Asia to succumb to the deadly strain that has apparently been spread by migratory birds. A 3rd sibling also was believed to have died of bird flu, but the World Health Organization has not confirmed the cause of death. A British laboratory, meanwhile, confirmed the deadly H5N1 strain of the virus in a 5-year-old Turkish boy, while preliminary tests in Turkey detected the strain in an 8-year-old girl. Both children are in intensive care in Van. Another brother and sister in Van also were found to be positive for H5N1 in preliminary tests, Health Ministry official Turan Buzgan said.

Birds in Turkey, Romania, Russia and Croatia have recently tested positive for H5N1, which killed 74 people in East Asia.

The H5N1 avian influenza virus has been identified in 5 more people across Turkey, a local health official said on Monday 9 Jan, while 21 people were being tested for the disease in Istanbul, the country's largest city. Health Ministry official Turan Buzgan told the state-run Anatolian news agency there were new human cases in the Black Sea provinces of Kastamonu, Corum and Samsun and the eastern province of Van.

The 1st case of the virus jumping from birds to humans outside China and southeast Asia occurred last week in rural eastern Turkey, where 3 children from the same family died after contracting the H5N1 strain. Turkey has now reported 12 people as suffering from H5N1 avian influenza virus infection, in addition to the 3 youngsters who died. However, the World Health Organization (WHO) has confirmed only 4 cases in Turkey, including 2 deaths. The WHO said other cases had not so far been verified by laboratory tests.

The children who died last week almost certainly caught the virus directly from chickens, officials say. World health authorities worry that human exposure to the bird flu virus could lead to the emergence of a mutation, allowing easier transmission between humans and raising the prospect of a global pandemic.

Turkey said on Sunday 8 Jan, 2006 that 3 people from villages in the Ankara region had tested positive for the virus, the farthest west
that any case of avian influenza in humans has been reported, and the latest stage in an apparent advance towards major economic centers in Turkey and Europe.

4 children have also tested positive for the H5N1 strain in the city of Van, about 800 km (500 miles) east of Ankara, the local authorities said. 21 people in the Istanbul area are in hospital amid fears they have bird flu, newspapers said on Monday [9 Jan 2006], raising concern that the deadly disease has spread to Turkey's commercial hub of 12 million people. If any of the tests are positive, it would mark the 1st time that human cases of a disease that originated in China and southeast Asia have been reported so far west.

Istanbul is about 400 km (250 miles) west of Ankara, Turkey's densely populated commercial and tourism hub, and marks the gateway to Europe. Health authorities expected to receive test results on the 21 people on Monday [9 Jan 2006], the Milliyet daily said. 14 of them were from the same family. Istanbul municipality was planning a news conference on Monday [9 Jan 2006]. Istanbul province deputy health director Mehmet Bakar said initial tests on 2 dead chickens in the Istanbul district of Kucukcekmece indicated they were infected by the bird flu virus, the reports said. A 3rd test was being carried out to determine the definitive diagnosis.

"The 21 people under suspicion (of having bird flu) have been kept in hospital under observation. Samples have been taken from these people and sent to the laboratory for examination," Bakar was quoted as saying in Star newspaper. Officials were not immediately available to confirm the reports.

At least 5 people, 3 in Ankara and 2 in Van, have tested positive for the potentially deadly H5N1 strain of the bird flu virus and are under treatment, a Turkish governor health official said on Sun 8 Jan 2006. Turan Buzgan, head of the health ministry's Basic Health Services, told the Anatolia news agency that the 5 were among specimens from 28 people tested so far at a government laboratory in Ankara. This brought to 9 the total number of people infected with H5N1, the most virulent form of the virus, since the outbreak began last month (December 2005); 2 of the 9 have died.

A health official in Corum, 240 km (150 miles) east of here, said that a 5-year-old boy was also hospitalized with the bird flu, but the chief physician of the hospital in nearby Cankiri, where the child is being treated, denied this and said final test results had not yet been received.

Ankara Governor Kemal Onal told Anatolia that 2 children and an adult were hospitalized in the capital, and Buzgan identified the 2 at the
Van hospital in eastern Turkey as a 9-year-old girl and a 3-year-old boy. He said both were from Dogubeyazit, near the border with Iran, where 3 children from the same family died during the past week [1st week January 2006]; tests were inconclusive concerning the death of a 3rd sibling.

The 2 children in Ankara are from the town of Beypazari, 100 km (about 60 miles) northwest of the capital, where 2 wild ducks were found dead from the bird flu in a reservoir 2 days ago.As of Sat 7 Jan 2006, the cumulative numbers of confirmed human cases of avian influenza A (H5N1) reported to the World Health Organization (WHO) since December 2003 are as follows:

Cambodia, 4 cases and 4 deaths
China, 7 cases and 3 deaths
Indonesia, 16 cases and 11 deaths
Thailand, 22 cases and 14 deaths
Turkey, 4 cases and 2 deaths
Viet Nam, 93 cases and 42 deaths.

