With its focus on health maintenance and disease prevention, demand for greater knowledge and use of Traditional Chinese Medicine (TCM) throughout the world continues to increase.

Facts About Bird Flu - Avian Flu 

WHO has warned several times over the past year of the potential evolution of the virus into a human pandemic which, in a worst-case scenario, could have devastatingly deadly consequences.

We all certainly hope that a serious worldwide influenza pandemic will not occur.

We all certainly hope that a serious worldwide influenza pandemic will not occur. Although we cannot ignore the possibility, and we cannot expect that governments and authorities will have all the answers. If it does occur it is likely to have a major impact on each of our lives.

I have chosen to contribute to be part of the solution and perhaps my efforts may help others, and maybe even save some lives. I hope the information I provide here to you on this web page, and attempt to keep current,  will keep you informed of the situation and provide you with the materials you need to educate and prepare yourself, your family and your community. Please help by spreading the word.

Pandemic Influenza A Global Threat - a short film by European Scientific Working Group on Influenza

WHO Latest Analysis of Bird Flu Prevalence and Cases

Frequently Asked Questions About Bird Flu

Reported Worldwide Bird Flu Case Count from Center for Infectious Disease Research & Policy (CIDRAP)

Reported Worldwide Bird Flu Case Count from Hong Kong Government

Graph from World Organisation for Animal Health Showing H5N1 Outbreaks in the Avian Population 

Comments from Mayo Clinic on Bird Flu
 

Comments and observations from myself:

• Despite our 21st century communications capabilities it is evident that many countries have a strong incentive to 'play-down' anything to do with H5N1, to protect their own economic interests. As Recombinomics points out "India claims to have never had H5N1 in poultry or people, although, poultry workers in India have H5N1 antibodies.  Thailand claims to have had no H5N1 cases in 2005 although the H5N1 isolated from birds closely matches the H5N1 in northern Vietnam isolated from patients.  Indonesia claim their H5N1 infections in 2003 were due to New Castle Disease and the H5N1 in a Jakarta suburban family was a fatal bacterial infection. China has denied any human cases of H5N1, including the large number of cases reported by Boxun in Qinghai and the pneumonia isolation wards in Tacheng, Xinjiang."
• China seems once again to be limiting the worlds ability to look into the details and prevalence of H5N1 in China. It seems to be repeating its handling of  SARS by keeping everything to itself and not allowing the rest of the world to know the real facts. It is clear that the rest of the world can have no expectation or reliance on China to help anyone but themselves. Concern for others, and a desire to help humanity, is evidently not part of the culture. 
• While most governments and their departments are getting together bird flu preparedness plans, so should many businesses that could be deemed to be essential community services. These would include those businesses in the community that are part of the supply chain for money & finance, food, health & medicines, utilities, communications, etc. Now is the time to act - not wait until a potential pandemic is on our doorstep. Governments have considered this important enough to spend millions of dollars of taxpayers money on right now. Why should preparedness stop there. And what should the average person in the community do to prepare themselves and their families for what may be about to occur? Governments are not likely to initiate this for fear of public unrest, and adverse political consequences. Bt that does not mean it is not necessary to do so.
• Surely it is time that governments of all countries started to encourage and educate people to exercise personal and environmental hygiene as an effective measure against contracting all types of influenza. With all our advancements in science, medicine, technology, and education it would appear from everyday observed practices in many countries (included developed countries in the west) that the human race has learnt very little about common hygiene. Common-sense hygienic practices alone could help prevent widespread infections.
• The apparent 'cover-up' by countries such as China on accurate and timely reporting of bird flu spread and infection, would seem to indicate their concern with their own image, 'face', politics, and international trade rather than any concern about the toll such a disease may have on humanity. Yes, we have progressed quite a lot from 1918 in many ways, but the characteristics being displayed by countries such as China in the face of a potential worldwide pandemic did not seem to be present in 1918, and today could be the biggest single factor that facilitates the worldwide spread of bird flu. In the past, Chinese authorities denied that there were cases of SARS in Beijing when it later transpired there had been.
• A problem during the 1918 influenza pandemic, which is now believed to have begun in the USA, was the lack of adequate testing equipment, facilities and knowledge available to confirm proper diagnoses. Fortunately today in the USA there exists considerable knowledge and facilities to prevent a similar occurrence there of the 1918 influenza pandemic. 
  However, it would seem from reports that many Asian countries today in which H5N1 is present severely lack adequate testing equipment, facilities and knowledge. Yet it is in these very Asian countries that H5N1 may be evolving into a serious worldwide threat. 
• At the early stages of the 1918 pandemic, before it was known to be of pandemic proportions, there were many unexplainable reports across the USA and other European countries of people becoming fatally ill with influenza, pneumonia and meningitis. It was not until some time later that these seemingly unrelated instances were recognised as the early stages of the worldwide pandemic.
  Today in several Asian countries there are seemingly unrelated instances of unexplained outbreaks of influenza, meningitis and pneumonia.
• During the 1918 influenza pandemic it was not uncommon for those infected by the pandemic to be diagnosed as having meningitis or pneumonia, both of which were found later to be secondary bacterial infections from the pandemic viral influenza.
  It seems during the first few months of 2005, there have been reported unusual outbreaks of meningitis in several countries, such as Philippines, India, Vietnam, and China.

The Independent August 21, 2005: Migratory ducks and waders could bring bird flu to Britain this winter, experts have warned, after the disease was found in wild flocks in Russia. The potentially lethal avian flu virus, H5N1, is now spreading westwards after health experts in Siberia and Kazakhstan discovered outbreaks of the virus in birds that will soon enter Europe. Yesterday, as the total number of confirmed cases in Russia hit 40, the authorities revealed the first suspected case of the virus at a commercial chicken farm in the western Siberian region of Omsk. Another 78 villages have suspected cases. Although the chances of the virus spreading from birds to humans within Britain is thought to be very low, the Cabinet's civil disasters committee, Cobra, is to stage its own emergency exercise next month.

MediaCorp August 20, 2005: The Rome-Fiumicino international airport has begun implementing precautionary measures involving passengers and merchandise originating from regions affected by bird flu. Passengers traveling to the Rome airport from China or Russia may be immediately hospitalized in an infectious diseases clinic if they shows signs of respiratory problems, airport authorities said Saturday.

SciDev August 18, 2005: The World Health Organization (WHO) has called on its offices worldwide to stockpile drugs to protect at least one-third of staff and their families from a potential bird flu pandemic. The call comes after news that the bird flu virus H5N1 has spread from South-East Asia to Kazakhstan and Russia. The WHO also advises their offices to stockpile medical equipment such as syringes, antibiotics and face-masks, and is giving advice on how to convert large areas, such as gymnasiums, into temporary wards.

Recombinomics August 13, 2005: Reports indicate H5N1 wild bird flu is expanding dramatically in Novosibirsk and points west along Russia's southern border (see map).  The leading edge of the advance now appears to be entering the province of Chelyabinsk.  The large number of additional points under suspicion suggests that there are additional unreported locations in northern Kazakhstan and the advance of the H5N1 has probably already entered European Russia. As the weather cools more migration into Europe is expected.

Bloomberg August 12, 2005: GlaxoSmithKline Plc's Relenza may be as effective as Roche Holding AG's Tamiflu in the treatment of bird flu, and should be included in government stockpiles against the potentially fatal illness, researchers said in this week's Lancet medical journal. Relenza, also known as zanamivir, causes fewer adverse reactions than Tamiflu and has a favorable resistance profile, according to Kenneth Tsang, a researcher at Queen Mary Hospital in Hong Kong. Tsang's study showed both drugs have similar efficacy.

Recombinomics August 11, 2005: The report of 20 meningitis cases in and around the village of Rybalovo in the Tomsk region is cause for concern.  The village is just northwest of Chany Lake in Novosibirsk where there have been at least 14 outbreaks of H5N1 bird flu (see map). Meningitis can also be due to secondary infections after the flu, so testing of the meningitis patients ffor influenza A is warranted.

Canadian Press 11, 2005: Enthusiasm over the news that U.S. researchers have proven a vaccine is effective against the H5N1 avian flu strain was tempered Monday with word that it took massive doses - roughly 12 times the normal amount - to produce a protective response in humans. Given that manufacturers can only make enough vaccine for a fraction of the world's population in normal times with regular dosing schedules, experts said the findings underscore the urgent need to find ways to produce the same response with smaller doses of vaccine. "I think these results suggest the world is even less prepared than more prepared," said Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. "And unfortunately many policy makers might take this announcement as being 'We've hit the gold mine' - when in fact I would suggest we are having a hard time even finding water." 

Xinhua August 9, 2005: A 35-year-old man from Vietnam's southern Ben Tre, has just been confirmed to die of bird flu, lifting the total fatal cases in the country to 41 since late 2003,local newspaper Young People reported Tuesday. Tests by the Pasteur Institute in southern Ho Chi Minh City showed that the man from the Ba Tri district named Phan Van Lu was infected with the virus strain H5N1. He died at a provincial hospital on July 31, one day after being hospitalized. 

Times Online August 7, 2005: THE government is to mount an exercise to help emergency services prepare for any potential bird flu pandemic that could kill thousands of people in Britain. Sir Liam Donaldson, the chief medical officer, has said that the question “is not if the pandemic comes, but when”. The exercise in September — a table-top simulation in a bunker beneath Whitehall — will be co-ordinated by Cobra, the cabinet civil emergencies committee, and will involve the army, police, health department and other key government organisations. According to the health department’s contingency plan, the healthcare system could be overwhelmed. Estimates of deaths in the first six weeks of the outbreak range from 20,000 up to 710,000, after which the disease would begin to subside. About 20m people could suffer serious breathing problems.

