HISTORY OF BIRD FLU: ITS START IN HONG KONG, OUTBREAK IN 2004-2005 AND SPREAD

HISTORY AND ORIGIN OF BIRD FLU

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 H5N1 virus first appeared in China in 1996. Researchers in Hong Kong have reported that the H5N1 flu virus has been circulating in mainland China since then and Chinese farms suffered major outbreaks in 1997, 2001 and 2003. Scientists have traced the virus that has devastated farms across Southeast Asia in 2005 to a strain isolated from a goose in China's Guangdong province in 1996.

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 virus was Guangdong Province in southern China, where millions of people and chickens live in close proximity. The New York Times reported, Guangdong is also believed to be the likely birthplace of previous flu strains — even if they later picked up names like “Hong Kong flu” — and to be where the SARS virus jumped from horseshoe bats to masked palm civets to humans.

The bird flu of 2003-2004 is believed to have originated in Fujian province in southern China. The alarming thing about it is that it is that it spread so widely in Asia, reaching Southeast Asia and Japan, and crossing the Pacific Ocean to Canada. It is not known how it could spread so widely. An investigation found that the bird flu had been around at least since April 2003, which meant that it didn’t spread very fast.

In 2006, a new strain was identified. It was called “Fujian-like virus” because it was first isolated in China’s Fujian Province. By June 2006 it was found in poultry in six provinces in China and might have become resistant to vaccines used in China since September 2005. It had also been found in Laos, Malaysia and Thailand linked was linked to human bird flu in Thailand.

First Cases of Bird Flu in Hong Kong

An outbreak of "bird flu" between May 1997 and January 1998 in Hong Kong infected 18 people and killed six. The disease was caused by a mutation of the H5N1 virus, a strain common in chickens and ducks, that inflected people for the first time. The first victim was a 3-year-old boy that handled an infected chicken at a petting farm. He was brought the hospital with a cough and fever. His symptoms quickly worsened. He was given massive doses of antibiotics. When he developed trouble breathing he was placed on a ventilator. He died of kidney failure after his left lung collapsed and liver stopped working. H5N1 was found in his windpipe.

Karen Kaplan wrote in the Los Angeles Times, “In May 1997, there was panic in Hong Kong over an outbreak of German measles that sickened more than 1,500 people, mostly teenagers.Amid the commotion, a 3-year-old boy with fever, aches and a sore throat was admitted to a Kowloon hospital. He had typical flu symptoms, nothing unusual in a young child.Yet as the days progressed, the boy's illness continued to worsen. His symptoms indicated viral pneumonia and Reye's syndrome, a rare disorder that causes brain inflammation.He died six days after being admitted to the hospital. Dr. Wilina Lim, a virologist with Hong Kong's Department of Health, tested a fluid sample from the boy's windpipe. It was a puzzle. She confirmed it was an influenza virus but couldn't identify it. [Source: Karen Kaplan, Los Angeles Times, January 10, 2006]

Michael Specter wrote in The New Yorker: On May 21, 1997, a three-year-old boy died in Hong Kong from a viral infection that turned out to be influenza. The death was not unusual: flu viruses kill hundreds of thousands of people every year. Hong Kong is among the world's most densely populated cities, and pandemics have a long history of first appearing there or in nearby regions of southern China, and then spreading rapidly around the globe. This strain, however, was unusual, and it took an international team of virologists three months to identify it as H5N1--"bird flu," as it has come to be called. Avian influenza had been responsible for the deaths of hundreds of millions of chickens, but there had never been a report of an infected person, even among poultry workers. [Source: Michael Specter, The New Yorker, March 12, 2012]

Kennedy Shortridge, a University of Hong Kong microbiologist, had identified a nearly identical virus to the one that killed the three-year-old boy a few months earlier as the cause of 4,500 chickens' deaths on farms in Hong Kong's Yuen Long district. Kaplan wrote: “To the virologists on the case, the notion that bird flu could kill humans was preposterous. At first, they suspected the samples had been contaminated by virus particles from Shortridge's lab. Only after ruling out that possibility did they realize the significance of the discovery. By the end of the year, eighteen people in Hong Kong had become sick, and six had died. That's a remarkably high mortality rate: if seasonal flu were as virulent, it would kill twenty million Americans a year.

