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Bird Flu Outbreak

As China reported its first case of the rapidly spreading bird flu Tuesday, Dr. Julie Gerberding, the head of the U.S. Centers for Disease Control and Prevention, discusses the implications of the outbreak on world health.

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  • MARGARET WARNER:

    The spread of a deadly bird flu throughout Asia has world health officials deeply alarmed.

    China today became the tenth country to report suspected cases of the virus — joining Laos, Pakistan, Japan, Thailand, Cambodia, South Korea, Taiwan, Indonesia and Vietnam.

    The virus has killed at least eight people in Vietnam and Thailand — most of them children under the age of 16. They're believed to have come into contact with sick chickens and their droppings.

    There are no reported cases of human to human transmission so far.

    But world health officials are worried about the way a possible mutation could spread easily among humans.

  • GEORGE PETERSON, World Health Organization:

    That this chicken virus, or influenza virus in chickens, should infect a person, that already is infected with human influenza virus, and that the two will combine to create a new type of virus that can be much more dangerous and that can go from person to person — this is only theoretical. But the scientists are still very concerned since we know this type of virus mutates very frequently.

  • MARGARET WARNER:

    Tens of thousands of chickens across East Asia have been slaughtered and burned in a frantic attempt to stem the outbreak. Some Thai chicken farmers complained that their government waited too long to admit that the bird flu had erupted in their country.

    SAMROENG NINGTYSONG, chicken farmer: If we'd known from the beginning, if the government had told us and didn't cover it up, we wouldn't have risked keeping our chickens. We'd have destroyed them straight away.

  • MARGARET WARNER:

    Some Asian countries have halted bird imports from their neighbors, and stepped up border checks to enforce the bans. Asian officials worry that if it's not contained, the bird flu could cause serious economic damage — as last year's SARS outbreak did.

    SARS killed 800 after emerging in China … and decimated tourism and business travel in East Asia. So far, the economic damage from bird flu has been confined to Asia's poor farming communities. The region's multi-billion dollar tourism business has not been affected.

  • MARGARET WARNER:

    For more about this bird flu, we turn to one of the country's top health officials who is monitoring these developments, Dr. Julie Gerberding, director of the Centers for Disease Control. She joins us tonight from Atlanta.

    And, welcome, Dr. Gerberding.

  • DR. JULIE GERBERDING:

    Thank you.

  • MARGARET WARNER:

    In the big picture, how serious is this outbreak?

  • DR. JULIE GERBERDING:

    Well, we're very concerned about the situation. There's widespread geographic involvement of so many birds in Asia. Right now, fortunately, it's not efficiently being transmitted to people, and we haven't seen person to person spread but we've got a lot to learn about this virus and containment is going to be very challenging.

  • MARGARET WARNER:

    Now so far in terms of human cases the reports are just ten cases with eight deaths. How reliable are those numbers?

  • DR. JULIE GERBERDING:

    You know, most of the exposure in this situation is likely to be in very rural areas where people don't have access to clinical care or laboratories or the kind of sophisticated surveillance systems we have here in the United States. So it's very possible that we're missing cases. Having said that, I don't think we're missing large outbreaks because those still would be conspicuous above the background.

  • MARGARET WARNER:

    Now, tell us a little bit about how this disease spreads first from bird to bird and then from bird to human.

  • DR. JULIE GERBERDING:

    Well, we're still studying it in this particular situation. But, in general, bird flu spreads through exposure to the contaminated secretions and feces of the infected birds especially when they're sick. Some birds carry the virus even though they're not sick and their feces can also serve as a route of exposure. People who come in contact with these ill birds can be infected through direct exposure to their droplets of respiratory fluids or through contaminated feces as well.

  • MARGARET WARNER:

    I've read that today, in fact over the last week, a number of countries have put bans on imports of chickens into their country from infected countries. My question is: Can a human get it from eating a chicken that had been infected and maybe not caught?

  • DR. JULIE GERBERDING:

    What we know right now is that chickens are not likely to serve as vectors of transmission if they're well cooked. Handling an infected bird could pose a risk. And I think that's what we're especially focusing in on in terms of advice to people who work with poultry or are living in these affected areas.

  • MARGARET WARNER:

    What are the symptoms in humans of bird flu and how deadly is it?

  • DR. JULIE GERBERDING:

    You know, there are actually many different strains of bird flu. The strain that we're seeing right now in Asia is the H-5 strain. What we know from the limited number of patients that have been thoroughly investigated is that the illness looks like a very severe case of influenza, the same sort of thing we were seeing here with the H-3 influenza involving so many people in the United States. But it's very early. And we don't really know the whole spectrum of disease. It's possible some people are exposed and not getting ill. It's also possible that we'll learn more as we discover and detect more cases.

