Bird Flu: Plea For Vaccine Stockpile (EU)

Leo Cendrowicz in Brussels, Helena Smith in Athens and John Aglionby in Jakarta
Saturday October 15, 2005
The Guardian (UK)

EU health officials last night demanded tough new measures to prevent the spread of deadly bird flu into Europe, including limits on public access to wetlands in high-risk areas and requirements that some poultry be kept inside.

Veterinary experts agreed recommendations from the European commission that will require poultry farmers to be vaccinated against the human flu virus and to remain vigilant for tell-tale signs such as a fall in egg production or increased bird mortality rates.

Countries will have to pinpoint "high risk" areas and take steps to keep wild birds away from domestic fowl, including keeping poultry indoors in some areas. They must report back to Brussels on measures taken within three weeks. The experts also called on governments to stockpile antiviral drugs and redouble their efforts to prepare for the possible spread of bird flu.

An international team will be sent to Turkey - where 8,000 chickens, geese, turkeys and pigeons have been culled since the discovery of the virus there - and Bulgaria. Tests on apparently infected birds from Romania are being conducted at the Veterinary Laboratories Agency in Weybridge, Surrey. Results are expected today.

There also was a setback for the preventative campaign, which is largely based on the effectiveness of the antiviral drug Tamiflu. Its manufacturer, Roche, is to double production by the end of the year and the British government has ordered 14.6m doses, enough to treat 25% of the population in the event of a pandemic. But yesterday the scientific journal Nature unveiled research suggesting that Tamiflu may not always be sufficient to combat the infection. After noting partial resistance to the drug in a Vietnamese patient, experts suggest complementary treatments may be needed.

As international organisations scrambled to respond to rising anxiety, fresh concerns emerged in Turkey, where nine people are under medical observation after 40 pigeons from their neighbourhood died in mysterious circumstances. The nine, who include a family of poultry farmers, will remain in hospital for at least a week, but Dr Vasil Haluk at the Turkish Medical Association in Ankara called it "a precautionary step", adding: "No case of bird flu in a human has been reported."

The nervousness in Europe was heightened by the scale of the crisis unfolding in south-east Asia, where Shigeru Omi, the World Health Organisation's director in the western Pacific, said £150m would be needed to fight a virus that was "unpredictable and unstable". "All attempts to bring it under control in south-east Asia have failed," he said. Bird flu is endemic in poultry in Vietnam, Thailand, Indonesia and Cambodia, and 60 people have died in these countries since it emerged in late 2003. The current mortality rate in humans is 50%, according to WHO officials.

British health officials claimed the UK would be ready to deal with a bird flu pandemic. David Salisbury, head of immunisation for the Department of Health said: "We are getting 800,000 more doses of Tamiflu every month, so we will have the level we believe appropriate if we have a pandemic in this country." He said experts were planning for the eventuality of bird flu mutating to spread between humans. "The risk is very real," he said.

The EU has contingency plans to make €1bn (£680m) available for antiviral drugs and vaccines, but said it could only do so once the overall EU budget for 2007 to 2013 is agreed. Officials complained that agreement was being blocked by Britain.

Facing up to the virus that could kill thousands

· Officials prepare for a national emergency
· But experts say pandemic remains unlikely

Mark Honigsbaum and David Adam
Saturday October 15, 2005
The Guardian (UK)

In July, almost unnoticed by the national press, a deadly bird virus arrived on a pheasant farm in Surrey. Experts from the Department for the Environment, Food and Rural Affairs (Defra) identified Newcastle disease, a virus usually mortal to turkeys and geese but not humans, in a flock of 9,000 pheasant chicks imported from France ahead of the shooting season.

Within hours of the diagnosis, veterinary experts had swung into action, throwing up a 3km exclusion zone around the farm near Cobham and culling 10,000 birds. The carcasses were burned and premises cleaned to stop the virus escaping. It was four weeks before Defra's Veterinary Exotic Diseases Division felt it was safe for poultry movements in the area to resume. This weekend, with the news that H5N1, a far more deadly bird virus, has reached Turkey, similar emergency plans are being readied by officials from Defra and other agencies. The scenario they are preparing for is that the H5N1 virus, which so far has led to the culling of billions of chickens in south-east Asia and 60 human deaths, will soon arrive on these shores.

What happens next depends on where the outbreak occurs, whether it can be contained and - most important of all - whether it mutates to become infectious between people. So far, only poultry workers or those directly exposed to chicken faeces or blood are thought to be at risk, though direct human-to-human transmission cannot be ruled out. "Every time a new person gets infected with the virus there is a small chance that person will trigger a pandemic," said Neil Ferguson, a scientist at Imperial College, who has been running simulations on what might happen were H5N1 to reach Britain. "It's a very small chance, probably 1 in a 1000, 1 in 10,000 or less."

