New flu pandemic could kill up to 150 million people

30/09/2005

A top UN public health expert warned yesterday that a new flu pandemic is expected at any time and could kill anywhere between five million and 150 million people – depending on action taken now to control the bird flu epidemic sweeping through Asia.

Dr David Nabarro of the World Health Organisation called on governments to take immediate steps to address the threat at a news conference following his appointment as the new UN co-ordinator for avian and human influenza.

“We expect the next influenza pandemic to come at any time now, and it’s likely to be caused by a mutant of the virus that is currently causing bird flu in Asia,” he said.

The H5N1 strain of bird flu has swept through poultry populations in Asia since 2003, infecting humans and killing at least 65 people, mostly poultry workers, and resulting in the deaths of tens of millions of birds. The virus does not pass from person to person easily but experts believe this could change if the virus mutates.

Nabarro said with the almost certainty of another flu pandemic soon, and experts saying there is a high likelihood of the H5N1 virus mutating, it would be “extremely wrong” to ignore the serious possibility of a global outbreak.

“The avian flu epidemic has to be controlled if we are to prevent a human influenza pandemic,” Nabarro said.

The 1918 flu pandemic killed more than 40 million people, and there were subsequent pandemics in 1957 and 1968 which had lower death rates but caused great disruption, he said. [...]

(Comment from Signs of the Times)


Comment: Things (not the public though) are looking up, eh? See our Signs Flu Supplement for the real origins of the 1918 epidemic and evidence that the current bird flu threat is anything but "natural".

LINK

Scientists in Desperate Race With Bird Flu

Wednesday, September 28, 2005
By Daniel J. DeNoon

Bird flu has scientists on the edge of their seats about when and if it will become a human pandemic, a sobering report shows. That’s the bad news.

The good news: Bird flu still doesn't spread easily among humans. Infected poultry was the source of virtually all of the 115 confirmed human infections with what scientists call H5N1 avian influenza. So far, only very few people seem to have caught it from other people, and then only after extremely close and sustained contact.

The bad news: More than half of the people who got bird flu have died. The true death rate for human cases of bird flu is not known. Mild cases don't show up in hospitals and don't get counted. But a new report on human bird flu infection shows that this is a very bad bug indeed.

The report comes from a May 2005 meeting of doctors and researchers held in Hanoi, Vietnam, by the World Health Organization. Among them is Frederick G. Hayden, MD, professor of clinical virology and internal medicine at the University of Virginia, Charlottesville.

"The news is concerning," Hayden tells WebMD. "Most cases are in apparently healthy adults and children. About half of them die from what appears to be a viral pneumonia, sometimes with secondary bacterial infections. Some suggest this virus behaves differently from human flu."

Hayden and colleagues' report appears in the Sept. 29 issue of The New England Journal of Medicine.

Bird Flu: Early Symptoms, Frequent Death

Even though people obviously do get bird flu from poultry, it's not something that happens often. Millions of domestic chickens and ducks have been infected. Yet relatively few people show evidence of infection, notes flu expert John Treanor, MD, professor of medicine and director of the vaccine and treatment evaluation unit at the University of Rochester in New York.

"When you think of the totality of human experience with infected poultry, fewer than 150 cases is only a small number," Treanor tells WebMD. "The opportunities for whatever needs to happen for this to spread among humans have been, thankfully, quite limited."

The earliest symptom of bird flu is a lot like that of human flu: a sudden high fever. After that, the symptoms tend to be different. Bird flu patients only sometimes have a runny nose. They tend to have lower respiratory symptoms, especially cough and shortness of breath. Other early symptoms may include diarrhea, vomiting, abdominal pain, lung pain, and bleeding from the nose and gums.

There may also be symptoms highly unusual for flu. Two patients had brain infections and diarrhea but not respiratory symptoms.

Typically, about five days after illness onset, patients have shortness of breath. Severe breathing problems are common; there may be bloody sputum. Patients often progress to acute respiratory distress in about six days, which requires oxygen therapy and may require assisted breathing with a machine. Multiple organ failure is common. Death usually comes from respiratory failure.

The disease has been particularly deadly for children. In Thailand, 89% of patients under the age of 15 years died an average of nine or 10 days after illness onset.