Bloomberg August 6, 2005: Preliminary human tests show an experimental vaccine made by Sanofi-Aventis SA is effective against a bird flu virus feared capable of starting a lethal worldwide outbreak of the disease, the National Institutes of Health said. Results from 113 people showed that protective proteins, called neutralizing antibodies, rose to an effective level after the shots, said Anthony Fauci, director of the NIH's National Institute for Allergy and Infectious Diseases. The full study will include results from more than 450 subjects, he said. An effective vaccine would provide a line of defense against the threat of the H5N1 bird flu that has killed at least 57 people and millions of birds in Asia. It might help health officials head off a repeat of the 1918 outbreak of deadly flu that may have killed as many as 50 million people worldwide.

Recombinomics August 6 2005: An earlier human vaccine against A(H5N1) avian influenza virus was prepared after it first appeared in the world, in Hong Kong in 1997. That vaccine was never fully developed or used, and the strain has mutated since then. In interviews over recent days, Dr. Fauci has said that tests so far have shown that the new vaccine produced a strong immune response among the small group of healthy adults under age 65 who volunteered to receive it, although the doses needed were higher than in the standard influenza vaccine offered each year.  The above comments on the development of a pandemic vaccine are overshadowed somewhat by the rapid spread of H5N1 across Russia, Kazakhstan, and Mongolia.  Although the sequence of the rapidly spreading H5N1 has not been published, descriptions of  the sequence sound much like the recently published H5N1 sequences from Qinghai Lake.  Those sequences suggest that the current pandemic vaccine being tested worldwide will not be effective against the H5N1 expected to spread throughout Asia and Europe in the upcoming weeks.

Recombinomics August 6, 2005: H5N1 bird flu has migrated to Mongolia.  Mongolia's proximity to Qinghai Lake, Russia, and Kazakhstan, all of which have confirmed H5N1 bird flu, predicted that bird flu would also reach Mongolia. Prior H5 isolates from Chnay Lake and Primorie had shown related to each other as well as H5 in Europe, indicting migratory bird transmit H5 from Chany Lake to Primorie or vice versa.  Either direction however would likely include flights over Mongolia. The H5N1 detected in China, Russia and Kazakhstan kills geese, which is unusual.  The dead geese in Mongolia strongly suggest that the H5N1 in the three adjacent countries has migrated to Mongolia also.  The dead geese in Mongolia also suggest H5N1 will be detected in Primorie also. The appearance of the Asian version of H5N1 has not been previously reported in Russia, Kazakhstan, or Mongolia.  Thus, H5N1 has expanded its geographical range as well as its host range.  After migrating from Russian and northern China, it seems likely that most of Asia and Europe will be H5N1 positive in the upcoming flu season in the northern hemisphere.

Times Online August 3, 2005: Scientists Warn Over Bird Flu Threat: Only decisive action within days of the first human to human cases of avian flu could prevent the triggering of a pandemic that would kill millions, scientists said today. If the H5N1 virus currently circulating among birds in Asia evolves the ability to pass easily from person to person, health authorities will have just three weeks to contain it with drugs before it becomes a global threat, according to two sophisticated computer models. Should this opportunity be missed, the result could be a pandemic that infects half the world’s population and kills even more than the 20 to 50 million who died in the "Spanish flu" of 1918-19. Countries worldwide, including Britain, would be powerless to protect themselves against the virus, though judicious use of drugs and vaccination might reduce the death toll. The findings, from two independent international research teams, show the urgency of building up a "mobile stockpile" of three million courses of the antiviral drug Tamiflu, that can be deployed anywhere in the world within three days. The World Health Organisation has just 120,000. The models suggest that swift preventive use of the drug to treat people who come into contact with sick patients could contain an outbreak before it turns into a pandemic. They also point to the importance of thorough disease surveillance in the Asian nations in which a human H5N1 outbreak is most likely. If the first cases and clusters are missed, vital time will be lost and containment efforts could become futile. "Control of a human outbreak is potentially possible but only when it is in its early stages," said Neil Ferguson, Professor of Mathematical Biology at Imperial College, London, who led the first study. "Once it is beyond this, once it reaches the UK, there is no chance of stopping it, only of mitigating its impact. We need to act quickly, detect cases quickly and treat people quickly. The challenges are great but the potential benefits are saving millions of lives. "This is our only option for making a big difference to a pandemic outcome. If we let it spread we’ll at best be able to prevent the deaths of perhaps half those infected in the UK." Ira Longini, Professor of Biostatistics at Emory University in Atlanta and the leader of the second team, said: "If detection and containment starts within three weeks or so, we have a good chance. Once the response takes more than a month there is a very poor chance of containment." Both teams said the World Health Organisation (WHO) should buy three million doses of Tamiflu, which could be sent within three days to contain an outbreak anywhere in the world. WHO is currently negotiating over a large stockpile with the manufacturers, Roche, which is understood to be considering donating the drugs. While there is an experimental vaccine against H5N1, a pandemic strain is likely to be genetically different from the present one, making it less effective. Tamiflu is considered the best option, as it can be used prophylactically to prevent infection.

Associated Press August 3, 2005: Rapid quarantines, travel restrictions and plenty of medicine quickly distributed could prevent millions of deaths in a bird flu outbreak in Southeast Asia, public health scientists said in a pair of studies examining the threat. Such an emergency plan would have to be enacted within two days and the spread of the virus limited to a few dozen cases – a challenge for an area where communications are often rudimentary and entire economies and transportation networks could be disrupted. "Containment is challenging," said Neil Ferguson of Imperial College in London and lead author of one of the two studies examining avian flu control measures. "We just can't cherry-pick the more easily implemented solutions." Once the virus spreads to mobile, urban nations like the United States or Great Britain, "chances of stamping out the pandemic are poor," he said in a news conference Wednesday. 

The Register August 3, 2005: Russia's Emergencies Ministry is warning that the H5N1 strain of the bird-flu virus, the strain dangerous to humans and responsible for the deaths of more than 50 people in Asia, could spread into mainland Europe from farms in Siberia. The Ministry issued a statement saying that the autumnal migration of birds from Siberia to the Caspian and Black Sea regions could increase the risk of new outbreaks, Reuters reports. "Human infection, especially among workers at poultry farms, cannot be ruled out," the statement warned. In the Novosibirsk region, where the virus has claimed nearly 3,000 head of domestic poultry, farmers have already begun slaughtering birds - a program that could last for at least a week, or even for 10 days. The H5N1 strain of the bird-flu virus can be passed from bird to human, but in Russia no cases of human infection have been officially registered. The greatest fear is that the virus will mutate and a strain will emerge that can be passed from human, to human, triggering a global epidemic.

myDNA August 2, 2005: A British pharmaceutical firm states that they have developed a vaccine for the deadly H5N1 virus, commonly known as the avian bird flu.

The vaccine is unique in that it is DNA-based, as other bird flu vaccines are derived from a developing egg. This proves beneficial, as egg-produced vaccines can take up to six months to produce, while the latest DNA vaccine can be produced at a much faster rate. Dr Clive Dix, CEO of PowerMed, the manufacturer of the vaccine, believes that if necessary, 150 million vaccines could be produced in three months. Dix also states that another advantage of the vaccine is its ability to adjust to any mutations present in the bird flu, as it would take a simple alteration in the genetic code to adapt the vaccine.

Associated Press August 2, 2005: Russian veterinary officials said Tuesday that an outbreak of an avian flu strain that can infect humans has spread to another region in Siberia, while authorities were struggling to contain the virus. Gennady Onishchenko, Russia's chief epidemiologist, sought to assuage public fears during an inspection trip to the Novosibirsk region Tuesday, saying the outbreak was being successfully contained. Almost all the humans who have been killed contracted the virus from poultry, but experts worry it could mutate into a more deadly virus that could spread from person to person.

Recombinomics August 2, 2005: Three Villages Razed In Qinghai After H5N1 Bird Flu Riots. According to the Qinghai Bulletin Board Service (BBS), the state of emergency imposed on the farming community and its surroundings in the Northwestern Qinghai City / Town of Yushu was lifted on the night of 28th July. When natives living further from the area made a trip to the farming community, they discovered that it had "vanished" together with 3 of its surrounding villages. Only some ruins, blocks from collapsed walls, remained. Apparently, the farms and villages had been flattened and there were signs that they had been razed. It is believed that some inhabitants from those 3 villages were workers in the farm. Around 200 people were estimated to have inhabited or worked in those 3 villages and the farm. There whereabouts are, as yet, unknown. The above translation of a boxun report suggest that three villages were razed in response to unrest linked to a forced bird flu quarantine in Yushu in northwestern Qinghai in China.  China has imposed news blackouts and arrested reporters in the past, so verifiable news from the area is difficult to obtain.

ThanHnien News August 2, 2005: Vietnam's northern Ha Tay province reported a local woman tested positive for the deadly bird flu virus that has killed over 41 people in the country since late 2003, said local Lao Dong newspaper Tuesday. Specimens from Nguyen Thi Them, a 49-year-old woman from Quoc Oai district, tested positive for the bird flu virus strain H5N1, a source told the newspaper. Although she no longer has an elevated temperature, she continues to require respiratory assistance at the Institute of Tropical Diseases in Vietnam’s capital Hanoi.

