BIRD FLU AND INFLUENZA: THEIR SYMPTOMS, DEADLINESS AND EARLY HISTORY

BIRD FLU

Bird flu is an infectious disease generally found in birds that is caused by several strain of influenza virus. It was first identified in Italy in 1878. All bird species are at risk, although some more than others. The natural hosts tend to be migratory waterfowl, such as wild ducks, who normally don’t get sick because of high resistance to infection. Domestic poultry is more susceptible because they don’t have resistance to the disease.

Bird Flu first appeared among humans in Hong Kong in 1997 and then was thought to have been eradicated. Then, in 2003, the virus reemerged, in Thailand. In the late 2003 and early 2004 there was an Asia-wide epidemic of H5N1 avian influenza (bird flu or avian flu), with the disease spreading to humans in Vietnam and Thailand. In 2005 the human form of the disease spread to Cambodia and Indonesia, killing people there. Later it spread around the world. By 2007 it had impoverished millions of poultry farmers, caused $20 billion economic damage, and spread to 50 countries including Nigeria, Britain, Afghanistan, Israel, Cameroon, Iraq, India, Myanmar, Thailand, Vietnam.

The mortality rate of bird flu as of 2012 was 59 percent among reported cases. Michael Specter wrote in The New Yorker: The true percentage is undoubtedly lower, since many cases go unreported. Even so, the Spanish-flu epidemic of 1918, which killed at least fifty million people, had a mortality rate of between two and three per cent. Influenza normally kills far fewer than one-tenth of one per cent of those infected. This makes H5N1 one of the deadliest microbes known to medical science. [Source: Michael Specter, The New Yorker, March 12, 2012]

Website: World Health Organisation (WHO), www.who.int/csr/disease/avian_influenza/en/ and click on “frequently asked questions”.

Bird Flu Numbers

As of March 2012 bird flu has killed 346 of the 587 people, near sixty percent of those it infected. It probably has infected many more people who didn’t know they were infected. As of March 2007, bird flu was known to have infected 277 people, killing 167 of them as well killing over 250 million birds.

Confirmed human bird flu cases by country as of 2007 according to the World Health Organization: 1) Vietnam (93 cases, 42 deaths); 2) Indonesia (81 cases, 63 deaths, with 6 cases and 5 deaths in 2007); 3) Thailand (25 cases, 17 deaths); 4) Egypt (22 cases, 13 deaths, with 4 cases and 3 deaths in 2007); 5) China (22 cases, 14 deaths); 6) Turkey (12 cases, 4 deaths); 7) Azerbaijan (8 cases, 5 deaths); 8) Cambodia (6 cases, 6 deaths); 9) Iraq (3 cases, 2 deaths); 10) Nigeria (1 case, 1 deaths, with 1 case and 1 deaths in 2007); 11) Djibouti (1 case, 0 deaths); 12) Laos (1 cases, 0 deaths, with 1 case in 2007).

As of August 2005, 12 people died and 17 cases were reported in Thailand; four died from four cases in Cambodia, at least one died in Indonesia and 50 died and 90 cases were reported in Vietnam and 200 million chickens and other birds had bee culled throughout Asia. Infected birds were found in Cambodia, Laos, Indonesia, China, Japan, South Korea, Taiwan, Malaysia, Thailand and Vietnam. Some of the dead of Thailand contacted the disease from fighting cocks whose owners regarded as too valuable to kill.

Bird Flu Symptoms

Symptoms of the disease vary but generally included influenza-like symptoms such as fever, coughing, sore throat and muscle aches as well as eye infections and eventually acute respiratory distress and pneumonia. Some people have no symptoms or are mildly sick. The contagious form strikes victims quickly and has a nearly 100 percent fatality rate. The virus can change from being a low-risk strain to a high risk one through genetic mutation in the body.

Anjana Ahuja wrote in The Times: “H5N1...ravages the lungs---X-rays show the black of the lungs replaced by a ghostly white cloud---to cause pneumonia. The virus can also spread elsewhere in the body, even to the brain, to cause multiple organ failure. [Source: Anjana Ahuja, The Times, October 30, 2006]

In February 2005, Reuters reported: The bird flu virus can produce a deadly encephalitis, diarrhoea and other symptoms that do not look like the classic respiratory disease, an international team of doctors said. They reported on the cases of a 9-year-old girl and her 4-year-old brother who died of encephalitis, a swelling of the brain case, in southern Vietnam one year ago. The children’s deaths were a mystery until the researchers went back and checked samples from the boy and found avian influenza virus.

"These cases suggest that the clinical spectrum of influenza H5N1 is wider than previously thought, and therefore they have important implications for the clinical and public health responses to avian influenza,” the researchers wrote in the New England Journal of Medicine. “The finding came in late 2004 after we tested several hundred samples,” Dr. Tran Tinh Hien, the deputy head of the Ho Chi Minh City Hospital for Tropical Diseases and one of the study’s authors, told Reuters. Hien noted that influenza viruses in general were known to cause encephalitis and can damage the respiratory, nervous and digestive systems as well as the heart, kidney and liver. “But we have not found encephalitis among the patients who died recently from bird flu in Vietnam,” Hien told Reuters. [Ibid]

Bird Flu Death

H5N1--the strain that causes bird flu in humans--is incredibly deadly. It has killed 60 percent of the people who have been known to have been infected by it. Bird flu causes the capillaries to leak blood and the immune system to overreact by producing excessive amounts of white blood cells and fluid. Human victims fight for their lives as the disease destroy their lungs and causes a massive inflammatory reaction. Healthy tissue dies and blood vessels leak, Many victims literally die of suffocation from the excessive fluid in their lungs. One victim was found with healthy lungs. He died in a coma after his brain became inflamed.

