Pandemic Flu Masks

I was discouraged reading this after having just purchased some masks, but I've bolded a paragraph toward the bottom that gives me hope. If we realize the limitations going in, then we can take greater precautions.

Don't count on masks if bird flu strikes

Devices offer little protection, could lead to false sense of security

Updated: 5:52 p.m. ET April 27, 2006
WASHINGTON - If a worldwide flu epidemic strikes, don’t reuse a face mask — and don’t assume, either, that it will offer a lot of protection, the Institute of Medicine said Thursday.

That’s the bottom line from an anxiously awaited probe requested by the government as it stockpiles supplies in case a flu pandemic begins.

If it does, millions undoubtedly will turn to masks, raising a dilemma for the prestigious scientific organization: There’s little evidence about whether masks truly block the influenza virus — and if they can, just how much protection they offer.

Without that information, wearing masks might spur a false sense of security, perhaps encouraging people to go into crowds or near infected patients when instead they should have stayed away.

“We don’t want to say, 'Don’t use it,' but don’t expect to be fully protected if you do use it. That’s a tough public health message to get out,” said Dr. Donald Burke, a professor of international health at Johns Hopkins University who co-chaired the IOM panel.

'Last resort'
Hence, “respiratory protection is the last resort to control infectious spread,” the report notes.

Health workers use masks — simple surgical masks or better-filtering ones called N95 respirators — to keep from breathing their own germs onto vulnerable patients, and to protect themselves from specific respiratory diseases, such as tuberculosis.

The masks are supposed to be used once and discarded. Anticipating a staggering demand if the bird flu or some other super-strain of influenza sparks a pandemic, the Department of Health and Human Services asked if such masks could be reused, to conserve supplies.

No, the IOM report concludes.

“We’re not surprised,” said William Raub, who oversees emergency preparedness at HHS, which has placed an initial order of 150 million masks for a national stockpile.

“While masks have a role to play, we must discourage people from an undue reliance on them,” he added.

The report shows the government should buy more, said Jeff Levi of the advocacy group Trust for America’s Health. Much smaller France, he said, has ordered 200 million N95 masks.

Raub said officials would reconsider federal stockpile levels once the initial order was in, but that hospitals and state officials should be stockpiling their own masks, too.

The bigger question is one the government didn’t ask: If different masks really block influenza, the IOM panel noted, calling for urgent study of that issue.

Flu can spread three ways:

By hand. Someone sneezes into his hand and then grabs a doorknob that you touch, or shakes your hand.

By large droplets of virus, if someone is in the direct path of a sneeze or cough. Those heavy droplets fall quickly to the ground.

By tiny particles, which can stay suspended in the air for far longer periods.
No one knows which of those methods is most important.

But, the IOM said, surgical masks aren’t designed to block tiny airborne particles, just larger ones. Thus, they probably would be of most use when worn by infected patients, to help cover coughs and sneezes.

One size doesn't fit all
While the N95 respirators haven’t been tested to see how effectively they block flu virus specifically, they are designed to block small particles and would be a logical choice for health workers. But N95s must be individually fitted to users’ faces so that air doesn’t seep into the sides, a problem for men with facial hair. Also, they come only in certain sizes, with none for children, and they’re uncomfortable to breathe in for long periods.

Regardless, if someone with flu sneezes on any mask wearer, the outside is contaminated, so users must remove them carefully to avoid infecting themselves, the IOM panel stressed.

More expensive reusable masks do exist, but there is no good way to decontaminate and reuse surgical masks and standard disposable N95s, the panel concluded.

It listed one exception: Someone could reuse his or her own N95 if the outside were protected from surface exposure, such as by placing a disposable surgical mask over it, stored it carefully to avoid creases or damage, and the user thoroughly washed hands before and after removal and rechecked the fit with each wearing.

What about using a handkerchief or some other improvised mask? They’re not likely as protective as even a surgical mask might be, but the panel hesitated to discourage use — assuming that some protection would be better than none. Generally, the tighter the fabric weave, the better.

Independent Team Declares Pandemic Level 4

H5N1 Pandemic Level 4 Declared by Research Team Citing 23 Clusters and Case Histories


"Using the World Health Organizations own guidelines for determining pandemic level status, an independent research team has gathered enough factual H5N1 data to substantiate the need to declare a "Pandemic Level 4" response to Avian Flu. The Information that supports this claim is derived from scientific and medical papers, laboratory reports, government, geneticist, virologist and other experts around the world. The combined effort focused on a three year period from 2003 to the 2006, listing 23 documented clusters of H2H. The report is based on millions of Internet searches and thousands of hours verifying data."

========================================
About the Flu Pandemic Stage
========================================

The World Health Organization (WHO) has developed a global influenza preparedness plan , which defines the stages of a pandemic, outlines the role of WHO, and makes recommendations for national measures before and during a pandemic. Currently, according to WHO, we are at state 3.
This stage is defined as: Human infection(s) with a new subtype, but no human-to-human spread, or at most rare instances of spread to a close contact.

