STORM2K

Human influenza may mix with bird flu, millions may die

The World Health Organization said yesterday a northern hemisphere human influenza virus may have reached Vietnam, raising the risk that it could combine with bird flu to create a lethal new virus.

The warning came as Vietnamese health authorities confirmed that an 18-year-old man passed away yesterday at a hospital in Ho Chi Minh City, becoming the ninth person to have died from the disease in the Southeast Asian nation.

"We are getting some reports of human influenza here but it is difficult to say how widespread it is," said Bob Dietz, the WHO's spokesman in Vietnam.

Shigeru Omi, director of the UN agency's Western Pacific office, warned last week that millions of people around the world could die if the H5N1 strain of bird flu mixes with the human H3N2 virus that was headed towards Asia.

"It is hard to believe that given the widespread nature of H3N2 in the northern hemisphere that it wouldn't be active in Vietnam," said Dietz.

"But so far we have not seen any evidence of interaction between the human and avian viruses."

Although H3N2 is a fairly aggressive strain of human influenza it is not in itself considered a public health threat.

The WHO says it is unable to predict the chances of the two viruses combining, but Omi warned last week that the pathogenicity of the current H5N1 virus was stronger than that seen in Hong Kong in 1997, when six people died

Only the swift culling of 1.4 million birds in the former British territory seven years ago averted a potential global health crisis.

Alarm bells also rang Sunday when, in what could be the first case of human-to-human transmission in Asia's bird flu crisis.

The WHO said two Vietnamese sisters who died on January 23 could have contracted H5N1 from their brother, who also died.

The pair, aged 23 and 30, were part of a cluster of four cases of respiratory illness in the northern province of Thai Binh that also included their brother and his wife, who has subsequently recovered.

But in an apparent bid to prevent panic, the WHO said there was "no evidence of efficient human-to-human transmission of H5N1 occurring in Vietnam or elsewhere."

"It doesn't seem that we have crossed the threshold into the scenario of general human-to-human transmission in the population," Dietz said yesterday.

"This case remains an anomaly but one that has to be fully understood before we can draw any greater conclusions about the course of infections."

Apart from the two sisters, the WHO has attributed the infections of the latest outbreaks of the disease across the region to contact with sick poultry.

With nine people confirmed to have died from H5N1 infections, Vietnam is the worst affected of 10 Asian nations tackling bird flu outbreaks.

Separately, in a desperate attempt to ward off bird flu, scarecrows have been erected in Cambodian fields by farmers anxious to keep the disease at bay.

"I made my scarecrow, which I hope will prevent the outbreak of the epidemic like in Vietnam, two weeks ago," said 53-year-old peasant Sun Sok from Kien Svay district just east of the capital Phnom Penh.

His initiative has been imitated by hundreds of farmers living near him on the main road linking Cambodia with Vietnam, which reported the first human casualties of the disease that has now hit 10 nations.

Some of the scarecrows wear menacing demon masks, others bear arms of rifles or swords carved from wood and some sport frying pans as hats.

http://www.etaiwannews.com/Asia/2004/02 ... 775119.htm[/url]

Bird flu cases in humans may be 'tip of the iceberg'

A leading scientist with the World Health Organization said Monday the handful of confirmed cases of human avian influenza may represent "the tip of the iceberg."

The actual number of those infected or exposed is unknown, said Dr. Klaus Stohr, the WHO's project leader for influenza surveillance, at a briefing in Geneva.

"We may have had dozens, hundreds or thousands of exposures of humans," he said. "We have a handful of cases detected. We believe that we might only perhaps be seeing the tip of the iceberg. There might be a number of cases in humans which just go unnoticed because they are much milder."

The human death toll in two countries rose to at least 12 Monday as the virus continued to spread widely among Asian poultry flocks. The Chinese government reported that it suspects the flu in five more areas of the country, including Xinjiang province, more than 1,000 miles from Guangxi, where the first infected flock in China was found.

