Dear readers,

The blog is temporarily suspended because of the ongoing emergency medical relief operation of Médecins du Monde - France in Yogyakarta after the 27th of May earthquake. Basically, we don't have time to search for information regarding the bird flu in Indonesia and South East Asia...
We apologyzed for the inconvenience and will try to come back asap.

No bird flu virus mutation seen in Indonesia

By Diyan Jari

JAKARTA, May 24 (Reuters) - Limited human-to-human transmission of bird flu might have occurred in an Indonesian family and health experts are tracing anyone who might have had contact with them, the World Health Organisation said.

But a senior WHO official said in Jakarta this was not the first time the world was seeing a family cluster and said that fresh scientific evidence has shown the virus in Indonesia has not mutated to one that can spread easily among people.

WHO said on Wednesday it had no immediate plans to call a meeting of experts to discuss raising its global bird flu alert.

"Right now it does not look like the task force will need to meet immediately, but this is subject to change depending on what comes out of Indonesia," WHO spokeswoman Maria Cheng said, when asked to comment on press reports of an imminent meeting.

Financial markets, however, were spooked on fears the Indonesia cluster could be the start of a pandemic. Currencies in Asia, where most bird flu cases have occurred, fell. U.S. commodity prices came under pressure while European markets slipped as investors turned jittery.

Concern has been growing about the case in north Sumatra in which seven family members from Kubu Sembilang village died this month. The case is the largest family cluster known to date.

WHO and Indonesian health officials are baffled over the source of the infection but genetic sequencing has shown the H5N1 bird flu virus has not mutated, the U.N. agency said on its Web site (http://www.who.int) on Tuesday.

Nor was there sign of the virus spread among villagers.

"To date, the investigation has found no evidence of spread within the general community and no evidence that efficient human-to-human transmission has occurred," the WHO said.

Sick poultry have been the source of bird flu infection for most human cases worldwide. Pigs are susceptible to the virus.

Clusters are looked on with far more suspicion than isolated infections because they raise the possibility the virus might have mutated to transmit efficiently among humans.

That could spark a pandemic, killing millions of people.

The WHO statement came after one of the family members, a 32-year-old father, died on Monday after caring for his ailing son, who had died earlier. The agency said such close contact was considered a possible source of infection.

CLOSING IN

But Firdosi Mehta, acting representative of the WHO in Indonesia, urged against any over-reaction, saying this was not the first cluster that the world has known.

Limited transmissions between people are caused by close and prolonged contact when the sick person is coughing and probably infectious. Experts in Kubu Sembilang were acting to contain any further spread.

"We are going wide, contacting the various contacts, putting on (anti-viral) Tamiflu whoever has had close contact, basically putting family members who have not been affected on Tamiflu as a precaution," Mehta told Reuters in an interview in Jakarta.

"There is active surveillance in the village, fever surveillance to look for any more cases that are occurring outside this immediate family cluster," he said.

But another WHO spokesman said the agency was worried.

"This is the most significant development so far in terms of public health," Peter Cordingley, spokesman for the West Pacific region of the WHO, said in the Philippine capital on Wednesday.

"We have never had a cluster as large as this. We have not had in the past what we have here, which is no explanation as to how these people became infected."

"We can't find sick animals in this community and that worries us," he added.

Bird flu has killed 124 people in 10 nations since it re-emerged in Asia in 2003. It is essentially a disease in birds and has spread to dozens of countries in wild birds and poultry.

In China, where the virus has been entrenched for the last 10 years, fresh trouble may be brewing as authorities confirmed an outbreak of the H5N1 among wild birds in its remote far-western Qinghai province and Tibet.

About 400 wild birds had been found dead "recently", its state Xinhua news agency said, quoting the Agriculture Ministry.

An outbreak of the H5N1 killed thousands of birds in Qinghai Lake this time last year and this strain of the virus has since turned up in parts of Europe, Africa and the Middle East.

Markets are also nervous about a suspected cluster in Iran.

An Iranian medical official told Reuters on Monday that a 41-year-old man and his 26-year-old sister from the northwestern city of Kermanshah had tested positive for bird flu.

But Health Minister Kamran Lankarani denied this although international health officials are still investigating.

The two siblings were among five members of a family who became sick and the other three remain in hospital.

WHO says no plans to raise bird flu alert level

Wed 24 May 2006

GENEVA, May 24 (Reuters) - The World Health Organisation (WHO) said on Wednesday it had no immediate plans to call a meeting of experts to discuss raising its global bird flu alert.

A WHO spokeswoman was asked to comment on press reports that the U.N. agency could convene a meeting of experts within the next few days because of concern about Indonesia where seven members of a family died this month.

"Right now it does not look like the task force will need to meet immediately, but this is subject to change depending on what comes out of Indonesia," WHO spokeswoman Maria Cheng told Reuters.

Under WHO's action plan for dealing with bird flu, the panel will be consulted before any change is made to the level of alert, which currently stands at three on a six-point scale.

There needs to have been increased human-to-human transmission, along with signs that the deadly virus is becoming more easily transmissible for a change in readiness to be made.

"Today we have no indication that the virus is more efficient," said Cheng.

In the Indonesian case -- which set international alarm bells ringing because it is the biggest cluster of human infections yet -- there was no indication that the virus had spread beyond the family members, she said.

"This is the biggest cluster we have seen, there may have been human-to-human transmission, and all this is something that needs to be responded to as quickly as possible," Cheng said.

Indonesia struggles to track H5N1 source, 2 more die

22 May 2006 11:37:23 GMT
By Fitri Wulandari and Tan Ee Lyn

JAKARTA, May 22 (Reuters) - Health officials in Indonesia are still struggling to track down the source of a worrying family cluster of H5N1 bird flu infections as tests showed that two more people have died of the same disease.

One of the latest victims belonged to a Sumatran family, which lost several members earlier this month to bird flu, sparking fears of human-to-human transmission.

While H5N1 is still regarded as a bird disease, experts have warned for more than a year that it might mutate and pass efficiently between humans and cause a global pandemic.

"One man from the same Sumatra cluster died this morning. He is the father of the child who died on May 13. He ran away after he received Tamiflu," said I Nyoman Kandun, director-general of communicable disease control at the health ministry.

"He was found in the village later but refused treatment," Kandun told reporters at a news conference.

Five of his relatives have been confirmed as bird flu deaths by the World Health Organisation (WHO) which also says another family member has survived being infected with H5N1.

Another death could not be confirmed because no samples were obtained but she is considered the initial case of the cluster in Kubu Simbelang village in north Sumatra.

The woman died on May 4 but, nearly three weeks on, Indonesian experts have come no closer to finding the source of the virus.

Blood samples taken from chickens, ducks and pigs in the neighbouring district of Kabanjahe -- where there was an outbreak of H5N1 in chickens in January -- have tested positive for antibodies for the H5 component for the virus.

But local scientists have yet to test the samples specifically for N1 antibodies.

Nasal swab samples of the animals tested negative for H5N1, meaning they were no longer infected.

Abdul Adjid of Indonesia's Veterinary Research Institute, which is handling the animal samples, said his laboratory would try to test the samples for N1 antibodies.

"We are trying to do the N1 tests. Maybe we will ask the WHO or the FAO (Food and Agriculture Organisation) to provide (assistance) so that we can improve our ability to do that," Adjid told Reuters.

If these samples come back positive for N1 antibodies, it could mean that the animals, which are healthy and free of the disease now, were infected with H5N1 some time in the past.

It takes between one and two weeks to test definitively for H5N1 antibodies in more sophisticated laboratories.

DISEASED POULTRY THE LINK?

Adjid suggested that the movement of diseased poultry might have played a role in the Sumatran family's tragedy. Kabanjahe is about eight kilometres (five miles) from Kubu Simbelang.

"There was an H5N1 outbreak in chickens in Kabanjahe in January, so maybe that's why the pigs, ducks and chickens are positive for H5," he said.

"People buy chickens and pigs from Kabanjahe ... the family bought chickens and pigs from Kabanjahe," he said.

The cluster has alarmed the medical community, which has called repeatedly for stronger measures to stem the disease in poultry.

"The fact that so many people are infected means that a lot of its poultry is infected ... if a place is infected, it usually starts with the chickens first, then pigs, then man," said Lo Wing-lok, a Hong Kong based infectious disease expert.

"There is no evidence yet of human-to-human transmission, but the problem is in poultry and mutation can happen in chickens."

Kandun, however, said there was no evidence the H5N1 virus had mutated or reassorted in the family members.

Based on previous genetic sequencing, the H5N1 virus in Indonesia is believed to have originated from Yunnan province in southern China. The first H5N1 poultry outbreak in Indonesia was identified in late 2003.

Kandun said a 38-year-old man from Jakarta who died last week had also been declared positive for bird flu by local tests.

The WHO has confirmed 32 fatalities from avian influenza in the world's fourth most populous nation, the second highest number of human deaths after Vietnam.

Commenting on the family cluster, Kandun said: "We cannot conclusively confirm nor rule out human-to-human transmission ... maybe they have genetics susceptibility, exposed to a common source ... a lot of things we don't know."

Bird flu deaths in Medan raise fresh fears

New Straits Times/Annie Freeda Cruez/23 May 2006

KUALA LUMPUR: Six avian flu deaths in Medan, a mere 157km across the Straits of Malacca, are sending chills up the spine of veterinary and health officials here.

Following a request by the Veterinary Services Department, the Customs and Immigration departments are looking out for the possibility of birds being smuggled to Malacca on barter and passenger boats.

Checks have been stepped up in Malacca and Port Klang.

Veterinary Services Department acting director-general Datuk Dr Mustapa Abdul Jalil said the department had been informed by its counterparts in Indonesia that the situation in Medan was serious.

"We have also been told that the source of the deaths were chickens," he told the New Straits Times.

Dr Mustapa urged Malaysians and Indonesians to abide by directives on the import and export of birds and their products from all avian flu-affected countries.

Under the Customs Act 1967, smugglers can be fined 10 times the amount of the seizure or jailed three years for the first offence. Subsequent offences carry a penalty of 20 times the amount or five years’ jail.

Dr Mustapa also urged farmers to be alert and to report unusual bird deaths to the nearest Veterinary Services Department.

An AFP report yesterday quoted Nyoman Kandun, director of the Indonesian health ministry communicable disease control centre, as saying that an epidemiological investigation had been launched into the deaths.

Five died some weeks ago with the sixth death, that of the father of one of the other victims, occurring yesterday.

He said experts feared this might be Indonesia’s first few cases of human-to-human transmission of the virus.

"We cannot confirm that (human-to-human transmission) has occurred but we cannot rule it out," said Kandun.

He said Indonesian officials were being assisted by the World Health Organisation, and the Centre for Disease Control and Prevention in Atlanta. Indonesia’s bird flu toll now stands at 32.

It has witnessed more bird flu deaths than any other country this year with the world’s second highest number of fatalities since 2003.

Meanwhile, Health Ministry Disease Control Division acting director Dr Zainal Ariffin Omar said his staff were working closely with the Veterinary Services Department on the matter.

"All doctors have also been directed to alert the ministry if they come across patients, especially foreigners and Malaysians who arrived from avian flu-affected countries, seeking treatment for bird flu symptoms."

He said clinical and ground surveillance had started, aside from checks on human traffic between the two nations and other avian flu-affected countries.

Coordination 'too poor' to contain bird flu virus

Tb. Arie Rukmantara, The Jakarta Post, Jakarta 22/05/06

Although the recent discovery of the country's largest bird flu cluster in North Sumatra has made Indonesians anxious about a possible human pandemic, a senior official says government agencies have just started to come up to speed on something they should have accomplished a long time ago: coordination.

A senior official at the National Commission on Bird Flu, Emil Agustiono, said the lack of coordination among government agencies, and between them and such international partners as the World Health Organization (WHO) and Food Agricultural Organization, partly contributed to the rapid spread of the H5N1 strain of virus across the 27 of the country's 33 provinces.

"There was a tendency to work individually, but now we're starting to step up our internal communication," he told The Jakarta Post over the weekend.

Lack of communication between the agencies has been a chronic problem. People have observed that the Health Ministry and the Agriculture Ministry always announce the results of their investigations separately, he said.

He cited the case of Medan, where the WHO confirmed a cluster of seven people in Karo regency were infected by the deadly flu. Leter, teams from the Health Ministry and Agriculture Ministry came and announced their findings separately, causing local residents to react with everything from panic to apathy.

"In the next several days, I will coordinate a visit to the Karo regency. This time we'll have a strong team, consisting of representatives of all the agencies, to find out the source of the virus and how it spread," he said, adding that he suspected organic fertilizers would likely turn out to be the source.

On Friday, a test from the Agriculture Ministry's laboratory in Bogor contradicted Agriculture Minister Anton Apriyantono's statement that pigs in the Karo regency tested positive.

"Based on this second test, our conclusion is that pigs there are free from the H5N1 virus," said the ministry's director for animal health, Samsul Bahri.

He said the earlier test indicated that the pigs had once been exposed to the virus but were not infected with it.

Samsul said he believed that the Medan case would be a good chance for both ministries to join forces in halting the spread of the disease.

"It should be a good start at working together for us, which we may have failed to do before," he said.

At least 32 of the 41 confirmed patients in Indonesia have died since the first human case was found in 2004.

WHO has confirmed the deaths of two more victims, one of whom was a 10-year-old boy from the Karo Regency cluster. The second was a 12-year-old boy from Bekasi, West Java.

WHO - Avian influenza – situation in Indonesia – update 13

19 May 2006

The Ministry of Health in Indonesia has confirmed an additional case of human infection with the H5N1 avian influenza virus. The case occurred in a 12-year-old boy from Bekasi in East Jakarta. He was hospitalized on 7 May and died on 13 May.

An investigation is under way to determine the source of his infection.

The newly confirmed case brings the total in Indonesia to 41. Of these cases, 32 have been fatal.

WHO - Avian influenza – situation in Indonesia – update 12

18 May 2006

The Ministry of Health in Indonesia has confirmed an additional seven cases of human infection with the H5N1 avian influenza virus. Six of the cases were fatal.

One fatal case, in a 38-year-old woman, occurred in the city of Surabaya, in East Java. She developed symptoms on 2 May, was hospitalized on 7 May, and died on 12 May. The case is the first reported from this area.

The remaining six cases are from the village of Kubu Sembelang in the Karo district of North Sumatra. All six are members of an extended family, and all but one lived in neighbouring houses.

Associated with the Kubu Sembelang outbreak is a seventh family member, a 37-year-old woman. She developed symptoms on 27 April and died of respiratory disease on 4 May. No specimens were obtained before her burial, and the cause of her death cannot be confirmed. She is, however, considered the initial case in this family cluster.

The six confirmed cases in Sumatra include the woman’s two sons, aged 15 and 17 years, who died respectively on 9 May and 12 May. The 28-year-old sister of the initial case died on 10 May. This sister had an 18-month-old girl, who died on 14 May. The fifth confirmed case, who is still alive, is the 25-year-old brother of the initial case. The sixth confirmed case is the 10-year-old nephew of the initial case. He died on 13 May.

One additional family member, who had been hospitalized, has subsequently been ruled out based on both negative laboratory results and the absence of clinical symptoms compatible with H5N1 infection.

This is the largest cluster of cases, closely related in time and place, reported to date in any country and is being carefully investigated by Indonesia’s ministries of health and agriculture and by WHO epidemiologists. The source of exposure for the initial case is still under investigation, with exposure to infected poultry or an environment contaminated by their faeces considered the most plausible source.

The likely source of infection for the additional cases has not yet been determined. Multiple hypotheses are being investigated. Apart from living in close proximity to each other, the cases in this cluster are known to have participated in a family gathering around 29 April. The cases may have acquired their infection from a shared environmental exposure yet to be identified. The possibility of limited human-to-human transmission cannot be ruled out at present.

Investigators at the outbreak site have found no evidence that infection has spread beyond members of this single extended family. No influenza-like illness has been identified in health care workers or other persons in close contact with the patients. If human-to-human transmission has occurred, it has not been either efficient or sustained.

The newly confirmed cases bring the total in Indonesia to 40. Of these cases, 31 have been fatal.

Indonesia says no bird flu cover-up, Egyptian dies

18 May 2006 15:17:18 GMT
By Achmad Sukarsono

JAKARTA, May 18 (Reuters) - Indonesia pledged on Thursday there would be no cover-up if human-to-human transmission of bird flu does occur, after five members of a family were confirmed to have died from the H5N1 avian flu virus.
The case has baffled experts because the source of the virus has not been confirmed and human-to-human transmission cannot be ruled out.
But, offering a possible answer, Indonesia's agriculture minister said pigs had tested positive for bird flu in the same village in North Sumatra.
The family slaughtered animals for a barbecue feast in late April before the outbreak in Kubu Simbelang village where pigs and chickens live near homes and cats and dogs roam freely.
Six of the family have died and one has survived. The sixth family member was buried before tests could be carried out.
"This is the largest cluster of cases, closely related in time and place, reported to date in any country ...," the World Health Organisation said in a statement.
The U.N. agency said exposure to infected poultry or an environment contaminated by their faeces was the most plausible source.
"The possibility of limited human-to-human transmission cannot be ruled out at present," the WHO said, but added: "If human-to-human transmission has occurred, it has not been either efficient or sustained."
I Nyoman Kandun, the Indonesian health ministry's director-general of communicable disease control, said there was no proof of H5N1 virus transmission between people in Indonesia.
"I guarantee Indonesia is not covering up. A cover-up has more harm than benefits. By opening up, we are actually welcoming contribution from everywhere."
He also called on leaders at all levels in the country to step up efforts to raise awareness among the public.
TIME BOMB
"There are so many people who do not know what has happened. Even the educated do not know the situation is like a time bomb," Kandun said.
Thirty-one people have died of bird flu in Indonesia, the second-highest toll of any country. More than half that number have died this year.
Egypt confirmed a sixth death on Thursday, a 75-year-old woman from Minya in the south.
H5N1 has killed 122 people worldwide since re-appearing in 2003. Virtually all the victims caught the disease from poultry.
Denmark on Thursday halted exports of poultry from Funen after birds on a farm on the island tested positive for the H5 strain of avian flu. The outbreak may force Denmark to halt all poultry exports.
In Russia, the H5N1 bird flu virus was found in six dead chickens in Siberia, where more than 80 dead birds have been found since the end of April, a regional health official said.
Indonesian Agriculture Minister Anton Apriyantono said a number of pigs from the village 50 km (30 miles) south of Medan city, had tested positive.
"After we brought them to Bogor, the serology test found positive results. From 11 pig samples, 10 are positive. Reconfirmation testings are still underway," he said, but did not refer specifically to the H5N1 virus.
The minister's comments are likely to concern health officials. Pigs can act as mixing vessels in which human and bird flu viruses can swap genes, leading to a strain that can easily infect people and pass from person to person.
Clusters of human infections are worrying because they indicate that the virus might be mutating into a form that is easily transmissible among humans. That could spark a pandemic in which millions might die.
For the moment, the virus is mainly a disease in birds and is hard for humans to catch.
The WHO and the U.N.'s Food and Agriculture Organisation say better surveillance is crucial for rapid detection of outbreaks in birds and family clusters like the Sumatra case.
"If we do not hear about it for a couple of weeks and there are already a hundred or so cases, then it may be too late," WHO spokeswoman Maria Cheng said in Geneva.
"We heard about it relatively quickly (Sumatra). Indonesia has much higher awareness than other countries because they have been dealing with human cases for almost year now," she said. (Additional reporting by Yoga Rusmana in Jakarta, Tan Ee Lyn in Hong Kong and Richard Waddington and Stephanie Nebehay in Geneva)

Bird flu case not human-to-human spread - Indonesia

JAKARTA, May 17 (Reuters) - An outbreak of H5N1 bird flu involving up to eight members of a family in Indonesia's North Sumatra province is not a case of human-to-human transmission, a Health Ministry official said on Wednesday.

Concern has been growing about the case in which six of the eight have already died. Local tests showed five members of the cluster were positive for the bird flu virus and tests were being carried out on the remaining three.

"The spread was through risk factors from poultry or other animals. There is no proof of human to human," Nyoman Kandun, director-general of disease control, told Reuters.

"The world is watching us. We are not being hasty," he added.

He said authorities were still trying to identify the source of the virus in the cluster case in Kubu Simbelang village in Karo regency, about 50 km (30 miles) south of the North Sumatran city of Medan.

Some reports have suggested chicken manure used as fertiliser might be the link, but there has been no confirmation of this. Infected birds can excrete large amounts of the H5N1 virus and this can be one way it can spread to birds, and people.

The World Health Organisation has sent a team to the area. The agency said it is on alert for signs that the virus is mutating into one that can be easily transmitted between people, a development that could signal the start of a pandemic in which millions could die.

Such a mutation could occur anywhere there is bird flu, the WHO says.

Experts have said in the past that possible bird flu cluster cases among family members do not mean the virus is necessarily mutating. It could be caused by the close contact normal in families.

There have been a number of such examples in Vietnam and Thailand, a WHO spokeswoman said in Geneva earlier this week.

The Indonesian Health Ministry has said blood samples of the five family members who had tested positive locally had been sent to a WHO-affiliated laboratory in Hong Kong for confirmation. Local tests are not considered definitive.

Bird flu has killed 115 people worldwide, the majority in east Asia, since reappearing in 2003. Virtually all the victims caught the disease from poultry.

The WHO has confirmed 25 deaths in Indonesia from the H5N1 virus, the second highest number after Vietnam, which has confirmed 42 deaths.

The virus is endemic in much of Indonesia, and on Tuesday a senior Agriculture Ministry official said H5N1 had been detected for the first time in poultry in remote eastern Papua province.

Bird flu found in fowl in Indonesia's Papua-official

JAKARTA, May 16 (Reuters) - Indonesia has found the avian flu virus in chickens in Papua province, the first bird flu case in the archipelago's easternmost province, a senior government official said on Tuesday.

A number of fighting cocks in Manokwari regency of western Papua tested positive for the H5N1 virus in late April, prompting authorities to cull about 200 chickens, Syamsul Bahri, animal health director at the agriculture ministry, told Reuters.

"The fighting cocks might have been brought to Papua from neighbouring Sulawesi island," Bahri said. "It was the first case we had in Papua."

"We culled around 200 chickens, mostly from backyard farms around the neighbourhood where the virus was found to prevent it from spreading," he said.

Bird flu has been found in poultry in about two-thirds of the country's 33 provinces.

The latest case in poultry in Papua highlights international concern over Indonesia's ability to contain the spread of the virus, which has killed 25 people in the country and at least 115 worldwide since 2003.

Although the human death toll has climbed, the government has resisted mass culling of birds, citing the expense and impracticality in a country where keeping a few chickens or ducks in backyards is common.

Culling at selective farms and their immediate surroundings has been the preferred method.

Millions of chickens and other fowl have died from the disease in Indonesia or been killed to prevent its spread since it first surfaced in the sprawling archipelago in late 2003.

Bahri said the government was considering intensifying culling, but faced opposition from the public over compensation.

"The government can only offer 10,000 rupiah ($1.07) for each fowl culled. But people want higher compensation," he said.

Shigeru Omi, the World Health Organisation's director for the Western Pacific, told Reuters earlier in Jakarta that Indonesia -- the nation with the most human deaths from bird flu this year -- had the will to combat the disease but far-flung provinces had fallen short at putting plans into action.

In the latest case, Indonesia is investigating an outbreak of bird flu in up to eight members of a North Sumatran family, of whom six have died.

WHO confirms avian flu case cluster in Indonesia

May 17, 2006 (CIDRAP News) – World Health Organization officials have confirmed five cases of H5N1 avian influenza in an Indonesian family in North Sumatra, plus a fatal case in a woman from East Java, news services reported today.

Additionally, Indonesia's health ministry said local tests revealed the H5N1 strain in a 12-year-old Jakarta boy who died 4 days ago, according to a Reuters report. This case, however, has yet to be confirmed by the WHO.

The North Sumatra case cluster was first reported by Indonesian officials several days ago, sparking concern about the possibility of person-to-person transmission. In today's reports, officials said the situation was still unclear and investigation was continuing. The WHO had not yet published an online update on the situation at this writing.

WHO officials said four of the five infected family members in North Sumatra have died, according to reports. An Agence France-Presse (AFP) story described them as two males, aged 19 and 17, a 29-year-old woman, and an 18-month-old baby. The fifth person, a 25-year-old man, was recovering, according to AFP.

The case in East Java was in a 38-year-old woman who worked as a caterer in Surabaya before her death last week, according to Reuters. She dealt with live pigs and handled pork in her work, the story said.

The five cases in North Sumatra were confirmed by a WHO-accredited laboratory in Hong Kong, Reuters reported. Tests on a sixth family member, a 10-year-old boy who died, are pending, according to AFP. A 37-year-old woman was the first person in the group to fall ill, but she died without any samples being taken.

WHO spokeswoman Maria Cheng in Geneva said it was "too early to draw any conclusions" about whether the virus has acquired the ability to spread among humans, according to Reuters. "I have not heard any suggestion that the virus is any different," she said.

Another WHO spokeswoman, Sari Setiogi, said the agency was carefully investigating the cases, according to AFP. "The current investigation that we have has no evidence of further spread beyond the cluster, so that's quite good news for us because it tells that the virus is not spreading further," she said.

However, Hong Kong virologist Guan Yi told Reuters that the lag reported between symptom onset in the first victim and in the second wave of victims in the extended family was unusual.

"If they were all infected by the same source," Guan said, "their onset time [of illness] would have been closer. . . . They may have infected one another . . . but we have no evidence."

Unofficially, the six new cases—the North Sumatra family and the caterer in East Java—bring Indonesia's case total to 39 and death toll to 30. The WHO had not yet updated its online case count at this writing.

