Indonesia Reels From Two New Bird Flu Deaths, Outbreak Feared

TWO Indonesian women have died of bird flu, a health ministry official said yesterday, taking the overall human death toll from the disease in the country to 61 amid a spike of new cases.

A 27-year-old woman from south Jakarta died after entering Persahabatan Hospital in the capital last Thursday for treatment, Muhammad Nadirin of the health ministry's bird flu information centre said. She died last Friday evening.

Asked whether the woman had been in contact with sick fowl, he said: "A week before she got sick, there had been dead chickens near her home."

The second death was of a 22-year-old woman from Tangerang west of Jakarta, who died in the early hours of yesterday, the official said.

Separately, an 18-year-old man being treated at a hospital was confirmed to have bird flu after his mother died of the disease last Thursday, marking a cluster case, another official said.

The husband and son of the 37-year-old woman, from Serpong in west Java, were being treated for symptoms of bird flu at Persahabatan Hospital.

Joko Suyono, another official at the bird flu information centre, said that the son had tested positive for bird flu.

It was not clear whether he had been in contact with sick birds, the official said.

There were no immediate test results on whether the father also had the virus, but Nyoman Kandun, director general of communicable disease control at the health ministry, said the positive test of the son signalled a cluster case.

The official said, however, there was no evidence of human-to-human transmission of the virus so far in this case.

The largest known cluster of human bird flu cases worldwide occurred in May 2006 in the Karo district of North Sumatra province, where as many as seven people in an extended family died. The cluster triggered fears the virus had mutated into a form that could spread easily between people.

Bird flu is endemic in around half of Indonesia's 33 provinces and the vast, developing country has struggled to contain the disease.

The latest cases bring the total number of human deaths in Indonesia to 61, the highest number in the world.

Millions of backyard chickens live in close proximity to humans and health education campaigns have often been patchy and rules difficult to enforce with the country's power structure increasingly devolved to the provinces.

Indonesian officials have, however, defended their efforts to tackle the disease.

"Aside from the latest cases, we have had some major improvements in fighting the disease but the danger is still there and the nature of this virus is random," Bayu Krisnamurthi, head of the national commission on avian influenza, said.

He said people were more vulnerable to the virus during the rainy season but hoped the latest cases did not indicate a trend.

Meanwhile, the Philippines has gone on alert to prevent any outbreak of bird flu following a resurgence of the disease in Asia, the head of the National Epidemiology Centre, said yesterday.

"We don't want to be caught off-guard," said Eric Tayag who heads the centre, tasked with countering the deadly avian influenza virus.

The centre is monitoring the cases of bird flu throughout the region, he said. People in the Philippines with flu will also be tested to make sure they do not have the disease.

In addition, the Health Department has stockpiled large supplies of the drug Tamiflu, used to fight the deadly strain of bird flu, he said.

The Bureau of Quarantine has also conducted a "simulation exercise", where an infected animal was discovered in the country. Local government units have also been trained to recognise any cases in their areas, Tayag added. The agriculture department continues to monitor poultry stocks and the entry of migratory birds.

Tayag said the government continued precautionary measures first imposed when bird flu gained worldwide attention.

Thermal scanners, used to detect possible fever in people, are still positioned at the international airport to detect people coming from abroad who may have contracted the disease.

Japan has also confirmed its first bird flu outbreak since 2005, local media said yesterday.

About 2,400 chickens have died at a farm in the south of the country, including 1,650 last Friday, reports said.

I suspect that this is the reason why bird flu keeps turning up in this part of the world, basically because a lot of people are living with their chickens.

Regular flu comes from China, which is the regular yearly source of it. It comes from China mainly because the Chinese live in close proximity with ducks and pigs.

I remember back in 1975 when I was driving my family toward a campground and broke down near Berchtesgarden (the place where Hitler died). We were given shelter by a woman who lived in a farm house in the area. The first floor was a cow stable, and the house was above it. Our very pleasant hostess served us at her table, but I couldn't help noticing that she was barefooted, and that her legs were smeared with cow manure up to the knees. The house was heated by one of those huge blue and white tiled wood stoves, and lacked plumbing. On the whole, Europe was ahead of Asia in sanitation, central heating, and plumbing, but the rural regions took a while to catch up.

