CAIRO, 12 October (IRIN) - Egyptian health officials on Thursday blamed the most recent case of human bird-flu infection in Egypt on poor observance of government regulations aimed at stamping out the virus, after it was confirmed on Wednesday that a 39-year old woman in the Nile Delta province of Gharbiya had contracted avian influenza.

Ministry of Health spokesperson Sayyid Abbasi said that "people are sticking to their habits, and they are forgetting our message."

Earlier this year, the Egyptian government and international agencies embarked on a nation-wide campaign to persuade the population not to keep poultry inside their homes.

The latest victim to be infected with the H5N1 virus , Hanan Aboul Magd, was admitted to hospital on 4 October. She reportedly contracted the virus after buying and slaughtering infected ducks at her home. She is the 15th human case of bird-flu in Egypt since the first signs of the outbreak were seen in the country in February. Six of those patients have since died.

Hanan is reported to be in a stable condition, and her family are being tested for the virus.

Egypt's densely populated Nile Valley saw the worst concentration of bird-flu infection this year outside Asia. The Valley lies on major routes for migratory birds, and has a large rural population that has traditionally reared poultry for food and income.

The government has overseen the culling of some 30 million birds since then, and has put into place tough restrictions on poultry keeping. So-called 'backyard birds', which are chickens or ducks kept in small numbers in low-income homes for extra food or cash, have been outlawed.

Dr John Jabbour, of the Communicable Diseases Surveillance Department at the World Health Organization's regional office in Cairo, said that "it is a matter of changing behaviour. People are sometimes not honest [about keeping birds]. They know they are in danger but for other reasons they still have them."

Jabbour also added that the government has succeeded in removing poultry from the homes of people in Cairo, "but in more rural areas people are not accepting that they have to get rid of backyard birds."

Minister for Health and Population Hatem el-Gabali said on Tuesday that hospitals across Egypt had been put on a high state of alert. The Ministry's spokesperson Abbassi also added "we are working to 'recharge' the media message, through all the available channels."

An incidence of the virus amongst poultry was also recorded last month in the Upper Egypt town of Edfu, although no human infection was reported.

HANOI, Jan. 10 (Xinhua) -- A mobile bird flu laboratory with an investment of 2 million U.S. dollars has become operational in Vietnam, local newspaper Pioneer reported Wednesday.

    The bio-safety lab inaugurated on Tuesday is able to rapidly conduct bird flu testing when the disease breaks out among human at large scale, the newspaper quoted Nguyen Tran Hien, director of Vietnam's National Institute of Hygiene and Epidemiology, as saying.

    The lab will give results of testing specimens from suspected bird flu patients in only one or two weeks, he said, noting that Vietnam now often has to send specimens abroad for testing and wait for outcomes in two months.

    In addition, it is easy to move the lab to localities with outbreaks among humans, helping reducing the risk of virus spreading on the way of transporting specimens and its jumping to health staff, Hien said.

    To date, Vietnam has detected 93 human bird flu cases, including 42 fatalities, in 32 localities, the Vietnamese Health Ministry said on Jan. 9, noting that it has seen no new human cases of infections since mid-November 2005.

    Bird flu has, since early December 2006, stricken 41 communes in 17 districts in the four southern provinces of Ca Mau, Bac Lieu, Hau Giang and Kien Giang, either killing or leading to the forced culling of more than 42,000 poultry, according to the Department of Animal Health under the Vietnamese Ministry of Agriculture and Rural Development.

    Bird flu outbreaks in Vietnam, starting in December 2003, have killed and led to the forced culling of dozens of millions of fowls in the country.    

Editor: Pliny Han

ABUJA, Nigeria -- The deadly H5N1 strain of bird flu has been found in two more Nigerian states, the Agricultural Ministry said Thursday.

The strain has been confirmed at two farms in Kano state and one in adjoining Plateau state, said Tope Ajakaiye, a ministry spokesman.

The highly pathogenic strain of avian flu, found in Nigerian chickens, is the first time the strain has been found in Africa, the World Organization for Animal Health and the World Health Organization (WHO) reported on Wednesday.

Africa's first documented case was reported Wednesday in Nigeria's Kaduna state, bringing the total to three states. "The federal government is doing everything to contain the disease within the three centers that have been located," said Ajakaiye in a statement.

The office of President Olusegun Obasanjo also confirmed the discovery of the disease.

Alex Thiermann, special adviser to the director general of the World Organization for Animal Health -- known as OIE, the initials of its French name -- said the discovery of the disease in one part of Africa does not bode well for the rest of the continent.

"We have been saying for a while that were the disease to get to Africa, it's a continent where most countries have very weak veterinary infrastructure," he told CNN. "And we know from our experience in Eastern Europe and in Southeast Asia that the rapidity to which the disease can be fought, and how quickly we can eliminate it ... is very directly related to the quality of the veterinary infrastructures."

Sixteen other countries have reported outbreaks of the H5N1 strain of avian flu in birds. Human cases of the deadly strain have been found in seven of those countries. About half of those infected -- 88 of 165 -- have died, according to the WHO.

"It is disappointing that the virus has spread this far," said WHO spokesman Dick Thompson.

"This does not change our pandemic alert level. The virus is moving around, and it makes it more difficult to pry it out of the environment. This does not change the overall risk assessment in terms of a pandemic."

According to an OIE news release, the first outbreak occurred in a commercial setting in the village of Jaji in the northern state of Kaduna.

Nigerian authorities quarantined the infected birds and began culling them. About 50,000 birds were affected, the organization said.

Nigerian Information Minister Frank Nweke Jr. said three farms were quarantined, one each in the states of Kaduna, Kano and Jos and that they could be out of operation for up to a year.

He said the government was paying farmers 250 naira ($1.95) for each bird culled to compensate for their loss and to encourage other farmers to report diseased birds.

OIE spokeswoman Maria Zampaglione told CNN that the organization would assemble a team of bird flu experts to send to Nigeria by the end of the week and that the government was being helpful in its assistance.

Part of the team's job, she said, will be to determine how the birds came to be infected.

Bird flu began ravaging poultry stocks across Asia in 2003, forcing the slaughter of 140 million birds and jumping to humans, killing dozens. It has since spread to Europe and the Middle East.

Health officials had feared a deadly bird flu virus could enter impoverished, loosely governed African regions where many people raise chickens at home for personal consumption.

Experts are also particularly concerned that H5N1 might mutate into a form spread easily among humans, triggering a pandemic capable of killing millions.

CNN Medical Producer Miriam Falco and journalist Christian Purefoy contributed to this report.

 

Indonesia braces as bird flu flares anew in Asia

By Mita Valina Liem

JAKARTA (Reuters) - Indonesia readied more hospitals to deal with a spike in bird flu cases while Japan confirmed its first outbreak of H5N1 in poultry in three years on Tuesday as the virus flared anew in Asia, mirroring past winters. 

