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tsunami raises bird flu concern

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    Tsunami raises bird flu concernPublic health experts worried about avian influenza amid tsunami chaos | By Katherine M Schlatter

    As Thailand's main disease tracking resources are diverted to deal with the aftermath of the tsunami disaster, flu experts have warned that avian influenza is again infecting humans in the region.


    Scott Dowell, an epidemiologist from the US Centers for Disease Control and Prevention, has been embedded within the Thai Ministry of Public Health for several years, collaborating on projects involving human flu surveillance.

    In the past 2 weeks, he has been working along side Thai health officials on mobilizing one of the largest humanitarian relief efforts in the country's history to meet the needs of tsunami survivors. In Thailand alone, an estimated 5300 people perished in the tsunami waves. Region-wide, at least 160,000 people were killed.

    Dowell warns that another impending danger is not receiving much attention these days. He told The Scientist that right now there's a greater risk that a bird flu outbreak in humans could go unnoticed.

    "The tsunami not only captured the attention of the press, but it's captured the attention of the public health systems in these countries," Dowell said.

    "In Thailand, the Ministry of Public Health has diverted its most important resources to respond to tsunami survivors," Dowell said. That diversion is appropriate given the scale of the crisis, but he points out that avian flu in poultry is endemic in Southeast Asia and worries that human-to-human transmission of avian flu, or the H5N1 virus, could become a reality region-wide.

    The World Health Organization (WHO) reported last week (January 6) that neighboring Vietnam confirmed two new deaths from avian flu, probably spread by chickens. The patients were both children, boys aged 6 and 9. A third child, who was infected in December with avian influenza, remains in hospital. At least 14 other cases are under investigation. It is not yet clear if any of the suspected cases in Vietnam were transmitted between people.

    "If what we're seeing in Vietnam is also occurring in Thailand, then that certainly is a concern, and that's one that we are keeping an eye on right now," Dowell told The Scientist. "If there aren't human cases of H5 [bird flu] or person-to-person transmission in Thailand in the coming week, I think everything is going to be fine."

    Although the latest Vietnamese cases were not in tsunami-affected areas, WHO is worried that people displaced by the tsunami are susceptible to bird flu. "Some guidelines will be released soon about [the possibility of] the avian influenza in disaster zones," said Art Pesigan, a Manila-based coordinator for WHO's relief effort to tsunami victims.

    Pesigan told The Scientist that WHO is very concerned about the risk of avian flu and has added the illness to a list of diseases that ad hoc surveillance systems in disaster zones are charting. Other notifiable diseases include dysentery, measles, malaria, and dengue fever.

    Dowell also worries that the media is less likely to report on human bird flu cases in the tsunami's aftermath. Last year during the bird flu crisis and during the severe acute respiratory syndrome crisis of 2003, Asia's media played a key role in alerting the public of disease outbreaks—weeks and sometimes months before official steps were taken to curb the new illnesses.

    "The H5 problem is not going away, and obviously if there's a mutation or a re-assortment event in H5, we could be facing quite a more considerable problem than we're facing now," Dowell said.

    In 2004, Thailand and Vietnam reported a combined figure of 45 human cases of bird flu—at least 34 of those victims died. The sudden spread of avian flu to humans last year prompted WHO to warn of potential pandemic, like that of 1918 and 1919. Almost a hundred years ago, that deadly and fast spreading flu killed an estimated 20 million people worldwide.
 
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