Marwaan Macan-Markar

BANGKOK, Jul 26 2006 (IPS) – With its 900,000-strong army of public health volunteers and its spending of over 250 million U.S. dollars to help affected poultry farmers, Thailand was held up as a role model for combating the spread of the deadly bird flu. But the avian influenza virus has proved it has many tricks under its wings.
This week saw Thailand s impressive record of remaining free of the H5N1 strain of the virus for over seven months being shattered by a virus that continues to remain resilient. Following reports in mid-July that there was a bird flu outbreak in the poultry population in the northern province of Pitchit comes confirmation, Tuesday, that a 17-year-old boy has died of the disease. It brings the human fatalities to 15 out of 23 reported human cases of bird flu in Thailand since 2004.

Elsewhere in South-east Asia, this deadly virus is spreading in rural communities, with Indonesia being the worst hit. On Jul. 20, Jakarta admitted that a 44-year-old man had died of bird flu, making him the 42nd Indonesian to die from the virus due to close contact with contaminated poultry.

Indonesia now joins Vietnam as the countries with the most human deaths from bird flu since the current outbreak began in the winter of 2003. But while Vietnam has brought bird flu under control with no human fatalities reported all this year Indonesia offers a study in contrast. Thirty-one of the country s 42 bird flu deaths occurred since January.

Indonesia has also carved itself a niche for having the highest fatality rate of people reported with H5N1. It has recorded 54 cases with the disease, of which four-fifths have succumbed to the deadly virus.

According to the World Health Organisation (WHO), 134 people have died of bird flu since early 2004 out of 231 people who have been affected. Deaths have occurred in Azerbaijan, 5, Cambodia, 6, China, 12, Egypt, 6, Iraq, 2, and Turkey, 4, besides 42 deaths in Vietnam and Indonesia and 15 in Thailand.
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Consequently, in an attempt to prevent a spike in such fatalities and lay the groundwork to respond to any sign of this virus being passed between humans, which could evolve into a global pandemic, killing millions efforts are underway in South-east Asia to strengthen the health responses in rural communities.

The blueprint the WHO and the U.S.-based Centres for Disease Control (CDC) have in mind are rapid response teams in local communities. Each team will be between five to seven people and will include medical and nursing staff with proper equipment, Dr. Mark Simmerman, a WHO epidemiologist, told IPS. They will be trained to follow new standards that places focus on areas such as containment efforts to control the virus.

The first three days after a virus is reported is pivotal, he adds. A containment plan, including shutting down schools, will be important to slow the spread of the virus. A quick response is vital.

In South-east Asia, such rapid response teams could number in the several hundreds or even one or two thousand as the programme develops, Simmerman explained following the conclusion of a training for public health experts from 13 countries that took place in Bangkok from Jul. 17-21. The countries that attended from South-east Asia and elsewhere include Bangladesh, Burma, Cambodia, China, Egypt, Guatemala, India, Indonesia, Kenya, Laos, South Africa, Thailand and Vietnam.

This will take time to accomplish, for the aim is to build a link between the local teams, the national response teams and international health teams, says Dr Anthony Mounts, who heads the international epidemiology team at CDC. The CDC is trying to improve lab facilities to help diagnose avian influenza locally.

Such upgrading of laboratory facilities will bring to an end the prevailing pattern in some countries across the region, affected by bird flu, of having to send virus samples for testing abroad, he explained in an interview. Time is a factor here. This will allow the specimens to be collected and transported to national labs for testing within 24 hours.

Aiding this effort is CDC s plans to make available new technology in the local laboratories real-time PCR (polymerase chain reaction). The machine will amplify the genes once a chemical is added that reacts and identifies the avian influenza gene, adds Mounts. It allows you to take specimens from the field and do these tests quickly. You can have accurate answers in a very short time.

The attempt to upgrade the public health responses to avian influenza comes at a time when experts are also drawing attention to the challenges that arise when detecting the H5N1 virus. The diagnosis of H5N1 is extremely challenging, wrote Kevin Baird, a microbiologist, in a commentary in The Jakarta Post this month. It requires highly skilled scientists equipped with very expensive gear and extremely carefully chosen reagents. Only two laboratories in Indonesia are capable of doing it reliably, and between the two of them they have examined about 400 people since the middle of last year.

At the same time, the past two-and-a-half years have served as a learning curve for South-east Asia in as much as it lived with the threat of bird flu. The region s readiness to respond to a possible pandemic comes from what we have learned from our responses to avian influenza, Dr. Tawat Suntharajan, director general of Thailand s department of disease control, said while training senior epidemiologists from the region.