Early Treatment May Help

Two flu drugs are active against bird flu: Tamiflu and Relenza. Tamiflu is taken orally, while Relenza must be inhaled. Because bird flu can infect organs other than the lungs, Tamiflu is considered the treatment of choice.

However, treatment must begin very soon after symptoms appear. Hayden and colleagues say that for severe cases of H5N1 bird flu, it's reasonable to use high doses of Tamiflu -- double the usually recommended dose.

A Bird Flu Pandemic

What experts worry about is that bird flu could learn to spread more easily among humans. This could happen in two ways. The bird virus could simply adapt to humans over time. Or a person could get infected with bird flu and human flu at the same time. Two viruses infecting the same person could swap gene segments. This "reassortant" virus might end up with the gene that lets it spread among humans.

It seems very easy for this to happen. Is it possible that for some reason bird flu just can't evolve into a human flu?

"I am not reassured that because it hasn't happened yet it will not occur," Hayden says. "I think we are watching an evolving event. There is real concern that either through transport of poultry or migratory birds, the virus will spread further. And that will increase the possibility it will reassort with a human virus or adapt to humans. Then one would be into a pandemic event."

Pandemic flu -- a flu bug that sweeps the globe -- happens every 10 to 40 years, says Stephen Morse, PhD, founding director of the Center for Public Health Preparedness at Columbia University's Mailman School of Public Health.

"All of us virologists and infectious disease epidemiologists who worry about flu for a living, we all feel a pandemic is virtually inevitable -- as inevitable as any unpredictable event can be," Morse tells WebMD. "We don't know if it will be a 1918-like epidemic, which is what we all fear -- the worst natural disaster we know of in history -- or whether it will be more of a standard pandemic like 1957 or 1968, where we have 4 million deaths rather than 100 million."

But if the next pandemic is bird flu, there really is no precedent. The terrible 1918 flu had a mortality [death] rate of only 2%, Morse says.

"The extra charge on that bomb is that H5N1 bird flu has a high mortality rate," he says. "That is one of the things that is very worrisome about this virus: A pandemic would mean a lot of people who are very sick. An H5 pandemic would be something very serious to contemplate."

Race Against Time

Nobody knows whether bird flu really will cause a pandemic. But researchers, governments, and drug companies are taking it very, very seriously.

There's already a prototype vaccine. This vaccine may not match the pandemic virus that eventually breaks out. But making it, testing it, and licensing it will greatly speed a better vaccine should the need arise, Treanor says.

The current vaccine requires two high-dose shots, many weeks apart. Treanor and others already are working on higher-potency vaccines. And the U.S. National Institute of Allergy and Infectious Diseases today announced that it is working with a drug company to use new technology to rapidly produce live vaccines using weakened, genetically engineered flu viruses. Such vaccines could protect against any possible flu virus.

Meanwhile, governments are racing to stockpile Tamiflu and Relenza. Right now, there is not nearly enough. But drug manufacturers are stepping up production. If the bird flu waits a few more years, the world will be in a lot better position to fight back.

"I do believe that this is now getting attention at the highest levels -- and we need that," Morse says. "Our capacity to make vaccines now is woefully inadequate. The nimbleness with which we can make new vaccine is questionable. We need the capacity to make vaccines rapidly. We need a stockpile of antiviral agents. If pandemic flu happened in the next year, we would have to do a lot of scrambling. If it happened in 10 years, the question is how much we are able to sustain the concern we have now."


By Daniel J. DeNoon, reviewed by Brunilda Nazario, MD

Bird flu: an emergency across Asia

24 September, 2005
ASIA

Jakarta (Asia News/Agencies) – Many countries across the Asian continent are seeking to counter a new wave of the H5N1 epidemic, that is, bird flu, which has struck down 113 people in Asia itself since July. From 2004, when the virus was isolated, H5N1 has claimed 59 victims. Vietnam, with 43 victims, takes first place as the country with the highest toll. The virus strikes birds which can transmit it to man. Scientists of the World Health Organisation (WHO) fear the virus could mutate and be transmitted from person to person, causing a pandemic which may claim millions of victims.

The international community should undertake to ensure that it is not caught ill-prepared to cope with such an emergency. Although vaccination of poultry is spreading and tens of millions of birds have been killed, it has been discovered that the virus is transmitted through migratory birds too. The virus is now found in Asia, but according to the WHO, it will reach Europe with the imminent bird migration. The unknown factor, say experts, is not “if it will arrive” but “when it will arrive”.