WHO reports only laboratory-confirmed cases, and the total number of cases includes the number of deaths. The total for Eurasia is 146 with 76 deaths.

Date: Tue 10 Jan 2006
Source: World Health Organization (WHO), CSR, Disease Outbreak
Turkey: Avian Influenza Situation - WHO Update 3

Tests conducted in Turkish laboratories have confirmed the country's 15th case of human infection with the H5N1 avian influenza virus. The patient is a 37-year-old woman with a history of exposure to diseased chickens. She resides in the central province of Sivas, the 7th
province to report cases. Although no poultry outbreaks have been officially reported in this province, it is located near areas with confirmed outbreaks in birds.

The situation in birds continues to evolve, with several new outbreaks under investigation in new parts of the country. All evidence to date indicates that patients have acquired their infections following close contact with diseased birds.

The Turkish government has launched an intensive public awareness campaign. Better public understanding of the disease, supported by more complete data on disease activity in birds, could help to reduce the risk of additional human cases, pending control of the disease in birds. As the majority of confirmed cases and persons under investigation are children, it is particularly important that messages about high-risk behaviours reach children.

Some 100 000 treatment courses of oseltamivir (Tamiflu) arrived in Turkey Friday evening [6 Jan 2006]. This supply, which is being used
for both the treatment of patients and prophylaxis of persons at risk, is considered by Turkish health officials to be adequate for responding to the current situation. WHO has organized additional support for laboratory diagnostic work, and this will be arriving within the next day or 2.

Dr Marc Danzon, the WHO Director for its European office, will be arriving in Ankara tomorrow to confer with the country's Minster of Health. They will assess the situation together and review needs for further support.

see also:
Avian influenza, human - Eurasia (07): Turkey 20060108.0065
Avian influenza, human - Eurasia (04): Turkey: WHO update 20060107.0052
Avian influenza - Eurasia (03): Turkey, Azerbaijan 20060106.0045
Avian influenza - Eurasia (04): Turkey, wild ducks... 20060106.0047
Avian influenza - Eurasia (06): Turkey, Azerbaijan 20060107.0054
Avian influenza - Eurasia (07): Turkey (Bursa) 20060108.0060
Avian influenza - Eurasia (05): Turkey, H5N1 20051013.2989
Avian influenza - Eurasia (10): Turkey, OIE 20051015.3008
Avian influenza - Eurasia (108): FAO, update 20051223.3674
Avian influenza - Eurasia (111): Turkey, Asia fish... 2005

Avian Influenza Update Information (12/27/2005)

Influenza up-date December 27, 2005 (from ProMed):
Topic: Mapping the evolution of influenza viruses by monitoring the molecular biology of the hemagglutinin receptors
Journal: Journal of Molecular Biology, 2005 in press
Title: Glycan microarray analysis of the hemagglutinins from modern and pandemic influenza viruses reveals different receptor specificities
Authors: James Stevens1, Ola Blixt1,2, Laurel Glaser3, Jeffery K. Taubenberger4, Peter Palese3, James C. Paulson1,2 and Ian A. Wilson1,5
Addresses: 1 - Department of Molecular Biology, The Scripps Research Institute,
10550 North Torrey Pines Road, La Jolla, CA 92037 USA
2 - Glycan Array Synthesis Core-D, Consortium for Functional Glycomics, The
Scripps Research Institute 10550 North Torrey Pines Road, La Jolla, CA
92037, USA
3 - Department of Microbiology Mount Sinai School of Medicine One Gustave L.
Levy Place Box 1124, New York, NY 10029 USA
4 - Department of Molecular Pathology, Armed Forces Institute of Pathology,
Rockville MD 20306, USA
5 - Skaggs Institute for Chemical Biology, The Scripps Research Institute,
10550 North Torrey Pines Road, La Jolla, CA 92037 USA).

Influenza A virus specificity for the host is mediated by the viral surface glycoprotein hemagglutinin (HA), which binds to receptors containing glycans with terminal sialic acids. Avian viruses preferentially bind to a2-3-linked sialic acids on receptors of intestinal epithelial cells, whereas human viruses are specific for the a2-6 linkage on epithelial cells of the lungs and upper respiratory tract. To define the receptor preferences of a number of human and avian H1 and H3 viruses, including the 1918 H1N1 pandemic strains, their hemagglutinins were analyzed using a recently described glycan array. The array, which contains 200 carbohydrates and glycoproteins, not only revealed clear differentiation of receptor preferences for a2-3 and/or a2-6 sialic acid linkage, but could also detect fine differences in HA specificity, such as preferences for fucosylation, sulfation and sialylation at positions 2 (Gal) and 3 (GlcNAc, GalNAc) of the terminal trisaccharide. For the two 1918 HA variants, the South Carolina (SC) HA (with Asp190, Asp225) bound exclusively a2-6
receptors, while the New York (NY) variant, which differed only by one residue (Gly225), had mixed a2-6/a2-3 specificity, especially for sulfated oligosaccharides. Only one mutation of the NY variant (Asp190Glu) was sufficient to revert the HA receptor preference to that of classical avian strains. Thus, the species barrier, as defined by the receptor specificity preferences of 1918 human viruses compared to likely avian virus progenitors, can be circumvented by changes at only 2 positions in the HA receptor binding site. The glycan array thus provides highly detailed profiles of influenza receptor specificity that can be used to map the evolution of new human pathogenic strains, such as the H5N1 avian influenza.

