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Bird flu prevention poster
As of March 2008, there were 20 confirmed bird flu deaths and 379 people had contacted bird flu in China. At that time and 239 had died of the disease worldwide, with most of the deaths in Southeast Asia.

China has been blamed for being the source of bird flu, a charge that officials in China have vehemently denied. A study published in November 2006, reported that the strain of bird flu found in most of the poultry outbreaks and some human cases in southern China?H5N1 Fujian-like?was also the primary strain found in Hong Kong, Laos, Thailand and Malaysia.

Genetic analysis of the various H5N1 strains by a team at the University of California in Irvine, published in the Proceedings for the National Academy of Sciences in March 2007, determined the source of the H5N1 Fujian-like virus was Guangdong Province in southern China. Genetic analysis of the H5N1 strains that showed up in Vietnam, Thailand and Malaysia in 2002 and 2003 closely resemble a strain from poultry markets in China’s Yunnan Province

China has repeatedly asserted that was not the source of bird flu and directly asserted the claim made by the University of California in Irvine team was “the wrong conclusion to the evidence and lacked credibility.”

Websites and Resources

Good Websites and Sources on Disease in China: The Chinese Center for Disease Control and Prevention ; Center for Disease Control on China CDC World Health Organization on China ; Wikipedia article on Public Health in China Wikipedia ; Rare Diseases in China , Lancet Article ; Burden of Disease in China pdf file ; AIDS-HIV: Article on AIDS in China ; WHO China Office Report on AIDS ; China AIDS Info China AIDS Medica Project ; SARS : CDC Paper on Origin of Sars ; SARS Map ; SARS Book Stanford University ; Influenza and A/H1N1 Flu: Flu in China ; Paper on Flu and Ducks ; Paper on effects of Flu Pandemic in China ; Bird Flu: Avian Influenza Info ; WHO Avian Influenza Reports ; Flu in China ; Bird Flu Center; CDC on Bird Flu

Good Websites and Sources on Health in China: Center for Disease Control on China CDC World Health Organization on China ; Wikipedia article on Public Health in China Wikipedia ; Short UNICEF Article on Health Issues in China ; On Health Care in China: Health Care in China, an IBM pdf file ; Pape on Chinese Helat Care from the 1990s ; Library of Congress Country Studies Paper on Chinese Health Insurance ; Ex-Pat Report ; China Health Care Blog Asia Health Care Blog


Bird Flu Details

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.

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 75̊C 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.

Bird Flu as a Killer

Bird flu is a nasty disease. It causes the capillaries to leak blood and the immune system to overreact by producing excessive amounts of white blood cells and fluid. Chickens that catch the disease swell and hemorrhage and often die as bloody heaps within hours after catching it. The disease can be just as destructive to mice, tigers and other mammals.

H5N1--the strain that causes bird flu in humans--is incredibly deadly. It has killed 75 percent of the people who were known to have been infected. Symptoms of the disease vary but generally included fever, coughing and eventual 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.

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, Instead he died in a coma after his brain became inflamed.

Biology of the Bird Flu 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).

Strains 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.

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.

Combating the Bird Flu Virus

The most effective way to fight bird flu is kill every bird that has the disease and then slaughter all the domesticated birds in the area, often for a several mile radius. Sometimes millions of healthy birds are killed after the appearance of one sick bird. Hong Kong has been able to avoid a return of bird flu by taking the above measures and regularly the sick chickens pe birds and even wild birds shutting down hundred fo live-poultry stalls twice a month to disinfect them and aggressively inspecting farms and markets,

People were encouraged not to eat potentially sick birds. Not because there is a danger of contacting the disease from eating (little chance of getting it from well cooked meat) but from preparing it.

There is a vaccine for birds and the United Nations has recommended that it be widely used because H5N1 seemed to firmly rooted in ducks and wildlife and culling is not enough. Each dose of the vaccine cost 5 cents. Up to three doses may be necessary. He vaccine has to be injected, which may present the greatest expense and challenge,

Flu researchers at the Center for Disease Control and in the Netherlands are deliberately mixing and matching genes from H5N1 and human flu viruses in a high-containment laboratory in an effort to create potentially deadly strains of flu and develop vaccines for them and figure out other ways to combat the disease before a pandemic breaks out in the real world.

Trials have been conducted with a H5N1 vaccine. In February 2005, Chinese scientists developed a bird flu vaccine for poultry and mammals.

Outbreaks of Bird Flu in 2004 in China

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bird flu prevention measures
In early 2004, China reported 49 confirmed cases of H5N1 avian influenza (bird flu) during an Asia-wide epidemic of the disease. The first cases---among ducks in Guangxi Province---were reported in late January. The government moved aggressively to combat the disease---culling 9 million chickens and quarantining farming areas---and declared it “stamped out” by March. No cases of human transmission were reported.

The government was eager not to repeat the mistakes made with SARS. For the most part it seemed eager and willing to cooperate with the WHO and other international organizations. A network of 300 stations was set up to monitor the disease. Road blocks were set up around infected areas and teams were sent to infected villages to kill all the poultry they could find.