Interfax July 31, 2005: A 20-year-old man showing bird flu symptoms has been hospitalized in Kazakhstan's Pavlodar region, where 600 domestic geese died between July 20 and July 30 as a result of an outbreak of the disease in the area. The patient, a poultry farm worker from the village of Golubovka, was later diagnosed with double pneumonia and taken to the intensive care unit of Pavlodar's regional infectious diseases hospital in a critical condition, sources in the region's emergency medicine center told Interfax. The first deaths of birds in Golubovka were registered a week ago, Yersain Aitzhanov, chief of the Irtysh district's emergency situations department, told Interfax. A quarantine order has been imposed in the village. "All necessary measures are being taken: the territory is being ploughed, additional fences have been built around the farm and a ban has been introduced on the delivery of poultry products and eggs from the village," Aitzhanov said.

Chicago Tribune July 31, 2005: Hundreds of fowl in Siberia have died of the same strain of bird flu that has infected humans across Asia, the Russian government said Friday. No human infections have been reported from the Siberian outbreak, Russia's Agriculture Ministry said in identifying the virus as avian flu type H5N1. The outbreak in Russia's Novosibirsk region in central Siberia apparently started about two weeks ago when large numbers of chicken, geese, ducks and turkeys began dying. An expert at the United Nations said it was still not known how many birds have been exposed. 

Reuters July 29, 2005: Bird flu has killed two more Vietnamese, taking the country's toll to 42, nearly half of them killed since the H5N1 virus returned in December, state-run media said on Friday. A 26-year-old who died in Ho Chi Minh City on Wednesday tested positive for the H5 component of the deadly H5N1 virus, the Tuoi Tre newspaper reported without disclosing the sex of the victim. A 24-year-old man from the southern province of Tra Vinh died on Monday in a provincial hospital and tests showed he had the deadly H5N1 virus which has also killed 12 people in Thailand, four in Cambodia and three in Indonesia, it said. Both had eaten sick chicken before falling ill.

Recombinomics July 26, 2005: A laboratory jointly run by universities in Hong and China said on Tuesday it had suspended studies into the H5N1 bird flu virus after Beijing issued new guidelines which triggered fears of a crackdown on academic freedom and independent research into the deadly disease. The new rules were issued on May 30, five days after the Joint Influenza Research Centre sent an article to the international journal Nature which said that infected wild birds in western China might have picked up the virus from poultry farms in southern China. A day after the article was published, Jia Youling, director general of the Ministry of Agriculture's Veterinary Bureau, criticised the findings and said no bird flu had broken out in southern China this year. The closing of an independent lab in China is cause for concern.  The lab has been doing H5N1 research in collaboration with Yi Guan's lab at Hong Kong University.  The publication in Nature clearly demonstrated that H5N1 was present in 2005 in eastern China, even though China had filed no OIE reports in 2005 prior to the May 21 report on Qinghai Lake.  Subsequent reports were filed on outbreaks in Xinjiang province, but there are still no reports of H5N1 in China in 2005 east of Qinhai Lake. China's actions strongly suggest they want to control and withhold vital information regarding H5N1 in China. The timing of the new announcement, in view of the 20 isolates deposited at GenBank and Los Alamos (which included all 12 isolates collected at Qinghai Lake), as well as the virulence of the Qinghai isolates, increases concerns that there is a raging pandemic in China and information  on H5N1 is being withheld.

Reuters July 26, 2005: A laboratory jointly run by universities in Hong and China said on Tuesday it had suspended studies into the H5N1 bird flu virus after Beijing issued new guidelines which triggered fears of a crackdown on academic freedom and independent research into the deadly disease. The new regulations require laboratories to obtain permission from the ministry before they can carry out research on deadly pathogens and restrict studies into H5N1 to three government laboratories.

CNN July 26, 2005: Three family members who died of bird flu earlier this month were infected by chicken droppings that contained the deadly H5N1 strain of the virus, Indonesia's agriculture ministry has said. Authorities earlier said they had no known contact with poultry but since found chicken feces in their backyard that "positively contained the bird flu virus," said Hari Priyono, an agriculture ministry spokesman.

LA Times July 25, 2005: Indonesia became the first known country to destroy pigs in an effort to contain the rapid spread of bird flu, which has killed at least 57 people across Asia since 2003 and devastated poultry stocks. Plans to kill 200 swine, however, were sharply reduced as authorities wrangled over the best way to battle the disease. Eighteen pigs that tested positive for the H5N1 strain of the virus were killed on a farm in Tangerang, about 25 miles west of Jakarta. 

Science Daily July 24, 2005: A strange illness has killed 17 farmers and 12 others were in critical condition Sunday in China's Sichuan province. Health Department officials believe the illness is caused by streptococcus suis, a bacteria typically spread by pigs, Red Nova.com is reporting from a China Daily story. Officials are denying the disease is SARS or avian flu, which have attacked Asia in recent years.

New Scientist July 16, 2005: In the spirit of the 1930s Soviet biologist Trofim Lysenko, China is ignoring science it finds inconvenient. The head of the ministry of agriculture's veterinary bureau, Jia Youling, has rejected research on bird flu published in the journal Nature last week by Yi Guan and his colleagues at the universities of Hong Kong and Shantou. The paper concluded from genetic analysis that the H5N1 bird flu killing migratory birds at Qinghai Lake in north-west China had come from southern China. An independent team in Beijing reported similar findings. Chinese officials had claimed that the virus came from another country. Last week Jia told the official Xinhua news service that Guan's paper "made the wrong conclusion" and "lacks credibility" because birds do not fly to Qinghai from southern China - even though this is a well-known migratory route. Ominously, Jia added that Guan's group did not even go to Qinghai or have permission to do the research, and that his lab does not meet safety standards. Yet Guan's BSL3 lab complies with international standards, and his team collected samples from Qinghai before the government introduced rules last month saying no one could study dead animals or bird flu, or even report an outbreak of animal disease, without permission. "They are trying to close everyone's lab," Guan told reporters. 

Daily Telepraph July 8, 2005: Asia's bird flu may be poised to spread through migrating birds to India, Australia, New Zealand and eventually on to Europe, scientists warned yesterday. If birds carry the H5N1 flu virus beyond its stronghold in South-East Asia, it could devastate poultry farms and raise the risk of a deadly flu pandemic in people, experts said. "They're going to spread this . . . thing further and further across central Asia and Europe and who knows where," said Robert Webster of the St Jude Children's Research Hospital in Tennessee, an author of a report released by the journal Nature.

Manila Times July 7, 2005: World Health Organization scientist Hitoshi Oshitani spends his days planning for a nightmare scenario—a bird-flu pandemic among humans that would kill millions and bring nations to their knees. There is much that experts still do not know about the deadly H5N1 strain of avian influenza—exactly how humans contract it from infected poultry, and why so many of its victims are healthy youngsters. But Oshitani says they do know vulnerable countries are ill-prepared and that if the virus mutates and erupts among humans in one of Asia’s crowded mega-cities, it will be impossible to prevent it from becoming a pandemic. “If a pandemic starts we cannot do anything to stop it. What we can do, once a pandemic starts, is just to reduce the negative impact by being better prepared,” said the Manila-based WHO policy-maker. “It’s probably just a matter of time. Every 30 to 40 years we have had a pandemic,” he told AFP on the sidelines of an international conference on bird flu held this week in the Malaysian capital. “Usually for influenza, it’s almost impossible to control. That’s why we have huge outbreaks every year.” To date, most bird flu victims have caught the disease from animals, but the fear is it will mutate into a form that can spread easily among humans, triggering a contagion that could kill tens of millions of people. “Our window of opportunity will be just two or three weeks,” he says. After that the virus would almost certainly have moved on. And in teeming cities like the Thai capital Bangkok or Vietnam’s Ho Chi Minh City, the sheer mass and movement of people would mean the virus would have to be allowed to run its course through the population. “There are no other alternative tools to stop the spread,” Oshitani said. What would happen then is the stuff of nightmares. Water and electricity supplies could be disrupted because utility workers are too sick to maintain them, the public transportation system could be abandoned for fear of infection, and those who cannot afford drugs would succumb in huge numbers. “If more than 20 percent of the population is affected, it could affect a whole range of social activities,” Oshitani said, adding the crisis would no longer be just a health issue, but one which could damage entire economies. “People do not want to get infected in a bus or the train. People may not want to go to the supermarket. So how to maintain that social life is a big challenge, particularly in urban areas.” Oshitani said there were worrying signs a mutation is looming. Growing numbers of people are being infected with bird flu—64 cases have emerged in Asia so far this year, compared with 44 for the whole of 2004. The disease is still circulating widely in the region, and the virus has continued to change and mutate since jumping to humans in 1997, when it killed six people in Hong Kong. Since resurfacing in 2003, it has killed 55 people in Asia including 39 in Vietnam, 12 in Thailand and four in Cambodia. “These are all bad indicators in terms of the risk of a pandemic,” he said.“If you start thinking of what you should do after a pandemic starts, it will be too late,” he warned.

Scotsman July 7, 2005: UNITED Nations agencies and health experts yesterday unveiled a multi-pronged strategy against bird flu, calling for Asian governments to overhaul backyard farming practices and vaccinate poultry to prevent the disease from becoming a human pandemic. The plan, hammered out after three days of deliberations, "gives us a real chance to make a mark on history as long as we work together with maximum energy and commitment", Mr Omi said. The UN plan focuses on educating small-time farmers and their families about the risk of living in close proximity with animals, and of combining various species such as chickens, ducks and pigs in one enclosure. Health experts say such practices increase the danger of the avian flu virus moving from one species to another and possibly mutating into a new strain more easily transmitted between humans than the current H5N1 virus. The virus currently appears to spread to people mainly when they come into close contact with sick poultry. Medical experts fear a mutated form could trigger a global pandemic. Delegates also expressed concern about the open vegetable and meat markets of Asia, where animals are often slaughtered in unsanitary conditions. This threatens the health of humans who are exposed to contaminated blood, faeces, feathers and carcases, the statement said. "The meeting agreed that the avian influenza situation in Asia is extremely serious, but determined that there was still a window of opportunity to ward off a pandemic," it said. 

