Special Report: Bird Flu in the Asia Pacific Regionunpan1.un.org/intradoc/groups/public/documents/APCITY/UNPAN02256… · Bird flu in the Asia Pacific Region ... later this year and

Hill & AsSpecial

Bird flu in the As

7 Octob

Hill & Associates Risk Consulting (S) Pte Ltd

sociates Report: ia Pacific Region

er 2005

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Table of Contents

Key Issues ............................................................................................................................. 4

Executive Summary .............................................................................................................. 5

Background ........................................................................................................................... 5 • Distribution .................................................................................................................... 6 • Vaccines........................................................................................................................ 6 • Anti-viral drugs ............................................................................................................. 6 • Death rates.................................................................................................................... 7 • Measures to contain the disease .................................................................................. 7

Hill & Associates Advice ...................................................................................................... 8

Country Situation Reports Australia .................................................................................................................................. 9

Bangladesh ............................................................................................................................. 9

Cambodia.............................................................................................................................. 10

China .................................................................................................................................... 10

Hong Kong ............................................................................................................................ 11

India .................................................................................................................................... 11

Indonesia .............................................................................................................................. 11

Japan .................................................................................................................................... 13

Malaysia................................................................................................................................ 13

Pakistan ................................................................................................................................ 14

Philippines............................................................................................................................. 14

Singapore.............................................................................................................................. 14

South Korea .......................................................................................................................... 14

Taiwan .................................................................................................................................. 15

Thailand ................................................................................................................................ 15

Vietnam................................................................................................................................. 15


KEY ISSUES

• The appearance of multiple variants of the H5N1 virus (which causes bird flu) in different countries, that may mutate further into a form more easily passed between people.

• The reported resistance of the H5N1 virus to powerful anti-viral drugs such as

Tamiflu.

• The development in the scientific community of an effective vaccine.

• The degree to which governments display a willingness to share resources.

• The extent to which major events such as the terrorist attacks in Bali on October 1 divert the attention of governments away from bird flu.


EXECUTIVE SUMMARY Despite recent reports indicating a surge in human avian influenza (bird flu) infections in Indonesia, there is no evidence yet that the potentially deadly H5N1 virus has mutated into a form more easily transmitted between humans. However, recent developments have underlined the need for clients to be aware that a pandemic is a possibility at some point in the near future, and that they should review business continuity plans accordingly. This is particularly true now that the terrorist attacks in Bali on October 1 could turn Jakarta’s attention away from the no less serious risks posed by bird flu. The coming months could be critical. The World Health Organisation has warned that flu virus activity in Indonesia may increase during the northern winter and Indonesia’s November to April wet season. The following points summarise the most recent developments:

• Bird flu, a deadly flu-like illness largely confined to poultry, is now widely regarded as

endemic in the region. • Since late 2003, 65 people are known to have died from the disease, which is

generally contracted through close contact with infected birds, droppings and feathers.

• The death rate among people infected with the virus is close to 50 percent. However, this figure most likely overstates the true virulence of the disease.

• The fact that migrating birds spread the virus makes it almost impossible to eliminate. • Airport screening is unlikely to be effective should the disease mutate into a form

more easily spread between humans. • About 30 countries are currently stockpiling Tamiflu, a drug known to fight the bird flu

infection, in anticipation of the virus becoming more contagious. • Scientists in Singapore say they have developed a test kit that can detect bird flu

infections in poultry within four hours. The team is currently testing the kits on human samples.

• The Association of Southeast Asian Nations (ASEAN) has endorsed a plan by a Malaysian-led taskforce to eradicate the virus within the next three years.

