Avian flu: Are we ready?

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In 1918 and 1919, influenza killed more people than were slaughtered in the entire First World War. And it could happen again, soon. All eyes are now on the H5N1 virus, which has already killed more than 50 people in Vietnam, Thailand and Cambodia. In this issue of Nature, leading researchers give their views on what should be done to avert a disaster, from controlling outbreaks at their source, to the need for a global pandemic task force. Read these together with coverage of the previous outbreaks in this accompanying Web Focus, free to access in association with The Royal Institution World Science Assembly


NatureNature devotes its News Feature and Commentary pages to a detailed consideration of the risks posed by avian flu, and how well we are prepared to deal with it. In the pages that follow, our reporters examine nations' capacity to produce a vaccine against a pandemic strain, and the adequacy of global stockpiles of antiviral drugs. They do not paint an encouraging picture.

Repeated warnings about the international community's failure to respond to the pandemic threat have fallen on deaf ears. So in our opening News Feature, we use the benefit of fictional hindsight to throw the issues into starker relief, describing a future pandemic through the weblogpage 415, experts who are grappling with the issues tackle some hard questions. Which nations are ready, and which are not? David Ho asks if China is in a better position to cope with new microbial threats since the 2003 SARS outbreak. And Anthony Fauci outlines what US researchers are doing to develop vaccines and drugs.

Asian countries are the most immediately vulnerable. Robert Webster and Diane HulseAlbert Osterhaus and his colleagues. They propose a permanent global flu task force to strengthen coordination among agencies on the ground.

If we are fortunate, we may still have the time to take these messages on board. As Michael Osterholm warns in his Commentary, a flu pandemic could bring human tragedy and a global economic catastrophe. Let's hope world leaders heed the warnings.

http://www.nature.com/cgi-bin/doifin...0.1038/435399a

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Pandemic Preparedness Project

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Flu pandemic 'could hit 20% of world's population'

Staff and agencies
Wednesday May 25, 2005
centre for infectious disease research and policy at the University of Minnesota, agreed that international cooperation was vital to minimise the impact of a pandemic flu virus.

He said there was a "critical need" for medical and non-medical planning, involving both the public and private sectors, at a level beyond anything considered so far.

"National, regional or local plans based on general statements of intent or action will be meaningless in the face of a pandemic," the professor said. He said a global effort was needed to develop a new type of vaccine that can be manufactured quickly and which targets multiple strains.

"Unfortunately, most industrial countries are looking at the vaccine issue through myopic lenses," he said, adding that time was running out to prepare for an outbreak.

"There will be an immediate response from leaders to stop the virus entering their countries by greatly reducing and even ending foreign travel and trade, as was seen in parts of Asia in response to the ... Sars epidemic.

"These efforts are doomed to fail given the infectiousness of the virus and the volume of illegal crossings that occur at most borders. But government officials will feel compelled to do something to demonstrate leadership. Individual communities will also want to bar 'outsiders'. Global, national and regional economies will come to an abrupt halt." The Asian H5N1 virus that first surfaced in poultry in Hong Kong and China eight years ago has killed 37 people in Vietnam, 12 in Thailand and four in Cambodia. Fears were raised in China this week after it was confirmed 178 migratory geese found dead in a nature reserve in Qinghai province had died of the H5N1 virus, but a report today in a government newspaper claimed the deaths were an isolated case.




http://www.guardian.co.uk/birdflu/st...492072,00.html

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Bird flu: 20% of globe may be hit

JAMES REYNOLDS
Thu 26 May 2005

A FIFTH of the world's population could be struck down with a new influenza pandemic, triggering global economic meltdown and a complete freeze on international travel, experts have warned.

Scientists say world leaders should start planning now for an outbreak that could lead to several million deaths, widespread panic and the collapse of international trade.

Only a global response, rather than countries focusing wholly on their own protection, would stand any chance of averting the catastrophe, it is claimed.

