New Findings Challenge Bird Flu Assumptions

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http://www.truthout.org/issues_06/011106HA.shtml

 

 

 

 

New Findings Challenge Bird Flu Assumptions

By Elisabeth Rosenthal

The International Herald Tribune

 

Wednesday 11 January 2006

 

Ankara - Two young brothers, aged 4 and 5, are being closely

watched at the gleaming new Kecioren Hospital here, a police car at

the entrance guarding a potential scientific treasure. Though both

boys have tested positive for the H5N1 virus after contact with sick

birds, neither has any symptoms of the frequently deadly disease.

 

Doctors are unsure if - for the first time - they are seeing human

bird flu in its earliest stages, or if they are discovering that

infection with the H5N1 virus does not necessarily lead to illness.

 

In any case, the unusual cluster of five cases detected in this

capital city over the past four days is challenging some doctors'

assumptions about bird flu and giving them new insights into how the

virus spreads and causes disease.

 

These cases have raised the possibility that human bird flu is not

as deadly as has been thought, and that there may be many mild cases

that have gone unreported.

 

" The two brothers are a very interesting finding that may for the

first time give us a chance to monitor the human response to the

disease, " said Guenael Rodier, who is leading a team of doctors and

researchers from the World Health Organization to study bird flu here.

 

[At a news conference here Wednesday, WHO officials urged the

public to remain calm over the recent outbreak and to avoid contact

with sick or dead poultry, The Associated Press reported. Turkey has

raced to contain the outbreak, destroying 300,000 fowl and blaring

warnings from mosque loudspeakers.

 

" The worst situation is a panic situation. There is no reason to

panic, " Dr. Marc Danzon, the organization's regional director for

Europe, said at a news conference with Health Minister Recep Akdag of

Turkey. Danzon said health officials are doing " everything that is

known to maintain and manage this difficult situation. "

 

In Rome, the UN Food and Agriculture Organization cautioned that

the outbreak in Turkey could spread to farms in neighboring countries.

 

" The virus may be spreading despite the control measures already

taken, " said Juan Lubroth, senior animal health officer at the agency.

" Far more human and animal exposure to the virus will occur if strict

containment does not isolate all known and unknown locations where the

bird flu virus is currently present. " ]

 

The run of flu outbreaks and infections that have beset this

country in the past week is leaving international scientists perplexed

on many fronts, because it has been so unusual. Turkey is the first

country outside East Asia to have human cases, and the first one

anywhere to have so many poultry outbreaks simultaneously.

 

In one week, Turkey has announced 15 confirmed human cases of

H5N1; Asia has seen about 140 cases in five years. In that same week,

Turkish agricultural authorities have announced bird flu outbreaks in

18 cities from Aydin on the west coast to Van in the far east; in

Asia, outbreaks have occurred more sporadically.

 

" We are not yet sure of the mechanism, " said Keith Sumption, an

expert with the UN Food and Agriculture Organization.

 

The five cases in Ankara hospitals are different than most of

those seen in Asia. First, four of the five display only mild symptoms

or no symptoms at all. Although all five had some recent contact with

birds, Rodier said, they live on the fringes of a major city; they are

not farmers or people who keep birds in their backyards.

 

All human cases so far have occurred through close contact with

birds, though scientists are worried that the virus might gain the

ability to spread more easily to humans or be transmitted among them,

setting off an epidemic.

 

The group includes two sets of brothers: The pair who show no

symptoms at all, and a pair from the distant suburbs who developed

mild symptoms after contact with gloves that had been used to dispose

of a dead duck. The fifth case is a 65-year-old man, who lives in the

city itself. The Health Ministry said he had " close contact with a

chicken, " without elaborating on the details.

 

In addition to observing the boys, who are being treated with

anti-viral medicines, scientists are struggling with other questions,

like whether bird flu might not be as deadly as thought.

 

A study released Tuesday in the Archives of Internal Medicine

suggested that the H5N1 virus might cause a wide spectrum of disease,

but that doctors in Asia might only detect the severest cases, the

ones that went to the hospital. The four children in Ankara bolster

that theory.

 

In Ankara, where even people with mild symptoms are going to the

hospitals to be checked for bird flu, milder cases might be more

likely to be detected. The government has been sending vans with

loudspeakers through areas like the Sincan District, where the

65-year-old lived, urging people to report symptoms and avoid fowl.

 

" I'm sure that part of the explanation for the high number of

cases in Turkey is better surveillance, " said Maria Cheng, a

spokeswoman for the WHO in Geneva. " Also because of the small number

of cases in Asia, we may not be seeing the full spectrum of disease

there, and we've getting a better picture of that here. "

 

In one urban district of pastel-colored apartment blocks and a few

small homes, residents said almost nobody in the area kept birds; they

bought poultry at the supermarket.

 

" After all these announcements we've decided not to eat chicken at

all, " said Parlak Inci, an elderly woman.

 

But poultry is found all around Turkey. Ibrahim Ercan keeps seven

chickens in the backyard of his small tire store, he said, " mostly as

pets, to create a farmlike atmosphere. " He is supposed to call to have

them killed, though he has not yet.

 

The vast number of bird flu outbreaks across Turkey is also

perplexing, scientists said. One theory is that migrating birds seeded

various areas in late December, although such outbreaks have not been

reported in adjacent countries where birds would have also passed.

 

Another possibility is that poultry-selling practices in Turkey

contributed to the spread.

 

In Dogubayazit, home to four of Turkey's 15 human cases, people

said that big chicken farms from other areas often send huge trucks of

old birds to the town, selling them to poor farmers for 1 Turkish

lira, or about 75 cents. The last truck arrived two or three weeks

ago, they said. If even one bird on such a truck had bird flu, experts

said, it could have quickly infected the others on board,

disseminating the virus to many villages.

 

No New Patterns Seen

 

Lawrence K. Altman of The New York Times reported from New York:

New mutations in the H5N1 virus do not appear to account for its

spread among humans in Turkey, a World Health Organization official

said Tuesday.

 

Though scientists have completed only the earliest stages of

epidemiologic and virologic investigations, they have found " no

evidence to suggest any difference in the disease pattern than what we

have previously seen for H5N1, " said Rodier, the WHO official.

 

The molecular pattern of the viruses that have infected people and

animals is similar, said Rodier, who added that he had " no reason to

believe anything strange is going on. "

 

The WHO does not intend to issue any restrictions for travel to

Turkey now, he said.

 

Rodier said that transmission seemed to be occurring in families

with children in an epidemiologic picture that closely resembled the

one seen in East Asia. The recent cases identified in Turkey are the

first outside of East Asia.

 

The sudden appearance of a number of cases of avian influenza in

different parts of Turkey is worrisome, Rodier said, but is probably

linked to the complexities of bird migration. There seems to be " more

efficient transmission from animals to humans, " he said.

 

A clearer picture may emerge from studies health workers are

considering in which they would test blood from a number of people to

determine the extent of infections in Turkish communities.

 

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