And international health agencies announced a three-day emergency summit to start today in Rome, where experts hope to focus on helping countries respond to their outbreaks and prevent spread of the disease. The meeting involves the WHO, the U.N.'s Food and Agriculture Organization, the World Animal Health Organization, and the U.S. Centers for Disease Control and Prevention.

Avian influenza has struck poultry in 10 countries: China, Thailand, Vietnam, Cambodia, Indonesia, Japan, Laos, Pakistan, South Korea and Taiwan. Only Vietnam and Thailand have had human cases of the disease.

Infections in humans have drawn great concern because the disease, having jumped from another species, causes severe illness and, if it became more infectious, could spark a wide-ranging epidemic. To stop the disease from spreading in Asia, governments have slaughtered tens of millions of chickens and ducks so far.

The two latest human victims include an 18-year-old man in Vietnam and a 58-year-old woman in Thailand. Most of the others who have died were children. Roughly 100 people have been evaluated as suspect cases, according to the CDC.

Every case found has been traced back to an infected bird, an indication that the virus -- influenza A/H5N1 -- has not yet acquired the ability to pass easily from person to person. The WHO is investigating a cluster of illness centered on a Vietnamese wedding in which the virus may have passed from person to person.

On Jan. 3, the day of the wedding, the groom and one of his sisters prepared a duck for the feast. The groom, his bride and two sisters became ill; only the bride survived. Neither human-to-human transmission nor direct contact with sick poultry can be ruled out, Stohr said.

Investigators said such a small cluster of cases does not prove the virus has acquired the ability to cause a fast-moving epidemic. Limited transmission among close contacts was seen in two earlier bird flu outbreaks that burnt out and did not become epidemics.

In Germany, doctors awaited test results on a woman who recently returned from Thailand complaining of nausea, dizziness and fever.

http://www.ajc.com/news/content/news/02 ... rdflu.html

Stage May be Set for Bird Flu Pandemic, Says Infectious Diseases Expert

Newswise — The simultaneous existence of bird flu and a particularly virulent form of human influenza circulating this season is the "perfect set-up for something weird and dangerous" to happen on the world health scene, according to a University at Buffalo expert on infectious disease and geographic medicine.

"The worry is that if the two flu viruses cohabitate in the same person they will exchange genetic information and produce an influenza strain totally new to humans that can be passed from person to person," says Richard V. Lee, M.D., professor of medicine at the UB School of Medicine and Biomedical Sciences.

"If that happens, we easily can have a pandemic flu on our hands," he says.

According to Lee and other experts, it probably will take four to six months to manufacture a vaccine to combat a human-to-human form of the bird flu.

In that time, the virus could spread around the world, Lee says.

"Humans have not had to deal with a major flu pandemic for 35 years (since the 1969 Hong Kong flu outbreak). "That could set the stage for something pretty dramatic to happen," he says.

Which is why the World Health Organization, World Animal Health Organization and Centers for Disease Control wisely are taking steps to get out ahead of the possible pandemic strain of bird flu, Lee says.

There also is the chance that the bird flu could jump back and forth between chickens, migratory fowl and other birds capable of spreading the virus across great distances, Lee warns. Or the bird flu could jump to pigs, undergo genetic changes that would produce infectivity among mammals, and then be transmitted to humans.

"When this new strain of bird flu comes into contact with a virus present in a pig, it could emerge from the pig with new genetic equipment to infect more pigs and humans, which would increase the risk of human-to-human infection," Lee says.

"What makes influenza viruses so special is their ability to infect and colonize in many different host species," he adds.

Lee, who studies the health status of geographically isolated human populations, is not surprised by the outbreak of bird flu, SARS, monkey pox and other viruses that seem to suddenly arise globally.

"There are places in the world that are a Pandora's box for certain kinds of infectious disease," he explains. "The way people live and interact with their environment sets the stage for letting these viruses out of their boxes."

Some of these places, according to Lee, include fish-farming villages in Southeast Asia -- where liver fluke infections, Japanese B encephalitis and Nipah virus threaten residents -- and agricultural communities in Africa that share boundaries with wildlife populations -- where the Ebola virus and African tick typhus are active.

http://www.newswise.com/articles/view/503078/