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Bird Flu Virus Spreading in Asia, Global Health Gaps Are Exposed

By Lawrence K. Altman

The New York Times -- Recently, reports about avian influenza in Asia have come almost daily, creating an impression that the viral disease is spreading among countries as fast as birds fly. Indeed, avian influenza has moved rapidly. The simultaneous appearance of avian influenza in eight countries, particularly in one region, is “unprecedented,” the World Health Organization says.

But avian influenza, or bird flu, may have been present for months in some of these countries. Now the sudden unmasking of government cover-ups and belated recognition of the disease’s presence have led to the perception of a mushrooming spread.

Still, it is a crisis that illustrates a critical need for strengthening the ties between veterinary and human health experts.

The A(H5N1) strain of current concern is a mutation of the same bird flu virus that caused outbreaks among chickens in Hong Kong in 1997 and 2003, when the virus infected 20 people, seven fatally. Now the mutated strain has caused 14 human cases, of which 11 were fatal, and led to the slaughter of 25 million birds. The human cases were believed to have resulted from direct contact with infected chickens, except for possibly two cases in Vietnam.

Infections in a Vietnamese family that were disclosed over the weekend reinforced fears among health experts that the mutated strain would swap genes with a human influenza virus to create a new virus that could cause a global epidemic. Even if scientists succeed in a crash program to develop a vaccine to prevent avian influenza in people, manufacturers lack the capacity to make enough to protect the entire world.

Most newly discovered viruses that have infected people have evolved from animals. Some, like A(H5N1), have infected a few people. But their inability to spread further among people illustrates how little is known about why some viruses can cross species barriers and then spread widely, while others are stopped cold.

The potential for migratory birds to transmit avian influenza to broader regions and the lack of strong systems to monitor animal diseases as human diseases are tracked further underscore the world’s vulnerability.

“There are big holes in the global public health network to monitor the many animal diseases that have implications for humans,” said Dick Thompson, a spokesman for the WHO, a U.N. agency in Geneva. “The world needs to understand how much of a stake it has in animal diseases in Third World countries.”

While the WHO studies some animal diseases, countries are not required to report them to the agency. “So we have to rely on information given to other organizations” like the Food and Agricultural Organization of the United Nations and the World Organization for Animal Health, said Dr. Klaus Stoehr, a veterinarian and influenza expert at the WHO.

Experts say a number of steps are needed to improve surveillance of animal diseases. They include better laboratory facilities, less costly diagnostic tests and more information-sharing among international health agencies.

While veterinarians are an integral part of the teams investigating the Asian outbreak, many experts also see a need for more of them to be integrated into public health. In addition, medical and veterinary schools need to cooperate more, said Dr. Frederick A. Murphy, dean emeritus of the University of California at Davis School of Veterinary Medicine.