CBC News June 30, 2005: A 73-year-old man has become the 39th victim of bird flu in Vietnam since the end of last year. Reports say the man, a Hanoi resident, was one of four people being treated in hospital for the H5N1 strain of the virus. 

IntlHeraldTribune June 29, 2005: Lack of information slows bird flu investigation in China. World Health Organization officials said Tuesday that efforts to determine the extent of a bird flu outbreak in western China were being hampered by a lack of information from the Chinese government. Julie Hall, a WHO expert investigating the outbreak, said that a Chinese government lab had analyzed virus samples from infected birds in Qinghai Province, but that the Chinese government had yet to share that information with the organization or with other countries. "Our understanding is that the virus has been isolated and sequenced," she said. "However, at this stage we do not have access to the sequencing information, so we don't know if the virus has changed." WHO officials also suggested that with migratory birds acting as infectious couriers, analyzing the virus and limiting its spread will be a daunting task that could be slowed by lack of information from China.

WHO June 28, 2005: The Ministry of Health in Viet Nam has confirmed an additional case of human infection with H5N1 avian influenza. The case occurred in the

northern province of Ha Tay in May 2005. The newly confirmed case brings the total, in Viet Nam, since mid-December 2004 to 60 cases, of which 18 were fatal. Four patients are undergoing treatment at a hospital in Hanoi.

Epoch Times June 28, 2005: An influenza pandemic is coming- public health experts worldwide agree. The main questions remaining are, when it will happen, and how effectively our health care systems will respond to it. There’s no way to nip this thing in the bud, it will happen. It’s just a question of when,” said Dr. Trevor Corneil, Clinical Associate Professor at Canada’s University of British Columbia and part of the province’s avian flu pandemic planning team. Now there is mounting evidence of human-to-human transfer, an essential precondition for a pandemic to emerge. According to a recent World Health Organization (WHO) report, although no human-to-human infection has been confirmed, in Vietnam “the pattern of disease appear[s] to have changed in a manner consistent with this possibility.” Another cause for concern is the high fatality rate of those already infected. Of the 100 H5N1 human cases recorded by the WHO in Vietnam, Thailand and Cambodia, 55 have died. “An H5N1 virus with this ability could lead to a global pandemic and many millions of deaths worldwide,” warns the WHO report. Australian Health Minister, Tony Abbott, estimates his country could see “2.6 million Australians seeking medical attention, 58,000 needing hospitalization and 13,000 deaths.” The American Center for Disease Control and Prevention predicts that even a “medium-level pandemic” would affect “between 15 percent and 35 percent of the US population” and 2 to 7.4 million would die worldwide. “There is a question about China,” says Corneil, describing the situation there as “a big mystery.” Until recently, during the extensive bird flu outbreaks in eight Asian countries, China admitted to only 50 cases which it “successfully…brought under control,” according to China’s state-controlled media. On May 21 of this year, the Chinese media confirmed the Qinghai province deaths of 178 wild geese as a result of infection from the H5N1 virus. On May 24, the independent US-based Chinese website Boxun News reported that 121 people in 18 villages had died in Qinghai due to “bird flu infection.” Another 1,300 people were reportedly in isolation. According to the report, “some of the family members of the victims have received warnings. If they keep the secret, the authorities will compensate the family members. Otherwise, they will be punished with the charge of ‘deliberately spreading rumors to harm public security’.” The WHO highlights the need for the world to take action well before “there is unmistakable evidence that the virus has become sufficiently transmissible among people to allow a pandemic to develop.” To head off a worst-case scenario, honest and timely disclosure of human H5N1 infections in China is not only beneficial, but absolutely essential.

Daily Telegraph June 28, 2005: An outbreak of avian flu in China is more lethal than previously thought, UN experts warned today as they called for an immediate and thorough study of the birds before it is too late. A total of 5000 birds have died on an island in Qinghai province, north-west China, according to officials from the World Health Organisation (WHO) and the Food and Agriculture Organisation (FAO) who visited the area. "This is the first time we've seen large numbers of migratory birds dying from bird flu," Julie Hall, the WHO official in charge of communicable diseases in China, said. "So the virus has obviously changed to be more pathogenic to animals. What it means to humans we don't know." 

Recombinomics June 25, 2005: "Everything suggests, that the situation we are in now, there is a greater risk for a pandemic than for many decades," said Dr. Peter Horby, a medical officer and epidemiologist for the World Health Organization in Hanoi. "The situation is much more complex than a year ago." "This year, there doesn't appear to be a stop," said Klaus Stöhr, head of WHO's global influenza program in Geneva. "Every human case is worrisome because there is another chance for the virus to [mutate] and a higher chance for a pandemic to occur." Stöhr said it was unclear why human cases have not receded this summer. It could be better surveillance or more instances of bird-to-human transmission. Or perhaps the virus has become more adept at infecting people. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, sees the developments in Asia as more reason to worry. He doubts the past will predict the virus' future. Unlike previous pandemics, where a virus underwent a major genetic overhaul all at once, Osterholm said the avian strain has been changing gradually since it was first identified in 1997. He believes the virus will continue to transform, increasing the likelihood it will ultimately lead to a pandemic. "We haven't done much to eliminate the source in Asia," said Osterholm, a former bioterrorism special adviser to the current Bush administration. "And there is a dynamic mutation laboratory over there. I see nothing to slow down the mutations." The above comments reinforce the notion that H5N1 is changing and becoming more genetically complex.

Reuters June 25, 2005: Vietnam's agriculture ministry was quoted as saying on Saturday that the mutation of a bird flu virus was increasing the infection possibility between humans. State-run media cited a ministry report as saying laboratory test results overseas and at home showed the antigen structure of virus is changing. "The ministry warned in the report that the mutation of the H5N1 virus is raising the possibility of infections on humans, because the test results of international and domestic laboratories showed the virus's antigen structure contained a change," the Saigon Giai Phong (Liberation Saigon) daily said. The mutation of the virus explains why Vietnam did not detect major outbreaks in poultry in recent months but people still fell sick of avian influenza, it said.

TodayOnline June 24, 2005: An international team of experts arrived in Vietnam to study the likelihood of greater human-to-human transmission of the bird flu virus. The top virologists and epidemiologists from Britain, Hong Kong, Japan and the United States were scheduled to work with Vietnamese scientists until the middle of next week. "These experts will be further studying issues first raised at a WHO meeting in Manila in May 2005, including the possibility of more widespread H5N1 human transmission, changes in the H5N1 virus, and the likelihood of increased human-to-human transmission," the World Health Organisation (WHO) said Friday. Neighbouring China has had three bird flu outbreaks in the past two months, leading authorities to cull thousands of infected birds.

Recombinomics June 21, 2005: China today reported a new outbreak of deadly bird flu which has infected 128 geese and ducks in the northwestern Xinjiang region, killing 63 of them, the UN Food and Agriculture Organization (FAO) told Agence France-Presse. The outbreak -- the third reported by the Chinese government in the past two months -- occurred in Changji city near Urumqi, the capital of Xinjiang, the FAO said citing Chinese government information. The latest outbreak is also in Xinjiang Province in northwestern China.  It is about 30 miles northwest of the capital; city of Urumqi, which lies between the early outbreak in water fowl, including migrating bar headed geese, and Tacheng, located near the border with Kasakhstan and about 100 miles south of China's border with Russia. The latest outbreak is similar to the outbreak near Tacheng, with about half of the infected geese reported as dead.  H5N1 usually does not kill geese, so the finding of the three outbreaks close in time and location suggests they are due to the same version of H5N1 and are being transported by migrating birds.  The latest report, like the two preceding reports, has noted the lack of human infections.  However, third party reports have described human infections and fatalities in the Qinghai Lake area as well as a pneumonia isolation ward in Tacheng. WHO has requested on site visits to Qinghai and Xinjiang.  The request to vist Tacheng in Xinjuiang has been denied, fueling speculation that the patients and health care workers in the isolation unit are infected with H5N1. third party reports have described human infections and fatalities in the Qinghai Lake area as well as a pneumonia isolation ward in Tacheng. WHO has requested on site visits to Qinghai and Xinjiang.  The request to vist Tacheng in Xinjuiang has been denied, fueling speculation that the patients and health care workers in the isolation unit are infected with H5N1.

ABC June 21, 2005: Vietnam has experienced its first outbreak of bird flu in two months, with more than 6-thousand chickens contracting the deadly virus in the country's south. The discovery has prompted a warning for "very high vigilance" from the Director of Animal Health at the Agriculture Ministry. He's accused some provinces of not paying serious attention to the situation.