BACKGROUND Avian influenza, more commonly known as bird flu, is a potentially very dangerous pneumonia-like illness largely confined to poultry. Many experts now regard it as endemic in the Asian region. The World Health Organisation (WHO) has repeatedly warned that the virus could trigger a global pandemic if it mutates into a form more easily transmissible from one person to another. WHO officials have warned that the virus could mutate into a far more contagious form. The risk is greater if an infected individual simultaneously suffers from a more common form of pneumonia. This raises the possibility that the bird flu virus could take on some of the characteristics of its human cousin. Currently, only those who come into close contact with the feathers or droppings of infected birds are likely to be infected. Although Asia has experienced three cycles of bird flu between 1997 and 2004 without any serious outbreak of the disease among humans, continuing reports of human infections this year in Vietnam, Cambodia and more recently in Indonesia, are worrying. Officials are


expecting another surge in human infections in Northeast Asia as the winter months approach. There are dozens of different known flu strains, named for two particular proteins that each virus carries. H5N1 refers to the bird flu strain that emerged in Hong Kong in 1997, killing or forcing the destruction of 1.5 million chickens, ducks and geese, infecting 18 people and killing six. Migratory birds, usually wild ducks, are the natural "reservoir" of bird flu viruses, and usually do not become sick when infected. Domestic poultry, including chickens and turkeys, die quickly when infected. Distribution The H5N1 strain first emerged in Hong Kong in 1997, where it killed six people, and surfaced again on the Korean peninsula in 2003. It has since been found in birds in Cambodia, China, Indonesia, Japan, Laos, Malaysia, Mongolia, Philippines, Taiwan, Thailand and Vietnam. The disease has also struck six Russian regions and Kazakhstan, causing the death of nearly 14,000 fowl. Migratory birds are expected to spread the disease further into the former Soviet states in the coming months. The outbreak was discovered in mid-July in Novosibirsk and has spread through Tyumen, Omsk, Kurgan, Altai and now Chelyabinsk, which is about 1,000km (625 miles) from Novosibirsk. Vaccines Ordinary flu vaccines do not provide any protection against bird flu. Several companies are working on a H5N1 vaccine. Australian company CSL Ltd is at an advanced stage of research and has just begun human trials. The Australian government gave CSL A$5 million in July to fast-track development of a vaccine. France’s Sanofi-Aventis has developed another promising vaccine. This has proved effective at stimulating an immune system response to bird flu in healthy adults. However, the doses of antigen required are very large. US-based Chiron Corp. aims to test its vaccine later this year and Britain's GlaxoSmithKline Plc plans large-scale clinical trials in 2006. However, these may not be effective should a pandemic break out. This is because researchers cannot forecast what a pandemic-capable virus would look like, so they cannot be sure that any vaccine developed now will actually work. Anti-viral Drugs Though not specifically designed to combat the H5N1 virus, two antiviral drugs can help fight the infection and may even prevent it, if taken regularly. These are Roche's Tamiflu, known generically as oseltamivir, and GlaxoSmithKline's Relenza, or zanamivir. Of the two, Tamiflu is regarded as the safest and most effective. About 30 countries are now stockpiling this drug. More recent reports suggest that strains of the virus in Japan and Vietnam are becoming resistant to Tamiflu. This highlights the continuing need for a vaccine to be developed.