The Hong Kong outbreak of bird flu was the first time in history an avian flu was documented making the jump to humans. One fortunate thing about the disease was that it couldn’t spread from person to person. All 18 people who got the disease got it directly from chickens and all but one visited live poultry markets. People were thought to have contracted bird flu in 1997 by breathing infectious dust stirred up when chickens, whose feathers were contaminated with virus-carrying feces, were taken flapping from their cages.

Combating First Cases of Bird Flu in Hong Kong and the Return of the Disease in 2001 and 2003

It was first thought the “bird flu” case that killed the three-year-old boy was a fluke. After three more people form the same disease died in December 1997 the Hong Kong government and disease experts decided that drastic measures were needed to prevent the disease from spreading and a major calamity from occurring. The flu season was just starting and officials were concerned bird flu strains mixing with seasonal human strains, producing deadly mutations.

Worried about the possibility of a worldwide pandemic, Hong Kong’s health director — now head of the World Health Organization (WHO) — Margaret Chan ordered every chicken in Hong Kong killed during the last week of December. Over 1.6 million chickens, geese, partridges, and quails were slaughtered. Secretaries, dog catchers and park rangers were recruited for the effort. Some of the birds had their throats slit. Others were stuffed into garbage bags and gassed with carbon dioxide. This operation took 1,300 government workers and farmers three days to complete. Some 1,300 tons of bird remains were disposed of in makeshift gas chambers. Killing the chickens ended the outbreak because the disease was not spread person to person.

After 1997 bird flu outbreak, the handing procedures of poultry was changed. Waterfowl, which can carry H5N1, were kept separated from chickens. Quails, also H5N1 carriers, were banned. Markets were required to undergo intensive cleaning twice a month. A H5N1 vaccine was developed and chickens were required to get shots.

The tactics appeared to have worked. "We felt we had dodged a bullet," Keiji Fukuda, the World Health Organization's assistant director-general for health, security, and environment, told The New Yorker. During the Hong Kong bird flu outbreak in 1997 he was the chief influenza epidemiologist at the Centers for Disease Control and Prevention, in Atlanta, He told Specter he spent a few tense weeks in Hong Kong, searching for clues to how the virus was transmitted from chickens to humans and whether it would set off a global pandemic. "It was a very scary time," he said, "and we were bracing ourselves for the worst. But by the end of the month nobody else got sick, so we crossed our fingers and went back to Atlanta." [Source: Michael Specter, The New Yorker, March 12, 2012]

A kind of bird flu returned to Hong Kong in May 2001. No people were killed. It was caused by a slightly different strain of H5N1. More than 1.2 million chickens were ordered slaughtered after 1,000 chickens with the disease were found at seven markets. H5N1 bird flu returned to Hong Kong in January 2003, killing a man and his daughter and sickening his son and wife. The family became ill after a trip to Fujian Province in southern China. The strain was similar but not identical to the one that struck in 1997. An investigation by a government commissions found that disease was likely to keep on recurring as long as live poultry was sold in markets. At that time the Hong Kong government spent $5 million annually to monitor farms and markets for outbreaks. It has also dished out $15 million in compensation payments for the culling that took place in previous outbreaks.

Bird Flu in 2003 and 2004

The outbreak of bird flu in 2003 and 2004 began in South Korea when poultry infected with a form of highly contagious bird flu was reported at a chicken farm near Seoul in mid December 2003. A mass cull was ordered as the disease spread throughout the country. In early January 2004, Vietnam says bird flu has shown up in poultry farms. By the end of January 2004, cases had been reported among poultry in Japan, Thailand, Cambodia and Laos. Cases showed up in China and Indonesia in February. Bird flu was thought to have stopped in March 2004. At that time eight people died and four more were infected in Thailand and 16 died and seven more were infected in Vietnam.

Bird flu returned in May 2004. The strain was the same — H5N1. It first appeared mainly in Vietnam and Thailand. There were a few cases in China, in Chaohu in Anhui Province, and Malaysia. An isolated outbreak was reported on the northern Thai province of Chiang Mai in May. In early July a large outbreak was reported in Ayutthaya. Afterwards more cases were reported in the northen provinces of Uttaradit and Sukothai. By September bird flu had been reported in 15 provinces in Thailand and 11 in Vietnam and 10 people had died.

