Pakistan - BF Suspected Human Cases December 18, 2007 to Feb 2, 2008

[Johnny Yuma]

Re: Pakistan: December 18+, WHO Begins Investigations

Dr. Niman,

I have been following your commentaries on your site for two years now, and I know that you post many commentaries that relate specifically to the role of recombination in H5N1 evolution. However, the events in Pakistan appear, in your most recent commentaries, without statements about whether they prove your ideas about recombination. For that, very many people are grateful for your ability to focus on the danger to everyone regardless of how the danger evolves.

You recently posted: "Local confirmation of the initial lab positives was projected to be completed yesterday, and disease onset dates for the cluster members should have been known for some time. This information is usually released in WHO situation updates, which give the age and gender of confirmed cases, as well as disease onset dates, hospitalization dates, and dates of death as well as relationships between cluster members.

Virtually all of the data has not been released even though the outbreak began almost 2 months ago, and WHO has been aware of this cluster for at least a week."

http://www.recombinomics.com/News/12190703/H5N1_Pakistan_H2H_Specifics.html

Are you suggesting that the missing information described above is known and is intentionally being withheld by either the Pakistani Government or WHO? And if so, why do think they might be witholding this information?

Regards, Snicklefritz

In addition to Dr. Niman's commentaries, this thread also answers your question:

http://www.flutrackers.com/forum/showthread.php?t=45816

[HenryN]

Re: Pakistan: December 18+, WHO Begins Investigations

Commentary at

http://www.recombinomics.com/News/12200701/H5N1_Pakistan_Sustained.html

[HenryN]

Re: Pakistan: December 18+, WHO Begins Investigations

WHO warns Pakistanis to be mindful of bird flu amid country?s first human cases
(AP)

20 December 2007



ISLAMABAD, Pakistan -The World Health Organization warned Pakistanis on Thursday to take precautions while handling poultry as experts investigate the country?s first human bird flu cases.
No new cases have been discovered since a WHO team arrived earlier this week, but health workers have been on high alert to monitor patients with flu-like symptoms who could be infected with the H5N1 bird flu virus, said Khalif Bile, the WHO country representative.<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" /><o:p></o:p>
The Health Ministry has detected up to nine suspect cases who fell ill earlier this month and in November, including several siblings. The WHO experts were working to piece together how they became infected and whether human-to-human transmission could have occurred. Poultry outbreaks had been reported in the area before the human cases.<o:p></o:p>
As many travelers head home for the Islamic holiday of Eid Al Adha, Bile said care should be taken when slaughtering and preparing poultry. He said the Health Ministry was reiterating the message with a public awareness campaign.<o:p></o:p>
The public is being informed through the media what precautions to take without any alarm,? he said. I think the situation so far seems to be under control, but we are monitoring it.?<o:p></o:p>
A second team from the US Naval Medical Research Unit No. 3 in Cairo arrived in Pakistan on Thursday. They were expected to retest samples already gathered from a number of patients who were positive for the H5N1 virus in initial government analysis.<o:p></o:p>
The WHO team has been working with hospital staff to strengthen infection control measures, while doing detective work to try to determine the relationship of the cases, when they were sickened and whether they were in contact with poultry.<o:p></o:p>
The hospitals are much better organized,? Bile said. They have been seen by WHO, and there are no cases as of today or yesterday. They are there to address all of the potential risks.?<o:p></o:p>
At least 209 people have died worldwide from the virus, which began plaguing Asian poultry stocks in late 2003, according to the WHO. It remains hard for people to catch, but scientists worry it could mutate into a form that spreads easily among people, potentially sparking a pandemic.

http://www.khaleejtimes.com/DisplayA...bcontinent&col=

[Niko]