There has been considerable criticism of WHO's reluctance to raise this to alert level 4 which is defined as: Small cluster(s) with limited human-to-human transmission but spread is highly localized, suggesting that the virus is not well adapted to humans.

(PRWEB) April 23, 2006 -- "Clusters of H5N1 infections," says one research member "They may indicate human to human transmission of H5N1 influenza or alternatively indicate common exposure to the virus from an environmental source, presumably avian. A cluster here is defined as two or more individuals: 1. Who are in close physical contact, 2. Who become very sick with a respiratory disease, and 3. at least one of whom is a confirmed H5N1 influenza case.

China - 2003 February
A family of 5 from Hong Kong visited Fujian province in Mainland China early in 2003. A mother went with two daughters and one son on January 25, 2003. The 7 year old girl developed respiratory symptoms and a high fever on January 27/28. She developed pneumonia on January 28 2003. The father joined his family in Fujian province on January 31. His 7 year old daughter died on February 4, 2003. She was not tested for H5N1 and was buried in Mainland China. Her 33 year old father became ill on February 7 with fever, cough and blood in sputum. The family returned to Hong Kong on February 9 2003. The father was admitted to a hospital in Hong Kong on February 11. He died on February 17. He was tested and was found to have been infected with H5N1. The 8 year old boy in the family became ill with a cough and fever on February 9, 2003. He was tested and was also found to be positive for H5N1, but recovered. Peiris et al 2004

Viet Nam - 2003 December
A 12 year old girl from Ha Nam became ill on December 25 2003 and was admitted to a Hanoi hospital on December 27 2004. She died on December 30 2003. This is first confirmed death from H5N1 in Viet Nam. Her 30 year old mother became ill on January 1 2004 and died of H5N1 influenza on Jan 9 2004. Corresponds to Olsen et al. cluster 1

A 7 year old girl Nam Dinh died on December 29 2003 of acute respiratory distress. No samples were tested from this girl. Her 5 year old brother was admitted to the hospital on December 29 2003. He died 17 days after becoming ill. H5N1 infection was confirmed. Corresponds to Olsen et al. cluster 2

Viet Nam - 2004 January
A family cluster of H5N1 infections was observed in Thai Binh province in January 2004 (see also WHO update 15). A 31 year old man was hospitalized on January 7 2004 with severe respiratory illness. He died on January 12. No samples from this patient were tested for H5N1. His 28 year old wife became ill with a severe respiratory illness on January 10, but recovered. H5N1 infection was confirmed. The man’s two sisters, 23 and 30 years old, became ill on January 11 and January 10, respectively. Both died on January 23. H5N1 infection was confirmed in both sisters. Corresponds to Olsen et al. cluster 3

Viet Nam - 2004 January-February
A 9 year old girl in Dong Thap province became ill with diarrhea, but no respiratory symptoms on January 28 2004. She died of acute encephalitis on February 2 2004. She was not tested for H5N1 influenza. Her 4 year old brother became ill with diarrhea on February 10 2004, also with no respiratory symptoms. He developed encephalitis and died of respiratory failure on February 17 2004. This 4 year old boy was tested for H5N1 influenza and found to be positive.

Viet Nam - 2004 July
A 19 year old man in Hai Giang province became ill on July 23, 2004 with symptoms of fever, breathing difficulties and hemorrhage. His 22 year old female cousin exhibited the same symptoms. They both died on July 30. They were not tested for H5N1 infection. The man’s 25 year old sister became ill with the same symptoms on July 31 2004. She died on August 2 2004. H5N1 infection was confirmed. Corresponds to Olsen et al. cluster 5

Thailand - 2004 September
A family cluster of H5N1 and severe respiratory illness was observed in September 2004 in Kamphaeng Phet province. A 11 year old girl from Kamphaeng Phet province became ill on September 2 2004 and died of pneumonia on September 8 2004. She was not tested for H5N1 infection, but was considered to be a probable H5N1 fatality. Her 26 year old mother lived in Bangkok but visited her daughter to take of her while she was ill. The mother became ill on September 11 2004 and died on September 20. H5N1 infection was confirmed. The girl lived with her 32 year old Aunt. The Aunt became ill on September 16 2004 but recovered. H5N1 infection was confirmed. The Aunt’s son became ill with a respiratory infection. This cluster is considered one of the most convincing cases of human-to-human transmission of H5N1 because the mother lived in an area which had no infected birds, Bangkok, and was exposed to H5N1 by her daughter (who did have exposure to sick chickens). Corresponds to Olsen et al. cluster 6

Viet Nam - 2005 January
A 45 year old man from Thai Binh became ill with a respiratory illness on December 26 2004 and died on January 9 2005. H5N1 influenza was confirmed. His 42 year old brother, from Hanoi, was hospitalized on January 10 but recovered. He was also confirmed to be infected with H5 influenza. A third 36 year old brother was reported to be positive for H5N1 infection, but did not exhibit any symptoms Corresponds to Olsen et al. cluster 7