Concern about the disease have rippled across the region, with an Indonesian hospital overwhelmed by human cases this week, and the virus spreading among flocks in Vietnam and flaring again in Thailand. 

Officials and residents cull poultry in a residential area in Jakarta January 15, 2007. Indonesia readied more hospitals to deal with a spike in bird flu cases while Japan confirmed its first outbreak of H5N1 in poultry in three years on Tuesday as the virus flared anew in Asia, mirroring past winters. (REUTERS/Stringer)

But the World Health Organisation (WHO) said there were no signs of the virus spreading between humans and the reaction of most countries was much better than in the past. 

"Obviously we are very concerned if this virus should develop the ability to transmit between humans. We have not seen any clear sign of that yet. We are hoping it will stay the way it is," Peter Cordingley, WHO spokesman for the Asia-Pacific, told Reuters Television in Manila. 

"A lot of countries have done very well. Their defences are better, the reaction is better, the surveillance is better. But if we want to describe this as a soccer game, I would say we are still in the first half and the virus is winning 5-2." 

Concerns grew as four Indonesians died this year after a six-week lull in cases, taking the number of human deaths from bird flu in the country to 61, the highest in the world. 

"In the event of an escalation, more hospitals must be prepared. We are taking an inventory of what they need," said Nyoman Kandun, the Indonesian health ministry's director general of communicable disease control. 

His comments came after a doctor at Jakarta's Persahabatan hospital, one of two designated to treat bird flu cases in the capital, said it was overwhelmed with patients with bird flu symptoms. 

FEARS OF A CLUSTER 

Six children were discharged after tests found they did not have the virus, but three are still in hospital and another three with similar symptoms have been admitted, said Muchtar Ikhsan, head of Persahabatan's bird flu ward. 

They include an 18-year-old man confirmed to have bird flu and his father from Serpong in west Java, who has similar symptoms but has so far tested negative for the H5N1 virus. 

The teenager's mother died of the disease last Thursday, raising fears of another possible cluster in Indonesia, where bird flu is endemic in around half of its 33 provinces. 

But Kandun said the father's negative results reinforced the suspicion that genetic factors were responsible for transmission of bird flu among humans. "Each of the 10 cluster cases that we have involved blood relatives." 

Indonesia has struggled to contain the disease as millions of backyard chickens live in close proximity to humans and health education campaigns have often been patchy. 

As Indonesia prepared to deal with the spike in cases, a Japanese farm official said an outbreak of bird flu at a poultry farm in southwestern Japan was due to the lethal H5N1 strain. 

There have been no reported cases of human infection or additional outbreaks in poultry in Japan. Almost 4,000 birds died from the disease at the affected farm, and authorities killed the remaining 8,000 chickens at the farm on Sunday. 

Authorities in Miyazaki prefecture said they had started to incinerate the dead birds, a process that was expected to take about 30 hours and end around midnight on Tuesday. Restrictions were also place on the movement of people and goods from farms located within a 10-km radius of the affected farm. 

H5N1 has spread across much of Asia, into Europe, the Middle East and Africa. Migrating birds and poultry smuggling are believed to be some of the ways the virus has spread. 

با سلام
ممنون از اطلاعات بسیار مفید و کامل شما ( منبع و تحقیقی کامل در مورد آنفولانزای مرغی )
امیدوارم مورد استفاده تمام اعضا قرار گیرد.....

What is avian influenza?

Avian influenza, or “bird flu”, is a contagious disease of animals caused by viruses that normally infect only birds and, less commonly, pigs. Avian influenza viruses are highly species-specific, but have, on rare occasions, crossed the species barrier to infect humans.

In domestic poultry, infection with avian influenza viruses causes two main forms of disease, distinguished by low and high extremes of virulence. The so-called “low pathogenic” form commonly causes only mild symptoms (ruffled feathers, a drop in egg production) and may easily go undetected. The highly pathogenic form is far more dramatic. It spreads very rapidly through poultry flocks, causes disease affecting multiple internal organs, and has a mortality that can approach 100%, often within 48 hours.

Which viruses cause highly pathogenic disease?

Influenza A viruses1 have 16 H subtypes and 9 N subtypes2. Only viruses of the H5 and H7 subtypes are known to cause the highly pathogenic form of the disease. However, not all viruses of the H5 and H7 subtypes are highly pathogenic and not all will cause severe disease in poultry.

On present understanding, H5 and H7 viruses are introduced to poultry flocks in their low pathogenic form. When allowed to circulate in poultry populations, the viruses can mutate, usually within a few months, into the highly pathogenic form. This is why the presence of an H5 or H7 virus in poultry is always cause for concern, even when the initial signs of infection are mild.

Do migratory birds spread highly pathogenic avian influenza viruses?

The role of migratory birds in the spread of highly pathogenic avian influenza is not fully understood. Wild waterfowl are considered the natural reservoir of all influenza A viruses. They have probably carried influenza viruses, with no apparent harm, for centuries. They are known to carry viruses of the H5 and H7 subtypes, but usually in the low pathogenic form. Considerable circumstantial evidence suggests that migratory birds can introduce low pathogenic H5 and H7 viruses to poultry flocks, which then mutate to the highly pathogenic form.

In the past, highly pathogenic viruses have been isolated from migratory birds on very rare occasions involving a few birds, usually found dead within the flight range of a poultry outbreak. This finding long suggested that wild waterfowl are not agents for the onward transmission of these viruses.

Recent events make it likely that some migratory birds are now directly spreading the H5N1 virus in its highly pathogenic form. Further spread to new areas is expected.

What is special about the current outbreaks in poultry?

The current outbreaks of highly pathogenic avian influenza, which began in South-east Asia in mid-2003, are the largest and most severe on record. Never before in the history of this disease have so many countries been simultaneously affected, resulting in the loss of so many birds.

The causative agent, the H5N1 virus, has proved to be especially tenacious. Despite the death or destruction of an estimated 150 million birds, the virus is now considered endemic in many parts of Indonesia and Viet Nam and in some parts of Cambodia, China, Thailand, and possibly also the Lao People’s Democratic Republic. Control of the disease in poultry is expected to take several years.

The H5N1 virus is also of particular concern for human health, as explained below.

Which countries have been affected by outbreaks in poultry?

From mid-December 2003 through early February 2004, poultry outbreaks caused by the H5N1 virus were reported in eight Asian nations (listed in order of reporting): the Republic of Korea, Viet Nam, Japan, Thailand, Cambodia, Lao People’s Democratic Republic, Indonesia, and China. Most of these countries had never before experienced an outbreak of highly pathogenic avian influenza in their histories.