Professor Jeremy Farrar, director of the Oxford University Clinical Research Unit at the Hospital for Tropical Diseases in Ho Chi Minh City (formerly Saigon) in Vietnam, told the Times of London: “Avian influenza is a horrible disease, and people can deteriorate incredibly quickly. I remember one patient having breakfast and talking and by the next morning she was dead. Seeing fit healthy young people, and especially children, go from being very well to very sick and then dying in a short space of time, is always traumatic.” [Source: Anjana Ahuja, The Times, October 30, 2006]

Influenza

Influenza is caused by a virus and can be very dangerous. Each year it infects 30 million to 60 million, killing 36,000 people, most of them elderly. The flu pandemic of 1918-19 killed at least 20 million people. There are number of different strains of virus. Some don’t event cause sickness. The word “influenza” comes from the Italian word for “influence” or visitation.”

One of the primary dangers of influenza and one reason its can spread so widely and so quickly is that people become infectious before they know they are sick. The flu spreads easily through tiny droplets that are exhaled by carriers and picked up by others through inhalation or touching surfaces that have come in contact with the flu virus. The virus has the ability to jump from species to species and mutates very quickly so that no one ever is completely immune.

The reason that we are able to easily fend off most influenzas is that our bodies have seen most flu viruses before or at least viruses similar enough to them that our immune system can muster an appropriate response. Deadly influenzas are the ones that are different enough from the others that the immune system has difficulty providing protection. Many of these are caused by viruses that have made a recent leap from another species to humans.

Strains of flu are named for two proteins on their surface that latch on to repsiratory cells and make it possible for them to invade the lungs. They are identified with H and N protein numbers. The strain that causes bird flu in humans is H5N1. When a virus with a new H-N combinations appears immunity to old forms of the H-N viruses don’t work.

The World Health Organization estimates that annual influenza epidemics infect 5-15 percent of the world population each year, cause 3-5 million cases of severe illness and 250,000-500,000 deaths. About 300 million people get the flu vaccine each year. Without it, says Smith, a person can expect to catch the flu about once every 10 years. New flu vaccines given each year typically includes a cocktail of three strains, and the scientists try to predict which strains will cause the most trouble each year. [Source: Maggie Fox, Reuters, April 17, 2008]

Often a rise in transmissibility is accompanied by a decrease in virulence. This is what happened with milder pandemics, such as the 1957 episode of H2N2 that killed two million people, and the 1968 outbreak of H3N2 that killed one million. Anjana Ahuja wrote in The Times, “The logic is that a virus that wipes out its host also wipes out its main vehicle for replication and transmission, so for a virus to be “successful”---such as HIV, which is still with us 25 years after emerging---it cannot be too virulent. [Source: Anjana Ahuja, The Times, October 30, 2006]

Biology of Influenza Virus

Most flus have two proteins, hemagglututinin (H) and nuramnidase (M) on their outer shells that act like hooks and allow them to invade other cells. Together H and N provide the virus’s chemical appearance and identity to the immune system. There are 15 forms of H and N proteins in the most populous class of flu viruses---influenza A (less common and less dangerous influenza B has only one type of H and N). Human influenza is takes around three days to make people ill, thus giving them ample time to infect others.

Karen Kaplan wrote in the Los Angeles Times, “The influenza virus is a simple device. Each spherical flu particle contains eight strands of RNA, which have instructions for making 10 proteins. One of them, hemagglutinin, forms spikes on the virus' outer shell to help it attach to a host cell. Once inside, the virus hijacks the cell's machinery to copy itself hundreds of times. Another protein on the outer shell, neuraminidase, helps the new virus particles detach from the host so they can find fresh cells to invade. [Source: Karen Kaplan, Los Angeles Times, January 10, 2006]

“These two proteins define a flu's character. Scientists have identified 16 types of hemagglutinin, or H, and nine kinds of neuraminidase, or N. The particular combination is what gives a flu its name. The power of influenza lies in its endless pursuit of change. Unlike more complex organisms, whose genetic code is stored in DNA, flu viruses have RNA, which cannot copy itself reliably. Each mutation changes the shape of the H and N proteins, and over time, the immune system fails to recognize them. This genetic "drift" is why the flu vaccine must be updated every year. Even small drifts enable viruses to sicken millions of Americans each winter and kill an average of 36,000. [Ibid]

“A more dramatic event is a "shift," which occurs when two flu viruses infect a cell at the same time and swap entire strands of RNA. The mixing could involve two kinds of human flu, or it could include strains from birds, pigs, horses, seals, whales or other animals. The most dangerous scenario is for a human virus to exchange its H -- or both its H and N -- with an animal equivalent. The combination probably would create a new strain, and no one would be immune. It would take months to develop a vaccine. That is precisely the scenario that makes scientists fearful of H5N1. [Ibid]

Biology of the Bird Flu Virus

All flus are believed to have orignated with ducks or waterfowl. Many carry the virus without getting sick. Strains among wild ducks spread through feces shed in the water but don’t affect the ducks because they have a resistance to the disease. Infected birds migrate and bring the disease to new places. If they had been dead or seriously ill they couldn’t spread it. When the disease comes in contact chickens who have no resistance they became very sick.

