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CRISIS PROFILE: Bird flu
27 Feb 2006 00:00:00 GMT
Source: AlertNet - background material
Emma Batha
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Coloured chicks on sale in Indonesia, one of the worst affected countries.
REUTERS/Beawiharta
Crisis in detail
Impact on the poor
Timeline
Useful links
CRISIS AT A GLANCE
Avian flu is devastating bird populations around the globe but if the virus acquires the ability to jump easily between humans it could unleash a pandemic, killing millions of people within months.
The current outbreak, which originated in southeast Asia in 2003, has spread to the Middle East, Europe, India and Africa. By early 2006 just over 90 people had died from the H5N1 strain. Almost all of them had caught it from birds, but scientists believe there have been a few cases of human to human transmission.
A human pandemic would be particularly catastrophic in developing countries where living conditions and malnutrition are likely to make people more vulnerable, health services are weak and vaccines and antivirals would be beyond reach.
Even if there is no pandemic, bird flu will threaten the livelihoods of millions of people in Asia and Africa as health officials carry out mass poultry cullings and other countries ban imports. Some 200 million birds have already died or been destroyed in more than 30 countries.
Countries with human deaths: Cambodia, China, Indonesia, Thailand, Turkey, Vietnam, Iraq
For a map showing the spread of the disease click here.
CRISIS IN DETAIL
By early 2006 just over 90 people had died from bird flu in a little over two years. The toll may not sound alarming but scientists fear that if the virus mutates into a human disease it could kill tens of millions within a few months.
Health experts agree a big pandemic of some sort is overdue and believe the strain of avian flu currently rampaging around the globe in birds is the most likely source.
The outbreak, the largest and most severe on record, originated in southeast Asia in 2003. It has now spread to the Middle East, Europe, India and Africa.
Even if there is no human pandemic, bird flu threatens the livelihoods of millions of people as health officials destroy flocks and other countries ban imports.
Disease and culls have already killed more than 200 million birds in 32 countries. Thailand lost its $1.2 billion poultry export industry to the European Union overnight and many small poultry farmers in Vietnam have seen their flocks wiped out.
The strain responsible for the human deaths, H5N1, kills around half the people it infects. About half those who have died were under 25.
The World Health Organisation (WHO) says there have been a tiny handful of cases where an infected person has infected another but at the moment the virus cannot pass efficiently between people.
However, if it acquires the ability to spread the way normal flu does it could be devastating, both because it is so pathogenic and because humans do not possess any immunity to it.
No one can say when this might happen – it could be tomorrow or in a decade or indeed never. It is also possible that the virus could lose its dangerous qualities as it mutates.
There were three major influenza pandemics in the last century - the 1918 flu, which killed between 20 and 100 million people, depending on the estimate, the 1957 flu, which killed about 2 million, and the 1968 flu, which killed about 1 million. All three mutated from forms of avian influenza.
H5N1 has similarities to the 1918 virus, suggesting it could affect healthy young adults more than the very old and very young who are usually most vulnerable to flu.
In January the international community promised $1.9 billion to help tackle avian flu in poor countries and boost global surveillance.
’Chicken ebola’
For the moment, the risk of catching bird flu is minimal. Despite the infection of tens of millions of birds over large geographical areas fewer than 200 people are known to have contracted the disease, according to the WHO.
Close contact with sick or dead birds is the main source of infection.
The risk of catching the virus appears greatest during the slaughtering and preparation of infected birds for eating. In a few cases, children are thought to have caught the disease through exposure to chicken faeces while playing in an area used by poultry.
Symptoms in humans include a fever, coughing and breathing problems. Pneumonia and multiple organ failure are common. Other symptoms can include diarrhoea, vomiting, abdominal or chest pain and bleeding from the nose and gums.
In poultry, H5N1 has been dubbed “chicken Ebola” because it causes massive internal bleeding. It can wipe out a flock within hours.
A human pandemic could start in two ways. If a person were infected with avian and human flu viruses at the same time they could swap genes creating a new strain transmissible between humans. In this case it would spread very rapidly.
Alternatively, the virus could adapt more gradually, improving its ability to bind to human cells during repeated human infection.
Is there a cure?
Public health experts agree the world is nowhere near ready to cope with a human pandemic.
No vaccine is available because there is no way to predict what the pandemic strain will look like. It takes at least six months to make a new flu vaccine once the virus has appeared.
Many countries are stockpiling antiviral drugs like oseltamivir, commercially known as Tamiflu, which may improve survival prospects if taken within 48 hours of symptoms appearing.