In Laos, H5N1 was found in a duck on a backyard farm, but it appears to be an isolated case, the UN Food and Agriculture Organization reported in a Reuters news story today.

The duck, found 12 miles south of Vientiane in February by researchers, represents the first case in Laos since an outbreak in poultry in early 2004. There have been no human cases in the country, according to WHO data.

Test confirms 25th bird flu death in Indonesia

08 May 2006

JAKARTA, May 8 (Reuters) - International tests have confirmed a 30-year-old Indonesian man who died last month had bird flu, a Health Ministry official said on Monday, taking the country's death toll from the virus to 25.

"A 30-year-old male from West of Jakarta who died on April 26 ... has been confirmed positive of bird flu by a Hong Kong laboratory," said Joko Suyono of the ministry's bird flu information centre.

Vietnam calls for more international aid for anti-bird flu

People's Daily Online 28/04/06

Vietnam needs some 400 million U.S. dollars for its fights against bird flu, 50 percent of which is expected to come from international donors, a local official said Friday.

Vietnam has done its utmost in preventing bird flu, and hoped that the international community would grant it stronger assistance, Minister of Agriculture and Rural Department Cao Duc Phat said at a press briefing after the wrap-up meeting of the joint assessment mission for the finalization of "Vietnam Integrated Operational Work Program for Avian and Human Influenza Control."

International donors have pledged to support the country 46 million U.S. dollars to combat the disease, he said, noting that the Vietnamese government has also poured large amount of money into the fight.

The government has recently decided to invest more than 1,000 billion Vietnamese dong (VND) (nearly 62.9 million dollars) in its healthcare system, and over 100 billion VND (nearly 6.3 million dollars) in its veterinary one, he said, adding that each locality in the country, on average, also spent one million dollars preventing bird flu early this year.

Talking about the Asia-Pacific Economic Cooperation (APEC) Meeting on Avian Influenza slated for early next month in the country, he said the meeting will discuss such issues as socioeconomic effects of the disease, regional and international cooperation on bird flu prevention, and APEC's specific plans on the matter.

Responding to the appeal of Vietnam, Laurent Msellati, Rural Sector Coordinator, Rural Development and Natural Resources Management of the Word Bank, said"we are still working on cost" to meet Vietnam's demand of 400 million dollars for the fight, under a medium-term plan for the 2006-2010 period. "The bank will help the country access sources of support as well as bank loans," he added

No new human cases of bird flu infection have been spotted in the country in the last six months, according to the joint assessment mission. Bird flu has hit 93 local people, causing 42 deaths, in 32 cities and provinces since December 2003.

The country has also detected no bird flu outbreaks among fowls for over four months, it said.

Source: Xinhua

Bird-flu hit Myanmar to end ban on fowl movement

27 Apr 2006 06:18:53 GMT
Source: Reuters
By Aung Hla Tun

YANGON, April 27 (Reuters) - Bird flu in central Myanmar is under control and a ban on the sale and movement of poultry will be lifted within days, the Livestock Department said on Thursday.

The restrictions were imposed after the country's first outbreak of the H5N1 virus was detected in March and spread to 13 townships in central Myanmar.

Officials now say the disease is under control after thousands of birds and eggs were destroyed on hundreds of farms in Sagaing and Mandalay Divisions.

"The committees will lift the ban before the end of April and are making arrangements for the regular flow of commodities," the Livestock Breeding and Veterinary Dept (LBVD) said in a statement carried in state media on Thursday.

Restrictions in Yangon, where no outbreaks are known to have occurred, were lifted this week.

Livestock officials defended the decision to lift the bans, saying it would not hurt surveillance efforts against the disease now endemic in many parts of Asia.

"Lifting the ban does not mean stopping measures to prevent this disease. We'll continue monitoring and surveillance in cooperation with experts from FAO and others," Dr. Myat Kyaw, a senior LBVD official, told Reuters.

Despite the military government's promise to stay vigilant, the decision is likely to unsettle neighbouring Thailand, where bird flu has not re-emerged for months.

Thailand is tightening surveillance along its porous border with Myanmar, fearing the disease could come across in smuggled poultry despite a ban on imports.

A senior official at the U.N. Food and Agriculture Organization (FAO) said two weeks ago Myanmar was battling more than 100 outbreaks of bird flu in poultry and the situation appeared to be "more serious than what we imagined".

He Changchui, the FAO's Asia-Pacific representative, said public awareness of bird flu in a nation ruled by military diktat for the past 44 years was a concern.

He also worried about getting accurate data from one of the most reclusive regimes in the world.

Thailand, Japan and U.N. agencies have sent experts, laboratory equipment, protective gear and vaccines to Myanmar since the first outbreak was announced on March 13.

There have been no reported human cases of H5N1 in Myanmar but it has killed 14 people in Thailand.

Scientists fear the virus, which has killed 113 people worldwide since 2003, could mutate into a form that jumps easily between people and start a global flu pandemic.

Vietnam - Smuggled poultry blamed for spreading bird flu

2006/4/27
LANG SON, Vietnam (AP)

Hired runners strap bamboo cages loaded with 20 live chickens onto their backs in China. Under cover of darkness, they navigate well-worn footpaths across a mountain into Vietnam, where bicycles wait to haul the clucking contraband away.

The smugglers easily evade patrols along the rugged 1,350-kilometer (840-mile) border by using two-way radios and a network of illegal crossings that have become gateways for a new threat _ bird flu.

Vietnam estimates about 4,500 chickens are trafficked into the country this way every day from China in a trade that is nearly impossible to police because of scarce resources.

The H5N1 bird flu virus has recently shown up in samples taken from confiscated birds, raising the stakes in Vietnam's battle to shift from the hardest-hit country to one that has successfully contained the virus.

"I think there is a very large undercover, underground trade that is going on," said Dr. Jeff Gilbert, an animal health expert at the U.N. Food and Agriculture Organization in Vietnam. "I think the biggest risk of re-infection (in Vietnam) is infection from China."

Many scientists believe much of the worldwide spread of H5N1 is linked to the migration of wild birds, but the Paris-based World Organization for Animal Health says it is investigating the possible role smuggling has played in some countries.

Last year, Taiwan confirmed its first case of bird flu, which was found in birds smuggled from China. A Nigerian official also has blamed illegal poultry imports for introducing the virus there earlier this year, though agency spokeswoman Maria Zampaglione said that has not been confirmed.

She said the organization is recommending that governments worldwide pay more attention to the illegal trade of poultry, but said China is not specifically being looked at as a source. Chinese officials have not responded to queries about whether smuggling has occurred.

The virus has killed at least 113 people since it began ravaging Asian poultry stocks in late 2003. Experts fear it could mutate and become highly contagious among people, potentially sparking a pandemic. So far, most human cases have been traced to contact with infected birds.

Most countries have strict quarantine laws to protect against importing infected animals and meat products. Bans have also been quickly slapped on countries where bird flu and other diseases like mad cow have appeared.

But a global smuggling network that has long existed hasn't been shut down by new bird flu precautions.

"There's lots of illicit movements of livestock products around the world," said Dr. Peter Roeder, an animal health expert at the FAO's base in Rome. "The meat comes in packed in vegetable containers and with other goods and the customs authorities just find it extremely difficult to be on top and inspecting everything."

In the past, infected beef and pork smuggled into Europe from Asia were blamed for outbreaks of foot-and-mouth disease and classical swine fever, Roeder said.

Roeder said he wouldn't be surprised if frozen poultry meat from Asia is entering Europe illegally.

He said another worry is the trade of manure-based fertilizers and animal feed, which often contains ground up poultry parts, from infected countries. FAO is examining what role they could play in the spread of H5N1.

Vietnam, where most human infections and deaths have occurred, launched a nationwide poultry vaccination campaign last year and has intensified surveillance and public awareness. It has not detected any outbreaks in poultry for four months and no human cases have been reported since November.

Its success has boosted demand for poultry as more Vietnamese shed their fears of eating infected meat. That, in turn, has fueled the smuggling.

Smuggled birds typically come from large Chinese farms where high volume and low feed prices keep overall costs low. The poultry can be resold in Vietnam for up to five times more, depending on the market.

For instance, older chickens that no longer lay eggs can be bought by smugglers for about 14,000 dong (88 cents) per kilogram, and can end up in markets in Hanoi and other cities.

In the Vietnamese border town of Lang Son, such birds fetch 37,000 dong (US$2.34) a kilogram _ still 10,000 dong (63 cents) cheaper per kilogram than Vietnamese-farmed chicken, said Do Van Duoc, director of the Lang Son Department of Animal Health.

In Vietnam, no outbreaks have been directly linked to smuggled poultry from China. But it's market inspector Lanh Van Nghe's biggest fear.

He leads an eight-man team responsible for stopping all Chinese poultry and eggs from entering Vietnam along a 100-kilometer (62-mile) stretch of border near the town of Dong Dang _ too few to be really effective, he says.

Dirt paths, some as wide as roads, have been worn into the landscape by traffickers toting in everything from bootlegged DVDs to shoes and electronics.

"Sometimes we lay our ambush until two or three in the morning," Nghe said. "Nearly a month ago, the smugglers built a cart, so they could use the railway here to transport up to eight cages of chickens. They moved the smuggled chickens for two kilometers to evade a checkpoint."

Current WHO phase of pandemic alert (just a reminder ;-)

November 2005

Current phase of alert in the WHO global influenza preparedness plan





Experts at WHO and elsewhere believe that the world is now closer to another influenza pandemic than at any time since 1968, when the last of the previous century's three pandemics occurred. WHO uses a series of six phases of pandemic alert as a system for informing the world of the seriousness of the threat and of the need to launch progressively more intense preparedness activities.

The designation of phases, including decisions on when to move from one phase to another, is made by the Director-General of WHO.

Each phase of alert coincides with a series of recommended activities to be undertaken by WHO, the international community, governments, and industry. Changes from one phase to another are triggered by several factors, which include the epidemiological behaviour of the disease and the characteristics of circulating viruses.

The world is presently in phase 3: a new influenza virus subtype is causing disease in humans, but is not yet spreading efficiently and sustainably among humans.

Ducks on Bali culled for bird flu

The Sydney Morning Herald/April 25, 2006

Authorities on Indonesia's resort island of Bali have slaughtered and burned hundreds of ducks after tests showed some had the bird flu virus, officials said.

The birds had been smuggled to Bali from neighbouring Java island, said Bali's senior government veterinarian, Anak Agung Gde Putra.

Bali has banned live poultry imports to try to stop the spread of the virus, which so far has killed at least 24 people in Indonesia, the world's fourth most populous nation.

Initial tests showed that 16 of almost 400 ducks seized at a house on Bali had the bird flu virus, Putra said.

The owner said they had been shipped in from Java, Indonesia's main island, he said.

Officials in protective suits culled the birds and burned them in a yard behind the house, which was then sprayed with disinfectant, Putra said.

"We don't want to take any risks because ducks infected with bird flu would spread the disease to other birds," he said.

Tuesday's tests used South Korean-made rapid testing kits, said another government veterinarian, Ketut Suarda.

He said that blood taken from the birds would be studied at a laboratory to confirm the results.

The bird flu virus is widespread in poultry on Bali, as in most Indonesian provinces, but is not known to have infected humans on the island.

The government is vaccinating birds and carrying out limited culls in areas where humans have died. It says it lacks the money for mass bird slaughtering in infected areas, the tactic recommended by the United Nations as the best way to stop the virus.

Health experts fear the bird flu virus will mutate into a form easily spread among people, potentially sparking a pandemic. So far, most human cases have been linked to contact with infected birds.

Thailand in the Dark about Burma’s Bird Flu

The Irrawaddy News
By Sai Silp
April 24, 2006

Thai public health authorities and medical NGOs are getting ready for a bird flu outbreak on the Thai-Burma border area of Tak province.

An official from the Tak Provincial Public Health Office told The Irrawaddy today that they have already supplied flu vaccines to all medical staff working in refugee camps and with Burmese migrants in Tak province. A limited number of Tamilflu tablets have also been distributed to refugee camps and the Mae Tao Clinic in Mae Sot.

Representatives from NGOs were given the vaccine today and Tamilflu will be issued on April 26, the official said.

“Medical staff [working with migrants] is the first group to receive this vaccine because of their work with high risk groups and they can identify the disease. The vaccine for refugees is not available yet because of a budget problem.”

A local staff member for the International Organization for Migration based in Mae Sot said that the control of a possible bird flu outbreak in the refugee camps would be easier to manage than one among the transient migrant groups living along the border.

Thai public health authorities are concerned about a lack of information about the bird flu situation in Burma. The IOM staff member said they had decided having a protection plan was the safest way to proceed.

“We’ve heard about outbreaks in poultry and human cases inside Burma, but the news is not confirmed. We have to be careful because we cannot control wild bird migration, and movement of people on the borderline is unpredictable.”

Thai health authorities say there is a need to raise awareness and concern among aid agencies working with Burmese migrants. An official said a lack of reliable health data from Burma meant they could not predict the actual situation inside.

The IOM official said they were working closely with Thai authorities.

“They gave us five doses of Tamilflu for each camp, and five for Mae Tao Clinic. Tamilflu is most effective if used within 48 hours of the flu symptoms starting. If we need more, we can ask the Thai authorities to supply it,” the official added.

The IOM official said bird flu management in Thailand is successful, but for refugees and migrants the policy is still not clear and local organizations are trying to set up a testing system and an immediate treatment response plan to prevent the spread of the disease.

The provincial health authority has already provided medical equipment, such as disease rapid testing kits, for use along the border area by specially trained staff.

Thai health officials say that in the event of a suspected case of H5N1 bird flu virus occurring in the refugee camps, a lock down would be enforced to stop people and poultry moving in and out of the camp. Following recent bird flu outbreaks, authorities have already stopped the flow of poultry in and out of the camps.

Tak public health officials have been meeting to formulate plans for possible outbreaks on the border since January 2006.

Thailand On Vigil For Bird Flu Outbreak

April 25, 2006 10:40 AM

BANGKOK, April 25 (Bernama) -- Caretaker Public Health Minister Pinij Jarusombat warned that Thailand, despite its success in containing bird flu outbreaks, must continue to be vigilant, TNA reported Tuesday.

Anticipating possible human flu and avian flu pandemic around the globe, he called on related government agencies to prepare their contingency plans.

The minister, who chaired a meeting to follow up progress in containing bird flu virus and the authorities' readiness to deal with future outbreaks, was quoted by the news agency as saying that international health experts had warned of possible pandemic and the probability of bird flu virus being transmitted from human to human.

Since last year's outbreaks, he said, bird flu viruses have been found in many different strains and spread in 17 countries in Asia, Europe and Africa.

The deadly H5N1 strain has so far killed 101 people.

The caretaker public health minister said Thailand had prepared two levels of contingency plans -- one for domestic outbreak of the flu and the other to provide assistance to other countries in the region.

He said Thailand had reserved 1.5 million capsules of anti-viral drug Oseltamivir and 300,000 doses of human flu vaccine.

Oseltamivir is a generic version of the drug Tamiflu which Thailand began manufacturing this year.

"The ministry has ordered health officials nationwide to be on alert and organise drills from time to time in dealing with possible bird flu outbreaks particularly in areas already infected by the flu," he said.

-- BERNAMA

Indonesian Ag Min: Govt Winning War Against H5N1

By Phelim Kyne

JAKARTA, Apr 18, 2006 (Dow Jones) -- Indonesia's government is confident that it can purge the country of H5N1 avian influenza by 2008, Minister of Agriculture Anton Apriyantono said Tuesday.

"We are on a declining curve (of H5N1 infections in poultry), Apriyantono told reporters.

"I am still optimistic that Indonesia, as we have expected, will be bird flu-free by 2008."

Indonesia's human and poultry H5N1 infections increased during the country's October-to-April rainy season, but the prevalence of the virus was on a "declining trend," he said, without elaborating.

But Apriyantono's optimism appears at odds with the reality of Indonesia's ongoing bird flu outbreak.

A growing number of avian flu cases in Indonesia, both in birds and humans, suggests there is a breakdown in the country's efforts to combat the disease, an expert at the World Organization for Animal Health said Friday.

Avian influenza has caused 23 human fatalities out of a total of 31 cases in Indonesia since July, the world's highest H5N1 human mortality tally after Vietnam.

Human and animal health experts say the virus is endemic in Indonesia's poultry stocks and that the widespread existence of essentially rural agricultural traditions within city limits heightens the potential for animal-to-human H5N1 virus transmission.

Epidemiologists warn that Indonesia's resource-starved public health sector makes the country a potential weak link in global efforts to prevent the emergence of a mutant H5N1 viral strain that could kill millions worldwide.

The Indonesian government in December unveiled its 2006-2008 National Avian Influenza Strategic Management Plan, a two-plank strategy that includes the control of avian influenza outbreaks in humans and animals and preparation for the possible emergence of a human pandemic bird flu strain.

WHO Says Ag Ministry Efforts Essential To Fight H5N1

The Ministry of Agriculture's efforts to contain H5N1 are "critical"
to reducing human infections of the illness, Jakarta-based World Health Organization press officer Sari P. Setiogi told Dow Jones Newswires.

"As long as (H5N1) remains circulating in poultry, it still poses a threat to human health," Setiogi said.

Successful containment of avian influenza requires Indonesia to implement "painstaking" bio-security measures for the country's millions of backyard farmers, David Nabarro, the United Nation's Senior System Coordinator for Avian and Human Influenza, told Dow Jones Newswires in an interview last week.

But Indonesia's cash-strapped government lacks the resources to effectively tackle its bird flu outbreak and prevent future human infections, analysts say.

"(Indonesia's) 2006 budget allocates just $14 million to combat the disease, although the government's own estimate is that at least 30 times that amount would be prudent," said the Asian Development Bank's latest Development Outlook released earlier this month.

Indonesia's animal health experts have gained valuable experience battling H5N1 since July and will implement a combination of "cleanup efforts and vaccination drives" to fight the spread of the virus, Apriyantono said, without elaborating.

But adequate resources to do that may be in short supply.

Indonesia's Ministry of Agriculture lacks the funds to purchase 480 million out of a total of 600 million H5N1 poultry vaccine doses needed for vaccination campaigns planned for May and June, the English-language Jakarta Post reported earlier this month.

Family 'infected' with bird flu

The Jakarta Post
April 19, 2006

BANDARLAMPUNG, Lampung: A family of five was admitted to Abdul Moeloek hospital in Bandurlampung on Sunday, all suffering from suspected bird flu.

The family -- Abidi, the husband and his wife Sarmawati, both 52, and three of their six children, Septi, 12, Fitri, 8 and Putra, 5 -- are now being treated in an isolation room. The five have all demonstrated a high fever and a cough, symptoms of the deadly bird flu.

Sarmawati has been treated at the hospital since last Thursday. Her other three children had been diagnosed with bird flu earlier. Mohtar Rozi, 15, died March 31, and Betharia, 19, died April 4, while Bakhrudin, 26, is still being treated at the hospital.

Both Mohtar and Betharia died at home before they could be sent to the hospital. Their parents had limited funds and knew little about the virus.

Laboratory tests on drug samples taken from the patients confirmed Bakhrudin, Septi, Fitri and Putra were infected with the bird flu virus, while Abidi and Sarmawati were negative, according to data from the Lampung health office.

In 2004 at least 1.83 million hens in nine regencies throughout Lampung province died, possibly from bird flu, and last year the virus killed another 4,305 hens in the province.

Seven other suspected bird flu patients had been admitted to Abdul Moeloek hospital before the family. After appropriate medical treatment, all recovered.

WHO - Avian influenza – situation in Indonesia – update 10

19 April 2006

The Ministry of Health in Indonesia has confirmed the country’s 32nd case of human infection with the H5N1 avian influenza virus. The case occurred in a 24-year-old man from Tangerang, near Greater Jakarta. He developed symptoms on 29 March, was hospitalized on 5 April, and died on 8 April.

His source of exposure is presently under investigation.

Of the 32 laboratory-confirmed cases in Indonesia, 24 have been fatal.

Sorry... I have been unable to "feed" the blog for a while...
Am back on it !

Vaccine shortage hampers government's bird flu fight

Tb. Arie Rukmantara, The Jakarta Post, Jakarta 11/04/06

A shortage of vaccines has hampered the government's plan to carry out a nationwide poultry vaccination drive against bird flu next month, a senior government official said Monday.

"We planned to hold two rounds of a massive vaccination campaign in May and June, but because we are short of vaccines, we have to reconsider the plan," Agriculture Ministry head of bird flu emergency response Delima Hasri Azahari told The Jakarta Post.

The vaccination effort would target mostly backyard and small-farm poultry, she said.

She explained that to carry out the drive, the government needed about 600 million doses of the vaccine for some 300 million birds across the country. Each would receive two shots.

"However, the 2006 state budget could only afford enough money to purchase 120 million dosses. So we are facing a gap of 480 million doses," Delima said. She could not specify how much money was needed to cover the shortage.

Delima said she believed if the shortage was not addressed immediately, the vaccination drive would not be effective.

"We could still carry out the vaccination drive according to schedule, but we could only focus on high-priority regions where bird flu is pandemic. Such measures wouldn't be effective, however, because to contain the spread of the virus we should vaccinate all poultry at the same time," she said.

High numbers of bird flu fatalities among humans and poultry have been recorded in nine provinces across Indonesia -- Jambi, Lampung, Jakarta, Banten, Central Java, West Java, East Java, Yogyakarta and South Sulawesi.

The H5N1 virus has killed 24 of 32 confirmed human bird flu patients. It has also killed millions of birds.

Health experts fear the virus could mutate into a form that can spread from human to human, potentially causing a global pandemic that could kill millions of people.

Delima said she and other senior government officials, led by Coordinating Minister for the People's Welfare Aburizal Bakrie, would discuss the disease Tuesday with World Bank chief Paul Wolfowitz in Tangerang, West Java.

"Recently, a team of World Bank experts did a preliminary assessment of bird flu in the country. So we expect they will understand our needs," she said.

"However, we also encourage the private sector to support the campaign," Delima said.

An advisor to Aburizal on bird flu issues, Emil Agustiono, told the Post recently that the private sector should do more to help the government battle bird flu.

He said that to date, of the Rp 9 trillion needed to fight bird flu from 2006 to 2008, the private sector had donated only Rp 200 million.

Secretary-General of the Indonesian Employers Association Djimanto said businesses were actually eager to help fight bird flu, since a pandemic could cost companies billions of rupiah in losses.

"Unfortunately, we are currently facing endless problems with this high-cost economy. We can barely afford to cover maintenance for our machinery. How do you expect us to set aside funds for bird flu?" he said.

Indonesia's Bird Flu Cases Indicate Virus Control Isn't Working

April 12 (Bloomberg) -- Human bird flu cases in Indonesia, averaging one a week since September, indicate measures to control the virus haven't stopped it spreading among poultry, a United Nations envoy said.

``I remain very concerned about the continued reports of human cases and fatalities because this means that bird flu in rural and urban areas is very pronounced,'' David Nabarro, the UN's senior coordinator for bird flu and pandemic influenza, said yesterday in an interview in Indonesia's capital, Jakarta.

Indonesia, the world's fourth-most-populous nation, has had outbreaks of the H5N1 avian flu strain in 26 of its 33 provinces, and so far 32 people have become sick and 24 of them have died. Diseased fowl increase the risk for humans and create opportunities for the virus to mutate into a form that may kill millions of people.

The disease is known to have infected at least 193 people in Asia, the Middle East and Africa since 2003, killing 109. The H5N1 strain has all prerequisites to spawn a pandemic except the ability to spread easily from person-to-person, the World Health Organization said last week. The last flu pandemic, in 1968, killed 1 million people worldwide, according to the Geneva-based agency.

The WHO yesterday confirmed Indonesia's 32nd avian flu case after a man in Padang city on Sumatra island tested positive for the H5N1 virus. The health agency also said confirmatory tests on samples taken from an 8-year-old who died in July 2005 showed she had the virus in the same month the country's first fatality was reported.

Jakarta

About half the Indonesians infected with the H5N1 virus have come from Jakarta and surrounding areas. Thirty million households in Indonesian villages keep more than 200 million chickens in backyards, according to the UN's Food and Agriculture Organization.

Nabarro said Indonesia needs to ``build up the animal health services from the bottom up'' and maintain disease surveillance.

``The government is very focused on the issue and the government is giving higher priority in improving animal health,'' he said. ``You have to maintain this effort for many years to come, particularly in improving bio-security in small- scale and backyard sectors.''

Bird flu controls in Indonesia, which successfully eradicated foot-and-mouth disease in cattle in the 1970s, have suffered because the government doesn't have enough people to monitor the spread of the disease in poultry. A law that came into effect in 2001 gave power to provinces and regencies with little supervision from the national government in Jakarta.

`Very Slow'

A ``very slow'' surveillance and monitoring system and communication problems between central and provincial governments are hampering efforts to contain the virus, Azmi Mat Akhir, an official with the Association of Southeast Asian Nations, said last month.

Indonesia, with a population of 220 million people, may spend about 3 trillion rupiah ($334 million) this year to implement control measures, including culling and vaccinating poultry, Finance Minister Sri Mulyani Indrawati said in February. The government on Feb. 24 started checking homes in Jakarta for diseased fowl in an effort to stem the spread of the virus.

Burma battles 100-plus bird flu outbreaks

www.bangkokpost.com 11/04/2006

The bird flu situation in Burma is more serious than expected, and the UN Food and Agriculture Organisation alone is tracking more than 100 separate outbreaks of H5N1 flu in areas near Mandalay and Sagaing, officials said in Bangkok on Monday.

He Changchui, FAO representative for Asia-Pacific, said the information in Burma is not comprehensive, and Burma is not ready to fight avian flu in terms of equipment, diagnosis and awareness. He said the FAO is trying to help get funds to send necessary medicine, equipment and compensation.