Avian flues can spread rapidly at poultry farms because the birds have had little exposure and thus little resistance to the virus; they are packed closely together in farms and markets so the virus can be spread quickly from bird to bird; and the stress caused by the crowding and poultry farm life in general lowers their resistance.

Karen Kaplan wrote in the Los Angeles Times, H5N1, the virus behind the bird flu outbreaks, “has already made a complex evolutionary journey. Researchers have traced the ancestor of its H5 gene to a virus identified in geese in 1996. The N1 came from a teal duck carrying a harmless H6N1 strain. Both pieces, scientists believe, finally came together in a quail, which provided essential proteins from an H9N2 virus. [Source: Karen Kaplan, Los Angeles Times, January 10, 2006]

Anjana Ahuja wrote in The Times: “H5N1---or, to give its full name, HPAI A(H5N1) appears to latch on to receptors in the lower lung. This part of the body is relatively inaccessible---which may explain why, even though the virus is endemic in poultry, human infection is so rare. Human flu, in contrast, hooks on to receptors in the upper respiratory tract, meaning that coughs and sneezes disperse the virus easily. Scientists have warned that H5N1 could mutate and begin to favour receptors in the upper tract, which would raise the threat level. Each person that the virus infects acts as a reservoir in which H5N1 can replicate and mutate. What scientists fear most is that the virus maintains its lethality while acquiring the capability to jump from person to person. [Source: Anjana Ahuja, The Times, October 30, 2006]

Scientists have found that bird flu is very hard to catch. According to a study by Yoshihiro Kawaoka, a virologist at the University of Tokyo and the University of Wisconsin, published in Nature in March 2006, tThe virus has trouble attaching to human cells in the nose, throat and upper airway, making infection unlikely. H5N1 infects only cells deep inside lungs in alveoli, tiny air sacs where the exchange of oxygen and carbon dioxide takes place. Victims transmit enough virus to their mouths for it to gain access to the lower lungs, a distance that is shorter in children than adults. Because it is so deep in the lungs, the virus is unlikely to be released by coughing or sneezing.

Influenzas Originate in China

Most strains of influenza from the past and virtually all new strains of the disease originated in China. By one estimate 80 percent of the influenzas that appeared in the last couple of decades originated in southern China, particularly in Guangdong, where there are millions if ducks, chicken, pigs and other animals believed to be the source of many of the flu-causing germs. [Source: Tim Appenzeller, National Geographic, October 2005]

Genetic analysis by teams who published their work in the magazine Nature and Science in 2008 indicates that flu viruses evolve freshly somewhere in East or Southeast Asia every year and fan out from there around the globe, for nine months or so, and then die out. One team led by Professor Edward Holmes of Pennsylvania State University cannot pinpoint the source but says both H3N2 and H1N1 strains of influenza appear to arise every year from a 'reservoir', perhaps in the tropics. A second team led by Dr Colin Russell and Professor Derek Smith of the University of Cambridge analysed 13,000 samples of H3N2 flu taken since 2002. These researchers demonstrate this source must be in east and southeast Asia, perhaps a different place every year. [Source: Maggie Fox, Reuters, April 17, 2008]

Maggie Fox of Reuters wrote: Many experts have long believed Asia, and specifically China, to be the source of most influenza viruses. Others hypothesised that flu viruses migrate back and forth between the northern and southern hemispheres, or that they cooked year-round in the tropics, to pop out every once in a while to the rest of the world, Russell says. "We find that viruses come out of east and southeast Asia as a region each year and it is not any one particular country that is the continual source of influenza viruses," he says. "So it is not as simple as saying out of China, because out of China is not the whole story." [Ibid]

In tropical regions, flu tends to break out in the rainy season. "In east and southeast Asia there is a there a lot of variability in the timing of the rainy season and the timing of the epidemic," Russell says. "Bangkok and Kuala Lumpur are only [1100 kilometres] apart but they have their flu epidemics at completely different times of year." This means flu epidemics can be occurring almost year-round in Asia, he says. Then the viruses die out every year in the Americas, Europe, Australia and the rest of Oceania, making these areas "evolutionary graveyards", Russell says. Even if travellers carry the flu viruses back from the Americas to Asia, for example, people living in Asia are already immune to those particular variants. [Ibid]

Influenza and Animals

Many influenzas are thought to have evolved in places where farmers keep ducks, chickens and pigs together. Pigs and ducks, common on Chinese farms, carry flu viruses, and perhaps they are where the new strains first get cooked up. In southern China, where many of the world's newest influenzas originate. a typical two-room brick house is occupied by a family on the top floor and animals on the bottom floor. Viruses grow well in hot climates and are active in live animal markets, where viruses can spread from animal to animal.