  • MARGARET WARNER:

    How serious a danger do you think there is as the WHO official that we quoted in our piece said that a human who had some kind of human flu who also got this avian flu that somehow it would combine and mutate into a really deadly form of the disease?

  • DR. JULIE GERBERDING:

    The health official is appropriately concerned about something we call reassortment, which is when different strains of flu are mixed in its particular host whether that's a bird or a pig or a human, they can exchange genetic material and result in new strains of virus or combination of virus genes emerging. Right now that's theoretical but one thing we know for sure about influenza is that it's always evolving. And we have to be right out in front of this situation so that we can detect any changes that suggest more efficient spread to people or possibly spread from one person to another. That's why we're taking this so very seriously.

  • MARGARET WARNER:

    Now, ten countries have reported cases. How confident are you and world health officials that it is limited so far to those ten countries and that they are really on top of how widespread it is within their countries?

  • DR. JULIE GERBERDING:

    Well, this is very challenging because the birds who are infected are generally in remote or rural areas and it's just not really possible for even the best health system to know with confidence whether or not any of the flocks are affected. So it's going to be a tough situation to really get out there in those rural areas and identify all of the suspect infections. The situation for clinical cases I think is going to improve for detection because we are working with WHO and so many other international health experts to get the word out to the village clinicians and to the other components of the health system to be on the watch for influenza-like illness. CDC is also providing test kits so that if a suspect patient does get admitted to the hospital, they have the capacity to see whether it's an H-5 strain or not.

  • MARGARET WARNER:

    We heard that chicken farmer I think from Thailand saying on our taped piece that he thought his own government had been reluctant to admit that the disease was present. How forthcoming are these countries' governments being?

  • DR. JULIE GERBERDING:

    Well, in general, once the virus has been identified as being the avian influenza, the governments have been very quick to report to WHO. What we're concerned about is simply not having the capacity to do the somewhat complicated virology to really know what's going on. So in lieu of these appropriate tests we've had to rely on word-of-mouth reports and sometimes the sick patient is the first signal that there's a problem in the community. Fortunately now, the spotlight is really shining on the whole region and I think everyone is alert to the possibility of suspecting this problem if they see illness in chickens or other birds.

  • MARGARET WARNER:

    In my taped piece I said tens of thousands of chickens; I actually think tens of millions of chickens have been slaughtered. Are these countries being aggressive enough between the killing of these foul and various import bans to control the spread?

  • DR. JULIE GERBERDING:

    Well, there is a great challenge here because there are hundreds of thousands of birds that are potentially affected. So to get out there and really motivate the mass culling of these flocks of birds quickly enough to really prevent spread from one flock to another, it's a terrific challenge. We are doing everything we can to support these efforts, but I don't think we're going to know for a while how successful or how complete the containment really is on the geographic by geographic basis.

  • MARGARET WARNER:

    All right. And then finally, let's turn to the risk to Americans. What is the risk to Americans from this and what steps are being taken to protect the U.S.?

  • DR. JULIE GERBERDING:

    Right now there are absolutely no cases suspected in the United States and no birds that we know of that are carrying the virus, but we're going to be very vigilant. We don't have travel advisories or alerts but we are recommending that people who travel to the countries that have been identified as having the virus to be very careful about avoiding contact with birds, particularly poultry, to stay away from the live food markets and to avoid anything that suggests potential for contamination with bird feces from the involved flock areas. In addition to that, we are recommending that doctors around the United States think about taking a travel history any time someone presents with the flu-like illness and if they have been traveling to these areas, the tests are done so that we can identify the first case, if one should occur here, as quickly as possible.

  • MARGARET WARNER:

    And what about the importation of live … are live foul from Asia imported into the U.S.?

  • DR. JULIE GERBERDING:

    The United States has several regulations that pertain to the importation of birds. Birds from the involved countries are banned from importation and exotic birds that could coincidentally harbor the virus even without being sick are held in quarantine under normal procedures here in the United States for 30 days. So it's unlikely that this is going to enter the country through the borders, but of course we're double checking to make sure that we don't have any plugs that need to be put back in place to keep this from happening.

  • MARGARET WARNER:

    I guess what I'm also asking is, is there any way in which Asian fowl makes its way into the U.S. food supply?

  • DR. JULIE GERBERDING:

    Right now, as far as we know, the answer to your question is no in terms of animals that haven't been processed or cooked. But, again, this is something that we're working very closely with the USDA on, we're checking through the import lists and taking all the steps we can to be sure that nothing slips in.

  • MARGARET WARNER:

    Dr. Julie Gerberding, thanks so much.

  • DR. JULIE GERBERDING:

    Thank you.

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