In early August 2004, Malaysia reported its first outbreak of H5N1 in poultry, becoming the ninth Asian nation affected. Russia reported its first H5N1 outbreak in poultry in late July 2005, followed by reports of disease in adjacent parts of Kazakhstan in early August. Deaths of wild birds from highly pathogenic H5N1 were reported in both countries. Almost simultaneously, Mongolia reported the detection of H5N1 in dead migratory birds. In October 2005, H5N1 was confirmed in poultry in Turkey and Romania. Outbreaks in wild and domestic birds are under investigation elsewhere.

Japan, the Republic of Korea, and Malaysia have announced control of their poultry outbreaks and are now considered free of the disease. In the other affected areas, outbreaks are continuing with varying degrees of severity.

What are the implications for human health?

The widespread persistence of H5N1 in poultry populations poses two main risks for human health.

The first is the risk of direct infection when the virus passes from poultry to humans, resulting in very severe disease. Of the few avian influenza viruses that have crossed the species barrier to infect humans, H5N1 has caused the largest number of cases of severe disease and death in humans. Unlike normal seasonal influenza, where infection causes only mild respiratory symptoms in most people, the disease caused by H5N1 follows an unusually aggressive clinical course, with rapid deterioration and high fatality. Primary viral pneumonia and multi-organ failure are common. In the present outbreak, more than half of those infected with the virus have died. Most cases have occurred in previously healthy children and young adults.

A second risk, of even greater concern, is that the virus – if given enough opportunities – will change into a form that is highly infectious for humans and spreads easily from person to person. Such a change could mark the start of a global outbreak (a pandemic).

Where have human cases occurred?

In the current outbreak, laboratory-confirmed human cases have been reported in four countries: Cambodia, Indonesia, Thailand, and Vietnam.

Hong Kong has experienced two outbreaks in the past. In 1997, in the first recorded instance of human infection with H5N1, the virus infected 18 people and killed 6 of them. In early 2003, the virus caused two infections, with one death, in a Hong Kong family with a recent travel history to southern China.

How do people become infected?

Direct contact with infected poultry, or surfaces and objects contaminated by their faeces, is presently considered the main route of human infection. To date, most human cases have occurred in rural or periurban areas where many households keep small poultry flocks, which often roam freely, sometimes entering homes or sharing outdoor areas where children play. As infected birds shed large quantities of virus in their faeces, opportunities for exposure to infected droppings or to environments contaminated by the virus are abundant under such conditions. Moreover, because many households in Asia depend on poultry for income and food, many families sell or slaughter and consume birds when signs of illness appear in a flock, and this practice has proved difficult to change. Exposure is considered most likely during slaughter, defeathering, butchering, and preparation of poultry for cooking. There is no evidence that properly cooked poultry or eggs can be a source of infection.

Does the virus spread easily from birds to humans?

No. Though more than 100 human cases have occurred in the current outbreak, this is a small number compared with the huge number of birds affected and the numerous associated opportunities for human exposure, especially in areas where backyard flocks are common. It is not presently understood why some people, and not others, become infected following similar exposures.

What about the pandemic risk?

A pandemic can start when three conditions have been met: a new influenza virus subtype emerges; it infects humans, causing serious illness; and it spreads easily and sustainably among humans. The H5N1 virus amply meets the first two conditions: it is a new virus for humans (H5N1 viruses have never circulated widely among people), and it has infected more than 100 humans, killing over half of them. No one will have immunity should an H5N1-like virus emerge.

All prerequisites for the start of a pandemic have therefore been met save one: the establishment of efficient and sustained human-to-human transmission of the virus. The risk that the H5N1 virus will acquire this ability will persist as long as opportunities for human infections occur. These opportunities, in turn, will persist as long as the virus continues to circulate in birds, and this situation could endure for some years to come.

What changes are needed for H5N1 to become a pandemic virus?

The virus can improve its transmissibility among humans via two principal mechanisms. The first is a “reassortment” event, in which genetic material is exchanged between human and avian viruses during co-infection of a human or pig. Reassortment could result in a fully transmissible pandemic virus, announced by a sudden surge of cases with explosive spread.

The second mechanism is a more gradual process of adaptive mutation, whereby the capability of the virus to bind to human cells increases during subsequent infections of humans. Adaptive mutation, expressed initially as small clusters of human cases with some evidence of human-to-human transmission, would probably give the world some time to take defensive action.

What is the significance of limited human-to-human transmission?

Though rare, instances of limited human-to-human transmission of H5N1 and other avian influenza viruses have occurred in association with outbreaks in poultry and should not be a cause for alarm. In no instance has the virus spread beyond a first generation of close contacts or caused illness in the general community. Data from these incidents suggest that transmission requires very close contact with an ill person. Such incidents must be thoroughly investigated but – provided the investigation indicates that transmission from person to person is very limited – such incidents will not change the WHO overall assessment of the pandemic risk. There have been a number of instances of avian influenza infection occurring among close family members. It is often impossible to determine if human-to-human transmission has occurred since the family members are exposed to the same animal and environmental sources as well as to one another.

How serious is the current pandemic risk?

The risk of pandemic influenza is serious. With the H5N1 virus now firmly entrenched in large parts of Asia, the risk that more human cases will occur will persist. Each additional human case gives the virus an opportunity to improve its transmissibility in humans, and thus develop into a pandemic strain. The recent spread of the virus to poultry and wild birds in new areas further broadens opportunities for human cases to occur. While neither the timing nor the severity of the next pandemic can be predicted, the probability that a pandemic will occur has increased.

Are there any other causes for concern?

Yes. Several.

• Domestic ducks can now excrete large quantities of highly pathogenic virus without showing signs of illness, and are now acting as a “silent” reservoir of the virus, perpetuating transmission to other birds. This adds yet another layer of complexity to control efforts and removes the warning signal for humans to avoid risky behaviours.

• When compared with H5N1 viruses from 1997 and early 2004, H5N1 viruses now circulating are more lethal to experimentally infected mice and to ferrets (a mammalian model) and survive longer in the environment.

• H5N1 appears to have expanded its host range, infecting and killing mammalian species previously considered resistant to infection with avian influenza viruses.

• The behaviour of the virus in its natural reservoir, wild waterfowl, may be changing. The spring 2005 die-off of upwards of 6,000 migratory birds at a nature reserve in central China, caused by highly pathogenic H5N1, was highly unusual and probably unprecedented. In the past, only two large die-offs in migratory birds, caused by highly pathogenic viruses, are known to have occurred: in South Africa in 1961 (H5N3) and in Hong Kong in the winter of 2002–2003 (H5N1).

Why are pandemics such dreaded events?

Influenza pandemics are remarkable events that can rapidly infect virtually all countries. Once international spread begins, pandemics are considered unstoppable, caused as they are by a virus that spreads very rapidly by coughing or sneezing. The fact that infected people can shed virus before symptoms appear adds to the risk of international spread via asymptomatic air travellers.