A number of HA receptor binding studies have been reported previously, but these have primarily employed cell-based assays to probe sialic acid specificities among different influenza viruses. Such assays involve enzymatic removal of endogenous sialic acid from red blood cells using sialidases, followed by resialylation with linkage-specific sialyltransferases. While such assays approximate the natural binding of a
virus to the host cell receptors, the results are subject to variation based on the quality of the cell preparations and degree of enzymatic
modification, both of which are difficult to control.  Use of whole viruses also introduces the uncertain effects of the viral neuraminidase on the binding assays. In other studies, competitive binding of viruses to synthetic natural analogs was analyzed, but again whole viruses were used here; we used recombinant HA protein as a probe to circumvent these problems.

The array technology, and the ease with which the chip can be customized for display of appropriate glycans, enhances the ability to probe pathogen-specific glycan interactions. In this application, the array could detect fine differences in HA specificity, allowing systematic investigation of the residues responsible for receptor specificity. The array results were surprising in a number of respects. A distinct binding profile was observed for each HA that could not be obtained by the usual hemadsorption or hemagglutination assays.

With this powerful glycan microarray technology, it is now possible to map the fine specificity of emerging influenza viruses and to revisit and complete the analyses on earlier human, pig and bird isolates. Changes in receptor specificity can now be quickly monitored and correlated with mutations in the receptor binding site to aid in prediction of new pandemics or epidemics. In-depth cellular studies will also now be needed to ascertain the range, levels and distribution of different carbohydrates on lung epithelial tissue and human airways, especially since HA specificities for sialylated sugars can be assessed not only for a2-3 or a2-6 linkages, but also can now include preferences for GalNAc versus GlcNAc at position 3 of sialylated sugars as well as for additional substituents, such as sulfate, fucose and extra sialic acid moieties.

Avian Influenza Update Information (12/15/2005)

Edited from ProMed December 15, 2005
Wed 14 Dec 2005
Marianne Hopp (
Source: World Health Organization (WHO), CSR, Disease Outbreak News,
Wed 14 Dec 2005  (

The Ministry of Health in Indonesia has confirmed a further case of human infection with the H5N1 avian influenza virus. The case occurred in a 35 year old man from West Jakarta. He developed symptoms of fever, cough, and breathing difficulty on 6 Nov 2005, was hospitalized on 9 Nov 2005, and died on 19 Nov 2005. Family members and close contacts were placed under observation and tested for possible infection. No evidence of additional cases has been detected. Investigations have been undertaken to determine the source of the man's  exposure. While he did not keep poultry in his household, chickens and other birds were found in his neighborhood. Samples from these birds have been taken and are undergoing tests to determine whether they may have been the source of infection. The newly confirmed case is the 14th in Indonesia. Of these cases, 9 have been fatal.


Mary Marshall (
The Jakarta Post, Wed 14 Dec 2005 (

Minister of health Siti Fadilah Supari has confirmed that a 35 year old man who died last month is the country's 9th human bird flu
fatality. "The World Health Organization (WHO) laboratory in Hong Kong has confirmed the test results. We now have 9 confirmed bird flu deaths from a total of 14 infections," Siti said on Tuesday. The latest casualty was a resident of West Jakarta, who died on 19 Nov 2005 at the private Pantai Indah Kapuk hospital in North Jakarta.

Doctors had initially planned to transfer the patient to the avian influenza treatment center at the Sulianti Saroso Hospital, but were unable to move him due to his critical condition. The Ministry of Health's director general of disease control, I Nyoman Kandun, said the man had been in contact with chickens that carried the H5N1 virus. "He was building his house and around it there were many chickens and birds running free. Researchers tested those birds and they tested positive for the H5N1 virus," Kandun said.

Meanwhile, Sulianti Saroso Hospital spokesman Ilham Patu said that 5 new suspected avian influenza patients were admitted overnight on Mon 12 and Tue 13 Dec 2005 from several areas of Jakarta. "We now have a total of 6 patients being treated for suspected avian influenza infections," Patu told Agence France Presse. Some of the 5 new cases, he said, were in a worse condition than the 6th patient, a 23 year old woman, who has been in intensive care for the past few days.

Siti said over the weekend the government expected to vaccinate 47 million people who have direct contact with poultry and birds across the country against regular human influenza. This would reduce the opportunity for H5N1 to interact by genetic re-assortment with the ordinary human flu virus and becomes easily transmissible. The cost of the vaccination drive, however, is estimated at Rp 5 trillion (nearly US$500 million), which the state budget cannot afford.