A 17 year old boy from Bac Lieu was hospitalized on January 10 2005. He died of H5N1 influenza on January 14 2005. His 22 year old sister also had respiratory symptoms and was hospitalized. Her fate and H5N1 status were not reported.Corresponds to Olsen et al. cluster 8

A 35 year old woman from Dong Thap became ill on January 14 2005. She died of H5N1 influenza on January 21. Her 13 year old daughter became ill on January 20 2005. She later died. H5N1 infection was confirmed. Corresponds to Olsen et al. cluster 9

Cambodia - 2005 January
A 14 year old boy from Kampot province became ill with respiratory symptoms and died on January 20 2005. He was not tested for H5N1 infection. His 25 year old sister became ill on January 21 2005. She traveled to Vietnam to receive care but died on January 30. H5N1 infection was confirmed. Corresponds to Olsen et al. cluster 10

Viet Nam - 2005 February
A 21 year old man from Thai Binh province ate meat from a sick chicken on February 8 2005. He developed a high fever and cough on February 14 2005. On February 20, he was admitted to an hospital with severe pneumonia. He received oseltamivir (Tamiflu -75 mg twice a day for 7 days) on February 23. He was discharged from the hospital on May 13. H5N1 infection was confirmed. His 14 year old sister cared for him from February 14 to February 21. She became ill with a mild cough and mild fever on February 23 2005. H5N1 infection was confirmed. She received an initial treatment with oseltamivir (Tamiflu -75 mg once a day) from February 24 to February 27. She was admitted to a hospital for observation on February 24. At this time, she had no fever but did have a mild cough. On February 27, she developed a high fever and severe cough. On February 28, she received oseltamivir (Tamiflu -75 mg twice a day for 7 days). She was discharged from the hospital on March 14 2006. The girl had no contact with poultry prior to becoming ill. A 26 year old male nurse, who cared for 21 year old male patient mentioned above, was admitted to a hospital in early March. H5N1 infection was apparently detected. The 80 year old grandfather of the 21 year old and 14 year old brother and sister was reported to be infected with H5N1. He did not exhibit any symptoms. Corresponds to Olsen et al. cluster 11

Viet Nam - 2005 March
Five members of a family in the city of Haiphong were all reported to be infected with H5N1 influenza and were hospitalized on March 22 2005. The 35 year old father, 33 year old mother, 13 year old daughter, 10 year old daughter and 4 month old daughter were all infected. Corresponds to Olsen et al. cluster 14

Indonesia - 2005 July
An 8 year old girl from Tangerang, a suburb of Jakarta, became ill on June 24 2005 and died on July 13. She was reported to be H5N1 positive, but was later judged by the WHO not to have an acute H5N1 infection. Her 1 year old sister became ill on June 29 2005 and died on July 9. She was not tested for H5N1 infection. The father of the two girls, a 38 year old man, became ill on July 2 2005 and died on July 12 2005. H5N1 infection was confirmed. Corresponds to Olsen et al. cluster 15

Indonesia - 2005 September
On September 10 2005 a 37 year old woman from Jakarta died of confirmed H5N1. Her 9 year old nephew became sick with respiratory symptoms. Initially he tested postive with PCR. It was later reported that he was not infected with H5N1.

On September 20 2005 a 21-year-old man from Lampung province developed symptoms. On September 24 2005 he was hospitalized; H5N1 infection was confirmed. On October 4, the 4 year old nephew of this man became ill. H5N1 infection was confirmed.

China - 2005 October
On October 8 2005, a 12 year old girl from Hunan province became ill with respiratory symptoms. She died on October 16. Her 9 year old brother became ill with respiratory symptoms on October 10 2005. He was confirmed to be infected with H5N1. He was released from the hospital on November 12 2005.

Thailand - 2005 October
A 48-year old man from Kanchanaburi province became ill on October 13 2005 and died on October 19. His 7 year old son became ill on October 16, but recovered. H5N1 infection was confirmed in both cases.

Indonesia - 2005 October
On October 19 2005, a 19 year old woman from Tangerang became ill. She died on October 28. Her 8 year old brother became ill on October 25. H5N1 infection was confirmed in both cases.

Indonesia - 2005 November
On November 3, two brothers, ages 7 and 20, from West Java province developed fever and respiratory symptoms. They died on November 11. On November 6, their 16 year old brother also developed fever and respiratory symptoms. He was hospitalized on November 16. H5N1 infection was confirmed in the 16 year old. The 7 year old and 20 year old were not tested for H5N1.

Turkey - 2006 January
The first reported case of H5N1 influenza in Turkey occurred in a 14 year old boy from Dogubayazit, in the province of Agri. He died on January 1 2006. His 15 year old sister died of H5N1 influenza on January 5 2006. The 12 year old sister of these children died on January 6 2006. The 6 year old brother of these children was hospitalized.

Two brothers, 5 and 2 years old, from Ankara province were reported infected with H5N1 on January 8 2006.

A 9 year old girl and her 3 year old brother, from the Dogubeyazit district in Agri Province, were reported infected on January 9 2006.