In Indonesia, there are four certified victims of the virus. Autopsy results are expected for another two suspect cases. Meanwhile 22 people are being kept under observation across the country, 17 of them in Jakarta. FAO officials say the Indonesian government “should immediately carry out control measures such as culling and targeted vaccination in high-risk areas”. A United Nations spokesman said Indonesian should immediately slaughter poultry in areas affected by bird flu and delegate more funds to stop the virus developing into a pandemic. The government in Jakarta has in recent days stepped up efforts to curtail the spread of the virus: infected animals will be culled and people showing symptoms of the disease will be hurried to hospital. The government is availing itself of help offered by a team of scientists from the United States and Japan, as well as aid from the international community, like 10,000 vaccines which Australia will send to Jakarta.

Some people contracted the virus while visiting the Ragunan zoo in Jakarta. The zoo was later shut down, after some eagles and other birds were found to have been infected. The epidemic has repercussions on the poultry market. Sales have dropped and many shops risk closure.

Vietnam has been the hardest hit by the virus. More than 90 people have been infected and 43 have died. The impact on the market does not seem to be that bad. “We are still doing good business,” said Nguyen Mai Anh, owner of a chicken noodle shop in Hanoi. "Customers trust us because we only buy chickens from farms that have been checked by animal health workers."

China is on high alert, especially in the southern province of Guandong. Sars expert Dr Zhong Nanshan, director of the Guangzhou Institute of Respiratory Diseases, defined the risk of bird flu in the region as "grave". He said: "The World Health Organisation has already issued an urgent warning in the region. For some time now, we have been acting in order to prevent an outbreak of the epidemic.” The doctor said rural areas were particularly vulnerable and he expected the disease to be found in provincial villages

In Thailand, the government wants to increase the number of vaccines which are however difficult to obtain. The Public Health Minister, Suchai Charoenratanakul said his country has vaccines for 75,000 people, which would be sufficient in normal circumstances. But if a pandemic breaks out, pharmaceutical companies will not be able to meet demands. Thailand was one of the countries hardest hit by the virus but since 25 February, no new cases of infection have been reported. For a time, breeding poultry was forbidden.

In the Philippines, vets, doctors and disease specialists are debating a plan to prevent the virus from reaching the country. The health department said that “for now, there have no cases of bird flu detected in people or in animals”.

Malaysia, which borders Indonesia, has taken a series of precautions to prevent an outbreak. Kuala Lumpur has stepped up border controls to prevent illegal importation of rare birds and it has also made the penalty for smuggling harsher. Agriculture Minister Muhyiddin Yassin said: "At the moment, we are still free from the avian influenza, but we need to be stringent at all times to prevent it”. For now, the only victims of the virus are poultry breeders who have registered heavy economic losses.

The authorities in Mongolia have declared that since July more than 560 birds struck by the H5N1 virus have died. The first cases were discovered on the border with Russia. Ganzorig, from the General Emergency Office, said that so far 563 birds, mostly migratory, had been found dead in 16 provinces.

"The infected birds staggered like drunk men," he said.

The Looming Pandemic: Bird Flu Takes Flight

Bird Flu Takes Flight
By ALAN FARAGO

As the latest Atlantic hurricane spilled into the Gulf of Mexico, 90 miles to the north, roadways were empty. A little rain fell on a city closed tighter than a drum.

The lucky people of Miami retreated behind walls from fitful gusts of wind, but if the next disaster is pandemic flu there will be no lucky people and nowhere to hide.

The rampant spread through bird populations in Southeast Asia of a killer strain of avian influenza called H5N1 is eerily similar to the gathering of clouds where warm ocean waters and prevailing winds fuel typhoons and hurricanes.

When H5N1 infects humans, it is extraordinarily lethal. Were a similarly lethal strain of virus to become easily transmittable among humans, the resultant flu pandemic would be catastrophic.

LINK to full story

World has slim chance to stop flu pandemic

By Michael Perry
Reuters
Sep 20 1:48 AM US/Eastern

NOUMEA, New Caledonia - The initial outbreak of what could explode into a bird flu pandemic may affect only a few people, but the world will have just weeks to contain the deadly virus before it spreads and kills millions.

Chances of containment are limited because the potentially catastrophic infection may not be detected until it has already spread to several countries, like the SARS virus in 2003. Avian flu vaccines developed in advance will have little impact on the pandemic virus.

