Coverstory

The Avian Fear
Are We Ready For It?

Shamim Ahsan

With the outbreak of bird flu in India with which it shares a 4,000 km long border, Bangladesh has never been so close to the deadly bird flu virus. Geographical proximity aside, the fact that Indian chicks are being brought into Bangladesh only heightens Bangladesh's vulnerability. In spite of a government ban thousands of Indian chicks are being smuggled into the country.

On March 31, the police captured 10,000 chicks in Comilla and seized 5,700 more while they were being transported from Natore to Dhaka. On April 1 the detective branch of Khulna Metropolitan Police seized 13,200 from a house in Khulna city. On the same day some 4,385 chicks were caught from different poultry farms in two upazilas of Sirajganj district.

One thing is obvious, smuggling of Indian chicks is going on in full swing and anyone who knows a little about the country's poultry industry would tell you that only a fraction of smuggled Indian chicks are actually being caught. So where are the others going?

The most likely answer is that they are spreading out across the country. And that's where the real worry lies. The ones that are being caught by police are readily culled, but the ones that are escaping capture are simply impossible to trace out, says Mati O Manush famed Shaeekh Siraj and managing director of Channel I. Siraj's popular programme recently featured Bangladesh's poultry industry and the possible threat of bird flu as a result of the smuggling of Indian chicks.

And that is where the danger lies. In the event of one or a few of the smuggled chicks being infected with the virus it will spread to other populations of chicks and infect them. If the flu virus becomes widespread among the birds the risk to humans increases.

Avian influenza is an infection caused by avian (bird) influenza (flu) viruses. These flu viruses occur naturally among birds. Wild birds worldwide carry the viruses in their intestines, but usually do not get sick from them. However, avian influenza is very contagious among birds and can make some domesticated birds, including chickens, ducks, and turkeys, very sick and kill them.

Infection with avian influenza viruses in domestic poultry causes two main forms of disease that are distinguished by low and high extremes of virulence. The "low pathogenic" form may go undetected and usually causes only mild symptoms (such as ruffled feathers and a drop in egg production). However, the "highly pathogenic" form spreads more rapidly through flocks of poultry. This form may cause disease that affects multiple internal organs and has a mortality rate that can reach 90-100%, often within 48 hours.

Avian influenza is very contagious among birds and can make domesticated birds very sick.

Infected birds shed influenza virus in their saliva, nasal secretions, and faeces. Susceptible birds become infected when they have contact with contaminated excretions or with surfaces that are contaminated with excretions or secretions. Domesticated birds may become infected with avian influenza virus through direct contact with infected waterfowl or other infected poultry or through contact with surfaces (such as dirt or cages) or materials (such as water or feed) that have been contaminated with the virus.

Bird flu viruses do not usually infect humans, but more than 170 confirmed cases of human infection with bird flu viruses have occurred since 1997. The World Health Organization (WHO) maintains situation updates and cumulative reports of human cases of avian influenza A (H5N1).

Most cases of avian influenza infection in humans have resulted from direct or close contact with infected poultry (e.g., domesticated chicken, ducks, and turkeys) or surfaces contaminated with secretions and excretions from infected birds. The spread of avian influenza viruses from an ill person to another person has been reported very rarely, and transmission has not been observed to continue beyond one person. During an outbreak of avian influenza among poultry, there is a possible risk to people who have direct or close contact with infected birds or with surfaces that have been contaminated with secretions and excretions from infected birds.

Meanwhile following the outbreak of the deadly flu, prices of chicks in India have plummeted. Each chick is now being sold at Tk 4-5. Such a low price is naturally a huge motivation for the Bangladeshi chick dealer. More so when they are being forced to pay three times more than the usual one if they buy them from the local chick producers, Siddiqui explains why chicks are being illegally imported in the thousands from India.