A 14 year old girl from the Dogubayazit district of Agri province became ill on January 4 2006. She died of H5N1 influenza on January 15. Her 5 year old brother also became ill on January 4 2006. He was confirmed to be infected with H5N1 influenza.

Indonesia - 2006 January
On January 6 2006, a 13 year old girl became ill. She died of H5N1 influenza on January 14. On January 8 2006, her 4 year old brother became ill. He died of H5N1 influenza on January 17. Their 14 year old sister was hospitalized with respiratory symptoms on January 14 2006. Their 43 year old father was hospitalized on January 17 with respiratory symptoms. On January 19 2006, a 9 year old girl from a neighboring village was hospitalized, but later recovered. H5N1 infection was confirmed.

Iraq - 2006 January
The first person reported to contract H5N1 influenza in Iraq was a 15 year old girl from the town of Raniya. She became ill on January 2 2006 and died on January 17. A US naval Medical Research Unit located in Cairo, Egypt confirmed infection with H5N1. Her 39 year old uncle, who cared for her while she was sick, became ill on January 24 2006. He died of a respiratory illness on January 27. H5N1 infection was confirmed in the uncle.

Indonesia - 2006 February
A 12 year old girl from Boyolali, Central Java became ill on February 19 2006. She died on March 1. H5N1 infection was confirmed. Her 10 year old brother also became ill on February 19 and died February 28. He was not tested for H5N1.

Azerbaijan - 2006 March
A 17 year old girl from Salyan Rayon died on February 23 2006. H5N1 infection was confirmed. Her first cousin, a 20 year old woman from Salyan Rayon died on March 3. H5N1 infection was confirmed. This woman’s 16 year old brother died on March 10. H5N1 infection was confirmed. A 17 year old girl, who was a close friend of this family, died on March 8. H5N1 infection was confirmed. A 10 year old boy from Salyan Rayon became ill. H5N1 infection was confirmed. A 15 year old girl from Salyan Rayon became ill. H5N1 infection was confirmed.

Egypt - 2006 March-April
A 6 year old girl from the Kafr El-Sheikh governorate became ill. H5N1 infection was confirmed. Her 1.5 year old sister became also became ill. H5N1 infection was confirmed.

"We substantiate the claim based on the data above to elevate the current WHO pandemic level from 3 to 4," says Cornelius Robertson team spokesman. "The importance of recognizing level 4 is a key to minimizing public heath impact and the welfare of the general public. By informing the public of pandemic flu alert from level three to four would increase survivability from this natural flu cycle. Pandemics run in historical waves every 30-45 years

Robertson continues, "Evidence points to global organizations and world governments reacting in the same manner as in the 1918 Spanish Flu pandemic which killed Tens of millions. Either for social economic reasons, geographical differences there is much foot dragging and under reporting in areas of like Africa the Middle East and Southeast Asia."

In this information age, using online resources of thousands of data bases, the team compiled its opinion. "We say facts are facts. We are declaring Pandemic level 4 for Avian Influenza."

Sources
http://www.who.int/csr/disease/avian_influenza/updates/en/index.html
http://www.cdc.gov/ncidod/EID/vol11no11/05-0646.htm
http://www.promedmail.org/pls/askus/f?p=2400:10001:1001333047747557695
http://www.recombinomics.com
http://www.fluwikie.com
http://www.avianflutalk.com

Azerbaijan: 3 Dead From Bird Flu

March 13, 2006 - CBS/AP) Tests have confirmed that three people recently died from bird flu, a top Azerbaijani health official said Monday.

Deputy Health Minister Abbas Velibeyov told The Associated Press that tests conducted by the World Health Organization had confirmed the diagnosis of avian influenza in the deaths of three people, who all came from the same district on the ex-Soviet nation's Caspian Sea coast, south of the capital, Baku.

Velibeyov said that names and ages of the victims would be released on Tuesday.

Also Monday, Myanmar reported its first case of the deadly H5N1 strain, and there was a high risk poultry in Afghanistan were also infected, officials said a day after the virus gained new ground in Europe and Africa.

The virus was discovered in wild birds in Azerbaijan last month in an area along the Caspian Sea coast and has spread to the northeast and the southwest near the border with Iran. The deaths are the first reported cases in humans in the country.

Azerbaijan shares a short border with Turkey, where four children died recently of the disease. Bird flu has killed at least 98 people in Asia and Turkey since 2003, according to the World Health Organization. Almost all of the human deaths have been linked to contact with infected poultry, but experts fear H5N1 could mutate into a form that spreads easily among people, sparking a human flu pandemic.

In other developments:

Authorities in Poland on Sunday announced confirmation of the country's fourth case of deadly avian flu. Laboratory tests confirmed the H5N1 strain in a dead swan found in a town near the border with Germany, said Tadeusz Wijaszka, head of the laboratory in Pulawy, central Poland.

Two wild swans in Greece tested positive for the deadly H5N1 strain, the Agriculture Ministry said Sunday, bringing to 32 the number of bird flu infections found in birds in Greece since the first case was confirmed Feb. 11.