Unlike most viruses which only infect a couple of species, flu viruses can strike a variety of animals including humans, horses, pigs, seals and many species of birds. When animals of different species are intermixing as they do in China it creates a situation in which viruses are being exposed to many kinds of different genetic material, making it possible for new strains to evolve.

Ducks and shorebirds carry flu viruses that are not harmful to them but can kill chickens and sometimes people. Southern China lies along a major fly route for water fowl migrating to and from Siberia. New flu viruses are thought to arrive in the area with waterfowls and are transferred to poultry in the area.

Pigs can carry flu viruses found in both humans and ducks. Scientists believe that many new flu strains evolve first in birds who pass the viruses on to domestic ducks. The viruses are then picked up by pigs and passed on to humans. Some think pigs act as a “mixing vessels,” taking on bird viruses from ducks and flu virus from farmers, allowing the flu viruses to “reassort,” creating a new potentially-lethal hybrid.

History of Influenza

In 412 B.C., Hippocrates described an outbreak a disease that was probably influenza in the city of Perinthus. It was the first recorded incident of the flu. Some scholars believe the disease may have contributed to the fall of Athens. The disease is believed to have originated with ducks, which were first domesticated around 2500 B.C.

There have been at least 30 pandemic of influenza, caused by strains of flu in which humans had little immunity. The first recorded pandemic was an outbreak that occurred n 1580 in Europe and parts of Asia and Africa. In 1889, an unknown influenza subtype, called the Russian flu, began in Central Asia and spread to Europe and parts of Asia and Africa. It killed roughly 1 million people.

Scientists say that flu pandemics occur on average about three times a century. The H2N2 strain that appeared in 1957 in southern China triggered a pandemic of “Asian flu--- that killed 70,000 people in the United States alone, and around 1 or 2 million worldwide. It was created by a bird flu and human flu that swapped genes, probably after infecting a pig. In 19955 avian flu was found to be caused bu the most virulent of the three forms of virus, influenza A.

The Hong Kong flu in 1968 was caused by H3N2. It killed about 750,000 people worldwide. Again, it was caused when bird and human influenzas swapped genes, probably after infecting a pig. The strain was similar enough to the 1957 strain that people had some immunity reducing the number of deaths. Many deaths are blamed on an inadequate supply of vaccine.

In 1977, H1N1 appeared again. By that time nearly everyone under 20 had never been exposed it and it caused a mini-pandemic. In 1976 a strain of swine flu appeared in New Jersey and 40 million Americans got vaccinations. In 2003 there was an outbreak of the highly pathogenic H7N7 strain of bird flu among birds in Germany and the Netherlands. More than 30 million birds were culled in the Netherlands. The highly pathologic H7 and H5 strains of bird flu---which are rare but lethal, killing 80 percent to 100 percent of birds infected---caused major outbreaks in the United States in 1924, 1983 and 2004.

H-N viruses are plentiful in other species, particularly birds. They can cause great damage in poultry industry and sometimes---as is the case with H5N1-make the species leap from birds to humans. The creation of potent flu viruses is especially dangerous in today’s world, where people and birds are crossing borders and can easily spread disease.

Great Flu Pandemic of 1918

The great pandemic of 1918 that killed between 15 million and 50 million people was caused by H1N1, a new flu strain that was identified in 1930 and later called swine flu. The flu was called the Spanish flu because the king of Spain got it not because it originated there. The disease was very deadly. It killed five to twenty percent of the people who caught it, some in two or three days. Some people woke up healthy, developed a severe headache and joint pain and were dead by bedtime.

It is estimated that 500 million people caught the 1918 flu. In many cases victims died after the virus multiplied rapidly in the lungs and provoked an immune system response that devastated the lung’s dedicate tissues and caused them to fill with bloody fluid, turning victims a sickly purple color and causing them to suffocate to death from the fluid in their lungs.

It is not clear where the H1N1 virus originated. The outbreak reached pandemic levels in Europe and thrived in conditions created by World War I, where sick and wounded men were packed together. Many victims were young adults who normally shrug off the flu. By the time it had run is course it had spread across the globe. Except for a few Pacific islanders everyone on Earth was exposed to the disease and half got sick.

Wendy Orent, an author of books on diseases and viruses, wrote in Los Angeles Times, the 1918 flu---was formed in the massive disease factory of the Western Front of World War I. Why was it a disease factory? Because soldiers were crowded into close quarters that were the perfect environment for the flu to mutate into something highly virulent. When a soldier got deathly ill, there was no place to move him, and he remained packed tightly in among the other soldiers. [Source: Wendy Orent, Los Angeles Times, January 15, 2012]

Bird Flu, Humans and the Possibility of a Pandemic

How the bird flu is spread to humans is still not known. Most access is believed to be related to contact with sick or dying dead poultry. But scientists are not sure whether it is picked by touching the birds, or eating or inhaling dust contaminated with their feces. The disease is believed to have been spread to humans by contact with the dust of feces or saliva of sick birds. No one ever caught the disease from eating meat with the virus, which is killed if meat is cooked at 75 degrees C or higher for a minute.