The severity of disease and the number of deaths caused by a pandemic virus vary greatly, and cannot be known prior to the emergence of the virus. During past pandemics, attack rates reached 25-35% of the total population. Under the best circumstances, assuming that the new virus causes mild disease, the world could still experience an estimated 2 million to 7.4 million deaths (projected from data obtained during the 1957 pandemic). Projections for a more virulent virus are much higher. The 1918 pandemic, which was exceptional, killed at least 40 million people. In the USA, the mortality rate during that pandemic was around 2.5%.

Pandemics can cause large surges in the numbers of people requiring or seeking medical or hospital treatment, temporarily overwhelming health services. High rates of worker absenteeism can also interrupt other essential services, such as law enforcement, transportation, and communications. Because populations will be fully susceptible to an H5N1-like virus, rates of illness could peak fairly rapidly within a given community. This means that local social and economic disruptions may be temporary. They may, however, be amplified in today’s closely interrelated and interdependent systems of trade and commerce. Based on past experience, a second wave of global spread should be anticipated within a year.

As all countries are likely to experience emergency conditions during a pandemic, opportunities for inter-country assistance, as seen during natural disasters or localized disease outbreaks, may be curtailed once international spread has begun and governments focus on protecting domestic populations.

What are the most important warning signals that a pandemic is about to start?

The most important warning signal comes when clusters of patients with clinical symptoms of influenza, closely related in time and place, are detected, as this suggests human-to-human transmission is taking place. For similar reasons, the detection of cases in health workers caring for H5N1 patients would suggest human-to-human transmission. Detection of such events should be followed by immediate field investigation of every possible case to confirm the diagnosis, identify the source, and determine whether human-to-human transmission is occurring.

Studies of viruses, conducted by specialized WHO reference laboratories, can corroborate field investigations by spotting genetic and other changes in the virus indicative of an improved ability to infect humans. This is why WHO repeatedly asks affected countries to share viruses with the international research community.

What is the status of vaccine development and production?

Vaccines effective against a pandemic virus are not yet available. Vaccines are produced each year for seasonal influenza but will not protect against pandemic influenza. Although a vaccine against the H5N1 virus is under development in several countries, no vaccine is ready for commercial production and no vaccines are expected to be widely available until several months after the start of a pandemic.

Some clinical trials are now under way to test whether experimental vaccines will be fully protective and to determine whether different formulations can economize on the amount of antigen required, thus boosting production capacity. Because the vaccine needs to closely match the pandemic virus, large-scale commercial production will not start until the new virus has emerged and a pandemic has been declared. Current global production capacity falls far short of the demand expected during a pandemic.

What drugs are available for treatment?

Two drugs (in the neuraminidase inhibitors class), oseltamivir (commercially known as Tamiflu) and zanamivir (commercially known as Relenza) can reduce the severity and duration of illness caused by seasonal influenza. The efficacy of the neuraminidase inhibitors depends on their administration within 48 hours after symptom onset. For cases of human infection with H5N1, the drugs may improve prospects of survival, if administered early, but clinical data are limited. The H5N1 virus is expected to be susceptible to the neuraminidase inhibitors.

An older class of antiviral drugs, the M2 inhibitors amantadine and rimantadine, could potentially be used against pandemic influenza, but resistance to these drugs can develop rapidly and this could significantly limit their effectiveness against pandemic influenza. Some currently circulating H5N1 strains are fully resistant to these the M2 inhibitors. However, should a new virus emerge through reassortment, the M2 inhibitors might be effective.

For the neuraminidase inhibitors, the main constraints – which are substantial – involve limited production capacity and a price that is prohibitively high for many countries. At present manufacturing capacity, which has recently quadrupled, it will take a decade to produce enough oseltamivir to treat 20% of the world’s population. The manufacturing process for oseltamivir is complex and time-consuming, and is not easily transferred to other facilities.

So far, most fatal pneumonia seen in cases of H5N1 infection has resulted from the effects of the virus, and cannot be treated with antibiotics. Nonetheless, since influenza is often complicated by secondary bacterial infection of the lungs, antibiotics could be life-saving in the case of late-onset pneumonia. WHO regards it as prudent for countries to ensure adequate supplies of antibiotics in advance.

Can a pandemic be prevented?

No one knows with certainty. The best way to prevent a pandemic would be to eliminate the virus from birds, but it has become increasingly doubtful if this can be achieved within the near future.

Following a donation by industry, WHO will have a stockpile of antiviral medications, sufficient for 3 million treatment courses, by early 2006. Recent studies, based on mathematical modelling, suggest that these drugs could be used prophylactically near the start of a pandemic to reduce the risk that a fully transmissible virus will emerge or at least to delay its international spread, thus gaining time to augment vaccine supplies.

The success of this strategy, which has never been tested, depends on several assumptions about the early behaviour of a pandemic virus, which cannot be known in advance. Success also depends on excellent surveillance and logistics capacity in the initially affected areas, combined with an ability to enforce movement restrictions in and out of the affected area. To increase the likelihood that early intervention using the WHO rapid-intervention stockpile of antiviral drugs will be successful, surveillance in affected countries needs to improve, particularly concerning the capacity to detect clusters of cases closely related in time and place.

What strategic actions are recommended by WHO?

In August 2005, WHO sent all countries a document outlining recommended strategic actions for responding to the avian influenza pandemic threat. Recommended actions aim to strengthen national preparedness, reduce opportunities for a pandemic virus to emerge, improve the early warning system, delay initial international spread, and accelerate vaccine development.

Is the world adequately prepared?

No. Despite an advance warning that has lasted almost two years, the world is ill-prepared to defend itself during a pandemic. WHO has urged all countries to develop preparedness plans, but only around 40 have done so. WHO has further urged countries with adequate resources to stockpile antiviral drugs nationally for use at the start of a pandemic. Around 30 countries are purchasing large quantities of these drugs, but the manufacturer has no capacity to fill these orders immediately. On present trends, most developing countries will have no access to vaccines and antiviral drugs throughout the duration of a pandemic.

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1 Influenza viruses are grouped into three types, designated A, B, and C. Influenza A and B viruses are of concern for human health. Only influenza A viruses can cause pandemics.

2 The H subtypes are epidemiologically most important, as they govern the ability of the virus to bind to and enter cells, where multiplication of the virus then occurs. The N subtypes govern the release of newly formed virus from the cells

Avian Influenza Infection in Humans
October 17, 2005

Although avian influenza A viruses usually do not infect humans, several instances of human infections have been reported since 1997. Most cases of avian influenza infection in humans are thought to have resulted from direct contact with infected poultry or contaminated surfaces. However, there is still a lot to learn about how different subtypes and strains of avian influenza virus might affect humans. For example, it is not known how the distinction between low pathogenic and highly pathogenic strains might impact the health risk to humans. (For more information, see “Low Pathogenic versus Highly Pathogenic Avian Influenza Viruses” on the CDC Influenza Viruses Web page.