Death Rates The H5N1 virus has killed 64 people since 2003 – about half of those known to have been infected. However, this figure is not a reliable indicator of the true death rate. This is because it does not take into account the milder, sub-clinical cases that never get reported. It is easier to count people who die than it is to count those who become infected but have minor symptoms or none at all. In fact, the virus has already been detected in some otherwise healthy individuals. A low death rate could translate into large numbers of deaths and severely disrupt the global economy. The flu pandemic that killed an estimated 20-40 million people in 1918 had a death rate of just two to three percent. Any estimate of the death rate from bird flu has to take into account the better health of the world population today, particularly in developed countries. However, it must also consider the fact that the disease will spread much more quickly as a result of international travel. David Nabarro, a Briton appointed by the UN to develop a global strategy to contain bird flu, has said that a flu pandemic could kill up to 150 million people. However, WHO officials have distanced themselves from this, suggesting that 2-7 million deaths was a more reasonable working figure. That said, recent studies showing that the H5N1 virus closely resembles the virus responsible for the 1918 pandemic; suggest that it may be more dangerous than previously thought. Measures to Contain the Disease Little has changed in terms of measures to contain the virus since our last update on bird flu in March this year. Culling or Vaccination of Poultry? The WHO recommends culling all healthy birds close to the source of an outbreak to prevent the spread of the disease. This practice has been adopted in other Southeast Asian countries, notably Vietnam and Thailand. However, it has been met with much resistance from farmers and has also encouraged smuggling of poultry out of infected areas. Indonesia and more recently China have avoided this approach in favour of using a largely untested poultry vaccine on the grounds that local governments have no money to pay culling compensation to farmers. One problem is that the vaccine only lessens the effect of the disease rather than prevent poultry from contracting the virus. While a vaccinated chicken is less infectious than an unvaccinated one, most vaccinated chickens fail to exhibit any symptoms if they do get infected. Thus, the virus could spread to other unvaccinated flocks if a rigorous surveillance system is not in place. Air Travel Restrictions Should the disease mutate into a form more easily spread between humans, air travel is the most probable route of international infection. However, airport screening is unlikely to work.


This is because, unlike SARS, infected individuals would be able to transmit the disease to others long before they showed signs of infection themselves. Early detection Scientists in Singapore say they have developed a test kit that can detect bird flu infections in poultry within four hours. The team is currently testing the kits on human samples. International Cooperation A start has been made in this direction, with the decision in late September by Southeast Asian Agriculture Ministers to endorse a three-year plan to combat the spread of the disease. The move by Australia and other governments to send emergency supplies of Tamiflu to Indonesia during a recent breakout there is also encouraging. However, how governments react in future will depend to some extent on their confidence in the ability of local authorities to use these resources in the most effective way. Australia is the host a regional meeting in Brisbane at the end of October to discuss an Asia-Pacific response. HILL & ASSOCIATES ADVICE Clients should review business continuity plans drawn up during the SARS scare in 2003. Such continuity plans should include provision for:

• Reduced airline travel in favour of teleconferencing. • Arrangements that would allow employees to work from home. • Exploring ways to overcome or limit the potential impact of a pandemic on supply

and distribution chains. • Companies may also consider finding reliable ways of gaining access to stockpiles

of Tamiflu. • Keeping up-to-date with recent developments, including government travel

advisories. Companies should also advise staff to:

• Consult a doctor if they fall sick with symptoms of influenza after visiting an infected area.

• Avoid locations with concentrations of live chickens or other birds. • Avoid uncooked or undercooked poultry or poultry products. • Clean hands frequently using soap. • Avoid traveling while sick.

Useful web links:

• WHO Communicable disease surveillance and response http://www.who.int/csr/outbreaknetwork/guidingprinciples/en/index.html

• Centre for Disease Control – Key facts

http://www.cdc.gov/flu/avian/gen-info/facts.htm


http://www.who.int/csr/outbreaknetwork/guidingprinciples/en/index.html

http://www.cdc.gov/flu/avian/gen-info/facts.htm

COUNTRY SITUATION REPORTS Country Official

Response to date

Projected ability of health system to cope with major pandemic

Extent of H5N1 Infection in Local Poultry

Overall Risk Assessment

Australia Excellent Excellent Nonexistent Low Bangladesh Unsatisfactory Unsatisfactory Nonexistent Medium Cambodia Unsatisfactory Unsatisfactory Localised High China Satisfactory Unsatisfactory Localised Medium/High Hong Kong Excellent Excellent Nonexistent

since 2004 Medium

India Satisfactory Unsatisfactory Nonexistent Medium Indonesia Satisfactory Unsatisfactory Widespread High Japan Excellent Excellent Localised Low Malaysia Excellent Satisfactory Nonexistent

since 2004 Medium

Pakistan Unsatisfactory Unsatisfactory Nonexistent since 2004

Medium/High

Philippines Satisfactory Unsatisfactory Nonexistent Medium Singapore Excellent Excellent Nonexistent Low South Korea Excellent Excellent Nonexistent

since 2004 Low

Taiwan Excellent Satisfactory Nonexistent Low Thailand Unsatisfactory Unsatisfactory Localised High Vietnam Excellent Unsatisfactory Widespread High