There is no human vaccine for bird flu. Human bird flu patients are treated with antivirals. The primary treatment, an expensive anti-viral called Tamiflu, appears to only be effective if it is given within one or two days of the onset of symptoms. Tamiflu is also given as a kind of vaccine.

The Center for Disease Control has called bird flu a “ticking time bomb” especially if human-to-human transmission begins to take place. Bird flu can spread through the air as well as in feces. If there is human pandemic some estimate that 180 million to 360 million would die. Modern transportation and travel make the spread of such a disease easy and containing it once it starts impossible. The World Health Organisation (WHO) said the potential for H5N1 to fuel a human influenza pandemic “is serious and has increased” ; that once a pandemic is under way it is “considered unstoppable”; that the best way to prevent one is to eliminate H5N1 in birds but that this is seen as “increasingly doubtful”.

A worrisome situation can arise among human if a human is carrying an avian flu also carries a normal human flu that is transferred easily from person to person. If the two viruses exchange genetic material, there is the possibility that a hybrid virus could be created that could be as deadly as H5N1 and infect humans as easily as a common human flu. Some fighting cock owners treat their injured birds by sucking the bird’s blood. The practice is quite dangerous with bird flu present. Boiling feshly-killed chickens helps remove feathers but doesn’t kill bird flu Authorities are also worried about migratory workers from the countryside bringing bird flu to the cities.

Michael Specter wrote in The New Yorker: “To ignite a pandemic, even the most lethal virus would need to meet three conditions: it would have to be one that humans hadn't confronted before, so that they lacked antibodies; it would have to kill them; and it would have to spread easily--through a cough, for instance, or a handshake. Bird flu meets the first two criteria but not the third. Virologists regard cyclical pandemics as inevitable; as with earthquakes, though, it is impossible to predict when they will occur. Flu viruses mutate rapidly, but over time they tend to weaken, and researchers hoped that this would be the case with H5N1. [Source: Michael Specter, The New Yorker, March 12, 2012]

Anjana Ahuja wrote in The Times: Human influenza is takes around three days to make people ill, thus giving them ample time to infect others. Very roughly, if a person carrying H5N1 went on to infect two or more people, it would be virtually impossible to contain a pandemic. Mathematical simulations by Professor Neil Ferguson, at Imperial College, London, shows that if each flu case infects an average of 1.8 people or fewer, a combination of containment strategies and pre-vaccination offers hope. Ferguson has predicted that a pandemic could cost up to 200 million lives. [Source: Anjana Ahuja, The Times, October 30, 2006]

Bird Flu and Different Species of Animals

In H5N1 is believed to have developed first in quails. The H5 came from a goose. the N1 came from a quail. A third component also came from a quail. Ducks or waterfowl can pass the disease onto pigs, horses, whales, seals, chickens and turkeys but there is no evidence that they can pass on to humans. It was once thought the avian flu could only make the species leap to humans through pigs because pigs were the only animal known that could catch both human and avian flues. The 1997 Hong Kong outbreak was the first evidence of a bird-to-human flu infection,

Bird flu made the leapt to species other than humans. In Thailand, 29 tigers and two house cats died after being infected with the disease from eating raw chickens or chicken bones. Another 40 tigers were culled. Later around 140 tigers died ay Sri Racha Tiger Zoo near Pattaya, Thailand after they had eaten chickens infected with bird flu. A report that a dog had come down with the disease was unfounded. In China there were reports of finches dropping dead from the sky (no link was found to bird flu however). In Vietnam, pigs tested positive for the disease. This was especially worrisome because in the past flu have made the species leap from pigs to humans and showed that disease could evolve in other animals.

Experiments in the laboratory by Chinese-based scientists showed how bird flu can change and acquire characteristics that would made lethal to mice. It was reasoned the same thing could make it lethal to humans. Some scientists say people should not worry too much because bird flu has evolved to be transmitted among birds and is still difficult for humans to catch. It s unlikely that World War I conditions would occur again and allow a birds specific virus evolve into a human killer.

H5N1 has been discovered in the snouts of pigs but not in their blood stream. Pigs can pick up the virus by sniffing the ground and have it present in their snouts without actually contacting the disease, which has to get into the blood stream to be infective. In Vietnam pigs were found with H5N1 in their snouts but not in their blood. It would be a worrisome trend if a strain of H5N1 developed that could be transmitted from pig to pig because pigs are mammals and are genetically similar to humans .

Animal and Human Victims of Bird Flu

Birds spread the virus via saliva, nasal secretions and feces. Most cases of infection in humans results from contact with infected poultry or contaminated surfaces. Chickens usually die within 24 hours of being infected.

Chickens that catch the disease swell and hemorrhage and often die as bloody heaps within hours after catching it. The manage of a state-owned farm in Laos that lost a quarter of its 2,000 chickens in five days in January 2004, told the New York Times: “they bled from the nose and the backs of their heads turned purple and then black, and then they died. The disease can be just as destructive to mice, tigers and other mammals.

Many of the victims of bird flu were children. This is thought to have been because they were often in contact with chickens, ducks and other fowl and play in areas used by farm animals. Another reason is that victims transmit enough virus to their mouths for it to gain access to the lower lungs, a distance that is shorter in children than adults.

