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Homeland Security

11 January 2006

Mideast Nations Must Be on Alert for Bird Flu, U.N. Says

Turkish outbreaks could lead to disease in neighboring nations

By Charlene Porter
Washington File Staff Writer

Washington – Nations of the Middle East need to brace themselves for the possibility of bird flu outbreaks, according to a top U.N. official monitoring avian influenza, now that the disease appears established in Turkey.

U.N. Coordinator for Avian Influenza David Nabarro said January 11 that government officials in nations bordering on Turkey need to be concerned about their capabilities to control animal disease and to launch public education campaigns about disease.

The first human cases of H5N1 – the viral strain first identified in Asian poultry and now moving westward – appeared in Turkey in early January.  The official number of cases confirmed by the World Health Organization (WHO) stood at 15 on January 10, but some media reports say more than 40 cases of human illness are being investigated as possible bird flu infection in humans. Health officials warn this widespread animal disease could escalate into an influenza pandemic among humans.

Briefing reporters at U.N. headquarters in New York, Nabarro said nations of the region need to make sure that their veterinary services are capable, equipped and prepared to move rapidly upon the appearance of disease outbreaks in their poultry populations. 

“It’s not actually easy to initiate a cull” of diseased chickens, said Nabarro. Destruction of birds upon the appearance of disease in a flock is the standard response for preventing further disease.

First you have to catch the chickens, Nabarro said, then “you’ve got to make sure they’re put into sacks, taken away, properly killed and buried.” Improper execution of that process can make a cull ineffective, allowing the continued circulation of disease.

Nations also must be sure that their “lab services are tuned up” so they’ll be able to conduct quick analysis of disease samples to ascertain what type of agent is causing disease in animal or human populations.

On the same day as the Nabarro briefing in New York, the Food and Agriculture Organization (FAO) of the United Nations affirmed from its Rome headquarters that avian influenza does pose a danger to neighboring countries. The FAO announcement recommended that Armenia, Azerbaijan, Georgia, Iraq, Iran and Syria be on high alert for possible outbreaks.

HUMAN DISEASE AND EDUCATION

The incidence of human cases of avian influenza in Turkey seems to be traceable to human contact with diseased poultry. The first children to fall ill and die, for example, reportedly had been playing with the decapitated head of a chicken prior to becoming sick.

People need to use greater caution around sick birds, Nabarro said, so threatened nations should step up public education about the dangers of contact with sick birds, and the need for good hygiene.

The U.N. official -- appointed by Secretary-General Kofi Annan to coordinate the international organizational response to bird flu and the possibility of pandemic -- said farm families also should be warned about the potential hazard of handling and eating birds that have become sick and died.

He urges families not to do “the tempting thing, which is to take those dead birds, and then cook them up and eat them.  We’d really prefer they not do that.”

At the same time, Nabarro has said he has been “a little bit alarmed” about reports that poultry consumption is way down in some areas, even though he is “absolutely certain” that the majority of poultry and meat raised for consumer consumption is going to be “totally safe to eat.”

TURKISH RESPONSE

Nabarro praised Turkey for its response to the bird flu outbreaks. He is “very much confident” that government officials are focused completely on their problem, and fully recognize the importance of their response in the context of national and global health.

Turkey has been effective in confronting the outbreaks in both animal and human populations, Nabarro said. A widespread cull of poultry is under way to eradicate the virus, and the Ministry of Health has put in place “the most up-to-date treatment we’ve got for suspected H5N1,” Nabarro said. 

Like any influenza, H5N1 causes congestion in the lungs that can develop into pneumonia.  Keeping a patient breathing through that is important, and Nabarro said the Turks have been able to do that.  They also had a supply of oseltamivir on hand that was quickly distributed to the ill, Nabarro said.  Also known as Tamiflu, oseltamivir is a drug that has shown some effectiveness in quelling the disease if administered in its early stages.

The disease has appeared in humans in Turkey in a way that is inconsistent with its earlier emergence in the five other nations that have experienced human cases of H5N1. 

“This pattern in Turkey gets scientists scratching their heads,” Nabarro said. Just under 150 human cases have appeared in East Asia over two years, but now, 15 cases -- perhaps more – have cropped up in Turkey in a matter of days. In addition, although the mortality rate for disease in Asia has been about 50 percent, so far it is much lower in Turkey. 

Both of these anomalies are going to be a matter of great interest to scientists, and potentially important clues to what sort of disease H5N1 really is.

The most significant question about this disease still has a negative answer.  The human cases in Turkey offer no evidence that H5N1 has become a disease contagious among humans, and thereby planting the seed for pandemic influenza.

Nabarro said when -- and if -- that will ever happen are still completely unknowable.

For additional information on the disease and efforts to combat it, see Bird Flu (Avian Influenza).

(The Washington File is a product of the Bureau of International Information Programs, U.S. Department of State. Web site: http://usinfo.state.gov)



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