“The situation there was more serious than we imagined," he told a news conference in Bangkok, Thailand. "Up to now, there are over 100 outbreaks."

He said, "The issue there is that awareness is rather poor. The information is not that comprehensive."

World Health Organisation representative Somchai Peerapakorn said Burma's ruling generals have requested help from the WHO, which will send a team to the country at the end of this month.

UN Coordinator for Avian and Human Influenza David Narbarro said he was satisfied with the improving situation in several countries, especially Thailand and Vietnam, but he is still concerned about Burma and Cambodia.

Burma reported its first case of bird flu on March 13 and said thousands of birds were culled to prevent the spread of the often dangerous H5N1 virus.

In Rangoon, the weekly Burma Times reported Monday that the outbreak of the H5N1 type bird flu in central Burma is ongoing, and claimed the authorities have contained it from spreading.

Burma has culled more than 470,000 birds and destroyed more than 400 farms in Mandalay and Sagaing, according to Burma's Livestock Breeding and Veterinary Department.

But the department is still receiving reports of chicken deaths, with the latest reports coming in from five poultry farms in different townships in Mandalay early this month, the paper said.

Dr Nabarro said that nations should be prepared to pledge hundreds of millions more dollars to combat bird flu as the H5N1 virus affects more developing nations.

Western and Asian donors had pledged $1.9 billion in January during a conference in Beijing to combat bird flu and improve containment and prevention methods in 12 countries, mostly in Asia.

But with the virus steadily spreading across the world through migratory birds, including infections in at least five African nations, health officials must reassess how much funding they will need to help developing nations that lack proper resources to detect, prevent and contain outbreaks, Dr Nabarro said.

"The amount of H5N1 in birds is considerably more than it was a year ago," he said.

The virus has killed at least 109 people who have come into contact with sick birds. But international health officials fear H5N1, the strain of the virus that has been deadly in humans, will mutate into a form that can be transmitted from human to human and spark a global pandemic that could kill tens of millions.

Nabarro, who is on a five-nation trip through Asia to assess bird-flu preparedness, warned in Bangkok against prolonged debates on whether more money should be pledged so soon after the Beijing conference.

"The potential cost of a global influenza pandemic is massively greater than might be the amount required to meet an international threat," he said.

Health officials fear Asia might be "ground zero" for a human pandemic, and Nabarro outlined a "mixed report" on how well affected countries were coping.

He applauded Thailand and Vietnam, which has the most reported human deaths from bird flu, as making tremendous progress while China, Indonesia and especially Myanmar (Burma) were lagging behind.

"The general impression I have is avian influenza remains a major challenge here," Nabarro said, but added that there had been "enormous progress" across the region in the past six months.

Myanmar has reported outbreaks in two administrative regions, which health officials fear could mushroom because public awareness there remains poor.

In Indonesia, the government is playing catch-up after an initial slow start in detecting and isolating the virus in its poultry population, where it is now endemic. To make matters worse, the Jakarta government recently postponed the signing of a multimillion-dollar agreement with Australia to combat bird flu because of a separate diplomatic row over refugees from the Indonesian province of Papua.

Nabarro said he hoped "political circumstances" would not prevent countries that need resources to fight bird flu from receiving them.

WHO confirms new bird flu case in Indonesia

JAKARTA (AFX)04.11.2006 - The World Health Organization has confirmed Indonesia's 33rd case of bird flu in a 23-year-old poultry worker, the health ministry said.

The patient is being treated at the M Djamil hospital in Padang, West Sumatra province, said Hariyadi Wibisono, director general of animal borne disease control.

Results arrived this morning from the WHO-affiliated Centers for Disease Control and Prevention in the United States which confirmed earlier local tests, Wibisono told Agence France-Presse.

'He had been in contact with sick chickens at his work place in the Bekasi suburb,' he said.

Local tests for the virus, which are usually accurate, are routinely sent to WHO-affiliated laboratories in Hong Kong or the US for confirmation.

Vietnam to cull smuggled poultry to prevent bird flu

People's Daily Online/UPDATED: 15:05, April 04, 2006

Vietnam will try to destroy all smuggled fowls and related products without compensation for their owners or transporters to prevent the outbreak of bird flu, local newspaper Pioneer reported Tuesday.

Under a recent instruction of Deputy Prime Minister Pham Gia Khiem, the People's Committees of 14 northern and southern cities and provinces will cooperate with relevant agencies to cull the smuggling of poultry and related products from bird flu-hit neighboring countries.

Earlier, the government ordered localities and ministries to step up monitoring bird flu, disinfecting farms, and accelerating the vaccination. Seeing no bird flu outbreaks over the past three months, some Vietnamese provinces have dropped their vigilance against the disease.

Last year, bird flu hit 44 cities and provinces of Vietnam, leading to the forced culling of nearly 4.8 million poultry. The total direct loss caused by the disease was estimated at more than 100 billion Vietnamese dong (6.3 million U.S. dollars).

Now, the country has a total fowl population of 220 million.

Source: Xinhua

Singapore Plans July Drill to Test Bird-Flu Readiness (Update2)

April 5 (Bloomberg) -- Singapore plans to hold a two-day drill in July, simulating an outbreak of avian influenza, to test the readiness of its public hospitals, clinics and nursing homes.

The government is also distributing an information handbook to 1.1 million households and may close schools and impose other measures. The country has stockpiled Roche Holding AG's Tamiflu, an antiviral drug, which will be enough for 680,000 doses, the government said and added it will have 1.05 million by the end of the year.

``The government is making every effort to ensure that Singapore can cope with a flu pandemic,'' Lee Boon Yang, Singapore's information minister, said at a briefing today, adding that the drill ``will involve the participation of the public and patients to test the work procedures and processes that have been worked out for crisis situations.''

Singapore, which hasn't yet had a bird-flu case, is girding for a widespread outbreak of avian influenza amid cases in Vietnam, Indonesia, Thailand, China, Turkey, Azerbaijan, Iraq and Cambodia. The World Health Organization confirmed four cases of bird flu in Egypt over the past month, including two fatalities, the first time the agency found human infections in Africa.

SARS Experience

Singapore's preparation follows the Severe Acute Respiratory Syndrome or SARS outbreak in the city-state three years ago, which killed about 33 in the country, one of the five most affected areas worldwide. At the height of the outbreak, tourist-arrivals plunged to a two-decade low, forcing the government to shut schools and isolate more than 4,000 people.

With avian influenza, the disease in birds creates more opportunity for human infection and increases the risk of the virus changing into a pandemic form. So far, there isn't any evidence that H5N1 is evolving to become more easily transmissible to humans as the disease spreads across Europe, Africa and Asia. The most recent flu pandemic in 1968 killed 1 million people worldwide.

Singapore has also stockpiled 50,000 doses of GlaxoSmithKline Plc's Relenza to combat the disease, as well as masks, gowns and antibiotics, the government said. It also almost tripled the number of rooms in public hospitals to isolate patients with infectious diseases to 320 since the SARS outbreak, said Balaji Sadasivan, senior minister of state for health and information.

``Since the time of SARS our physical infrastructure has been improved,'' Balaji said at the briefing, adding that ``all our hospitals are equipped with a surveillance system'' to detect patients suspected of bird flu.

The government has also taken measures to ``bird-proof'' local poultry farms to prevent chickens from coming into contact with wild birds. It will also vaccinate birds at public parks such as the zoos, swans in the botanic garden and peacocks on the southern tourist island of Sentosa.

AIDS, TB, Malaria, Bird Flu Go Unchecked in Burma

The John Hopkins Univ. Gazette, April 3, 2006

Public health experts say diseases pose threat to regional and global health

By Tim Parsons
School of Public Health

Government policies in Burma that restrict public health and humanitarian aid have created an environment where AIDS, drug-resistant tuberculosis, malaria and bird flu (H5N1) are spreading unchecked, according to a report by researchers at the Johns Hopkins Bloomberg School of Public Health.

In that report authors Chris Beyrer, director of the Bloomberg School's Center for Public Health and Human Rights; Luke Mullany, Voravit Suwanvanichkij and Nicole Franck document the spread of these infectious diseases, which if left unchecked could pose a serious health threat to other Southeast Asia nations and the world.

They believe international cooperation and policies are needed to restore humanitarian assistance to the Burmese people but caution that new restrictions imposed by the military junta are making such efforts more difficult. The full report was presented at a briefing for State Department officials on March 24 and is available from the Johns Hopkins Center for Public Health and Human Rights at www .jhsph.edu/burma. The report is also under review for publication with the journal Public Library of Science Medicine.

The report states that Burma reported its first cases of bird flu among poultry to the World Health Organization on March 8. However, the ruling junta censored reports of the outbreak to its own public until March 17, by which time the outbreak had killed 10,000 more birds, and 41,000 needed to be culled to stem further spreading.

The report documents a long-standing and severe underfunding of health and education programs in Burma. Health expenditures in Burma are among the lowest globally, including an annual budget of less than $22,000 for the prevention and treatment of HIV among a total population of 43 million people. Much of the country lacks basic laboratory facilities to carry out a CD4 blood test, the minimum standard for clinical monitoring of AIDS care. In 2005, 34 percent of tuberculosis cases in Burma were resistant to any one of the four standard first-line drug treatments, which is double the rate of drug-resistant cases in neighboring countries. Nearly half of all deaths from malaria in Asia occur in Burma. The report also reveals that 70 percent of anti-malarial pills sold in Burma contain substandard amounts of active ingredients, which increases the risk of drug resistance.

"There is a growing humanitarian crisis in Burma. In our report, we document how the ruling government's policies have restricted nearly all aid and allowed serious infectious diseases to spread unchecked," said Beyrer, who is also an associate professor in the Department of Epidemiology at the Bloomberg School. "With the global spread of bird flu, there is a fear that if a human form of H5N1 were to take hold in Burma, it could potentially spread unchecked for weeks or months before anyone knew about it. Uncontrolled spread of any disease, especially an emerging disease like H5N1, poses a serious health threat to Burma's populous neighbors, like China and India, as well as the rest of the world."

The report also documents threats and restrictions to foreign relief workers and relief groups, including the Red Cross. Because of the deteriorating situation, the United Nations Global Fund for AIDS, Tuberculosis and Malaria was forced to withdraw its five-year $96 million grant agreement with Burma. Backpack Health Worker Team, an aid group that provides primary health care services in rural areas of Eastern Burma and Thailand, is also raising concerns about its ability to monitor and contain outbreaks of bird flu and other diseases.

"The Burmese junta is increasing restrictions on humanitarian assistance and public health while the health of Burmese people deteriorates, posing a widening threat to Burma and her neighbors," Beyrer said.

The report was funded by the Center for Public Health and Human Rights and the Bill and Melinda Gates Population and Family Health Institute.

Indonesia confirms 24th flu death

Indonesian health officials say an eight-year-old girl who died last July had the deadly H5N1 strain of bird flu.

A spokesman for the Indonesian health ministry, Runizar Ruesin, said the virus was confirmed in tests by the World Health Organization (WHO).

The result brings to 24 the number of deaths from bird flu in Indonesia.

The girl's father and sister were confirmed last year to have died from the H5N1 strain of the virus, but further tests had been delayed.

The government had problems getting adequate specimens of the girl's blood, which delayed shipment to a WHO-affiliated laboratory in Hong Kong, Mr Ruesin told Reuters news agency.

The H5N1 strain of the bird flu virus has been found in birds in 26 of Indonesia's 33 provinces. Almost all the deaths have been linked to contact with infected poultry.

On Friday, the WHO confirmed that a one-year-old girl died from bird flu after coming into contact with dead poultry.

More than 100 people around the world have died from the disease since 2003.

The vast majority of the deaths have been in Asia, but cases in people and birds have also been recorded in Europe and Africa.

Experts fear the virus could combine or mutate into a form that passes easily between humans, possibly sparking a pandemic, but there is no evidence that this has happened yet.
Story from BBC NEWS Published: 2006/04/04 09:05:48 GMT

WHO - Avian influenza – situation in Indonesia - update 8

4 April 2006

The Ministry of Health in Indonesia has confirmed an additional case of human infection with the H5N1 avian influenza virus. The case, which was fatal, occurred in a 20-month-old girl who resided in Kapuk, West Jakarta. She developed symptoms of fever and cough on 17 March, was hospitalized on 22 March, and died on 23 March.

Field investigation found a history of deaths in a chicken flock near her home about one week prior to symptom onset. Chicken deaths in the neighbourhood have continued, but the cause has not yet been identified. Family members and neighbours have been placed under observation and samples from these people have been taken for testing. Preliminary results are negative, but follow-up investigation is continuing.

The newly confirmed case brings the total in Indonesia to 30. Of these cases, 23 were fatal.

Bird flu killed Indonesian baby girl

Reuters - Jakarta, Saturday, April 01, 2006

A one-year-old baby girl, who died this month, has been confirmed as Indonesia's latest bird flu victim, the Health Ministry said on Friday, citing results from a World Health Organisation-affiliated laboratory.

The girl, from west Jakarta, is the country's 23rd victim of bird flu, senior ministry official I. Nyoman Kandun told Reuters after receiving results from the laboratory in Hong Kong.

He said it was unclear if the baby had had any contact with sick birds, the usual mode of transmission of the virus to people, but added there was a lot of fowl in her neighbourhood.

Indonesia first announced the death last Saturday, but had been awaiting confirmation of the cause. The H5N1 avian influenza virus has spread in birds at an alarming rate in recent months, sweeping through parts of Europe, down into Africa and flaring anew in Asia.

It is difficult for humans to catch but has killed 105 people, according to the most recent WHO figures.

Experts fear the virus could evolve into a form passed easily from human to human, causing a pandemic that could kill millions.

In Indonesia, the highly pathogenic strain of bird flu has affected birds in about two-thirds of the country's provinces.

Indonesia had the most bird flu deaths of any country so far this year.

Stamping out the virus is a huge, if not impossible, task in Indonesia, a sprawling archipelago of about 17,000 islands and 220 million people.

The government has resisted the mass culling of fowl seen in some other nations, citing the expense and the impracticality in a country where the keeping of a few chickens or ducks in backyards of homes is common in cities and on farms.

Agencies have concentrated instead on selective culling, and on public education and hygiene measures aimed at prevention.

A sweeping door-to-door campaign to try to control the disease in the capital Jakarta, the country's biggest city which along with its suburbs has about 12 million people, only got underway at the end of February.

Agriculture officials estimate that Jakarta alone has some 500,000 fowl.

Indonesia forms national bird flu control committee

Jakarta, Tuesday, March 28, 2006

Indonesia has established a national committee for bird flu pandemic preparedness (KFBPI) in a bid to enhance control over bird flu outbreaks.

The KFBPI is tasked with outlining national strategies and policies, directing the country's fight against bird flu, and making preparations for a possible bird flu pandemic. The 20-member committee is chaired by the Indonesian Minister of Coordination and People's Welfare, with its vice chairmen being the Ministers of Economic Coordination, Agriculture and Public Health.

In the next three months, the committee plans to speed up implementation of strategies and programmes on bird flu control currently overseen by the Ministry of Public Health and the Ministry of Agriculture.

(Vietnam News Agency Via Thomson Dialog NewsEdge)Jakarta, March 27 (VNA)

Indonesia aims to cut tuberculosis deaths

The Associated Press
Wednesday, March 22nd, 2006

JAKARTA, Indonesia (AP) - Indonesia aims to cut in half the number of deaths from tuberculosis by 2015, reducing the threat from the disease that is one of the nation's leading killers, officials said Wednesday.

Health Minister Siti Fadilah Supari, speaking to reporters ahead of world Tuberculosis Day on March 24, said Indonesia ranks third after India and China in the number of cases for the respiratory disease, which kills 140,000 people each year in the nation of 220 million.

"We expect to meet the Millennium Development Goals target to halve tuberculosis deaths from the current 300 deaths daily to around 200 in 2010 to eventually 150 in 2015," she said.

Indonesia joined this year's global effort with China, India and the Philippines to step up the fight against tuberculosis. According to the World Health Organization, the disease kills 1.7 million people worldwide each year.

Indonesia has improved its case detection rate - the number of cases reported as a percentage of total estimated cases - from 20 percent in the years before 2001 to 67 percent last year, said Dr. Firdosi Mehta, WHO Indonesia Medical Officer for Tuberculosis, who was present at the health minister's announcement.

Jan Voskens, a senior consultant for the Hague-based tuberculosis foundation KNCV, who was also at the news conference, expressed concern that international concern of a possible bird flu pandemic could draw funding away from the programs to combat tuberculosis.

He said the aid arm of the U.S. government, USAID, now "has more concern for bird flu" than tuberculosis.

Mehta said among the challenges ahead, health providers need to focus on handling tuberculosis infections in HIV/AIDS patients and maintain an international standard in handling tuberculosis cases.

The WHO says tuberculosis is the top killer of HIV/AIDS patients, whose compromised immune systems are more vulnerable to the disease.

Papua New Guinea - Migratory birds, ducks pose bird flu threat

Migratory birds, ducks pose bird flu threat

The National, PNG, By BONNEY BONSELLA 03/23/06

THE National Agriculture Quarantine and Inspection Authority said yesterday migratory water birds and nomadic ducks pose the biggest threat to the entry of bird flu into PNG.
NAQIA managing director Andrew Yamanea said the migratory birds could spread the disease across the PNG/Indonesian borders, especially along the Tonda wetlands of Morehead district of the Western province.
Mr Yamanea said the area was a well known stopover between the months of August and October for migratory and nomadic ducks from Russia, China and even Indonesia.
Wetland areas in Manus and Sepik were also considered high risk surveillance areas.
Mr Yamanea revealed this while clarifying media reports about the outbreak of the bird flu in Timika across the border in the West Papua province.
“NAQIA wishes to officially inform the public that there is no such outbreak or confirmation of it and West Papua province remains free of bird flu,” said Mr Yamanea.
He said the closest affected place is South Sulawesi, which is quite far from Papua New Guinea.
He said NAQIA was only aware of Classical swine fever (hog cholera) cases in Timika which could have been mistaken for bird flu.
It is a predominantly pig disease that spreads rapidly in pig population and pose no harm to humans which NAQIA has already issued alert notices to officers on the ground.
Mr Yamanea said NAQIA had taken preventive measures against the bird flu and other plants and animal diseases across the border and has instructed communities and public servants to immediately report any suspected cases of plants or animals dying, including poultry and water birds to the nearest NAQIA or other authorities for further investigations.
Mr Yamanea said NAQIA would be conducting a joint public awareness with the Health Department and the Ok Tedi Mining Ltd and the communities in the Fly River next week.
Similar campaigns have been done in West Sepik province while other high risk areas will be targeted when funding is available.
Minister responsible for Disaster and Emergency Services and Inter-Government Relations Minister Sir Peter Barter is taking no chances, and has directed his office and the director-general of National Disaster Centre to liaise with NAQIA and Health Department to seek donor assistance to ensure stock of anti-viral for bird flu is available to treat any detection.

Vietnam clamps down on Chinese poultry smuggling

23 Mar 2006
Reuters

HANOI, March 23 (Reuters) - Vietnam, where bird flu has been contained for nearly three months, has ordered a new crackdown on poultry smuggling from neighbouring China to keep out healthy looking birds which may carry the H5N1 virus.

Agriculture Minister Cao Duc Phat, in an urgent message seen on Thursday, ordered authorities in all Vietnam's 64 cities to act against smuggling.

The National Anti-Bird Flu Committee also ordered health, agriculture, finance, trade and police officials to join forces to stop smuggling of poultry from China through the northern border.

Vietnam banned the import of poultry and poultry products from all neighbouring countries last year, including China, to fight the spread of bird flu.

The new crackdown on smuggling, Animal Health Department officials told Reuters, came after reports of asymptomatic cases of the H5N1 virus in Chinese poultry.

But they said random tests samples from 20,000 chickens around Vietnam had not turned up any such cases, in which birds show no symptoms of the disease despite carrying the virus, which they can pass on to other fowl.

Smuggling of poultry from the northern neighbour has been on the rise as Chinese chicken can cost as little as 5,000 dong ($0.31) per kg and sell for as much as 60,000 dong per kg in Vietnam.

The H5N1 virus has killed 42 people in Vietnam, the highest number of fatalities in any of the nations where bird flu has infected people.

Bird flu has spread rapidly from Asia to Europe, the Middle East and Africa with 30 countries having reported outbreaks this year.

Indonesia bird flu campaign exposes loopholes

22 Mar 2006
By Tomi Soetjipto

PURWAKARTA, Indonesia, March 22 (Reuters) - Armed with vaccines and green rubber boots, veterinarian Sri Wuryasturati is ready to hit the road for Indonesia's anti-bird flu campaign.

Except she doesn't have the most essential item to get going: a motorcycle.

Dressed in a crisp brown civil servant's uniform and scarf, the 42-year-old eventually takes off hours later to join hundreds of veterinarians at the forefront of efforts to contain bird flu in Indonesia, which has the world's second highest number of human deaths from the disease.

"We have got the vaccines ready," she said, pointing to a refrigerator full of vaccines for poultry. "But sometimes some of us can't go out because there are no vehicles."

Without motorcycles, it is impossible for vaccinators to reach villages in the morning before locals release their backyard chickens into the fields.

And there are lots of villages in Indonesia, a country of 220 million people spread across thousands of islands.

Although Indonesia has launched high-profile, door-to-door checks of poultry and birds in some provinces, the country remains vulnerable because of poor planning and surveillance.

Jakarta has set up a national team to combat bird flu, but its members and volunteers only reach areas in the capital while those in provinces rely on their own networks of vaccinators.

WEAKNESS

Yoke Sudarbo, a programme manager at Partnership, a U.N.-sponsored non-governmental organisation, said lack of coordination mirrored the state of bureaucracy in Indonesia.

"The weakness in handling bird flu is an example of inadequate public services in Indonesia and it highlights the country's poor infrastructure," said Sudarbo.

Government officials in Jakarta said they were in control.

"Support systems such as two-wheeled and four-wheeled vehicles will be provided, we are working on that," said Mathur Riyadi, head of the Agriculture Ministry's poultry department.

He added the government had distributed leaflets to government offices, outlining basic health and hygiene procedures and safe ways to cook chicken.

Indonesia has had 22 confirmed deaths from the H5N1 strain of the avian flu virus since 2003 and half of those deaths have occurred this year.

The rising toll is worrying U.N. health officials who fear the more the virus spreads in birds, the more human cases there will be and the greater the risk H5N1 might mutate into a form that could pass from person to person.

If such a mutation occurs, it could spark a pandemic in which millions could die.

Globally, the virus has killed at least 103 people since 2003, the majority in Asia where many people live side-by-side poultry. For the moment, it remains hard to catch from birds.

In Indonesia, most bird flu cases in humans have been in or around Jakarta. But the virus has been detected among poultry in about two-thirds of the country's 33 provinces.

HOSTILITY

A big stumbling block is opposition to the control campaign from villagers.

"People get hostile sometimes. Some even hide their chickens, which is silly because we can still hear the noise," said Sri the veterinarian.

Despite a 30 billion rupiah ($3.3 million) scheme to cull fowl within a kilometre radius from the point where the virus is found, some workers are afraid to kill the birds as there is no legal apparatus to act freely.

Moreover, there is no monitoring system as in Thailand to alert authorities in case of a suspected outbreak.

In Thailand, the government has tagged its bird flu monitoring efforts onto a nationwide network of 800,000 health volunteers, set up decades ago as a first line of defence against ailments such as diarrhoea, tuberculosis and chickenpox.

With each volunteer assigned to monitor between 10 and 20 households in Thailand, as well as educate them about the risks and symptoms of bird flu, officials are confident any outbreak in either poultry or humans will not go unnoticed for long.

"If a chicken dies unusually, we will know about it within the day," said 58-year-old Manop Sungyont, who has been a health volunteer for 29 years in Suphan Buri province, 100 km (60 miles) northwest of Bangkok.

In the event of a possible outbreak, the likes of Manop pass the information up a command chain to either animal or human health officials, triggering the swift arrival of expert teams to collect samples, treat victims or start culling. (Additional reporting by Ed Cropley in Bangkok and Diyan Jarri in Jakarta)

OIE says some China bird flu vaccines ineffective

21 Mar 2006

PARIS, March 21 (Reuters) - China may be using some substandard poultry vaccines to fight bird flu that could allow birds to keep spreading the virus despite not showing symptoms, a top animal health expert said on Tuesday.

Christianne Bruschke, a member of the bird flu task force at the Paris-based World Animal Health Organisation (OIE), said the vaccines made in China at the Harbin Veterinary Institute conformed to international standards and were fully effective.

"But there are local companies in China that produce vaccines and it's possible these don't have the efficacy of those made at Harbin," she told Reuters.

Chinese officials have said their vaccines are effective and that no healthy-looking bird has yet been found carrying H5N1.

But there have been outbreaks in areas where poultry were supposedly already vaccinated and this has raised the possibility that birds are continuing to spread the virus.

"There are two possibilities," Bruschke said. "Either the vaccine is not strong enough, or that it is a good vaccine but not administered properly. Vaccines have to be given twice to be fully effective, maybe that is not happening.

"When a vaccine is not effective enough, it could prevent clinical signs from showing but the bird could still spread the virus. That's certainly a possibility," she said.

And she said poultry that had not been properly vaccinated may also pose a health risk to humans although it was difficult to quantify the danger.

Research in Europe, which did not import vaccines from China, showed drugs stopped the spread of the virus, she said.

"The vaccines are, when administered properly according to manufacturers' instructions, effective in preventing the spread in chickens and ducks," she said, adding that more research was needed on other bird species.