The number of wild birds found infected with H5N1 bird flu in Germany is approaching 200, authorities said Monday, after the confirmation of several new cases. A federal laboratory said the strain has been found in 192 wild birds, most of them near Germany's Baltic Sea coast. Three cats and a stone marten also have been diagnosed with the strain. The laboratory also said six ducklings found dead at a farm in Bavaria tested negative for the virus, relieving fears that H5N1 had reached farm birds in the country for the first time.

A racing pigeon association urged authorities Monday not to cull the country's 800,000 racing pigeons, arguing that the birds were not carriers of the deadly H5N1 strain of the flu virus. "Racing pigeons have a strict diet and are vaccinated against all diseases," said a statement from the Union of Federations of Romanian Pigeon Enthusiasts. There are about 6,000 breeders in Romania; they have 800,000 pigeons which take part in national and international competitions.

A new IMF report says a bird flu pandemic similar to the 1918 outbreak that killed more than 40 million could result in a "sharp but only temporary decline" in the world's economic activity. The report, released Monday, studied the possible financial and economic impact on the world should a bird flu pandemic erupt.

Lab tests confirmed the outbreak in northern Myanmar after 112 chickens died, said Laurence Gleeson, a senior official at the U.N. Food and Agriculture Organization, citing a report from the Myanmar government.

The Cameroon government announced its first case on Sunday, becoming the fourth African country to be struck by the virus. The H5N1 bird flu strain was detected in a duck on a farm close to the northern town of Maroua, near the border with neighboring Nigeria, the government said in a statement broadcast on state radio.

In Afghanistan, meanwhile, the U.N. Food and Agriculture Organization said that an H5 subtype of bird flu was found in poultry samples in Kabul and Jalalabad, and that there was a "high risk" further tests could prove the samples to be the H5N1 strain.

The deadly bird flu virus has not yet reached Afghanistan, but the FAO warned last month that it would and chided the government and donor nations for being slow to prevent it.

Dr. Azizullah Esmoni, of the Afghan Agriculture Ministry, said he expected further results within 48 hours to determine whether the H5N1 virus had struck the Afghan poultry.

The H5N1 strain of bird flu has killed or forced the slaughter of tens of millions of chickens and ducks across Asia since 2003, and recently spread to Europe, Africa and the Middle East. Health officials fear H5N1 could evolve into a virus that can be transmitted easily between people and become a global pandemic.

That has not happened yet, but at least 97 people have died from the disease worldwide, two-thirds of them in Indonesia and Vietnam, according to figures by the World Health Organization.

There was no evidence of human infection in Myanmar, said Than Tun, director of the country's livestock breeding and veterinary department, a division of the Agriculture Ministry.

"We are taking all measures to control the situation," he told The Associated Press, pledging that authorities would deal with the outbreak in a "transparent manner."

Than Tun said the remaining chickens in the flock of nearly 800 were immediately slaughtered, and that experts were inspecting farms within a two-mile radius of the farm where the infected birds were found.

The cases were detected at four farms north of Mandalay, the country's second largest city, said Jum Conix, a WHO spokesman in Myanmar.

Myanmar's military government — which generally restricts the free flow of information and exercises tight control over the mostly state-owned mass media — had previously said it would deal openly with any outbreaks of bird flu.

Gleeson said that testing was carried out at laboratories in Mandalay and Yangon, the capital, where technicians had received training in how to detect bird flu from the Food and Agriculture Organization and other international agencies.

"We have every reason to expect there is sufficient competence (in Myanmar) to make the diagnosis," Gleeson said. "If the government says they've got it, then they've got it."

Samples have also been sent to a laboratory in Australia, according to Than Tun, but Gleeson said the FAO had not been informed of that.

The World Health Organization was waiting for confirmation from the Australian tests before officially declaring an outbreak in Myanmar, said Jum Conix.

Cameroon's Minister of Livestock Aboubakary Sarki told reporters the infected duck was among 10 birds that died in Maroua from Feb. 12-26. He said the government had already slaughtered birds in the area as a precaution, but did not say how many.

The fatal virus was first discovered in Africa on a commercial poultry farm in Nigeria in February. It has since been reported in Niger and Egypt.

India and France Confirm Cases

BOMBAY, Feb. 18, 2006
©MMVI, The Associated Press

India and France both confirmed their first outbreak of the deadly strain of bird flu among fowl on Saturday, and an Indian official said authorities planned to cull a half-million birds to check the spread of the virus.

Tens of thousands of chickens have died from bird flu in recent weeks in western India, and people suffering from flu-like symptoms in the region were to be tested for the infection, officials said.

The challenge is to keep sick wild fowl from infecting domestic birds because most human beings catch bird flu from domestic poultry, reports CBS News Correspondent Elizabeth Palmer.

Saturday's announcement came as other nations fought to contain outbreaks of the H5N1 strain, which has spread from Asia amid fears of a worldwide flu pandemic if the virus mutates into a form that is easily transmitted between humans. Bird flu has killed at least 91 people—most of them in Asia—since 2003, according to World Health Organization figures.