Bird flu returned yet again in 2005. As of mid 2005 about 80 percent of all human bird flu cased occurred on small-scale farms in China and Southeast Asia.

Outbreaks of Bird Flu Among Birds in 2004 in China

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.

Bird Flu in Thailand

During the outbreaks if bird flu in 2004 and 2005 there were 12 deaths and 17 cases in Thailand, compared to 41 deaths and 91 in Vietnam, 4 deaths and 4 cases in Cambodia and 3 deaths and 5 cases in Indonesia.

The outbreak of bird flu started in Thailand in November 2003 but wasn’t announced to the public until two months later. It hit 40 of Thailand’s 76 provinces and was particularly severe in the heart of Thailand’s chicken farming industry in Suphan Buri Province. Agricultural officials initially insisted the disease was fowl cholera, which does not pose a threat to humans, and there was no need to worry.

Millions of birds were culled. Teaas employed by the Thai Agriculture Ministry fanned out across the country. concentrating on Suphan Buri Province, about 60 miles northwest of Bangkok, killing the birds by placing them in plastic feed bags until they suffocated and then burying them in pits coated with lime. Great care was taken among the workers who culled the chickens to make sure they didn’t get the disease. They were vaccinated, given preventive medicine and dressed in special clothes.

The Thai government bought 5 million duck eggs for $600,00 and destroyed them as part of the offensive to get rid of bird flu. The idea was to cull the birds before they were born. Doctors went to search for victims rather than wait for them to show up at the hospital. New victims displayed dengue fever-like symptoms. Before the symptoms were rained most to respiratory system.

Government officials were accused of lying and covering up, which caused credibility problems and hurt the fresh, frozen and semi-cooked food industry. When the first human case of the disease was reported, Prime Minister Thaksin responded by denying it.

Lucrative exports dried up. More than 37 million birds were culled. Farmers were angry with the government for not acting quickly enough nipping the disease at the bud when it started. In some cases the agriculture officials continued to insist the disease was fowl cholera even when birds were dying at rate of several a day at individual farms and reports were coming out in other countries of bird flu.

Some farmers gave up poultry farming after the outbreak. The cockfighting industry was hard hit. The sport was banned because the birds were often transported long distance for fights and health officials worried that they could spread the disease to areas that had not been affected.

Bird Flu in Thailand in 2004

In October 2004, Reuters reported: “Asia’s bird flu epidemic, which experts fear could spawn a human pandemic, has claimed its 31st victim, a nine-year-old Thai girl who had contact with infected chickens at home. She died on Sunday night, soon after being confirmed as having the H5N1 bird flu virus nearly a month after falling ill, Health Ministry spokeswoman Nitaya Chanruang Mahabhol told AMN. "The girl was in poor condition before being sent to the hospital,” Nitaya said on Monday of the 11th Thai to die of bird flu since the virus swept through much of Asia early this year. It has also killed 20 Vietnamese. [Source: Reuters, October 4, 2004]

“The government, spurred into a frenzy of action by Thailand’s first probable human-to-human transmission of the virus last week, is determined no one else will linger untested and untreated for so long. Volunteers would inspect every village in the country and put anyone showing flu-like symptoms on the government’s bird flu watch list, Health Minister Sudarat Keyuraphan told reporters. So far, 85 patients in 22 of Thailand’s 76 provinces are waiting for H5N1 test results after being sent to hospital with flu-like symptoms, a ministry statement said.

“Prime Minister Thaksin Shinawatra gave his government until the end of October to eliminate the virus, promising heads would roll if the drive failed. Experts say that task is nearly impossible given the resilience of a virus that has survived the slaughter of tens of millions of poultry. What they fear most is that the H5N1 virus could infect an animal also able to host a human flu virus - most likely a pig - and then mutate and start a pandemic in a human population with no resistance to the mutated virus.

“Last week, it killed a Thai woman whose daughter died in her arms, coughing blood.Dutch researchers reported last month that domestic cats can get the avian influenza virus, which means pets are at risk of catching and spreading the disease. However, a report that a Thai dog had also caught it proved to be an error probably caused by a mislabeled sample, the Health Ministry said.