It will take scientists four to six months to develop a vaccine that protects against the pandemic virus, by which time thousands could have died. There is little likelihood a vaccine will even reach the country where the pandemic starts.

Link to story

Influenza virus can spread from poultry to humans

A less-virulent strain of avian influenza virus can spread from poultry to humans, suggests a study published in The Journal of Infectious Diseases.

Previous studies have focused on the ability of highly pathogenic strains to spread from poultry to humans. But, according to this study, less pathogenic strains are also capable of jumping to humans, giving them the opportunity to swap genetic material with human strains, which could result in a more virulent virus.

Researchers in Italy studied outbreaks that occurred among poultry between 1999 and 2003, to determine the risk of avian influenza virus transmission to persons in contact with the animals. The outbreaks occurred in northern Italy in regions where the majority of the country's commercial poultry are raised on farms.

They performed a serologic analysis of individuals exposed to infection during the outbreaks, collecting 983 blood samples from poultry farm workers in the outbreak regions.

The outbreaks involved two serotypes of avian influenza: one low and one highly pathogenic H7N1 and a low pathogenic H7N3 virus. Seven individuals exposed to the more recent outbreak of low pathogenic H7N3 tested seropositive for H7N3. The infected persons came from different farms in two locations and had close contact with turkeys or chickens.

The authors of the study, Dr. Isabella Donatelli and colleagues, say their findings highlight the importance of improving disease surveillance not only during outbreaks of highly pathogenic avian flu, but also when less pathogenic strains are circulating.

To forestall genetic exchange between human and avian strains, as in mixed infections, they emphasized that poultry workers should be systematically vaccinated, pointing out that such workers are identified as high-risk and included in the annual Italian vaccination campaign. (ANI)

Fifth H5N1 Case in Jakarta Indonesia Confirmed

Recombinomics Commentary
September 17, 2005

The Indonesian ministry of health again examined the blood sample of a six-year-old child, only identified as MT, for likely being infected by avian influenza (AI), the ministry`s official said here Saturday.

I Nyoman Kandun, the ministry`s director general for disease control and environmental improvement, said his team was conducting a further examination on the blood sample of the child, currently treated at Sulianto Saroso Hospital here since September 14.

"The patient`s serological test has shown that the virus is Avian Influenza but the child`s PCR (Polymerase Chain Reaction) is negative," he said.

As a result of the negative PCR result, Kandun said his team would again conduct another PCR test.

MT was firstly hospitalized at Siloam Gleanegles in Tangerang district, Banten Province,

Full Article

Avian Flu: Is the Government Ready for an Epidemic?

Virus Poses Risk of Massive Casualties Around the World

London Looking For Morgue Space To House Victims Of H5N1 Virus

ABCNEWS

Sept. 15, 2005 — It could kill a billion people worldwide, make ghost towns out of parts of major cities, and there is not enough medicine to fight it. It is called the avian flu.

This week, the U.S. government agreed to stockpile $100 million worth of a still-experimental vaccine, while at the United Nations Summit in New York, both the head of the U.N. World Health Organization and President Bush warned of the virus' deadly potential.

Full Article

U.S. Buys $100 Million of Bird Flu Vaccine

By LAURAN NEERGAARD, AP Medical Writer
September 16, 2005

WASHINGTON - Mass production of a new vaccine that promises to protect against bird flu is poised to begin, as the government on Thursday agreed to stockpile $100 million worth of inoculations.

The new contract with French vaccine maker Sanofi-Pasteur marks a major scale-up in U.S. preparation for the possibility that the worrisome virus could spark an influenza pandemic.

While the vaccine is still experimental, preliminary results from the National Institutes of Health's first testing in people suggest the inoculations spur an immune response that would be strong enough to protect against known strains of the avian influenza, sparking the new investment.

But just how many doses the $100 million will buy isn't yet clear.

Full Story SOTT

WHO BIRD FLU WARNING

The boss of the World Health Organisation, Lee Jong-wook, has issued a new warning about avian flu.

He has again warned that the virus, which has triggered a major health scare in Southeast Asia, could mutate into a major killer.

At present, the H5N1 strain of bird flu, harboured by wild migrating birds and poultry flocks, is lethal for humans but is not very contagious, nor can it be easily transmitted from person to person.