See Symptoms

Backyard Chickens, Live Markets and Panic Over Bird Flu

Alan Sipress wrote in the Washington Post: Markets in several countries, including Vietnam and Cambodia, have long sold live chickens and ducks, but health experts now warn that the virus can be spread by sick birds to other poultry and to people who buy and sell them, especially if they do not wear protective gear. At Phnom Penh's cavernous Orussey Market, for instance, live chickens and ducks are hawked on muddy floors, where they are crammed together, legs bound. In the warren of aisles, peddlers with bare hands butcher, pluck and wash them. [Source:Alan Sipress, Washington Post, April 14, 2005]

“Millions of villagers across the region, meanwhile, raise chickens in their back yards and even inside their homes. When the birds fall sick, villagers are more likely to eat them than dispose of their bodies, U.N. agriculture officials say. Often, the home-raised birds are fighting cocks. In Thailand alone, estimates put their number in the millions. [Ibid]

Alan Sipress wrote in the Washington Post: “In Europe, where the virus was confirmed in wild birds across the continent this year, the consumption of chicken and eggs immediately tumbled. The discovery of a single dead swan infected with bird flu in Scotland this month sent Britain into a tizzy. The British media went on a war footing and callers flooded animal health hotlines with suspected sightings of sick birds, a likely preview of the American response should migratory fowl carry the disease to the West Coast as predicted. [Source:Alan Sipress, Washington Post, April 30, 2005]

“Panic has also swept Egypt, where people responded by turning off their tap water after television stations broadcast news that infected carcasses were being dumped by farmers into the Nile River. In India, a farmers group reported this month that seven peasants had committed suicide after the disease destroyed their livelihoods. [Ibid]

Bird Flu, Cockfighting and Duck Blood Soup

Alan Sipress wrote in the Washington Post: Cockfighting, popular in many parts of Southeast Asia, is suspected of spreading the highly lethal bird flu virus from poultry to humans through contact with blood, feces and droplets of fluid. It is one of several cultural practices, including the eating of raw duck blood and the raising of chickens in back yards, that are threatening to help spark a global pandemic that the World Health Organization warns could kill tens of millions of people. [Source:Alan Sipress, Washington Post, April 14, 2005]

“Vietnamese have traditionally eaten a dish called tiet canh vit, prepared from duck blood, stomach and intestines, to mark the anniversary of a death in the family and other special occasions. Health investigators suspect that as many as five people from two families near Hanoi contracted bird flu this year after dining on this pudding. [Ibid]

“According to WHO and local news reports, infected fighting cocks may have caused at least eight confirmed human cases of avian influenza in Thailand and Vietnam since the beginning of 2004. In September, the virus killed an 18-year-old Thai man who raised fighting cocks outside Bangkok. Thai health officials said he had the habit of sucking mucus and blood from the beaks of his injured roosters and sometimes even slept with his birds. Earlier last year, a 13-year-old boy who frequented cockfights in Vietnam's Ho Chi Minh City and often held the birds before the bouts also succumbed to the disease. [Ibid]

“It is this proximity to the blood and breath of the frenetic fighters that can make cockfighting so hazardous to humans. But the intimacy of the owners and trainers with their birds also poses a profound danger. Between the 20-minute rounds, the owners scrubbed the blood off their birds with bare hands, wringing out the rags on the ground. Then, with ordinary thread, they stitched the wounds around their eyes and fed them painkillers. Sometimes, Phapart recounted as he watched the hurried surgery, the injuries are so severe that owners relieve the swelling by sucking out the blood by mouth.” [Ibid]

Efforts to Contain Bird Flu by Controlling Cockfighting

Alan Sipress wrote in the Washington Post: “Some owners hid their roosters when Thai officials ordered the mass culling of poultry to contain the bird flu epidemic. Others have smuggled cocks across provincial lines, potentially spreading the disease. Officials in Malaysia blamed the outbreak in the north of their country in September on fighting cocks illegally transported from Thailand. [Source:Alan Sipress, Washington Post, April 14, 2005]

“Thai officials have imposed a system of fighting cock passports that requires owners to get a veterinarian's stamp before taking their birds into another district. Though Phapart said he obeyed these rules, he acknowledged that many villagers did not... Phapart dismissed the government's worries about bird flu as overblown and its proposals as unworkable. "The decision-makers analyze the situation just on paper," he said, growing agitated. "Their feet aren't on the ground. They don't really know how we treat the cocks and don't really share our feelings." He urged that the owners of fighting cocks be left to police themselves because, in his view, they have the most to lose if the virus spreads among the birds. "We care more for the fighting cocks than the health officers do," he argued. [Ibid]

“Last summer, roosters on Phapart's family farm in Chiang Mai province developed flu symptoms. Instead of informing the government, he said, he slaughtered all 600 and burned their bodies. For good measure, he gave away 10 others he was keeping in bamboo cages behind his house for fear they might catch the virus. He has already restocked. The new birds are still young, he said, cradling one in his arms, but he likes their looks. They may even grow to be champions like his beloved rooster Lucky, who died undefeated and whose framed photograph hangs in Phapart's living room. Phapart leaned forward intently and vowed, "They'll never be able to stop us from doing cockfighting." [Ibid]