Tamiflu and another drug, Relenza, known generically as zanamivir, were developed to treat seasonal flu and work by preventing the virus from replicating itself. But no one really knows how effective they would be against a bird flu pandemic.
Swiss drug maker Roche, which manufactures Tamiflu, said around 65 governments, including nine in Africa, had now put in orders or said they intended to. The cost to developed countries is 15 euros ($18) per course. Developing countries pay 12 euros ($14) in capsule form and 7 euros ($8) in powder form.
The pharmaceutical giant is donating over 5 million treatments to WHO. Of these, 3 million will be stored centrally for use at the site of an outbreak to stop it escalating into a pandemic and 2 million will be kept in regional stockpiles.
Roche has given companies in China and India the green light to manufacture the drug. Several other firms around the world have also started making copycat versions.
This may sound reassuring, but countries need to stockpile enough to cover 25 to 50 percent of the population. And the costs are still going to put the drug out of reach of most people in the developing world.
“In terms of global coverage clearly we’re a long way off the target,” says David Reddy, Roche’s Pandemic Taskforce leader. “We’re still ramping up production because in the event of a pandemic demand will be enormous.
“But we’re so much better prepared than we were this time last year. This is the first shot in history at trying to stop a pandemic at its outbreak.”
WHO has estimated that even a mild form of the disease would kill 2 million to 7.4 million people.
A serious pandemic would send the world into recession as workers became ill and others stayed at home to care for them or avoid infection. It would disrupt trade, transport and food supplies. Extra costs would include hospital and medical treatment and measures to contain the disease in birds.
The World Bank has estimated a pandemic could cost the global economy $800 billion a year, while the Lowy Institute, an Australian think-tank, says a really catastrophic scenario could kill more than 140 million people and cost $4.4 trillion.
Human deaths
Scientists believe the massive increase in Asia of human and bird populations living alongside one another has helped the disease to cross the species boundary.
The first human cases of H5N1 occurred in Hong Kong in 1997 when 18 people were infected and six died. Hong Kong’s entire poultry population, estimated at 1.5 million birds was killed.
Avian flu reappeared in poultry in southeast Asia in 2003, affecting birds in South Korea, Vietnam, Japan, Thailand, Cambodia, Laos, Indonesia, China, and Malaysia.
In July 2005 the virus spread to Russia and Kazakhstan. Three months later it was reported in Turkey, Romania and Croatia. Since then it has spread to Nigeria, India and a host of countries in western Europe.
Human cases have been reported in Cambodia, China, Indonesia, Thailand, Turkey, Vietnam and Iraq.
There are hundreds of strains of bird flu. Many wild birds carry flu viruses with no apparent signs of harm but other bird species including poultry develop disease when infected.
Migrating wildfowl are believed to be responsible for spreading the virus westwards, but trade in live poultry may have played a role in its movement around Asia.
WHO has warned that countries along migratory flight routes from central Asia may face a persistent risk of re-infection.
Africa
The arrival of bird flu in Nigeria in early 2006 is particularly alarming. Millions of households live alongside chickens throughout the region, increasing the chances of the virus crossing into humans.
Poor medical, veterinary and laboratory services, lack of health education, porous borders and high mortality rates from other diseases mean a new human virus could easily spread undetected.
Malnutrition and poverty will make people more vulnerable across Africa where impoverished health services are already struggling with the burden of AIDS, tuberculosis and malaria.
There is concern that Nigerian authorities have been slow to implement culling and quarantine measures. Farmers and villagers, many unaware of the risks, have been disposing of infected birds without protective masks and clothing.
But even with a concerted education campaign many Nigerians are likely to continue selling or eating birds that have died because they cannot afford to throw away meat even if it might be infected.
"If the situation in Nigeria gets out of control, it will have a devastating impact on the poultry population in the region," Samuel Jutzi, director of the FAO’s animal health division, said.
"It will seriously damage the livelihoods of millions of people and it will increase the exposure of humans to the virus."
THE POOR GET POORER
Nigerian poultry trader Ismail Musa has been selling his birds at less than half price in the northern city of Kano since the arrival of avian flu in Africa’s most populous country.
Even if there is no human pandemic, bird flu threatens to have a devastating affect on the livelihoods of millions of people in Asia and Africa who depend heavily on poultry both for income and food.
Deaths and mass culls have already badly hit rural communities in southeast Asia. In many countries the government says it cannot afford to fully compensate people for destroyed birds.