That's what you call living with animals, and I suspect it is much the same in most of rural China and Indonesia. Not surprising that they are breeding grounds for flu and other diseases. That's also where the Black Death came from.

Buddist ritual raises fears over bird flu

Monday, January 15, 2007

Something was strange about a little brown bird found dead with bird flu on New Year's Eve in one of Hong Kong's busiest shopping districts.

The bird - a scaly-breasted munia - usually lives in rural areas. So what was it and five others doing flitting around in such a bustling, crowded area - possibly exposing some of the thousands of locals and tourists to the deadly virus?

Experts think the bird may have been a prop in a Buddhist ritual that involves freeing hundreds of birds to improve one's karma. As the threat of bird flu reemerges in Asia, the government finds itself in the awkward position of urging that the religious practice be stopped to protect the public's health.

The fear deepened Saturday when the government disclosed a dead crested goshawk - which preyed on small birds including the scaly-breasted munia - found on a hill in Shek Kip Mei January 9 also tested positive to the H5 avian flu strain.

Hong Kong is extremely alert about potential disease outbreaks - especially bird flu. The illness first appeared here in 1997 when it jumped to humans and killed six people. That prompted the government to slaughter the entire poultry population of 1.5 million birds.

Since then, the disease has largely spared this city of 6.9 million people.

When health officials discovered that the scaly-breasted munia found on New Year's Eve tested positive for the H5 virus, they held a televised news conference. A few days later, they said further tests showed the bird had the deadly H5N1 strain.

The scaly-breasted munia is native to Hong Kong, but it is usually found in tussocks in rural areas, said Lew Young, a manager at the Mai Po bird sanctuary.

"Six scaly-breasted munias being found dead at the same spot at one time easily leads one to suspect whether they were being released," he said.

The birds are commonly used in the Buddhist ceremonies, Young added.

"They are usually transported to Hong Kong from the mainland in boxes. If one of the birds is sick, the rest are likely to be sick as well since they are crammed in one box," he said.

Aidia Chan, a postgraduate student in ecology, said the bird-freeing ritual is held often. Chan studied the releases for her thesis last year at Hong Kong University.

She contacted 229 religious groups and 48 admitted they released birds to seek blessings. The groups practiced the ritual one to 18 times each year, releasing as many as 3,000 birds each time.

"Based on the figures they gave me, I estimate they have released a range of 400,000 to 600,000 birds in 2006," Chan said.

"There are also people who buy and release birds individually, and there's no way for me to quantify them. There should be more than 48 groups."

Figures from the Agriculture, Fisheries and Conservation Department showed 38,000 munia species - including white-backed munia and scaly- breasted munia - were imported into Hong Kong last year.

Hong Kong tested 11,000 birds for the H5 strain of bird flu last year and 17 were positive.

One Buddhist group said many of its followers had stopped releasing birds since the outbreak of bird flu in the city.

"Some of the followers do not feel comfortable getting in touch with birds since bird flu cases were reported. They were worried the birds might be infected," said Winnie Lam of the Hong Kong Buddhist Cultural Association.

Lam recalled they would free more than 1,000 birds at one time as part of the ritual, but have now switched to releasing hundreds of fish into the sea each month. "We believe releasing life can build up one's benevolence and life belongs to nature," Lam said.

The government has called on the public not to release birds as they have little chance of surviving in the wild. But it declined to comment whether the administration has considered a complete ban on releasing birds.

Young said while releasing life is a virtuous deed, people should realize the birds were caught somewhere else before they could be released to perform the ritual.

"It may take more than 150 [caught birds] to provide 100 birds," he said.

"Many might have died before they were delivered in Hong Kong. So are they doing a good cause?"

Bird flu 'buddies' plan

Jo Revill, health editor
Sunday January 14, 2007
The Observer

Everyone in Britain will be asked to name a friend or relative who would be willing to bring them life-saving medication in the event of a flu pandemic.
Under a national pandemic plan being unveiled this week, patients who fall ill with symptoms of a highly virulent form will rely on their 'bird flu buddies' to bring them emergency Tamiflu tablets, rather than a doctor or nurse.

