Avian Flu - What we need to know

Vietnam finds new outbreaks near Chinese border

Vietnam has detected bird flu on three farms near the Chinese border, the second such finding in the past few days, an animal health official said on Saturday.

Health workers slaughtered 157 chickens and ducks after farmers said 30 birds died on March 19 on three farms in Cao Bang province, said Dang Quang Binh, head of the provincial Animal Health Department.

"We sent samples for testing and on March 25 the results showed H5 was found in poultry samples from the three farms," Binh told Reuters by telephone from Cao Bang, 270 km (167 miles) north of Hanoi.

He was referring to the H5 subtype avian flu virus.

No further tests were likely be done to confirm if the strain was H5N1, which has killed 42 people in Vietnam since late 2003.

Source. This story comes days after infected birds were found smuggled from China.

Bird flu found in poultry smuggled from China to Vietnam

Health authorities in Vietnam have discovered bird flu in poultry illegaly imported from China and are conducting tests to find out if it is the deadly H5N1 strain of the virus, officials said Thursday.

"We made test last week on 30 samples of smuggled poultry in northern Lang Son province," said Le Van Tao, deputy director of the Animal Health Institute at the agriculture ministry.

"Results have shown one of the samples was positive to the H5 virus of avian flu," he said.

Experts still had to determine whether it was the deadly H5N1 virus that has claimed 42 lives in the communist nation since December 2003.

Tests were also under way done on another 40 samples in neigbouring Quang Ninh province, which also borders China.

No new bird flu cases have been identified in Vietnam since December and the last human death was reported in November.

Source.

Vietnam update

In an impressive burst of action, Vietnam, once the epicenter for bird flu, has temporarily stamped out the disease: no people infected since November, and no poultry outbreaks since December.

The poor communist nation says it accomplished this feat by vaccinating millions of chickens and ducks, slaughtering millions more, by being honest with international health officials, and by educating its citizens.

There were even crackdowns on local delicacies, like duck blood pudding, believed to be the source of at least one death.

[...] Vietnam spent $18.9 million vaccinating 120 million birds last year and plans to immunize 160 million more birds, said Hoang Van Nam, deputy director of the Department of Animal Health. Eighty percent of the poultry sampled after vaccination had enough immunity to protect against the disease and none was found to be carrying the virus.

China claims to have vaccinated all of its 14 billion domestic birds, but it has continued to see outbreaks and human infections. Last week, Shanghai logged its first human bird flu death, bringing the human toll in China to at least 11, according to WHO.

Widespread immunization requires thousands of workers who must keep the vaccine chilled and return to farms to give booster shots three or four weeks after the first inoculation. A third injection is given four months later to poultry raised up to a year. But many birds have much shorter life spans, meaning the cycle constantly starts over.

Read more at CNN.

Vietnam announces new bird flu outbreak

Central Quang Tri province, one of 14 localities of Vietnam meeting criteria to announce an end to bird flu outbreaks, has just declared that the disease has reoccurred in its territory, local newspaper Saigon Liberation reported Tuesday.

Some fowls in the two districts of Gio Linh and Trieu Phong, and the two towns of Quang Tri and Dong Ha have recently died of bird flu virus strain H5N1, said the provincial People's Committee on Monday.

However, the Ministry of Agriculture and Rural Development has yet to confirm the return of bird flu in Quang Tri. The ministry's Department of Animal Health, on Dec. 26, announced that only seven localities, including the six northern provinces of Ninh Binh, Son La, Thai Nguyen, Quang Ninh, Ha Giang and Yen Bai, and the central province of Thanh Hoa, have yet to meet the criteria (detecting no new outbreaks for at least three weeks).

Read more here.

Two new human cases suspected in Indonesia and Vietnam

A 39-year-old Indonesian man "strongly suspected" of being infected with the deadly bird flu virus has died in hospital, a medical spokesman said here.

If confirmed, the man would be the 10th fatality from avian influenza in Indonesia. Five other infections have been confirmed here but the patients have survived.

The latest suspected victim came from South Jakarta and was admitted Monday to the Sulianti Saroso hospital, Indonesia's main bird flu treatment centre, but died on Tuesday, hospital spokesman Ilham Patu, told AFP.

He had shown symptoms of carrying the potentially deadly H5N1 bird flu strain, such as high fever and respiratory difficulties and had been moved from a private hospital in South Jakarta.

"He also showed another key symptom of bird flu infection, a rapid lowering of his white blood cell count," Patu said.

Source.

H5N1 links to a Reuters article claiming that a toddler from Vietnam's southern province of Hau Giang is believed to have died of bird flu.

Addendum: more recent media reports claim the Vietnamese toddler did not die from H5N1.

