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Bird Flu Spreads to Europe, Africa

March 2, 2006 at 12:00 AM EST
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RAY SUAREZ: The lethal avian flu continued its flight across Africa and Europe this week. Bosnia, Niger, Georgia and France were the latest countries to confirm cases of the H5N1 strain of the virus that’s infected millions of birds and some 170 people worldwide.

Authorities began vaccinating 1 million free-range birds in France after it became the first European country to suffer an outbreak among poultry this weekend. The virus’ rapid spread has been blamed on migratory birds. European Union officials have voiced concerns about controlling it, especially with spring migrations beginning.

BERNARD VAN GOETHEM, Director of Animal Health, European Commission: I’m concerned that it will be very difficult to stop its further spread in Europe and even more difficult to eradicate the disease, at least in the short term.

RAY SUAREZ: Avian influenza, or bird flu, is a naturally occurring virus in wild birds. It’s highly contagious among fowl and often fatal to domesticated birds and poultry. The outbreaks of the H5N1 strain first emerged in birds in late 1996 in southern China, then spread to Hong Kong, where it was first detected in humans in 1997.

The virus surfaced in humans again in Hong Kong in 2003 and spread across Asia. Since then, it’s spread westward through Asia, the Middle East, crossed to Europe and Africa, to more than 20 countries in the past month alone. And the World Health Organization reports the virus has infected more than 170 people around the globe; more than half of them have died.

And while human deaths have been primarily linked to contact with infected poultry, many experts fear the virus will mutate into a contagious form among humans and cause a pandemic. So far, there have been no reported cases among birds or humans in the U.S., but government health officials warned during a congressional hearing today that that the virus could arrive in the U.S. eventually.

Dr. Julie Gerberding is the head of the Centers for Disease Control.

DR. JULIE GERBERDING: So our current situation right now is not a good situation. We have these widespread and ongoing outbreaks. We have evidence of domestic poultry outbreaks in more and more countries, and that’s accelerating. This is high season for avian flu.

RAY SUAREZ: To help prepare for any eventual outbreak, the Food and Drug Administration today issued new guidelines for manufacturers to help accelerate approval for a new pandemic flu vaccine.

RAY SUAREZ: For more on the state of bird flu in Europe and around the world, I’m joined by Canice Nolan, head of food safety, health and consumer affairs for the European Union delegation in Washington, and Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

Canice Nolan, just in the last days and weeks, the disease has cropped up in Serbia, India, France, Georgia. Is this moving in a surprising way, in a way that wasn’t expected?

CANICE NOLAN: No, I wouldn’t say that. It’s moving faster than expected, but in the sense of being surprising, no.

What was a surprise is we were all planning for the spring migration of the birds coming in a couple of weeks, coming back north. In this case, I think most of the outbreaks in Europe are due to swans trying to escape this cold snap over Central Europe. It’s been one of the coldest winters in recent years, and the swans have had to come further into Europe, bringing the infection with them.

RAY SUAREZ: So, when they find a wild duck in Italy, as they did in the last couple of weeks, dead, is that a sign or is that assumed to be a sign there are many more that they just haven’t found or, like flu in individual human beings, are there some who get sick and some who just don’t?

CANICE NOLAN: I think there are some who get sick and some who just don’t. We’ve actually been monitoring wild bird populations for several years now in Europe. And the fact that it’s cropping up now is a strong indication that it’s only appearing now. RAY SUAREZ Dr. Fauci, in the past few years, as we saw in our map as it marched across the world, the flu strains have been tracked closely by scientists. Have they been changing in the way that human flus do from year to year, so we have to redo the vaccine?

ANTHONY FAUCI: They have been molecularly changing, in the sense of drifting their structures, as it were. It’s still an H5N1.

The thing that has not happened, and that’s the thing that we’re watching very carefully, is the concern that it will assume a greater efficiency of going from bird to human and then, importantly, a greater efficiency in going from human to human.

Right now, both of those are very inefficient. By inefficient, we mean, of the tens of millions of chickens that have been infected and the hundreds of thousands of people that are intermingling, there have been a total of 174 infections and 94 deaths. So it’s still very inefficient, and there has been maybe one or two documented cases of human-to-human transmission.

The concern is, since these viruses tend to evolve, that they’re going to evolve in a way in which it will become more and more efficient and then ultimately be efficient enough to spread rapidly enough to be a human pandemic. So we need to assume in our preparations that worst-case scenario, namely that it will do that, even though it might not. But the assumption, as public health officials, is that that’s what we have to prepare for.

RAY SUAREZ Well, are you making that assumption? Looking at a map where it’s popping up in 20 different countries over a span of weeks, can you then say, “Well, it must be more efficient now in getting from bird to bird”?

ANTHONY FAUCI: No. No, not necessarily. Not necessarily. What it seems to be doing is spreading, as Dr. Nolan said, more quickly than we thought, very likely because of the patterns of the migratory birds.

But when we were looking at them, and still are, in Southeast Asia, once it would get into a flock, it would be devastating. It’s a highly virulent pathogenic virus for the chickens, the domesticated flocks. And when it gets into a flock, there were mass die-offs, as well as cullings, which needed to be done to protect the other flocks.

RAY SUAREZ: Canice Nolan, are birds raised indoors getting the disease, too?

