As deaths climb, experts dig in for long fight against avian flu

Sep 29, 2004 (CIDRAP News) – New cases of avian influenza in Southeast Asia this week have heightened surveillance, as key international health organizations ratchet up concerns about the pervasiveness of the disease

A 14-month-old Vietnamese boy who died on Sep 5 has been posthumously confirmed as a victim of H5N1 avian influenza, news reports said today.

Thai officials are investigating a family whose avian flu cases may have included a human-to-human transmission. Two members of that family have been confirmed as having the disease. Authorities have confirmed that a 26-year-old woman died from avian influenza after caring for her 11-year-old daughter, who also died. The daughter is believed to be the index case, but her flulike symptoms haven't been confirmed as H5N1, reports said.

One expert cautioned that the possibility of person-to-person transmission might have limited significance.

"Because the mother lived in a separate city, it was much easier to be confident that the likely mode of transmission or the probable mode of transmission was person to person," said Scott Dowell of the US Centers for Disease Control and Prevention (CDC) in Atlanta. "It doesn't necessarily tell us that anything has changed about the virus and about the way it is transmitted." Experts say that the 26-year-old's death resulted from close and prolonged contact with her daughter as she helped the girl in the hospital, and this did not indicate any risk to the wider population, the International Herald Tribune reported.

The second confirmed case is an aunt of the 11-year-old, a 32-year-old woman who is recovering. Her son is also recovering from a flulike illness. Those cases bring the number of laboratory-confirmed avian flu illnesses in Thailand and Vietnam to 42 in the months since a new outbreak hit Southeast Asia. Thirty of those victims have died.

Thai Prime Minister Thaksin Shinawatra on Wednesday told an emergency meeting of 76 provincial governors that the disease is "a big problem."

The deputy prime minister, Chaturon Chaisang, said the government had not educated poultry breeders well, and he criticized government agencies for not collaborating properly. He predicted Thailand would be grappling with this virus for at least 3 to 5 years.

"There are no fences along borders of countries in Asia to block migrating birds," he added, referring to the birds blamed for the movement of the disease across much of Asia this year. "As long as the disease persists in China, Vietnam and Malaysia, Thailand won't be able to get rid of bird flu and vice versa."

International authorities struck a similar theme, calling the avian flu epidemic a "crisis of global importance."

The UN Food and Agriculture Organization (FAO) and the World Organization for Animal Health (OIE) in a joint statement said that recent outbreaks in China, Vietnam, Cambodia, Malaysia, and Thailand show the virus will not likely be eradicated in the near future. The groups called for more research to understand the role of wildlife, domestic ducks, and pigs in transmitting avian influenza and encouraged major investments in veterinary services and early warning surveillance.

Responding to recent controversies about vaccinating birds against the disease, FAO and OIE said the slaughter of infected animals is still the best way to control the disease. The organizations said this policy may not be the most practical or adequate in some countries. Under those circumstances, countries wishing to eradicate the disease may choose vaccination to complement other efforts, the joint statement said. Use of vaccines does not imply an automatic loss of export markets, it added.

That was a step into a difficult debate. Thailand announced in mid September that its poultry would not be inoculated against the disease because vaccines offer no guarantee of safety. The country is among the top four poultry exporters in the world, the Associated Press reported earlier this month. Meanwhile, Chinese officials have issued a circular saying that poultry should be immunized more strongly in key areas and quarantined before and after they are butchered, the China Daily newspaper reported today.

See also:

FAO/OIE joint statement
http://www.fao.org/newsroom/en/news/2004/50961/index.html

World Health Organization Sep 28 update on Thailand
http://www.who.int/csr/don/2004_09_28a/en/

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