In some cases teams arrived in villages in the middle of the night rounded up all the chickens, ducks and geese in the village and suffocated them on plastic bags and then carried the dead birds off. To ensure that all the domesticated birds in the village had been killed, team members who stayed in tents stuck around for several days to make sure no stragglers survived. Farmers who owned the birds were compensated by the government for their losses.

In August 2004, Chinese scientists at a laboratory in Harbin said they discovered a H5N1 in pigs. It was not clear whether the pigs were infected with the disease or had picked up the disease in their snouts without becoming infected. See Vietnam.

In August 2004, an outbreak of bird flu was reported in Anhui Province after dead chickens, ducks and geese discovered at farms there were found to be carrying the bird flu virus. The government took action to prevent the disease from infecting people. There were reports that a girl died of flulike symptoms after eating sick chickens.

Outbreaks of Bird Flu in 2005 and 2006 in China

In June 2005, wild birds with bird flu were found dead at Lake Qinghai Nature Reserve in Qinghai Province, an important transit area for 189 species of migratory bird Thousand of wild birds---including bar-headed geese, cormorant and black-headed gulls---came down the with the disease. It was the largest known outbreak among wild birds Some thought migratory birds were the source. Others think the disease was brought to region from live poultry based on the fact that such a large number of birds would not have been able to fly to the remote region if they were sick. People were barred from entering the region Three million domesticated birds in the area were vaccinated.

In July 2005, there were outbreaks of bird flu in Xinjiang, with one case near Kazakhstan. Most of the infected birds were domesticated geese and ducks. Migratory birds may been involved in spreading the disease. A third of the bird flu cases in 2005 were in Xinjiang. In August 2005, 2,608 birds at a chicken farm near Lhasa in Tibet were culled to contain an outbreak of bird flu there after 113 chickens died from the disease.

There were 29 outbreaks of bird flu in areas throughout China between October 2005 and January 2006, with the first outbreaks in Anhui Province. The first poultry cases were limited to chickens but later ducks and geese also became infected. The outbreaks are thought to have been spread by migrating wild geese and struck places as far apart as Hunan, Inner Mongolian and Xinjiang.

Liaoning Province was particularly hard hit in part because it lies on major routes for migratory birds traveling to and from Siberia. One farmer in the village of Taian told the Times of London, “I was very frightened. Some of my chickens were sick when I fed them in the morning and I came back after lunch they were dead. I knew it must be bird flu because trucks go down the streets every day broadcasting warnings.” Within hours his 3,800 birds had been incinerated. A total of 160,000 birds were destroyed in the farmer’s village and 12 million were killed in Liaoning. Another 320 million were vaccinated. Farmers were happy to get $1.20 per chicken in compensation even though the could have gotten twice as much had they sold their birds in market.

During the outbreak the government took strict anti-flu measures. Millions of chickens, ducks and other poultry were killed; poultry markets were closed down; and shipments of poultry were inspected nationwide. Roadblocks were set up outside infected areas and vehicles were required to drive over corn starch sprayed with disinfectant.

In May 2006, bird flu was discovered in a dead goose Qinghai Province in northwestern China. In July 2006, bird flu was found in the northwestern region of Ningxia.

As of March 2008 there were five outbreaks of bird flu in China in 2008. The fifth out outbreak occurred in Guangzhou, where chicken in a poultry market were found to have the H5N1 virus. There were two outbreaks of bird flu in Tibet in the winter of 2008. One was in village outside of Lhasa.

Early Bird Flu Victims in China

The first human victim of bird flu in China was a 24-year-old soldier who died in 2003. The man was thought to have had SARS but tests conducted later confirmed he had bird flu. The case was not revealed until 2006. It was first reported in a letter by Chinese researcher to the New England Medical Journal and was confirmed by China’s health ministry in August 2006.

In November 2005, three women---two farmers in the central province of Anhui and a farmer in the northern province of Liaoning---and 12-year-old girl in Hunan Province died from the bird flu. The girl became weak and pale after eating a dead duck and died six days later of a lung infection. The duck also sickened members of her family.

Other bird flu deaths included a 10-year-old girl in Guanxi and a 35-year-old man from Jiangxi in December 2005; and a 31-year-old woman and a 29-year-old woman in Sichuan Province in January 2006,

In February 2006, a 20-year-old female farmer in Suining in southern Hunan Province became the 8th person to die from bird flu in China. Several other people in the areas became ill with the disease, Some of the victims said they had no contact with poultry They are thought to have come in contact with the virus in their surroundings.

In March 2006, a 32-year-old man from Guangzhou in Guangdong Province and a 9-year-old girl from coastal province of Zhejiang died from bird flu. The man did a survey at local markets and spent a long time near a place where chickens were slaughtered. In April a 21-year-old migrant died of bird flu and an 8-year-old girl in southwest Sichuan came down with it after she came in contact with poultry sickened by the disease.

In June 2006, a truck drive from Shenzhen was diagnosed with bird flu. he was the 19th reported to have contacted the disease. In August 2006, a farmer in western China became the 14th person to die from bird flu in China.