The H5N1 virus has killed 71 people in Asia since 2003, out of 138 people known to have been infected. There has been fear that contact between infected birds and humans could eventually result in the virus mutating into a form that could easily pass between humans, sparking a pandemic that could kill millions.

The highly pathogenic H5N1 strain is endemic in poultry in parts of Asia, and has affected poultry in two thirds of the provinces in the country. The WHO has recommended the mass culling of poultry to effectively contain the spread of the virus, but the government said it lacked the funds to compensate farmers and bird owners.

Viet Nam:
Avian influenza may have killed a 3 year old child in Viet Nam where the H5N1 virus has struck in 15 of the country's 64 provinces, a doctor said on Wed 14 Dec 2005. The toddler from the southern province of Hau Giang died on Mon 12 Dec 2005, 7 hours after admission to hospital for severe lung infection, a doctor at the Paediatric Hospital in Can Tho City said. "All the clinical symptoms indicated ...bird flu and we are waiting for test results now," said the doctor, speaking on condition of anonymity.

The child's blood sample has been sent to the Pasteur Institute's avian influenza laboratory in Ho Chi Minh City for tests. The H5N1 flu virus has killed 71 people including 42 in Viet Nam, the country worst affected in Asia, since it swept through in late 2003.

Summary of Cases: by Mary Marshall (
As of Wed 14 Dec 2005, the cumulative number of confirmed human cases of avian influenza A (H5N1) virus infection reported to WHO since December 2003 is the following: Cambodia, 4 cases and 4 deaths; China, 5 cases and 2 deaths; Indonesia, 14 cases and 9 deaths; Thailand, 22 cases and 14 deaths; Viet Nam, 93 cases and 42 deaths; giving an overall total for East Asia of 138 cases and 71 deaths  ( As reported above there another 6 suspected cases in Indonesia and one in Viet Nam awaiting independent confirmation.

See also on ProMed:
Avian influenza, human - East Asia (197): Indonesia 20051213.3591
Avian influenza, human - East Asia (193): China, Indonesia 20051206.3516
Avian influenza, human - East Asia (192): Indonesia 20051206.3514
Avian influenza, human - East Asia (191): Indonesi... 20051205.3510
Avian influenza, human - East Asia (190): Indonesia 20051204.3501
Avian influenza, human - East Asia (188): Indonesia 20051130.3459
Avian influenza, human - East Asia (187): Indonesia, China 20051129.3453
Avian influenza, human - East Asia (186): Viet Nam 20051126.3433
Avian influenza, human - East Asia (177): Indonesi... 20051119.3368
Avian influenza, human - East Asia (169): Viet Nam... 20051113.3325
Avian influenza, human - East Asia (167): Viet Nam... 20051111.3295
Avian influenza, human - East Asia (165): Viet Nam... 20051109.3278
Avian influenza, human - East Asia (164): Viet Nam... 20051108.3271
Avian influenza, human - East Asia (163): Indonesia 20051107.3260
Avian influenza, human - East Asia (160): Indonesia 20051105.3239
Avian influenza, human - East Asia (158): Indonesia, Viet Nam 20051103.3220
Avian influenza, human - East Asia (150): Indonesia 20051021.3068
Avian influenza, human - East Asia (149): Indonesia, Thailand 20051020.3059
Avian influenza, human - East Asia (138): WHO review 20051003.2892
Avian influenza, human - East Asia (117): WHO Update 20050818.2423
Avian influenza, human - East Asia (19): Viet Nam 20050125.0273
Avian influenza, human - East Asia (17): Viet Nam 20050124.0257
Avian influenza, human - East Asia (09): CDC update 20050116.0144]

Avian Influenza Update Information (11/18/2005)

ProMed: Avian Influenza Up-date
Thu 17 Nov 2005
From: C Griot <>
Source: Associated Press Report

The World Health Organization stated on Thu 17 Nov 2005 that it sees no sign that avian influenza is being passed from person to person after China reported its first cases of human infection. "There is no evidence for human transmission so far," said Henk Bekedam, the WHO representative in China. "If there would be something like that, we would expect more people would be unexpectedly dying of very severe pneumonia."

The Chinese Health Ministry reported on Wed 16 Nov 2005 China's first human cases of bird flu. It said there were 2 confirmed cases -- a 24 year old woman who had died and a 9 year old boy who had recovered. It said the boy's 12 year old sister, who died, was a suspected case.

The H5N1 avian influenza virus has killed at least 64 people in Asia since 2003 and experts have warned that it could mutate into a form that can easily spread between people. Millions could die in a pandemic. Asked whether there was any sign that China was facing a flu epidemic, Bekedam said, "If there's evidence of human-to-human transmission, there will be small clusters. We are not at that stage."

