ZKEA

Biological Warfare : Biological Terrorism : Emerging Diseases

Archived News
Week ending March 3rd, 2005

On a recent afternoon, Ly Sovann sat perspiring in his stuffy office and wondered if he had an epidemic on his hands. Since word spread that a Cambodian woman in a remote village succumbed to avian influenza in January, Dr. Sovann's cellphone hasn't stopped ringing as health workers call in suspected cases of the disease.

The problem: Few here know what avian flu is or how to recognize it. That makes Dr. Sovann's job as Cambodia's chief flu-hunter at the cash-strapped Ministry of Health difficult. Worse, his emergency budget for educating this country's 13 million people about bird-flu dangers is just $2,500.

"A lot of the time the reports turn out to be diarrhea or measles," Dr. Sovann said as his phone buzzed to life again.

The long-term diagnosis may not be nearly as benign. Julie Gerberding, director of the U.S. Centers for Disease Control and Prevention in Atlanta, said last week that there was a real risk of Asia's bird-flu problem transforming into a global threat, comparing the danger to the 1918 flu that killed between 20 million and 40 million people. At a conference in Vietnam last week, World Health Organization regional director Shigeru Omi went further. He said: "The world is now in the gravest possible danger of a pandemic."

A close look at Cambodia suggests a worrying complication: a critical shortage here of even the most basic tools or diagnostic skills to identify the virus in the first place, much less control or treat it.

The bird-flu strain, known to scientists as H5N1, was first spotted in Hong Kong's poultry markets in 1997. Since then, the virus has become both more lethal to birds and more widespread. When the virus appeared in Vietnam, Laos and Thailand in late 2003 and early 2004, it caused around $10 billion in damage as officials ordered the destruction of millions of chickens, ducks and other domestic poultry.

Now the virus is resurging in rural Southeast Asia. Cambodia, Thailand and Vietnam have each reported outbreaks in poultry this year. Scientists say the virus has probably become entrenched here, spread by poultry traders and wandering duck populations.

Since 2003, bird flu has killed at least 46 people, with a fatality rate of about 72%. That compares with six people who died during the 1997 outbreak in Hong Kong. The virus still doesn't easily spread from birds to humans, nor from one human to another...

The world is poorly prepared for a future influenza pandemic, with only a dozen countries purchasing significant quantities of antiviral drugs and just 50 with contingency plans on how to cope with such an outbreak.

A Financial Times analysis on the eve of a World Health Organisation meeting on preparing for a pandemic shows widely differing approaches between countries that already have plans, and a sharp divide between richer countries and many poorer nations, creating splits that could hinder efforts to curb disease. The analysis comes as concern rises about the likelihood of a pandemic linked to widespread outbreaks of bird flu in south east Asia, which have killed at least 42 people. The WHO, which meets in Luxembourg on Wednesday with 52 countries from the European region, estimates that up to 8m people could be killed and 30m could be hospitalised. Klaus Str, WHO global influenza co-ordinator, said a dozen countries led by Australia, Canada, France, the US and Sweden had bought strategic stockpiles of the antiviral drug Tamiflu, while Singapore and Thailand have bought smaller amounts. Most of the developing world including other Asian countries on the frontline of the bird flu outbreak is well behind.

The UK on Tuesday became the latest to upgrade its contingency plan, pledging to spend about £200m ($385m) over two years to increase its stockpiles of Tamiflu from 100,000 to 15m treatments.

Tamiflu is the only widely commercialised treatment which has proved to be effective in reducing the severity of flu symptoms and acting as a prophylactic, although it is untested against new flu pandemic strains.

Roche, its Swiss-based manufacturer, confirmed it had only received a dozen firm orders. It said talks were under way with a number of other countries and it was already expanding its manufacturing capacity, but it would need more commitments to make additional investments.

Mr Stahr said only about 50 countries had national flu pandemic plans to co-ordinate their response, and that they vary widely in terms of how recently they have been revised, their quality and their length from a single sheet of paper to 400 pages. Almost a dozen companies have recently signalled to the WHO their interest in producing pandemic flu vaccines, but are waiting for clearer funding commitment from governments. A vaccine cannot be produced until the precise strain that causes a pandemic has been identified, but scientists are trying to simulate a bird flu virus and develop methods to step up production very quickly...