CANICE NOLAN: There has been one reported outbreak in France. And I think this is the first in the world where a commercial production of poultry has had a report of that. And that’s still under investigation, how that actually happened.

RAY SUAREZ But that’s a disturbing threshold, isn’t it?

CANICE NOLAN: It is very disturbing.

RAY SUAREZ And how many millions of birds are we — France has a pretty big commercial poultry industry?

CANICE NOLAN: France has a huge commercial poultry industry; in fact, Europe has a huge commercial poultry industry, although it’s about half the size of that of the United States. Most of that is indoors and, until now, I would have said highly protected against cross-contamination from these wild birds.

 

RAY SUAREZ So what effect is this having on the European food business?

CANICE NOLAN: It’s having an effect in several ways. One is consumer confidence is plummeting. I mean, consumption of chicken is down 70 percent in Italy, 25 percent in France because the message has not yet been put across to people that, “OK, a bird may be infected, but if you cook that bird properly, it’s very safe to eat.”

RAY SUAREZ Haven’t some Asian markets banned the import of various poultry products?

CANICE NOLAN: Asian markets, there are several counties which have banned European or French poultry. In fact, this is not a good thing. Under the World Animal Health Organization rules, it should be possible to regionalize, to limit the actual trade bans that you put in place.

And it’s quite important to do that, because, as far as bird flu or a human pandemic goes, the most important thing is early reporting and early detection. And if you put barriers up — you need to provide incentives to people to report when it breaks out.

And if there are threats that, “We will stop this,” or, “We will destroy that,” this is putting a barrier in place. And we really want to avoid that. In that sense, I think we should compliment the U.S. government because they have really regionalized France and taken very sensible and pragmatic restrictions.

RAY SUAREZ Well, speaking of complimenting with the United States, has this disease and the threat it poses, both economically and in public health terms, broken down all kinds of barriers? So now people in the United States are in regular consultation with agricultural ministers, directors of virology, your equivalents in other countries?

ANTHONY FAUCI: Right, not only internationally, but even among ourselves. I mean, the hearing that you showed on the piece, Ray, was the Department of Health and Human Services, USAID and the State Department. Now we’re talking both domestically and internationally, and particularly interacting with our colleagues.

The important issue is that, as this virus evolves, it needs to be monitored, because if and when — and we hope it never happens — it does assume this capability of going more efficiently either from chicken to human or, hopefully not, human to human, we need to get those isolates and we need to work with our international colleagues, knowing what that is, so that we can, in real time in our vaccine production capability, make sure that we’re targeting the proper virus.

Right now, the vaccine that we’ve made is based on a 2004 strain that we isolated from a Vietnamese patient. We call that a pre-pandemic vaccine. So it is likely that that vaccine, if the virus changes, is not going to be as efficient as you would want it to be against the strain that ultimately does become the real problem.

So what we’re doing in preparation is building up the vaccine production capacity, so that when that does happen, if it does happen, we’ll be able to rapidly surge up to make vaccine against the appropriate strain.

And the same thing holds true for the development of drugs, the stockpiling of drugs, the production of drugs. But also, importantly, is, for example, what’s happening right now in the country with Secretary Leavitt literally going to all 50 states and talking about a broad, comprehensive plan that the president announced on November 1st of an international surveillance, domestic, state, local government, business, and the individual units of family units of knowing the kinds of things that you can do to help protect yourself. So that kind of communication is unprecedented.

RAY SUAREZ: Well, Canice Nolan, short of killing every bird that you see, what is the efficient way, the smart way, of putting up a roadblock in front of the natural movement of this disease?

CANICE NOLAN: I think you have to isolate the birds. And in fact, as I had said earlier, commercial production imposes certain biosecurity measures. You really limit the access to the birds, and this is very effective. This is most of the poultry industry, I think, in Europe and in North America uses this type of isolation.

Compare that to what you see in Southeast Asia, where most of the birds — say, 75 percent or more — are out in the backyards. They’re in very close contact with people.

RAY SUAREZ: In a rich country, in an E.U. country, when a cull is ordered, there’s probably mechanisms to compensate farmers, mechanisms to make sure the birds are killed and disposed of properly. Is that existing everywhere? In poorer countries, can you really be sure that a flock is being killed and disposed of properly?

CANICE NOLAN: Well, that’s for the poorer countries to say. And I think we are working with the World Health Organization, the Food and Agricultural Organization, the World Bank, and the OIE to get the mechanisms and the infrastructures in place to allow this to happen.

RAY SUAREZ: Very quickly, if the disease crosses that threshold and becomes, as you say, more efficient, will you know quickly? How will you know?

ANTHONY FAUCI: Well, it depends on where it happens. If it happens in a country in which the surveillance is very transparent and information exchanged, you will know when you start seeing health workers who are taking care of patients getting sick, doctors, and nurses and family members who have absolutely no contact with poultry, which will likely be the vehicle whereby it goes from the chicken to the human and then around to humans.

So we’ll see it. We hope that the countries throughout the world, and in developed nations like the European Union, it will likely be very transparent. We’re concerned, for example, if things happen in Southeast Asia, where there isn’t that kind of a communication, as well as in the developed nation, that will be less transparent.

RAY SUAREZ Dr. Fauci, Dr. Nolan, thank you both.

CANICE NOLAN: Thank you.