Rasmus.Biz  2007

Bird Flu or You better get your flu shot now bubba.

Conclusions Disease in the mother and aunt probably resulted from person-to-person transmission of this lethal avian influenzavirus during unprotected exposure to the critically ill index patient.

1.25.2005.  Thailand has warned that bird flu could kill up to two million of its people as it announced an emergency plan to combat the disease.

Thai authorities on Monday detected a third outbreak of the deadly H5N1 strain of the virus this month, while nearby Vietnam recorded its ninth bird flu death this year.

Thailand's deputy premier Chaturon Chaisaeng said a committee supervising attempts to control the virus had devised a three-year strategy aimed at saving lives in the event of a massive outbreak.

"There will be a stock of 100,000 doses of flu medicine, 10 million masks and preparation to produce vaccines and the preparation of bird flu testing equipment," Mr Chaturon told reporters.

The 776-million-baht ($A26 million) Thai scheme was needed because such an outbreak would likely kill some two million Thais, said Mr Chaturon, without indicating how the government had arrived at the estimated death toll.

The virus was found in a third Thai province, after two outbreaks were detected earlier this month.

The latest outbreak was detected in locally bred chickens in the western province of Nakhon Pathom.

Some 711 chickens in the district of Dontoom died of bird flu and 464 others were culled to prevent the disease from spreading.

Thailand has been under high alert for bird flu since two earlier outbreaks of the virus were detected in Rayong and Phitsanulok provinces.

Meanwhile the avian flu claimed two more victims in Vietnam on Saturday, bringing to nine the number of deaths since December 30.

Vietnam's Prime Minister Phan Van Khai has asked hospitals in affected areas to prepare for a larger epidemic.

In total, 29 people died in Vietnam after being infected since the end of 2003.

The virus has been reported in 25 provinces in Vietnam and around 600,000 poultry have been culled since the start of the year.

The World Health Organisation has repeatedly warned that the virus could mutate into a highly contagious human-to-human form that could trigger a human flu pandemic.

But WHO Asia-Pacific spokesman Peter Cordingley said this could be averted with the right precautions.

ABSTRACT

Background During 2004, a highly pathogenic avian influenza A (H5N1) virus caused poultry disease in eight Asian countries and infected at least 44 persons, killing 32; most of these persons had had close contact with poultry. No evidence of efficient person-to-person transmission has yet been reported. We investigated possible person-to-person transmission in a family cluster of the disease in Thailand.

Methods For each of the three involved patients, we reviewed the circumstances and timing of exposures to poultry and to other ill persons. Field teams isolated and treated the surviving patient, instituted active surveillance for disease and prophylaxis among exposed contacts, and culled the remaining poultry surrounding the affected village. Specimens from family members were tested by viral culture, microneutralization serologic analysis, immunohistochemical assay, reverse-transcriptase-polymerase-chain-reaction (RT-PCR) analysis, and genetic sequencing.

Results The index patient became ill three to four days after her last exposure to dying household chickens. Her mother came from a distant city to care for her in the hospital, had no recognized exposure to poultry, and died from pneumonia after providing 16 to 18 hours of unprotected nursing care. The aunt also provided unprotected nursing care; she had fever five days after the mother first had fever, followed by pneumonia seven days later. Autopsy tissue from the mother and nasopharyngeal and throat swabs from the aunt were positive for influenza A (H5N1) by RT-PCR. No additional chains of transmission were identified, and sequencing of the viral genes identified no change in the receptor-binding site of hemagglutinin or other key features of the virus. The sequences of all eight viral gene segments clustered closely with other H5N1 sequences from recent avian isolates in Thailand.

Conclusions Disease in the mother and aunt probably resulted from person-to-person transmission of this lethal avian influenzavirus during unprotected exposure to the critically ill index patient.

Notice: To coincide with a symposium on pandemic influenza, this article was published at www.nejm.org on January 24, 2005. It will appear in the January 27 issue of the Journal.

The World Health Organisation (WHO) has raised the spectre of human-to-human transmission of deadly avian influenza following confirmation that two Vietnamese brothers had contracted the virus and one had died.

The WHO confirmed that laboratory results had found the two brothers from northern Vietnam had been infected with the H5N1 avian influenza virus. The older one, a 47-year-old, had died on January 9. The younger one, 42, was recovering.

The WHO said the younger brother was known to have provided bedside care for his sibling. But it said transmission might also have occurred during a family meal when raw duck products were eaten.

The WHO said it had not confirmed media reports that a third brother had been hospitalised with flu symptoms but it said limited transmission of the virus between people could be expected.

"All evidence to date suggests that isolated instances of limited, unsustained human-to-human transmission can be expected from avian influenza viruses in humans," the WHO said in a statement seen on Saturday.

"Their occurrence does not call for any change in the present level of pandemic alert," it said.

The virus has killed 27 people in Vietnam and 12 in Thailand over the past year. Vietnamese media said on Saturday doctors were doing tests to determine if a woman who died on Friday in Ho Chi Minh City in the south also had the virus.

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