AUSTRALIA Australia has officially warned its citizens about the risk of contracting bird flu in Asia. In September 2005, the foreign affairs department also announced that Tamiflu and protective facemasks would be stored at Australian diplomatic posts throughout the region for the use of staff and their families. Canberra is spending A$160 million (US$123 million) over five years to prepare for a national pandemic. The government has also sent senior policy advisers and technical specialists to Jakarta to assist in anti-bird flu efforts. BANGLADESH No cases of bird flu have been detected. However, Bangladesh does harbour large numbers of domestic ducks. It is also situated along one of the major bird migratory routes. Thus, it has the potential to become a new large endemic area of infection. In early 2004, the government banned poultry imports from India, Pakistan, Malaysia, Vietnam, Thailand, South Korea, Japan and Taiwan. In July 2005, it extended this ban to cover Cambodia, China, Indonesia, Laos and North Korea as well.


CAMBODIA Bird flu has killed at least four people in Cambodia. The first reported victim was a woman who died in Vietnam in January after having sought treatment there. In July, the media reported a serious outbreak of influenza among children, some of whom died after reportedly coming into contact with chickens. The outbreak strained the nation’s grossly inadequate health care system, forcing at least one hospital to put three or four children to a bed. However, it appears the victims were suffering from the Influenza B virus rather than bird flu. CHINA China announced colour-coded emergency measures on September 28 as part of a wider plan to cope with an influenza pandemic. It has also set up a national anti-influenza leadership group, has stockpiled vaccines, and urged regional governments to coordinate monitoring efforts. Four levels of alert – blue, yellow, orange and red – will indicate the seriousness of the outbreak. According to the Ministry of Health, the most serious level, red, will be announced in case of a consistent and rapid spread of a new sub-type flu virus among the people, or if the World Health Organisation announces the outbreak of a flu pandemic. Many experts believe that southern China could be the source of such a pandemic because many residents live in close proximity to livestock, allowing animal diseases such as bird flu to jump to humans. Bird flu broke out in January-March 2004 in the provinces of Anhui, Guangxi, Guangdong, Shanghai, Tibet, Yunnan, Gansu, Hubei and Jiangxi. In February 2005, the Chinese Ministry of Foreign Affairs denied reports in the British media that there had been several cases of human infection. More than 560 birds have died in Mongolia since July of suspected bird flu, prompting authorities to send emergency teams to the worst hit areas. Some 250 birds were found dead at a popular tourist lake in Hovsgol province near the Russian border in late July. Tests identified the H5N1 strain of the virus as the killer. China was widely accused of suppressing information about the 2003 SARS outbreak, confusing and delaying efforts to contain it before it spread to Hong Kong, Taiwan, Singapore and other countries and regions around the world. This has led to considerable scepticism about just how reliable it will be in reporting any future outbreak of bird flu within the general population. That said, the Chinese health system is better able to handle a pandemic now than it was during the SARS outbreak. Special hospitals for contagious diseases have been built both at the state and provincial level. All domestic hospitals are also now equipped with alert procedures to handle infectious diseases. However, the new system has yet to be tested. Like Indonesia, China has taken the controversial step of vaccinating its chickens.