US Embassy Japan June 20, 2005: "A pandemic of influenza could result in 350 million deaths globally,” said Michael Osterholm of the U.S. Department of Homeland Security, “and would cripple the global economy with the suspension of international trade." Osterholm, associate director for the National Center for Food Protection and Defense, spoke at a Council on Foreign Relations meeting June 16. Osterholm characterized a pandemic influenza as "the perfect storm" for the global economy because of its potential effect on countries that depend on overnight international trade for critical services. "Collateral damage from the pandemic would also be significant because a suspension in trade would mean that countries will not have access to imported products used for manufacturing, life-saving medications and other consumer items," Osterholm said. According to Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, mortality rates would be highest among healthy adults between the ages of 20 and 40, a grave consequence that would also result in a severe depletion of labor in some countries. "One of the problems of bird flu is that there are no naturally immune humans from this type of virus," Fauci said. "In the past pandemics, there have been reservoirs of people with immunity from the outbreak," he added. "We have every reason to believe that the H5N1 virus in Southeast Asia has the potential for a pandemic type of infection," Fauci said. Osterholm noted it would take five to seven years to develop the capacity for global influenza vaccinations.

Kazinform June 20, 2005: In the Chinese People’s Republic 25 km from the border with East Kazakhstan is registered large outbreak of bird flu among birds. According to WHO, 1042 ducks were detected with symptoms of bird flu, and 406 of them died. It has been said by deputy Healthcare Minister, chief state sanitary inspector of Kazakhstan Anatoliy Belonog. According to the Chinese veterinary services, at one of the private farms of Chuguchak (Tacheng) in SUAR province have been destroyed 13 000 birds, as well as other measures taken including isolation and disinfection. Besides, urgent poultry immunization was carried out at all neighboring fowl-farms.In the Chinese experts’ view, bird flu virus uprise at the west of China is connected with its carry-over by migrating birds from the South Asia via Tibet and the Himalaya.

Canada June 20, 2005: In a soon-to-be-released issue of a scientific journal, researchers from Thailand and Hong Kong will report the findings of an autopsy of a six-year-old Thai boy who died from avian influenza. Slated for publication in the July issue of Emerging Infectious Diseases, their findings of an atypical pattern of infection - deep in the lungs, away from the tracheal lining where virus could easily be coughed out at others - may help explain why H5N1 influenza doesn't yet spread easily among people. While at least 54 people have died from H5N1 infections since December 2003, autopsies have been performed on fewer than a handful of cases. For cultural and other reasons, body after body has been buried or cremated, robbing pathologists of the precious chance to chart the havoc the virus wrecks on its victims. "That's one of the reasons why it's so difficult to understand what the virus does in the body," says Dr. Klaus Stohr, who heads the World Health Organization's global flu program.

ABC June 20, 2005: Two more people from northern Vietnam have been sickened with bird flu, and thousands of chickens have dropped dead in the south, officials said Monday. The poultry outbreak is the country's first in three months. The two new victims tested positive for the virus after being admitted to Bach Mai Hospital in Hanoi over the weekend, said hospital director Tran Quy. 

VOA June 20, 2005: The World Health Organization and other international agencies are looking into reports that Chinese farmers have been using a human anti-viral drug to suppress bird flu. Some experts say such use may make the virus resistant to the drug. Chinese officials had no immediate comment on the report, which first appeared in the U.S. newspaper The Washington Post. The newspaper said that Chinese farmers, with the encouragement of the government, violated international livestock guidelines by feeding the drug Amantadine - intended for humans - to chickens during the past several years. That has experts concerned the drug would no longer help humans fight off the disease in the event of a worldwide avian-influenza epidemic.

Sun Star June 20, 2005: IT IS GETTING real and imminent! World Health Organization (WHO) scientists and health experts are calling for stepped-up surveillance of avian influenza in Southeast Asia and that includes the Philippines, after reports surfacing from northern Vietnam suggest that the deadly virus may be evolving into something more easily transmitted to humans. scientists who met five weeks ago in Manila concluded there are numerous signs that the virus is undergoing an evolutionary change. "If action is delayed until there is unmistakable evidence that the virus has become sufficiently transmissible among people to allow a pandemic to develop, then it most likely be too late to implement effective focal, national or regional response," - a warning statement from the Manila WHO summit.

Telegraph June 19, 2005: China ruins best chance of beating bird flu epidemic. China has been trying to suppress a bird flu outbreak by feeding poultry a human antiviral drug, threatening public safety in the event of a global pandemic. China first reported an avian flu outbreak in February last year. Yet for more than eight years, according to drug company officials in Beijing quoted in the US media, the agriculture ministry has been urging farmers to use the drug, amantadine, on infected birds, in breach of international guidelines. It explains why scientists discovered late last year that the virus had grown resistant to amantadine, which cannot now be used to fight it in humans. Dick Thompson, a spokesman for the World Health Organisation in Geneva, said last night that the UN body had long suspected China of using amantadine on poultry. Mr Thompson said that the drug, which is now ineffective against the H5N1 strain of the virus found in Asia, should have been a key part of the fight against a global outbreak. "It would have been important in a pandemic and it is a disappointment that it may have been lost to us." Chinese farmers and officials from pharmaceutical companies confirmed that the drug had been used since the late 1990s to treat sickly chickens and prevent healthy birds from catching it. A farmer from Hebei province, near Beijing, confirmed that he had been giving his chickens the drug for several years. "Local government vets have always recommended it," he said. Three years ago China was condemned internationally for trying to hide the extent of the SARS outbreak, which ultimately infected 8,000 people and killed about 800.

Recombinomics June 17, 2005: The treatment of 23 bird flu cases [in Vietnam] represents an all time high for confirmed or suspected bird flu cases.  An earlier report described nine patients, which was followed by another report with two confirmed patients and 5 patients positive for influenza A.  Those five were awaiting H5N1 test results.  Thus it would appear that two patients were admitted in the first week of June, 13 in the second week, and 8 more so far this week. Although most of these cases are described as mild, the positive result in the physician is a strong indication of human-to-human transmission.  The large number of admissions this month clearly move the phase of the pandemic to 5.  Since these cases are mild, the number of unreported cases may be markedly higher, indicating the pandemic in northern Vietnam has already moved to phase 6. Similarly, the unofficial reports on human cases in Qinghai and Xinjiang provinces in China suggest that region is also experiencing phase 6 pandemic conditions, but with a strain that is markedly more lethal than northern Vietnam. The major outbreaks demand a rapid response, yet there are no publicly available 2005 H5N1 sequences at GenBank.  Moreover, many suspect countries like India and Bangladesh have yet to be H5N1 tested. As the pandemic of 2005 begins to spin out of control, the monitoring of H5N1 reamins scandalously poor.

VNA June 17, 2005: Four individuals were confirmed infected with the H5N1 virus [in Vietnam], which causes the avian flu, between June 1-17, raising those diagnosed with avian flu so far to nationwide 86, 38 of whom have died, according to the Health Ministry. The ministry said that it is striving to discover how the virus is transmitted and that almost all patients have had direct contacts with infected poultry. The ministry has failed to explain why no one was infected with the H5N1 virus in the 50 days prior to May 31. In addition, the Ministry of Agriculture and Rural Development has affirmed that there has been no bird flu outbreak nationwide for more than one month. However, the ministry stressed that thus far all people contracting influenza type A from the H5N1 virus came from bird flu-stricken areas.

ABC June 17, 2005: Hard on the news of Indonesia recording its first human case of bird flu, comes reports that six new human infections have been recorded in Vietnam. The World Health Organisation says it's trying to confirm the situation with the Vietnamese Government, but says it believes they are accurate. The six people are being treated for the H5N1 strain of the virus in a Hanoi hospital. 

Recombinomics June 17, 2005: A directive issued in China appears to be restricting information on the current H5N1 bird flu outbreak at all levels.  The latest outbreak began with a report on 180 dead bar headed geese in Qinghai Lake Nature Reserve.  All reserves in China were closed when China announced that 519 birds had died and were positive for H5N1.  A follow-up news conference indicated over 1000 birds had died, which was unprecedented for H5N1, which usually is not lethal in ducks or geese.  Reports by nine students through Abundant News at boxun.com indicated that over 8000 birds had died.  Reports indicated that 6 tourists and 121 residents in the area also died.  The government denied that there were human cases and reports indicated that at least 8 of the 9 students had been arrested. These reports were followed by reports of another outbreak near Tacheng City in Xinjiang province.  Geese on a backyard farm began to die an they too were H5N1 positive.  All of the poultry in the area was culled and the outbreak was said to be contained. However, reliable source indicated that a pneumonia cluster had developed at Tacheng Hospital.  Both patients and health care workers had been placed in isolation.  These reports fueled speculation that there were significant numbers of human H5N1 infections and deaths in Qinghai and Xinjiang provinces. Now China has announced limits on movement of samples out of China, which is another indication that speculation about widespread efficiently transmitted human infections were being covered up by the government and the dead and infected patients signaled the beginning of phase 6 of the 2005 flu pandemic.

WebMD June 16, 2005: U.S. health officials and infectious disease experts have been sounding the alarm for more than a year on the deadly potential of a widespread pandemic of the bird flu troubling Southeast Asia. But their warnings have become unmistakably ominous as they struggle to convince the public and policy makers of the need to prepare for the mass casualties, chaos, and devastation that will likely result if the disease spreads across the world. In congressional hearings and on television, officials have repeatedly advised the public of the potential for millions of casualties if bird flu gains the ability to easily spread from birds to people or between humans themselves. But the warnings have now become decidedly darker as officials warn of a catastrophic economic shutdown and a global political crisis if bird flu strikes an unprepared world. "This is much larger than a public health threat. The vast majority of the world just doesn't get how vulnerable we are," says Michael Osterholm, MD, associate director of the National Center for Food Protection and Defense in the Department of Homeland Security and a former bioterrorism advisor to the Bush administration. Osterholm complains that U.S. officials and companies have not planned for the widespread logistical disruptions that would result if bird flu were to spread within the next couple of years. Local and federal agencies have not planned for widespread disruptions to schools and workplaces as the public is told to stay home and gymnasiums are converted to emergency medical facilities, he says. Travel restrictions and a run on vital supplies, such as masks able to filter flu viruses, would "no doubt" lead to an economic shutdown, he adds. What can the U.S. do to prevent the continued spread of flu from billions of Asian chickens and ducks? "The bottom line message is: almost nothing," says Osterholm, who is also a professor at the University of Minnesota. 