Aid agencies say inadequate compensation will not only tip millions into extreme poverty but will help spread avian flu by discouraging people from reporting the disease.
“People fear reporting sick birds because their flocks will be destroyed and they may not be compensated for their losses. So instead, they hide the sick birds or sell them and that, in turn, contributes to the transmission of avian flu to new areas.” said Sanjay Sinho, CARE International’s health programme director.
“Much of the $1.9 billion pledged at the recent World Bank conference for avian flu must go toward livelihood issues like compensation for destroyed birds, so people will report outbreaks more quickly, and to strengthening health systems.”
Whether farmers are compensated at all and by how much varies greatly.
Vietnam, one of the worst hit countries, initially recommended compensating people 50 percent of the value of their birds, but some regions said they could only afford 30 percent, according to the U.N.’s Food and Agricultural Organisation (FAO). Thailand recommended 70 percent in the early stages but has pushed this up to 100 percent in some cases. By contrast Cambodia said at the end of 2005 it was not planning any compensation at all.
Escaping poverty
The FAO said a study of one Vietnamese village estimated bird flu had cost households $69-$108 – a large sum when compared to a villagers’ daily income of $2 or less.
But it is small commercial farmers rather than backyard poultry keepers who are most vulnerable, the FAO says.
Ironically, U.N. agencies and many donor governments have in recent years been promoting small scale poultry farming as a way out of poverty. Chicken is a cheap form of protein and can bring a 700 percent annual return of capital invested.
Encouraged by various development schemes, many people in Asia and West Africa have taken out loans to start small poultry businesses, buying a few hundred birds and building shelters for them.
In countries like Vietnam some of these farmers had not even broken even before having their whole stock destroyed. Compensation, which is only partial, is taking months to come through. Vietnam has urged banks to extend loans to prevent people sinking even further into debt.
The speed of compensation is crucial. India, which reported its first outbreak on Feb. 18, has been praised for its prompt payments. To see the FAO’s presentation on compensation click here.
Protein
Nigerian poultry trader Musa is not the only one selling his birds at rock-bottom prices. Some Indian farmers saw prices fall 40 percent overnight after the arrival of bird flu in western Maharashtra state.
Poultry is one of the fastest-growing sectors in India where there is widespread protein deficiency, particularly in rural areas. The country is the fifth-largest producer of eggs in the world and has nearly 500 million poultry.
There are fears bird flu could affect nutrition levels in poorer countries by reducing people’s incomes at the same time as pushing up the price of alternative protein sources. In Indonesia, where bird flu is now endemic, protein choices are already limited - the predominantly Muslim population does not have the option of pork and there is very little beef.
Aid agency ActionAid says bird flu could have a disastrous affect on the developing world where around 70 per cent of people live in rural communities alongside their bird and animal stocks.
It has called for major public information campaigns, generous internationally-funded compensation schemes and affordable medicines for the poor.
"If we don’t act quickly, we will see a human epidemic,” ActionAid’s Puthanveettil Unnikrishnan said. “And the likelihood is that this will happen first in a poor community in a developing country. Yet the poorest are currently at the bottom of the list as far as global preparations are concerned. Not only is this unjust, it is also foolish.”
TIMELINE
(In the following chronology bird flu refers to the H5N1 strain.)
1996 - H5N1 detected in a goose in Guangdong province, China.
1997 – First documented outbreak of human H5N1 infection. Six of the 18 people infected die. Hongkong’s entire poultry population is destroyed.
2003
Dec 15 - South Korea confirms bird flu at a chicken farm near Seoul and begins a mass cull when the virus spreads across the country.
2004
Jan 8 - Vietnam says bird flu found in poultry.
Jan 11 – Vietnam confirms human cases.
Jan 23 – Thailand confirms its first human cases.
Jun/July – Thailand, China, Indonesia and Vietnam report recurrence in poultry following outbreaks earlier in the year.
Aug 12 – Vietnam reports three new human cases, all fatal.
Sept 7 – Vietnam reports a fourth fatal case. Thailand confirms another two days later.
Sept 27 - Thailand says it has found a case where one human probably infected another.
Sept/Oct – Thailand confirms three more human cases. Death toll is now 32 - 12 in Thailand and 20 in Vietnam.
2005
Feb – Cambodia reports its first human case. Three more fatal cases reported in March, April and May.