“For a few months it looked as if the virus was being defeated, but it sprang up again in Thailand and Vietnam in July, China has had one new case, Indonesia several and Malaysia confirmed its presence for the first time. Migratory wildfowl, which can carry bird flu viruses without falling ill, are thought to have brought the H5N1 variety to Asia during the last northern winter. Thaksin’s end of October target for eliminating it marks the start of this year’s migrations. However, the first main target in Thailand’s intensified campaign to eliminate the virus is the large flocks of ducks moved from place to place and which, like their wild brethren, can spread it without falling ill.

“We will start buying all nomadic ducks right away and we will kill infected ones,” Deputy Prime Minister Chaturon Chaisang told reporters, saying he would seek a $120 million budget for such additional preventive measures. “We are doing this because we have detected H5N1 in many nomadic ducks,” he said.The government was also trying to figure out ways to stop village people raising free-range chickens that wander and defecate at will, spreading the virus if they have it, said Chaturon, who is in charge of eliminating bird flu. “We might need to come up with some sort of incentives or subsidies,” he said.

Bird Flu Cases in Thailand

In late October 2004, a 9-year-old girl died n the disease at her house in the northern province of Phetchabun. She was victim No. 31 worldwide, and the 11th victim in Thailand.

In late October 2004, a 14-year-old girl died n the disease in northern Sukhothai Province in Thailand. She was victim No. 32 for the year in Southeast Asia, and the 12th victim in Thailand. The other 20 died in Vietnam. The disease was also found in Indonesia and Pakistan and in two hawks found in the bags of a Thai man at Brussels Airport.

In July 2006, the H5N1 virus was fund in the Thai northeast near the Laos border, prompting the culling of 310,000 hens and a 17-year-old died from bird flu in a northern province, where birds were slaughtered and movements restricted. . It was the first outbreak in eight months.

An outbreak of bird flu was reported in northeastern Thailand in January 2007. The diseases was found in Sukhothai Province in November 2008.

Backyard Chickens and Live Markets

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.

Bird Flu and Cockfighting

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]

“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.

“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.”

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.

“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."

Bird Flu in Vietnam

Vietnam has been hit hard by bird flu. Only Indonesia has been hit harder.In the outbreaks in 2004 and 2005 Vietnam racked up the worst numbers: 41 deaths and 91 cases as of the end of 2005, compared to 12 deaths and 17 cases in Thailand, 4 deaths and 4 cases in Cambodia and 3 deaths and 5 cases in Indonesia. In China there was a bird death flu death in 2003 and four in late 2005. The only bit of good news to come out of Vietnam was that mortality rate of bird flu declined as the disease spread.

Bird flu killed 16 people in Vietnam during the outbreak of the disease in 2004, more than in any other country. Most of the victims were children under the age of 12. One of the victims was a 27-year-old farmer who fed himself and his family three chickens that had died of the disease. Most of the other cases were linked to direct contact with infected birds. The 9th victim in Vietnam was an 18-year-old boy who raised fighting cocks who reportedly had the habit of sucking blood and other fluids from the mouths of injured birds.

Alan Sipress wrote in the Washington Post: “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. [Source: Alan Sipress, Washington Post, April 14, 2005]

Most of the early cases were in northern Vietnam. Scientists suspected the disease may have been introduced by birds smuggled in from China. More than 38 million chickens and other fowl were culled — 15 percent of the total poultry industry. Many of the workers who took care of the culling did so without the most basic protective gear such as gloves and rubber boots. Fortunately none of them came down with the disease.

For a while there were concerns that disease being transmitting between people. The 10th case was a 26-year-old woman who may contracted the disease from her 11-year-old daughter. The daughter had died in her arms coughing up blood. The girl’s aunt also caught the disease, possibly from human to human contact, and recovered. Tests by the WHO indicated that this was not the case: that all the victims contacted the disease from diseased birds. Some pigs had bird flu, which raised the possibility that humans may have picked up the disease from an animal other than a bird.

