Bird flu around the world
James Sturcke and David Batty
Thursday April 6, 2006
Bird flu has spread from poultry to infect humans in nine countries. The World Health Organisation (WHO) recognises 109 deaths from among the 193 cases recorded globally so far.
Vietnam is the country worst affected by bird flu, with 42 deaths and 93 cases. Most of the deaths were recorded between late 2003 and mid-2005.
Nearly 50 million poultry have been culled in attempts to limit the spread of the disease. On January 5 2006, the government said it had completed its programme of vaccinating 150 million poultry around the country.
The country suffered at the beginning of the current outbreak, with 22 cases and 14 deaths among humans since December 2003.
After a lull lasting nearly a year, authorities confirmed on November 1 2005 that three people had been infected during the previous month. This coincided with a recurrence of bird flu among poultry in six provinces.
The latest victim was a five-year-old boy whose death was confirmed on December 9 2005. The Thai government has announced it will start producing a generic version of the anti-viral drug Tamiflu.
Thirty people have been infected in recent months. Twenty-three of them have died. The latest was a 20-month-old girl from Kapuk, West Jakarta, who died on March 23.
The authorities have imposed "extraordinary" measures, including the power to force people suspected of having bird flu into hospital. Most Indonesian households keep chickens or caged birds as pets.
Eleven of the 16 people infected in China have died. There have been confirmed outbreaks in seven provinces and regions - Hunan, Anhui, Guangxi, Liaoning, Jiangxi, Fujian and Sichuan.
On November 15 2005, the government announced plans to vaccinate all 14 billion of China's farm birds after more than a dozen confirmed outbreaks. Millions of birds had already been culled before the programme was announced.
In August 2004, the authorities revealed that the H5N1 virus had been found in pigs, but denied claims they had kept an outbreak of bid flu secret for more than a year.
British flu experts visited China in October 2005 to find out how the Chinese were responding to the threat. During the Sars outbreak in Asia, there was concern that China had failed to reveal the full extent of the crisis.
There have also been reports that China's use of the anti-viral drug amantadine in animals may have resulted in the H5N1 virus becoming resistant to treatment in the Far East.
Bird flu in humans was confirmed on January 5 2006 when a brother and sister died from the H5N1 virus in the eastern town of Dogubayazit, close to Turkey's border with Iran. A week later, a third sibling died, followed by a 12-year-old girl from the same town and a 14-year-old girl who died on January 15.
The WHO has confirmed 12 of the 21 cases of H5N1 avian influenza previously announced by the Turkish Ministry of Health in 12 of Turkey's 81 provinces. The other nine are undergoing further testing.
On October 10 2005, the EU banned the import of live birds, poultry meat and feathers from Turkey after 1,870 birds died of avian flu in the country. A two-mile quarantine zone was imposed around the affected area, and thousands of turkeys were culled.
All five people confirmed to have contracted bird flu in Cambodia have subsequently died. US health officials have expressed concern about the country's surveillance and containment capacities should a mutation take place.
The US has offered $2m to improve the country's response systems.
Both of the people confirmed to have contracted H5N1 bird flu in Iraq have died. The first death confirmed by the WHO was on January 17 of a 15-year-old girl from Ranya, in the northern Kurdish part of country close to the border with Iran and Turkey.
Iraqi government officials have expressed a need for emergency supplies and equipment, including antiviral drugs. Difficulties in the transportation of patient samples for diagnostic confirmation have been compounded by the security situation in the country. On February 15 2006, Iraqi authorities declared a bird flu alert in the southern Maysan province and called for security forces to prevent people carrying birds in and out of the region.
On April 6 2006, Egypt announced that a 16-year-old girl had died of the H5N1 strain of the virus and an eight-year-old boy had tested positive. The announcements bring to 11 the number of human cases in the country, including three people who have died. All of Egypt's fatalities have been women, the previous two were in their 30s. Two people have been cured of the virus while six are receiving treatment.
Bird flu has been confirmed in poultry in 47 countries. These include:
Among the first countries to be affected by the current outbreak of bird flu. In March 2004, a poultry firm boss and his wife committed suicide after apparently covering up an outbreak.
The H5N1 strain was confirmed in the country on October 15 2005, with the authorities placing an exclusion zone around the villages in the Danube delta where bird flu had been found.
The Guardian' s Mark Honigsbaum witnessed police apparently confused about which vehicles should be sprayed. There were also local reports that dead birds had been washed up on the shores three months before officials acted.
In February 2006, more bird flu cases were found in three Danube villages in eastern Romania.
Greek authorities said on February 11 2006 that the H5N1 virus had been discovered in three swans found in the northern gulf of Thermaikos. Two days later, a wild goose found on the Aegean island of Skyros was also confirmed as carrying the disease.
A suspected outbreak of bird flu was reported at a turkey farm on the Aegean island of Oinouses, near the coast of Turkey, on October 17 2005. However, the European commission said on October 31 that a second series of tests had proved negative.
On February 11, Italian officials confirmed six wild swans found in the southern regions of Sicily, Puglia and Calabria tested positive for the highly contagious H5N1 strain. A 3km high-risk protection zone was established around each outbreak area, and a surveillance zone of an additional 7km was set up. Chicken farmers said sales of poultry fell by 50% in the immediate aftermath of the disease's discovery.