The Netherlands, France and Russia have announced plans to vaccinate some of their poultry against bird flu. But Dutch farmers have mostly chosen to wait before vaccinating their birds because they fear a negative impact on exports.

David King, the British government's chief scientific adviser, said the often close contact between humans and chickens in China meant that vaccines were particularly necessary there.

"The Chinese are using a number of different vaccines and one of the vaccines it is claimed has a high efficacy," he said.

"But we couldn't possibly use a vaccine that hadn't been fully through the European procedures of testing," he added.

It would be interesting to know if these suspicious vaccines have been exported from China and where...

Corporate bird flu worry highest in Asia - survey

21 Mar 2006

NEW YORK, March 21 (Reuters) - About one in five multinational companies is not at all concerned about avian flu, and among those that are, few have plans in place to deal with a deadly global outbreak of the disease, according to a survey by Watson Wyatt Worldwide.

Not surprisingly, the survey of 90 multinational companies conducted within the last 60 days found the greatest level of concern from those operating in the Asia-Pacific region, where the vast majority of bird flu deaths among humans has occurred.

Some 74 percent of companies surveyed expressed great or moderate concern for operations in the Asia-Pacific region, with 52 percent saying they are considering putting programs in place to deal with a human outbreak in the region. Some 32 percent said they already have a plan in place for Asia.

Despite warnings from world health officials that a global bird flu pandemic among humans was highly likely, the level of concern remains far lower for other regions, as was the percentage of companies with avian flu outbreak plans in place, the survey found.

"While focusing on Asia is a logical response to news of flu cases there, employers need to make sure they are considering the possible impact the avian flu could have on all regions," said Robert Wesselkamper, director of international consulting at Watson Wyatt.

"A good first step for companies is to note what worked and what didn't in their planned responses to past threats such as SARS," Wesselkamper said

PLANNED RESPONSE

Forty-eight percent of companies operating in the United States said they are considering such plans, although only 15 percent said they have plans in place. Thirty-four percent of responders with U.S. operations said they were greatly or moderately concerned about avian flu.

Among those with European operations, 45 percent expressed a high level of concern for the region with only 11 percent saying they have plans set to deal with a European outbreak. Some 47 percent said they were considering such programs.

Just 9 percent of responding companies said they have plans in place to deal with an outbreak in Latin America, where 36 percent of companies expressed great or moderate concern.

Wesselkamper declined to identify any of the 20 percent of companies that expressed no concern, for fear of upsetting their employees.

The vast majority of the companies surveyed were headquartered in the United States, with several based in Asia or Europe, Wesselkamper said.

Responding companies on average had more than 15,000 employees worldwide, with nearly half having operations in at least five regions.

The World Health Organization has confirmed 103 human deaths from the H5N1 strain of avian influenza. The disease has not mutated into a form that can easily be transmitted from human to human, but health officials have said they believe it is more a matter of when rather than if that will happen, and that such a development could kill millions.

Malaysia official says bird flu spread nationwide possible

AFX News, 03.21.2006

KUALA LUMPUR (AFX) - A Malaysian deputy minister warned that the deadly bird flu virus may spread nationwide after two more outbreaks were reported in a northern state.

'There is always the possibility (of this),' Mah Siew Keong, deputy agriculture minister, told reporters.

'We hope there will be not be many more new cases. We are taking all the steps. The ministry is concerned at the outbreaks.'

An official in the northern state of Perak reported two new outbreaks of the H5N1 strain there, at Changkat Legong and at Titi Gantung, which is 60 kilometers to the west of Changkat Legong.

But no birds have died of the disease in the two areas, Perak agriculture committee chairman Mohamad Radzi Manan was quoted as saying by Bernama news agency.

Mohamad Radzi said veterinary officials have begun to slaughter poultry in the two areas and expect to kill some 3,000 birds.

In the first outbreak in Malaysia in more than a year, H5N1 was detected last month in 40 free-range chickens in four villages in Gombak near Kuala Lumpur.

Last Thursday Malaysia announced outbreaks of H5N1 in an eco-park and at Changkat Tualang, which is within 5.0 kms of Changkat Legong.

Yesterday, an outbreak of H5N1 was announced in Permatang Bagak village in Penang state bordering Perak.

'Unfortunately, yesterday the bird flu was confirmed in mainland Penang. So it means since last month's outbreak in Gombak, it has spread to Perak and now it is confirmed in Penang,' Mah said, adding that authorities have yet to confirm how the birds were infected.

Mah said the government is on full alert to stop the spread of the disease, which is threatening the poultry industry.

He said neighboring Singapore has banned poultry imports from Perak, which is one of Malaysia's biggest exporters of poultry.

Officials have slaughtered tens of thousands of birds at the site of outbreaks. No human cases of bird flu have been reported so far in the country.

WHO - Pandemic influenza draft protocol for rapid response and containment
http://www.ads-net.org/All%20Documents/Guidelines%20&%20Protocols/fluprotocol_17.03.pdf

WHO - Advice on use of Oseltamivir

http://www.ads-net.org/All%20Documents/Guidelines%20&%20Protocols/useofoseltamivir2006_03_17A.pdf

Infection resurfaces in Cambodia

Reuters 17/03/06

Phnom Penh: The deadly H5N1 bird flu strain has turned up again in eastern Cambodia in the same province the virus hit last month, according to a Food and Agriculture Organisation (FAO) report obtained yesterday.

"H5N1 has been identified in samples, showing that the virus is circulating," said the FAO bulletin, dated March 2.

It is not clear why the test results, which confirmed H5N1 around 30 km from another outbreak in the eastern province of Kampong Cham in February, took two weeks to emerge.

A Cambodian official who helps coordinate the impoverished Southeast Asian nation's bird flu surveillance network also confirmed it as H5N1, but asked not to be named for fear of losing his job.

The FAO said 450 ducks, 150 chickens and 15 fighting cocks had displayed symptoms such as respiratory difficulties and cloudy eyes.

Poultry in the immediate area were culled shortly after test results confirmed H5N1, officials said. There have been no reports of human infections in the affected district.

Bird flu has killed around 100 people worldwide since 2003. Four of those victims were Cambodian.

Southeast Asian study to trial higher drug doses against bird flu

03.17.2006

HANOI (AFX) - Researchers in Vietnam, Thailand and Indonesia will soon start a two-year study to find out at what dosage the drug Tamiflu is most effective against the deadly H5N1 bird flu strain, officials said.

'We have decided to double the Tamiflu dose to 300 miligrams for H5N1 patients,' said Doctor Nguyen Tuong Van of Hanoi's Institute for Tropical Diseases, one of five Vietnamese clinics to take part in the trials.

'Research has shown that the amount of virus in samples of dead patients is still high, creating the need to raise the treatment dose to find the optimal therapy,' Van told Agence France-Presse.

There is no cure for bird flu, but Tamiflu is considered the most effective frontline treatment available to counter the highly pathogenic H5N1 strain that has killed almost 100 people in seven countries since 2003.

The project was launched this week in Hanoi by more than 100 international experts of the Southeast Asian Avian Influenza Clinical Research Network.

It will take place in the three Southeast Asian countries that have accounted for the bulk of human deaths caused by avian influenza.

Indofarma to supply tamiflu

The Jakarta Post, Jakarta 17/03/06

The government has appointed state pharmaceutical company Indofarma to supply the 12 million tamiflu tablets the government wants distributed around the country to reduce bird flu fatalities.

The Health Ministry appointed the drug company to produce 7 million tablets of the bird flu drug oseltamivir and asked the company to import another 5 million from India, the company's executives said Thursday.

"We will start production in either July or August," Indofarma executive director Dani M. Pratomo told Antara.

The drugs would cost the government Rp 112 billion (about US$12 million), he said.

Indofarma would cooperate with India's Hetero Drugs, which holds a license from tamiflu producer Roche, to produce the drug, he said.

The company has also struck a deal with Hetero to buy 5 million tamiflu tablets worth Rp 80 billion, which are expected to arrive here by the end of this month.

Earlier, Health Minister Siti Fadilah Supari said the government would distribute 12 million tablets across the country in an attempt to lower the number of human fatalities from avian flu.

The country has so far recorded 22 human deaths from bird flu.

Experts worry that the virus could mutate to a form that is easily transmitted between humans and spark a pandemic that would kill millions worldwide.

A senior official at the Health Ministry's department of research and development, Erna Tresnaningsih Suharsa, said people should stay on the alert for signs of the flu in poultry and humans. There were no vaccines for the virus and experts could not predict when a pandemic would occur, she said.

"The virus keeps mutating. We are trying to identify genotypes of the mutated viruses to seek a vaccine that would work," she said at the Health Ministry on Thursday morning.

"We need to conduct joint research with other countries."

One ministry official was currently in Vietnam, discussing the idea of setting up a regional center to study the flu, Erna said.

The highly pathogenic virus has killed 98 people in seven countries and millions of birds across the world.

US has yet to meet its promise to help Indonesia's bird flu

Mar 15 16:09

Jakarta (ANTARA News) - Indonesian Health Minister Siti Fadilah Supari said a promise made by the US government last year to provide USD3.1 million worth in assistance to Indonesia to combat the spread of bird flu had yet to be met.

"The US Health Secretary who visited Indonesia last year pledged to give USD3.1 million assistance, but till now it has not yet been realized," she said here recently.

The assistance pledged by the US would be used to provide 44 designated hospitals with equipments required to handle the bird flu infection.

"We need a fund to equip 44 designated hospitals with public movement program," he said.

Considering the fund has yet to be handed over, she further said that at present the Health Ministry had to use the state budget to make the programs run as expected.

The minister pointed out that in order to improve the capacity of the 44 designated hospitals to handle bird flu-infected patients, the government needed at least Rp44 billion, while for buying five million oseltamivir/ tamiflu (anti avian influenza virus pills) the government needed a fund amounting to around Rp88 billion.

The minister said in addition to the US, The European Union earlier also promised to provide 30 million Euro worth in assistance to ASEAN countries to help them combat the spread of bird flu and in fact the assistance was not a part of new budget, but it was only a transfer of fund usually allocated for health program which was often given to ASEAN countries.

Data from the US embassy in Jakarta said that the US assistance to Indonesia in the Fiscal Year 2006 include: Education: $31.9 million, Health & Water: $33.3 million, Democracy: $36.3 million, Economic Growth: $21.9 million, Environment: $6.9 million, Tsunami reconstruction: $400 million, Avian Influenza: $11 million, and Peace in Aceh: $11 million.

Australian war funding dwarfs bird flu

The Age/March 14, 2006 - 3:04PM

Australia is spending 80 times more on its military deployment to Iraq than on confronting bird flu in neighbouring Indonesia, where officials say they are struggling to fight the disease on its frontline.

Australia last year committed just over $15 million to combating bird flu in the sprawling island chain, where 22 people have so far died from the deadly H5N1 virus strain.

But a senior Indonesian health official said only around $4.2 million had so far arrived.

"That's the only aid we have received. The rest is still promises," Dr Muhammad Nadhirin, who coordinates the special incidents office in Indonesia's health department, told AAP.

"To overcome bird flu, this is still very little compared to the huge national need we have."

The response is despite a recent warning from the Paris-based World Organisation for Animal Health that the risk of the virus reaching Australian shores was "very high" given the narrow sea gap and high bird migration between the two countries.

This financial year the government budgeted $420 million on combat deployments in Iraq, bringing total military spend there to around $1.2 billion.

Add the cost of Afghanistan and the total bill tops $2 billion, or $100 for every man, woman and child in Australia.

That is 20 times the $100 million that Prime Minister John Howard last November pledged to help bolster flu pandemic planning in the region over the next four years.

At that time Mr Howard said Australia was probably better prepared than any other country to deal with an avian influenza outbreak. More money would be spent if necessary, "but a critical element in any plan to prevent an outbreak, and deal with one if it occurs, is cooperation between countries and between agencies," he said.

Health Minister Tony Abbott predicted international travel could all but come to a standstill if bird flu mutated and became a human-to-human pandemic.

He also said another $15 million would be spent by Australia on flu measures in other parts of the region.

Indonesia's Finance Minister Sri Mulyani Indrawati has estimated cash-strapped Jakarta needs $432 million to cull infected poultry just on Java, where 60 per cent of Indonesia's 220 million people live.

Two young children - a three-year-old boy and a 12-year-old girl from Central Java - became the latest confirmed victims of the virus last week.

Indonesia has been criticised for not doing more to stop the spread of the disease when it first appeared in chickens three years ago.

But the government of President Susilo Bambang Yudhoyono has argued it can do little more than vaccinate poultry given the daunting logistics and cost of slaughtering chickens and ducks across the archipelago.

The virus has already appeared in birds in 26 of the country's 33 provinces.

Australia sent several health experts to Jakarta last year to help assess the threat and provided 50,000 flu-fighting Tamiflu tablets for local hospitals.

Canberra promised $5.5 million to the World Health Organisation to support Indonesia, as well as $10 million to help in detection, diagnosis and containment of the virus.

A Jakarta Embassy aid official said $4.2 million spent so far was "about right" and an agreement covering another $10 million would be signed in coming weeks.

"That money will mostly cover mainly animal health," she said. "We picked those areas based on the government of Indonesia, what they said they wanted."

She said the extra money would fund village virus surveillance in Java and other provincial hotspots such as Aceh, as well as technical advisers.

World Organisation for Animal Health director-general Bernard Vallat last week warned Australia, Canada and the US were at high risk of seeing H5N1 spread to their shores.

Two Australian scientists recently said the virus was probably already in Australia undetected.

Bird flu has spread across Asia to Europe, Africa and the Middle East since 2003, killing at least 97 people - two-thirds of them in Indonesia and Vietnam - and triggering fears of a possible global flu pandemic which could kill millions.

© 2006 AAP

Myanmar finds first bird flu case, culls chickens

13 Mar 2006 10:50:48 GMT
By Darren Schuettler

BANGKOK, March 13 (Reuters) - Myanmar has found the H5N1 bird flu virus in chickens in what is believed to be the secretive country's first case of the deadly disease, but there was no sign of human infection, a U.N. official said on Monday.

"The information is there is no human case so far," said the U.N. official in Yangon, who declined to be named.

Myanmar health officials ordered surveillance to be stepped up after the outbreak in the central Mandalay region was reported to the U.N. Food and Agriculture Organisation (FAO) and the OIE, the Paris-based international animal health body, on Monday.

The case emerged on March 8 after 112 chickens died on a farm in Aung Myae Thar Zan township near the city of Mandalay, about 430 miles (700 km) north of Yangon.

Officials destroyed a flock of 780 birds and sent samples for testing at government laboratories in Mandalay and Yangon.

"They have carried out some tests and they believe that they have identified H5N1," said Laurence Gleeson, an FAO official in Bangkok.

Dr. Tang Zhengping, the FAO representative in Yangon, said samples had been sent to laboratories in Australia and Thailand to confirm the findings.

He did not know if foreign experts would be allowed to visit the site, but he said the military government had been cooperative on bird flu issues.

Other foreign aid and humanitarian groups say their ability to operate in the former Burma has been curtailed since the purge of Prime Minister Khin Nyunt in October 2004.

"We have close cooperation. I am satisfied," Zhengping said.

LACK OF RESOURCES

The military-ruled country is seen by some international health experts as a potential black hole in the global fight against the disease, which has killed 97 people worldwide.

While neighbouring China, Thailand and Laos battled the disease which swept across much of Asia in late 2003, Myanmar's junta insisted the country was bird-flu free.

Experts feared the virus would go unreported -- either through lack of surveillance or a government cover-up -- long enough to mutate into a form that passes easily between humans and trigger a pandemic that could kill millions.

Then Yangon said in December it would tell the world if bird flu were detected in the country.

It has worked with U.N. agencies to step up surveillance, including monitoring of prime stopover points for wild birds which could bring the virus from neighbouring countries.

A public information campaign has urged people to report suspected cases, But there was no mention of the country's first outbreak on state-controlled radio or television on Monday.

In Yangon, business was brisk at the main poultry market as reports of the outbreak trickled out of Mandalay.

"I hope this news is wrong," said chicken seller Ko Kyaw Soe.

With help from the World Health Organisation (WHO), Myanmar's Health Ministry has drawn up a pandemic preparedness plan, but resources remain a big problem.

Years of mismanagement have crippled the economy and, despite a relatively large number of foreign-trained doctors, there is a dire lack of infrastructure in a country where military spending far outstrips that on health care.

While millions of aid dollars flow into Laos and Cambodia to fight bird flu, raising funds for Myanmar has proved harder due to its pariah status over human rights and the detention of democracy icon Aung San Suu Kyi.

Aid experts say sanctions and isolation will be in nobody's interest if a pandemic breaks out in Myanmar.

"It's a case of damned if you do and damned if you don't. But if there is serious bird flu it will affect everybody," said one official of a regional development agency. (Additional reporting by Aung Hla Tun in YANGON)

WHO - Avian influenza – situation in Indonesia - update 7

13 March 2006

The Ministry of Health in Indonesia has confirmed an additional case of human infection with the H5N1 avian influenza virus. The case, which was fatal, occurred in a 12-year-old girl from Boyolali, Central Java. She developed symptoms (fever) on 19 February, was hospitalized on 23 February, and died on 1 March. Chickens in her household died in the days preceding symptom onset.

The girl’s 10-year-old brother also fell ill on 19 February and died on 28 February. As his symptoms were compatible with a clinical diagnosis of dengue haemorrhagic fever, no testing for H5N1 was carried out. It will therefore never be known whether he may have died following co-infection with dengue and H5N1 avian influenza.

A local investigation was conducted and no additional cases or symptomatic contacts were found. Rapid tests detected the H5 virus subtype in chickens from the children’s household.

The newly confirmed case brings the total in Indonesia to 29. Of these, 22 were fatal.

Myanmar tests dead birds for suspected bird flu

12 Mar 2006 12:20:00 GMT
Source: Reuters
By Aung Hla Tun

YANGON, March 12 (Reuters) - Myanmar authorities are testing scores of dead chickens and quails in the central Mandalay region to determine if they died from bird flu, industry and government officials said on Sunday.

If confirmed, it would be the first case of avian influenza in the secretive military-ruled country that is seen by some health experts as a black hole in the global fight against the disease.

"Over a week ago, a large number of chickens on some farms in Mandalay Division died of a disease very similar to bird flu," a poultry industry official in Mandalay told Reuters.

Authorities are testing for avian influenza and if confirmed, whether it is the H5N1 strain which has killed millions of birds and at least 97 people in Asia and the Middle East since 2003.

"We are taking all necessary measures to control the situation and to find out more accurate information about the disease," said a senior official at the Ministry of Livestock Breeding and Fisheries.

"We're still trying to know whether it was caused by H5N1 or not. We can't say anything for sure yet," the official, who declined to be identified, told Reuters.

Myanmar's junta promised last December to let the world know if bird flu spread to the country, which borders China, Thailand and Laos where outbreaks have already occurred.

Experts say it is only a matter of time before the virus arrives in the nation formerly called Burma, an increasingly isolated country ruled by the military since 1962.

They fear the virus will remain unreported -- either through lack of surveillance or a government cover-up -- long enough to mutate into a form that passes more easily between humans and trigger a pandemic that could kill millions.

However, Yangon has cooperated with U.N. agencies to step up surveillance in the countryside, including monitoring of prime stopover points for wild birds which could bring the virus from neighbouring countries.

The Yangon representative for the U.N. Food and Agriculture Organization (FAO) was unavailable for comment on Sunday.

Bird flu has killed at least 97 people in Asia and the Middle East since 2003. Victims contract the virus through close contact with infected poultry.

Indonesia says 22nd human bird flu death confirmed

Fri Mar 10, 2006 1:02 PM GMT

JAKARTA (Reuters) - ird flu has killBed its 22nd human victim in Indonesia, a 12-year-old girl, according to tests by the World Health Organisation's Hong Kong laboratory, an Indonesian health ministry official said on Friday.

The confirmation came just hours after Indonesia reported its 21st human bird flu victim, a three-year-old child, according to tests by the U.S. Centres for Disease Control and Prevention in Atlanta.

The official said the 12-year-old girl had had contact with poultry. The three-year-old boy who died earlier this month in Indonesia's Central Java province, had also been in contact with fowl, according to initial information.

Contact with infected birds is the most common means of transmission of the H5N1 virus to humans.

"We have confirmation from the Hong Kong lab that Hanif, a 12-year-old girl from Boyolali in Central Java, died of bird flu. We now have 30 cases, with 22 of them dead," said Hariadi Wibisono, director-general of control of animal-borne disease at the health ministry.

Bird flu has killed at least 98 people in East Asia and the Middle East since late 2003 and scientists fear the virus could mutate and spread easily from person to person, triggering a pandemic that could kill millions and cripple economies.

Of Indonesia's internationally confirmed fatalities from the H5N1 virus, 11 have been in 2006, making it the country with the most bird flu deaths so far this year.

H5N1 has killed birds in more than 30 countries in the Middle East, Asia, Europe and Africa. It has spread to 14 new countries in the past month.

In Indonesia, the highly pathogenic strain of bird flu has affected birds in about two-thirds of the country's provinces.

Stamping out the virus is a huge, if not impossible, task in Indonesia, a sprawling archipelago of about 17,000 islands and 220 million people.

The government has resisted the mass culling of fowl seen in some other nations, citing the expense and the impracticality in a country where the keeping of a few chickens or ducks in backyards of homes is common in cities and on farms.

Agencies have concentrated instead on selective culling, and on public education and hygiene measures aimed at prevention.

A sweeping door-to-door campaign to try to control the disease in the capital Jakarta, the country's biggest city which along with its suburbs has about 12 million people, only got underway at the end of February.

Agriculture officials estimate that Jakarta alone has some 500,000 fowl.

Bird flu would ravage Asian markets: report

ANGELA BARNES

Globe and Mail Update/09/03/2006

Asian markets outside of Japan are vulnerable to big declines should an avian flu pandemic occur in the region, Citigroup Global Markets Inc. says.

“We believe Asian ex-Japan markets are pricing in very little bad news, so a potential outbreak of H5N1 avian flu could lead to substantial market declines,” Citigroup said in an extensive report that outlines various potential avian flu scenarios and possible winners and losers among market sectors.

Some Asian markets took substantial hits ranging from 5 per cent to almost 10 per cent during the SARS outbreak of 2003 but have risen substantially since then.

Should an avian flu pandemic emerge, “airlines, hotels and luxury goods stocks in the initially affected area will likely be the first to suffer from cancellations, falling sales and a rapid move to net losses, as with SARS,” Citigroup said.

Accordingly, the global team that wrote the report see companies such as American Airlines Inc., Qantas Airways Ltd., Hilton Hotels Corp, Nieman Marcus and Tiffany & Co. as potential losers in that scenario, along with a number of insurers and shopping mall operators.

On the other hand, drug companies that make anti-virals, such as Gilead Sciences Inc. and GlaxoSmithKline PLC, vaccine makers such as France's Sanofi-Aventis Group and hospital chains including Tenet Healthcare Corp. should benefit, the brokerage firm said.

So too should cleaning product suppliers such as Clorox Co. and Reckitt & Colman PLC. Home entertainment providers including Nintendo Co. Ltd. and Blockbuster Inc. also stand to benefit as people stay indoors more, the team suggested.

If a pandemic were to spread beyond Asia, some sectors and companies will be less affected than others. “Those most affected include the travel and hospitality industry, oil stocks and mining and metals companies,” the report said. Cyclical sectors such as pulp and paper and chemicals would also likely suffer.

Meanwhile, telecom companies including Deutsche Telekom AG, internet commerce including eBay Inc. and Google Inc., utilities and defensive sectors including the pharmaceuticals made the potential winners column in a spreading pandemic scenario.

The Citigroup team consider avian flu a rising risk to the global economic outlook. The best case scenario is that the H5N1 avian flu virus doesn't mutate so it can be transmitted to humans; the worst is that avian flu becomes a global pandemic, Citigroup said. Should a pandemic occur, the economic impact will be determined by the severity of the pandemic.

“If the pandemic is mild, we would expect the world's health authorities and scientists to be able to master it, like SARS or the 1968 influenza pandemic,” the team said. In that case, the economic impact could only be short term. “We would expect economies to bounce back from the temporary disruption, equity markets to rally (potentially quite strongly), and bond prices to reverse,” the report said.

Everything changes in the case of a more virulent pandemic. “We would expect global economic activity to decline, raw material prices to collapse, risk aversion to rise, monetary policy to ease and interest rates to fall,” the report said.

Bird flu kills Indonesian child

BBCNews/10/03/2006

An Indonesian child has become the latest victim of bird flu, raising the country's death toll to 21.

A WHO-sanctioned laboratory confirmed that the three-year-old boy had died from the disease, health ministry official Hariadi Wibisono said.

The boy died on 28 February in a hospital in Semarang, Central Java province, Mr Wibisono said.

The child is thought to have been in contact with sick chickens shortly before he became ill.

More than 90 people have now died of the H5N1 strain of bird flu since 2003.

The vast majority of the deaths have been in Asia, but cases in people and birds have also been recorded in Europe and Africa.

Almost all the deaths have been linked to contact with infected poultry.

Experts fear the virus could combine or mutate into a form that passes easily between humans, possibly sparking a pandemic, but there is no evidence that this has happened yet.

Australia 'not high risk for bird flu'

AAP/March 10, 2006

THE Government's chief vet has rejected the world animal health authority's assessment that there is a high risk of the bird flu pandemic reaching Australia.

The World Organisation for Animal Health (OIE) this week said the risk of the H5N1 strain reaching Australian shores was "very high".

OIE director-general Bernard Vallat made the assessment before a French parliamentary commission on the disease and put the United States and Canada in the same risk category.

Australia would likely see infection brought from Indonesia by migratory birds, he said.