More than 700 scientists sent a petition on Monday to the director of the National Institutes of Health protesting what they said was the shift of tens of millions of dollars in federal research money since 2001 away from pathogens that cause major public health problems to obscure germs the government fears might be used in a bioterrorist attack.

The scientists, including two Nobel Prize winners and a biologist who is to receive the National Medal of Science from President Bush in March, say grants for research on the bacteria that cause anthrax and five other diseases that are rare or nonexistent in the United States have increased fifteenfold since 2001. Over the same period, grants to study bacteria not associated with bioterrorism, including those causing diseases like tuberculosis and syphilis, have decreased 27 percent, the petition said.

"The diversion of research funds from projects of high public-health importance to projects of high biodefense but low public-health importance represents a misdirection of N.I.H. priorities and a crisis for N.I.H.-supported microbiologist research," the letter said.

Scientists specializing in viruses were not asked to sign because their grants are handled separately, but some virologists have expressed interest in organizing a similar petition, said Richard H. Ebright, a molecular biologist at Rutgers University who was the primary organizer of the petition.

"A majority of the nation's top microbiologists - the very group that the Bush administration is counting on to carry out its biodefense research agenda - dispute the premises and implementation of the biodefense spending," Dr. Ebright said in an interview.

Dr. Zerhouni declined through a spokesman to comment on the letter. But Dr. Anthony S. Fauci, the director of National Institute of Allergy and Infectious Diseases, which controls about 95 percent of the institutes' biodefense research spending, said the petition's signers were mistaken on several points. Dr. Fauci said the $1.5 billion a year the administration decided to spend on biodefense research starting in 2003 was new money and was not taken from existing N.I.H. programs. Moreover, he said, much of the biodefense research should also help protect against natural emerging disease threats.

For example, he said, research centers around the country that his institute has designated for biodefense financing will also work on the possibility of an influenza pandemic, which he acknowledged is a greater threat today than bioterrorism...

Two new retroviruses never before seen in humans have turned up among people who regularly hunt monkeys in Cameroon, researchers reported on Friday. Like the AIDS virus, these viruses insert their genetic material directly into cells and perhaps even into a person's or animal's chromosomes. Closely related versions of the viruses cause leukemia, inflammatory and neurological diseases.

The two new viruses are called human T-lymphotropic virus types 3 and 4 or HTLV-3 and HTLV-4. They are closely related to two known viruses called HTLV-1 and HTLV-2, which experts believe were transmitted to people, like HIV, from monkeys and apes.

Because HIV originated as a cross-species infection from a non-human primate virus, the question was how much cross-species retrovirus infections are occurring and what are the consequences of these infections, said Walid Hemeine of the U.S. Centers for Disease Control and Prevention, who led the study.

They examined blood samples from 930 Cameroonians who had handled or eaten bush meat -- monkeys or apes hunted for food. They used antibody screening and genetic analysis to find at least six different simian retroviruses had infected 13 of the people.

Two hunters were infected with two previously unknown HTLV viruses. One person was infected with HTLV-3, which is genetically similar to a simian virus, STLV-3, and represents the first documented human infection with this virus, the researchers told the 12th Annual Retrovirus Conference being held in Boston. The second hunter was infected with HTLV-4, a virus distinct from all previously known human or simian T-lymphotropic viruses.

"It's totally new so we don't know any other simian virus that is related to it",Hemeine said in a telephone interview.

Now the team, which includes researchers at Johns Hopkins University in Baltimore, plans to look more extensively in Central Africa for the virus, Hemeine said. They could be more widespread than we think they are, he said...

he HIV infection rate has doubled among blacks in the United States over a decade while holding steady among whites - stark evidence of a widening racial gap in the epidemic, government scientists said Friday. Other troubling statistics indicate that almost half of all infected people in the United States who should be receiving HIV drugs are not getting them.

The findings were released in Boston at the 12th Annual Retrovirus Conference, the world's chief scientific gathering on the disease.

"It's incredibly disappointing," said Terje Anderson, director of the National Association of People With AIDS. "We just have a burgeoning epidemic in the African American community that is not being dealt with effectively."

Researchers and AIDS prevention advocates attributed the high rate among blacks to such factors as drug addiction, poverty and poor access to health care.

