Posted 7/15/2006 8:01 PM ET
JAKARTA, Indonesia (AP) — A 44-year-old man died of bird flu in Indonesia, a senior health official said Sunday, putting the country on the cusp of being the world's hardest hit by the disease.
The man died July 12 after being hospitalized for two days with high fever, coughing and breathing difficulties, said the official, Nyoman Kandun.
"Local tests showed he was infected with the H5N1 virus," he said, adding that the man was from eastern outskirts of the capital Jakarta and had reportedly had contact with birds.
If confirmed by a World Health Organization-sanctioned test, the number of people killed by bird flu in Indonesia rise to at least 42, tying it with hardest-hit Vietnam.
India; Vaccination for poultry:
Bird flu vaccine offers protection above 90%, immune response good
http://www.hindu.com/2006/07/18/stories/2006071800730900.htm
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WHO prepares instructions to prevent human-to-human bird flu spread in Azerbaijan
[ 18 Jul. 2006 17:44 ]
The World Health Organization’s experts are preparing instructions to prevent communicable diseases, especially human-to-human bird flu,
which is supposed to break out in autumn in Azerbaijan.
The WHO Office in Azerbaijan told the APA that the instructions on inflection in hospitals are being prepared by the WHO’s proposals and recommendations. These instructions are for health servants and will be published in several thousand of copies at the initial stage. Health servants will get these instructions free of charge./APA/
http://en.apa.az/news.php?id=12210
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Annals of Internal Medicine
18 July 2006 | Volume 145 Issue 2 | Pages 141-144
"Avian influenza, or influenza A (H5N1), has 3 of the 4 properties necessary to cause a serious pandemic: It can infect people, nearly all people are immunologically naive, and it is highly lethal. The Achilles heel of the virus is the lack of sustained human–human transmission.
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"Analysis of H5N1 shows that it is avian, and nearly all cases have resulted from direct contact with poultry; human-to-human transmission has been reported but is rare.
"Those who are skeptical about an H5N1 pandemic point out that genetic changes to facilitate efficient person-to-person transmission are unlikely to occur by either mechanism, since the virus has not acquired this property during 10 years of existence.
"If they are right, H5N1 will remain primarily an avian pathogen that sporadically causes disease in people, with most cases occurring in those who have close contact with sick poultry. "
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"...many of the patients with avian influenza died despite access to antibacterial agents, antiviral agents, and ventilatory support. Despite modern intensive care, the mortality rate for avian influenza is about 20-fold higher than that for the influenza of 1918.
"The 1918 pandemic and avian influenza also have virologic similarities. Analysis of the reconstructed 1918 pandemic influenza strain shows unusual similarities with H5N1, including the fact that both strains have genes of avian influenza viruses."
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"Current planning assumptions are based largely on the anticipated experience if a virus comparable to the 1918 flu strain were to cause a pandemic now.
"The medical consequences would include the following: 1) The attack rate in the United States would be 30%, causing 90 million cases; 2) of those infected, about 50% would seek medical care; 3) the excess mortality would be 209 000 to 1 903 000 deaths; and 4) the outbreak in a community would last about 6 to 8 weeks.
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"Caring for victims of an influenza pandemic will endanger health care workers. The risks involve exposure to H5N1, a virus to which unvaccinated people are considered universally immunologically naive.
"Health care workers and their families need to receive the highest priority for vaccination, assuming a vaccine exists, and for access to antiviral agents that are active against the epidemic strain.
"Health care workers should expect hospitals to provide optimal protection, and someone needs to take the lead to resolve the current controversy about the need for negative-pressure rooms and N95 masks or powered air-purifying respirators versus surgical masks.
"What are the obligations of health care professionals to care for the sick at great risk to themselves? Historical experience on this point is varied. The Hippocratic Oath is silent on whether physicians are obliged to care for the sick. Many physicians, including Galen and Sydenham, are said to have fled patients with contagious epidemic diseases.
"But AIDS, SARS, and smallpox have focused attention on the duty to serve, and a consensus has emerged. The American Medical Association Code of Medical Ethics states "that a duty to serve overrides autonomy rights in societal emergencies, even in cases that involve personal risk to physicians".
"Some states regard the obligation to treat during an emergency as a legal duty punishable by criminal sanctions for failure to act or for abandonment of patients. Some health care contracts specify that health care workers are required to provide services in emergencies.
"The moral obligation to treat seems obvious, but it has a possibly less obvious reciprocal obligation for institutions to provide maximum available protection, including antiviral agents, vaccines, personal protective equipment, and liability protection. "
http://www.annals.org/cgi/content/full/145/2/141