The main problem is that people who are importing these birds have little or no clue about what they are doing. Neither do those who are buying these banned Indian chicks. Again, the generally unhygienic conditions of the poultry farms will also exacerbate the situation. "Workers in the poultry farms do not follow even the most basic safety rules like wearing gloves and masks. The farms are also not regularly cleaned. Since humans can contract the virus if they come in direct contact with an affected bird, the farm workers are the most vulnerable group and unhealthy condition of the farms will make them all the more vulnerable," Siraj explains.

Direct contact with infected birds can prove to be dangerous	Anyone in close proximity to poultry could be at risk

Though there has been no evidence yet that the virus can travel from human to human, scientists have not ruled out this possibility altogether. In any case the outbreak of the bird flu in India has put Bangladesh in an alarming position. More so as Bangladesh does not have the means, logistic-wise, to face the situation. Bangladesh Livestock Research Institute (BLRI) is the only place in the entire country that has technical know-how to detect the virus, but its ability is still untested. Farm owners or workers are hardly aware of the risk they are running. Neither do general people have any idea about it. The government as usual does not seem to have realised the gravity of the situation. The fact that the police are seizing Indian chicks almost on a daily basis only goes to show that the government is not being able to stop Indian chicks getting inside the country.

While an outbreak poses a huge threat to human lives it may also wreck the country's poultry industry, the second largest sector after garments, Siraj points out. In fact as far as the poultry industry is concerned it does not need an actual bird flu threat, even a rumour of a bird flu outbreak may very well destroy this very sensitive poultry industry. Rumours of bird flu dealt a huge blow to the poultry industry back in 2004.

Shaeekh Siraj, MD, Channel i

Reports of daily raids and capture of smuggled birds at the Indian border can only increase our trepidation. With regular outbreaks of the flu in neighbouring India it seems only a matter of time before we are hit with the virus. The question is are we ready for it?

The only known treatment for the avian influenza is an American drug called Tamiflu available in the US.

Thankfully Bangladeshi equivalents of the flu drug are already in the market. Eskayef, Bangladesh Ltd (SK+F) has come up with SKFlu which promises to have the same curative and preventive properties as Tamiflu. Beximco Pharmaceuticals has also launched its own version of the drug only about a week or so ago. More companies are getting on the bandwagon.

The Marketing Manager of SK+F, Dr Shagufa Anwar, says the drug can be used for treating bird flu (a dose of 10 capsules spread over ten days or five days is necessary) but it can also be taken as a preventive measure for those who are at risk of exposure. This includes people working with poultry or travelling to countries where bird flu outbreaks have occurred. The drug can also be taken for those who have been exposed already for instance if a family member has been infected. The dosage for preventive or post exposure would be different says Dr Shagufa. The drug in suspension form for children, is already being made. The price of the local drug though lower than if it had been imported, is still quite steep -180 taka per capsule which would be out of the reach of poor patients. Dr Shagufa informs that the World Health Organization through the government is already planning to stockpile the drug by this month. How soon this will happen and whether this means that the drug will be made available for poorer patients are of course open to question.

Dr Shagufa adds that making people aware about the virus and how to combat it is vital. While companies like SK+F are carrying out awareness programmes in schools, universities and among those associated with poultry farming, the government still seems lethargic about informing the public. With no account of the chicks already smuggled into Bangladesh, the most fearsome knowledge is that we are clueless about when the virus may attack us. "It could be a matter of days," says Dr. Shagufa.

In spite of a government ban on imports, chicks are being smuggled across the border	Even a rumour of a bird flu outbreak could destroy the poultry industry

Flu-Facts

What are the symptoms of avian influenza in humans?
Symptoms of avian influenza in humans include typical human influenza-like symptoms (fever, cough, sore throat, and muscle aches) to eye infections, pneumonia, severe respiratory diseases (such as acute respiratory distress syndrome), and other severe and life-threatening complications. The symptoms of avian influenza may depend on which specific virus subtype and strain caused the infection.