"The existing H5N1 hasn't yet acquired its ability to transmit among the humans,” Lee said.

“But when it acquires this ability, and there is some evidence that this will be the case, I hope this will be simply less toxic than the existing H5N1, which has killed half the people infected," he told reporters.

The WHO's director general spoke at the fringes of a UN Summit where US President George W Bush launched what he called an "international partnership" aimed at preventing avian flu and other new strains from becoming the first new pandemic of the 21st century.

The WHO's biggest fear is that H5N1 may mutate, acquiring genes from the human influenza virus that will make it highly infectious as well as lethal.

Pressed on whether the stage had come to prepare for a mutated
H5N1 virus, Lee said "the biggest fear (is) that it will acquire this capacity but ... the issue is timing."

"We cannot afford to face the pandemic unprepared," Lee said after announcing that the WHO would join the US-led initiative, which is focused on sharing samples of the virus among lab researchers.

The WHO last month said current production of anti-viral vaccines was insufficient to deal with a catastrophic flu epidemic like the one that struck in 1918 and killed some 40 million people around the world.




SOURCE: World News

Spread of bird flu to the United States is a "time bomb waiting to go off"

Disease/Infection News

One of the government's top scientists said Monday that the spread of bird flu to the United States is a "time bomb waiting to go off" but that federal and industry efforts to produce a vaccine are progressing.

"Although the threat of pandemic flu is there, it is impossible to predict in a number" what the odds are of it striking the United States, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told reporters. "But I can say it is much much greater than a few years ago."

"We do know that sooner or later there will be a pandemic flu" in the United States, Fauci said, and "we, the government, are working very hard to get a vaccine capability in shape ?You know something likely will occur, but you don't know when."

He said the aim is to have 100 million doses ready if bird flu is detected in the United States. Even if the strain is different than what is now found in Southeast Asia, the scientific infrastructure is in place to quickly shift to "massive production" of a new vaccine. The goal in the next few years is 150 million to 180 million doses.

Last year, contamination of flu vaccine in a British facility curtailed the distribution of about 48 million doses to the United States, half of what was planned.

"Pandemic flu" is defined as a strain never before seen in humans and that spreads across the globe. There were three such pandemics in the 20th century, in 1918, 1957 and 1968 - the latter two much milder than the first, which killed between 20 million and 40 million people worldwide, and infected one in four Americans, killing 675,000.

The flu infecting fowl in Southeast Asia can spread to people, although not very efficiently, Fauci said, and spreading it from one person to another is even less efficient. There have been only 112 cases reported so far of human-to-human infection. As a result, he said, there is no reason to vaccinate everyone in the United States against bird flu.

But it will eventually spread, he predicted. "It's an epidemiological time bomb waiting to go off," Fauci said, although he cautioned it would not occur suddenly and massively and would give officials time to produce a vaccine.

"It's unlikely that if the H5N1 (flu strain) we see now in Asia develops the capability of efficiently spreading from human to human, which we don't see now, it is unlikely to happen overnight. It is likely to develop over a period of months. It is not going to happen between Tuesday and Thursday. It is going to happen between February and April," he said, using the time frame as an example rather than a prediction.

He said federal spending on pandemic flu increased by a factor of 10 in the past four years and that scientists are moving from using eggs to incubate a vaccine to using cell-based cultures, which would avoid the problem of a chicken infection killing an egg and would allow faster production in an emergency.

If there is enough vaccine available in the future, Fauci said it may be recommended that shots be given not only to infants and the elderly, who are most vulnerable to flu, but to healthy children as well. Vaccinating children, he said, would protect the larger population from disease spread. Children get the mild form of flu "and they sneeze on grandpa and grandma," putting them at high risk.

VIPs to get flu jabs

What a suprise!

By LINCOLN WRIGHT
04sep05

THE Prime Minister and his Cabinet head a list of people with preferential access to life-saving, anti-viral shots if an avian flu pandemic hits Australia.

A leaked Health Department document details the controversial priority list for the shots, devised by a senior medical committee.
Anti-virals ease the effects of the flu, but Australia's stocks only run to 3.8 million doses and they are very expensive to make.

Also on the priority list are state Premiers, senior bureaucrats, judges and funeral parlour workers.

Others to be protected first will include police and workers in Australia's health services, in water and power, telecommunications, sewerage, and those making vaccines.