Bird Flu Survivor in Vietnam

Reporting from Saigon, Anjana Ahuja wrote in the Times of London, “Hn Diem Hong Nguyen, 11, and her 14-year-old brother Druong Suan live, like so many Vietnamese city-dwellers, in a two-bedroom apartment in a narrow, crowded alley with their parents and extended family. The living room...opens on to the alley. The living room doubles up as a bedroom for Hn’s aunt. In December 2003 this pretty, slightly built schoolgirl was fighting for her life in the city’s Hospital for Tropical Diseases (HTD). She caught H5N1 from a duckling that she bought outside her school. It seemed an innocuous addition to the family’s domestic menagerie: a monkey, a dog, birds and fish.[Source: Anjana Ahuja, The Times, October 30, 2006]

“Hn says: “I bought the duckling as a pet. It was so small and cute and I loved it. I fed it rice and vegetables three times a day, just as my mother feeds me, and when I came home from school, I played with it and hugged it. After a week it got sick and died. I decided to bury it at the end of the alley outside my house and went off alone with a dinner spoon. I felt sad but I didn’t cry. About three days later a neighbour asked me to dig it up because it smelt. So I dug it up and went with two friends to bury it in a nearby cemetery. I had wrapped the duck’s legs in paper, so that I didn’t have to touch it. After burying it, I came home and washed my hands without soap.” [Ibid]

“The next day, Hn developed a fever. Her mother Chau recalls: “After two days, the fever hadn’t come down, so we took her to a paediatric hospital. The doctor admitted her immediately. Within five days her fever had worsened and she needed oxygen to breathe. I cried a lot. I was so afraid that she would die. Doctors isolated her and told me that her lungs were getting worse every day. They sent a blood sample to the Pasteur Institute (in Ho Chi Minh City). [Ibid]

“One morning they told me that it was bird flu and that afternoon she was transferred to the HTD. I was scared because I’d read in a newspaper of bird flu in the north and the person died. The doctors told me that my daughter was the first bird flu case in the south, and that I should pray. I prayed every day before bed and we went to church every day. I think God heard my prayers---that’s why my daughter survived.” Hn’s father recalls seeing around 15 other cases of bird flu during his daughter’s recuperation; most died within three days of arrival. [Ibid]

“He remembers that his daughter was given Tamiflu an hour after reaching the HTD. By this time she was unconscious, only one third of one lung was functioning, and her immune system had almost shut down (recent research suggests that this shutdown may have saved her life as H5N1 appears to trigger a potentially lethal “immune storm”). Her father adds: “We had to wait 24 hours to see if Tamiflu worked. I stayed with her the whole time and stopped working. Then we saw her fever had come down---we were so happy that it was working. She had half a Tamiflu pill a day and was fed intravenously. [Ibid]

“She stayed in hospital for a month and three days. Ten days before she came home the doctors said that there was no virus in her body and that she’d survive. We just thanked God. I hugged the doctors. We thought we were luckiest people alive.” One of Hn’s most vivid memories was that her father bought her a pair of pink slippers to help her to walk again---she’d been bedridden for so long. “I couldn’t walk because I was so weak. ...The family will never keep pets again (the city has banned the keeping of domestic poultry). “We wouldn’t dare,” says Chau. “It is too scary.” [Ibid]

“Hn’s recovery has come at a financial cost in a country where healthcare is not free (except for children under 6) and the average income is £320. Her parents estimate their medical costs at about $4,000 (£2,140), half of which covered drugs and hospital care. The other half went on medical transportation plus other expenses, such as a large donation to the local church which held a special ceremony to pray for Hn, and gifts to doctors. Hn’s illness coincided with the Tet, or Vietnamese New Year, during which it is customary to give to others. As our meeting draws to a close, Hn smiles serenely and reaches for her mother’s hand---and pledges to pay her parents back with proceeds from the catwalk. [Ibid]

Nearly Dying from Bird Flu Survivor

Anjana Ahuja wrote in the Times of London: Oanh Duong Thi Kieu Duong, 27, is tall and slim...A tailor, Oanh rents a single room in Ho Chi Minh City, returning once a month to her husband and eight-year-old daughter, who live in a one-room hut in a province 170km (105 miles) away. Oanh’s husband is a poor farmer. Oanh told the Times: “It was December 2004 and we had about 50 chickens in the house. I saw that some of them were ill and dying. I buried the small ones and kept the biggest one to cook and eat. I cleaned and plucked it but, because I had a headache, I left it for my husband to cook when he came from work. [Source: Anjana Ahuja, The Times, October 30, 2006]

“That afternoon I started feeling dizzy. The next morning I felt so bad that I went to the local health centre. I felt as if my head would explode. They gave me tablets. I wrapped myself in a blanket and went to my sister’s house so she could perform a treatment, “rubbing wind”, on me, which involves taking a coin and rubbing it on the head, to get the poisoned wind, or bad chi, out of my body. It didn’t make me better so my brother came over and took me to a provincial hospital on the back of his motorbike. I could barely hold on for the hour-long journey. A doctor diagnosed a respiratory infection and I told my brother to buy all the medicines he prescribed. I took them all in one go. [Ibid]