Fears of a pandemic have arisen after outbreaks of the H5N1 bird-flu strain in south-east Asia, which has caused a total of more than 50 confirmed human deaths. The fatality rate of humans infected by the virus is as high as 60 per cent.

At present, there is no evidence that the strain can be transmitted from one person to another, but it may only be a matter of time before the virus mutates into a form that can easily pass between people. Should that happen, it would spread rapidly around the world, with devastating consequences.

Scientists writing in the journal Nature said the world today was far more vulnerable to the effects of a pandemic than it was in 1918, when a deadly strain of influenza killed between 20 million and 40 million people.

An optimistic estimate suggests that the next flu pandemic could cause 20 per cent of the world's population to become ill. Within a few months, almost 30 million people would need to be hospitalised, and a quarter of them would die.

But the effects on today's highly interconnected world economy would be just as serious, it is claimed.

Professor Michael Osterholm, of the Centre for Infectious Disease Research and Policy at the University of Minnesota in Minneapolis, said: "The arrival of pandemic flu will trigger a reaction that will change the world overnight.

"There will be an immediate response from leaders to stop the virus entering their countries by greatly reducing and even ending foreign travel and trade - as was seen in parts of Asia in response to the severe acute respiratory syndrome [SARS] epidemic.

"These efforts are doomed to fail given the infectiousness of the virus and the volume of illegal crossings that occur at most borders. Global, national and regional economies will come to an abrupt halt."

International co-operation was vital to minimise the impact of a pandemic, Prof Osterholm said. In particular, a global effort was needed to develop a new type of vaccine that could be manufactured quickly and that targeted multiple strains. But he added: "Unfortunately, most industrial countries are looking at the vaccine issue through myopic lenses."

He warned that time was running out to prepare for the next flu pandemic and said there was a "critical need" for medical and non-medical planning, involving both the public and private sectors, at a level beyond anything considered so far.

Meanwhile, four Dutch experts, led by Dr Albert Osterhaus, from the Erasmus Medical Centre in Rotterdam, made an urgent call for a global taskforce to control a future pandemic.

It would consist of leading specialists in the fields of human and animal medicine, virology, epidemiology, pathology, ecology and agriculture. It would also include experts in translating science into policy. Management teams would be available to target specific flu outbreaks occurring anywhere in the world.

"Given the large geographical area in which the H5N1 virus has become endemic, and the greater potential for rapid virus spread, an efficient, effective, outbreak management team strategy, with centralised guidance, is urgently needed," the Dutch team said. Early detection and a rapid response to bird flu at a global level would greatly reduce the cost of dealing with a full-blown outbreak, they added.

Hugh Pennington, the internationally renowned emeritus professor of bacteriology at Aberdeen University, said: "If the mutation takes place or some kind of gene exchange happens to allow it to spread from person to person, then we get into the severity that this article [in Nature] discusses.

"Against this virus, we don't have any immunity, and it is the fact that it is brand new to our immune systems that gets people worried.

"How serious it is will depend on the kind of virus that develops, but we have no way of knowing, so it is really quite difficult to make any definitive predictions or put any odds on it happening at all. They are right to be concerned, and to call for well-formulated contingency plans, but it is very much something that we will have to wait and see about."


http://news.scotsman.com/international.cfm?id=573902005

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Flu pandemic looms, experts warn world

Many millions will die if Southeast Asian bird virus mutates to lethal form, spreads


Sabin Russell, Chronicle Medical Writer
Thursday, May 26, 2005

A lineup of leading infectious disease experts warned Wednesday that the world is unprepared for the health and economic consequences of an outbreak of pandemic influenza that could spring from a lethal strain of bird flu now ravaging poultry flocks in Southeast Asia.

In commentaries published in the British science journal Nature, doctors used some of the strongest language yet to suggest that the bird flu virus known as H5N1 could mutate into a form easily transmitted among people, creating a strain capable of killing millions.