Government planners believe the NHS would soon be overwhelmed if healthcare staff had to see every sick person before handing out packets of the antiviral medication that can lessen the complications of pandemic flu.

The tablets need to be given ideally within 12 hours of the appearance of symptoms, which include a very high temperature and difficulties with breathing.
The bird flu virus, H5N1, is endemic in many parts of the Far East, but has not yet changed into a form capable of spreading easily between people, which would then cause a global pandemic.

However, Margaret Chan, the new head of the World Health Organisation, has warned that the risk is higher than ever given recent deaths in Indonesia, and that countries need to look at how to ensure that treatment would reach people easily.

The new model of care would come into action if H5N1 starts to mutate and shows signs of spreading between people. Everyone in Britain will be asked by their local primary care trust to name a friend or relative who could be called on for help in a pandemic.

If or when the pandemic arrives in Britain, people who fall ill would ring a helpline and, if their symptoms match those of pandemic flu, the 'buddy' would be contacted and asked to collect the medication from a central depot and deliver it as quickly as possible to their friend.

Anyone who is seriously ill would either receive a home visit or be sent to an influenza centre - a new medical facility which would deal only with those suffering from complications, which could include people with heart disease or diabetes, or young children.

Under current predictions that around 35 per cent of people would catch the virus, the numbers falling ill are likely to run into several million. Although most would recover, around a third of those affected would have a complication and a further 3 per cent would need hospital care.

A Department of Health spokeswoman confirmed that it was looking at a new model of emergency care. 'This would be a unique situation for the country, and we will be asking people to take a personal and social responsibility for their care.

The NHS won't be able to do everything, so we would ask people to identify a friend or member of their family to collect the medication if they are symptomatic.'

Europe warned over resurgence of bird flu
By John Aglionby in Jakarta

Published: January 14 2007 18:21 | Last updated: January 14 2007 18:21

The deadly H5N1 strain of avian influenza is making a seasonal resurgence in Asia and could easily spread to Europe again this year, the World Health Organisation warned on Sunday.

The alarm follows four human deaths in Indonesia in the last five days, the first human case in China for six months (though the infected man has since recovered) and new poultry outbreaks in Vietnam – despite a huge campaign against it – and northern Nigeria.

“We are convinced that we’re in a repeat of last year and the year before when the virus began to get very active again [in the northern hemisphere winter] and spread from Asia into the Middle East and beyond,” said Peter Cordingley, the WHO spokesman for the western Pacific region.

Indonesia, where 61 people have died since 2005, remained the “biggest flashpoint” but nowhere in the region “has got it licked”. “Most countries are becoming better prepared and the countries that were caught out last year, especially wealthier ones in Europe and close to Europe, we hope are going to be better prepared,” he said. “But we’re still losing more than we’re winning.”

The strain detected in Asia is a mutation of last year’s but “it is not showing any sign of moving to a strain that would be more dangerous to humans or have a greater likelihood of human-to-human transmission,” Mr Cordingley said.

All four human fatalities in Indonesia contracted the virus from infected birds, authorities say. Experts fear that H5N1 will combine with a human flu strain to mutate into a form that would cause a global human pandemic.

Tri Satya Naipospos, the deputy head of Indonesia’s bird flu commission and a persistent critic of the country’s efforts, said Jakarta was still not allocating adequate financial or human resources to the issue.

The latest outbreak in Vietnam, in six southern provinces, comes despite a widespread poultry cull and tight controls on birds that had resulted in no human cases since 2005.

In signs that neighbouring nations view south-east Asia as the most likely source of a pandemic, both China and Australia announced new assistance at a regional leaders’ summit. Japan’s Miyazaki prefecture yesterday began the disposal of 12,000 chickens after confirming the first outbreak of avian influenza since January 2006 and tests will determine whether it is the deadly H5N1 strain.

Additional reporting by Amy Kazmin in Bangkok, Roel Landingin in Cebu and David Pilling in Tokyo.

http://www.ft.com/cms/s/e9f79c66-a3f9-11db-bec4-0000779e2340.html

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