Re: Pakistan: December 18+, WHO Begins Investigations

Pakistan urges safer culling after bird flu outbreak

By Alistair Scrutton

Added text - updated article

20 Dec 2007 14:29:38 GMT
<!-- 20 Dec 2007 14:29:38 GMT ## for search indexer, do not remove --> Source: Reuters
<!-- AN5.0 article title end -->
<script language="JavaScript" src="http://www.alertnet.org/bin/js/article.js"></script><input value="13" name="CurrentSize" id="CurrentSize" type="hidden"><!-- Pakistan urges safer culling after bird flu outbreak --><!-- Reuters --> (Adds comments by WHO in Geneva)
A team from the U.S. Naval Medical Research Unit NAMRU-3 laboratory in Cairo has also arrived in Pakistan to test samples from the suspected human bird flu cases, the WHO said on Thursday. "They are setting up their laboratory and starting to work with the samples," WHO spokesman Gregory Hartl said in Geneva. The team, composed of two experts, will test samples taken from the suspected cases. The WHO requires additional testing by one of its network of collaborating laboratories, which includes NAMRU.

http://www.alertnet.org/thenews/newsdesk/SP251818.htm

[Niko]

Re: Pakistan: December 18+, WHO Begins Investigations

Commentary at

http://www.recombinomics.com/News/12...Sustained.html

<big><big>Commentary</big></big>

Sustained Human to Human H5N1 Transmission in Pakistan?

Recombinomics Commentary
December 19, 2007

"Right now it doesn't look like pure human to human transmission. It looks like the veterinarian, who was the index case, and a number of other suspect cases had poultry exposure," Fukuda told Reuters in an interview.

"It is definitely possible that we have a mixed scenario where we have poultry to human infection and possible human to human transmission within a family, which is not yet verified." But human to human transmission "would not be particularly surprising or unprecedented," he added.

In Thailand, a mother was killed by the virus in 2004 after cradling her dying infected daughter all night. The largest known cluster of human bird flu cases worldwide occurred in May 2006 in Indonesia's North Sumatra province, where as many as seven people in an extended family died.

The above comments on the human to human (H2H) transmission in Pakistan, and two examples of such infections in the past are accurate, but the extensive H2H transmission in Pakistan is likely to cause confusion, because media reports and the public believe that H2H of H5N1 is rare, when it is very common. The more extended transmission chains, as noted above, are rarer, and the transmission in Pakistan may be the most sustained H2H reported to date, but H2H among family members is quite common, and most first reports of H5N1 in patients are H2H clusters.

The H5N1 H2H usually involves only two people, which are the index case and a family member caring for the index case. These small clusters have the diagnostic time gap between onset dates, but the linkage of the index case to a poultry source extends to a family member, so the proof of H2H is not absolute.

When there are two time gaps, suggesting H2H2H, then the likelihood of H2H increases markedly, especially when there is epidemiological data linking the cases.

However, the number of cited H2H examples is also reduced because samples are frequently not collected from the index case, and testing of contacts may use samples collected after the start of prophylactic oseltamivir (Tamiflu) treatment.

In the first example above. The lack of a poultry connection added to the likelihood that H2H was involved, and the number in the cluster was three and there were two time gaps. Therefore, it has been cited as the first example of H2H. The index case was a child staying with her aunt in rural Thailand. Her mother was an office worker in Bangkok. The index case was likely infected by a pet chicken, which died and was buried by the child. However, she was mis-diagnosed as having dengue fever. Consequently, there was no protective equipment given to her visiting mother, who was probably infected while holding her daughter in the hospital. The daughter died and was never tested for H5N1, but the mother developed symptoms after returning to Bangkok, and the aunt of the index case also developed symptoms several days after the mother left. Initially the mother was not tested either, but after she died, a nurse notified investigators of the bird flu symptoms, and samples were collected just prior to cremation. The mother was H5N1 positive and the aunt was also H5N1 positive, although initial tests on the aunt were inconclusive. Thus, if there wasn?t a cluster, it is likely hat none of the cases would have been official confirmed cases. However, because of the lab confirmation in the mother and aunt, the cluster is a strong example of H2H or H2H2H.

