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Saturday, January 03, 2009

New bird flu cases revive fears of human pandemic

By Mary Engel

Just when you thought you could scratch bird flu off your list of things to worry about in 2009, the deadly H5N1 virus has resurfaced in poultry in Hong Kong for the first time in six years, reinforcing warnings that the threat of a human pandemic isn't over.

India, Bangladesh, Vietnam and mainland China also experienced new outbreaks in December. During the same period, four new human cases -- in Egypt, Cambodia and Indonesia -- were reported to the World Health Organization. A 16-year-old girl in Egypt and a 2-year-old girl in Indonesia have died.

The new cases come afer two-year a decline in the number of confirmed human deaths from H5N1 bird flu and as fewer countries are reporting outbreaks among poultry. A United Nations report released in October credits improved surveillance and the rapid culling of potentially infected poultry for helping to contain and even prevent outbreaks in many countries.

Yet H5N1 has continued to "at the very least smolder, and many times flare up" since the chain of outbreaks began in 2003, said Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota in Minneapolis.

The year-end uptick is a reminder of how quickly the situation can turn as long as the H5N1 virus is still out there, Osterholm and other scientists said. "What alarms me is that we have developed a sense of pandemic-preparedness fatigue," he said.

H5N1 already has been a disaster for poultry farmers in Asia. Public health officials estimate that as many as half a billion fowl have been killed by the virus or culled to contain its spread, causing enormous economic strain and food shortages. But the bigger fear has always been that H5N1 would give rise to a human pandemic like the so-called Spanish flu of 1918, which killed an estimated 50 million people worldwide.

It was in Hong Kong in 1997 that the H5N1 virus was first observed to jump from chickens to humans, infecting 18 people and killing six of them, raising fears of a worldwide catastrophe. Hong Kong ordered its entire poultry population, estimated at 1.6 million birds, destroyed within three days.

A more recent chain of poultry outbreaks began in South Korea in 2003 and spread over the years to 61 countries in Asia, Africa and Europe.

To fuel a pandemic, a virus must be able to both infect humans and spread readily from person to person. The currently circulating H5N1 strain does neither well.

The total number of verified human cases since the 2003 outbreak began is 391, of whom 247 died. After peaking in 2006 at 115 human cases with 79 deaths, human infections dropped to 40 in 2008, with 30 deaths, according to a World Health Organization update in mid-December.

Most of the human cases were traced to direct contact with poultry, especially in Southeast Asia where many people have backyard flocks and few wear gloves or masks while handling them. The few suspected human-to-human transmissions occurred in those who were closely involved in caring for an infected relative.

But as long as the virus continues to circulate, the threat that it could mutate to pass more easily among humans remains, according to the U.N. report.

The Hong Kong poultry outbreak last month is significant because the government thought it had stamped out H5N1 in the Chinese territory after an outbreak in 2003. Since then, Hong Kong has vaccinated poultry against the virus and strictly regulated farm sanitation.

The government ordered the slaughter of 80,000 fowl at two large farms after the latest outbreak killed 60 chickens at one of the farms. Investigators are looking for the source of the infection and testing the effectiveness of the vaccine used since 2003 to inoculate chickens, geese and ducks against H5N1.

Hong Kong uses a vaccine that protects poultry against several flu subtypes. But some scientists believe that the H5N1 virus may have mutated to break through the vaccine. Flu viruses change constantly, which is why human vaccines for seasonal flu are modified every year, said Scott P. Layne, a professor of epidemiology and environmental health sciences at UCLA.

Mainland China is using a newer poultry vaccine developed specifically for H5N1. But vaccination programs there and in Vietnam have not eliminated outbreaks.

The vaccine itself could be the problem, said Robert Webster, a virologist and avian flu expert at St. Jude Children's Research Hospital in Memphis, Tenn.

Vaccines should be used only in areas where the virus is out of control, and then only temporarily, he said. That is because routinely administering the vaccine encourages the evolution to resistant strains.