Avian influenza confirmed in wild swans in Italy
Two swans found on February 14 2006 near the southern city of Graz were the country's first cases of H5N1. They have been sent to a UK laboratory for further tests.
Officials immediately brought forward plans to order all birds indoors after two swans infected with bird flu were found on a beach on the Baltic island of Rugen on February 15 2006. A northern goshawk found dead on the island on the same day has also tested positive for H5N1. The country's agriculture minister, Horst Seehofer, has announced laws to order all farmed birds to be brought indoors. On April 5 2006, officials announced that about 30,000 farm birds would be culled on a farm in the eastern state of Saxony after the virus was found in commercial poultry for the first time in the country
Germany is one of the few countries stockpiling large quantities of Relenza as an alternative to Tamiflu. Its order, for 1.7m units, reportedly exceeded the global sales of the drug for the past four years.
Nigeria Africa's first case was confirmed on February 8 2006 on a poultry farm in Jaji, a village in the northern state of Kaduna. In the following days further outbreaks were confirmed in Kano and Plateau states with suspected cases in another five regions.
Scientists had been particularly worried about bird flu arriving in Africa.
"The FAO [UN's Food and Agriculture Organisation] is concerned that with trade, the movement of people and animals and migratory birds, new countries could become infected," the FAO deputy general, David Harcharik, said. "If it were to become rooted in the African countryside, the consequences for a continent already devastated by hunger and poverty could be truly catastrophic."
On October 21 2005, authorities confirmed that a parrot from Surinam had died in quarantine in Essex after being infected with bird flu, which was later confirmed as the H5N1 strain. Government scientists said it was likely the bird had caught the disease from Taiwanese birds in quarantine.
On April 6 2006, a dead swan found a week earlier in the coastal Fife village of Cellardyke, about nine miles from St Andrews, tested positive for H5N1. The swan is the first wild bird in Britain to be discovered carrying the virus. Tests are also being carried out on two dead swans found in Richmond Park in Glasgow.
The government is spending money to buy 14.6m doses of Tamiflu. It is also purchasing 2m treatments of bird flu vaccine to treat key workers.
Birdwatchers have been enlisted to help identify any arrival of bird flu quickly. The Department of Health has published its contingency plan, as has Defra, the rural affairs and agriculture department.
In December 2005, a House of Lords committee report said the government could do more to prepare the UK for a pandemic, and warned of food shortages and panic buying if the disease struck.
The initial reaction has been to set up a protection zone around the village of Cellardyke, with a minimum radius of 1.8 miles, as well as a surveillance zone of six miles. In London, the Cabinet Office has activated its emergency committee, Cobra.
A full list of countries where cases of H5N1 has been confirmed in poultry is available from the World Organisation for Animal Health.
On February 22 2006, EU vetinary officials agreed to allow France and the Netherlands to vaccinate their flocks against bird flu. On October 25 2005, the EU announced a month-long ban, since extended, on the import of wild birds after the H5N1 strain was discovered among birds held in British quarantine.
Officials had decided already to restrict keeping poultry outdoors in areas at particular risk of avian influenza, such as those near marshland. Member states are responsible for defining the risk areas.
The standing committee also agreed on an immediate, EU-wide ban on the collection of birds at markets, shows, exhibitions and cultural events unless specifically authorised by authorities.
Officials have approved additional bio-security measures including, if deemed appropriate, vaccination to protect birds kept in zoos.
On November 7 2005, the EU announced it would give €30m (￡40.2m) to help Asian countries tackle the disease. An additional €50m was pledged on January 13 2006.
On March 16 2006, the Danish ministry for consumer and family affairs confirmed that a wild buzzard had tested positive for H5N1after being found near Naestved, south of Copenhagen.
The French health minister, Xavier Bertrand, said on January 11 this year that the country will have spent $844m (￡477m) between 2004 and 2006 on preparing for a flu pandemic.
Provisions include 14m doses of antiviral drugs, 50m face masks for hospitals (with 150m more on the way) and 40m doses of any future vaccine. Airport controls have been stepped up, and a good practice guide distributed to farmers, who have been told to keep birds indoors as much as possible.
By January, two-thirds of poultry had been ordered to be kept indoors. The agriculture minister, Dominique Bussereau, said poultry sales had dropped by 20% in the previous quarter.
On February 15, the president, Jacques Chirac, ordered the cabinet to "immediately strengthen" measures and the national food safety agency recommended all fowl be taken indoors to reduce the risk that they come in contact with migrating birds.
Although there have been no cases of the current bird flu outbreak in the US, the president, George Bush, says he has considered using the military to maintain control should the strain appear.
Grounding airlines could be another measure, Mr Bush - who took a book about the 1918 Spanish flu pandemic on holiday with him recently - indicated.
In September 2005, the Senate voted to spend $3.9bn in bird flu funds, largely to build domestic stockpiles of antiviral drugs and vaccines. By mid-October 2005, the US had a stockpile of around 2.3m courses of Tamiflu, with more on order.
It also has around 83,000 courses of zanamivir (Relenza), another antiviral, which could be used to treat sufferers.
Officials at San Francisco airport, a major gateway to the US from Asia, have been told to look out for signs of avian flu among travellers.
With bird flu outbreaks confirmed in neighbouring countries, Singapore banned people from keeping live chickens on the island of Pulau Ubin in June 2005. The government has also told people not to visit poultry farms.