But he warned of the need to be vigilant. "We need to closely monitor the virus," Bekedam said. "The key is that at a certain moment, there will be changes, that we will be able to detect it early." That means strong surveillance systems and quick responses, he said. "That's also a challenge not only for China, but a challenge for the whole world," he said. Officials had warned that a human infection was inevitable in China, which has seen 11 outbreaks of bird flu since October 2005 among its vast poultry flocks.

Chinese officials initially said that a 12 year old girl who died in the central province of Hunan, where an outbreak was reported in poultry,
tested negative for the virus, as did her brother and a schoolteacher who fell ill at the same time. But the government later asked the WHO to help re-examine the cases. The teacher, who cut his hand while handling a chicken that may have been sick, was recovering in hospital, state media said. The WHO said the man was under observation and tests were still being carried out to see if he had contracted the virus. WHO said Chinese investigators were confident the girl died of avian influenza, but she couldn't be considered a confirmed case under the agency's guidelines because her body was cremated and there weren't adequate samples for testing.

The 24 year old woman who died was a poultry worker in the eastern province of Anhui, which suffered an outbreak on 20 Oct 2005. Bekedam said the woman didn't live near that site but had been infected by birds that died in her village in a possible unreported case.

Health officials were also monitoring a poultry worker in Liaoning province in China's north east, which has seen 4 outbreaks, prompting the vaccination and slaughter of millions of poultry. This woman had tested negative for the virus and was leaving the hospital within 10 days, the China Daily newspaper said Thu 17 Nov 2005, citing Liaoning health officials. Meanwhile, the government has ordered all ports to require passengers to fill out health forms, the official Xinhua News Agency said. In Guangdong province in the south, the cities of Shenzhen and Zhuhai will check the temperatures of departing passengers, Xinhua said.

Also on Thu 17 Nov 2005, market operators in Shanghai were seeking to reassure shoppers about the safety of their chickens. Sales of live chickens at Shanghai's Sanguantan Poultry and Eggs Wholesale Market have dropped recently by 90 per cent to 5000 a day, said a report posted on the city government's website. All retail and wholesale markets are being disinfected several times a day, it said.

byline: Audra Ang

Avian Influenza Update Information (11/8/2005)

Source: Reuters Foundation AlertNet, Tue 8 Nov 2005

An Indonesian girl who died on Tuesday [8 Nov 2005] is suspected to have been the country's 6th avian influenza victim, but a hospital
spokesman said officials are waiting for local test results. The latest death, if confirmed by further testing, would bring to 10 the number of human cases in the world's 4th most populous nation. 5 Indonesians are confirmed to have died.

The 16-year-old girl was admitted to a Jakarta hospital on Sunday [6 Nov 2005] suffering from high fever and heavy pneumonia and died on Tuesday morning [8 Nov 2005]. She lived in an East Jakarta suburb near a bird market but no evidence of direct contact with infected fowl has yet been established.

"Based on the clinical symptoms, it looks like bird flu," said Ilham Patu, spokesman for Jakarta's Sulianti Saroso hospital "We have taken samples and the test result should be available in the next 2-3 days." Local testing is usually followed by analysis at a Hong Kong laboratory recognised by the World Health Organization.

Over the weekend, officials had confirmed another Indonesian woman, who died in October 2005, had been a bird flu victim. Her brother, whom an official had earlier identified as her nephew, also tested positive for H5N1 virus strain, but is in relatively good condition. A case involving a nurse with bird flu-like symptoms was still under investigation but an initial local test was negative.

Bird flu first surfaced among Indonesia's fowl in late 2003, and has been found in 23 out of its 33 provinces, killing more than 10 million domesticated birds. Officials say new infections in fowl in 2005 are so far around 800 000, compared with 5.3 million for all of 2004. But the U.N Food and Agriculture Organisation (FAO) warns Indonesia needs to be prepared and to revitalise public awareness because the flu most easily spreads among both poultry and humans in the rainy season that usually runs from October to February.

After intense bird flu activity earlier "everyone thought the problem was over but in fact it isn't," Peter Roeder, the animal health officer heading an FAO emergency team, told Reuters. "There is such urgency about getting started to reinvigorate the process here," he added.

The FAO is setting up 4 local disease control centres across Java island and establishing disease surveillance teams at the village level where many so-called "backyard" chickens are found. The task force may involve several thousand people.

"Most of the known human infection has occurred in a fairly small area in the western part of Java. There's obviously something there which is enabling the disease to transmit to humans more frequently," said Roeder. "So it makes sense to try and stop that, because everything we're doing is, in fact, trying to reduce the risk of human infection eventually." He said the disease control effort would likely be extended to other bird flu hotspots within the archipelago early in 2006.

The H5N1 virus has infected at least 123 people in Asia and killed more than 60, for a known mortality rate of more than 50 percent. Viet Nam on Tuesday confirmed its 42nd human death from bird flu. 13 have died in Thailand and 4 in Cambodia. Most cases have been [attributed to] direct or indirect contact with infected chickens.

