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24 February 2005

Concerns Mount About Emergence of Global Flu Pandemic

Asia's bird flu has potential to leap to humans, health officials say

By Charlene Porter
Washington File Staff Writer

Washington – International health officials are renewing their warnings about the potential for the birth of a worldwide flu epidemic on some unknown farm in Asia.

Poultry producers in the region have been battling outbreaks of avian influenza in their flocks for the last year. Hundreds of millions of birds have been culled in attempts to shut down the chain of disease transmission. In several dozen cases, the virus, known as H5N1, has leapt to humans with fatal consequences. The World Health Organization reports 55 human cases, with 42 deaths, all of them thus far in Vietnam and Thailand.

Against this backdrop of developments over the last year, the Food and Agriculture Organization of the United Nations (FAO) and the World Animal Health Organization (OIE for Organisation Mondiale de la Sante Animal) convened a meeting in Ho Chi Minh City, Vietnam, February 23-25 to develop strategies to contain the regional epidemic and improve detection in hopes of preventing the disease from making a cross-species leap that could set a global pandemic in motion.

“Avian influenza has had great economic and social impact on affected countries,” said Dr. Samuel C. Jutzi of the FAO, “and the disease situation could, in the worst case, lead to a new global human influenza pandemic.” Jutzi, director of FAO’s Animal Production and Health Division, spoke at the opening of the Ho Chi Minh City meeting.

“It is in the interest of both developed and developing countries to invest in the control and containment of avian influenza,” Jutzi said. “Our objective is to protect human health - locally and internationally - and to promote food security - and our strategy is to control the disease at source.”

Many of the nine nations that have experienced outbreaks need help in achieving that end, Jutzi said, and he called on developed nations to increase their support to improve veterinary services, diagnostic capabilities and surveillance systems. The FAO reports that donor nations have contributed $18 million to assist in the disease detection and control effort.

The H5N1 virus has clearly demonstrated its capability to jump the species barrier, and that is why health officials from Asia, Europe and the United States are paying such close attention. The most deadly flu epidemics in history have started with a similar leap, notably the Spanish Flu epidemic of 1918, which killed an estimated 20 to 50 million people.

"The concern in Asia is that we have this highly pathogenic strain of influenza, circulating widely,” said U.S. Centers for Disease Control and Prevention Director Julie Gerberding in a Washington speech February 21. “And there are really wonderful opportunities for this virus to either reassort (its genes) with human strains of influenza, or with other avian species, and evolve into a strain that has whatever that secret ingredient is that allows it to be effectively transmitted from person to person."

Through 2004, Vietnam and Thailand were the only nations to report human cases, even though the virus infected birds in nine Asian nations. In most cases, medical investigation has been able to trace exposure of these individuals to contact with infected poultry.  A few cases have apparently resulted from human-to-human transmission.

On February 2, the World Health Organization reported the confirmed H5N1 death of a Cambodian woman who sought treatment of her illness in neighboring Vietnam, a case that demonstrates how insignificant national borders are to a virus.

The emergence of a previously unknown, frequently fatal respiratory disease in China in 2002 was another warning of how fast a disease can spread in a world that has become highly mobile and interconnected. The rapid spread of severe acute respiratory syndrome (SARS) from country to country prompted an unprecedented degree of cooperation and collaboration among international and national health agencies.  Several Asian nations were most dramatically affected by the outbreak, but SARS appeared ultimately in 29 countries.  More than 8,400 people took ill with the flu-like disease; almost one thousand died. 

"A problem in a remote corner of the world becomes a world problem overnight," Gerberding said in an address to a major national scientific meeting. "A world problem quickly becomes a local problem, in every corner of the world."

CDC has been engaged in a number of activities in the international campaign to assist nations where H5N1 has appeared. The agency, based in Atlanta, Georgia, has also implemented a $5.5 million initiative to improve influenza surveillance in Asia. CDC is monitoring the situation and remains in close contact with WHO and other international partners.

The CDC maintains a Web page on bird flu at