But Australia's chief veterinary officer Gardner Murray disputed the assessment and said the threat of avian influenza to Australia remained low.

"While there is a risk of migratory birds introducing the H5N1 strain of avian influenza into Australia, the risk is substantially less than for most other countries because waterfowl ... which are the normal host of avian influenza viruses do not normally migrate to Australia," Dr Murray said.

"The migratory shorebirds and waders that do come to Australia from infected regions are less likely to carry avian influenza viruses.

"While these birds do pose a risk, the pathway for transmitting a virus into domestic birds would need to involve a number of intermediate steps."

Dr Murray said migratory birds would need to infect nomadic wild birds like ducks and water fowl, which would then need to pass it to production birds such as chickens.

Australia's strict biosecurity laws and tight surveillance favoured keeping the disease out, he said, but authorities could not afford to be complacent.

"It is important to remember we are dealing with a biological agent, and it is virtually impossible to know with absolute certainty how it will continue to evolve and spread," Dr Murray said.

The H5N1 strain of avian flu originated in Asia in 2003 and which has since spread to the Middle East, Africa, Russia, Turkey and Europe.

Most affected countries have recorded the deadly disease only in birds, but nearly 100 people have died in Asia and Turkey.

Firm to produce new bird flu vaccine for poultry

JAKARTA (AFP/09/03/2006): An Indonesian-Japanese joint venture will start producing bird flu vaccine for poultry using reverse genetics technology, the company said Thursday.

IPB Shigeta has acquired patent rights from US-based MedImmune Inc. to manufacture vaccine for use in 44 countries, company president Yoshiyuki Nishio told a press conference.

"Our company ... will start to produce the vaccine up to a million doses per month. Also in the near future, IPB Shigeta will start to build a new factory with capacity of 100 million doses per month for chickens," Nishio said.

The company is a joint venture between Bogor Agricultural University (IPB) and Japan's Shigeta Animal Pharmaceuticals. Its plant is located near the university's campus in Bogor south of Jakarta.

Reverse genetics is being used worldwide to develop the H5N1 strain of avian influenza virus for use in a human vaccine, a company statement said.

"The traditional method for developing a vaccine which involves culturing the virus in embryonated hen eggs has so far proved difficult with H5N1 due to highly pathogenic avian influenza strains," the statement said.

The genetic modification using reverse genetics technology removes the virulence so that the virus grows well in eggs and eliminates the risk of infection in vaccine factory workers, it said.

Vaccination of poultry remains controversial. While it can protect poultry it could leave them carriers of the virus without showing symptoms and could also make it easier for bird flu to mutate and endanger people.

H5N1 has killed 20 people in Indonesia, while infections in birds have been found in 26 of Indonesia's 33 provinces since 2003.

Experts fear that H5N1, which has killed more than 90 people since 2003, mostly in Asia, may mutate into a form that can pass between humans, sparking a deadly pandemic. (**)

Australia, Kenya Increase Surveillance for Bird Flu (Update1)

March 9 (Bloomberg) -- Veterinarians from Australia to Kenya are stepping up checks for bird flu, reported to have spread to 22 countries in five weeks, as at least a dozen people are treated for the lethal virus in Indonesia.

``More than 300 birds have been tested'' in Kenya, including around the cities of Nairobi and Mombasa, Livestock and Fisheries Minister Joseph Konzollo Munyao said in a statement on the government's Web site yesterday. Veterinary workers were told ``to move out in the field and actively search for the disease.''

Australia plans to spend an extra A$1.6 million ($1.2 million) on monitoring for the lethal H5N1 avian-flu strain and increasing public awareness, said Carson Creagh, a spokesman for the government's quarantine agency.

The rate of H5N1 infections in humans has increased this year as the virus spread to more parts of Asia, and to Africa, Europe and the Middle East. The virus has killed at least 96 of 175 people infected since late 2003. It is reported to have infected an average of three people a week this year, killing an average of two a week. Last year, 23 cases, including 14 fatalities, were reported in the first 10 weeks.

Two children were hospitalized in Jakarta yesterday, taking to at least 12 the number of suspected avian-flu patients in Indonesia. Almost half the Indonesian fatalities from the lethal H5N1 strain have occurred this year.

The 1-year-old boy and 4-year-old boy admitted to Sulianti Saroso Hospital are from north Jakarta and aren't related, said Ilham Patu, a senior doctor at the hospital. Ten others are being treated for suspected avian flu, he said.

Gaining Pace

Albania and Poland yesterday reported initial outbreaks in birds, adding to the 20 other countries reporting new infections to the World Organization for Animal Health since Feb. 2. The disease in birds raises the risk of human infection and provides more opportunity for the virus to mutate in a pandemic form.

In Romania, blood samples from a swan and a moor hen in the town of Mangalia, by the Black Sea, tested positive for the H5N1 virus strain, the Agriculture Ministry said today in an e-mailed statement. Samples from the town of Harsova, in the country's east, also tested positive for the H5 virus.

As many as 42 outbreaks have been reported in Romania since October, according to the ministry.

Migrating Birds

Birds migrating over the Arctic Circle from Africa and Europe in the next few months may carry the virus to Alaska, David Nabarro, the United Nations' coordinator for bird flu and pandemic influenza, said in New York yesterday.

The virus probably will be carried to the rest of the U.S. six months later when birds that pick it up in Alaska migrate south, Nabarro said.

Federal, state and local health officials in the U.S. may test as many as 100,000 birds for the virus this year, mainly in Alaska, Frank Quimby, a spokesman for the U.S. Interior Department, said yesterday.

``Americans should be concerned, and they seem to be taking the appropriate steps,'' said Peter Beers, a veterinarian coordinating bird flu efforts for Australia's Department of Agriculture, Fisheries & Forestry in Canberra. ``They have a lot of waterfowl migrating across the Bering Strait and Bering Sea.''

In Australia, state and federal government vets are undertaking more testing, and sampling birds from wider population sources, Beers said in a telephone interview today.

Lower Probability

Australian officials said there is a lower probability of H5N1 taking hold in Australia because most of the wild migratory birds traversing the country from Asia and Europe nest around coastal and estuarine areas, and have a lower prevalence of infection.

``Ducks, geese and swans are the normal hosts for avian influenza viruses and the ones associated with bird migration in the Northern Hemisphere, and they don't migrate to Australia,'' Beers said. ``The probability is considerably less than the Northern Hemisphere.''

Health authorities are concerned avian flu is taking root in Africa, a continent ravaged by poverty and HIV/AIDS, after it was reported this week to have spread to more states of Nigeria.

Poultry sales in the West African nation have declined 85 percent since an initial outbreak was detected a month ago, Reuters reported, citing the Poultry Association of Nigeria.

Egypt and Niger have since reported outbreaks, heightening concern that the H5N1 virus may be found in the Great Rift Valley. The valley, running 8,700 kilometers (5,400 miles) from Syria to Mozambique, attracts millions of migratory birds flying between northern Asia and South Africa.

``With migratory birds, you would have to be worried'' the virus may reach more countries in eastern Africa, Beers said.

Indonesian boy becomes latest suspected bird flu death

AFP / Tue Mar 7, 3:36 AM ET

A four-year-old boy has become the sixth person in Indonesia feared to be infected with the H5N1 strain of avian flu to have died in the last eight days, health workers have said.

The boy died Monday at the state-run Sayidiman Hospital in Magetan, East Java, less than 10 minutes after arriving, Sudarsih, a nurse, told AFP.

He was suffering symptoms of the virus, which Indonesian authorities have confirmed has killed 20 Indonesians, she said, adding that he had a history of contact with poultry.

The boy's death follows five recent suspected bird flu deaths: a pregnant woman, 25, on Monday; a 10-year-old Saturday; a brother and sister last Wednesday; and a three-year-old last Tuesday.

The woman was from Jakarta, where most of Indonesia's bird flu deaths have been recorded, but the siblings and 10-year-old were from Central Java's Boyolali district and the three-year-old died in Central Java's Semarang.

Local positive tests, which are usually considered reliable, are sent to a World Health Organisation (WHO)-affiliated laboratory abroad for confirmation.

Indonesia's last confirmed fatality was on February 25.

Meanwhile in Jakarta, five more suspected bird flu patients were admitted overnight at Sulianti Saroso Hospital, the capital's main centre for treating bird flu patients, its deputy director Sardikin Giriputro said.

The five, two of them children, came from several districts in Jakarta and the nearby town of Bekasi in West Java, and had all been in contact with sick chickens, Giriputro said.

Hospital spokesman Ilham Patu said the hospital was now treating a total of seven suspected bird flu patients. Five people were discharged Monday after being cleared, he said.

Infections have been found in birds in 26 of Indonesia's 33 provinces.

Experts fear that H5N1, which has killed more than 90 people since 2003, mostly in Asia, may mutate into a form that can pass between humans, sparking a deadly pandemic.

WHO - World : Affected countries with confirmed human cases of H5N1 avian influenza since January 2006

Indonesia - 'Fowl play' as badminton hopes at risk from shuttlecock snag

Jakarta Post, March 07, 2006

SURAKARTA: The national team's preparation for the upcoming Thomas Cup men's team badminton championship in Japan may encounter a setback, with shuttlecocks likely to be hard to find.

Shuttlecock producers in the Central Java town of Surakarta complain that the supply of chicken feathers has dropped 50 percent in the past two weeks, amid the massive poultry cull in the wake of the bird flu outbreak in the mayoralty.

"Our suppliers are finding it difficult to provide cock feathers, while they are the main material for shuttlecocks. Previously, we got 200,000 to 300,000 feathers a day, now we receive only 50,000 to 80,000 daily," Sarno of Pringgolayan subdistrict was quoted as saying by detik.com.

"We've been unable to meet deadlines of shuttlecock orders due to the minimal supply of feathers," said Kasmo, another producer.

There has yet to be a report from the country's largest shuttlecock production district, Tegal, with the issue only now gaining attention ahead of the April-May 2006 Thomas Cup.-- JP

Indonesia - Bird flu fears put soldiers on guard

Jakarta Post, March 07, 2006

First Lt. Sugito holds a young egret (shown above) Monday after it fell from a tree in a military compound in Srondol, near the Central Java capital of Semarang.

The presence of hundreds of wild egrets nesting in trees at the 400 Raider Battalion compound has heightened fears of an outbreak of avian influenza, and its possible spread to humans, among denizens of the complex.

"We're worried the birds have bird flu, especially since five to 10 birds die every day and fall from the trees," said the battalion's deputy commander, Maj. Amilwan Akin, as the birds were tested for the deadly H5N1 strain of avian influenza.

Concerns have intensified after reports of the death of five people from suspected infection with H5N1 in recent months in the province.

The stench of the droppings from the huge number of birds also presents a problem, especially for soldiers assigned to clean up the mess. As well as direct contact with dead birds infected with H5N1, the virus also is believed to be transmitted by breathing in contaminants from dried droppings.

Amilwan said killing the birds was out of the question because the battalion was ordered to preserve the surrounding environment.

Three months ago, a random check of the birds found them free of the virus. "But we want to make sure, so we're testing them again today," Amilwan said. (JP/Suherdjoko)

H5N1 : «Les Etats ont péché par manque de solidarité»

Jacques Diouf, directeur général de la FAO, rappelle que, si la crise aviaire a débuté fin 2003, les pays riches n'ont réagi qu'une fois le virus à leur porte.

par Christian LOSSON
QUOTIDIEN : lundi 06 mars 2006

Jacques Diouf est directeur général de la FAO, l'Organisation des Nations unies pour l'alimentation et l'agriculture, en première ligne dans la lutte contre la grippe aviaire. Pour Libération, il revient sur l'histoire d'une crise sanitaire annoncée. Et très mal anticipée.

Les institutions ont-elles tardé à prendre les mesures qui s'imposaient face à la grippe aviaire ?

Ce sont surtout les Etats qui ont péché par manque d'anticipation et de solidarité. On est incapable de tirer les leçons du passé. La crise aviaire a vraiment commencé en décembre 2003. Dès février 2004, la FAO a injecté 5,5 millions de dollars sur ses fonds propres pour tenter d'aider la Thaïlande, le Vietnam et la Chine. Dans la foulée, on est aussi intervenu dans sept autres pays ­ jusqu'aux Philippines ­ pour tenter de circonscrire l'épizootie, avec l'OIE (Organisation mondiale de la santé animale) et l'OMS (Organisation mondiale de la santé). Les résultats ont été assez probants puisque le développement du virus a, en grande partie, été enrayé. On a alors tenté d'alerter la communauté internationale. «Mettons le paquet maintenant pour circonscrire l'épidémie !» lui disait-on. A l'époque, on avait tous les atouts en main. On pouvait éliminer rapidement la volaille contaminée, discuter du choix de vacciner ou non, mettre en place des centres de référence, renforcer les services vétérinaires...

Et que s'est-il passé ?

Les pays développés ont pensé que cela se passait en Asie, que tout cela était très loin et que l'on exagérait les risques d'épidémie. Mais le virus est passé des poulets aux oiseaux sauvages, puis aux migrateurs, et la grippe aviaire s'est retrouvée au Kazakhstan, en Russie. Très vite, on a dégagé 2 millions de dollars pour le Moyen-Orient et l'Afrique, afin de sensibiliser les autorités politiques. Et appelé à l'aide pour des fonds supplémentaires. Rien. Comme on le redoutait, la grippe aviaire a touché la Turquie, les Balkans, l'Afrique (au Nigeria) et l'Europe. Pendant ce temps, on était déjà dans les Caraïbes, où l'on débloquait encore 2 millions de dollars pour anticiper la mondialisation de la grippe aviaire. On a multiplié les conférences pour tenter de lever des fonds. A Ottawa en 2005, puis à Genève dans la foulée et à Pékin début 2006. Les pays riches ont commencé à bouger quand le virus est arrivé en Turquie. Avant, on demandait, avec l'OMS et l'OIE, 430 millions de dollars pour effectuer une véritable politique de prévention. On n'a même pas eu 30 millions de promesses ! A Pékin, on a demandé 1,2 milliard de dollars, on nous a promis 1,9 milliard ! A ce jour, la FAO n'a reçu que... 16 millions.

La FAO n'est-elle pas prise de court par ces crises désormais planétaires ?

Dès 1994, on a mis en branle un programme de lutte préventive contre les prédateurs, les maladies transfrontalières, avec un système de détection rapide, la mise en réseau de centres spécialisés, etc. Ça a marché, mais on n'en a pas parlé. Depuis 2000, on fait face à l'invasion acridienne au Soudan, la fièvre porcine africaine, la fièvre de la vallée du Rift (des moutons et des boeufs)... Mais quand les criquets ont envahi la Mauritanie, les fonds ont cruellement manqué. Cette invasion a été terrible. Des essaims de 72 kilomètres, un traitement de 11 millions d'hectares, sans parler des dégâts collatéraux. Quand la grippe aviaire est arrivée, on a lancé aux Etats : «Ne soyez pas aussi passifs qu'en Afrique face à l'invasion de criquets !» Tout au long de l'année où l'on poussait des cris d'alarme, on nous avait affecté 2 millions de dollars, avant de débloquer 55 millions en catastrophe une fois la crise arrivée.

Comment lutter contre la diffusion du H5N1 ?

Renforcer les services vétérinaires dans les pays les plus démunis, multiplier le développement de labos de détection, travailler sur des vaccins plus simples à administrer et moins coûteux, assurer une surveillance des points d'eau et des zones de transit des oiseaux migrateurs. Indemniser les paysans les plus pauvres, sinon les gens cachent leur volaille malade, sensibiliser les médias pour qu'ils informent précisément sur les risques. Tout cela tient du bon sens...

... qui n'a pas vraiment été la règle ?

Pas vraiment, non. Médias et autorités politiques ont plutôt relayé les messages de l'OMS sur la pandémie humaine, alors que notre discours, comme celui de l'OIE, n'a pas été entendu pendant près de deux ans ! Et les pays développés se sont tellement cristallisés sur les risques de pandémie qu'ils ont dépensé des milliards pour l'achat de médicaments ou de masques, au lieu de mettre le paquet pour enrayer l'épizootie, dont le développement peut entraîner la pandémie. Mettre l'accent sur les animaux plutôt que les humains aurait permis, de surcroît, d'éviter les tentations de psychose collective que l'on voit dans les pays développés. On a le sentiment que les ministres de la Santé ont été davantage en première ligne que les ministres de l'Agriculture ; cela aurait dû être l'inverse.

Etes-vous inquiet ?

Pour les pays les plus pauvres, oui. Le poulet y est souvent la seule source de protéines. D'ailleurs, si les tendances se maintiennent, le nombre de personnes qui souffrent de la faim dans le monde ne diminuera de 50 % qu'en 2150 et non en 2015, comme les objectifs du millénaire de l'ONU l'avaient fixé.

La grippe aviaire illustre-t-elle la crise de la mondialisation ?

Oui, en partie, parce qu'elle montre que derrière le discours sur le village global et planétaire, les réflexes nationaux l'emportent, l'égoïsme règne et la gouvernance mondiale fondée sur la solidarité tient du rêve.

Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO

Jakarta, Tuesday, March 07, 2006

Uploaded by : Zainul Bakri Country 2003 2004 2005 2006 Total cases deaths cases deaths cases deaths cases deaths cases deaths Cambodia 0 0 0 0 4 4 0 0 4 4 China 0 0 0 0 8 5 7 4 15 9 Indonesia 0 0 0 0 17 11 10 9 27 20 Iraq 0 0 0 0 0 0 2 2 2 2 Thailand 0 0 17 12 5 2 0 0 22 14 Turkey 0 0 0 0 0 0 12 4 12 4 Viet Nam 3 3 29 20 61 19 0 0 93 42 Total 3 3 46 32 95 41 31 19 175 95 6 March 2006 Total number of cases includes number of deaths. WHO reports only laboratory-confirmed cases.
Source: WHO

Bird flu suspect dies in Surakarta

The Jakarta Post, Boyolali/Semarang, 06/03/2006

A 10-year-old boy suspected of having avian influenza died in the Central Java town of Surakarta on Saturday. The boy, a native of Boyolali regency, is reported to have contracted the disease through direct contact with affected chickens two weeks earlier.

The boy's hometown in Sanggrong village, Andong district, some 30 kilometers north of Surakarta city, is an area where avian influenza or bird flu is endemic. Thousands of chickens and birds reportedly have died there since the bird flu outbreak in 2004.

The boy was taken to Dr. Moewardi hospital for treatment Wednesday, the day when a 12-year-old girl who was suspected of having bird flu died at the same hospital. The girl, also a Boyolali native, died two days after her 10-year-old brother passed away after suffering from the same classic bird flu symptoms. None of the three have been confirmed as bird flu cases through laboratory tests.

A member of the medical team in charge of suspected bird flu patients at the hospital, Suradi, said the latest patient had similar symptoms to the two who had died, such as a high fever and declining thrombocyte levels.

"We had to isolate the boy since he arrived at the hospital in a critical condition," Rivtiono, another team member, said Saturday.

The team however did not explain whether a sample of the boy's blood had been sent for laboratory tests to confirm he had bird flu.

Head of Boyolali Regency Health Office, Syamsudin, confirmed the boy was suspected to have died of avian influenza. "A day after the victim had direct contact with a dead chicken in his house, he suffered from fever and a cough. He was treated at Andong community health center before being referred to Dr. Moewardi hospital," Syamsudin told The Jakarta Post.

The Boyolali health, agriculture and animal husbandry officials conducted a mass cull Sunday in a radius of some 1,000 meters from the victim's house, he said. "We don't want another case like this," he said.

Meanwhile, 20 hospitals in Central Java have been appointed as referral hospitals to treat suspected bird flu patients,

According to the head of the Central Java Health Office, Budihardja, the hospitals were appointed to ensure a quick response to the spread of bird flu in the province. Earlier, only four hospitals were appointed, he said. "But following the spread of bird flu, we have increased the number of referral hospitals," Budihardja said.

Government still dragging feet on bird flu

The Jakarta Post, Jakarta, 06/03/2006

The deadly avian influenza virus continues to take its toll on the population as the government discusses the formation of a national commission on bird flu.

The Office of the Coordinating Minister for Public Welfare had promised to establish a national commission on bird flu early this year, almost three years after the initial outbreak of avian influenza in the country in 2003.

President Susilo Bambang Yudhoyono, however, is yet to sign into operation the commission that could speed up action on bird flu.

The seriousness of the problem is evident, with Indonesia now having the highest fatality rate after Vietnam, with 70.3 percent of suspected bird flu patients dying. Moreover, the country has the highest number, five, of cluster cases in the world.

Bird flu is endemic among poultry in 26 of 33 provinces in the country, with birds in 161 cities and regencies exposed to the H5N1 virus. Six of the provinces have reported human deaths.

With the commission not yet established, ministries such as the Health Ministry and the Agriculture Ministry are alone in handling the increasingly serious disease.

An official at the Center for Indonesian Veterinary Analytical Studies, H. Soehadji, said Tuesday the government lacked coordination and focus in its handling of the disease.

A national strategic plan has been set into place with 10 main points to accomplish. These points include controlling avian influenza in poultry and in humans, protecting high-risk groups, increasing integrated surveillance, capacity building of medical workers and laboratories, and research.

Other points are the restructuring of the poultry industry, strengthening legislation, monitoring and evaluation. However, the Office of the Coordinating Minister for Public Welfare, charged with the coordination of ministries in the handling of bird flu, faces difficulties with no national commission to support it.

Soehadji said that because the country was now dealing with a widespread disease, the commission was needed to break through sectoral and regional barriers. "This commission is needed because in this special autonomy era, the central government cannot just give orders to local administrations."

An expert adviser to the public welfare minister, Emil Agustiono, who has been appointed a member of the national commission, also agreed on the importance of the commission.

He said Monday integrated special body that could cut through the bureaucracy was needed to halt the spread of the disease.

"There's a bit of difficulty in coordinating, because the Agriculture Ministry is not under the Office of the Coordinating Minister of Public Welfare," he said.

He added that hopefully next week the President would legalize the commission.

Besides coordination, Emil noted that financial problems were also a factor slowing down the handling of the bird flu problem.

International organizations such as the World Bank, which have promised to help the country, have yet to provide funding for either mass culling or medicine stockpiling.

Emil said the donors' delay in granting funding was probably because they first wanted to see proof of Indonesia's commitment to handling the disease.

He noted that last week, the World Bank's country director to Indonesia, Andrew Steer, promised to donate US$10 million in the form of a grant,

The World Bank, when asked for confirmation, said they were planning to send a team to assess the possibility of granting the funds needed by Indonesia, but had yet to specify any amount.

The Agriculture Ministry's director general of farming, Mathur Riadi, said the government has allocated Rp 30 billion for the culling of about three million birds exposed to the virus in 26 provinces.

Indonesia plans massive increase in Tamiflu-paper

05 Mar 2006 03:30:59 GMT
Source: Reuters

JAKARTA, March 5 (Reuters) - Indonesia, which has suffered more deaths from bird flu this year than any other country, plans a massive increase in its supply of anti-flu Tamiflu tablets, the Jakarta Post newspaper reported on Sunday. If taken within two days of contracting the virus, Tamiflu can work against the often deadly H5N1 flu, which international tests show has killed nine people in Indonesia so far in 2006. The government plans to distribute 12 million Tamiflu tablets to affected areas of the sprawling archipelago, although currently it has just 16,000 in stock, the Jakarta Post said. "I expect we will have up to 5 million tablets by April," Health Minister Fadillah Supari was quoted as saying on Saturday. She said pills would be handed out to health institutions in provinces with recorded outbreaks. Another minister has said the pills would have to be imported since local companies have yet to start making the drug. On Saturday a senior health official said a local test had shown a three-year-old boy from Central Java province died of bird flu last week. If confirmed by a U.N.-recognised laboratory, the boy would be Indonesia's 21st death from the H5N1 virus, now endemic in poultry in the world's fourth most populous nation. The boy had been in contact with fowl, according to initial information. Contact with infected birds is the most common means of transmission of the H5N1 virus to humans. Bird flu has killed at least 94 people in East Asia and the Middle East since late 2003. Scientists fear the virus could mutate and spread easily from person to person, triggering a pandemic that could kill millions and cripple economies. Stamping out the virus is a huge, if not impossible, task in this vast country of some 17,000 islands and 220 million people. The government has resisted the mass culling of fowl seen in some other nations, citing the expense and the impracticality in a nation where the keeping of a few chickens or ducks in backyards of homes is common in cities and on farms. Agencies have concentrated instead on selective culling, and on public education and hygiene measures aimed at prevention.

Chairul Anwar Nidom: Fighting avian flu through research

Indra Harsaputra, The Jakarta Post, Surabaya 03/03/2006

With the government here struggling to control the spread of avian influenza (AI), which has claimed dozens of lives, the same endeavor to overcome the bird flu threat is also going on in other parts of the world.

Chairul Anwar Nidom, 48, is an Indonesian researcher into the H5N1 virus. "As no laboratory facilities to detect the disease exist in Indonesia, I have to make frequent visits to Japan," he told The Jakarta Post on February 24.

In Japan, Nidom, who was a member of the DNA identification team for Bali bombing victims in 2003, is doing most of his research at Tokyo University, which has Biosafety Level 3 (BSL-3) instruments for this particular purpose. At the university he works with Prof. Yoshihiro Kawaoka, head of the virology department at the Institute of Medical Science, who studies AI in Japan.

In order to deepen his research, he is also studying virus molecular science at Kobe University under the guidance of Prof. Hak Hotta, head of the microbiology department at the School of Medicine. "I'm not fluent in Japanese, which has been a constraint on my research. We communicate mostly via body language and medical terminology," said the doctor, born in Pasuruan, East Java.