In western India, officials planned to immediately begin slaughtering hundreds of thousands of birds in a 1.5-mile radius around the poultry farms in the town of Navapur where the confirmed cases were detected, said Anees Ahmed, the minister for animal husbandry in the state of Maharashtra.

"Around 500,000 birds will be killed," he said.

An unknown number of people in the area were reportedly suffering from flu and fever, and scientists were to start testing them on Sunday, said Milind Gore, deputy director of the National Institute of Virology in Pune.

At least 30,000 chickens have died in and around Navapur, a major poultry-farming region of Maharashtra, over the past two weeks, Ahmed said.

Police have cordoned off the area around the poultry farms, Ahmed said.

An area of three to five miles around the cordoned region will be under surveillance, and all poultry not killed will be vaccinated against bird flu, the health ministry said in a statement.

Indian chicken farmers were devastated by the announcement.

"All of us will have to start again from scratch, and I don't know how many of us will survive," said Ghulam Vhora, a member of the Navapur Poultry Farmers Association. "Most farmers cannot believe the news and are hoping the lab tests confirming bird flu are wrong."

France confirmed its first case of the H5N1 strain in a wild duck found dead in a bird reserve some 20 miles northeast of Lyon, France's third-largest city, the Agriculture Ministry said. All fowl have been ordered indoors or vaccinated there.

"There's a little bit of panic because we don't know what to do," said Madeleine Monnet, 60, in the town of Joyeux, where the diseased bird was discovered. "Here everybody has a little bit of fowl—chickens or ducks—for their personal consumption."

Countries from Europe to Asia were struggling with their outbreaks.

In Indonesia, another man died from the H5N1 virus, bringing the nation's death toll to 19, a Health Ministry official confirmed Saturday.

The man, who died Feb. 10, had frequent contact with poultry, said Hariadi Wibisono, a health ministry official.

German and Austrian authorities ordered all poultry and fowl kept indoors, and in Germany, 28 wild birds were diagnosed with the deadly strain on the same northern island where the country's first cases were detected earlier this week.

Egypt's agriculture minister, meanwhile, said Saturday that the number of cases of bird flu in the country are not high enough to warrant large-scale slaughter of birds, but that authorities will act accordingly if the disease spreads.

There have been conflicting reports about the number of H5N1 cases found in Egypt, but the government said Friday there had been seven cases in three provinces.

"The disease is not at a level that leads to getting rid of large numbers" of fowl, Amin Abaza told the Arabic-language Al-Arabiya satellite channel. "There are known international measures that are taken. Poultry within a certain radius get culled."


Animal Cases: Summary of Current Situation
Since December 2003, avian influenza A (H5N1) infections in poultry or wild birds have been reported in the following countries:

Africa:
Nigeria
East Asia & the Pacific:
Cambodia
China
Hong Kong (SARPRC)
Indonesia
Japan
Laos
Malaysia
Mongolia
Thailand
Vietnam
Europe & Eurasia:
Austria
Azerbaijan
Bosnia & Herzegovina (H5)
Bulgaria
Croatia
France (H5)
Germany
Greece
Italy
Romania
Russia
Slovenia (H5)
Turkey
Ukraine
Near East:
Egypt
Iraq (H5)
Iran
South Asia:
India
Kazakhstan

For additional information about these reports, visit the
World Organization for Animal Health Web site.

Updated February 21, 2006

Bird flu 'could take 142m lives'

Worst case economic cost is $4.4 trillion

Thursday, February 16, 2006; Posted: 10:28 a.m. EST (15:28 GMT)

SYDNEY, Australia (CNN) -- As many as 142 million people around the world could die if bird flu turns into a "worst case" influenza pandemic, according to a sobering new study of its possible consequences.

And global economic losses could run to $4.4 trillion -- the equivalent of wiping out the Japanese economy's annual output.

The study, prepared for the Sydney, Australia-based Lowy Institute think tank, says there are "enormous uncertainties" about whether a flu pandemic might happen, and where and when it might happen first.

But it says even a mild pandemic could kill 1.4 million people and cost $330 billion.

In its "ultra" or worst-case scenario, Hong Kong's economy is halved, the large-scale collapse of Asian economic activity causes global trade flows to dry up, and money flows out to safe havens in North America and Europe. Deaths could top 28 million in China and 24 million in India.

The report's release in Sydney Thursday comes as two more countries in Europe -- Germany and Austria -- report that the deadly H5N1 bird flu virus has been detected in wild fowl (Full story).

The Lowy Institute's report, titled Global Macroeconomic Consequences of Pandemic Influenza, looks at four possible scenarios:

Mild, in which the pandemic is similar to the 1968-69 Hong Kong flu;

Moderate, similar to the 1957 Asian flu;

Severe, similar to the 1918-19 Spanish flu (which infected an estimated 1 billion people and claimed as many as 50 million lives);

An "ultra" scenario that is worse than the Spanish flu outbreak.

Although the 1918-19 flu outbreak probably originated in Asia, it was known as the Spanish flu because the Spanish media were the first to report on its impact.