Avian Influenza Update Information (10/29/2005)

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Science Magazine; October 25, 2005.

Outbreaks of highly pathogenic avian influenza H5N1 virus in poultry and wild birds in the World Health Organization (WHO) European region have caused widespread public concern due to fears that human cases may ensue, as has happened in South East Asia [1].

Part of the concern is the mistaken assumption that the geographical spread of the H5N1 virus in bird populations signals the start of an influenza pandemic, even though it does increase the size of the human/animal interface and the chances of adaptation of an avian virus to a human host. However, efforts should continue to clarify that the spread of avian influenza in birds does not constitute an influenza pandemic in humans.

So far no human cases have been detected in the WHO European region, but we must be prepared for this event. Close collaboration between veterinarian and human surveillance is of utmost importance to ensure early detection of possible human cases. For these reasons, the WHO Regional Office for Europe (WHO EURO) is undertaking a number of actions to monitor the situation.

Outbreaks of avian influenza H5N1 have now been confirmed in 5 countries, either by the World Organization for Animal Health (OIE) or national government agencies in the WHO European region: Croatia, Kazakhstan, Romania, the Russian Federation and Turkey. In addition to this, avian influenza H5N1 has been confirmed in an imported parrot in the United Kingdom. There are now numerous further outbreaks of disease in birds under investigation in several European countries.

Since the occurrence of outbreaks of highly pathogenic avian influenza H5N1 virus in migratory birds, the risk of transmission to domestic birds has increased [2]. Surveillance in wild birds has thus become a priority and the European Union has made guidelines available [3]. It is likely that migratory birds are responsible for the introduction of H5N1 in the European region, as the viruses from outbreaks in Kazakhstan, Romania and Turkey [4] are phylogenetically almost identical to the virus that caused the wild bird die-off at Lake Qinghai in China in May 2005 [2].

Migratory bird flyways are complex, but indicate that additional introduction of the H5N1 virus by wild birds into domestic poultry in the
European region may continue [5].

Between 17 and 20 Oct 2005, a joint WHO/ECDC mission performed a risk assessment and response evaluation in Romania at the request of the Romanian authorities. The situation was assessed to be under proper control following a timely and joint response by the national veterinarian and public health authorities. The H5N1 virus has been introduced in an area limited to the Danube delta, and the complete evaluation of this new animal reservoir requires additional investigations by veterinary and wildlife services. Measures to control the interface between wild bird and domestic poultry would have to be long-term and involve a regional approach, particularly with the countries sharing the Danube delta.

WHO EURO, in collaboration with the European Centre of Disease Prevention and Control (ECDC), can supply technical assistance to countries experiencing outbreaks of avian influenza. The avian influenza epidemiological situation is being closely monitored. On country request, WHO will give technical assistance to countries regarding influenza, particularly on surveillance, laboratory capacity and country preparedness planning. Further to this, in collaboration with the European Commission (EC) and the ECDC, the 2nd joint EC/ECDC/WHO EURO workshop on pandemic preparedness was held in Copenhagen this week. The results of this workshop will be available soon.


Beigel JH, Farrar J, Han AM, Hayden FG, Hyer R, de Jong MD et al. Writing Committee of the World Health Organization (WHO) Consultation on Human Influenza A/H5. Avian influenza A (H5N1) infection in humans. N Engl J Med. 2005; 353:1374-85.

Chen H, Smith GJ, Zhang SY, Qin K, Wang J, Li KS et al. Avian flu: H5N1 virus outbreak in migratory waterfowl. Nature. 2005; 436:191-2. (<>)

European Commission. Guidelines for Member States enhanced surveillance for avian influenza viruses in wild birds in the European Union - September 2005 to January 2006. Press release MEMO/05/304, 7 Sep 2005. (<>)

World Organisation for Animal Health. Highly pathogenic avian influenza in Romania. OIE follow-up report no. 3. [accessed 27 Oct 2005]

Food and Agriculture Organization of the United Nations. H5N1 outbreaks in 2005 and major flyways of migratory birds. Situation on 30 Aug 2005. [accessed 27 Oct 2005] (<>)

[Byline: Caroline Brown (<, Olaf Horstick, Fanny Naville, Guenael Rodier, Bernardus Ganter Communicable Disease Surveillance and Response Unit, WHO Regional Office for Europe, Copenhagen, Denmark]

Avian Influenza Update Information (10/18/2005)

At the request of the Russian authorities the World Organisation for Animal Health sent a team of world-renowned experts in avian influenza and ornithology to Siberia in order to assess the avian influenza situation in the region (see OIE press release of the 4 Oct 2005). The complete Mission Report of this scientific mission is now available online [click here].

One of the main conclusions of the report is that in certain conditions migratory birds could carry the Asian H5N1 influenza virus to other parts of the world. The migratory routes of these potentially infected wild birds are mainly directed to the Caspian Sea, the Middle East, and Africa. A few of these birds could rest during the migration or migrate to western Europe.