The latest human cases

A 25-year-old Indonesian woman who died has tested positive for bird flu, a senior researcher at the health ministry said on Wednesday.

Endang Mamahit said the woman had been treated at the Sulianto Saroso hospital, Jakarta's hospital for treating bird flu patients. She died on Tuesday.

From Reuters. Another human case is reported in Vietnam:

A 51-year-old man from Vietnam`s northern Thanh Hoa province has been hospitalized after exhibiting bird flu symptoms, local newspaper Vietnam Agriculture reported on Wednesday.

The man named Le Truong Hong is under treatment at the Thanh Hoa General Hospital, the hospital`s director Hoang Sy Binh said, adding that he still had high fever and breathing difficulties on Tuesday afternoon.

The patient`s specimens are being tested for bird flu viruses, Binh said, adding the man bought two ducks, slaughtered and ate them before he fell ill several days ago.

NPR report on Vietnam

Michael Sullivan reports from Hanoi, where he seems impressed with the measures taken by the local authorities. In addition to H5N1, H3 and H4 strains of bird flu have recently been reported in Vietnam, read Effect Measure on the implications.

More on the mutation discovered in Vietnam

H5N1 has already been mutating rapidly in Vietnam, where few chickens are vaccinated. Cao Bao Van, head of the Pasteur Institute in Ho Chi Minh City in Vietnam, told the Vietnamese press this week that 24 isolates of H5N1 from poultry and humans, taken between December 2003 and March 2005, show “significant variation”.

Cao was also quoted as saying a mutation had been observed in the PB2 gene of a virus isolated from a human case in March, which “allows more effective breeding of the virus in mammals”. PB2 codes for part of the polymerase enzyme which replicates the virus.

That mutation, at amino acid number 627 of the protein, changes the glutamic acid of bird flu to the lysine typical of human flu. The change allows the virus to replicate in the human respiratory tract, which is cooler than the bird guts where bird flu normally replicates.

The same mutation has been turning up since 2004 in several isolates of H5N1 from humans and other mammals in east Asia and shows the virus is adapting to mammals while infecting them. It was also a feature of the 1918 pandemic virus, which was a bird flu virus that adapted to humans.

From a New Scientist article that also informs us of a Chinese plan to vaccinate all poultry against bird flu.

New flu strain in Vietnam?

Vietnam, the country worst hit by bird flu, will send soldiers and police to help contain the spread of the virus as more outbreaks erupt and the sudden death of ducks in two provinces hints at a more virulent strain.

[...] The urgency was reinforced by Veterinary Institute head Truong Van Dung, who told a government meeting that bird flu may have become more virulent.

He cited the death within three to four hours of a flock of ducks in Bac Giang province. Even though none showed symptoms of the virus while alive, all 15 samples taken after their deaths were positive for the H5N1 strain of bird flu.

Dung could not be reached for further comment and there was no proof that H5N1 had become more virulent, but many ducks also died quickly in a field in Hai Duong province, the Nong Nghiep Vietnam newspaper said.

Source.

Roche transfers Tamiflu stockpile to government in China

The Chinese arm of Roche Holding AG said in a statement Tuesday that Tamiflu supplies are "now being transferred to China's Ministry of Health for centralized allocation and distribution." In the event of a possible human flu pandemic, Roche said, "the government is in the best position to handle rapid response and distribution" of Tamiflu, one of the few drugs believed to be effective against bird flu.

China hasn't reported any infections in humans with the virulent H5N1 strain of the virus, which has killed at least 62 people elsewhere in Asia. But health officials say a case is inevitable if China can't stop repeated outbreaks in poultry.

Chinese Health Minister Gao Qiang ordered local officials to step up efforts to prevent human infections and preparations to treat possible cases, the official Xinhua News Agency said. In a nationwide video conference, Mr. Gao told officials "to strengthen work at three key links, namely monitoring, control and treatment," Xinhua said. Mr. Gao ordered local health departments to share information and, in the event of a human infection, to use traditional Chinese medications, the report said. It didn't give any other details.

From the WSJ. The same article provides some details on the latest human death in Vietnam:

In Hanoi, meanwhile, an official in Vietnam's Health Ministry said the nation had confirmed its 42nd human death from bird flu. The 35-year-old man, who died at a Hanoi hospital on Oct. 29, tested positive for the H5N1 strain, said Nguyen Van Binh, deputy director of the Preventive Medicine Department under the Ministry of Health.

Mr. Binh said the man was admitted to the hospital on Oct. 26, four days after his family bought a prepared chicken from a market near his house in the Dong Da District of Hanoi. Other family members didn't show any symptoms of bird flu, he added.