Since bird flu first appeared in China's Guangdong province -- which adjoins Hong Kong -- in 1996, the disease has claimed more than 90 human lives -- almost all in Asia, with the most recent deaths in Turkey.

In addition, about 200 million birds around the world have died or been culled.

Outside of Asia, there have been bird flu outbreaks in Greece, Italy, Turkey, Croatia, Russia, Azerbaijan and Romania in Europe, Iraq and Iran in the Middle East and in Nigeria, Africa. (Full story)

This spread of the disease from Asia to the fringes of Europe in recent weeks has prompted massive global attention on possible prevention measures, with the U.S., the EU and countries such as China and Japan committing hefty financial and human resources to combating the disease.

But the new Lowy Institute report, by the Australian National University's Prof. Warwick McKibbin and research fellow Dr Alexandra Sidorenko, says the major difficulty with influenza vaccine development is "the need to hit the constantly moving target as the virus mutates very rapidly."

Their observation follows a scientific study released last week which said bird flu was much more diverse than previously thought, with at least four distinct types of the deadly H5N1 virus (Full story).

In that study, a group of 29 scientists around the globe found that the virus was both more genetically diverse and able to survive in birds showing no signs of illness.

One of the researchers, Dr. Malik Peiris, professor of microbiology at Hong Kong University, told CNN on February 8 that regional virus types meant there was a need to look for "broad cross-protection" rather than a single vaccine.

Peiris said that while wild birds may contribute to the introduction and spread of bird flu, the perpetuation of the disease was through stocks of domestic poultry. He said no country was fully prepared to combat the disease, which needed to be tracked back and tackled at its source.

Further mutation
So far, all but a handful of cases of human sickness have been caused by direct contact with sick birds, suggesting the virus is unable to move easily among humans.

But health officials have warned that with continued exposure to people, the virus could mutate further and develop that ability.

While scientists scramble to prepare an effective medical response, the Lowy Institute report primarily looks at the macroeconomic impact of a flu pandemic.

It said there would be four main sets of "shocks" for each scenario: shocks to the labor force (through deaths and dislocation to production); additional supply shocks through increased costs; demand shocks; and risk premium shocks, involving financial flows.

In the worst scenario, it said the death toll could reach 28.4 million in China, 24 million in India, 11.4 million in Indonesia, 4.1 million in the Philippines, 2.1 million in Japan, 2.0 million in the United States and 5.6 million in Europe. In the world's least developed countries, the toll could top 33 million.

The study's figure of 142 million possible deaths is similar to an earlier estimate of 150 million deaths by World Health Organization senior official David Nabarro, when he was named as head of the United Nations avian flu response team in September last year.

The Lowy Institute study found that East Asian economies would be proportionately more affected than the United States or Europe. In the "ultra" or worst-case scenario, Hong Kong's economy, for example, would shrink by more than 53 percent.

"This is clearly a major economic catastrophe," the report's authors note.

"The large scale collapse of Asia causes global trade flows to dry up and capital to flow to safe havens in North America and Europe."

Japan would experience a larger shock than other industrialized economies, but a smaller shock than the rest of East Asia. However, its integration with the collapsing East Asian economies means it would take a further shock through declining trade flows.

The authors say a "key part of the story" is the monetary policy response.

"Those countries that tend to focus on preventing exchange rate changes are coincidentally the countries that experience the largest epidemiological shocks," they say.

"This is particularly true of Hong Kong, which receives the largest shocks and has the most rigid exchange rate regime."

The report concludes that a "large investment of resources" should be dedicated to preventing an outbreak of pandemic influenza.

Bird flu reports spread in Europe

Iran detects deadly strain in dead swans

Tuesday, February 14, 2006; Posted: 10:17 p.m. EST (03:17 GMT)

CNN) -- Three new countries on Tuesday reported they had detected the deadly strain of bird flu as public health officials battled the H5N1 strain of avian influenza on various fronts across the globe.

Germany and Austria reported apparent cases of H5N1 bird flu in wild swans, becoming the third and fourth European Union nations to detect the virus that has killed 91 people since 2003, according to the World Health Organization. Italy and Greece reported swan deaths from the highly pathogenic strain on Saturday.

Iran's government said H5N1 had been detected in wild swans found dead near the Caspian Sea. (Full story)

Experts had said it was only a matter of time before the H5N1 strain dangerous to humans broke out in Iran, a wintering place for wildfowl that may be carriers. (Migratory patterns)

Both Germany and Austria -- each of which found the virus in two swans -- said they were sending samples of the dead swans to the EU laboratory in Weybridge, Britain, for further confirmation.

German Agriculture Minister Horst Seehofer said Tuesday night that initial tests revealed the virus in two swans on Ruegen Island in northern Germany, and he ordered all fowl to be quarantined by Friday to help keep the disease from spreading, especially among birds that migrate.

Last year bird owners in Germany were required to keep their animals indoors for several months in a similar precaution.

"We expect a confirmation on Thursday," Seehofer said Tuesday night.

"The chance is very high. ... At the moment, where farming livestock is hopefully not affected, we do not have to slaughter."

