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From: Food Quality & Safety magazine, June/July 2006

Desperate Defense

Many countries are gearing up for the worst in the fight against an Avian Flu pandemic, yet experts say they have a “long way to go”.

by Mark A. DeSorbo and Joanne C. Twaddell

Sumeyya Mamuk loves animals and cared for many a stray puppy or kitten in the Yalim Erez neighborhood of Van, Turkey.

The chickens in her backyard were beloved pets, too, and the 8-year-old would feed them, pet them and take care of them. When they started getting sick and dying, she hugged them and kissed them goodbye.

Her affinity for her ailing pets, however, would cause her face and eyes to swell. She also developed a high fever. According to The Associated Press, Sumeyya was rushed to the hospital, and five days later, she was diagnosed with having the deadly H5N1 strain of Avian Flu.

Her story is one of many that continually air on national newscasts and make headlines in newspapers, for while Sumeyya was one of the lucky ones, Avian Flu has been reported in 57 countries, caused 224 infections and killed 127 people worldwide, according to the World Health Organization (WHO), which also notes that most of the deaths occurred in Asia, with four in Turkey, and children, like Sumeyya, have been the worst hit.

Along with the usual updates on deaths, infection cases and how countries are gearing up for the worse, media coverage of the potential pandemic throughout the world seems to change hourly with reports of underreporting of instances because of budget constraints, vaccines, the wild bird factor and human transmission of the virus.

Toby Moore, vice president of the USA Poultry and Egg Export Council (Atlanta, Ga.), says he is discouraged by media coverage, saying it has blown aspects out of proportion and is void of rather important information.

“There are too many checks and balances in place here,” he says. “If it does happen, it will not be a naturally occurring problem. It will be because of a smuggled bird, like a parrot or game foul. If it ever does enter commercial poultry, there’s almost absolutely no way it would enter the food supply. Any bird with the flu would be put down in the blink of an eye. Federal and state governments are taking this very seriously. Even if it did enter the food supply, cooking poultry to the right temperature kills the virus.”

Exportation of U.S. poultry is also bouncing back, Moore says. “As far as exports, the flu seems to have run its course,” he says. “There has not been a lasting impact. Prices have started to come back and the demand in some countries has come back. I hesitate to say we’re out of the woods, but we never really saw a dip. What was hurtful was the impact on the prices. The prices exporters were getting were certainly down. About 85 percent of all exports are the chicken leg quarter. They were in the neighborhood of $.15 per pound and now it’s back in the 20s.”

“Long Way to Go”

Scientists throughout the world have been trying to determine the best line of defense as the deadly H5N1 virus has spread rapidly from Asia into parts of the Middle East, Europe and Africa, decimating domestic flocks with the culling and slaughtering of millions of birds.

At a recent bird flu conference in Rome that was organized by the Food and Agriculture Organization (FAO) and World Animal Health Organization (OIE), many experts were quick to say that it could be years before they fully understand how bird flu spreads.

“We still have a long way to go before we can fully understand this disease, especially as far as wildlife is concerned,” Gideon Bruckner, of the OIE’s scientific department, said in a statement.

One of the problems scientists face is that they still do not know whether the virus can become endemic in wild birds such as ducks and geese and whether these animals can carry the disease without showing any symptoms. Dr. Robert Webster, an expert on the infection, told conference attendees that the outbreak of H5N1 is due to a combination of factors.

Dr. Webster, a professor at St. Jude Children’s Hospital (Memphis, Tenn.), was one of more than 300 experts from over 100 countries who met at FAO’s headquarters in Rome in late May to discuss the spread of the virus.

“There is no doubt that the wild birds play their role (in spreading the virus), but so do humans,” says Webster. “People acknowledge that probably the most important spreader of influenza overall is the human and the globalization of trade.” He also said that there was evidence that migrating wild birds helped to spread bird flu to Mongolia from China last year and in general contributed to the spread of the virus from Asia to Europe, the Middle East and Africa.

A spokesperson for St. Jude Children’s Hospital declined a request from Food Quality for an interview with Dr. Webster, saying his schedule would not permit it.