The cluster in Indonesia is also considered to be a cluster because there were two time gaps, and there was epidemiological evidence for H2H2H. However, the index case died prior to collection of a sample. Seven family members tested positive for H5N1 and the onset of symptoms was several days after the index case, most of whom slept in the same room as the index case while she was very sick and coughing extensively. The son of one of the infected brothers also developed symptoms several days after his father, so the Indonesia clusters was H2H2H, although the index case was not lab confirmed.

Most clusters however only involve two family members. The first cases in Cambodia were a cluster. The index case collected dead chickens. He developed bird flu symptoms and died prior to sample collection. When his sister developed symptoms, she went to Vietnam for treatment and was H5N1 confirmed after she died, so although the brother likely infected his sister, the cluster was not considered H2H because no sample was collected from the brother. The first cases in Hunan China were also a cluster with a time gap, but were not considered a cluster until a rising antibody titer was detected in the index case after he died. The first cases in Indonesia were also a cluster, but there were no early samples from the index case, no sample was collected from her sister, and H5N1 was confirmed in the father after his two daughters had died. This cluster had two time gaps, but one sister was not an official case because she was not tested.

There are dozens of similar examples. Some of the earlier clusters from Vietnam and Thailand were published, but there have been many examples since the earlier clusters were reported, and these clusters include the first case from Turkey, Iraq, Azerbaijan, and Nigeria. All of these cases involve the Qinghai strain of H5N1, which is almost certainly the case fro the cluster from Pakistan.

However, this cluster is likely to the most sustained to date. The index case was a veterinarian who developed symptoms on October 25. Two brothers developed symptoms after visiting the index case in the hospital, and the dates of death on November 19 and 29 suggest this transmission chain was H2H2H. However, at least two more brothers were infected, and one or two health care workers had symptoms or were H5N1 confirmed, so they represent H2H2H2H, if confirmed, and since one is still hospitalized, the transmission has been sustained for two months. Moreover, samples of contacts are being collected after the start of Tamiflu treatment, so additional transmissions may not be lab confirmed.

The detail of this cluster will be clearer when disease onset dates are released, but the current cluster appears to be the most sustained H5N1 cluster reported to date, and also representing the largest number of links on the chain.

[HenryN]

Re: Pakistan: December 18+, WHO Begins Investigations

Pakistan urges culling after bird flu outbreak
(Reuters)

20 December 2007



ISLAMABAD - Pakistan is urging provincial authorities to obey health guidelines to stop any bird flu outbreaks after fears lapses in poultry culling methods led to eight people being infected with the H5N1 virus.
The Health Ministry is sending out messages via radio and pamphlets to villages and farms in North West Frontier Province, where the eight people, including a veterinarian involved in culling, were infected in South Asia?s first human cases.<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" /><o:p></o:p>
The vet?s brother died of bird flu. A third brother also died but it is unclear if he was also infected with the virus.<o:p></o:p>
?These winter months are critical,? Federal Health Secretary Khushnood Akhtar Lashari told Reuters on Thursday.<o:p></o:p>
?We are asking provincial authorities to adhere to safely guidelines, but it is quite difficult because many of these places are in remote areas and many people have the attitude that ?it can?t happen to me?.?<o:p></o:p>
Authorities now believe there is no threat of a pandemic from the bird flu cases in Pakistan as World Health Organisation (WHO) experts carried out tests in the region.<o:p></o:p>
But the H5N1 thrives best in winter months in part because people spend more time indoors and in close proximity to each other and their livestock.<o:p></o:p>
Lashari said the man believed to have been infected first, a veterinarian who helped operations to cull chickens and who has now recovered, might have not worn a mask because he suffered from asthma.<o:p></o:p>
He might also have taken his culling equipment back home with him. While he recovered, his two brothers died.<o:p></o:p>
Six people have since recovered, while the remaining case is still being treated, the Health Ministry says.<o:p></o:p>
The case highlights the difficulty of health control in Pakistan, where the health system is weak, particularly in the countryside. Many villagers are also illiterate, making communications harder.<o:p></o:p>
Team arrives<o:p></o:p>
In the Pakistan cases, the WHO said they were likely to be a combination of infections from poultry and limited human-to-human transmission of the H5N1 avian flu virus due to close contact.<o:p></o:p>
The WHO says a similar case occurred in Indonesia in 2006 among family members believed to have contracted the virus while caring for sick loved ones.<o:p></o:p>
The H5N1 virus is hard for humans to catch and is mainly a bird disease. But experts fear the strain could spark a global pandemic and kill millions if it mutates into a form that spreads easily between people.<o:p></o:p>
A WHO team, led by Hassan El-Bushra of its regional Cairo office, have been in Pakistan this week helping investigate the outbreak.<o:p></o:p>
A team from the U.S. Naval Medical Research Unit NAMRU-3 laboratory in Cairo has also arrived in Pakistan to test samples from the suspected human bird flu cases, the WHO said on Thursday.<o:p></o:p>
?They are setting up their laboratory and starting to work with the samples,? WHO spokesman Gregory Hartl said in Geneva.<o:p></o:p>
The team, composed of two experts, will test samples taken from the suspected cases.<o:p></o:p>
The WHO requires additional testing by one of its network of collaborating laboratories, which includes NAMRU.<o:p></o:p>
Since H5N1 resurfaced in Asia in late 2003, the virus has killed 209 people in 11 countries, according to the WHO. The latest Pakistan cases have yet to be included in the formal WHO tally.