At the end of 2005, Nidom received his doctorate in the postgraduate study of medicine at Airlangga University, Surabaya, for his research thesis titled A molecular analysis of the H5N1 avian influenza virus genome in Indonesia.

In his research Nidom revealed an important finding about the spread of the AI virus in Indonesia. H5N1 in this country originates in Guangdong and Yunan, China, and has very distant family links with isolates from Vietnam and Thailand.

After completing his research, Nidom strongly criticized the Indonesian government, describing it as lacking the appropriate urgency in tackling bird flu cases and controlling the AI virus' transmission to poultry in Indonesia.

"I was, on several occasions, prevented from speaking publicly on appropriate measures to deal with this situation," he said.

Undaunted by these restrictions, Nidom became even more popular as a bird flu specialist following his pressure on the government to address the disease properly.

Local and foreign media began to interview him. "We have to work with the media because the government seems to be covering up this issue due to pressure from business interests. In fact, the public has been very anxious," he added.

He first warned the government in 2003 that the spread of H5N1 among domestic fowl needed to be properly controlled, but the government initially responded by stating that it was a conventional poultry disease, not AI, that was killing birds.

In Surabaya, where he brought up his three children, chickens were frequently found dead on the Sepanjang Waru outskirts of Sidoarjo in 2005, while the largest bird market in the East Java provincial capital was also affected by the virus.

"I was worried by the public misunderstanding of the bird flu. I heard of teachers telling their students not to eat chicken, chicken traders complaining about declining sales and people being scared of getting close to fowl," Nidom said.

Several weeks ago, Nidom met with a housewives who were waiting for their children at a Surabaya private school, and discussed with them their concerns about bird flu, reassuring them that chicken, provided it was properly cooked, was safe to eat.

In his neighborhood in Klampis Semolo Timur, Surabaya, Nidom, as head of the local residential association, has been recommending the consumption of aloe (Aloe vera) as a precaution against AI. Aloe contains emodin and Scutellaria (skullcap mint), antiviral substances that prevent the growth of viruses in the human body.

"Apart from my research, I've been campaigning in government and public circles through seminars, as well as door-to-door activities," he said. Earlier, he had spoken before regional councillors in Papua to brief them about the control of AI virus transmission, particularly to exotic wildlife species in Papua, such as birds of paradise and other rare fowl.

"I'm leaving for Japan for follow-up research to examine the development of family cluster bird flu cases, in which the whole family or community is affected," he revealed. The family cluster phenomenon in Indonesia is different in that nearly all victims have no direct contact with poultry, unlike in Thailand and Vietnam.

For this study Nidom collected specimens from bird flu victims in Indonesia, obtained from the Ministry of Health.

"Results of the research at the end of March will hopefully bring improvements in AI virus control and save a lot of Indonesian people from bird flu infection," concluded Nidom, who is also a member of the National Quarantine Commission at the Agriculture Ministry.

Indonesia - Suspected bird flu cases on rise across the country

Wahyoe B. Wardhana and Fadli, The Jakarta Post, Malang/Batam 03/03/2006

Suspected bird flu cases are being detected in the country at an alarming rate, with more people falling sick in Surakarta in Central Java, Madiun and Malang in East Java and Batam in Riau Islands province.

An as-yet unnamed 12-year-old girl suspected of contracting bird flu died Wednesday night after being treated at the Moewardi Hospital in Surakarta.

Her body has been sent to her hometown in Boyolali, Central Java, for burial, hospital director Mardiatmo told Antara.

Blood tests for the victim have been sent to a Jakarta laboratory for confirmation.

Another seriously ill suspected bird flu patient is being treated in isolation at the hospital.

"Clinical symptoms, including coughing and a high fever, indicate that he is bird flu-positive. The patient also used to live near large-scale quail breeding centers," Tri Lastiti, the deputy director of the hospital, told The Jakarta Post.

The 31-year-old man, identified as Daryoto, was believed to have been infected by the carcasses of dead birds, which had been dumped in the area during the past month.

"Thousands of quails died every day and their remains were just thrown away into a nearby river," Nanik, Daryoto's wife, said.

Central Java Governor Mardiyanto said earlier the provincial administration would launch a large-scale poultry cull of infected birds. The culls would occur in five of the province's 35 regencies -- Karanganyar, Boyolali, Sukoharjo, Sragen and Klaten.

Mardiyanto ordered people to be on the alert for the virus and immediately report any suspected bird flu outbreaks among poultry to their local animal husbandry office.

"If people see scores of chickens dying, they should report this to the nearest office. Animal husbandry and health officials will soon follow up their reports," Mardiyanto said.

In Bandung, the number of suspected bird flu patients rose by 11 to 66 as of Wednesday. The latest patient was admitted to the city's Hasan Sadikin Hospital on Wednesday.

In Madiun, East Java, the condition of a 12-year-old patient from Singkil village, Ponorogo, who is believed to be infected with the virus, remained serious.

"The patient is still in intensive care by our team of doctors, and cannot be visited yet," a Dr. Soedono Hospital spokesman said Thursday. A sample of the patient's blood has been sent to Jakarta for testing and the results would be available within a week, the spokesman said.

In Malang, a seven-year-old boy was admitted to the intensive care unit at the Saiful Anwar Hospital with suspected bird flu symptoms.

However, Gatoet Ismanoe, a doctor of the hospital, said the boy, who had earlier been treated at the Muhammad Saleh Hospital in Probolinggo, was still under observation to determine his illness.

In Batam, the local animal husbandry office sprayed disinfectant at Panglong village in Nongsa district Thursday, after laboratory tests found bird flu in the area's poultry.

At least eight chickens were found dead in the area with blue and swollen heads -- recognizable symptoms of the flu. (With additional reporting from Suherdjoko in Semarang, Blontank Poer in Surakarta and Yuli Tri Suwarni in Bandung).

Indonesian Girl and Brother Treated for Bird Flu Symptoms Die

March 2 (Bloomberg) -- An Indonesian girl and her brother, both hospitalized with bird flu symptoms, have died, according to a hospital in Indonesia's Central Java province.

Hanif Chaya Fitri, 12, died last night after being treated for nine days for breathing problems, severe coughing, high fever and swollen lungs, Reviono, a doctor in charge of treating bird flu patients at Moewardi hospital in Solo, Central Java, said in a phone interview.

Moewardi has sent samples from Fitri to a Health Ministry laboratory in Jakarta for testing. Fitri's brother, Nandya Kurniawan, 10, died a day earlier, Reviono said. He didn't elaborate. The two children were residents of Jurug village in Boyolali regency of Central Java.

The spread of the avian influenza virus in birds creates more opportunity for human infection as people come into contact with poultry during slaughtering, plucking feathers or butchering. At least 93 of the 173 people known to be infected with the bird flu have died, including 20 in Indonesia, according to the World Health Organization.

Moewardi hospital in Solo is also treating a 31-year-old man with bird flu symptoms, Reviono said. He didn't elaborate.

Bekasi residents beg govt to get bird flu drive off the ground

Rusman, The Jakarta Post, Bekasi 02/03/2006

Residents have warned the Bekasi authorities they can no longer afford to neglect the bird flu threat.

Neighboring Jakarta, which has been fighting accusations it has been slow to act on bird flu, wound up on Sunday a three-day door-to-door inspection of poultry and pet birds.

Fearing avian influenza is becoming firmly established in Bekasi, some residents wrote to the regency administration asking it to take immediate action.

Bird flu has taken two lives in Bekasi.

"The administration must listen to us. It has done nothing. West Java and Jakarta are showing their concern. Bekasi is in between the two, but it's just sitting back, doing nothing," Sulaeman, a resident of Karang Satria district, said.

He said many pet owners in his neighborhood had tried to hide their birds. Moreover, they never cleaned the birds' cages.

"We are worried, that's why we are pleading with the local government to do something," he said.

As reported earlier, the Bekasi administration says it is facing a serious funding gap in its fight against bird flu.

Door-to-door checks will only commence in the regency once funding comes through from the provincial administration.

Bekasi is part of West Java province. The provincial administration has received Rp 5 billion from the central government to fight bird flu, which must be spread between the province's 12 regencies and municipalities.

Bekasi Husbandry Agency official Tri Rollyanroza said that right now the administration was focusing its efforts on markets.

He said it was impossible for the administration to meet public demands for inspections of residential areas.

"On the other hand, the growing demand shows the public cares -- if they come across sick birds they will immediately report them to us," he said.

Tri said he had received a number of reports from people who did not own birds but were worried their neighbors' pets were sick.

"They asked us to vaccinate or spray disinfectant (on the cages) of their neighbors' birds," he said.

Bekasi administration secretary Candra Oetama said the regency's markets were under constant surveillance.

"We are checking birds and chickens that come to our markets from Jakarta. We don't want our traders selling sick chickens to customers," he said.

Community health centers to be optimized to tackle bird flu

Feb 28 16:26

Jakarta (ANTARA News) - Health Minister Siti Fadilah Supari said the government will reactivate Community Health Centers (Puskesmas) to tackle avian influenza (AI) cases. Puskesmas would be well equipped to enable them to provide first aid for suspected bird flu patients and prevent any delay in treating patients, Minister Siti Fadilah said here Tuesday. "In the future, I hope Puskesmas will be more proactive in treating patients suspected of being infected with the avian influenza virus," the minister said after attending the dedication of a water treatment system at the Office of the Coordinating Minister for the People`s Welfare. For that purpose, Puskesmas will be equipped with tamiflu stocks and rapid diagnostic test facilities which could help detect AI virus in relatively short time. The government would intensify public campaigns on bird flu to inform the people of how to prevent bird flu virus infection and handle persons suspected of having infected with the AI virus, she said. Most of the patients, who had been sent to hospital, were too late to be saved because they or their relatives had failed to recognize the symptoms of the bird flu virus, she said. The government was planning to buy five million more tamiflu in anticipation of AI virus spreading to wider areas, she said.

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Lab network proposed to avert bird flu pandemic

01 Mar 2006 18:00:41 GMT

Source: Reuters
Researchers from the US Department of Defence Global Emerging Infections Surveillance and Response System (DoD-GEIS) in Maryland said the facilities would improve preparedness against bird flu and other emerging infections in poor regions such as sub-Saharan Africa. "There is an existing model, based on a network of US military overseas laboratories, that we believe is worth copying," said Jean-Paul Chretien of DoD-GEIS in the journal Nature. LONDON, March 1 (Reuters) - A global network of laboratories modelled on existing US military facilities could help to avert an influenza pandemic, scientists said on Wednesday. Since late 2003, the H5N1 virus has killed 93 people and infected 173. Although it is essentially an animal disease, scientists fear it could mutate into a form that could become highly infectious in humans and capable of causing a pandemic that could kill millions of people. The avian virus has spread in birds from Asia to countries in Europe, the Middle East and Africa. Chretien said developing countries often lack the surveillance facilities essential for detecting and containing diseases. The military laboratories, which work with the World Health Organisation (WHO) and national governments, would provide expertise in badly needed areas. The US Naval Medical Research Unit-2 (NAMRU-2) in Jakarta helped to detect avian influenza there last summer. Another unit in Egypt was essential in spotting cases of the virus in humans in Turkey and Iraq, according to the scientists. Both units were among many set up decades ago. But due to budget cuts and other reasons, labs in Panama, Puerto Rico, Brazil, Congo, Uganda, Ethiopia and Malaysia have been closed. The current DoD-GEIS influenza surveillance network, which was beefed up a decade ago and supports but does not duplicate the WHO's work, includes sites in more than 20 countries. But the scientists said there are critical gaps. "We cannot be optimistic that a deadly and easily transmissible disease emerging in sub-Saharan Africa, or a rural part of Asia or South America, would be detected, characterised and contained before spreading," said Chretien and his colleagues. They added that there is now an unprecedented opportunity to improve preparedness against bird flu or other emerging diseases in poor countries. The researchers called on the WHO to consider the model they propose and judge its feasibility. "The next pandemic -- which may or may not involve influenza -- could begin anywhere in the world," they said. "Making long-term investments in laboratory and epidemiologic capabilities could help us to detect and control it."

Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO

Jakarta, Thursday, March 02, 2006

Uploaded by : Zainul Bakri Country 2003 2004 2005 2006 Total cases deaths cases deaths cases deaths cases deaths cases deaths Cambodia 0 0 0 0 4 4 0 0 4 4 China 0 0 0 0 8 5 6 3 14 8 Indonesia 0 0 0 0 17 11 10 9 27 20 Iraq 0 0 0 0 0 0 2 2 2 2 Thailand 0 0 17 12 5 2 0 0 22 14 Turkey 0 0 0 0 0 0 12 4 12 4 Viet Nam 3 3 29 20 61 19 0 0 93 42 Total 3 3 46 32 95 41 30 18 174 94 1 March 2006 Total number of cases includes number of deaths. WHO reports only laboratory-confirmed cases.
Source: WHO

Human Avian Influenza, Indonesia up to 27 February 2006

Jakarta, Wednesday, March 01, 2006

Since July 2005 up to 27 February 2006, Indonesia has had reported 337 cases (cumulative number) and based on clinical, epidemiological investigation, and laboratory examination the results can be classified as follow: 176 cases Non Avian Influenza, 28 confirmed cases of Human Avian Influenza (of whom 20 died), 132 cases Under investigation (of whom 31 died) and 1 exposured case (no clinical symptom, positive serology examination). No. Province Human AI Under investigation Non AI # of cases Death # of cases Death # of cases 1 Nangroe Aceh Darussalam 0 0 0 0 1 2 North Sumatra 0 0 0 0 1 3 Riau 0 0 3 0 0 4 West Sumatra 0 0 1 0 0 5 Jambi 0 0 0 0 1 6 South Sumatra 0 0 0 0 1 7 Lampung 3 0 5 1 3 8 Banten 4 3 14 6 24 9 DKI Jakarta 9 8 52 12 102 10 West Java 11 9 46 8 32 11 Central Java 1 0 1 1 3 12 DI Yogyakarta 0 0 1 1 2 13 East Java 0 0 1 0 3 14 Bali 0 0 0 0 1 15 East Kalimantan 0 0 4 1 0 16 South Sulawesi 0 0 4 1 2 Total 28 20 132 31 176
Source: WHO

WHO - H5N1 avian influenza in domestic cats

28 February 2006

Authorities in Germany have today announced detection of H5N1 avian influenza in a domestic cat. The cat was found dead over the weekend on the northern island of Ruegen. Since mid-February, more than 100 wild birds have died on the island, and tests have confirmed H5N1 infection in several.

There is no present evidence that domestic cats play a role in the transmission cycle of H5N1 viruses. To date, no human case has been linked to exposure to a diseased cat. No outbreaks in domestic cats have been reported.

Unlike the case in domestic and wild birds, there is no evidence that domestic cats are a reservoir of the virus. All available evidence indicates that cat infections occur in association with H5N1 outbreaks in domestic or wild birds.

Experimental studies, published in September 2004, demonstrated that the H5N1 virus can infect domestic cats, and that cats can transmit the virus to other cats. In these experiments, the cats developed disease following direct inoculation of virus isolated from a fatal human case, and following the feeding of infected raw chicken.

The current H5N1 panzootic in birds, which began in mid-December in parts of South-East Asia, has been accompanied by a few anecdotal reports of H5N1 infection in domestic cats. In all such reports, eating raw infected poultry was considered the most likely source of infection for the cats.

Several published studies have demonstrated H5N1 infection in large cats kept in captivity. In December 2003, two tigers and two leopards, fed on fresh chicken carcasses, died unexpectedly at a zoo in Thailand. Subsequent investigation identified H5N1 in tissue samples.

In February 2004, the virus was detected in a clouded leopard that died at a zoo near Bangkok. A white tiger died from infection with the virus at the same zoo in March 2004.

In October 2004, captive tigers fed on fresh chicken carcasses began dying in large numbers at a zoo in Thailand. Altogether 147 tigers out of 441 died of infection or were euthanized. Subsequent investigation determined that at least some tiger-to-tiger transmission of the virus occurred.

War on bird flu continues

Jakarta Post, Monday, February 27, 2006

Vowing to continue the war against bird flu, the Jakarta administration has completed a three-day door-to-door check on poultry and pet birds during which 5,026 birds and chickens were culled, an official said Sunday.

The door-to-door inspection by the 600-strong bird flu team started Friday. The team scoured 55 subdistricts in 42 districts throughout the capital.

From a total of 117,840 fowls tested, 37 were found to have the H5N1 strain of avian influenza.

"There are 2,553 feces samples that will be taken to our laboratory to be tested further," head of Jakarta Husbandry Agency, Edy Setiarto, told The Jakarta Post on Sunday.

"We cannot promise when we'll get the test results. We will deliver those samples to the Veterinary Research Centers in Bogor and Ragunan in the next two days," he said.

Edy said during the inspection his teams did not encounter any resistance from bird lovers or chicken breeders who refused to have their fowls tested.

"I am glad because the public welcomed us. Most of them appreciated the inspections," Edy added.

The teams will conduct inspections in Kepulauan Seribu (Thousand Islands) on Monday. The islands were excluded from Friday and Saturday's simultaneous inspections due to bad weather.

During the door-to-door inspection, several teams immediately culled the chickens and birds that tested positive for bird flu. Earlier, an official had told The Post that they would not kill infected fowls until laboratory tests on feces samples confirmed they had bird flu.

"Although we can get the results in about 10 minutes after testing the poultry, we still need further checks before collecting all of the infected poultry to be culled in selected areas which will be determined later," deputy head of the animal health unit at the agency, Adnan Ahmad, said Wednesday.

He said it would take two to three days to verify if the birds and chickens were infected with bird flu.

Meanwhile in Bojong Gede district in Depok, most of chickens belonging to residents of Agriculture Ministry housing complex were found to be infected with bird flu.

One of the residents, Gatot, said his three chickens suddenly died Friday. He fed his chickens two hours before he found them dead with chests, heads and legs bluish.

"I immediately reported the deaths to the head of the neighborhood unit," he said as quoted by Tempointeraktif.

A team from the Depok Agriculture Agency came to the complex and inspected chickens and pet birds belonging to the residents Saturday.

From a rapid test of chicken's feces, several chickens and birds tested positive for bird flu.

"That day, we culled 50 chickens and three turtle doves," a resident Herman Talo said.

Malaysia targets fighting cockerels in bird flu battle

27 Feb 2006 11:23:51 GMT
Source: Reuters
PUTRAJAYA, Malaysia, Feb 27 (Reuters) - Malaysia has stepped up checks on fighting cockerels after the country's strain of bird flu proved similar to a strain found in neighbouring Indonesia, a minister said on Monday. State news agency Bernama said 15 people had tested negative for the H5N1 virus detected in 40 chickens found dead in Malaysia's first poultry infection in more than a year, though the test results of one more were still awaited. No human cases of bird flu have so far been reported in Malaysia, which last found the H5N1 virus in a chicken in the northern state of Kelantan in 2004. "I'm not saying that this is a result of any smuggling in of chickens from Indonesia," Muhyiddin said. "I'm just saying this as a matter of fact based on the similarity of the H5N1 virus strain from Indonesia." Neighbouring Thailand has restricted the movement of fighting cockerels, which some veterinarians say are more resilient to the virus and can pass on the disease without showing symptoms, in its efforts to stop the flu. Agriculture Minister Muhyiddin Yassin said preliminary checks showed the H5N1 strain could have come from fighting cockerels reared by illegal immigrants living in the affected area, who were known to engage in the outlawed sport. Bird flu has killed at least 92 people worldwide since 2003, spreading from Asia to the Middle East and reaching Europe this year along bird migration routes. Many scientists fear the virus could mutate into a form that easily passes among people, so triggering a global flu pandemic. Malaysia, which has so far killed 3,418 birds to contain the disease, was increasing vigilance on its borders to keep out the virus, the minister added. "We are now tightening up our border checks," he said. "Various enforcement agencies like the police and military will even be asked to look into the boots of cars to ensure no birds are being brought in." Existing penalties were fines of 500 ringgit ($135) or two years imprisonment or both, Muhyiddin said. Sales of poultry and poultry-related products have fallen between 20 and 25 percent at certain supermarkets and retail outlets, he said. "I can understand the psychology, but what we'd like to say is the flu is not spreading like wildfire. It is being contained." No new cases of H5N1 have emerged since Feb. 19.

WHO - Avian influenza – situation in Indonesia - update 5

27 February 2006

The Ministry of Health in Indonesia has confirmed an additional case of human infection with the H5N1 avian influenza virus. The case, which was fatal, occurred in a 27-year-old woman from West Java Province. She developed symptoms on 13 February and died on 20 February.

Investigations carried out by local authorities found reports of chicken deaths in the woman’s neighbourhood four days prior to her onset of symptoms.

The newly confirmed case brings the total in Indonesia to 27. Of these, 20 were fatal.

Bird-loving Indonesians worried about mass culling

24 Feb 2006 02:40:20 GMT

Source: Reuters
By Tomi Soetjipto JAKARTA, Feb 24 (Reuters) - Perched inside a lavishly decorated cage, a palm-sized Indonesian songbird looks unsuspectingly at its owner. Rudjiono is worried he may have to kill his six-month-old zebra dove if the government orders a cull in his neighbourhood to stamp out bird flu, which has already killed millions of fowl across the sprawling archipelago. "This is a very sensitive and loving creature. How can you kill it? It makes no sense," said Rudjiono, the musical sound of some 100 songbirds in a wooden cage filling the air. Rudjiono, who heads a local association of zebra dove lovers, is one of millions of Indonesians on tenterhooks as the government begins scouring high-risk areas in Jakarta on Friday to test thousands of birds for the H5N1 virus. Officials will slaughter all fowl within a kilometre of where infected birds were found in a renewed campaign to stamp out bird flu which has killed 19 people in Indonesia. So far, the government has resisted the mass culling of fowl seen in some other nations, and concentrated instead on selective culling and spreading public awareness. But many Indonesians are worried. For many people like Rudjiono, the zebra dove -- locally known as Perkutut -- and other exotic birds are more than just pets. They're almost a national obsession. Priced as high as $30,000, a trained Perkutut is treated with special care and kept in decorative cages. It is given herbal medicine to beautify its voice and bathed in rose water. Millions of rural families in the world's fourth most populous nation have traditionally kept poultry in their backyards while the more affluent ones keep their prized songbirds inside their homes. INGRAINED IN CULTURE Keeping backyard chickens is ingrained in Indonesia's culture and for many families exotic birds are also a status symbol. According to Bird Life, a bird conservation group, there are more than 2.5 million pet birds in Indonesia, including protected species such as the brilliantly coloured Bird of Paradise. "From our research in five main cities in Indonesia on average, one in every five households keeps singing birds as pets," Bird Life's manager of research, Pete Wood, told Reuters. Government officials put the number of backyard poultry in Indonesia at 370 million fowls. Bird flu, which first surfaced among Indonesia's fowl in late 2003, has been found in 23 of its 33 provinces and has killed more than 10 million domesticated birds. Although new infections in fowl dropped significantly last year from the previous year, the number of cases among humans has risen in the past six months. The government has set up a national team to combat bird flu, but progress has been slow due to the lack of a strategy. "The government must have a concrete plan to re-arrange backyard farms and give training on hygiene and sanitation," said Budi Tri Akoso of the Association of Indonesian Veterinarians. Veterinarian Arsentina Panggabean, one of the officials in charge of building awareness among poultry breeders, said many residents were resentful of the plans to slaughter fowl. "It's actually easier to talk with residents whose areas are exposed with bird flu because the issue has hit them in the face," Panggabean said. "But if we talk to those living in non-affected areas then they would have their own ideas." (with additional reporting by Yoga Rusmana)

Indonesia begins massive anti-bird flu campaign

JAKARTA, Indonesia (AP)
24/02/2006

Authorities in the Indonesian capital kicked off a massive anti-bird flu campaign on Friday, vowing to test chickens across the teeming city and cull all birds within one kilometer of an outbreak.

"With this I declare war on bird flu,'' Agriculture Minister Anton Apriyanto told hundreds of government workers and vets gathered outside city hall at a ceremony to mark the beginning of the campaign. "Bird flu has now reached an alarming level.''

Indonesia, which has so far recorded 19 deaths from the virus, was criticized for failing to take the threat seriously when humans first began dying last year. Most of the cases have been in the capital, Jakarta.

The three-day campaign aims to test birds across the city of 12 million people, many of whom keep one or two chickens or songbirds in the their backyards. There are tens of thousands of other live chickens at markets or poultry distribution centers. Officials have said that all birds within one kilometer of an outbreak will be slaughtered, and their owners paid the equivalent of US$1 a bird. Chickens fetch between US$1 and US$2 on the market, songbirds considerably more.

It remains to be seen how effective the campaign will be in city known for its corrupt and inefficient government. Moreover, there have been no sanctions announced for those who refuse to give in their birds.

The H5N1 virus has devastated poultry stocks and killed at least 92 people, mostly in Asia, since 2003, according to the World Health Organization.

Most human cases of the disease have been linked to contact with infected birds. But scientists fear the virus could mutate into a form that is easily transmitted between humans, possibly sparking a global pandemic.

WHO - bird flu map

Jakarta, Thursday, February 23

26 Indonesian provinces hit by bird flu

JAKARTA, Feb. 21 (Xinhuanet) -- The Indonesian government said Tuesday the avian influenza has attacked 26 out of 31 provinces across the country with the rain season accelerating the outbreak.

Syamsul Bahri, director of veterinary with the Ministry of Agriculture, said in Central Java province bird flu outbreak spread very quickly from one area to another, with total 161 regencies and towns reporting the outbreak.

"In the past, bird flu case was reported every three months. But now we heard such a case every three days. The spreading is both very quick and very dangerous," he was quoted by Detikcom news website as saying.

He said the rain season helped accelerate the virus spreading.