Some countries have managed to stop the virus by culling infected poultry flocks. Japan, South Korea and Malaysia are considered to be free of H5N1, according to the World Health Organization.

But the virus appears to be entrenched in Indonesia, parts of China, Vietnam, Egypt and other countries where backyard flocks are more difficult to regulate than commercial chicken farms, according to the United Nations' Food and Agriculture Organization.

Though bird flu viruses are common, highly pathological ones such as the 1918 virus and H5N1 -- which has been lethal to 100% of chickens infected and 63% of humans known to be infected -- are rare.

Scientists have little experience with which to gauge how H5N1 will evolve.

But, Webster said, "We still have to treat this as a potentially very, very dangerous virus."
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Cycle of hope

By Pat Gee

A retired Hawaii Kai couple is still recycling bottles to raise thousands of dollars to help impoverished villages in Cambodia, but now they hardly need to scavenge for throwaways because others are doing it for them.

When Florence Doi and Takeshi Terada first visited a "black and smelly village" outside Phnom Penh in 2004 with members of the University Avenue Baptist Church, they were appalled at the sight of "garbage children" picking through rubbish they would sell to survive. They were called "scavenger villages," Doi said.

"You would cry," she added.

When they returned home, Doi turned to Terada and said, "Let's be scavengers for them. Let's go out into the beaches and parks, and go into the rubbish cans."

And now the helpers have helpers. Church groups and individuals learned of their mission and are collecting bottles on their behalf.

"I couldn't have done this without all this help," she said last month. "This has been my happiest year. I want to thank everybody; all the contributions have multiplied. ... The churches offer their help. I don't call them; they call me."

Takahashi Koji of Makiki Christian Church has been collecting bottles for three years. "That's how much he feels for us," Doi said. A few days ago, a gift arrived in the mail from his church, which consists of a small Japanese congregation, she said.

"I was stunned; my feet and my heart danced when I received a check for $2,635," Doi said.

Other regular donors include Holy Nativity Church (Episcopal) in Aina Haina, First Presbyterian Church of Honolulu in Kaneohe and Kaimuki Christian Church.

This recent Christmas was the first in four years that Doi and Terada did not make the trip to Cambodia with an outreach program of the multicultural University Avenue Baptist Church, which sponsors several overseas outreach missions.

It's not that the couple is any less devoted. Doi said they decided to forgo their trip due to the uncertainty of safety conditions, and wanted to spend the holidays with their Hawaii family for a change.

She reluctantly admits that they are getting older -- Terada is 84 and Doi is 78 -- and "we're tired." It's no wonder, with all the sorting and rinsing their recyclables, taking them to the recycling center and holding a weekly garage sale.

They both used to collect bottles at Sandy Beach almost every day, but now Terada goes by himself twice a week. Since May they've noticed fewer bottles and such, perhaps because more people are recycling, too.

The couple is trying to downsize their Saturday garage sales because it's such heavy work to pick up donations, like furniture, and unload them at home. But because they have a truck and many don't, they feel obligated to pick up items that are guaranteed moneymakers, she said.

"How are we going to stop?" asked Terada, who recently set up a tent in his yard to house the furniture. "You can't say, 'Oh, don't bring anything.'"

The couple started wiring money to banks in southern Cambodia last year and have already sent about $20,000 to what they consider "the poorest of the poor," she said.

Their pet project is to help build a new church for Tes Kim, pastor of Tuol Sala Church Sreang in Kandal province. They have already sent more than $7,500 to purchase property that Doi picked. They plan to send about $10,000 more for building materials.

Then there is a new orphanage of Heritage of Jesus Christ Church under pastor Chum Sarith in Toulklong village in Kampong Speu that needs help. And the renovation of the New Family In Christ Church in Kampong Cham province, under pastor Un Vannak, who has two blind children, Doi said.

"I'm so excited," she said. "The dreams get more beautiful. ... I pray to God a lot every day. I believe in the power of the Lord. We've come this far and we can do more."

For garage sale location and arrangements for donations, call 396-0850.
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