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Wednesday, November 16, 2005

China Confirms Three Cases of Bird Flu in Humans - New York Times

China Confirms Three Cases of Bird Flu in Humans - New York TimesNovember 16, 2005
China Confirms Three Cases of Bird Flu in Humans
By KEITH BRADSHER and ELISABETH ROSENTHAL

BEIJING, Nov. 16 - China's Ministry of Health today confirmed three human cases of bird flu, including two in central China's Hunan Province and one in east China's Anhui Province.

The announcement, which provided no further details, was posted on the Web site of Xinhua, the official news agency, a day after China's Agriculture Ministry said that it would inject all of the nation's 5.2 billion chickens, geese and ducks with a vaccine against bird flu.

That campaign, disclosed by the official New China News Agency, would be the largest single vaccination effort ever for any species, according to the United Nations Food and Agriculture Organization in Rome. It promises to be logistically complicated, not least because it entails chasing and catching billions of free-range birds. The Agriculture Ministry did not provide a timetable.

Dr. Qi Xiaoqiu, the director general of the department for disease prevention and control at China's Health Ministry, said at a news conference on Tuesday that it was "highly probable" that a boy and a girl who suffered high fevers last month - the girl died - had been the country's first human cases of bird flu. Prime Minister Wen Jiabao warned last week that China faces a "very serious situation" as it seeks to control the virus.

At any one time, China has about 4 billion chickens and 1.2 billion ducks and geese, but even those numbers understate the size of the vaccination task. The country consumes about 14 billion domestically grown chickens, ducks and geese every year.

Dr. Qi said that three-fifths of the poultry in China was kept by families, who let the birds and other domesticated animals wander around the neighborhood and the yard and often through the house. Constant close contact between animals and people is worrisome because birds and pigs can carry the H5N1 bird flu virus and may transmit it to people.

"People raise pigs and people keep birds just like Americans keep dogs," Dr. Qi said. "Those pigs and birds are part of the family. It is a kind of self-sufficient, outmoded production method."

Dr. Qi and Roy Wadia, a World Health Organization spokesman here, said on Tuesday there had been no sign yet of human-to-human transmission of bird flu, a critical ability the virus needs to develop if it is ever to cause a human pandemic.

In an interview at the same conference at which Dr. Qi spoke, an American official who insisted on anonymity said before the Chinese announcement that migratory birds were likely to spread flu to poultry in the United States at some point.

Kristen Scuderi, the Agriculture Department's deputy press secretary, said the United States had 40 million doses of bird vaccine in stock and another 30 million doses in production, which would be used to create a barrier zone around an area with a severe outbreak. "The initial response is culling, but if the outbreak was really egregious we might go into the stockpile," she said. Some outbreaks have resulted in the deaths of millions of birds.

China reported 50 outbreaks of bird flu in 16 provinces last year, and has reported 11 more to international health agencies this autumn, including 2 more small outbreaks reported on Tuesday. Poultry infections have been especially severe this autumn in Liaoning Province.

The official New China News Agency reported last week that a fake flu vaccine, possibly including active virus, may have actually spread the disease instead of preventing it, although there has been no suggestion that this occurred elsewhere.

"The harm is incalculable," said Jia Youling, the chief of the veterinary department at China's agriculture ministry, according to the news agency.

China has also developed its own version of Tamiflu, an antiviral drug, and is preparing to produce it in large quantities if a human pandemic occurs, official news media said. There is no human vaccine against bird flu because it is impossible to predict the form the virus will take if it develops the capacity for human-to-human transmission.

Veterinary experts at the Food and Agriculture Organization's headquarters in Rome said that more information was needed to assess the wisdom of China's decision to vaccinate all poultry.

"With the recent multiplication of outbreaks in China they have now decided on countrywide vaccination, but at this point we cannot say if such a massive program is either possible or advisable," said Joseph Domenech, chief of Veterinary Services. He added that if any country can carry out such a program, "China can do it."

Bird vaccination campaigns involve a huge amount of manpower because the animals must be injected one by one. The Food and Agriculture Organization normally recommends such large-scale programs only in areas where the H5N1 bird flu virus has become endemic - places where it persists in the environment and where culls and quarantines have proved ineffective.

Parts of Vietnam and Indonesia fall into this category, and widespread vaccination programs have controlled flu among poultry in some areas. Dr. Domenech said he had seen no evidence that this was true for all of China.

Bird vaccine has been widely available for several years. Costing merely 10 cents a dose and produced by a dozen manufacturers, it is nearly 100 percent effective. China's Agriculture Ministry said Tuesday that it was producing 100 million doses a day, a figure that Dr. Domenech said was plausible.

The difficulty with the bird vaccine, particularly in Asia, is organizational: Veterinary workers must go village to village and door to door, since most poultry in this part of the world is kept on small farms and in backyards.

In most parts of Asia, the vaccine is administered in endemic areas and in areas surrounding outbreaks that have been controlled by culls. The vaccine is also given to poultry in areas where wild birds are known to be infected.

The Chinese have given no indication that H5N1 virus is widespread in their country, and have said that all outbreaks this autumn have been brought under control.

The vaccine is not recommended for use in birds in Europe or North America, as bird flu is still rare in Europe and has not been seen at all in the United States. In such places, the preferred method for stamping out the disease is culling birds for a radius of up to a few miles around the outbreak and quarantining poultry in a wider area for several weeks.

"The vaccine may be appropriate in Asia, but our first response would definitely be culls and quarantines," said Philip Tod, spokesman for the European Union's health department.

In the last month, Europe has experienced its first outbreaks - in Turkey, Romania and Croatia. All have been controlled in this manner. Mr. Tod said no European governments are currently stockpiling vaccines because they can be produced relatively easily and quickly.

Keith Bradsher reported from Beijing for this article, and Elisabeth Rosenthal from Rome.

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