HONG KONG No human bird flu cases have been identified in Hong Kong since 2004. Soon after the latest outbreak in Indonesia, letters were sent to all doctors in Hong Kong updating them about the bird flu situation and reminding them to remain vigilant regarding the disease. Doctors must notify the centre of any suspected case of bird flu for prompt investigation and control measures. To raise awareness among Indonesians and other ethnic minorities in Hong Kong of the threat of bird flu, the authorities have arranged for publicity pamphlets in eight languages to be sent to relevant organisations for distribution among the target population. INDIA Bird flu has not yet been detected in India. However, the country is considered at risk because, along with Bangladesh, it is situated along one of the major migratory routes of birds that could bring the disease from East Asia. Officials have said they intend to keep a close watch on migratory birds flying into the country from China, Kazakhstan and Vietnam. India has a burgeoning poultry sector. The country is the second largest egg producer and one of the world's top ten broiler chicken producers. India has maintained its ban on the import and export of domestic and wild birds, hatching eggs, bird semen, fresh meat and processed poultry meat to all countries to prevent bird flu from reaching its shores. In January 2004, the federal government asked state governments to closely monitor the situation. INDONESIA The bird flu virus has spread to 22 of the country's 33 provinces since late 2003. Attempts to stop the spread of the disease by selective culling and inoculations of bird populations earlier this year do not appear to have worked. Deaths The WHO has confirmed three deaths from bird flu, based on Hong Kong tests. International experts believe another two deaths were almost certainly due to the disease. The number of people confirmed or suspected of being infected or exposed has risen to 85 as of October 5. Shortage of anti-viral Drugs The country faces a shortage of the anti-viral drug Tamiflu needed to treat the disease should a major pandemic break out. As of September 30, only 20,000 antiviral drug courses had arrived in the country. Another 20,000 courses are expected shortly, and Australia has promised another 40,000. Profile of Current Victims Hill & Associates’ interviews with doctors and nurses at major hospitals in Jakarta, as well as with local residents and Department of Health officials have revealed the following:


• About 80 percent of the patients had contact with Jakarta’s Ragunan Zoo (which has since been closed), while the remaining 20 percent had contact with dead poultry or lived near a slaughterhouse or chicken flocks.

• Most of the patients live in Jakarta (except West Jakarta), Bekasi and Tangerang. • Those affected by the virus spanned a wide range of ages. • No clear evidence of human-to-human transmission of the disease has yet been

found. • Most of those infected practiced poor hygiene.

Distribution of Disease Among Local Poultry Bird flu is endemic among poultry in the following parts of the country:

• Java Island. Given the high population density and the large numbers of chickens, this is also the most likely place for a pandemic to begin.

• Most of Kalimantan Island, except for the northern part. • Most of Sumatra Island, except in the far north. • South Sulawesi.

Tangerang Now a “Red Zone” The district of Tangerang, about 30km (19 miles) west of Jakarta, is officially considered a “red zone” because WHO investigators have not be able to determine how Iwan Siswara Rafei, a 37-year-old man who died of bird flu on July 12, contracted the disease. The family did not have birds or chickens as pets. However, close monitoring of the man’s contacts has not turned up fresh bird flu cases. Official Response The Indonesian government, which was initially accused of responding slowly to the outbreak, has recently stepped up efforts to stop the spread of the disease. It has fired the country's chief of animal health control and threatened to forcefully hospitalise anyone showing symptoms of the disease. The WHO has been urging the government to begin the mass culling of poultry in order to stop the spread of the virus. Indonesian officials say they cannot do this because they do not have the funds to compensate farmers. Instead, the government has been carrying out selective culls and relying on vaccination programmes. Public Attitude Chicken traders and farmers in Jakarta say bird flu fears have sparked a sharp drop in sales. However, they seem to show remarkably little fear of catching the disease. Workers who handle poultry rarely use masks or gloves.