Washington Post June 16, 2005: An Indonesian poultry worker has tested positive for bird flu, in the country's first human case of the disease that has so far killed 54 people in Southeast Asia, health officials said Thursday. The worker on the island of Sulawesi is showing no symptoms of the disease, but blood tests show he was exposed to the H5N1 strain of the disease and has produced antibodies to it, said Hariadi Wibisono, director for the eradication of diseases transmitted by animals at the health ministry. "This is the first case found," Dr. Georg Petersen, WHO's representative in Indonesia, told The Associated Press. The Indonesian case is an ominous development in the global battle to prevent the bird flu strain from mutating into a form that passes easily between people and spawn a pandemic. Health experts have warned that Indonesia _ which allocates only a tiny percentage of its gross domestic product to the health sector _ may struggle to contain a major outbreak. Indonesia has reported scores of outbreaks of bird flu at poultry farms across the country. "We have to raise our guard once again," Wibisono told The AP. "There is a possibility we will find more cases, but we hope that this does not transpire."

Recombinomics June 14, 2005: Comments from the latest WHO update on Vietnam describes three more milder H5N1 cases in northern Vietnam.  More geographical or familial relationships were not provided, but the trend in northern Vietnam has been set since the beginning of the year.  The clusters are larger and more frequent and the cases are milder.  These milder cases are similar to severe cases of human flu and therefore many H5N1 human infections in northern Vietnam may go undetected. Sequence data from northern Vietnam included an HA cleavage site missing an ARG.  This missing basic amino acid matches the cleavage site from 2003 and 2004 isolates in Hong Kong and southeastern China, raising the possibility that mild human H5N1 cases are also in China.  The homology with 2005 Thailand isolates also raises the possibility of more human infections there also. Recent comments on the sequence of H5N1 from bar headed geese at Qinghai Lake also linked bird flu there to H5N1 in southeastern China.  The bar headed geese winter in India and Bangladesh and fly over Tibet to nest at Qinghai Lake in May and June.  Recently there have been meningitis outbreaks in northern India, which coincide in time and location with the bar headed geese migration.  Interestingly, the crested eagles smuggled into Belgium from Thailand had sequences matching those in Thialand, but the eagles originated in Tibet. The linkage by time location and sequence of H5N1 cases throughout southern and eastern Asia raise serious questions about H5N1 monitoring of birds and people.  The scandalously poor monitoring significantly compromises flu pandemic containment strategies.

The Standard June 14, 2005: Vietnamese health authorities say a test of a homegrown bird flu vaccine on chickens has been successful and they are awaiting a green light to test it on humans. ``The chickens that were given the vaccine have produced immunity,'' said Nguyen Tran Hien, director of the National Institute of Hygiene and Epidemiology in Hanoi. The World Health Organization had warned Vietnam of the dangers of not adhering to WHO standards when developing the vaccine. The UN health agency is concerned that the virus will mutate and jump the species barrier to humans, causing a world pandemic. 

Recombinomics June 14, 2005: South Korea has halted the import of poultry products from New York state after the United States reported a suspicious case of bird flu in the region, the Ministry of Agriculture and Forestry said on Tuesday. The U.S. Agriculture Department informed the World Organization for Animal Health on June 10 of the outbreak of a low-pathogenic bird flu case on a duck farm in Sullivan, New York, the ministry said. The virus is known as the H7N2 strain, but it can develop into a high-pathogenic one and infect humans, the ministry said, adding the U.S. farm authorities are conducting further tests. Additional testing of H7N2 in New York will be of interest.  The two avian sero-types that have produced reported fatalities in humans are H5N1 and H7N7.

Deutsche Welle June 12, 2005: Although at the moment H5N1 cannot be easily transmitted from human to human, scientists say it is only a matter of time until this happens. They also worry that migratory birds could carry the virus around the planet and thus spread the epidemic. Last month, more than 1,000 migratory geese were found dead from the strain of avian flu in China, an early warning sign of the virus' ability to spread, said German virologist Robert Webster.

The Independent June 12, 2005: International experts fear that bird flu is mutating into a strain that will cause a worldwide pandemic, killing many millions of people after the mass deaths of wild birds in China. Unconfirmed reports say that more than 100 people have also died, suggesting that the virus may have evolved to pass from person to person, breaking the final barrier preventing a worldwide catastrophe. The Chinese government, while denying the reports of human deaths, has adopted emergency measures in Xinjiang, its remote north-western province, and has sealed off affected areas with roadblocks and closed all nature reserves. "We are worried," says Noureddin Mona, of the UN Food and Agriculture Organisation's representatives in Beijing. "We should be prepared for the worst." Shigeru Omi, of the World Health Organisation's regional director for the western Pacific, says "the virus has become highly pathogenic to more and more species". "It remains unstable, unpredictable, and very versatile. "Anything can happen. Judging from the way the virus has behaved, it may have new and unpleasant surprises in store for us."

AsiaNews June 11, 2005: Greater vigilance and more transparency to monitor the unpredictable evolution of bird flu… this is what Shigeru Omi, director of the Pacific section of the World Health Organisation (WHO) said: “With bird flu, anything could happen.” The H5N1 virus has now contaminated all Asia: according to WHO sources, it is unstable and could evolve to the point of reaching a high pathogenic rate [capable of affecting genes of different NDR types]. WHO said that – compared to Vietnam – the virus has appeared at its most pathogenic in China: its spread in Qinghai and in Xinjiang [central-northern regions of the country] has killed several species of flying creatures which had seemed immune to infection at first. The virus therefore made a shift of species, and after recent cases of infection, WHO fears it could pass to a phase of direct human contagion. In Vietnam, the H5N1 appears even more unstable: although the mortality rate dropped from 70% in 2004 to 20% in 2005, there have been cases of people infected with the virus who have not shown any symptoms. “Information must be circulated in real time and with total transparency,” said Omi. He called on the Chinese government to allow WHO to carry out analysis of virus samples and on all Asian countries to develop vaccines and to create antiviral medicines “in expectation of a possible pandemic”. Hend Bekedam – director of WHO’s China section - said Beijing had not yet given the go-ahead for an inspection of its territory.

TechNewsWorld June 10, 2005: A top World Health Organization official Friday warned that the avian flu virus is evolving quickly and urged heightened vigilance because the strain in China appears to have increased in virulence. Shigeru Omi, the WHO's Western Pacific regional director, said two outbreaks in China's remote west in the past month have killed large numbers of species of birds that had previously been relatively resilient to the disease. "The outbreaks indicate that the virus has become highly pathogenic to more and more species," he told a news conference. "The virus remains unstable, unpredictable and very versatile," he said. Omi said the H5N1 virus is behaving differently in China and Vietnam. China has reported no human cases of bird flu; Vietnam has had 38 of Asia's 54 human deaths. But the cases in Vietnam appear to be becoming less deadly, with fatality rates dropping from 60 to 70 percent last year, to about 10 to 20 percent in 2005, Omi said. Vietnam has also seen more cases where people are infected but don't develop symptoms. "Anything could happen," he said. "Judging from the way the virus has behaved, it may have new and unpleasant surprises in store for us." The only way to safeguard against further outbreaks or worse -- a mutation of the virus into a form easily passed between humans -- is "heightened vigilance," he said. "Our work remains urgent," Omi said. That means it's imperative for countries to share information, research and samples from their outbreaks with international agencies to strengthen efforts to fight the disease, he said. Beijing has in the past been criticized for its reluctance to release information on its outbreaks. Omi said the WHO is looking forward to getting samples from China because "sharing samples is very critical." WHO officials said they were waiting for Beijing to approve a trip with Chinese health officials to Qinghai province, where more than 1,000 wild birds, including geese and gulls, were killed by the H5N1 flu strain in late May. Gao Qiang, China's health minister, told reporters in Hong Kong that WHO teams would be free to visit infected areas. "During the 2003 SARS outbreak, WHO experts were able to go wherever they wanted. And with bird flu, there's no place they can't go," Gao said. On Thursday, the Agriculture Ministry confirmed a second outbreak of bird flu in the Xinjiang region. It said it had culled more than 13,000 geese at a farm after discovering that about 460 had died from the virus. China said both outbreaks appeared to be isolated incidents, with the case in Qinghai possibly carried there by migrating birds.