Later Bird Flu Victims in China

In March 2007, a 16-year-old boy from Bengui in Anhui Province died if bird flu. he was the third victim in China in 2007. A 44-year-old farmer in Fujian Province and 37-year-old farmer in Anhui Province also came down with the disease. There was also an outbreak in Tibet.

In June 2007, a 19-year-old Chinese soldier stations din Fujian Province died of bird flu. The government did not release information on where he was stationed or how he might have contacted the disease.

The three deaths in 2008 included a 22-year-old man in central China and a 44-year-old female migrant worker who died in Haifeng County in eastern Guangdong Province in February. The woman had come into contact with poultry.

In February 2009, the first bird flu outbreak among poultry of the year broke out in Xinjiang. More than 13,000 fowl were culled.

In January 2009, three people died of bird flu, including a 27-year-old woman in the city of Jinan in Shandong Province; a 16-year-old male student in Hunan Province; and a 19-marriage woman in Hebei Province. All three of the victims had come in contact with infected poultry. The mother of a two-year-old toddler that came down with disease in Hunan Province died of pneumonia. Before that nearly a year had passed with no report of human cases of bird flu. The deaths brought the brought the bird fu death total in China to 21.

Human-to-Human Transmission of Bird Flu

In November and December 2007 there was a case of human-to- human transmission of bird flu in the eastern province of Jiangxi Province in China involving a 52-year-old father and his 24-year-old son. The two were diagnosed with bird flu within a week of each other. Ths son picked up the virus from poultry while the father had no known contact with the virus except from his son. The son died. He was the 17th reported death from the disease in China.The father who was diagnosed at an early stage of the disease, survived.

The strains of H5N1 found in the father and son were almost identical. The father was treated with antivirals and plasm from a woman who had been vaccinated against H5N1 in a clinical trial, which suggests this method or similar methods may be useful in treating the disease,. The Chinese government was unusually forthcoming with data from the cases, which give the international researchers useful information to fight bird flu.

The Jiangxi father and son case was carefully studied by Chinese scientists who published a report in The Lancet. Among their findings, which were encouraging in terms that the virus still lacked a punch to become a pandemic, were: 1) the strain of the virus found in the father and son were similar to the standard strain which showed that little mutation had taken place; 2) the father and son came in close contact with 91 other people who didn’t catch the disease, which suggests it doesn’t pass easily to humans; and 3) the fact that two close relatives caught the disease, raises the possibility they might have a genetic susceptibility to the disease, and if that is case this could lead to better ways of treating the disease and even developing drugs and vaccine to fight it.

There have been a dozen cases of possible human-to-human bird flu transmissions. In every case the transmission occurred between close blood relatives who had been in close contact with the virus, and the disease did not spread to the wide community.

Combating Bird Flu in China

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bird flu prevention measures
During the outbreaks of bird flu between October 2005 and January 2006 thousands of teams on motorcycles fanned out across China, going from village to village and house to house, vaccinating chickens, geese and ducks for bird flu. Each team handled about 600 birds a day. The goal of the nationwide effort was to innoculate all of China’s 14.2 billion domesticated birds. Nearly a million officials and soldiers were mobilized in Liaoning Province alone. The government is worried about migratory workers from the countryside bringing the disease to the cities.

Typically the team had little training. Often one person held the bird, while another swabbed it and a third person injected the needle. Many workers failed to take even the most basic hygienic measures such as wearing rubber gloves and masks. Sometimes used needles were simply discarded on the ground. There were worries the teams might catch and spread the disease.

Production of bird flu vaccines were stepped up. Nine plants worked around the clock producing 100 million doses a day. The inoculation effort proceeded relatively smoothly and rapidly in poultry farming areas but was slower going in hard-to-reach areas. Many places complained about receiving supplies late or receiving far less vaccinations than they needed.

The pharmaceutical giant Roche and the state-owned Shanghai Pharmaceutical company reached an agreement to make the bird flu drug Tamiflu in China. The Chinese government was criticized all the misuse of amantadine an effective bird flu drug intended for humans. Farmers used the drug on poultry which can make the virus resistant to the drug in birds and then make it useless in human cases.

The WHO complained that China refused hand over samples of the disease collected during the outbreaks in 2005 and 2006. Some speculated that China failed to do this so it could make a vaccine and reap huge profits before foreign competitors could make one. Researchers from Hong Kong complained that Chinese authorities interfered with their studies of the disease.

In 2006, 100 hundred monitoring stations and 1,000 workers were spread along bird migration routes in Jiangsu Province eastern China to monitor if the disease was being spread by migrating birds. An estimated 3 million birds pass through the area being monitored.

The raising of chickens in urban areas was banned in Shandong Province, where a 27-year-old woman died of bird flu in the city of Jinan

Image Sources: Landsberger Posters, Environmental News

Text Sources: New York Times, Washington Post, Los Angeles Times, Times of London, National Geographic, The New Yorker, Time, Newsweek, Reuters, AP, Lonely Planet Guides, Compton’s Encyclopedia and various books and other publications.

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© 2008 Jeffrey Hays

Last updated April 2010

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