Vietnam reported that it was free of bird flu in March 2004. The disease returned in the summer of 2004 when a case was reported in the Mekong Delta area in June 2004. This time around many cases were in southern Vietnam. As of August the disease had been reported in 10 provinces. In August 2, a woman died in in the southern province of Hau Giang and two more — an 11-month-old girl and 4-year-old boy — died in northern Ha Tay province. The 11-month-old girl appeared to have contacted the disease from Muscovy dusks. Thousands of chickens, ducks and other birds were culled in the areas where the disease resurfaced.

Later Vietnam admitted that if had a few small scale outbreaks of bird flu in the months between the two major outbreaks but failed to report them. In April there was a small outbreak in southern province of Ding Thap. In May cases were reported in southern Vinh Long and central Qang Ngaim provinces. In June thousands of infected birds were found in the three Mekong Delta provinces of Bae Lieu. Tien Giang and Can Tho. After the cases were reported the government issued an emergency directive to take preventive measures and increase vigilance to avert a major outbreak. Bird flu wiped out 1.1 million poultry in Ben Tre province.

Bird Flu Carried Into Vietnam from China Via Smuggled Chickens

Reporting from Dong Dang, Vietnam, Alan Sipress wrote in Washington Post, “The smugglers first appeared on the distant ridgeline and then, like ants, streamed down a dirt track carved from the lush, sculpted mountains that separate Vietnam from China. As the figures grew closer, their stooped posture became visible, backs heaving under bamboo cages crammed with live chickens. On the road below, two young men identified by local officials as lookouts buzzed past on red dirt bikes... One man produced a two-way radio and started speaking urgently. Though his words were inaudible to the visitors, within moments the figures on the hillside melted into the brush. [Source: Alan Sipress, Washington Post, July 30, 2006]

“These traffickers haul more than 1,000 contraband chickens a day into Lang Son, one of six Vietnamese provinces along the Chinese border, flouting a chicken import ban. In doing so, heath experts say, they have also repeatedly smuggled the highly lethal bird flu virus from its source in southern China into Vietnam. Vietnamese veterinary officials disclosed in April 2006 that they had found bird flu in a sample taken from smuggled chickens confiscated in Lang Son during a bust on the border. Days later, officials in the remote, neighboring province of Cao Bang reported the virus in poultry samples taken from three farms on the Chinese border after dozens of chickens had started dying and smuggling was suspected. These two episodes were the first official cases of bird flu in Vietnam since December.

“In May 2005, researchers had already found evidence that smuggling was bringing in the bug: They isolated a strain of the H5N1 virus that was new to Vietnam but similar to one common in Guangxi, just over the mountains from Lang Son. Lang Son's jagged border with China runs for about 150 miles through angular, misty mountains with craggy cliffs that seem drawn from a stylized painting. The highest peak, which lends its name, Mau Son, to the local rice wine, rises nearly 4,500 feet. For centuries, the extended families straddling this border have navigated treacherous footpaths to run goods from one side to the other, in recent years including electronics, DVDs, exotic wildlife and all nature of clothes and shoes. The bootleg poultry business turned lucrative two years ago after Vietnam started slaughtering about 50 million chickens to contain its bird flu epidemic. The resulting shortage of chicken meat, a prime source of protein for the Vietnamese, sent prices soaring on their side of the border.

“Do Van Duoc, director of animal health in Lang Son, explained that the huge difference in prices on opposite sides of the border makes for a flourishing business despite the ban on poultry imports from China. Prices fluctuate, but on average, chicken that sells for 30 cents per pound or less in China can fetch a dollar or more in Vietnam. this year, officials said.The syndicates running the smuggling rings pay local villagers about 30 cents a bird to haul the contraband along mountain trails that in some cases snake for more than 10 miles, said Nguyen Thang Loi, director of market inspections in Lang Son. Some smugglers, especially women and children, can carry only a few birds, but fit men haul as many as 20 at a time. Over the course of a week, the earnings can far outstrip the salaries of animal health officers, inspectors and others charged with stemming the trade.