AI’s North American Arrival

Gary Ades, senior vice president of EHA Consulting Group Inc. and a member of Food Quality’s Editorial Advisory Panel¸ says H5N1 will arrive in North American waterfowl in the near future, adding that this is also the consensus of a think tank discussion recently held at the 2006 International Livestock Congress in Houston, Texas.

Ades, along with representatives from the domestic and international poultry industry, governmental agencies in the United States and Canada, food service, distributors, academia, trade associations, vaccine manufacturers and consultants, gathered to discuss the future of Avian Influenza (AI).

“If AI invades commercial poultry systems, it will be quickly identified, contained and controlled at the local level,” Ades says. “This will be accomplished with effective bio-security in production systems, through testing of commercial flocks, aggressive surveillance and rapid response.”

He adds that media-driven consumer over reaction will also occur and the industry will suffer from consumers seeing flocks destroyed and the expected loss of consumer demand over the false fear of contracting AI from eating poultry.

This false fear is indeed false. “When a chicken is infected with AI, it doesn’t make it to slaughter. It dies,” Ades comments. “And even though that infection scares the heck out of people, it shouldn’t. Also, the kill temperature for AI is 160° F. The government lists a temperature of 165° F, but that is to kill resistant Salmonella. It’s a kill temperature, not a cook temperature. You would cook chicken at a higher temperature; otherwise it would still be bloody.”

The think tank panel did, however, find some issues of concern. Impact from recreational fowl (gamecock, waterfowl and upland game birds such as quail and pheasants) and backyard flocks (which include free-range, live/wet markets) will be the primary factor in the failure of containment-control strategies, according to Ades.

“The live wet markets are popping up all over the country,” he says. “These markets sell live chickens. You pick it, they kill it. And free range birds are not the best thing to have despite what consumers think. These chickens are subjected to all kinds of environments, eating anything they want, which includes contaminants. Birds that are raised in houses or cages are very well cared for. Their environment is controlled and they are eating properly for controlled growth.

It doesn’t behoove anyone, from a financial standpoint, to mistreat these animals.” Ades also cites concern over lack of a consistent or effectively communicated planning strategy. “There is a lot of information available from USDA, WHO, OIE, trade associations, academia and SSAFE,” he says. “But we want a unified message. In the eyes of the consumer, who is the spokesperson? The industry lacks credibility.”

Effective leadership is needed to link the constituents to drive planning and communications efforts prior to emergence of infection in North America, according to the think tank panel’s recommendations. “We need guide programs for crisis planning and risk communication,” Ades says. “And we need to select spokespeople who are credible to the public.”

In addition, suggestions were made to have more government and industry interaction, conduct emergency AI tabletop exercises and risk assessment, engage public interest groups in discussions and assure that bio-security measures are in place and functioning properly.

“If AI were to infect humans—that is a whole different deal,” Ades continues. “I’m not sure it will occur. The virus would have to mutate and have easy contact from human to human. In the past, AI mutated through a pig, and humans and AI act like a mixing bowl.” He believes that the original 1918 AI was caused by this mix. “It will probably mutate in Asia where there is more human contact with farm animals. Will it come over here and keep mutating? I don’t know.”

The official government site, www.pandemicflu.gov, now has a pandemic checklist for businesses and federal, state and local governments. “The issue is trying to work with folks and see where they are,” Ades says. “It is a good idea to have planning, but even with so many programs, we will be sorely taxed if the pandemic hits.”

He offers this diatribe of questions: How do we get nurses into the hospital to take care of flu-stricken patients; are there enough laundry facilities in the hospital to accommodate the increased load; who is watching the kids if there’s no childcare, how do you communicate if cell phones aren’t working, how do you file medical claims if no one is in the office, what kind of travel restrictions will there be, is IT strong enough to support a ripple effect. Do we have the infrastructure needed to keep communication lines open? “Lots of people,” Ades says, “lots of plans. There hasn’t been enough testing to understand where the gaps are. Will all the programs work? Probably not.”