Because of concerns about the potential for more widespread infection in the human population, public health authorities closely monitor outbreaks of human illness associated with avian influenza. To date, human infections with avian influenza A viruses detected since 1997 have not resulted in sustained human-to-human transmission. However, because influenza A viruses have the potential to change and gain the ability to spread easily between people, monitoring for human infection and person-to-person transmission is important. (See Information about Influenza Pandemics for more information.)

Instances of Avian Influenza Infections in Humans
Confirmed instances of avian influenza viruses infecting humans since 1997 include:

H5N1, Hong Kong, Special Administrative Region, 1997: Highly pathogenic avian influenza A (H5N1) infections occurred in both poultry and humans. This was the first time an avian influenza A virus transmission directly from birds to humans had been found. During this outbreak, 18 people were hospitalized and six of them died. To control the outbreak, authorities killed about 1.5 million chickens to remove the source of the virus. Scientists determined that the virus spread primarily from birds to humans, though rare person-to-person infection was noted.
H9N2, China and Hong Kong , Special Administrative Region, 1999: Low pathogenic avian influenza A (H9N2) virus infection was confirmed in two children and resulted in uncomplicated influenza-like illness. Both patients recovered, and no additional cases were confirmed. The source is unknown, but the evidence suggested that poultry was the source of infection and the main mode of transmission was from bird to human. However, the possibility of person-to-person transmission could not be ruled out. Several additional human H9N2 infections were reported from China in 1998-99.
H7N2, Virginia , 2002: Following an outbreak of H7N2 among poultry in the Shenandoah Valley poultry production area, one person was found to have serologic evidence of infection with H7N2.
H5N1, China and Hong Kong, Special Administrative Region, 2003: Two cases of highly pathogenic avian influenza A (H5N1) infection occurred among members of a Hong Kong family that had traveled to China . One person recovered, the other died. How or where these two family members were infected was not determined. Another family member died of a respiratory illness in China , but no testing was done.
H7N7, Netherlands, 2003: The Netherlands reported outbreaks of influenza A (H7N7) in poultry on several farms. Later, infections were reported among pigs and humans. In total, 89 people were confirmed to have H7N7 influenza virus infection associated with this poultry outbreak. These cases occurred mostly among poultry workers. H7N7-associated illness included 78 cases of conjunctivitis (eye infections) only; 5 cases of conjunctivitis and influenza-like illnesses with cough, fever, and muscle aches; 2 cases of influenza-like illness only; and 4 cases that were classified as “other.” There was one death among the 89 total cases. It occurred in a veterinarian who visited one of the affected farms and developed acute respiratory distress syndrome and complications related to H7N7 infection. The majority of these cases occurred as a result of direct contact with infected poultry; however, Dutch authorities reported three possible instances of transmission from poultry workers to family members. Since then, no other instances of H7N7 infection among humans have been reported.
H9N2, Hong Kong , Special Administrative Region, 2003: Low pathogenic avian influenza A (H9N2) infection was confirmed in a child in Hong Kong . The child was hospitalized and recovered.
H7N2, New York , 2003: In November 2003, a patient with serious underlying medical conditions was admitted to a hospital in New York with respiratory symptoms. One of the initial laboratory tests identified an influenza A virus that was thought to be H1N1. The patient recovered and went home after a few weeks. Subsequent confirmatory tests conducted in March 2004 showed that the patient had been infected with avian influenza A (H7N2) virus.
H7N3 in Canada, 2004: In February 2004, human infections of highly pathogenic avian influenza A (H7N3) among poultry workers were associated with an H7N3 outbreak among poultry. The H7N3-associated, mild illnesses consisted of eye infections.
H5N1, Thailand and Vietnam, 2004, and other outbreaks in Asia during 2004 and 2005: In January 2004, outbreaks of highly pathogenic influenza A (H5N1) in Asia were first reported by the World Health Organization. Visit the Avian Influenza section of the World Health Organization Web site for more information and updates.
Symptoms of Avian Influenza in Humans
The reported symptoms of avian influenza in humans have ranged from typical influenza-like symptoms (e.g., fever, cough, sore throat, and muscle aches) to eye infections (conjunctivitis), pneumonia, acute respiratory distress, viral pneumonia, and other severe and life-threatening complications.

Antiviral Agents for Influenza

Four different influenza antiviral drugs (amantadine, rimantadine, oseltamivir, and zanamivir) are approved by the U.S. Food and Drug Administration (FDA) for the treatment of influenza; three are approved for prophylaxis. All four have activity against influenza A viruses. However, sometimes influenza strains can become resistant to these drugs, and therefore the drugs may not always be effective. For example, analyses of some of the 2004 H5N1 viruses isolated from poultry and humans in Asia have shown that the viruses are resistant to two of the medications (amantadine and rimantadine). Monitoring of avian influenza A viruses for resistance to influenza antiviral medications is ongoing.

Transmission of Influenza A Viruses Between Animals and People
October 17, 2005
General Information on
Avian Flu
Key Facts
Flu Pandemics
Infections in Humans
Transmission Between Animals & People
Spread among Birds
Flu Viruses
Avian Flu A Viruses


Influenza A viruses have infected many different animals, including ducks, chickens, pigs, whales, horses, and seals. However, certain subtypes of influenza A virus are specific to certain species, except for birds, which are hosts to all known subtypes of influenza A. Subtypes that have caused widespread illness in people either in the past or currently are H3N2, H2N2, H1N1, and H1N2. H1N1 and H3N2 subtypes also have caused outbreaks in pigs, and H7N7 and H3N8 viruses have caused outbreaks in horses.

Influenza A viruses normally seen in one species sometimes can cross over and cause illness in another species. For example, until 1998, only H1N1 viruses circulated widely in the U.S. pig population. However, in 1998, H3N2 viruses from humans were introduced into the pig population and caused widespread disease among pigs. Most recently, H3N8 viruses from horses have crossed over and caused outbreaks in dogs.

Avian influenza A viruses may be transmitted from animals to humans in two main ways:

Directly from birds or from avian virus-contaminated environments to people.
Through an intermediate host, such as a pig.
Influenza A viruses have eight separate gene segments. The segmented genome allows influenza A viruses from different species to mix and create a new influenza A virus if viruses from two different species infect the same person or animal. For example, if a pig were infected with a human influenza A virus and an avian influenza A virus at the same time, the new replicating viruses could mix existing genetic information (reassortment) and produce a new virus that had most of the genes from the human virus, but a hemagglutinin and/or neuraminidase from the avian virus. The resulting new virus might then be able to infect humans and spread from person to person, but it would have surface proteins (hemagglutinin and/or neuraminidase) not previously seen in influenza viruses that infect humans.