Bird Flu in Indonesia

Indonesia has been hardest by bird flu. The virus was first detected in poultry in 2003. The first human infection was found in July 2005, when three people in the same family — a man and his tow daughters — died on the outskirts of Jakarta. In February 2008 it recorded its ninety-ninth and hundredth bird flu — a nine-year-old boy and 20-year-old woman from near Jakarta. At that time Indonesia accounted for half of all deaths attributed to the disease worldwide. As of August 2012, The World Health Organization says Indonesia remains the hardest-hit country, accounting for 159 deaths of 359 victims worldwide.

Donald G. McNeil Jr. wrote in the New York Times, “The disease took Indonesia, the world's fourth-most populous country, by surprise, he said. It had no response plan or clear chain of command for veterinarians, and it has endemic Newcastle disease, which mimics flu in chickens. Large producers protected their own flocks quickly, he said, but the flu became entrenched in "kampong chickens," the millions of free-roaming household birds that roost in trees. Peter Roeder, a FAO veterinarian, told the New York Times,"The virus got away before the first cases were detected.”[Source: Donald G. McNeil Jr., New York Times, January 29, 2007]

In February 2006, the Jakarta Post reported: “ A total of 304 human bird flu cases have been reported since last July, when the first human case was reported. Twenty-six of these 304 people have tested positive for bird flu, with 18 fatalities. The deadly H5N1 strain of the bird flu virus has continued its insidious spread through the country, while the government seems to have adopted an attitude of "everything will be all right". When the first human bird flu case emerged last July, it took at least three months before another case was detected. Today we are seeing new cases almost every three days. [Source: Jakarta Post, February 21, 2006]

“Indonesia now has the highest human mortality rate from bird flu (69.56 percent), compared to Thailand and China (63.63 percent), Vietnam (45.16 percent) and Turkey (33.33 percent). A meeting between President Susilo Bambang Yudhoyono and the governors of the six provinces with the highest numbers of bird flu cases provides fresh hope the government is ready to get serious about dealing with the virus. There is reason to be optimistic the government is finally determined to take firm measures, including mass culls of poultry within a radius of up to 10 kilometers of an outbreak, which it has avoided in the past.

Spread of Bird Flu

Initially cases of the H5N1 viruses were confined to Southeast Asia, but after it is detected in wild birds (bar-headed geese) in Qinghai Lake, China’s largest lake and major stopover for migratory birds, in February 2005 the virus rapidly spreads westward. Qinghai is a saltwater lake that sits at the crossroads of avian flyways to both Europe and Asia. The virus found there was slightly different than the one that was killing people in Vietnam at the time. In any case, By July and August 2005 it was in poultry in Russia and Kazakhstan and wild birds in Mongolia. In October it reached poultry in Turkey and Romania and wild birds in Croatia. In early 2006 there were human deaths in Turkey and Iraq and reports of the disease in Cyprus, Nigeria. Kuwait and Azerbaijan. In 2006, 65 outbreaks of H5N1 are reported worldwide killing a total of 115 people - the highest number to die from the disease in a single year.

In May 2005, Donald G. McNeil Jr. wrote in the New York Times, the bird flu virus in China “escaped in migratory birds going north and traveled across Russia, Europe and Africa. It became known as the Qinghai strain after the lake in Northern China where thousands of ducks and geese were found dead. (The older strain in Southern China and Southeast Asia is sometimes called the Fujian strain.) [Source: Donald G. McNeil Jr., New York Times, March 27, 2007]

“The Qinghai strain has a mutation known as PB2 E627K. (The abbreviation can be read this way: at position No. 627 on polymerase basic protein 2, the amino acid called glutamic acid, abbreviated by scientists as E, has been replaced by lysine, known as K.) The change helps the virus grow at the temperatures found in human noses, which are cooler than the insides of birds’ intestines. It is “characteristic of a gene that’s been in mammals,” said Dr. Robert G. Webster, a virologist at St. Jude Children’s Research Hospital in Memphis. “It says to me that it was in a mammalian species in China, and got back into ducks. But what species? We don’t know.”