Recombinomics June 10, 2005: WHO comments that the H5N1 virus "remains unstable, unpredictable and very versatile" highlight the need to gather additional data.  H5N1 evolves via recombination within hosts that are infected with two viruses.  As the number of hosts infected with H5N1 increase, the number of possible new recombinants also increase.  New emerging strains can be predicted based on the current gene pool, but the holes in the database are substantial.  WHO and FAO should be encouraging affected countries to get more serious about collecting and sharing data. The two most glaring examples are China and India.  China has almost certainly generated sequence data for the Qinghai Lake isolates.  This data should be publicly available via deposits at GenBank.  Currently there are no 2005 H5N1 sequences.  China, Vietnam, Thailand, and Indonesia certainly have sequences data, even if only from birds.  The 2004 H5N1 bird sequences are virtually identical to the human sequences, so bird sequences will be quite useful. The initial reports from Qinghai Lake described bar headed geese as the only bird flu victims.  Although the number of species expanded, the bar headed geese are key.  They winter in northern India and can fly 1000 miles in 24 hours (the distance from northern India to Qinghai Lake).  There are almost certainly H5N1 sequences in India.  Although India has claimed to lack facilities to isolate and sequence H5N1 they can simply pack up bird dropping and ship them off if they can't come up with the appropriate resources. Similarly the meningitis cases in northern India as well as the dying crows in western India should be tested for H5N1.  WHO has previously indicated they will test unexplained deaths for H5N1.  So far there is little evidence that Meningitis / meningococcal deaths in the Philippines and India have been tested for H5N1. Like China's blanket denials of human H5N1 cases, WHO blanket calls for vigilance are inadequate.  Media reports quote Chinese official as saying WHO is welcome to visit all areas of China.  Similarly, India has not told WHO or FAO to stay out. It is time for WHO to get off the phone and get on the ground in China and India to get real data on increasingly ominous developments. 

Radio Australia June 9, 2005: Hundreds of geese in China's north-western Xinjiang region have reportedly died from bird flu in a new outbreak. Chinese authorities say the disease has been detected in around 1,040 geese, of which 460 have died. They say around 13,000 birds have been culled. Authorities say the situation has been brought under control. The outbreak in Xinjiang follows the deaths from H5N1 of more than 1,000 migratory birds last month in Qinghai southeast of Xinjiang. It was the first confirmed outbreak in China in nearly a year from the virus. 

XinHua June 9, 2005: France has done a lot of work to prevent a possible massive spread of bird flu to human beings, French government health consultant Didier Houssin said on Wednesday. According to the W orld Health Organization (WHO), the bird flu virus has acquired the capacity to be transmitted to human beings, although its animal-to-human and human-to-human transmission capacity is still limited at the current stage, said Houssin. Hospitals across France are now well-prepared to host a 10- to 46-percent increase in patients in case of a possible outbreak of the virus among humans and a large team of medical personnel is ready to render home services, he said. France currently has a reserve of 13.8 million doses of antiviral drugs and more is under production, he added. Moreover, the country has purchased about 40 million doses of vaccine and more than 10 million masks, which will be ready for use by 2006, when maneuvers against a massive bird-flu outbreak among humans will be staged, he said.

The Standard June 4, 2005: Taking anti-influenza medicine needlessly may hasten the spread of bird flu by decreasing the drug's force against the virus, a doctor warned. Public awareness of bird flu - which the World Health Organization predicts could infect 30 million and kill 7.5 million people worldwide - has been lowering in the past few months while the risks remain just as high, Center for Health Protection controller Leung Pak-yin said Friday. He warned against taking Tamiflu, which is seen as the last defense against the H5N1 virus, as a preventive medication for common flu. ``If people take Tamiflu whenever they catch common flu, when a flu pandemic comes the virus may already be drug-resistant, and that will affect the whole picture of infection control,'' Leung said. ``When a flu pandemic hits, there will usually be a second or third wave attack,'' Leung said. ``If we used up most of our stock even before the pandemic, we would have no defense when the virus launched its next round of attacks.'' ``Unlike Sars, we can hardly avoid contacting the flu virus when the pandemic hits.`` 

Recombinomics June 1, 2005: The information on the over than 1000 dead birds near Qinghai Lake comes from many sources.  Initial wire service reports described the deaths of 178 bar headed geese.  These initial reports clearly indicated that the deaths were not linked to bird flu. Follow-up reports indicated dead birds had tested positive for H5N1, although the number and relationship to the 178 previously reported deaths was unclear.  Clarification came from the initial report filed by China to the OIE, which described 519 dead birds representing 5 species in Gangcha Province, Qingahia Province.  These deaths were laboratory confirmed.  In the weekly OIE report the 519 were again listed but the report indicated that the virus isolated from the birds was H5N1 and was highly pathogenic in laboratory infected chickens. The official report was followed by a news conference, which was widely reported.  At the news conference the deaths of over 1000 birds were reported and one media report indicated most were in Qinghai Province, suggesting the bird deaths might be widespread. For the human cases, the initial report came from Promed, who had translated the Abundant News story.  That report indicated six tourists had died.  Four were named and three of the four were from Chengdu, Sichuan Province (about 400 miles southeast of Qinghai Lake).  The clustering of three deaths of three tourists from the same location would be cause for concern.  These initial reports were followed by a report of 121 deaths in 18 communities in Gangcha Province, along with 79 infections generating a case fatality rate of over 60%. Follow-up reports included a smaller number of cases in more distant communities as well as a news blackout, checks of computer, difficulties connecting to the Internet, and related issues centered on limiting news. All of the reports linked to the human cases come from the same source and have not been independently verified.  However, these reports are quite specific and the severity of the reported events is quite clear and not lost in translation.  If verified, these reports would dwarf prior reports on human H5N1 cases and move the 2005 flu pandemic from phase 5, which involve an increase in human-to-human transmission, to the final phase 6, which is sustained and widespread human-to-human transmission. Although not verified, the reports via Abundant News are quite specific and consistent. The disease described is somewhat atypical, involving fever and vomiting, but not respiratory illness.  The specifics in the series of reports are not adequately addressed with blanket denials by official sources in China.  

Medical News Today May 31, 2005: While the Indonesian government talks about eradicating bird (avian) flu by the year 2007, WHO has stated that bird flu is endemic in the country. Agriculture minister, Anton Apriyantono, expressed disappointment at WHO's (animal health dept) declaration, saying cases of bird flu have been declining in Indonesia since last year.

Forbes May 29, 2005: Roche Holding AG confirmed that huge demand for Tamiflu -- the only drug deemed efficient against Asian bird flu -- is causing a production bottleneck, with new customers likely to face waiting time of up to two years. 'This is clearly a challenge for us,' the Swiss pharmaceuticals group said. The sharp increase in new orders was triggered by warnings by the World Health Organization (WHO) about a new bird flu pandemic, which according to conservative estimates could lead to 28 mln infections and up to 7 mln deaths. Tamiflu is the only drug that is able to stop the massive reproduction of the H5N1 bird virus at an early stage of infection. Moreover, the treatment works preemptively. According to Roche, 25 countries have already followed WHO warnings and have placed orders with Roche or have signed a memorandum of understanding to build-up stockpiles of the drug. In order to satisfy US demand, Roche plans to open a new production plant in North America during the second half of the year. Major orders have also been placed by the governments of the UK, France, Switzerland, Finland and Germany.

Medical News Today May 28, 2005: An official from China's agricultural department said the death toll from bird flu in the West of China is five times greater than official reports had stated. The number of migratory birds killed was much larger than people had thought, he said. He added that the reports refer only to the death of birds and that no humans have died. Rumours are rife among experts and throughout the internet that there has been a massive cover-up. People are saying nobody really knows how bad the situation really is/was. Rumours abound that many humans have perished. Officials now say more than 1,000 migratory birds have died after being infected with the H5N1 strain of bird flu. The H5N1 is the most lethal one. Official reports had talked about just 178 birds, all of them geese, perishing in Qinghai Lake - now, they say the real number is over 500. China has not reported one human death from bird flu - even though nearby countries such as Vietnam have had 38 deaths. In total, the number of human deaths from bird flu in South East Asia has totalled 54. Health experts say that in order to tackle a possible pandemic which could spread to humans and become a human-to-human transmissible disease, we need accurate, reliable information. If authorities are not able to provide reliable figures it is virtually impossible to know what to do and when and where to do it. A pandemic could kill millions and millions of people throughout the globe.

SciDev May 27, 2005: Genetic analyses of samples from patients recently infected with the H5N1 bird flu virus suggest that new strains are emerging in the north of Vietnam. The report, posted on the World Health Organization (WHO) website last week, says the data are limited and that more studies are needed, but cautions against complacency in the face of the growing pandemic threat (see Time to prepare for bird flu pandemic 'running out'). At a WHO meeting in the Philippines in early May, scientists also concluded that the transmission of the virus from person to person could be more common than previously thought. The data — from the Centers for Disease Control and Prevention in Atlanta, United States, and Japan's National Institute of Infectious Diseases — could signify changes in the virus because clusters of infection are larger and more numerous than seen recently, and in some cases exposure to poultry could not be traced. 

ChannelNewsAsia May 26, 2005: China remains woefully ill-equipped for tackling avian flu, a top scientist said, as other experts spelt out fears that hundreds of millions of people may die or fall sick if the virus triggers a global pandemic. David Ho, an internationally-renowned US researcher, said China had received a wakeup call in 2003 after its initially tardy and secretive response to Severe Acute Respiratory Syndrome (SARS). But the new political will to strengthen China's rickety medical infrastructure had yet to be matched on the ground, and this has left the country dangerously exposed to avian influenza, Ho said. "There is little doubt that China will be in deep trouble if the flu pandemic were to strike in the next few years," Ho, who works at the Aaron Diamond AIDS Research Center in New York, said in a commentary published by the British science journal Nature. "It has a moral obligation to its own people, and to the world, to rectify the situation as soon as possible." The problems highlighted by Ho include a "grossly underfunded" epidemiological system to spot disease outbreaks; an inefficient alert system to warn and advise hospitals, doctors, officials and the public; and decrepit healthcare infrastructure and poorly trained physicians. 