From Maine to Hawaii: Preparing for a Possible Pandemic

The Hawaii State Department of Health (HDOH) has worked together with state and federal partners to enable Hawaii to become the first state in the nation to establish an airport surveillance program designed to detect novel influenza viruses, including AI. The program’s goal is to improve the state’s ability to detect, identify, and prevent the spread and outbreak of common and uncommon flu viruses as well as help curb the potential threat of a pandemic flu outbreak.

“Due to Hawaii’s unique geographic location in the Central Pacific Ocean, we realize how important it is to establish some type of monitoring as well as detection system,” says Health Director Dr. Chiyome Fukino. “We are very concerned in Hawaii about the fact we are the western doorway to the United States. We see a large number of visitors and a good proportion of them are from the Far East where we know a good number of emerging diseases are originating.”

The program uses the current existing protocol, in which the Queen’s Airport Medical Service is called to evaluate ill passengers at the arrival gate when pilots notify the Honolulu airport tower of such. The CDC and Prevention Station as well as the HDOH may also be notified if the passenger is assessed to have a potentially communicable disease.

Under the airport surveillance program, passengers with fevers and respiratory symptoms would also be requested to undergo testing for the flu virus by sampling with a nasal swab. This program is an important extension of Hawaii’s influenza sentinel surveillance.

The HDOH has also launched a new Web page, www.hawaii.gov/health, that provides resources for comprehensive information about Avian Flu and preparing for the possibility of a global outbreak or pandemic. The site combines resources from multiple agencies at the local, state and federal levels and organizes it for various groups, including businesses, governments, the agricultural community and for individual citizens. “Although there is no pandemic, and avian flu has not developed in the United States, it is important for everyone to know how to prepare their families, friends, coworkers and neighbors and what to do in case of a pandemic” Fukino says.

Indiana’s Lt. Gov. Becky Skillman agrees, saying she wants Hoosiers to know that the state has a coordinated plan of action to respond to both avian influenza and a human influenza pandemic. “While state government is ahead of the curve, every Indiana resident and business should also have an action plan,” she says. “Through the partnerships that have formed as we have prepared the state, we have collected and made available important information that every Hoosier can use.”

State agencies have joined together to create a Web site, www.fluinfo.in.gov, which serves as a clearinghouse of timely and accurate information for Indiana residents and other visitors to the site.

“This new Web site is an excellent example of how a number of state agencies are working together to prepare for these possible health threats,” says Cliff Wojtalewicz, Indiana Department of Homeland Security planning division director. “Each agency has an important role to play, and this site will explain those roles and provide Hoosiers with easy access to other important information.”

Avian influenza might not cause a human influenza pandemic, but preparedness is a must, says Judith A. Monroe, M.D., Indiana’s health commissioner. “We are working closely with our state agency partners to prepare for avian influenza in Indiana, in case it should become a threat to human health,” she adds.

The Hoosier’s State Veterinarian Bret Marsh cautions, however, that a diagnosed case of avian influenza in Indiana or the United States would not signal the start of a human influenza pandemic. “It would prompt us to increase further our ongoing monitoring of wild and domestic birds statewide,” he adds. “A strong partnership between the Board of Animal Health and Indiana’s poultry industry has helped us nearly double the testing of flocks.

We also need to point out that poultry production in the United States is very different from other parts of the world, and avian influenza presents little risk to America’s poultry and egg supply.”

Wayne Bivans, chief of Indiana’s Department of Natural Resources, says there is presently no evidence indicating that this virus is present in the North American wild bird population. “However, the DNR is working pro-actively with the USDA Wildlife Services to monitor migratory wild birds,” he says.

Gov. John E. Baldacci of Maine has also started a Web site at maineflu.gov. “This one Web site will provide information on pandemic influenza, avian flu or bird flu,” he says. “This means that no matter what your questions or concerns are about flu, or whether you are a physician, parent or pandemic preparedness planner, this one Web site will provide a place for getting that information.”

The site is a private public partnership between five Maine state agencies and over 20 diverse private sector organizations and associations, including the American Lung Association of Maine, the Sportsmen Alliance of Maine, the Maine Medical Association, the Maine Hospital Association, the Audubon Society, the Maine Business Chambers and the Maine Farm Bureau.

