Jun 20, 2008 (CIDRAP News) – Lax biosecurity measures around poultry in some countries could lead to an increasing number of H5N1 avian influenza outbreaks that could exacerbate the global food crisis, an official from the United Nations Food and AgricultureOrganization (FAO) said at an international infectious disease conference in Malaysia today.
Juan Lubroth, senior officer with the FAO's infectious diseases group, made the comments during symposia on influenza in animals and people at the International Congress on Infectious Diseases (ICID), which started yesterday in Kuala Lumpur and runs through Jun22. ICID is the annual meeting of the International Society for InfectiousDiseases.
Lubroth said though fewer countries have experienced recent avian flu outbreaks, numerous small outbreaks continue to occur, according to an Associated Press (AP) report today. "It's like a boiling pot, and we need to keep the lid on that before it gets worse," he said.
He said 80% of the world's poor depend on livestock for their livelihood, and poultry has been an inexpensive protein source, the AP reported. However, he added that about 240 million poultry have been slaughtered to control the spread of H5N1.
Failure to protect the food supply of the world's poor only makes worse the effect of rising prices of rice, corn, and other staples, Lubroth said.
Global veterinary service capacity needs to be expanded, and more countries need to be transparent regarding disease surveillance and develop surveillance systems and policies to manage the disease, he said. "We fail to see that political commitment."
In the abstract that accompanied the presentation, Lubroth wrote that veterinary experts worry that government officials, in a panic over the threat to human health, are focusing nearly all of their efforts on accumulating antiviral and vaccine stockpiles, "forgetting that the origin of the malady was—and remains—a poultry problem."
Lubroth wrote that a lag in funding for poultry safety initiatives has prevented national veterinary services from mounting the border and regulatory controls needed to contain the disease within Southeast Asia.
Biosecurity: stalled or improving?
Today's comments from the FAO seem to counter some of the recent comments from a UN official on the state of global pandemic preparedness. On Jun 18, David Nabarro, the UN's influenza coordinator, listed national improvements in poultry biosecurity as a reason behind the organization's assessment that the world is better prepared for an influenza pandemic, according to an earlier report. He also said more countries are focusing their efforts on the link between human and animal health.
Other pandemic experts, such as Michael T. Osterholm, PhD, director of the University of Minnesota Center for Infectious Disease Research and Policy, publisher of CIDRAP News, disagree that the world is better prepared for a pandemic and say governments have not planned for supply, medicine, and utility disruptions that could severely damage the world's economy and worsen the impact of the disease on health.
Nabarro, however, expressed concern that the virus remains entrenched in several countries, particularly Indonesia, the country that has had the highest number of human cases anddeaths.
Indonesia reports on diagnostic challenges in human cases
In another presentation during the same ICID symposia, Sardikin Giriputro, director of the Sulianti Saroso Infectious Disease Hospital in Jakarta, Indonesia, gave an update on that country's clinical cases and spoke of challenges in diagnosing H5N1 infections.
With 135 cases and 110 deaths from the disease, according to the most recent World Health Organization (WHO) update, Indonesia has been hit harder than any other country by the H5N1 virus.
However, early this month Indonesia's health minister, Siti Fadilah Supari, said that the number of human cases has slowed this year, according to a Jun 5 AP report. She said only 18 people have been infected with the virus so far this year, compared with 27 for the same period in 2007 and 35 in 2006.
Giriputro said that some patients with H5N1 infections have been misdiagnosed with dengue fever and typhoid, which has delayed antiviral treatment, according to a report today from Reuters. Oseltamivir (Tamiflu) is the drug of choice for H5N1 illnesses and is best given within 24 to 36 hours of symptom onset.
He told the group that medical officials in Indonesia are finding that rapid test kits used to diagnose the H5N1 virus in animals are less reliable for testing human samples, according to the Reuters report.
"It depends on the viral load [from human samples]," Giriputro said, adding that false-negatives can occur when there isn't enough virus in the human sample.
Indonesia's government has been distributing oseltamivir to health centers in areas that have had poultry outbreaks and human cases, he said. Physicians prescribe the virus without waiting for laboratory results if patients have influenza-like illnesses and may have had contact with sick poultry.
In an abstract that accompanied his talk, Giriputro said about 50% of Indonesia's H5N1 patients had a history of direct contact with sick birds, 30% had indirect contact, and 20% had no contact that could be determined.
Lubroth and Giriputro ICID abstracts (pages 2 and 3, respectively)
Jun 18 CIDRAP News report "UN:Pandemic preparedness pays off, but threat remains