He said the National Crisis Board would meet Wednesday to discuss the situation with all ministers and all relevant organizations.

"All possible means will be discussed and if necessary implemented so that a transmission from wild birds to farming livestock can be prevented. That is the most crucial point at the moment," Seehofer added.

The Austrian Health Ministry said its dead swans were found in the southern part of the country.

The Health Ministry said it had taken preventive measures, including the creation of a restricted zone within a 3-kilometer (2-mile) radius of where the dead swans were found, near Graz in the Styria region bordering Slovenia, Reuters reports.

In this area, all poultry trade has been banned for at least 30 days. Monitoring for signs of bird flu will be carried out within a further 10 kilometer (6-mile) radius, and poultry bought and sold only with ministry permits.

In the entire area, farmers would have to confine their poultry stock to barns. Poultry markets and shows, and hunting for wild fowl, have been banned, the ministry said.

Italy said Saturday that six wild swans found in the southern regions of Sicily, Puglia and Calabria tested positive for H5N1. Northern Greece also reported cases Saturday.

The avian influenza threat in all affected EU countries will be reviewed by the EU's Food Chain and Animal Health Committee which meets on Wednesday and Thursday, the European Commission said in a separate statement, according to AP.

About 200 million birds have died or been culled around the world since the disease first appeared in China's Guangdong province -- which adjoins Hong Kong -- in 1996.

So far the World Health Organization has confirmed 165 human cases of the disease in a number of nations, including Cambodia, China, Indonesia, Thailand, and Vietnam, which has suffered the most fatalities.

Outbreaks have also been detected in Turkey, Croatia, Russia, Azerbaijan and Romania in Europe, Iraq and Iran in the Middle East and in Nigeria, Africa. (Full story)

All but a handful of cases of human sickness have been caused by direct contact with sick birds, suggesting the virus, so far, is unable to move easily among humans.

But health officials have warned that with continued exposure to people, the virus could mutate further and develop that ability.

Officials have expressed fears that the virus is currently acting similarly to the 1918 flu virus, a pandemic that killed an estimated 20 million to 50 million people.

Nigeria screens farm workers for bird flu virus

KADUNA, Nigeria (AP) — A deadly strain of bird flu may have emerged in eight of Nigeria's 36 states, authorities said Monday, as concerns grew that the virus had been spreading long before officials knew it was in Africa.

Farm workers wait to see a doctor outside of a medical center in Nigeria.
By George Osodi, AP

The disease has also apparently spread further into Greece, where a wild goose tested positive on the Aegean Sea island of Skyros — adding to the three known cases in the northern Greek mainland.

With this weekend's discovery of the H5N1 strain in Greece and Italy — both European Union members — countries throughout the continent are increasing preventative measures against the disease, which has killed at least 91 people since 2003, mostly in Asia.

Albania, which is close to both Greece and Italy, is buying protective clothing and stockpiles of antiviral drugs. In Bulgaria, where the disease has been confirmed in wild birds, authorities declared six-mile "risk zones" around the places where the dead birds were found and police were restricting traffic around some wetlands.

In the Netherlands, the agriculture minister has ordered commercial fowl to be kept indoors as a protective measure to prevent an outbreak, Dutch media reported Monday.

Nigeria, which reported Africa's first cases of the disease in birds, was screening workers from the farm where the H5N1 strain was first discovered. It was confirmed in three northern states and has already killed thousands of birds in the area.

On Monday, health officials said five additional states were also suspected to have the disease.

Barry Schoub, executive director of South Africa's National Institute for Communicable Diseases, said the virus probably has spread over a much more extensive area in Nigeria and that he expected to see large-scale destruction of birds there.

"The Nigeria case is very, very concerning because the spread in poultry appears to have been going on for quite some time and may well be more extensive," Schoub told reporters in Johannesburg, South Africa.

He said destroying birds was the most effective way to stop the spread of the infection in developing countries.

Health officials fear H5N1 could evolve into a virus that can be transmitted easily between people and become a pandemic. Most human cases of the disease so far have been linked to contact with infected birds.

On Sunday, samples taken from a Nigerian family with two sick children suspected of contracting bird flu were sent abroad for testing, said Abdulsalam Nasidi.

Nasidi gave no details on the family's size and declined to say where the tests were sent. He said the children "are in fairly good condition ... but we are still observing them."

In the northern town of Jaji, near the farm where H5N1 was first confirmed, doctors examined 20 workers but lacked proper testing materials, which they said a World Health Organization team would bring by Tuesday.

But scores of workers failed to present themselves for tests. After years of repressive and corrupt military rule, many Nigerians shy away from any contact with officials.

Ibrahim Hassan, who worked at Sambawa Farms before it was quarantined last week, said his co-workers were worried about being taken away somewhere by the health officials if they tested positive for bird flu.

"Many people are afraid to come," he said.

Nigerian officials have tried to contain the disease by burning chickens and other birds suspected of being infected across the north, but poultry markets continue to operate and birds are being shipped around the country despite international recommendations to stop those practices.