Facing the current and potential evolution of the Avian influenza spread, the OIE confirms its position about the priority of eliminating the virus at the animal source, emphasizing the importance of the early detection and rapid response mechanisms carried out by Veterinary Services in countries at risk.

Avian Influenza Update Information (10/3/2005)

A review article entitled "Avian Influenza A (H5N1) Infection in Humans" has been compiled by The Writing Committee of the World Health Organization (WHO) Consultation on Human Influenza A/H5 [see below for a list of participants] and published in the Current Concepts section of the New England Journal of Medicine (online). The authors have tabulated available data on human cases of avian H5N1 influenza virus infection, covering: incidence, transmission, clinical features, pathogenesis, case detection and management, and prevention. This review is an invaluable repository of information not otherwise available on human cases of avian H5N1 influenza virus infection.

The authors have drawn the following conclusions. Infected birds have been the primary source of influenza A (H5N1) infections in humans in Asia. Transmission between humans is very limited at present, but continued monitoring is required to identify any increase in viral adaptation to human hosts. Avian influenza A (H5N1) in humans differs in multiple ways from influenza due to human viruses, including the routes of transmission, clinical severity, pathogenesis, and perhaps, response to treatment. Case detection is confounded by the non-specificity of initial manifestations of illness, so that detailed contact and travel histories and knowledge of viral activity in poultry are essential. Commercial rapid antigen tests are insensitive, and confirmatory diagnosis requires sophisticated laboratory support. Unlike human influenza, avian (H5N1) influenza may have higher viral titers in the throat than in the nose, and hence, analysis of throat swabs or lower respiratory samples may offer more sensitive means of diagnosis. Recent human isolates are fully resistant to M2 inhibitors, and increased doses of oral oseltamivir may be warranted for the treatment of severe illness. Despite recent progress, knowledge of the epidemiology, natural history, and management of influenza A (H5N1) disease in humans is incomplete. There is an urgent need for more coordination in clinical and epidemiologic research among institutions in countries with cases of influenza A (H5N1) and internationally.

The WHO writing committee consisted of the following: John H. Beigel, M.D., National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md.; Jeremy Farrar, D.Phil., Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam; Aye Maung Han, M.B., B.S., Department of Child Health, Institute of Medicine, Yangon, Myanmar; Frederick G. Hayden, M.D. (rapporteur), University of Virginia, Charlottesville; Randy Hyer, M.D., World Health Organization, Geneva; Menno D. de Jong, M.D., Ph.D., Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam; Sorasak Lochindarat, M.D., Queen Sirikit National Institute of Child Health, Bangkok, Thailand; Nguyen Thi Kim Tien, M.D., Ph.D., Pasteur Institute, Ho Chi Minh City, Viet Nam; Nguyen Tran Hien, M.D., Ph.D., National Institute of Hygiene and Epidemiology, Hanoi; Tran Tinh Hien, M.D., Ph.D., Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam; Angus Nicoll, M.Sc., Health Protection Agency, London; Sok Touch, M.D., Ministry of Health, Phnom Penh, Cambodia; and Kwok-Yung Yuen, M.D., University of Hong Kong, Hong Kong SAR, China.

Address reprint requests to Dr. Hayden at the Department of Internal Medicine, P.O. Box 800473, University of Virginia Health Sciences Center, Charlottesville, VA 22908, or at <>.

Avian Influenza Update Information (8/25/2005)

World Health Organisation (WHO), CSR
Disease Outbreak News, Thu Aug 2005

Marianne Hopp

Geographical Spread of H5N1 Avian Influenza in Birds; Situation Assessment and Implications for Human Health

Beginning in late July 2005, official reports to the OIE from government authorities indicate that the H5N1 avian influenza virus has expanded its geographical range. Both Russia and Kazakhstan reported outbreaks of avian influenza in poultry in late July, and confirmed H5N1 as the causative agent in early August. Deaths in migratory birds infected with the virus have also been reported. Outbreaks in both countries have been attributed to contact between domestic birds and wild waterfowl via shared water sources. These are the first outbreaks of highly pathogenic H5N1 avian influenza recorded in the 2 countries. Both countries were previously considered free of the virus.

Since the initial reports, the Russian H5N1 outbreak in poultry, which has remained confined to Siberia , has spread progressively westward to affect 6 administrative regions. In Kazakhstan , several villages bordering the initial outbreak site in Siberia are now known to have experienced disease in poultry. To date, outbreaks in the 2 countries have involved some large farms as well as small backyard flocks, with close to 120 000 birds dead or destroyed in Russia and more than 9000 affected in Kazakhstan .

In early August, Mongolia issued an emergency report following the death of 89 migratory birds at 2 lakes in the northern part of the country. Avian influenza A virus has been identified as the cause, but the virus strain [serotype] has not yet been determined. Samples have been shared with WHO reference laboratories and are currently being investigated. Also in early August, an outbreak of H5N1 in poultry was detected in Tibet, China. In all of these recent outbreaks, authorities have announced control measures in line with FAO and OIE recommendations for highly pathogenic avian influenza. To date, no human cases have been detected, vigilance is high, and rumours are being investigated by local authorities.