“People are concerned about it,” says Baldacci. “They have a lot of questions and this is a start to providing some of the answers.”

Anti-Avian Arsenal

St. Jude’s Dr. Webster also suggests to look carefully into the trading of poultry, both live and frozen, and compare trade maps with the geography of the virus. Many poultry experts have already done so, turning to Google Earth and a sophisticated computer imaging to help them prepare for the arrival of AI later this year.

Sherill Davison, professor of avian medicine at the University of Pennsylvania, told Reuters that geographic information system technology is being used to pinpoint the location of commercial poultry flocks, feed mills and processing plants. The information is used to create buffer zones around an infected flock to contain the H5N1 virus.

For several months now, poultry experts have also been using Google Earth, which combines satellite imagery, maps and the company’s search engine to span the globe. It provides added details including the location of buildings, schools and roads in proximity to large chicken and turkey farms and production facilities.

“Twenty years ago, we had to drive around the countryside and find the chicken farm that reported a disease,” Davison says in an interview with Reuters. “Now, we can very quickly, within an hour, know exactly how many farms are in an (affected) area. Then we can know which farms to send teams for extra sampling.”

Other industries are supplying weaponry for the fight as well. At press time, PowerderMed Ltd, an Oxford, U.K. based pharmaceutical firm, announced that it had formulated a safe experimental flu vaccine that blasts tiny particles into the skin instead of using a needle. The company said it would move into bigger tests of its vaccine, which uses DNA from the flu virus to stimulate immunity. In an article penned for the journal, Vaccine, PowderMed scientists said the vaccine stimulated an immune response in all 36 volunteers. Based on these results, PowderMed will start phase II studies using both annual and bird flu strains later this year.

A finished product, however, is still years away.

At the same time, Roy Curtiss, a researcher at Arizona State University (Phoenix), is trying to figure out if he can make a Salmonella-laced cocktail as a vehicle for an AI vaccine. A genetically modified strain of Salmonella, he says, would not cause poisoning. Instead, it would be capable of inducing immunity in the airways and other key parts of the body susceptible to flu viruses.

Federal health officials will have proverbial suits of armor in the AI fight. DuPont (Wilmington, Del.) has been asked to provide USDA with approximately 75,000 DuPont Tychem garments that workers will don before handling infected game and poultry. DuPont Tychem garments are used for protection against a range of chemicals. The garment is worn in a variety of industries — including environmental cleanup operations, hazardous response and waste management.

There is also a combat cache for chicks, too. Log on to VWR International’s Web site to order the Avian Rhinotracheitis (ART) Flockscreen kit ($527.11) and a visitor will find a message with a hint of urgency: “This item is restricted for purchase to customers with an established account and the proper documentation on file.”

The West Chester, Pa.-based supplier also distributes the Microbix Pandemic Response Kit ($55), which features two respirators, a pair of safety glasses, 52 pairs of various nitrile gloves, a bottle of antiseptic hand spray and a user manual. The technology to combat bird flu gets down right space-age, too.

Paris-based AirInSpace says its Plasmer technology makes the virus vanish.

According to the company, an independent review at the Laboratory of Virology and Viral Pathogenesis in Lyon, France, tests showed complete elimination of highly concentrated airborne avian flu virus by the Plasmer reactor, a biological air decontamination technology that is based on non-thermal plasma and amplified electrical fields to destroy airborne pathogens.

The technology was originally used to protect astronauts and equipment in the international space station. It has recently been adapted for use in critical care centers to protect immune-compromised patients suffering from blood disease and cancer and to improve air quality in operating theaters to fight against nosocomial infections.

The defenses may sound desperate, yet such efforts are warranted, said David Nabarro, U.N. System Influenza Coordinator, before attendees and the bird flu conference in Rome.

“H5N1 means the engagement of all the countries of the world through political machinery to deal with avian influenza,” he says. “We’ve got to be prepared for the possibility of re-introduction of H5N1 into poultry populations anywhere in the world at any time, and we’ve got to be prepared for that as long as the virus is circulating somewhere in wild birds or in commercial and domestic poultry.”

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