http://www.khaleejtimes.com/DisplayA...bcontinent&col=

[HenryN]

Re: Pakistan: December 18+, WHO Begins Investigations

<TABLE><TBODY><TR><TD>

Workshop on Bird Flu

</TD></TR><TR><TD>
</TD></TR><TR><TD>Staff Reporter
</TD></TR><TR><TD>LAHORE: Eid travel will not increase the risk of the bird flu transfer to the peoples visiting the NWFP. Bird flu is not a contagious disease and does not spread with casual contacts or shaking hands, hugging or embracing. The only way it can spread to the human being is close and continuous contacts with the birds affected by this disease. These views were expressed by Chairman PMS Dr. Masood Akhtar sheikh while addressing the workshop in connection with the "Bird flu" under the auspices of Pakistan Medical Society.

He opined that if the chicken are kept for 3 days in the shops and are still healthy, it is a reasonably safe to say they are not affected by the serious form of the bird flu. The peoples related with the poultry should take precaution and use soaps and hot water to disinfect there hands or face on return from the poultry farms.
</TD></TR></TBODY></TABLE>

http://thepost.com.pk/CityNews.aspx?dtlid=135125&catid=3

[Treyfish]

Re: Pakistan: December 18+, WHO Begins Investigations

Pakistan warned of bird flu by WHO


Islamabad, Dec. 20: The World Health Organisation warned Pakistanis on Thursday to take precautions while handling poultry as experts investigate the country?s first human bird flu cases.
No new cases have been discovered since a WHO team arrived earlier this week, but health workers have been on high alert to monitor patients with flu-like symptoms who could be infected with the H5N1 bird flu virus, said Khalif Bile, the WHO country representative.
The health ministry has detected up to nine suspect cases who fell ill earlier this month and in November, including several siblings. The WHO experts were working to piece together how they became infected and whether human-to-human transmission could have occurred.
Poultry outbreaks had been reported in the area before the human cases. As many travellers head home for the Islamic holiday of Id ul-Zuha, Mr Bile said care should be taken when slaughtering and preparing poultry. He said the health ministry was reiterating the message with a public awareness campaign.
"The public is being informed through the media what precautions to take without any alarm," he said. (AP) http://www.asianage.com/presentation...lu-by-who.aspx

[cartski]

Re: Pakistan: December 18+, WHO Begins Investigations

<big><big>Commentary</big></big>

Sustained Human to Human H5N1 Transmission in Pakistan?

