Best defence against avian flu is to fight the virus in Asia

Abstract

Farming practices, long-held lifestyle traditions and poverty-line economics all make recent outbreaks of avian flu in Asia a far bigger global public health threat than westward spread of disease into Europe's poultry flocks. For many rural Asian communities, backyard chickens and very small-scale poultry farms are part of landscape. Children play in same yard where household's flock scratch and where chickens that die are typically eaten in order not to waste a valuable source of protein. Every infection of poultry has serious consequences for farmers concerned. Flocks must be culled in a wide radius around area of infection and every person in contact with infected live or dead poultry is at risk of contracting disease. Whilst most western Europeans would get no closer to poultry than peeling away shrink-wrap cover on a pack of supermarket chicken breasts, in Asia most of 67 confirmed deaths from H5N1 avian flu virus have been attributed to direct contact with infected birds, such as slaughter, defeathering, gutting and preparation of chicken and duck. All 130 known human cases of H5N1 have occurred in Asia. In Asia, bird flu outbreaks have been reported over last two years in Cambodia, China, Indonesia, Japan, Kazakhstan, Lao People's Democratic Republic, Malaysia, Thailand and Viet Nam, latter having borne brunt of human infections with 42 WHO-confirmed deaths out of 92 cases since December 2003. Many governments in region are posed with a dilemma over how much scarce public funds should be poured into fight against avian flu. Governments in region have been making efforts to educate population about preventive and surveillance measures, but misconceptions abound about disease, both in poultry and humans. Education campaigns in affected countries are still not getting through to individuals most at risk. Common misconceptions that owners of poultry have include mistaken belief that it won't happen to them, that chickens frequently fall sick and that this time is no more serious than any other time, according to Peter Cordingley, WHO's spokesman for Western Pacific Region, in Manila. Worse than any misconceptions, though, is continuing ignorance in Asia, fact that after two years people still know so little about risky practices. The latest case in Thailand confirmed by WHO was a woman who apparently cleaned out muck from a poultry shed where her husband's chickens had died mysteriously, and this was 50 km or so from Bangkok, he said. Dangerous misconceptions also exist at government level including the belief early on by some governments that outbreaks could be covered up and fixed, thus protecting poultry industry without endangering public health and that vaccinating poultry is a quick, inexpensive and effective way of preventing or responding to outbreaks. Vaccination may stop spread of virus but does nothing to eliminate it. Culling is only option, backed up, where appropriate, by vaccinating, said Cordingley. China, where H5N1 avian flu originated, is grappling with a resurgence of disease among poultry and has confirmed first two human cases of infection with virus on 17 November. National government policy is at odds with what happens at grassroots level because of patchy reporting at local level of outbreaks elsewhere in country. Local level officials also fear incurring ire of their superiors by being open about suspected or confirmed outbreaks and are reluctant to deal with economic consequences of any decision to announce an outbreak and cull poultry. There has to be even greater public awareness. Even though bird flu is not new to China and has been widely reported over last two years, news of every outbreak does not reach everyone and one of biggest dangers is that this might lead to a sense of complacency, said Roy Wadia, WHO's spokesman in China. …