“By March 2007 the Qinghai strain had reached about 50 countries. “To give a sense of how important such a tiny change can be: switching just one of the 1,255 amino acids in the SARS virus protein that attached to cells in the masked palm civet, a relative of the mongoose that is sold in wild-meat markets in Asia, allowed it to attach to human cells. After that discovery, the Chinese government ordered that all the 10,000 civets in captivity in Guangdong be killed, thus probably wiping out the disease everywhere except in bats. In avian flu, two mutations known to help viruses spread more easily — because they attach to the receptors in human noses and throats instead of those deep in the lungs — were found in outbreaks in Azerbaijan and Iraq in 2006. But those outbreaks were snuffed out.

H5N1 spread the quickest in the cooler winter months when birds are most likely come down with influenza. Scientists are not sure why this happens but suspect the reasons may be similar to why human influenzas appear and spread every year when temperatures drop. There were worries about large outbreaks during the time of the Chinese Lunar New Year and tet in Vietnam in February when large numbers of people travel and are packed close together on trains and buses and in stations and large amounts of poultry are sold live in markets, slaughtered, handled and eaten. In 2004 and 2005 bird flu first emerged in January and spread rapidly in February

Human-to-Human Transmissions 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.

Reporting from Jandi Meriah, Indonesia, Alan Sipress wrote in the Washington Post, Dowes Ginting, a wiry 32-year-old, had watched disease burn through his family over the previous two weeks, killing six and sickening two others, including himself. International health experts grew increasingly concerned when laboratory tests confirmed they were sickened by bird flu, the largest cluster of the disease ever recorded. [Source: Alan Sipress, Washington Post, August 30, 2006]

“Health investigators have concluded that the eight-person cluster in Sumatra began with Ginting's older sister, who fell ill in late April. They suspect she was infected with bird flu from live chickens sold in a market where she peddled oranges, limes and chili peppers, or from contaminated poultry droppings in manure used in her garden. She died and was buried before any samples were taken to confirm bird flu.

Resurgence of Bird Flu Since 2008

Outbreaks have risen progressively since 2008. In January 2008, a A major outbreak of the H5N1 virus occurred in West Bengal, India. It lead to the culling of 2.6 million birds. Twenty countries had outbreaks of the disease in the first nine months of 2008, with worrisome outbreaks in Thailand and Bangladesh.

In June 2008, Hong Kong ordered the slaughter of all chickens in the city's markets after the H5N1 virus was detected in birds for sale. In February 2009, at least 21 dead birds, including ducks and chickens, wash up on beaches in Hong Kong. At least three of them test positive for the H5N1 avian flu virus. An outbreak of bird flu in December 2008 was blamed on smuggled fertilized eggs from China containing infected chicken embryos.

Almost 800 cases of bird flu reported in 2010-2011, The FAO said in August 2011 that bird migrations over the past two years have brought H5N1 to countries that had been virus-free for several years, including Israel, the Palestinian territories, Bulgaria, Romania, Nepal and Mongolia. "Wild birds may introduce the virus, but people's actions in poultry production and marketing spread it," said FAO's chief veterinary office Juan Lubroth in urging greater preparedness and surveillance.

Bird Flu in 2011 and 2012

In February 2012, AP reported: Recent human deaths in Asia and Egypt are a reminder that the H5N1 virus is still alive and dangerous, and Vietnam is grappling with a new strain that has outsmarted vaccines used to protect poultry flocks. Ten people have died in Cambodia, Indonesia, Egypt, China and Vietnam since December during the prime-time flu season when the virus typically flares in poultry. "We are worried, and we will be very cautious," said To Long Thanh, director of Vietnam's Center for Animal Health Diagnostics in Vietnam. [Source: AP, February 17, 2012]

Vietnam has long struggled to control the virus, but it has made progress - going 21 months before reporting its two most recent deaths in the past month. It has also experienced a burst of poultry outbreaks in 11 provinces nationwide over the same period.

In August 2012, AP reported that bird flu had killed a man in central Indonesia, marking the country's ninth fatality attributed to the H5N1 virus in 2012. The victim, 37, died July 30 in Yogyakarta province after spending five days in hospital, the Indonesian Health Ministry reported on its website on Monday. It confirmed the man, who lived near a chicken slaughterhouse, had been infected with the virus, also known as bird flu, after apparently coming into contact with sick birds. [Source: Associated Press, August 13, 2012]

See China

Bird Flu More Common and Less Deadly than Thought

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.

“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.

Last updated November 2012