LAHORE, 4 February 2008 (IRIN) - The avian flu epidemic that has swept across parts of neighbouring India has led Pakistan's Health Ministry to begin putting in place a number of preventative measures.

In a letter sent out to provincial health officials, hospital heads and other health workers, the ministry warned that hospitals should remain on "high alert" and make "emergency arrangements" to tackle any outbreak of avian flu.

On 1 February the authorities confirmed the deadly H5N1 bird flu virus at two poultry farms in Karachi, but with no human infection so far.

Pakistan shares a long border with India, where at least 50,000 birds have been culled in the past few days in a bid to curb the disease's spread.

Pakistan, with the cooperation of the World Health Organization (WHO), has started training health workers in dealing with suspected cases of avian flu.

Two infectious diseases isolation wards are now being set up, with WHO assistance, at medical facilities in Peshawar and Abbotabad in Pakistan's North West Frontier Province (NWFP).

"We are providing technical assistance to the Ministry of Health and funds will be mobilised," Fawad Khan, WHO's avian human influenza coordinator, told IRIN on 4 February in Islamabad.

The ministry has advised those dealing directly with poultry or other birds to follow international standards, including the use of goggles, gloves and masks to help avoid contracting the virus.

However, given current levels of awareness amongst such workers, it is unlikely such measures will be adopted: "My two brothers and I work at a poultry farm in the Raiwind area, on the outskirts of Lahore. We have heard about bird flu, but we have never used gloves or other equipment and we don't possess such gear," Muhammad Irfan, 18, told IRIN.

Poultry sector

Pakistan's poultry farming sector is a huge industry, with at least 12,000 farms of varying sizes dotted across the country, according to figures from the governments Livestock Department.

Most farms are located in the NWFP. The business employs thousands of people, but awareness about bird flu and how to prevent it remains limited.

"I am not educated and what I know about this sickness I have heard only from friends," said Irfan, adding: "God will save us from any risk."

Human case

Pakistan faced a bird-flu panic a few months ago, when it was feared a mutation of the virus may have caused a case of human-to-human transmission, much feared by international health experts.

In late November 2007, Muhammad Ilyas, a poultry farm worker, was admitted to the Khyber Teaching Hospital in Peshawar with symptoms of bird flu. He died within hours, and tested positive for the H5N1 virus that causes the disease.

The discovery that Ilyas's brother, Muhammad Idrees, had died some days earlier and the admission of other relatives to the hospital raised fears that the virus had been transmitted from one human to the other.

A WHO team which visited Pakistan from Geneva, and carried out genetic sequence testing said in January there was no confirmation of human-to-human transmission.

Since then, the Pakistani authorities have been accused in the media of dragging their feet and not doing enough to prevent a wider outbreak. But reports from India, coupled with recent events in Karachi, appear to be spurring them into action, with hospitals issuing directives regarding the treatment of patients showing symptoms of avian flu.

Experts question preventative measures

Yet despite those efforts, some experts say that not enough is being done.

A workshop on bird flu in Asia organised last month in Lahore by the Pakistan Medical Society (PMS) called for poultry farms and poultry selling areas to be moved away from densely populated localities to avoid transmission of the virus to humans.

According to Masood Akhtar, the PMS chairperson, the "non-professional manner" in which the poultry business was conducted in many Asian countries raised the "risks posed by bird flu to humans". He called for the comprehensive vaccination of birds, to make them less susceptible to the virus, as well as methods to ensure the safe disposal of poultry waste.

The number of cases of bird flu reported in recent months is still low - with six to eight persons reportedly affected - but the potential for a wider epidemic remains very real. However, as yet there has been no widespread awareness-raising campaign.

kh/ds/ar

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