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Pandemic risk rises as bird flu spreads link
By Elisabeth Rosenthal and Donald G. McNeil Jr. The New York Times
SUNDAY, FEBRUARY 12, 2006

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The arrival of bird flu in Italy, and in the European Union, had been predicted for some months, as the virus has marched steadily from eastern Asia, to Russia, to the Balkans and, in the last week, to West Africa. Experts say the virus is being carried by migrating birds, so all countries on their flight paths are vulnerable.

World health officials say they have not had the cooperation they need from many poor countries, even those on the flight paths of migrating birds known to carry flu. Because of poor surveillance and rudimentary laboratory capabilities, they often received lab samples for testing weeks or months after problems begin - and for that reason, they worry that the disease is already much more widespread than they can prove.
"We are fighting the good fight, but to win it we'll need a lot more proactive surveillance and prevention," said Juan Lubroth, a senior veterinarian at the UN Food and Agriculture Organization, in Rome. There was strong evidence that bird flu took root in Nigeria "a few months ago," Lubroth said, even though it was only confirmed last week, after Nigerian veterinary officials had said last Monday that bird flu was not in the country.

There may be more unreported outbreaks in Africa and the Caucasus region, he said. "We've been repeating over and over to countries that they have to be vigilant, but in most countries, it's business as usual. They say, 'Avian influenza isn't here now. We'll deal with it when it arrives.' But then it's too late." Maria Cheng, a spokeswoman for the World Health Organization, said the agency suspected there might be human cases of bird flu in Africa, but had no way to confirm that yet. "We're getting a team ready to go," she said, "but we're waiting to get the invitation from Nigeria."

But Africa also has the worst AIDS epidemic in the world; in some countries nearly a third of the adult population is infected. In the initial stages, having a depressed immune system could have a protective effect, said Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, because virulent flus set off a powerful immune reaction that can drown the lungs in fluid. However, he added, it would probably hurt patients trying to fight off secondary immune reactions. But HIV-infected people who managed to fight off bird flu would become ideal crucibles in which the H5N1 virus could exchange genes with other viruses, dramatically increasing the likelihood of a bird flu strain that could readily infect humans. "If H5N1 gets into people with AIDS it would likely persist and throw off mutants left, right and center," Oxford said. If bird flu takes root in Africa - or if has already done so, undetected - it could prove disastrous not just for that continent, but for Europe as well, experts say, since the northern migration of birds begins next month. "The prospects are not good," said Oxford. "Soon they'll be coming back over Europe and why wouldn't it cause a great danger?" As a virologist, Oxford said that he could only assume that Nigeria was just the "red light we could see," but that there were similar bird flu problems in many other places.