"This virus has the potential to trigger the next pandemic, which, judging from history, is well overdue,'' wrote Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases in Bethesda, Md. "Clearly, there is much to be accomplished, and time is of the essence.''

Flu pandemics are global outbreaks of virulent influenza caused by a viral strain so different from those of prior years that the human population has no natural resistance to it.

The 1918 Spanish flu was such a pandemic, and it killed an estimated 20 million to 100 million people around the globe. The H5N1 virus has worried flu experts since 1997, when it first appeared in the Hong Kong chicken markets as a lethal virus dubbed bird Ebola. After it infected 18 people, killing six of them, Chinese authorities ordered the slaughter of 1.5 million chickens, abruptly stopping the outbreak.

In December 2003, H5N1 re-emerged in Southeast Asia and has killed millions of birds and 53 people. Efforts to contain the virus by culling birds have failed. The virus is being spread by wild ducks, which carry the virus but don't die of it.

In an interview, Fauci said the purpose of the Nature commentaries is to draw more world attention to the problem. "The ingredients (for a pandemic) are starting to accumulate,'' he said. "This is a situation that might go away this season, but it's not going away forever.''

Fauci said that federal spending on influenza preparedness has increased to $419 million from $40 million over the past five years but concedes he is not satisfied with the United States' current level of readiness.

For example, even though an experimental H5N1 vaccine is being tested, the system for manufacturing it -- the same system that produces millions of ordinary flu shots -- is failure-prone. "Capacity needs to be built up,'' Fauci said.

Similarly, the federal government has stockpiled only enough Tamiflu, an antiviral drug that has shown promise against bird flu, to treat 2.3 million Americans. That is less than 1 percent of the population. Great Britain has ordered enough to cover 25 percent of its people.

"We're definitely going to increase the stockpile. That's for sure,'' Fauci said, calling it a top priority of the Department of Health and Human Services. Just how much drug the government wants, he wouldn't say.

Swiss pharmaceuticals maker Roche Inc. produces the entire world supply of the drug at a single European plant. Federal authorities have been negotiating with Roche to build a Tamiflu factory in the United States.

In another Nature commentary, famed virologist Dr. David Ho of New York's Aaron Diamond AIDS Research Center argued that China needs to confront the emerging threat of bird flu openly. "The world, China included, must respond as if the next pandemic is imminent,'' he wrote. Ho estimated that up to 207,000 Americans could die in it. "What will the death toll be in China?" he asked.

Michael Osterholm, director of the University of Minnesota's Center for Infectious Disease Research and Policy, warned in his Nature paper of the economic consequences of a major pandemic.

"The world today is much more vulnerable to the collapse of trade than it was in 1918,'' he wrote. He dubbed the potential economic fallout "pandemic shock.''

Osterholm wrote that an H5N1 pandemic strain could rival the devastation of the 1918 pandemic. Industrialized nations reliant on "just in time" delivery of health care goods do not have enough medical supplies to care for the sick. "Nor are there detailed plans on how to handle the dead bodies whose numbers will soon outstrip our ability to process them,'' he wrote.

Osterholm said the world's leading economic powers need to confront the problem directly at the forthcoming G8 meeting in Scotland. He calculates that, with the world population swelled to 6.5 billion, a flu strain as lethal as the one in 1918 could kill 180 million to 360 million people worldwide.

Also an expert in terrorism, Osterholm observed that there were ample warning signs that an event such as the Sept. 11, 2001, attacks was possible. Those warnings were fully recognized only after the fact.
"People like myself are often seen as scaremongers," he said, "but I'm afraid we are doing this all over again.''

http://www.sfgate.com/cgi-bin/articl...MP&type=health<!-- END STORY -->

[Salman Al-Farsi]

I got Flu :(

[Mary Carol]

Avian Flu?

Best then that you skip the next Brother's Tuesday Meetup.