The virus has killed hundreds of thousands of chickens in the country, he said.

Earlier in the day, Minister of Health Siti Fadillah Supari said Indonesia had the highest human mortality rate in bird flu cases, given that 19 of 27 bird flu patients died.

Indonesia woman dies of bird flu, local tests show

22 Feb 2006 03:27:15 GMT
Source: Reuters
JAKARTA, Feb 22 (Reuters) - A 27-year-old Indonesian woman who lives in the capital has died of bird flu, a Health Ministry official said on Wednesday, citing local hospital tests. If confirmed by outside laboratories recognised by the World Health Organisation (WHO), the woman will be the 20th Indonesian to die from avian flu. "The (local) tests of the woman from East Jakarta who died this week show it's positive," said Hariadi Wibisono, head of control of animal-borne diseases at the Health Ministry.

Malaysia reports fresh H5N1 bird flu case

Reuters, 20/02/2006

Malaysia on Monday reported its first case of H5N1 bird flu since November 2004, with the death of 40 chickens in central Selangor state last week. But Agriculture Minister Muhyiddin Yassin said it was an isolated case and that the public need not worry as no human was affected. "Tests conducted confirmed the death of the free range chickens was caused by H5N1 avian influenza virus," he said in a statement issued through state news agency Bernama

WHO - Avian influenza – situation in Indonesia - update 4

20 February 2006

The Ministry of Health in Indonesia has confirmed an additional case of human infection with the H5N1 avian influenza virus. The case, which was fatal, occurred in a 23-year-old man from East Jakarta who was employed as an egg seller at a wet market.

He developed symptoms on 5 February, was hospitalized on 7 February, and died on 10 February. None of the contacts traced showed influenza-like illness.

The newly confirmed case brings the total in Indonesia to 26. Of these, 19 were fatal.

Indonesia to boost bird flu testing, culling

JAKARTA (AFX) 02.20.2006

The government will launch an intensive bird flu testing and culling campaign this week, an agriculture official said here.

Birds will be randomly tested in six out of 33 provinces in the country, said Syamsul Basri, director of animal health at the agriculture ministry. The two-month campaign will kick off in Jakarta on Friday.

'The aim is to lower the possible sources of infection, both for humans and birds,' he said.

If tests yield positive results, birds will be selectively culled within a one-kilometre (half-mile) radius, he said.

'We will take various factors into consideration, including whether analysis shows that the finding of positive infection cases reflects a high potential of other infections in the same area,' Basri said.

Poultry farms with high safety measures in place would be spared, he said, adding that other provinces to be targeted were Banten, West and Central Java, Lampung on Sumatra and South Sulawesi.

In Jakarta, at least 50 teams consisting of about six to eight members will be involved and will be made up of students, Red Cross workers and staff from the veterinary association as well as officials from the health and agriculture ministries.

Indonesia, the world's fourth most-populous nation, reported its latest bird flu fatality on Saturday, bringing the number of fatalities from the H5N1 virus to eight this year alone -- the world's highest reported figure.

Most of Indonesia's bird flu victims have come from the capital and its surrounding areas, where many people live in close proximity to poultry. Infected birds however have been found in 26 of Indonesia's provinces.

Since 2003, more than 90 people have died from bird flu in China, Southeast Asia, Iraq and eastern Turkey after coming into contact with infected poultry saliva, nasal secretions or faeces.

Spread of avian flu jumps in West and Central Java

Jakarta Post, Saturday, February 18, 2006

Officials are planning emergency measures to deal with a worrisome spike in the incidence of avian bird flu in densely populated West and Central Java. "Almost no region (in West Java) is free from bird flu infection," Fatimah Resmiati of the West Java health office told The Jakarta Post on Friday. Data from the office showed that chickens tested positive for the deadly H5N1 virus in 17 of the 25 regencies in West Java, while human infection has been found in 12 regencies. Resmiati blamed the fast spread of the virus on the limited control of the traffic of live chickens in West Java. "In the period from September 2005 to Feb. 14, 2006, up to 50 people were suspected of being infected with the bird flu virus, of whom 15 died, with 10 confirmed as positive for the virus," she said. West Java Governor Danny Setiawan was scheduled to hold an emergency meeting on curbing the spread of bird flu on Monday with all regents and mayors. In Central Java, representatives from the province's 35 regencies will be invited to a ceremony for the avian flu eradication campaign in Ungaran, Semarang regency, on Wednesday. Central Java Deputy Governor Ali Mufiz said in Semarang on Thursday that the government would go ahead with its plan to undergo mass culling of infected chickens. "We are still in the process of collecting data. Like the mass culling in 2005, this year's culling has to be conducted selectively," he said. Central Java Governor Mardiyanto also confirmed in Surakarta that mass culling would be conducted in five regencies -- Boyolali, Klaten, Karanganyar, Sukoharjo and Sragen -- where 151,000 of 161,640 chickens tested positive for the virus. "However, there is no need for the public to worry about the culling as the government will provide compensation for the culled chickens," he said. The provincial administration earmarked Rp 32 billion (US$3.45 million) for the culling, with farmers compensated Rp 10,000 for each chicken killed. The Central Java health office will also distribute 12 million bird flu vaccine samples this year, more than double the amount of 5 million distributed last year. The bird flu virus has killed at least 90 people worldwide since the end of 2003 and 18 in Indonesia. The increasing number of birth flu deaths in the country prompted the government last November to deploy troops and volunteers to conduct door-to-door checks for fowl infected with the virus. The search was first concentrated in Greater Jakarta and areas deemed "difficult" for officials to detect the avian influenza virus. Yuli Tri Suwarni and Suherdjoko, The Jakarta Pos, /Bandung, Semarang

Human Avian Influenza, Indonesia up to 14 February 2006.

Jakarta, Thursday, February 16, 2006 12:00:00 AM

Uploaded by : Zainul Bakri Since July 2005 up to 14 February 2006, Indonesia has had reported 302 cases (cumulative number) and based on clinical, epidemiological investigation, and laboratory examination the results can be classified as follow: 176 cases Non Avian Influenza, 26 confirmed cases of Human Avian Influenza (of whom 18 died), 99 cases Under investigation (of whom 28 died) and 1 exposured case (no clinical symptom, positive serology examination). No. Province Human AI Under investigation Non AI # of cases Death # of cases Death # of cases 1 Nangroe Aceh Darussalam 0 0 0 0 1 2 North Sumatra 0 0 0 0 1 3 Riau 0 0 3 0 0 4 West Sumatra 0 0 1 0 1 5 Jambi 0 0 0 0 0 6 South Sumatra 0 0 0 0 1 7 Lampung 3 0 2 1 3 8 Banten 4 3 9 6 24 9 DKI Jakarta 8 7 38 11 102 10 West Java 10 8 35 6 32 11 Central Java 1 0 1 1 3 12 DI Yogyakarta 0 0 1 1 2 13 East Java 0 0 1 0 3 14 Bali 0 0 0 0 1 15 East Kalimantan 0 0 4 1 0 16 South Sulawesi 0 0 4 1 2 Total 26 18 99 28 176
Source: CDC&EH MOH Indonesia

Ministers sound alarm over bird flu

Rendi Akhmad Witular, The Jakarta Post, Jakarta - 16/02/2006

With more human cases of bird flu being reported in the country, ministers warn the virus may be mutating into a more virulent form that is capable of being transmitted from human to human.

"The amount of time between contracting the virus and death is becoming shorter, raising the possibility the virus is becoming more virulent," Agriculture Minister Anton Apriyantono said Wednesday before a limited Cabinet meeting with governors from five provinces to discuss efforts to combat bird flu. The meeting comes at a time of increased criticism over the government's perceived failure to respond to the crisis with the necessary speed or force.

Of the 26 people who have tested positive for the H5N1 form of the avian influenza virus since last year at a World Health Organization-accredited laboratory in Hong Kong, 18 have died. Eight of these cases have occurred this year, with seven fatalities. Most of the victims raised poultry or lived in areas where poultry was common.

Indonesia has reported the second-highest number of human bird flu cases in the world, and has suffered the second-highest number of fatalities.

Health Minister Siti Fadillah Supari said the country had experienced the highest number of bird flu cluster fatalities, which involve the infection of people living near one another. There have been six cluster fatalities reported here.

"The more cluster fatalities the greater the possibility for the virus to mutate into a form that can be easily transmitted among humans, triggering a pandemic," Siti said after the meeting.

Coordinating Minister for Public Welfare Aburizal Bakrie said after the meeting that in addition to culling sick poultry within a one-kilometer radius of all reported human bird flu cases and vaccinating all poultry within a three-kilometer radius, the government also would begin next week going door-to-door looking for infected fowl in five provinces.

These provinces -- Jakarta, Banten, West Java, Central Java and Lampung -- have reported the highest number of human bird flu cases and infected poultry.

"President Susilo Bambang Yudhoyono has instructed the governors (of the five provinces) to inspect backyard poultry farms and limit contact between the birds and people living nearby," he said.

According to a report from the United Nation's Food and Agriculture Organization, 30 million village households in Indonesia are keeping around 200 million chickens, excluding wild birds.

Anton said the governors also were told to order poultry farmers to cage their birds, to reduce contact with humans.

Two Indonesians suspected of bird flu infection die: official

JAKARTA (AFP): Two Indonesians suffering symptoms of avian influenza died on Thursday after being treated for a day at the country's main hospital for bird flu patients, an official said.

The 15-year-old girl and 27-year-old man died within hours of each other after being admitted to the Sulianti Saroso hospital in the capital early Wednesday, a spokesman for the hospital, Ilham Patu, told AFP.

He said local tests had yet to show whether they were infected with the H5N1 virus but if they did, officials would then ask a World Health Organisation (WHO)-affiliated laboratory in Hong Kong to confirm the findings.

If they are positive, it would bring the number of fatal cases in Indonesia this year alone to nine -- the highest reported globally.

Health Minister Siti Fadilah Supari warned Wednesday that Indonesia's high number of so-called cluster bird flu cases was increasing the possibility of the virus mutating into a more pathogenic form.

A senior health ministry official has said Indonesia has seen five of the so-called cluster cases, which refers to infections among people living in close proximity to each other.

"More cluster cases usually means there has been a genetic mutation or change. This means the possibility of human-to-human transmission is near," the health minister said.

Experts fear that H5N1 could mutate into a form easily transmissible by humans, sparking a global pandemic with the potential to kill millions.

Indonesia's overall death toll from the virus rose to 18 last weekend, with two more sets of positive test results returned.

Indonesia, the world's fourth most populous nation, was initially charged with covering up outbreaks of bird flu, which has now killed at least 90 people worldwide since late 2003.

Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO

Jakarta, Tuesday, February 14, 2006

Country 2003 2004 2005 2006 Total cases deaths cases deaths cases deaths cases deaths cases deaths Cambodia 0 0 0 0 4 4 0 0 4 4 China 0 0 0 0 8 5 4 3 12 8 Indonesia 0 0 0 0 17 11 8 7 25 18 Iraq 0 0 0 0 0 0 1 1 1 1 Thailand 0 0 17 12 5 2 0 0 22 14 Turkey 0 0 0 0 0 0 12 4 12 4 Viet Nam 3 3 29 20 61 19 0 0 93 42 Total 3 3 46 32 95 41 25 15 169 91 13 February 2006 Total number of cases includes number of deaths. WHO reports only laboratory-confirmed cases.
Source: WHO

Indonesia to boost hospitals' bird flu treating capacity

Jakarta, Tuesday, February 14, 2006 12:00:00 AM

Uploaded by : Zainul Bakri

Indonesian health ministry plans to boost the capacity of 44 reference hospitals for bird flu patients in an effort to optimize the fight against the disease, an official said on Monday.

"The government is now still mapping the conditions of the hospitals concerned," I Nyoman Kandun, the ministry's director general of disease control and environment sanitation, said.

"We want to know if the hospitals already have an isolation ward, complete equipment and skilled personnel," Antara news agency quoted the director as saying.

He said the plan was part of efforts to minimize the disease's fatality rate. "With good management of cases and availability of equipment and drugs to deal with the disease, it is hoped the fatality rate will drop," he said.

He said the rate of fatality in bird flu cases in Indonesia had reached around 70 percent or was higher than in other countries such as Vietnam, where the rate was recorded at only 23 percent, Thailand (63 pct) and Turkey (28 pct).

The health ministry had recorded a total of 26 positive cases of bird flu from July to Feb. 12 this year in 16 provinces in the country and the cases had led to 18 deaths.

Meanwhile, out of 91 patients treated on suspicion of carrying H5N1 strain of bird flu virus 28 had died, he said.

Among the factors that had caused the high rate of fatality was because most bird flu patients were taken to hospital only after it was too late.

He said Tamiflu was only effective medicine for bird flu patients 24 hours after infection.

WHO - Avian influenza – situation in Indonesia - update 3

13 February 2006

The Ministry of Health in Indonesia has confirmed an additional two cases of human infection with the H5N1 avian influenza virus. Both cases were fatal.

The first case occurred in a 22-year-old woman who developed symptoms on 25 January and died on 10 February. Her neighbours kept chickens. Samples from these chickens and from pet birds in a market near the woman’s home are being tested by Indonesia’s animal health authorities.

The second case occurred in a 27-year-old woman who developed symptoms on 31 January and died on 10 February. Deaths of chickens in her neighbourhood were reported four days prior to symptom onset.

The two women resided in different sub-districts of West Java Province.

The newly confirmed cases bring the total in Indonesia to 25. Of these, 18 were fatal.

Suspected bird flu case in S. Jakarta

Jakarta Post: 14 02 2006

A resident of Lebak Bulus, South Jakarta, died of respiratory problems after being treated at state-owned Fatmawati Hospital on Sunday evening.

The hospital's medical and treatment director, Chaerul Nasution, said Monday doctors found the avian flu virus in the lungs of the 27-year-old patient.

"We are still examining the virus but he died as we were planning to transport him to Sulianti Saroso Hospital in North Jakarta. We took all the necessary precautions when treating his body, on the assumption he died of bird flu," Chaerul said.

It is standard procedure for the bodies of bird flu victims to be wrapped in plastic and placed in a coffin for burial.

If the diagnosis of bird flu is confirmed, the patient would be the country's 28th human case of avian influenza.

WHO - Avian influenza – situation in Indonesia - update 2

6 February 2006

The Ministry of Health in Indonesia has confirmed an additional four cases of human infection with the H5N1 avian influenza virus. Two of these cases were fatal.

The first fatal case was a 22-year-old man from West Java who died on 26 January. He worked as a banana vendor at a market in East Jakarta where poultry meat was sold. Neighbours near his home reported poultry deaths prior to his onset of symptoms.

The second fatal case was a 15-year-old boy from West Java who died on 1 February. Deaths in chickens near his home were reported in the week prior to symptom onset.

The third case is a nine-year old girl from West Java who was hospitalized on 19 January and has since recovered. She lived in a village neighbouring that of the two fatal cases in siblings confirmed on 23 January. Investigation of those cases resulted in the girl’s prompt hospitalization and treatment. She has now fully recovered. Poultry deaths were reported in her village prior to symptom onset.

The fourth case is a five-year-old boy from Lampung Province who developed symptoms in October of last year and has since fully recovered. The child is the brother of a previously confirmed case, a 20-year-old man who developed symptoms in late September and likewise fully recovered. Both the child and his brother had direct exposure to diseased chickens during slaughtering. As initial diagnostic tests produced inconclusive results, retrospective confirmation of the child’s infection relied on antibody levels in acute blood samples taken during his illness and convalescent samples taken following recovery.

All three cases with recent symptom onset resided in West Java, where a resurgence of virus activity in birds has been reported.

The newly confirmed cases bring the total in Indonesia to 23. Of these cases, 16 were fatal.

Indonesia to conduct door-to-door bird flu inspections

JAKARTA (DPA) 06/02/2006

Alarmed by the rising human death toll from bird flu, Indonesian government has planned to conduct door-to-door inspections to prevent the spread of the deadly H5N1 virus, a cabinet minister said Monday.

Minister of Agriculture Anton Apriantono said that the ministry had already conducted house inspections on fowl in Sumedang and Purwakarta districts in West Java recently.

A similar move would be launched in other regions prone to the deadly H5N1 strain of bird flu , Anton said.

"We are trying to be proactive," he told reporters."Bird flu cases on poultry can still be found in West Java and Central Java according to the latest report we received," Antara news agency quoted the minister as saying.

Indonesia, the world's fourth most populous country, has had 16 deaths from bird flu confirmed by the World Health Organization-affiliated laboratory and seven cases where patients have survived.

The H5N1 strain of avian influenza has killed more than 80 people worldwide. Though the virus is not transferable between humans, scientists fear it could mutate and set off a global pandemic that might kill millions.

The highly pathogenic avian influenza virus has spread to more than two-thirds of the provinces in the vast archipelago country, killing millions of poultry since late 2003.

Indonesia has millions of chickens and ducks, many in the backyards of rural or urban homes. The country is preparing an early bird flu warning system aimed at reaching remote areas to speed up reporting of any outbreaks.

Three Days With a Bird Flu Sleuth

A WHO Epidemiologist Probes The Death of a Jakarta Nurse As Fears of Viral Mutation Grow

By Alan Sipress
Washington Post Foreign Service
Monday, February 6, 2006

JAKARTA, Indonesia The maroon minivan had just edged into morning traffic, but passenger Gina Samaan, a field investigator for the World Health Organization, admitted she was already a bit worried.

This much was for sure, she said, reviewing the case from the back seat on an excursion one day last month. A 29-year-old Jakarta woman hospitalized with acute pneumonia had died two days before, and the early diagnosis was bird flu. Her samples had tested positive for the avian influenza virus at a government laboratory and another, little-publicized lab run by the U.S. Navy across from the capital's main prison.

The local news media were reporting that chickens in the woman's neighborhood had recently fallen sick and died, suggesting she had caught bird flu from poultry like other Indonesian victims. But Samaan disclosed that bird samples tested by the city's veterinary department had all come back negative.

If the source was not chickens, could it have been another person? If so, it might mean the virus had mutated into a form more easily transmitted among humans -- signaling the earliest stages of a global influenza pandemic that could potentially kill millions.

That ominous prospect seemed to grow for a time as this influenza gumshoe followed a trail of clues that led her unexpectedly into a neighboring province and back again.

As in many cases on the influenza beat, Samaan, 29, might never be able to nail the culprit. But she was bent on determining whether human infection was at least the likely explanation.

If the evidence pointed to a chain of human cases, WHO might have to sound a global alert. Since the middle of last year, more people had died in Indonesi a from bird flu than anywhere else, and international health experts were warning that if a worldwide epidemic were to erupt, there was no likelier starting place for it than here.

Day 1: East Jakarta

Samaan, her dark eyes earnest and intent behind rimless glasses and her brown hair tied back in a ponytail, wasn't taking any chances. She had stashed several masks in the back of the WHO van. In her bulky brown pocketbook, she kept a small bottle of pink antiseptic hand sanitizer and a cheap thermometer. She had been taking her temperature twice a day since arriving in Jakarta eight months earlier from Australia's Health Department.

She had donned simple shoes with covered tops to protect her feet from sources of contamination, such as bird droppings, and with flat soles that were easy to clean. She said she washed them in the sink after each outing and, as a result, was going through a new pair every other month or so.

But for all her preparations, Samaan wasn't expecting what she saw when she pulled up in the victim's neighborhood, accompanied by her Indonesian interpreter and an official from the Health Ministry's national lab. WHO and Indonesian health officials allowed a reporter to join investigators on condition that the names of the victim and her relatives, home address and place of work be withheld for medical privacy reasons.

It was as if the whole neighborhood had turned out in a single grassy yard to wait for Samaan. Several men crowded around her, confirming that two chickens had died about a month earlier not far from the victim's home and that the carcasses had been quickly burned.

Samaan listened intently, lips pursed, jotting down the details in a spiral notebook. Two dead birds, no samples. It was hard to conclude they were the cause.

She found the victim's mother and ushered her to the shade of a tree in a quiet corner of the yard. The mother was a handsome woman in a plain orange dress, hair pulled back in a bun. Samaan inquired about the other members of the family, where they lived and whether they were healthy. Everyone, she was told, was fine.

Samaan asked whether the woman had noticed any dying birds.

"We didn't see any sick chickens. But most of the time we weren't home. We're a working family," the mother said, furrows deepening across her brow. Then she added, "My daughter's a nurse at a hospital."

Samaan's expression didn't change. But she later recalled feeling her heart drop. If the victim was a nurse, she might have been infected by a patient -- or, worse, passed the disease to others at the hospital.

"Which department did she work in?" Samaan probed. "ICU? Pediatrics?"

"I don't really know," the mother said. "She's a regular nurse."

Samaan asked to see the family's home and was led down a narrow, concrete alley, past small, neat dwellings with laundry hanging out front. The victim had lived at the end of the block. Samaan took a quick tour of the house, peeking into the refrigerator for possible contamination, examining the hanging basket where the family kept eggs for any sign of bird droppings. Everything looked clean.

In fact, except for a pair of black hens hiding in a bush near the house of the neighborhood official for the block, there was no trace of poultry anywhere, Samaan noted.

Though Indonesian and foreign media would continue in the coming days to blame chickens for the woman's death, Samaan did not think so. It could be something far worse.

Day 2: West Java Province

Samaan had been so anxious about checking out the hospital where her victim worked that she hadn't had time to arrange for the WHO van to take her. She roused her interpreter with a playful, early morning plea: "C'mon, let's go save the world." Then they hailed a taxi on the street.

After waiting nearly an hour in the lobby of the modern, five-story hospital in Jakarta's southern suburbs, Samaan was escorted to a conference room, where four hospital executives joined her across an oval table. The hospital's personnel chief, a slight woman in a pink blazer, recalled that the victim had complained of fever and chills when she reported for work on New Year's Day, so she was sent home. She had usually worked in the maternity ward as a midwife.

That last detail was welcome news. It made it less likely that the woman had contracted the illness in the hospital, because the maternity ward's patients tended to be healthy.

The personnel chief produced schedules and time sheets. Samaan and several others huddled around them. Samaan made a mental note of two overnight shifts the midwife had worked on Dec. 27 and 28 -- the dates she was most likely to have contracted the virus.

Samaan asked whether there was any illness among women who had given birth in the maternity ward or their families. Nothing unusual, she was told. She asked about the other midwives. All were healthy. She requested to meet a few.

The maternity ward was clean and quiet. Four newborns slumbered in small, glass-sided cribs. The personnel director showed in two midwives. They reported that their health was good, further allaying Samaan's fear that the hospital was the source of infection.

Samaan inquired about their colleague's final days.

"She mentioned she had been coughing for a while. That's all," one said.

"Did she ever talk about going to a poultry market?" Samaan continued, following up on what the family had told her a day earlier.

The young midwife giggled softly, covering her mouth with her hand. "Sometimes she would go after work," she recounted. "She would go buy chicken feet. That was one of her favorite foods."

Day 3: East Jakarta

Markets made Samaan uneasy.

When she first came to Indonesia, she recalled, she was always fretting about catching bird flu. "I counted the sneezes I'd make," she quipped. As she learned more about the disease's behavior, she worried less about the risk of contracting it at victims' homes or from their families.

But traditional Asian poultry markets -- where butchers, birds and buyers come into intimate contact, blood flowing and feathers flying -- could be dangerous places.

After two days of detective work, Samaan believed she had now tracked the infection to a large, covered market in a teeming quarter of the capital. She suspected that the victim had come here to pick up some chicken after an overnight shift at the hospital.

Samaan and two Health Ministry officials walked up to the second floor and waded into the dim aisles, passing gold shops, cluttered grocery kiosks and music stalls blaring Indonesian pop tunes.

Soon they could hear the thud! thud! of a meat cleaver. They sloshed along tile floors slick with water, mud and rivulets of blood. On the counters, butchered chickens lay in rows, claws extended upward. Toward the back, a few survivors clucked in dissent, their legs bound to makeshift wooden cages.

"Her friends at the hospital said she really liked chicken feet," Samaan said, pointing to a small pile on the counter.

Samaan and the other officials approached a merchant who was busy grasping chickens with his bare hands and slitting their throats. They asked whether the market had been checked for bird flu.

The merchant responded that local veterinary authorities tested the market once or twice a week.

"What did they find?"

Swoosh went the knife. "It's disease-free," the merchant said.

Samaan said she was skeptical about the quality of the local testing. Neither the merchant's responses nor the unsanitary conditions inspired confidence.

But then, emerging into the sunlight, she spied something else: several peasant women seated on the blacktop hawking chickens off wooden crates.

"She didn't have to go all the way in there," Samaan said, retracing the victim's steps in her mind. "She could have bought the chicken right here. That might be more risky."

Samaan had found no evidence that her victim caught the virus from another person. But she had been reluctant to end the probe until she was confident of a better explanation. Now, she said, she had uncovered the missing piece.

"There was plenty of potential for exposure here," Samaan concluded.