“I still didn’t feel better so I contacted my cousin, who works as a doctor there. She admitted me and X-rayed my chest. They asked if I’d eaten chicken. I said yes, even though I hadn’t. I lied because I was scared, the pain was so horrible. All the doctors went to get masks. As soon as I saw the masks, I thought that I was dying. I asked the doctor if I was going to be OK and she said that she didn’t know. I heard the doctors tell my husband it was bird flu---it was first time I’d heard of it.” [Ibid]

“Oanh was transferred to the HTD in Ho Chi Minh City, where she stayed for ten days. “All I remember is that I didn’t know the faces of the doctors who treated me, and that when I had a high fever I was unconscious. I remember thinking that, because I was isolated and wearing a mask, if I died, nobody would hear my last words. I didn’t know if I would be around to be a mother to my daughter. I prayed every day. My family came to say goodbye to me. My poor daughter could not eat---someone gave her money to buy breakfast and instead she saved it for me.” [Ibid]

The memories make Oanh cry. But the drama did not end after going home. She discovered she had been pregnant throughout her illness. Six months into the pregnancy, a scan showed the foetus had an abnormally swollen belly. She was advised to abort to avoid the foetus dying inside her and causing a fatal infection. She agreed. She believes that the many medicines she took---which saved her life---cost her the baby. Sadly, Oanh suffered another miscarriage earlier this year.

“Professor Jeremy Farrar says that the effects of an aggressive course of anti-flu medication on developing foetuses remains unknown but, given the deadliness of bird flu, the mother must be the priority. Oanh is grateful to be alive: “If it wasn’t for my cousin, I’d be dead. I saw so many people come here and die of bird flu. And I survived because of my faith and because I am the youngest in my family (she has 11 siblings). I needed to survive so that I could mourn my parents when they die.” She no longer eats poultry or eggs or keeps chickens. She has run up 4 million dong (£132) in debts, and has sold a piece of farmland to pay her medical bills. Her hopes for the future? “I hope that I can pay all my debts and have a second child.” [Ibid]

Bird Flu More Common and Less Deadly than Thought But Still a Threat

On a study that suggests bird flu may be more common and less lethal than previously thought, AFP reported: “Researchers at Mount Sinai School of Medicine in New York analyzed 20 previous international studies that tested the blood of nearly 13,000 participants worldwide, according to the study in the journal Science, and found that between one and two percent of those tested showed evidence of a prior H5N1 avian flu infection, meaning millions of people may have been infected around the globe. The research could help soothe concerns about the potential for a deadly pandemic that may kill many millions of people. [Source: AFP, February 23, 2012]

“The researchers said the WHO may be overlooking cases by focusing only on hospitalizations and severe illnesses, and recommended a new approach to calculating the true number of bird flu cases. The findings could also mean that the death rate from bird flu is underestimated, largely because many of the people who get sick from it live in rural farming areas where medical care may be difficult to come by. "We suggest that further investigation, on a large scale and by a standardized approach, is warranted to better estimate the total number of H5N1 infections that have occurred in humans," the authors wrote. [Ibid]

“A study published in January 2006 in the Archives of Internal Medicine also suggested the virus is more widespread than thought. In that study 45,476 randomly selected residents of a region where bird flu is rampant among poultry---Ha Tay Province, west of Hanoi--- were checked for bird flu. More than 80 percent lived in households that kept poultry, and one-quarter lived in homes reporting sick or dead fowl. A total of 8,149 reportedly had flulike symptoms, with a fever and cough. Residents who had direct contact with dead or sick poultry were 73 percent more likely to have had those symptoms than residents without direct contact. The researchers said between 650 and 750 flulike cases could be attributed to direct contact with sick or dead birds. While most patients said their symptoms had kept them out of work or school, the illnesses were mostly mild, lasting about three days. "The results suggest that the symptoms most often are relatively mild and that close contact is needed for transmission to humans," wrote Dr. Anna Thorson of Karolinska University Hospital in Stockholm, with colleagues who conducted the study. [Source: AP, January 11, 2006)

Impact of Bird Flu

By one estimate bird flu caused $10 billion worth of damage worldwide by the end of 2004. The multi-billion dollar industrial poultry industry was devastated by the disease.

In November 2005 The World Bank estimated that a bird flu pandemic could cost the world $550 billion and kill between 100,000 and 200,000 people in the United States alone. Around the same time the Asian Development Bank estimated that a bird flu pandemic could cost the world $300 billion and kill about 3 million people worldwide and possibly push the world intoo recession.

During the bird flu crisis million of birds that normally provide feathers for shuttlecocks were slaughtered. Shuttlecocks were sold made with inferior feathers. The feathers were finer and the shuttlecocks fell apart. Players around the globe complained. Even top produces could not get the quality feathers they needed.

Image Sources: Wikimedia Commons

Text Sources: New York Times, Washington Post, Los Angeles Times, Times of London, The Guardian, National Geographic, Smithsonian magazine, The New Yorker, Time, Newsweek, Reuters, AP, AFP, Wall Street Journal, The Atlantic Monthly, The Economist, Global Viewpoint (Christian Science Monitor), Foreign Policy, Wikipedia, BBC, CNN, NBC News, Fox News and various books and other publications.

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© 2008 Jeffrey Hays

Last updated November 2012

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