This type of major change in the influenza A viruses is known as antigenic shift. Antigenic shift results when a new influenza A subtype to which most people have little or no immune protection infects humans. If this new virus causes illness in people and can be transmitted easily from person to person, an influenza pandemic can occur.

It is possible that the process of genetic reassortment could occur in a human who is co-infected with avian influenza A virus and a human strain of influenza A virus. The genetic information in these viruses could reassort to create a new virus with a hemagglutinin from the avian virus and other genes from the human virus. Theoretically, influenza A viruses with a hemagglutinin against which humans have little or no immunity that have reassorted with a human influenza virus are more likely to result in sustained human-to-human transmission and pandemic influenza. Therefore, careful evaluation of influenza viruses recovered from humans who are infected with avian influenza is very important to identify reassortment if it occurs.

Although it is unusual for people to get influenza virus infections directly from animals, sporadic human infections and outbreaks caused by certain avian influenza A viruses and pig influenza viruses have been reported. (For more information see Avian Influenza Infections in Humans .) These sporadic human infections and outbreaks, however, rarely result in sustained transmission among humans.

Spread of Avian Influenza Viruses among Birds
Avian influenza viruses circulate among birds worldwide. Certain birds, particularly water birds, act as hosts for influenza viruses by carrying the virus in their intestines and shedding it. Infected birds shed virus in saliva, nasal secretions, and feces. Susceptible birds can become infected with avian influenza virus when they have contact with contaminated nasal, respiratory, or fecal material from infected birds. Fecal-to-oral transmission is the most common mode of spread between birds.

Most often, the wild birds that are host to the virus do not get sick, but they can spread influenza to other birds. Infection with certain avian influenza A viruses (for example, some H5 and H7 strains) can cause widespread disease and death among some species of domesticated birds. (For more information, see “Low Pathogenic versus Highly Pathogenic Avian Influenza Viruses.”)

Avian Influenza Outbreaks in Poultry
Domesticated birds may become infected with avian influenza virus through direct contact with infected waterfowl or other infected poultry, or through contact with surfaces (such as dirt or cages) or materials (such as water or feed) that have been contaminated with virus. People, vehicles, and other inanimate objects such as cages can be vectors for the spread of influenza virus from one farm to another. When this happens, avian influenza outbreaks can occur among poultry.

Avian influenza outbreaks among poultry occur worldwide from time to time. Since 1997, for example, more than 16 outbreaks of H5 and H7 influenza have occurred among poultry in the United States . The U.S. Department of Agriculture monitors these outbreaks.

Low pathogenic forms of avian influenza viruses are responsible for most avian influenza outbreaks in poultry. Such outbreaks usually result in either no illness or mild illness (e.g., chickens producing fewer or no eggs), or low levels of mortality.

When highly pathogenic influenza H5 or H7 viruses cause outbreaks, between 90% and 100% of poultry can die from infection. Animal health officials carefully monitor avian influenza outbreaks in domestic birds for several reasons:

the potential for low pathogenic H5 and H7 viruses to evolve into highly pathogenic forms
the potential for rapid spread and significant illness and death among poultry during outbreaks of highly pathogenic avian influenza
the economic impact and trade restrictions from a highly pathogenic avian influenza outbreak.
the possibility that avian influenza could be transmitted to humans
When avian influenza outbreaks occur in poultry, quarantine and depopulation (or culling) and surveillance around affected flocks is the preferred control and eradication option.

Pandemic: A Worldwide Outbreak of Influenza
An influenza pandemic is a global outbreak of disease that occurs when a new influenza A virus appears or “emerges” in the human population, causes serious illness, and then spreads easily from person to person worldwide. Pandemics are different from seasonal outbreaks or “epidemics” of influenza. Seasonal outbreaks are caused by subtypes of influenza viruses that already circulate among people, whereas pandemic outbreaks are caused by new subtypes, by subtypes that have never circulated among people, or by subtypes that have not circulated among people for a long time. Past influenza pandemics have led to high levels of illness, death, social disruption, and economic loss.

Appearance (Emergence) of Pandemic Influenza Viruses
There are many different subtypes of Influenza or “flu” viruses. The subtypes differ based upon certain proteins on the surface of the virus (the hemagglutinin or “HA” protein and the neuraminidase or the “NA” protein).

Pandemic viruses emerge as a result of a process called "antigenic shift,” which causes an abrupt or sudden, major change in influenza A viruses. These changes are caused by new combinations of the HA and/or NA proteins on the surface of the virus. Changes results in a new influenza A virus subtype. The appearance of a new influenza A virus subtype is the first step toward a pandemic; however, to cause a pandemic, the new virus subtype also must have the capacity to spread easily from person to person. Once a new pandemic influenza virus emerges and spreads, it usually becomes established among people and moves around or “circulates” for many years as seasonal epidemics of influenza. The U.S. Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) have large surveillance programs to monitor and detect influenza activity around the world, including the emergence of possible pandemic strains of influenza virus.

Influenza Pandemics during the 20th Century
During the 20th century, the emergence of several new influenza A virus subtypes caused three pandemics, all of which spread around the world within a year of being detected.

1918-19, "Spanish flu," [A (H1N1)], caused the highest number of known influenza deaths. (However, the actual influenza virus subtype was not detected in the 1918-19 pandemic). More than 500,000 people died in the United States , and up to 50 million people may have died worldwide. Many people died within the first few days after infection, and others died of secondary complications. Nearly half of those who died were young, healthy adults. Influenza A (H1N1) viruses still circulate today after being introduced again into the human population in 1977.
1957-58, "Asian flu," [A (H2N2)], caused about 70,000 deaths in the United States . First identified in China in late February 1957, the Asian flu spread to the United States by June 1957.
1968-69, " Hong Kong flu," [A (H3N2)], caused about 34,000 deaths in the United States . This virus was first detected in Hong Kong in early 1968 and spread to the United States later that year. Influenza A (H3N2) viruses still circulate today.
Both the 1957-58 and 1968-69 pandemics were caused by viruses containing a combination of genes from a human influenza virus and an avian influenza virus. The 1918-19 pandemic virus appears to have an avian origin.

Stages of a Pandemic
WHO has developed a global influenza preparedness plan , which defines the stages of a pandemic, outlines the role of WHO, and makes recommendations for national measures before and during a pandemic. The phases are:

Interpandemic period

Phase 1 : No new influenza virus subtypes have been detected in humans. An influenza virus subtype that has caused human infection may be present in animals. If present in animals, the risk of human infection or disease is considered to be low.

Phase 2 : No new influenza virus subtypes have been detected in humans. However, a circulating animal influenza virus subtype poses a substantial risk of human disease.