Recombinomics Commentary
December 19, 2007

"Right now it doesn't look like pure human to human transmission. It looks like the veterinarian, who was the index case, and a number of other suspect cases had poultry exposure," Fukuda told Reuters in an interview.

"It is definitely possible that we have a mixed scenario where we have poultry to human infection and possible human to human transmission within a family, which is not yet verified." But human to human transmission "would not be particularly surprising or unprecedented," he added.

In Thailand, a mother was killed by the virus in 2004 after cradling her dying infected daughter all night. The largest known cluster of human bird flu cases worldwide occurred in May 2006 in Indonesia's North Sumatra province, where as many as seven people in an extended family died.

The above comments on the human to human (H2H) transmission in Pakistan, and two examples of such infections in the past are accurate, but the extensive H2H transmission in Pakistan is likely to cause confusion, because media reports and the public believe that H2H of H5N1 is rare, when it is very common. The more extended transmission chains, as noted above, are rarer, and the transmission in Pakistan may be the most sustained H2H reported to date, but H2H among family members is quite common, and most first reports of H5N1 in patients are H2H clusters.

The H5N1 H2H usually involves only two people, which are the index case and a family member caring for the index case. These small clusters have the diagnostic time gap between onset dates, but the linkage of the index case to a poultry source extends to a family member, so the proof of H2H is not absolute.

When there are two time gaps, suggesting H2H2H, then the likelihood of H2H increases markedly, especially when there is epidemiological data linking the cases.

However, the number of cited H2H examples is also reduced because samples are frequently not collected from the index case, and testing of contacts may use samples collected after the start of prophylactic oseltamivir (Tamiflu) treatment.

In the first example above. The lack of a poultry connection added to the likelihood that H2H was involved, and the number in the cluster was three and there were two time gaps. Therefore, it has been cited as the first example of H2H. The index case was a child staying with her aunt in rural Thailand. Her mother was an office worker in Bangkok. The index case was likely infected by a pet chicken, which died and was buried by the child. However, she was mis-diagnosed as having dengue fever. Consequently, there was no protective equipment given to her visiting mother, who was probably infected while holding her daughter in the hospital. The daughter died and was never tested for H5N1, but the mother developed symptoms after returning to Bangkok, and the aunt of the index case also developed symptoms several days after the mother left. Initially the mother was not tested either, but after she died, a nurse notified investigators of the bird flu symptoms, and samples were collected just prior to cremation. The mother was H5N1 positive and the aunt was also H5N1 positive, although initial tests on the aunt were inconclusive. Thus, if there wasn?t a cluster, it is likely hat none of the cases would have been official confirmed cases. However, because of the lab confirmation in the mother and aunt, the cluster is a strong example of H2H or H2H2H.

The cluster in Indonesia is also considered to be a cluster because there were two time gaps, and there was epidemiological evidence for H2H2H. However, the index case died prior to collection of a sample. Seven family members tested positive for H5N1 and the onset of symptoms was several days after the index case, most of whom slept in the same room as the index case while she was very sick and coughing extensively. The son of one of the infected brothers also developed symptoms several days after his father, so the Indonesia clusters was H2H2H, although the index case was not lab confirmed.

Most clusters however only involve two family members. The first cases in Cambodia were a cluster. The index case collected dead chickens. He developed bird flu symptoms and died prior to sample collection. When his sister developed symptoms, she went to Vietnam for treatment and was H5N1 confirmed after she died, so although the brother likely infected his sister, the cluster was not considered H2H because no sample was collected from the brother. The first cases in Hunan China were also a cluster with a time gap, but were not considered a cluster until a rising antibody titer was detected in the index case after he died. The first cases in Indonesia were also a cluster, but there were no early samples from the index case, no sample was collected from her sister, and H5N1 was confirmed in the father after his two daughters had died. This cluster had two time gaps, but one sister was not an official case because she was not tested.

