Bird Flu Kills Turkish Children on Europe's Doorstep

ANKARA, Turkey, January 10, 2006 (ENS) - Three children are dead in rural eastern Turkey, raising fears across Europe about the emergence of human cases of bird flu on the continent.

The three deaths struck the same family in the rural community of Dogubayazit, with three siblings dying in less than a week. A fourth child in the family has survived the illness.

A total of 14 human cases of disease caused by the highly pathogenic avian influenza virus known as H5N1 have been confirmed in Turkey, according to an update Monday from the World Health Organization (WHO).

In Van province, where the young siblings died, 38 more people are being treated for what could be H5N1. Most patients are children and all have been hospitalized for treatment and evaluation.

Turkish and international officials are working together to achieve identification of the virus.

The initial WHO team, accompanied by the Turkish Minister of Health Professor Dr. Recep Akdag, arrived in Van Province Sunday evening. The team is now investigating the epidemiological situation, assessing risk factors and control measures, and discussing with local authorities the possible need for additional equipment and supplies.

An official sprays ducks with disinfectant in the Turkish town of Dogubeyazit. (Photo courtesy WHO)

In recent days, the Turkish Ministry of Agriculture has confirmed H5N1 outbreaks in birds in 10 of the country's 81 provinces. Extensive culling is under way, and several other possible outbreaks are under investigation.

The quality of laboratory testing at Turkey's National Influenza Center in Ankara is high, WHO said in a statement Monday. Results from tests conducted there last week were fully confirmed by a WHO collaborating laboratory in the United Kingdom.

With the agreement of the Turkish Ministry of Health, two epidemiologists and two experts in laboratory diagnosis will join the initial WHO team in the next few days. Given the present high level of awareness of the disease and its presence in poultry in several parts of the country, the number of people concerned about possible exposure is expected to increase.

This additional support should expedite understanding of the epidemiological situation and increase the capacity to rapidly confirm or rule out persons under investigation for possible infection, WHO said.

Turkey is the sixth nation to discover human cases of H5N1, the first outside East Asia, where this pathogen first started killing poultry two years ago.

The number of human cases has crept upward steadily over the last few months, at 146 as of January 7, with 76 deaths, according to WHO.

At least 140 million chickens and ducks have been culled in the past two years in attempts to keep the H5N1 virus from spreading. (Photo courtesy FreeFoto)

As first news of the human cases emerged from Turkey, U.S. Health and Human Services (HHS) Secretary Michael Leavitt reiterated the U.S. commitment to work with the international community to combat disease.

“We will continue our vigorous efforts in concert with the WHO Secretariat, its regional offices and other international partners,” Leavitt said in a January 5 statement, “to track the global spread of the H5N1 influenza virus and to detect human cases as early as possible.”

From mid-December 2003 through early February 2004, poultry outbreaks caused by the H5N1 virus were reported in eight Asian nations, listed in order of reporting: the Republic of Korea, Vietnam, Japan, Thailand, Cambodia, Laos, Indonesia, and China. Most of these countries had never before experienced an outbreak of highly pathogenic avian influenza.

In early August 2004, Malaysia reported its first outbreak of H5N1 in poultry, becoming the ninth Asian nation affected. Russia reported its first H5N1 outbreak in poultry in late July 2005, followed by reports of disease in adjacent parts of Kazakhstan in early August. Deaths of wild birds from highly pathogenic H5N1 were reported in both countries.

Almost simultaneously, Mongolia reported the detection of H5N1 in dead migratory birds. In October 2005, H5N1 was confirmed in poultry in Turkey and Romania. Outbreaks in wild and domestic birds are under investigation elsewhere.

Japan, the Republic of Korea, and Malaysia have announced control of their poultry outbreaks and are now considered free of the disease. In the other affected areas, outbreaks are continuing with varying degrees of severity.

The discovery of human bird flu cases in a nation thousands of kilometers from where the disease originated illustrates the virus’s ability to spread.

Though still apparently not contagious among humans, the virus finds many means of travel – in flocks of migratory wild birds, in shipments of infected birds in agriculture trade or in the mud and dust that travel on a truck from an infected farm.

Just as the virus has spread, so has awareness among world governments of the need to prepare for the possibility of pandemic and improve their ability to understand and control diseases that may pass from animal to human populations.

But WHO says that despite an advance warning that has lasted almost two years, the world is still "ill-prepared" to defend itself during a pandemic.

WHO has urged all countries to develop preparedness plans, but only around 40 have done so. WHO has urged countries with adequate resources to stockpile antiviral drugs nationally for use at the start of a pandemic. Around 30 countries are purchasing large quantities of these drugs, but the manufacturer has no capacity to fill these orders immediately.

"On present trends, most developing countries will have no access to vaccines and antiviral drugs throughout the duration of a pandemic," the world health body said in December.