Pandemic alert period

Phase 3 : Human infection(s) with a new subtype, but no human-to-human spread, or at most rare instances of spread to a close contact.

Phase 4 : Small cluster(s) with limited human-to-human transmission but spread is highly localized, suggesting that the virus is not well adapted to humans.

Phase 5 : Larger cluster(s) but human-to-human spread still localized, suggesting that the virus is becoming increasingly better adapted to humans but may not yet be fully transmissible (substantial pandemic risk).

Pandemic period

Phase 6 : Pandemic: increased and sustained transmission in general population.

Notes: The distinction between phases 1 and 2 is based on the risk of human infection or disease resulting from circulating strains in animals. The distinction is based on various factors and their relative importance according to current scientific knowledge. Factors may include pathogenicity in animals and humans, occurrence in domesticated animals and livestock or only in wildlife, whether the virus is enzootic or epizootic, geographically localized or widespread, and other scientific parameters.

The distinction among phases 3 , 4, and is based on an assessment of the risk of a pandemic. Various factors and their relative importance according to current scientific knowledge may be considered. Factors may include rate of transmission, geographical location and spread, severity of illness, presence of genes from human strains (if derived from an animal strain), and other scientific parameters.

Vaccines to Protect Against Pandemic Influenza Viruses
A vaccine probably would not be available in the early stages of a pandemic. When a new vaccine against an influenza virus is being developed, scientists around the world work together to select the virus strain that will offer the best protection against that virus. Manufacturers then use the selected strain to develop a vaccine. Once a potential pandemic strain of influenza virus is identified, it takes several months before a vaccine will be widely available. If a pandemic occurs, the U.S. government will work with many partner groups to make recommendations guiding the early use of available vaccine.

Antiviral Medications to Prevent and Treat Pandemic Influenza
Four different influenza antiviral medications (amantadine, rimantadine, oseltamivir, and zanamivir) are approved by the U.S. Food and Drug Administration (FDA) for the treatment and/or prevention of influenza. All four usually work against influenza A viruses. However, the drugs may not always work, because influenza virus strains can become resistant to one or more of these medications. For example, the influenza A (H5N1) viruses identified in human in Asia in 2004 and 2005 have been resistant to amantadine and rimantadine. Monitoring of avian viruses for resistance to influenza antiviral medications continues.

Preparing for the Next Pandemic
Many scientists believe it is only a matter of time until the next influenza pandemic occurs. The severity of the next pandemic cannot be predicted, but modeling studies suggest that the impact of a pandemic on the United States could be substantial. In the absence of any control measures (vaccination or drugs), it has been estimated that in the United States a “medium–level” pandemic could cause 89,000 to 207,000 deaths, 314,000 and 734,000 hospitalizations, 18 to 42 million outpatient visits, and another 20 to 47 million people being sick. Between 15% and 35% of the U.S. population could be affected by an influenza pandemic, and the economic impact could range between $71.3 and $166.5 billion.

Influenza pandemics are different from many of the threats for which public health and health-care systems are currently planning:

A pandemic will last much longer than most public health emergencies and may include “waves” of influenza activity separated by months (in 20th century pandemics, a second wave of influenza activity occurred 3 to 12 months after the first wave).
The numbers of health-care workers and first responders available to work can be expected to be reduced. They will be at high risk of illness through exposure in the community and in health-care settings, and some may have to miss work to care for ill family members.
Resources in many locations could be limited, depending on the severity and spread of an influenza pandemic.
Because of these differences and the expected size of an influenza pandemic, it is important to plan preparedness activities that will permit a prompt and effective public health response. The U.S. Department of Health and Human Services (HHS) supports pandemic influenza activities in the areas of surveillance (detection), vaccine development and production, strategic stockpiling of antiviral medications, research, and risk communications. In May 2005, the U.S. Secretary of HHS created a multi-agency National Influenza Pandemic Preparedness and Response Task Group. This unified initiative involves CDC and many other agencies (international, national, state, local and private) in planning for a potential pandemic. Its responsibility includes revision of a U.S. National Pandemic Influenza Response and Preparedness Plan.

Avian Influenza Vaccines
October 14, 2005
H5N1 Vaccines
Currently no vaccine is available to protect humans against the H5N1 virus that is being seen in Asia. However, vaccine development efforts are under way. Research studies to test a vaccine to protect humans against H5N1 virus began in April 2005. (Researchers are also working on a vaccine against H9N2, another bird flu virus subtype.) For more information, please see the following sites:

Avian Influenza A Viruses

Influenza viruses that infect birds are called avian influenza viruses. Only influenza A viruses infect birds, and all known subtypes of influenza A viruses can infect birds. However, there are substantial genetic differences between the subtypes that typically infect both people and birds. Within subtypes of avian influenza A viruses there also are different strains (described in Influenza Viruses – Types, Subtypes, and Strains).

Avian influenza A H5 and H7 viruses can be distinguished as “low pathogenic” and “high pathogenic” forms on the basis of genetic features of the virus and the severity of the illness they cause in poultry; influenza H9 virus has been identified only in a “low pathogenicity” form. Each of these three avian influenza A viruses (H5, H7, and H9) theoretically can be partnered with any one of nine neuraminidase surface proteins; thus, there are potentially nine different forms of each subtype (e.g., H5N1, H5N2, H5N3, H5N9).

Summary information follows about these three prominent subtypes of avian influenza A viruses:

Influenza A H5
Potentially nine different subtypes
Can be highly pathogenic or low pathogenic
H5 infections have been documented among humans, sometimes causing severe illness and death
Influenza A H7

Potentially nine different subtypes
Can be highly pathogenic or low pathogenic
H7 infection in humans is rare, but can occur among persons who have direct contact with infected birds; symptoms may include conjunctivitis and/or upper respiratory symptoms
Influenza A H9

Potentially nine different subtypes
Documented only in low pathogenic form
At least three H9 infections in humans have been confirmed

Avian influenza – situation in Turkey - update 4
Sequencing of human virus

12 January 2006

Laboratory tests conducted in Turkey have confirmed detection of the H5 subtype of avian influenza virus in samples from an additional two patients. The patients are residents of Sanliurfa Province, near the southern border with Syria, and Siirt Province, which is adjacent to Van in the eastern part of the country. Human cases have now been reported from nine of the country’s 81 provinces.

Both patients are young children, aged four and six years, and both have a documented history of direct contact with diseased birds. In Sanliurfa Province, outbreaks in backyard poultry are now thought to date back to late November 2005. Altogether, agricultural officials have confirmed poultry outbreaks in 11 provinces and are investigating possible outbreaks in an additional 14 provinces across the country.