Indonesia says four more bird flu cases confirmed

Jakarta, Sunday, February 05, 2006 12:00:00 AM

A Hong Kong laboratory recognised by the World Health Organisation has confirmed four more human bird flu cases in Indonesia, including two deaths, a senior Indonesian Health Ministry official said on Saturday. Hariadi Wibisono, the ministry's director of control of animal-borne diseases, said that raised Indonesia's total confirmed human bird flu cases to 23. "There are now 23 confirmed cases in Indonesia. Of these, 16 have died," Wibisono told Reuters. Turkey and Iraq last month became the latest countries outside Asia to report human cases of the H5N1 strain of avian flu. While it mostly affects birds, bird flu has infected 161 people and killed 86 of them since 2003, according to the World Health Organization. Wibisono said the newly confirmed Indonesian deaths were of a 22-year-old male chicken seller from Jakarta who died late last month and a 15-year-old boy who died in the West Java city of Bandung this week. Those still alive included a 5-year-old girl from around the town of Indramayu in West Java province and a 5-year-old boy from the province of Lampung on the island of Sumatra. The girl came from an area near where two Indonesian children from the same family died of bird flu in January, Wibisono said. The girl was unrelated to them. The boy was an older case where initial tests had proven inconclusive, he added. Most Indonesian cases have shown the victims had contact with dead chickens. One of the greatest fears of experts is that the H5N1 virus will mutate to become easily passed between humans, triggering a pandemic. The current H5N1 strain of bird flu has not mutated. The highly pathogenic strain of bird flu has affected birds in two-thirds of the provinces in Indonesia, an archipelago of about 17,000 islands and 220 million people. The country has millions of chickens and ducks, many in the yards of rural or urban homes, making it likely that more humans will become infected with the virus.
Source: Reuters-AlertNet

Hope in new bird flu cases?

By HELEN BRANSWELL, THE CANADIAN PRESS
30 janv 2006

With word yesterday that all but three surviving avian flu cases have been discharged from Turkish hospitals, questions are swirling over whether the world has overestimated the virulence of the H5N1 virus.

Some wonder if the fatality rate in the Turkish outbreak - four of 21 cases, if all are confirmed - is proof the assessment of the virus's virulence has been skewed by a failure to detect mild, even symptomless cases in the other countries where human infections have been recorded.

Could H5N1's high death toll - stubbornly hovering over 50% - be the product of faulty math? Of not using the right denominator to calculate the rate?

Experts caution that people shouldn't read too much into the Turkish numbers at this point.

'TOO EARLY TO CONCLUDE'

"I think it's really too early to conclude anything," says Dr. Guenael Rodier, an infectious disease expert with the World Health Organization's European office in Copenhagen.

Rodier led the international team that travelled to Turkey to help contain the outbreak.

"True scientists are patient people. And the ones who are impatient, I tend not to trust their science.

"We know things are often more complex than anticipated.

"It takes time."

For one thing, there is still a theoretical possibility some of the Turkish cases may turn out to be false positives.

As of Friday, the WHO's collaborating laboratory in Britain had only concluded confirmatory testing on 12 of the 21 cases.

Even if the London lab confirms all 21, the evidence from the outbreaks in Southeast Asia and China paints a different picture: a high death rate and very little sign of the type of mild infections that might initially evade detection.

'ESSENTIALLY FOUND ZERO'

"The evidence for widespread asymptomatic infections is just not there," says Michael Perdue, a scientist with the World Health Organization's global influenza program in Geneva.

Certainly the odd case here and there probably went unnoticed, the experts assume. Mild cases are more likely to fall through the surveillance net than severe ones.

But a number of studies have been done in Vietnam, Thailand and Indonesia looking for antibodies to the virus in the blood of people who were exposed but who didn't show signs of being ill. Chicken cullers. Relatives of known cases. Hospital staff who cared for H5N1 patients.

"And they essentially found zero. They haven't found any," says Dr. Scott Dowell, an official with the U.S. Centers for Disease Control in Atlanta.

DAVOS-Branson: flu pandemic will ground most planes

Fri Jan 27, 2006 1:47 AM IST

DAVOS, Switzerland (Reuters) - A human bird flu pandemic could ground up to 70 percent of aircraft, Virgin Group boss Richard Branson said on Thursday.

"You're just going to have to be strong enough to keep your head down for a year," the entrepreneur behind Virgin Atlantic Airways and other carriers told business leaders at the World Economic Forum in Davos.

"If it happens, an airline is going to have 50 percent of its planes grounded, maybe more -- 60, 70 percent," he said.

The only positive would be a fall in fuel costs: "It will certainly bring down oil prices with a thump."

Air travel is expected to be in the frontline should the H5N1 strain of bird flu become easily transmitted between people.

Air travel was crucial in spreading the deadly Severe Acute Respiratory Syndrome, or SARS, virus around Asia and to Canada in 2003.

"Statistically, there is about a 6 percent chance that in any one year of the next 10 years this becomes a person-to-person problem, and we just have to hope it is not this year," Branson said.

Virgin has purchased enough doses of the antiviral drug Tamiflu for all airline employees at the group in an attempt to protect them in the event of a pandemic.

Indonesian chicken vendor has bird flu: ministry

Wed Jan 25, 2006 5:43 AM ET

JAKARTA (Reuters) - An Indonesian chicken seller in Jakarta is in hospital after being infected with the H5N1 bird flu virus according to local test results, a senior Health Ministry official said on Wednesday.

Hariadi Wibisono, director of control of animal-borne diseases at the ministry, said the 22-year-old man was being treated in a Jakarta hospital designated for bird flu patients.

"Local tests show he was positive for bird flu. He is a chicken vendor in a traditional market," Wibisono said, adding blood samples had been sent to a Hong Kong laboratory recognized by the World Health Organization (WHO) for confirmation.

Indonesia has had 14 confirmed deaths from bird flu and five cases where patients have survived.

Bird flu has killed at least 82 people in six countries since late 2003.

The H5N1 virus is not known to pass easily between humans at the moment, but experts fear it could develop that ability and set off a global pandemic that might kill millions of people.

Drawing attention to the threat posed by traditional markets in Indonesia, the WHO on Wednesday urged that hygiene and sanitation standards be improved.

"Massive interaction between humans and live poultry takes place every day in wet, traditional markets here and it might be a potential transmission of avian influenza," Alexander von Hildebrand, the WHO's Southeast Asia regional adviser for environmental health, said in a statement.

The WHO said preventive measures included limiting contact between humans and poultry in markets, as well as having better access to water and improved waste management.

Sanitation in many traditional markets in Indonesia is poor, with dirty or drainage water used to wash produce and stalls.

Indonesia's confirmed bird flu cases include two children from the same family in West Java province who died this month.

They were Indonesia's fifth cluster of cases, where people living in close proximity have fallen ill.

Two other members of the same family, a 14-year-old sister and the 43-year-old father, were hospitalized with respiratory symptoms and samples from their cases have been tested locally, with the results negative for bird flu, Wibisono said.

There has been no evidence of human-to-human transmission in the deaths of the two children and officials have said dead chickens were found in their neighborhood.

Jakarta is also awaiting confirmation from local tests that showed a 39-year-old man died of bird flu earlier this month.

The highly pathogenic strain of bird flu is endemic in poultry in parts of Asia, and has affected birds in two-thirds of the provinces in Indonesia, an archipelago of 17,000 islands and 220 million people.

Indonesia devolution seen hurting bird flu fight

24 Jan 2006 22:44:23 GMT
Source: Reuters

By Paul Eckert, Asia Correspondent WASHINGTON, Jan 24 (Reuters) - Extensive government decentralization in Indonesia, where bird flu has caused 14 deaths, is hampering the country's fight against infectious diseases, a Southeast Asian medical analyst said on Tuesday. Bob Bernstein, a U.S. physician and public health expert for Singapore Health Services, said long-standing health care problems of the archipelago of 220 million people were made worse by devolution of power since 2001. Recent outbreaks of polio and diphtheria had highlighted deficiencies in the surveillance, reporting and analysis of infectious diseases, he said. "Now you have 400 plus autonomous district and municipal health departments which are attempting to undertake autonomous authority over their health sector resources, but without sufficient capacity in terms of laboratory or field epidemiology," Bernstein said. On Tuesday, the top World Health Organization official for Asia said Asian countries have lagged in reporting some human cases of bird flu and this could jeopardize the chances of swiftly containing any potential pandemic. The H5N1 virus has killed at least 82 people in six countries since late 2003. It remains a disease mostly of birds but experts fear it could mutate into a form that passes easily from person to person, causing a pandemic. Bernstein said the Indonesian government had shown high-level commitment to tackling bird flu, but added that "there needs to be the adoption of a culture of transparency and accountability" before policies were executed locally. National medical standards and methods often "were adopted, put in place, but not used" in the sprawling country, where public doctors also support themselves with private practice and have little time to learn policies. Without local capacity to assess bird flu, in the event of an outbreak, there was a risk that "human cases will not be detected until mid-stage in the epidemic," Bernstein told a Washington gathering of officials, aid workers and scholars. Indonesia's two national laboratories lack virological facilities, so suspected cases of bird flu have to be analyzed in Hong Kong or Singapore, requiring handling and packaging standards that localities may not be able to meet, he said.

Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO

Jakarta, Tuesday, January 24, 2006 12:00:00 AM

Uploaded by : Zainul Bakri

Date of onset	Cambodia		China		Indonesia		Thailand		Turkey		Viet Nam		Total
	cases	deaths	cases	deaths	cases	deaths	cases	deaths	cases	deaths	cases	deaths	cases	deaths
2003	0	0	0	0	0	0	0	0	0	0	3	3	3	3
2004	0	0	0	0	0	0	17	12	0	0	29	20	46	32
2005	4	4	8	5	16	11	5	2	0	0	61	19	94	41
2006	0	0	1	1	3	3	0	0	4	2	0	0	8	6
Total	4	4	9	6	19	14	22	14	4	2	93	42	151	82

WHO: Avian influenza – situation in Indonesia - update

23 January 2006

The Ministry of Health in Indonesia has confirmed an additional 2 cases of human infection with the H5N1 avian influenza virus. Both cases were fatal.

The first patient was a 13-year-old girl. She developed symptoms on 6 January, was hospitalized on 12 January, and died on 14 January. The second patient was her four-year-old brother. He developed symptoms on 8 January, was hospitalized on 14 January, and died on 17 January.

Two other family members, a 14-year-old sister and the 43-year-old father, remain hospitalized with respiratory symptoms. The sister was hospitalized on 14 January and the father on 17 January. Samples from these cases are being tested to determine whether they were also infected with the H5N1 avian influenza virus.

Investigations conducted by the Ministry of Health and WHO found evidence of a large poultry outbreak in the family’s neighbourhood. Chickens kept by the family began to die three days before the first patient developed symptoms. All family members had close contact with the diseased chickens and assisted in the removal of dead birds.

Contacts have been traced, blood samples have been taken, and monitoring for signs of influenza-like illness continues. The authorities began culling operations in the area over the weekend. The newly confirmed cases bring the total in Indonesia to 19. Of these cases, 14 were fatal.

Bird flu confirmed in deaths of 2 Indonesian children

21 Jan 2006 10:31:34 GMT

Source: Reuters

(Adds details) JAKARTA, Jan 21 (Reuters) - A Hong Kong laboratory has confirmed the H5N1 strain of bird flu killed two children from the same Indonesian family this month, a senior official at the Health Ministry said on Saturday. Indonesia has now had 14 confirmed deaths from bird flu, said the official, Hariadi Wibisono, director of control of animal-borne diseases at the ministry, and five cases where patients have survived. "These two cases have been confirmed positive from Hong Kong," Wibisono told Reuters by telephone, referring to the laboratory, which is recognised by the World Health Organisation (WHO). The two children were a 4-year-old boy and a 13-year-old girl from the town of Indramayu in West Java province. Their father has also been admitted to hospital suffering suspected bird flu, although no test results have come back for him yet. Officials had previously said the boy was aged 3. The Indramayu family is Indonesia's fifth cluster of cases, where people living in close proximity have fallen ill. There has been no evidence of human-to-human transmission in the deaths of the children and officials have said dead chickens were found in their neighbourhood at Indramayu, which lies 175 km (110 miles) east of Jakarta. The children died in the past week. Apart from the two Indramayu children, Indonesia is awaiting confirmation from local tests that showed a 39-year-old man died of bird flu earlier this month. The H5N1 virus is not known to pass easily between humans at the moment, but experts fear it could develop that ability and set off a global pandemic that might kill millions of people. Prior to the two Indonesian children, the confirmed death toll from bird flu was 80 people in six countries since late 2003. The highly pathogenic strain is endemic in poultry in parts of Asia, and has affected birds in two-thirds of the provinces in Indonesia, an archipelago of 17,000 islands and 220 million people.

Suspected bird flu cases rising in West Java

Yuli Tri Suwarni, The Jakarta Post, Bandung 18/01/2006

A three-year-old boy who died Tuesday is believed to be the second fatality from avian influenza in his family after an older sibling's death last week.

The boy was pronounced dead at Hasan Sadikin Hospital in Bandung after his 13-year-old sister died in their hometown of Indramayu, West Java, last weekend. A preliminary Health Ministry investigation showed the children's family allowed poultry in their home.

Initial tests by the Health Ministry showed the teenager was positive for the deadly H5N1 strain of avian influenza which has already killed at least 80 people worldwide.

The ministry's laboratory, accredited by the World Health Organization (WHO), has confirmed 12 deaths in Indonesia and five cases where patients have survived the illness, although final confirmation is needed from the WHO laboratory in Hong Kong.

Most of the dead victims hailed from Greater Jakarta.

The H5N1 virus is not known to pass between humans at present, but experts fear it could develop that ability and set off a global pandemic that may kill millions of people.

Siti, 53, another suspected avian influenza patient, died on Sunday evening after being treated for eight hours at Hasan Sadikin hospital.

Avian influenza is also suspected in the condition of three other people hospitalized at the hospital, including the Indramayu siblings' 15-year-old sister. The other patients are a West Java health service officer and a resident of Bandung.

All of the patients were admitted to the hospital with similar symptoms -- breathing problems and high fever -- but two of them also had acute pneumonia.

The death of the toddler only a few days after his sister has raised concern among medical workers. Hadi Jusuf, head of the hospital's special infections team, said the boy's condition showed improvement Monday, with a drop in his temperature, but he experienced breathing problems Tuesday.

"We tried to give him oxygen and artificial respiration, as well as antibiotics and Tamiflu, but God decided otherwise," said Hadi, who was convinced the boy died of H5N1.

Health Ministry and WHO representatives have been sent to Indramayu to investigate the suspected cases in the one family.

The head of the disease evaluation and counseling section of the Health Ministry, Tato Suharto, said an initial investigation found 14 dead chickens near the family's home.

"Because of the fear of theft, the family put their chickens in their kitchen at night. Besides living together with the chickens, the family also lived close to other animals, including birds and ducks," he said.

Pigeons were also kept at the home.

Hadi also said most of the suspected avian flu patients being treated at the hospital were also believed to have had close contact with poultry.

When We Do Not Need the “Astronauts”

16 Jan 2006 11:35:00 GMT

Source: Indonesian Red Cross Society - Indonesia

Hadi Kuswoyo

Website: http://www.palangmerah.org

PMI's volunteer sprayed the disinfectant to the poultry
Hadi Kuswoyo/The Indonesian Red Cross

The morning had just left toward to the afternoon. At the Pasar Bebek, Semper, North Jakarta, a small amount of the population were still busy with their activities. It was so silence enough. Apparently the voice of ducks at the poultry near the village broke the silence. At least there are three medium scale of poultries located in that area. Nevertheless the silence was not stand any longer. As amount of the communities went out of their house to see the “guest” came to their village. Their presence to the village attracted the attention of the communities due to their uniform as like as astronauts. The white uniform covered full of their body, while they also us masker on their face. But the most interesting of these “guests” is the tube on their back shoulder. While their hand hold the spraying pipe. The children seemed so happy to follow them. They were not definitely astronauts or a group of creatures from outer space who will attack the people as described in some movie. Yup, they were the Indonesian Red Cross volunteers. It was signed on the word attached on the tube and their uniform. On that day, the PMI volunteers had assignment to spray the disinfectant in the some poultry at the village. They came to place by place which identified potentially affected by the virus. “We did this as a part of PMI program to prevent the spreading of the avian flu,” said Edo, one of the volunteers on duty. The avian flu has become something frightened. It is understood that there are already 9 people death of 14 people affected. ”The case of avian flu has on alert level of pandemic,” said Dr. David Nabarro, Senior Coordinator of United Nation for Avian Flu on the Regional Meeting of South East Asian Red Cross and Red Crescent on Avian Flu at Jakarta. As already known, the human affected by Avian Flu firstly noted on 25 June 2005. Since then various prevention activities and improving the treatment care for the people affected continuously conducted by the government. Therefore as a support to the prevention program to this disease, the Indonesian Red Cross is also declare to conduct the prevention in particular to raise the awareness of the community. “Beside the bio-security activity, we also held the awareness program to the community to be prepared instead of panic,” said dr. Lita Sarana, the Head of Social Service and Community Healthcare of PMI National Headquarter. So that is way during the spraying disinfectant, the volunteers were also distributing the brochure containing the information about the avian flu disease. ”There were various response from the communities, some were very enthusiastic, but the others neglected. Nevertheless we still tried to deliver the correct information about the Avian Flu,” said Edo. It is truly needs hard work and consistent to raise the awareness to anticipate the pandemic. Even when the volunteers deliver the messages to the owner of poultry to clean the stable regularly, the response came uncooperatively. ”They said they did not have much time. On the contrary they asked us to do it,” expressed Edo. In fact, keeping ourselves and the environment in hygiene are the most important to prevent the pandemic of Avian Flu. Then we do not need the “astronauts” to be assigned on the earth. ***

Human Avian Influenza, Indonesia up to 16 January 2006

Jakarta, Tuesday, January 17, 2006 12:00:00 AM

Uploaded by : Zainul Bakri Since July 2005 up to 16 January 2006, Indonesia has had reported 266 cases (cumulative number) and based on clinical, epidemiological investigation, and laboratory examination the results can be classified as follow: 164 cases Non Avian Influenza, 17 confirmed cases of Human Avian Influenza (of whom 12 died), 84 cases Under investigation (of whom 27 died) and 1 exposured case (no clinical symptom, positive serology examination). No. Province Human AI Under investigation Non AI # of cases Death # of cases Death # of cases 1 Nangroe Aceh Darussalam 0 0 0 0 1 2 North Sumatra 0 0 0 0 1 3 Riau 0 0 3 0 0 4 Jambi 0 0 0 0 1 5 South Sumatra 0 0 0 0 1 6 Lampung 2 0 3 1 3 7 Banten 4 3 8 6 24 8 DKI Jakarta 8 7 35 13 97 9 West Java 3 2 25 3 25 10 Central Java 0 0 2 0 3 11 DI Yogyakarta 0 0 1 1 2 12 East Java 0 0 1 0 3 13 Bali 0 0 0 0 1 14 East Kalimantan 0 0 2 1 0 15 South Sulawesi 0 0 4 2 2 Total 17 12 84 27 164
Source: CDC&EH MOH Indonesia

Indonesia: Red Cross to launch anti-bird flu campaign

JAKARTA (AFP): Indonesia's Red Cross said Tuesday it will launch a program to teach backyard farmers how to clean their chicken coops in a bid to curb further bird flu outbreaks in the vast archipelago nation.

The Rp 100-billion (US$10.67-million) program will involve 56,000 volunteers who will scour small-scale farms in 150 high- risk villages nationwide, Red Cross spokesman Hadi Kuswoyo told AFP.

"Our recent investigation shows that most farmers do not know how to properly clean the birds' cages," he said.

"This program will show them how to do it properly and will also provide free weekly disinfections for a year for them."

A one-month trial in the Curug area of Java's Banten province began Monday, with the focus on farms with less than 500 chickens. Small farms are often missed by health officials undertaking surveillance.

Indonesia tests boy for bird flu after sister dies

17 Jan 2006 07:09:05 GMT

Source: Reuters

JAKARTA, Jan 17 (Reuters) - An Indonesian toddler died on Tuesday and was being tested for bird flu, several days after his 13-year-old sister died of the deadly H5N1 virus according to local tests, a senior Health Ministry official said. Hariadi Wibisono, the ministry's director of control of animal-borne diseases, said the latest local test results on the 3-year-old boy were not conclusive on whether he had bird flu. An initial result had earlier shown he was positive for the virus. "He is a borderline case so we need to have more tests," Wibisono told Reuters. Wibisono on Monday had said another sibling, a 15-year-old girl from the same family that came from the West Java town of Indramayu, also had bird flu. However, latest local results on her were negative, he said. Outside laboratories recognised by the World Health Organisation have confirmed 12 deaths in Indonesia and five cases where patients have survived. It is usually some days before confirmation is available. The H5N1 virus is not known to pass easily between humans at the moment, but experts fear it could develop that ability and set off a global pandemic that might kill millions of people. It is confirmed to have killed 79 people in six countries since late 2003. The highly pathogenic strain is endemic in poultry in parts of Asia, and has affected birds in two-thirds of the provinces in Indonesia, an archipelago of 17,000 islands and 220 million people.

Experts Fear Burma Is Ill-Equipped to Handle Bird Flu

15 Jan 2006 09:14:57 GMT

Source: Factiva - The Washington Post

When the chickens began dying in Mon state last year, residents feared that East Asia's lethal bird flu epidemic had finally crossed to Burma. The provinces over the Thai border had already been hit hard by the disease and now hundreds of Burmese chickens were suddenly perishing without explanation. A local veterinary official initially blamed some of the deaths on sunstroke. Alerted to the outbreak by reports on a Norway-based radio station run by Burmese exiles, the United Nations contacted Tang Zhengping of the Food and Agriculture Organization -- the chief U.N. agriculture official in Rangoon -- who in turn called the government's top animal health expert to inquire, according to U.N. and Burmese sources. The government official responded that he didn't know anything about it. Burmese officials repeated as recently as last month that they have no confirmed cases of bird flu in either humans or poultry. A cluster of suspected human cases two months ago was reportedly caused by a less lethal strain of influenza, while several instances of mass bird deaths have been attributed by officials to ailments other than avian flu. But the Burmese government said in a regional report last year that the country "is a frontier line between the affected and non-affected countries," adding that "the resources needed to launch a response are not adequate." Global health experts outside Burma have been anxious to learn more about the situation on the inside, repeatedly questioning whether the military government is being candid when it claims the country remains free of the lethal virus. The disease has already devastated poultry flocks across East Asia, including in China and Thailand, both of which border Burma, and has now appeared in Turkey. It has also infected at least 162 people, killing at least 80. International health officials have cautioned that the virus could spark a global pandemic if it develops into a form more easily passed from one person to another. Burma's handling of the Mon state outbreak last year has reinforced concerns about whether its secretive, cash-strapped government could head off a bird flu outbreak, which international health experts warn might then spread quickly west to India and other South Asian countries that have so far been spared the epidemic. In response to the telephone call from Tang, the FAO official, veterinary officials at the country's Livestock and Fisheries Ministry investigated the outbreak in Mon state. They reported back that it was caused by Newcastle disease, a widespread poultry ailment of little threat to humans. But in an interview, a senior Burmese official admitted last month that he did not have complete confidence in these findings. He said it had taken so long for central authorities to learn about the outbreak that the samples were no longer fresh. "In some situations, the communication is not so good in our country, so reports and information from the village level cannot reach the central government in time," said the official, who spoke on condition of anonymity. Though the government had reassured international health experts that the poultry deaths were not due to bird flu, the official added that Burmese livestock experts had never tested the chickens for this virus. Animal health workers had run out of bird flu test kits while surveying live poultry markets, he explained. Burmese and international health experts said the country's health and veterinary services are starved for money, and have difficulty dealing with the disease. While foreign health experts and diplomats in Rangoon widely praise the professionalism of Burma's health and livestock officials, these observers questioned the willingness of authorities to disclose outbreaks. They said Burmese culture coupled with years of rule by the military discourages the reporting of bad news, including natural disasters and disease. The government, for instance, had long denied the severity of an AIDS outbreak until the prime minister finally called attention to it in late 2001, by which time it had already become one of the worst in Asia. Officials also minimize the threat of cholera, though foreign medical experts and local press reports mention continuing outbreaks. "You'd have to assume there's been a big question mark about their data," said a foreign health expert, who spoke on condition of anonymity for fear of government reprisal. "They may not know if they have bird flu. If they did know, the question is how quickly anyone else would know." A paper prepared in November by the Livestock and Fisheries Ministry acknowledged that Burma's location is "strategic," along the routes of East Asian migratory fowl. Several types of wild birds, including a species of geese that has already suffered casualties from the virus, fly from China, Mongolia and the Siberian region of Russia through Burma's east coast and on to South Asia. A second flyway runs from China, another country with human cases of bird flu, through a vast nature reserve in northern Burma before continuing to Thailand. In areas where migratory birds congregate, Burmese officials have warned farmers to take precautions to protect poultry against infection. So far, Burmese officials and other wildlife experts have said there is no sign of abnormal disease among migratory birds. Posing a second threat is trade and traffic across Burma's borders, especially from Thailand. Since bird flu erupted in Southeast Asia in 2003, most of the Thai provinces bordering Burma have recorded diseased poultry, and one of Thailand's most recent human cases also came from a border province. Burmese livestock officials said they had stepped up monitoring of markets and farms in border towns, enlisting police in the effort. "Now there's a possibility that some outbreaks at the village level could involve avian influenza," said a Burmese agriculture official. "It's possible we would not know." In the last year, there have been several suspicious poultry die-offs. One this summer was so widespread among free-ranging chickens that it squeezed the supply of meat in the markets, forcing prices up, according to a local press report. Government officials have attributed poultry deaths to either Newcastle disease or avian pox. Burmese health officials became worried two months ago when they learned that about 15 people in eastern Shan state had come down with a serious influenza-like illness, said Soe Lwin Nyein, a senior government epidemiologist. Of the 15, three children died. But health officials sent nine samples to a laboratory in Bangkok associated with the World Health Organization, which determined that four of the cases were ordinary human influenza while the others tested negative for flu altogether, Soe Lwin Nyein said. U.N. officials welcomed the Burmese government response and are now urging reluctant livestock officials to likewise send virus samples from poultry to a foreign laboratory for testing. Given Burma's lack of openness, this would enhance international confidence, said a U.N. official, adding that the stakes of remaining secretive are tremendous. "If they have an outbreak, I think it will spread very fast," he said.