Should diseased birds reach Britain, the first step for veterinary officials would be to contain the outbreak as they did with Newcastle disease. An amber alert would be sounded and samples sent to the Veterinary Laboratory Agency (VLA) in Weybridge, Surrey. If Ian Brown, the head of avian virology there, confirms the cause of death as H5N1, the alert level will be raised to red and a whole series of emergency procedures, from quarantine, restriction of poultry movements to culling, will swing into action. Other agencies, such as the Department of Health, the Health Protection Agency and the Ministry of Defence, would be brought into the loop. In the event that the outbreak cannot be contained, Defra may have to consider mass culling programmes and - as in the foot and mouth outbreak - the possibility of vaccination.

At this point, with the risk of the virus spreading to human populations, the Department of Health would appoint a UK national influenza pandemic committee to coordinate the response of hospital trusts and local authorities. The Civil Contingency Secretariat (CCS) of the Cabinet will also be alerted and Cobra, the emergency committee which coordinates Whitehall's response to terrorism, readied for a possible breakdown in civil order.

The Department of Health's pandemic preparedness plan published in March envisages as many as 54,000 Britons dying in the first few months of a flu pandemic. But in June, CCS officials warned that that could be an underestimate. The more likely figure, they said, was 700,000 - a projection the Department of Health is expected to take on board when it updates its pandemic plan later this month.

In the most serious case, officials estimate there would be as many deaths in the 12 weeks of an epidemic as there usually are in a year. At the peak of the pandemic, 19,000 people would require hospital beds, prompting councils to requisition schools to accommodate the sick.

To treat the dying, the government would begin drawing down its stockpiles of oseltamivir (Tamiflu), an anti-viral drug that treats flu. But with only 14m courses, enough for a quarter of the population, likely to be available, sooner or later rationing would have to be imposed, with health professionals and essential civil servants the first in line. The government would also come under pressure to release stores of its precious flu vaccine. At present there are contingency plans for just two to three million doses.But there is no guarantee that vaccines which protect against annual human flu strains will also work against H5N1.

The consequences hardly bear thinking about. Earlier this year, in a dress rehearsal in the East Midlands codenamed Operation Arctic Circle, officials quickly concluded that mass mortuaries would be needed to bury the dead. But no one knows whether, in the event of a pandemic, any of these measures will prove effective. John Avizienius, senior scientific officer at the RSPCA and a member of Defra's avian influenza stakeholder group, said: "All you can do is plan for the worst case scenario."

Next week, in committee rooms across Europe, officials will be doing just that. The first item on their agenda will be the results of VLA tests being conducted this weekend on dead ducks and chickens recovered from a farm in Romania's Danube delta. If the Romanian birds are found to have the virus, as in the case of the turkeys from a farm in the Asian region of Turkey which the VLA last week said had died from H5N1, the European Union may have no choice but to close its borders.

With the news that several poultry workers in Turkey may have contracted the disease, the EU may soon be faced with having to take more drastic measures - such as restricting the movement of people too.

But will it do any good? Last week, wildfowl experts and amateur bird watchers were urged to fan out across the Thames Estuary, Morecambe Bay and the Ribble, looking for tell-tale deaths among migratory birds arriving from Russia.

The fear is that wild geese moving from western China to Siberia may have spread the virus to several species of ducks and gulls that briefly visit British shores on their annual migration north. These ducks, many of which may not show signs of illness, may be passing on the virus to poultry on British farms.

In the hope that they are not, Defra and the Wildfowl and Wetland announced last week that they would be conducting tests on 11,000 wild birds - three times the normal level. "The risk of avian influenza spreading from eastern Russia to the UK via migrating birds is still low," said Defra's chief vet, Debby Reynolds. "However, we have said all along that we must remain on the look out."

FAQ: Precautions

What could I do to protect myself and my children?
If you are fit and healthy, not a lot. There is no vaccine that can protect against the H5N1 avian flu virus because scientists do not yet know what we will be up against.

Isn't there a vaccine in development?
Some manufacturers are working on general H5N1 vaccines which they hope would provide some protection in the event of a pandemic.

Two antiviral drugs, Tamiflu and Relenza, reduce the severity of a flu bout and shorten it, which could save people's lives and reduce the period during which they are infectious to others. The government has ordered 14m doses of Tamiflu.

Can children take it?
It is only licensed for those over 13, but experts believe it is safe at lower doses for those much younger.

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