The outbreaks in Russia and Kazakhstan provide evidence that H5N1 viruses have spread beyond their initial focus in south-east Asian countries, where outbreaks are now known to have begun in mid-2003.

Despite aggressive control efforts, FAO has warned that the H5N1 virus continues to be detected in many parts of Viet Nam and Indonesia and in some parts of Cambodia, China, Thailand, and possibly also Laos. The south-east Asian outbreaks, which have resulted in the death or destruction of more than 150 million birds, have had severe consequences for agriculture and most especially for the many rural farmers who depend on small backyard flocks for income and food. Human cases, most of which have been linked to direct contact with diseased or dead poultry in rural areas, have been confirmed in 4 countries: Viet Nam, Thailand, Cambodia, and Indonesia. Only a few instances of limited human-to-human transmission have been recorded. Poultry outbreaks of H5N1 avian influenza in Japan, Malaysia, and the Republic of Korea were successfully controlled.

WHO fully agrees with FAO and OIE that control of avian influenza infection in wild bird populations is not feasible and should not be attempted. Wild waterfowl have been known for some time to be the natural reservoir of all influenza A viruses. Migratory birds can carry these viruses, in their low-pathogenic form, over long distances, but do not usually develop signs of illness and only rarely die of the disease. The instances in which highly pathogenic avian influenza viruses have been detected in migratory birds are likewise rare, and the role of these birds in the spread of highly pathogenic avian influenza remains poorly understood.

Very large die-offs of migratory birds from avian influenza, such as the one detected at the end of April at Qinghai Lake in central China , in which more than 6000 birds died, are considered unusual. Research published in July 2005 indicates that H5N1 viruses in that outbreak are similar to viruses that have been circulating in south-east Asia for the last 2 years.

Analyses of viruses from the Russian outbreak, recently published on the OIE website, show apparent similarity to viruses isolated from migratory birds during the Qinghai Lake outbreak. Specimens from the Mongolian outbreak in migratory birds should also prove useful in shedding light on these recent developments. Monitoring the spread and evolution of avian H5N1 viruses in birds and rapidly comparing these results with previously characterized H5N1 viruses is an essential activity for assessing the risk of pandemic influenza.

Implications for human health

The poultry outbreaks in Russia and Kazakhstan are caused by a virus that has repeatedly demonstrated its ability, in outbreaks in Hong Kong in 1997, in Hong Kong in 2003, and in south-east Asia since early 2004, to cross the species barrier to infect humans, causing severe disease with high fatality. A similar risk of human cases exists in areas newly affected with H5N1 disease in poultry.

Experience in south-east Asia indicates that human cases of infection are rare, and that the virus does not transmit easily from poultry to humans. To date, the majority of human cases have occurred in rural areas. Most, but not all, human cases have been linked to direct exposure to dead or diseased poultry, notably during slaughtering, defeathering, and food preparation. No cases have been confirmed in poultry workers or cullers. No cases have been linked to the consumption of properly cooked poultry meat or eggs.

Factors relating to poultry densities and farming systems seen in different countries may also influence the risk that human cases will occur. During a 2003 outbreak of highly pathogenic avian influenza, caused by the H7N7 strain, in the Netherlands , more than 80 cases of conjunctivitis were detected in poultry workers, cullers, and their close contacts, and one veterinarian died. That event, which was contained following the destruction of around 30 million poultry, underscores the need for newly affected countries to follow FAO/OIE/WHO recommended precautions when undertaking control measures in affected farms.

Pandemic risk assessment

The possible spread of H5N1 avian influenza to poultry in additional countries cannot be ruled out. WHO recommends heightened surveillance for outbreaks in poultry and die-offs in migratory birds, and rapid introduction of containment measures, as recommended by FAO and OIE.

Heightened vigilance for cases of respiratory disease in persons with a history of exposure to infected poultry is also recommended in countries with known poultry outbreaks. The provision of clinical specimens and viruses, from humans and animals, to WHO and OIE/FAO reference laboratories allows studies that contribute to the assessment of pandemic risk and helps ensure that work towards vaccine development stays on course.

The expanding geographical presence of the virus is of concern, as it creates further opportunities for human exposure. Each additional human case increases opportunities for the virus to improve its transmissibility, through either adaptive mutation or re-assortment. The emergence of an H5N1 strain that is readily transmitted among humans would mark the start of a pandemic.

The cumulative numbers of confirmed human cases of avian influenza A (H5N1) virus infection reported to WHO:

Viet Nam , 90 cases with 40 deaths
Thailand , 17 cases with 12 deaths
Cambodia , 4 cases with 4 deaths
Indonesia , 1 fatal case
Total - 112 cases, 57 deaths.

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