April – More than 6,300 migratory birds, infected with H5NI, begin dying in Qinhai Lake, central China. Prior to this wild bird deaths from highly pathogenic avian flu viruses were rare. Viruses detected later in 2005 in countries along migratory routes are found to be almost identical to the Qinhai Lake virus.
July 21 – Indonesia reports its first human case.
July/Aug – Russia and Kazakhstan report outbreaks in poultry. Dead migratory birds are reported in the vicinity.
Oct 10 – First cases of H5N1 in poultry in Turkey, prompting the European Union to bans imports of live birds and feathers from Turkey.
Oct 15 - H5N1 confirmed in ducks in Romania, the first case in mainland Europe.
Oct 20 – Thailand reports its first human case in a year.
Oct 26 - Croatia confirms H5N1 in wild birds.
Nov 11 - Kuwait reports H5N1 in a flamingo, the first known case in the Gulf Arab region.
Nov 16 – China reports its first two human cases.
Dec 3 - Ukraine tackles its first outbreak in poultry.
2006
Jan 15 - Turkey says a fourth child from the eastern town of Dogubayazit has died of bird flu.
Jan 18 - International donors pledge $1.9 billion to combat the spread of bird flu at a conference in Beijing.
Jan 29 - H5N1 is confirmed in poultry in northern Cyprus.
Feb 2 – WHO confirms a person has died from bird flu in Iraq.
Feb 6 - WHO confirms two deaths in Indonesia, taking the overall toll to 88.
Feb 8 - The first African cases of H5N1 are detected in poultry in three northern Nigerian states.
Feb 11/12 - Italy and Greece say tests on swans are positive. These are the first known cases in the European Union. Bulgaria and Slovenia also report H5N1.
Feb 13 - The WHO confirms two human deaths from bird flu in Indonesia and one in China, taking the overall toll to 91.
Feb 14 – Iran, Austria and Germany report cases in swans.
Feb 17 - Egypt finds its first cases of H5N1 in chickens.
Feb 18 - India announces its first cases of H5N1, finding the virus in poultry in a western state.
Feb 20 - The WHO confirms another death in Indonesia, taking the overall toll to 92. These comprise four in Turkey, 19 in Indonesia, eight in China, four in Cambodia, 14 in Thailand, 42 in Vietnam and one in Iraq.
Feb 21 - Tests confirm H5N1 in dead swans in Hungary.
Feb 24 - Cambodia says H5N1 has returned and Slovakia confirms its first cases in wild birds.
Feb 25 - France confirms H5N1 at a farm where thousands of turkeys have died - the first cases in farm birds in the EU.
Feb 27 - Tests show H5N1 in domestic ducks in Niger.
USEFUL LINKS
The World Health Organisation provides all the latest updates on bird flu. Its fact sheet is the best place to start for a thorough introduction to the virus in birds and humans.
If you want to know more about the impact of the disease on those whose livelihoods depend on poultry try the Food and Agriculture Organisation’s bird flu site.
It’s a well written and presented site with animated graphics, slide shows and question and answer sections as well as academic reports and research papers.
CARE International also has excellent material on how bird flu could push millions into poverty.
A useful feature on teh FAO site is the gallery of maps which is regularly updated as bird flu spreads around the world.
There’s a good animated graphic illustrating the spread of the disease and the role of migratory birds.
For an animated guide explaining why chickens are such a crucial source of income for millions of families in Vietnam and a useful map showing how bird flu has hit the country’s poorest areas click here.
For a global graphic showing human outbreaks and poultry outbreaks
click here.
The World Bank’s avian flu website provides information on programmes to prevent the disease and describes the potential economic impact - $800 billion a year according to one bank economist.
But that sum is peanuts compared to the worst-case scenario predicted by the Lowy Institute for International Policy. A severe pandemic could kill 140 million people and cost the world $4.4 trillion, according to a report by the independent Australian think-tank which also lays out a range of less scary forecasts.
The Asian Development Bank says even a mild pandemic could kill 3 million in Asia alone and cost the region $300 billion. There’s some brief and clearly written background and some papers on the potential economic impact in Asia.
For information on the risk to the United States visit the Centers for Disease Control and Prevention. Its bird flu section has some of the most easy to understand general background on the disease.
The European Centre for Disease Prevention and Control focuses on the risks to Europe but is a lot more technical in tone than the CDC site.
The World Organisation for Animal Health, which was set up in 1924 to help countries work together to eradicate diseases threatening their livestock, keeps its site regularly updated with news of the latest outbreaks. It also has information in French and Spanish.
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