There are dozens of similar examples. Some of the earlier clusters from Vietnam and Thailand were published, but there have been many examples since the earlier clusters were reported, and these clusters include the first case from Turkey, Iraq, Azerbaijan, and Nigeria. All of these cases involve the Qinghai strain of H5N1, which is almost certainly the case fro the cluster from Pakistan.

However, this cluster is likely to the most sustained to date. The index case was a veterinarian who developed symptoms on October 25. Two brothers developed symptoms after visiting the index case in the hospital, and the dates of death on November 19 and 29 suggest this transmission chain was H2H2H. However, at least two more brothers were infected, and one or two health care workers had symptoms or were H5N1 confirmed, so they represent H2H2H2H, if confirmed, and since one is still hospitalized, the transmission has been sustained for two months. Moreover, samples of contacts are being collected after the start of Tamiflu treatment, so additional transmissions may not be lab confirmed.

The detail of this cluster will be clearer when disease onset dates are released, but the current cluster appears to be the most sustained H5N1 cluster reported to date, and also representing the largest number of links on the chain.

This was a helpful, clear analysis. Thank you.

J.

[Treyfish]

Re: Pakistan: December 18+, WHO Begins Investigations

Bird flu a clear, present danger, says WHO
ISLAMABAD: The World Health Organisation warned Pakistanis on Thursday to take precautions while handling poultry as experts investigate the country's first human bird flu cases.
No new cases have been discovered since a WHO team arrived earlier this week, but health workers have been on high alert to monitor patients with flu-like symptoms who could be infected with the H5N1 bird flu virus, said Khalif Bile, the WHO country representative.
The Health Ministry has detected up to nine suspect cases who fell ill earlier this month and in November, including several siblings. The WHO experts were working to piece together how they became infected and whether human-to-human transmission could have occurred. Poultry outbreaks had been reported in the area before the human cases.
As many travellers head home for the Islamic holiday of Eidul Azha, Bile said care should be taken when slaughtering and preparing poultry. He said the Health Ministry was reiterating the message with a public awareness campaign.
"The public is being informed through the media what precautions to take without any alarm," he said. "I think the situation so far seems to be under control, but we are monitoring it."
A second team from the US Naval Medical Research Unit No. 3 in Cairo arrived in Pakistan on Thursday. They were expected to retest samples already gathered from a number of patients who were positive for the H5N1 virus in initial government analysis.
The WHO team has been working with hospital staff to strengthen infection control measures, while doing detective work to try to determine the relationship of the cases, when they were sickened and whether they were in contact with poultry.
"The hospitals are much better organised," Bile said. "They have been seen by WHO, and there are no cases as of today or yesterday. They are there to address all of the potential risks." - AFP http://statesman.com.pk/topnews/topnews.htm

[Sally Furniss]

Re: Pakistan: December 18+, WHO Begins Investigations

Thank you Dr Niman for commentary on Sustained Human to Human H5N1 Transmission in Pakistan?


What proportion of cases world wide do you consider to be h2h, either confirmed or highly suspected?

[Laidback Al]

Re: Pakistan: December 18+, WHO Begins Investigations

Following up on Niman's comments about the Pakistan cluster, two things stand out regarding the index case of this cluster. First samples were collected from him and second he survived. As noted by Niman most index cases in clusters are never tested because the infection is not recognized as H5N1. Because the infection is not recognized as H5N1, very few of these index cases receive antiviral treatment in time and they almost never survive. Probably less than 10% percent of index cases in clusters have survived.

[HenryN]

Re: Pakistan: December 18+, WHO Begins Investigations

Thank you Dr Niman for commentary on Sustained Human to Human H5N1 Transmission in Pakistan?


What proportion of cases world wide do you consider to be h2h, either confirmed or highly suspected?

There is fluctuation from location to location. In Vietnam it was about 1/3. In Indonesia initially it was closer to 1/2. Almost all cases in Turkey, Iraq, and Azerbaijan were in clusters and most looked like H2H. Lately the number of clusters in Indonesia has been lower and clusters are fairly rare in Egypt.