AgricultureOnline May 25, 2005: The Director General of the World Health Organization last week referred to avian influenza (bird flu) as the "most serious known health threat the world is facing today." Dr. Lee Jong-wook made the statement as he concluded his opening remarks to the 58th World Health Assembly in Geneva, Switzerland last Monday. The Assembly ended today after adopting revised International Health Regulations that govern national and international response to disease outbreaks. "The timing cannot be predicted, but rapid international spread is certain once the pandemic virus appears," Jong-wook said about avian influenza. "This is a grave danger for all people in all countries." 

Time May 23, 2005: The most frightening aspect of avian flu has always been its astonishing virulence, but the human death rate in hard-hit northern Vietnam has fallen to 34% this year, down from almost 80% for the entire country in 2004. Good news? Not if you're an epidemiologist. Investigators for the World Health Organization (WHO) have raised concerns that even though the H5N1 bird-flu virus appears to be weakening, it may be adapting better to human beings potentially opening the door to a flu pandemic. Researchers have found that as the fatality rate dropped in northern Vietnam, there has been an increase in the number of cases clustered close together and in the age of those infected signs that the virus may be finding more efficient ways to infect people, including human-to-human transmission, the principal barrier to a pandemic. The falling death rate could mean that this process of adaptation is accelerating. "In gaining the ability to go from one person to another, a virus may well lose its virulence," says Dr. Jeremy Farrar, director of the Oxford University Clinical Research Unit at the Hospital for Tropical Diseases in Ho Chi Minh City. The 1918 Spanish flu, for example, the worst pandemic in history, had a fatality rate of 2.5%. But it was extremely contagious, infecting hundreds of millions. The data from Vietnam is still far from conclusive, and the reduced fatality rate may be due to more experienced investigators detecting the sort of mild cases they might have missed last year. But that wouldn't explain the difference between situations in Vietnam's north and in the south, where the death rate has remained high and infections have remained comparatively low. Either way, public-health experts are preparing for the worst. Says Dr. Peter Brown, a WHO epidemiologist: "If we wait until we definitely know there is a problem, it may be too late."

Reuters May 23, 2005: Bird flu may have claimed the life of a Vietnamese man in the past week, bringing the country's toll to 18 since the latest outbreak in late December, health officials said on Monday. A provincial health official told Reuters preliminary tests by the Hanoi-based National Institute of Hygiene and Epidemiology had confirmed the 46-year-old man from the northern province of Hung Yen died last Thursday at a Hanoi hospital from bird flu. The official said by telephone from Hung Yen, 64 km (40 miles) southeast of Hanoi, that the man was admitted to hospital a week ago with a high fever and coughing. A Health Ministry spokesman said the man's death was still not officially recognised as being caused by the H5N1 virus.

WebMD May 20, 2005: The world is one step closer to a devastating killer flu pandemic, World Health Organization (WHO) experts suspect. Two developments in northern Vietnam spur the renewed concern: 

Deadly bird flu infections are being seen in larger clusters of people -- with a much wider age range -- than ever before. 

The virus is changing in ways that suggest it may be adapting to humans. 

Also of concern is the revelation that one virus isolate was partially resistant to TamiFlu, the only effective treatment for human infection with type H5N1 bird flu.

Because of these developments, the WHO urgently convened a panel of experts that met earlier this month in Manila, Philippines. The panel's report, written on May 11, was released yesterday. "All countries, both those affected and unaffected by avian H5N1 … should move ahead as quickly as possible and develop or finalize practical operational pandemic preparedness plans," the panel advised. 

The WHO lists six stages leading from the detection of a new flu virus in animals to a global human flu pandemic. So far, the H5N1 bird flu has been at stage 4: small, highly localized clusters of human infections. At this stage, the virus cannot spread easily from person to person. The new evidence suggests -- but does not yet prove -- that bird flu may be moving to stage 5. That would mean the virus is becoming increasingly better at person-to-person spread. When stage 6 is reached, there will be rapid human-to-human flu spread and pandemic flu. It's only a matter of time, says virologist Klaus Stöhr, PhD, DVM, project leader for the WHO Global Influenza Program. "We are in a situation where we simply have to deal with uncertainties on when this will happen -- not whether this will happen or not," Stöhr said yesterday in a news conference. "We believe a pandemic will happen, but we don't know when and also [we don't know] the severity of the event." The last flu pandemic was in 1968. That means that this is the first time the world has had the tools in place to track a flu pandemic as it develops. Guénaël Rodier, MD, MSc, director of the WHO Department of Communicable Disease Surveillance and Response, says it's becoming clear that there are many small steps -- rather than alarming leaps -- that lead to a flu pandemic. "There is no evidence of a big crisis," Rodier said at the news conference. "But there are enough elements to say there may be something going on. … We have enough data to be concerned. At the same time we don't have enough data to be sure." "In the last 18 months, we have seen an incremental increase in our concern," Stöhr said. "We do not know if a pandemic can occur next week or next year."

LA Times May 14, 2005: Indonesian researchers have found a strain of bird flu in pigs on the densely populated island of Java, raising fears the virus could more easily spread to humans, the government and scientists said Saturday. The scientist who made the discovery identified the strain found in the pigs as H5N1, the same version of the virus that has jumped from chickens to humans elsewhere in Southeast Asia, killing 36 in Vietnam, 12 in Thailand and four from Cambodia. Until now, human infections have been traced to direct contact with infected poultry or poultry waste, and millions of chickens and other fowl have been slaughtered in attempts to stem the disease. But last fall, the World Health Organization urged scientists to examine other mammals, in particular pigs. Pigs, which are genetically similar to people, often carry the human influenza virus. Experts worry that pigs infected with both bird flu and its human equivalent could act as a "mixing bowl," resulting in a more dangerous, mutant virus that might spread to people more easily -- and then from person to person. Indonesia has yet to report any case of humans contracting bird flu, but has reported scores of outbreaks at chicken farms around the sprawling archipelago.

Canadian Press May 13, 2005: It's impossible to say whether recent changes in both the pattern of human cases of avian influenza and in the genetic makeup of the circulating viruses mean the risk of a flu pandemic has risen, the head of the World Health Organization's influenza program said Wednesday. Dr. Klaus Stohr said experts can't make that judgment, because too little scientific informa  tion is flowing out of Southeast Asia to the WHO's network of reference laboratories. "The data in humans is inconclusive and is too incomplete to draw any profound conclusions," Stohr said from Hanoi, Vietnam, where he is attending a second meeting of experts in as many weeks on the H5N1 problem. The agency has recently acquired some new genetic information that may help it in efforts to reassess the risk posed by the H5N1 virus, he suggested. Analysis of the new data confirms the virus is changing. But what that signifies remains a mystery, Stohr said. 

Recombinomics May 13, 2005: [In India] Two more people died of meningococcemia in the capital yesterday. The disease is displaying characteristics never seen before. It is supposed to occur among children aged between 1-5, but the worst hit are adult males in the 15-30 age group..... There have been 260 suspected cases and 20 deaths in the space of one month. Though these figures have alarmed some people, the government maintains the situation is well under control. 

The meningococcemia / meningitis outbreak in India has some striking parallels with the outbreak in the Philippines.  There have been no reports on bird flu tests on these patients, even though the infections are clustered, spreading rapidly, and affecting an unusual age group.  Previously, WHO had said that clusters of unusual deaths would be tested for H5N1.  There is little evidence for such tests and there are significant concerns about the sensitivity of such tests.  Moreover, menigococcemia is a known secondary infection of influenza. Recent reports of H5N1 antibodies in poultry workers in India raise a red flag on bird flu.  The sera were from 2002, but the monitoring of bird flu in India has been minimal, and there have been no attempts to isolate or sequence the virus.  Thus, the current bird flu situation in India is not well understood. In Vietnam a high percentage of ducks are asymptomatically infected with H5N1, and an increasing percentage of chickens are also asymptomatically infected.  False negatives in humans are frequent in both northern and southern Vietnam, so the distribution of the virus in endemic areas is not monitored well, and the evolving virus is becoming increasingly difficult to detect with probes directed against earlier isolates. Similarly, the probes being used to detect WSN/33 H1N1 in Korean pigs also yield false negatives, as the number of fatal swine infections increases and spreads. Bird flu appears to be spreading in greyhounds in the United States leading to unprecedented levels of fatal infections which are being diagnosed as an unusually aggressive form of kennel cough, although the descriptions match the fatal H3N8 infections in Florida last year. Although WHO has complained about a lack of samples, they have indicated that the were too busy to verify the fatal swine infections in Korea.  Moreover, the WHO makes pronouncements about the absence of reassortment in Vietnam H5N1 isolates, although they have very limited data.  Likewise, there has been no announcement on the fatal infections in dogs in the Untied States.  Explanations for the meningitis outbreaks in the Philippines and India have also been lacking. The recent infections of people, birds, pigs, and dogs create striking parallels with the 1918 flu pandemic.  The fatal infections in the fall were preceded by mild but unusually widespread reports of atypical infections in the spring. Although it is 87 years later and the number of scientific and medical advances has been significant, simple monitoring of various influenzas, including H5N1 is scandalously poor.
China Post May 13, 2005: A young Cambodian woman suffering from bird flu symptoms has been hospitalized in a serious but stable condition in southern Vietnam, a doctor said Friday. The 20-year-old woman from Kampot province has been on a respirator since she was admitted Wednesday to the General Hospital in Kien Giang province that borders Cambodia, Dr. Do Thanh Binh said. Her high fever and coughing have almost disappeared, but two X-rays of her lungs showed serious damage, he said. Binh said the woman first developed symptoms two weeks ago and was trea