JAPAN There have been no reported cases of human infection so far. Following the revision of the Infectious Disease Law in November 2003, bird flu has been categorised as an “Infectious Diseases Type IV” in Japan, which requires doctors to report any outbreak to the relevant authorities and take certain counter measures. Since early 2004, when three bird flu cases were detected, reporting procedures in the poultry industry, medical institutions, related ministries and local governmental bodies have been strengthened. The government also announced that it would establish systems to support businesses in the poultry industry affected by the disease. Authorities such as the Infectious Disease Surveillance Centre have warned the general public on its website to take basic precautions against bird flu, such as keeping one’s hands and mouths clean, keeping pets’ living environments hygienic, and not visiting poultry farms needlessly. In July 2005, Japan found a new case of bird flu in an area that had already been hit by the disease, leading authorities to prohibit the movement of more chickens. A farm in Ibaraki, some 100km (60 miles) north of Tokyo, that had been declared clean in previous tests was found to be infected by the disease. Authorities immediately banned the movement of chickens and their eggs within 5km (3 miles) of the poultry farm. The farm was near another chicken farm where a flu outbreak was discovered in June. MALAYSIA Officials say that bird flu was first brought into Malaysia in 2004 by fighting cocks that had been exposed to the virus in neighbouring Thailand. The continued smuggling of chicken meat caused further outbreaks. At the height of the outbreak, import bans by Singapore and other countries caused local farmers to experience daily losses of up to RM10 million (US$2.63 million). Malaysia declared itself free from bird flu after battling to contain the virus in the affected area in the northeastern state of Kelantan. On September 21, in response to reports of a wave of human infections in Indonesia, the government announced that it would set up a multi-agency task force charged with preventing an outbreak, comprising officials from the agriculture, health, customs and immigration departments, police and armed forces. Officials said on September 28 that they had decided to join other countries in stockpiling Tamiflu. The Health Ministry wants to have enough Tamiflu to treat 10.4 million people (about 40 percent of the population) should a pandemic break out. The cabinet has also announced that the government will take a tougher line on those caught smuggling live, processed or even cooked birds. According to Agriculture and Agro-based Industry Minister Muhyiddin Yassin, offenders previously only had their goods confiscated and destroyed. Now they would now be charged for smuggling. Malaysia has well equipped and modern medical facilities staffed with trained personnel. However, the system is not designed to manage a bird flu pandemic where untold thousands could fall critically ill in a very short time.


PAKISTAN There was an outbreak of bird flu in the southern province of Sindh and the southern port city of Karachi in 2004. However, there have not been any reports of human infection. Government run hospitals in large cities are overcrowded and have insufficient funds and medical staff to provide proper health care to the public in the event of a major pandemic. PHILIPPINES Bird flu has not been reported in the country. However, officials have expressed fears that migratory birds flying from Indonesia, where the virus is endemic in many provinces, may bring H5N1 to their shores. Tests on blood samples from ducks in a backyard farm in Calumpit, Bulacan (60km / 37.5 miles north of Manila) that were initially reported as infected by a low-risk flu strain on July 8, have turned out to be negative for the virus causing the deadly avian influenza. The Philippines is one of the very few countries in Asia with a large poultry industry that has not been affected by the virus. President Gloria Arroyo has set up a 250 million peso (US$4.4 million) fund to deal with the danger of bird flu entering the country. Some of this money will be used to monitor the movement of birds in sanctuaries or wetland areas where migratory birds are expected to arrive in the last quarter of this year. The government says it is capable of handling the disease should it penetrate the country. However, based on past experiences, such as the handling of meningococcemia disease in Baguio city late last year and the SARS case in Pangasinan province (200 km / 125 miles north of Manila) two years ago, this assurance cannot be taken at face value. Top private hospitals in Manila may also hesitate to admit any patient suspected of having the disease due to the fear that it may affect other patients and visitors. It is likely that such patients will therefore be confined to public hospitals, which usually lack the necessary equipment and appropriate drugs. SINGAPORE There have been no reports of bird flu in Singapore, either in human or local bird populations. However, the government has been stocking up on Tamiflu in preparation for a possible outbreak should the disease become more infectious. According to the Health Ministry, the country has enough flu medicine stockpiled to treat 430,000 people and is trying to secure enough Tamiflu to treat 25 percent of the population before a pandemic breaks out. The Health Ministry has put aside S$30 million to buy the drug. Singapore has committed a total of S$100 million to prepare the country to deal with a flu pandemic. This includes discussions with the pharmaceutical companies that produce flu vaccines to prioritise the country should they develop a vaccine against the pandemic. SOUTH KOREA According to the Ministry of Agriculture and Forestry, the government plans to issue a bird flu alert in mid-October in preparation for the arrival of migratory birds in winter. Special monitoring and quarantine activities will also be activated from November to February. This will include avian sanctuaries used by migratory birds near the demilitarised zone.