[HenryN]

Re: Pakistan: December 18+, WHO Begins Investigations

<TABLE cellSpacing=0 cellPadding=0 width=600 align=center border=0><TBODY><TR bgColor=#f4faff><TD class=heading_txt height=20>Hospitals taking measures to tackle bird flu threat</TD></TR><TR><TD></TD></TR><TR><TD bgColor=#efefef></TD></TR><TR><TD></TD></TR><TR><TD class=small_txt height=20>By Muhammad Qasim
12/21/2007</TD></TR><TR><TD class=small_txt>Rawalpindi

The hospitals at the twin cities have taken several steps to deal with any untoward situation in case of an outbreak of avian influenza in humans in light of recommendations given by National Institute of Health.

NIH has asked almost all healthcare facilities at both the provincial and federal levels to be ready to receive bird flu patients after confirmation of Avian Influenza - bird flu H5N1 virus - in birds in various parts of country. However, many of the hospitals in town have received no guidelines from the NIH so far.

?We have circulated instructions, on treatment and management of the infection, to our staff in case they receive a patient showing symptoms of avian influenza strain,? said the RGH chief Dr Habib Ahmed Khan while talking to ?The News?.

He said a protocol has been circulated among the staff, which provides guidelines for handling and treatment of a patient with strain of avian influenza and as well has identified ward to be isolated in case of bird flu outbreak.

To a query, Dr Habib said his hospital had taken all possible pre-cautionary measures to contain the virus if that is detected in some patient at the RGH. ?We have also made arrangements for proper management and treatment of patients of the infection during Eid holidays from December 20 to December 23 and have collected as many as 50 doses of Temiflu for treatment of patients with strain of avian influenza,? he said. Temiflu can reduce severity and duration of illness caused by avian influenza.

Within last three weeks, number of avian influenza outbreaks has been reported in areas of NWFP and federal capital including Islamabad, Murree, Abbottabad, Mansehra and adjoining areas and the NIH had also confirmed high concentration of H5N1 influenza virus in these areas. According to NIH, the high concentration may pose a serious threat to human health.

District Headquarters Hospital (Civil Hospital), one of the three teaching hospitals in town, has taken no initiative for handling patients showing symptoms of avian influenza. ?We have received no advice on the subject from the NIH,? said DHQ hospital chief Dr Khalid Iqbal Malik while talking to ?The News? Thursday. He also admitted that there is no drug available at the DHQ for treatment of a patient conceived avian influenza virus.

The Holy Family Hospital has also made no special arrangements on the subject of adequate stock of Tamiflu, ventilators, nursing and personal protective equipment (PPE).

Studies reveal that avian influenza spread from birds to humans and not person-to-person however, scientists fear that combination of avian flu strain with human variant of influenza may result in a novel virus strain that can pass easily from person to person and cause a global epidemic killing millions of people. The greatest disaster on the subject was the ?Spanish flu? outbreak in 1918 - originated from avian viral strain - that claimed 20 million to 50 million lives around the world. The most effective way of fighting avian influenza presently available to man is destruction of infected birds or those at risk of infection.

Seabirds, shorebirds, and other wildfowl contain avian influenza viruses and through faecal droppings infect domesticated birds for which it is fatal. Nasal and faecal secretions of sick birds spread illness to other poultry in both the farm enclosures and live animal markets.

http://www.thenews.com.pk/print1.asp?id=87365</TD></TR><TR><TD> </TD></TR><TR><TD bgColor=#efefef></TD></TR><TR><TD bgColor=#efefef></TD></TR></TBODY></TABLE>

[Treyfish]

Re: Pakistan: December 18+, WHO Begins Investigations

Workshop

LAHORE, Dec 20: If a chicken is kept for three days in a shop and is still healthy, it is not affected by any form of bird flu, says Pakistan Medical Society president Dr Masood Akhtar Sheikh. — Staff Reporter

http://www.dawn.com/2007/12/21/nat13.htm