Two main risks for human health from avian influenza are 1) the risk of direct infection when the virus passes from the infected bird to humans, sometimes resulting in severe disease; and 2) the risk that the virus if given enough opportunities will change into a form that is highly infectious for humans and spreads easily from person to person.

How is avian influenza in humans treated?
Studies done in laboratories suggest that the prescription medicines approved for human influenza viruses should work in treating avian influenza infection in humans. However, influenza viruses can become resistant to these drugs, so these medications may not always work. Additional studies are needed to determine the effectiveness of these medicines.

Does the current seasonal influenza vaccine protect you from avian influenza?
No. Influenza vaccine for the 2005-06 season does not provide protection against avian influenza.

What is the avian influenza A (H5N1) virus?
Influenza A (H5N1) virus also called "H5N1 virus" is an influenza A virus subtype that occurs mainly in birds, is highly contagious among birds, and can be deadly to them.

Outbreaks of avian influenza H5N1 occurred among poultry in eight countries in Asia (Cambodia, China, Indonesia, Japan, Laos, South Korea, Thailand, and Vietnam) during late 2003 and early 2004. At that time, more than 100 million birds in the affected countries either died from the disease or were killed in order to try to control the outbreaks. By March 2004, the outbreak was reported to be under control.

Since late June 2004, however, new outbreaks of influenza H5N1 among poultry and wild birds have been reported in countries in Africa, Asia, Europe, and the Near East.

Human cases of influenza A (H5N1) infection have been reported in Azerbaijan, Cambodia, China, Indonesia, Iraq, Thailand, Turkey, and Vietnam. For the most current information about avian influenza and cumulative case .

What are the risks to humans from the current H5N1 outbreak?
H5N1 virus does not usually infect people, but more than 170 human cases have been reported. Most of these cases have occurred from direct or close contact with infected poultry or contaminated surfaces; however, a few cases of human-to-human spread of H5N1 virus have occurred.

So far, spread of H5N1 virus from person to person has been rare and has not continued beyond one person. Nonetheless, because all influenza viruses have the ability to change, scientists are concerned that H5N1 virus one day could be able to infect humans and spread easily from one person to another. Because these viruses do not commonly infect humans, there is little or no immune protection against them in the human population.

If H5N1 virus were to gain the capacity to spread easily from person to person, an influenza pandemic (worldwide outbreak of disease) could begin. No one can predict when a pandemic might occur. However, experts from around the world are watching the H5N1 situation in Asia and Europe very closely and are preparing for the possibility that the virus may begin to spread more easily from person to person.

How does H5N1 virus differ from seasonal influenza viruses that infect humans?
Of the few avian influenza viruses that have crossed the species barrier to infect humans, H5N1 virus has caused the largest number of reported cases of severe disease and death in humans. In the current situation in Asia, more than half of the people infected with the virus have died. Most cases have occurred in previously healthy children and young adults.

Unlike seasonal influenza, in which infection usually causes mild respiratory symptoms in most people, H5N1 infection may follow an unusually aggressive clinical course, with rapid deterioration and high fatality. Primary viral pneumonia and multi-organ failure have been common among people who have become ill with H5N1 influenza.

How is infection with H5N1 virus in humans treated?
Most H5N1 viruses that have caused human illness and death appear to be resistant to amantadine and rimantadine, two antiviral medications commonly used for treatment of patients with influenza. Two other antiviral medications, oseltamivir and zanamavir, would probably work to treat influenza caused by H5N1 virus, but additional studies are needed to demonstrate their current and ongoing effectiveness.

Is there a vaccine to protect humans from H5N1 virus?
There currently is no commercially available vaccine to protect humans against the H5N1 virus that is being detected in Asia and Europe. However, vaccine development efforts are taking place. Research studies to test a vaccine that will protect humans against H5N1 virus began in April 2005, and a series of clinical trials is under way.

Source: Internet

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