The HIV rates were derived from the widely used National Health and Nutrition Examinations Surveys, which analyze a representative sample of U.S. households and contain the most complete HIV data in the country. Researchers at the Centers for Disease Control and Prevention compared 1988-1994 data with figures from 1999-2002. The surveys look only at young and middle-aged adults who live in households, excluding such groups as soldiers, prisoners and homeless. Thus, health officials believe the numbers probably underestimate true HIV rates in this country.

Still, they show a striking rise in the prevalence of the AIDS virus from 1 percent to 2 percent of blacks. White rates held steady at 0.2 percent. Largely because of the increase among blacks, the overall U.S. rate rose slightly from 0.3 percent to 0.4 percent...

A dozen HIV-positive women donned flowing evening gowns and glittering jewelry to compete in a beauty pageant aimed at fighting the stigma that still surrounds the deadly virus in this AIDS-ravaged southern African country.

Botswana has one of the world's highest rates of HIV infection, with about 37 percent of its 1.7 million population testing positive for the virus that causes AIDS. Organizers of the Miss Stigma Free pageant hope the contest -- now in its third year -- will show the disease does not prevent women from being beautiful and living positively. Cynthia Leshomo, a 22-year-old AIDS counselor in a floral gown, was crowed the winner Saturday to loud applause from the crowd of about 500.

"I am going to urge our government to involve us HIV-positive people in work on HIV/AIDS, especially in hospitals, because ... we know how it is to live with HIV/AIDS," she said. Her prizes include cash, an academic scholarship, beauty treatments and a computer.

Judy Peacock, Miss Botswana 2004, helped the contestants prepare for Saturday's pageant by coaching them in how to answer judges' questions about AIDS and walk down the runway with poise. The women, aged 18-35, were making an important statement by participating, Peacock said.

"They are telling the world: 'We accept our condition, and we want to live positively with the virus,"' she said...

Lek, a beggar who squats like a troll atop a pedestrian bridge in central Bangkok, used to keep a fluffy baby chick to attract passers-by to his outstretched cup.

When bird flu broke out last year and Thai farmers were forced to cull 60 million poultry, he switched to a cute duckling instead.

Last week, when Thailand's livestock ministry announced that 2.7 million free-range ducks must be slaughtered because water fowl can harbour and transmit the deadly H5N1 virus without showing any symptoms, Lek replaced his duckling with a wind-up toy.

Yet even though a third wave of avian influenza is scything through hen houses in nearly half the provinces of neighbouring Vietnam, there is little consumer concern in the Thai capital. Such a blase response is surprising, given that 42 people in South-east Asia have died from bird flu complications during the past 13 months, with 13 fatalities since January.

The authorities are anything but blase. "The world is now in the gravest possible danger of a pandemic," Dr Shigeru Omi of the World Health Organisation warned an emergency UN conference in Vietnam last week.

Joseph Domenech, head of animal health at the Food and Agriculture Organisation, called the threat "a sword of Damocles" hanging over the world. And Dr Julie Gerberding, head of the US Centers for Disease Control and Prevention, said: "This a very ominous situation for the globe." It was a week of the direst predictions yet that the flu could soon rapidly spread across the globe, killing tens of millions of people; by one authoritative estimate 500,000 could die in Britain alone.

On Friday, New Zealand became the latest government to announce a mass purchase of oseltamavir, the only drug known to be effective against the virus...

Amid dire warnings of an Asian pandemic, the government is preparing to test an experimental bird flu vaccine and is increasing disease surveillance in hopes of reducing the toll from any eventual American outbreak. Antiviral drugs are being stockpiled, and 2 million doses of vaccine are being stored in bulk form for possible emergency use and to test whether they maintain their potency.

United Nations officials warned on Wednesday that the Asian bird flu outbreak poses the "gravest possible danger" of becoming a global pandemic.

Dr. Julie Gerberding, director of the federal Centers for Disease Control and Prevention, told the National Press Club this week that "it is a worrisome" situation,though she also said the United States "is not immediately on the brink of an avian flu epidemic."

The flu has affected poultry in eight Asian countries, with 45 human deaths among people who caught the illness, a strain of flu known as H5N1. So far, humans appear to have caught this flu from chickens and other poultry, and the virus is not known to have spread from person to person. What health authorities most fear is that the virus will mutate into a form that can pass easily from one human to another. That' when a global threat would be most likely.

The deadly flu of 1918, which killed from 20 million to 50 million people worldwide, didn't appear suddenly but mutated gradually into the deadlier form, Gerberding explained...