From December 2003 to March 2004, 19 poultry farms in 10 regions reported cases of bird flu, causing the government to order the destruction and burial of 5.3 million birds. No additional outbreaks have been reported since. Officials declared on October 4 that they will not follow China and Vietnam in resorting to mass vaccinations of poultry should additional cases be found. They will continue the mass culling of flock as recommended by the WHO. TAIWAN Although the H5N1 virus has not yet been detected in Taiwan, a weaker strain – H5N2 – was discovered in January 2004 at two farms in Changhua and Chiayi counties. All the chickens on the two farms were slaughtered. Taiwan also placed bans on bird imports and related products from other countries affected by bird flu, including South Korea, Japan and Thailand. The Council of Agriculture will hold an exercise in mid-October in the central county of Changhua against a possible outbreak of avian flu, with the participation of three other government agencies. The council's strategy includes such measures as stopping the disease at Taiwan's borders, strengthening quarantines, taking precautionary steps in Taiwan's communities and heightening the preparedness of all hospitals. The Department of Health of the Taipei city government has announced that citizens of Taipei City aged 65 or over will get free flu vaccinations from October 3. However, such vaccinations are unlikely to provide any protection against the H5N1 virus. Officials will also be seeking the help of Taiwan's bird-watching societies to monitor the activities of migratory birds from Siberia. These birds may carry the bird flu virus, although they may not be ill. The bird-watchers will be asked to notify authorities in charge of animal disease prevention whenever they spot a dead migratory bird. In addition, the Council of Agriculture will help poultry and hog raisers in Taiwan set up bird nets around their farms to prevent migratory birds from coming into contact with chickens, ducks, geese and pigs on the farms. THAILAND Bird flu was widespread in early 2004, affecting some 41 provinces and leading to the culling of over 40 million birds. Seventeen people were diagnosed with the disease and 12 died. There were at least two cases of suspected human-to-human transmission, but this was never verified. Many critics believe the number of infected people was likely under-reported by the government. Recently, Public Health Minister Suchai Charoenratanakul announced that the country has enough Tamiflu shots for 75,000 people. Thailand also has a 100,000-dose stockpile of anti-influenza vaccine. However, its usefulness against bird flu is questionable. VIETNAM Since late 2003, bird flu has killed 43 people in Vietnam. The Health Ministry has confirmed that a total of 64 local people from 25 localities have been infected with bird flu since early this year, of whom 21 have died. However, there have been no reports of human infection since early August.


In August, Vietnam began nationwide vaccination of its poultry covering all 64 provinces. The vaccination campaign is expected to end by mid-November. The government has received a donation of 600,000 Tamiflu tablets from Taiwan and is planning to buy another 70,000 for its national stockpile. The ministries of agriculture and health are coordinating a preparedness plan for a bird flu pandemic. In September, the official Vietnam News Agency reported that Vietnam asked the World Health Organisation to help it strengthen surveillance in 800 hospitals throughout the country. Local media also reported on September 29 that the government planned to build two international-standard labs for bird flu tests. The government has ordered officials to rapidly cull infected fowls, isolate bird flu outbreaks, and forbid the transport of poultry as well as poultry products out of affected areas wherever the disease is spotted. Reports say that up to 70 percent of waterfowl in the southern Mekong Delta has recently tested positive for H5N1. Vietnam has also culled over 1,300 fowls in the eight localities of Dong Thap, Ben Tre, Can Tho, Tra Vinh, Yen Bai, Ha Giang, Bac Ninh and Hanoi since early April.


Documents

Special Report: Bird Flu in the Asia Pacific Regionunpan1.un.org/intradoc/groups/public/documents/APCITY/UNPAN02256… · Bird flu in the Asia Pacific Region ... later this year and