Laboratory tests completed today in Turkey have detected the H5 virus subtype in post-mortem specimens taken from a 12-year-old girl, from Agri Province, who died 7 January. The child was the sibling of two other patients who died earlier. Their infection with the H5N1 virus was subsequently confirmed by a WHO collaborating laboratory in the United Kingdom.

The Ministry of Health is now reporting 18 laboratory-confirmed cases, of which three, all from the same family, have been fatal.

Arrangements have been made to send specimens from several patients to the UK collaborating laboratory for further analysis. Due to official holidays in Turkey, specimens are not expected to arrive in the UK before Monday. The head of the collaborating laboratory is now in Ankara to support diagnostic work at the country’s national influenza centre. Ways are being sought to expedite the testing of patient samples. High awareness of the disease in the Turkish population, combined with almost daily reports of poultry outbreaks in new areas, has resulted in a large number of people concerned about exposure and seeking reassurance.

The rapid assessment of patients with a possible exposure history is providing a unique opportunity to learn more about the disease in humans. It is also generating data that can be used to assess the efficacy of antiviral drugs, as most people with an exposure history or respiratory symptoms are receiving oseltamivir either prophylactically or very early after the onset of symptoms.

Members of the international teams, in Van Province and Ankara, are today working with local experts to plan relevant studies. These studies should deepen understanding of the epidemiology of the disease, including the possibility that any human-to-human transmission may have occurred, the vulnerability to infection of health care workers and other occupationally-exposed groups, and the possibility that milder forms of the disease might be occurring in the general population.

All available evidence indicates that no sustained human-to-human transmission has occurred. As in Asia, contact with infected birds is the principal source of infection. The risk of infection for travellers to Turkey is negligible provided direct contact with dead or diseased domestic and wild birds is avoided.

Gene sequencing information on human viruses

The WHO Collaborating Centre for Reference and Research on influenza at the MRC National Institute for Medical Research in Mill Hill, London, has today completed genetic and antigenic analyses of viruses recovered from the first two fatal human cases in the Turkish outbreak.

Information provided to WHO indicates that these viruses are very similar to current avian H5N1 viruses isolated from birds in Turkey. They are also closely related to viruses isolated from the large outbreak in migratory birds that occurred at the Qinghai Lake nature reserve in China, beginning in late April of last year.

These analyses indicate that the Turkish viruses are sensitive to both classes of antiviral drugs, including oseltamivir and amantadine. WHO and collaborating experts will review the data on amantadine sensitivity. Oseltamivir remains the drug of first choice recommended by WHO.

Virus from one of the patients shows mutations at the receptor-binding site. One of the mutations has been seen previously in viruses isolated from a small outbreak in Hong Kong in 2003 (two cases, one of which was fatal) and from the 2005 outbreak in Viet Nam. Research has indicated that the Hong Kong 2003 viruses bind preferentially to human cell receptors more so than to avian cell receptors. Researchers at the Mill Hill laboratory anticipate that the Turkish virus will also have this characteristic.

Interpretation of the significance of this finding for human health will depend on clinical and epidemiological data now being gathered in Turkey.

All available evidence indicates that no sustained human-to-human transmission is occurring in any country experiencing human cases.

The present WHO level of pandemic alert remains at phase 3: human infections with a new virus subtype are occurring, but the vast majority of these infections are acquired directly from animals.

Grippe aviaire
27/01/2006 - Derniers cas humains

L'Organisation Mondiale de la Santé a récemment confirmé de nouveaux cas humains d'infections par le virus H5N1 en Indonésie et en Chine. Deux personnes en Indonésie, une jeune fille de 13 ans et son petit frère de 4 ans, ont succombé à la grippe aviaire. Deux autres membres de leur famille souffrant de symptômes respiratoires, leur père et leur sœur, sont actuellement hospitalisés. Tous avaient eu des contacts étroits avec de la volaille infectée et avaient même participé à l'évacuation de poulets morts. En Chine, un dixième cas d'infection humaine, également fatal, a été recensé, chez une femme de 29 ans de la ville de Chengdu, dans la province de Sichuan. Cette province est touchée depuis fin décembre par l'épizootie. Au total depuis fin 2003, 152 cas humains, dont 83 mortels, ont été recensés, incluant les 4 cas confirmés mi-janvier en Turquie


آخرین مورد انسانی آنفلوانزای پرندگان
سازمان بهداشت جهانی ابتلای موارد جدیدی به ویروس آنفلوانزای H5N1 را در اندونزی و چین تایید كرده است. دو نفر در اندونزی ( یك دختر جوان 13 ساله و برادر 4 ساله او به این بیماری دچار شده اند. دو عضو دیگر از خانواده این بیماران علائم بیماری را از خود نشان می دهند. پدر خانواده و خواهر بیماران كه در حال حاضر بستری می باشند. تمام این افراد با طیور بیمار در تماس بوده اند.
در چین یك مورد مرگ ناشی از این بیماری در یك زن 29 ساله در شهر شنگ دو در استان سی چوان گزارش گردیده است. این استان از اواخر دسامبر گذشته درگیر اپیدمی بوده است. در مجموع از اواخر سال 2003 تاكنون ، 152 بیمار كه 83 نفر از آنها تلف گردیده اند گزارش شده است. بعلاوه در ماه ژانویه 4 مورد در تركیه به این بیماری مبتلا شده اند.
منبع: انستیتو پاستور پاریس

Avian Influenza: It’s not in your food
The scientific name for "bird flu" is "H5N1 highly pathogenic avian influenza" or "H5N1 HPAI."

We do not have H5N1 HPAI in the United States, and we have never had it.

Furthermore, you can feel confident that you cannot get the human form of avian influenza from properly handled and cooked food.

The heat of normal cooking destroys the virus that causes avian influenza. Microorganisms of all kinds are destroyed when the product reaches an internal temperature of 160 degrees Fahrenheit.

As usual, you should continue to take the normal steps to ensure the quality and safety of poultry products – chicken, turkey and eggs.

Keep the product refrigerated or frozen until ready to cook.
Thaw in refrigerator or microwave.
Keep raw meat and poultry separate from other foods.
Wash working surfaces (including cutting boards), utensils and hands after touching raw meat or poultry.
Cook thoroughly.
Keep hot foods hot.
Refrigerate leftovers immediately or discard.
The following chart provides the temperature to which your food is not only safe, but is the best quality:
Chicken, Turkey White Meat: 170 degrees F
Chicken, Turkey Dark Meat: 180 degrees F
Ground Chicken, Turkey: 165 degrees F
Eggs: 160 degrees F

Be assured that if the dangerous types of avian influenza should occur in the United States, the flocks involved will be destroyed. They will not be sold for use as raw food. No special precautions need to be taken by the consumer because of any fears about avian influenza.

More information is available from these web sites:
www.eatchicken.com
www.eatturkey.com
www.eggsafety.org
www.fightbac.org