And Australian Broadcasting Corporation staff are on the list.

Australia's Chief Medical Officer, Professor John Horvath, said the list was devised to ensure people who carried out critical functions were protected.

"The nation's leaders are the most important of all," Dr Horvath said.

"At the end of the day, there's got to be someone to make the decisions.

"And the media, but not all of the media, will be terribly important in the event of a pandemic."

Australia's military leaders had their own system to protect themselves, Dr Horvath said.

Medical officials fear the deadly avian flu virus now spreading through the world could mutate and infect humans, sparking a pandemic -- a deadly global infection without an immediate cure.

A new variant of the virus, H5N1, has killed more than 50 people in Asia.

The World Health Organisation estimates up to 100 million could die in a pandemic, while in Australia, more than 2.5 million would get the flu and up to 13,000 would die.

The anti-viral drugs are the first line of defence before vaccines can be developed.

"In the absence of vaccines, anti-virals are the only medical intervention for providing protection against disease and some therapeutic benefit in those who are ill," the pandemic action plan states.

Australia has the largest stock of anti-viral drugs in the world, but still has only about 3.8 million doses.

It is estimated they could protect Federal and State Governments and a million essential workers for six weeks. Australia could use three types of anti-viral drugs: Tamiflu, Relenza and Symmetrel.

Iran bans import of wheat from Russia

Tehran, Sept 3, IRNA-


Iran has banned import of wheat for feeding cattle from Russia and the countries infected by bird flu.

A report released by the website of wheat project commissioner quoting the Russian news agencies said, Iran's decision will leave its negative impact upon the corn market of the countries bordering the Caspian Sea.

According to a Russian official, as a consequence of the ban the export price of Russian wheat dropped by 3.38 dollars, which at present costs 87.41 dollars per ton.

Iran annually imports a great amount of cattle wheat from abroad to supply part of its cattle's required food.

The related statistics show that 160,000 tons of cattle wheat were imported by the Ministry of Commerce last year, while the figure stood at 63,000 tons over the first quarter of the current fiscal year (started March 21).

France Prepares For Avian Flu Pandemic

France is takinig bigger steps than most Western countries to prepare for a potential avian flu pandemic.

French newspaper Liberation said the government had already acquired 5 million doses of the antiviral drug Tamiflu, produced by Swiss pharmaceutical giant Roche, and was planning to raise the level to 14 million by the year end.

France has a population of over 60 million people. Not all the population would get sick. 14 million Tamiflu doses might be enough if many steps were taken to reduce the rate of transmission of the flu virus.

The French government is also negotiating contracts to produce large stocks of flu vaccines. But pre-stocking flu vaccines might not work since the avian H5N1 viruses in birds are still mutating. If a viable strain emerges in humans it might look antigenically very different than any strain used now to base a vaccine on.

The French government is also purchasing a couple hundred million face masks.

The number of protective face masks in stock would be increased to 200 million by the start of next year from 50 million.

One wonders how long these masks would last. The 3M N100 and P100 masks last for 150 hours. However, most masks last for about an order of magnitude less time. Therefore individuals out in public all day would need many masks to get through the length of time of a pandemic.

Bird flu diagnosis confirmed in Altai district

BARNAUL, September 2 (Itar-Tass) - The bird flu diagnosis was confirmed in the laboratory in the Khabary district, Altai territory.

More than 200 poultry were killed in four farms of Khabary, and the remaining poultry was isolated, a source in the territorial veterinary department told Itar-Tass on Friday.

All poultry or about 10,000 of hens, ducks, geese and turkey cocks were killed at the Mamontovskoye poultry station. Since the station is isolated and all necessary measures have been taken there, quarantine was lifted at the station. But specialists do not recommend bringing new poultry there until migrating wildfowl that spread infection flies away. According to him, the second bird flu outbreak is possible over the fowl migration.

The regional emergencies department said the list of settlements where quarantine was imposed after the bird flu outbreak did not reduce. Quarantine is in effect in nine settlements in six districts of the territory. Additional restrictive measures over suspected bird flu cases are taken in another three settlements in three districts. Poultry is isolated in all 12 villages, veterinarians and doctors go on door-to-door rounds of private farms, disinfection barriers are placed, and sanitary services and policemen control supplies of fodder and poultry products, including eggs and poultry meat.