Последние три недели в Феодосийскую ветлечебницу общества защиты животных горожане приносят больных голубей с одинаковыми симптомами: нарушение координации и глотания.
По словам ветеринара Елены Филипповой, эти симптомы очень похожи на проявление энцефалопатии - отека головного мозга. Некоторые болезни передаются человеку от птиц, но в этом случае людям вряд ли что-то угрожает.
«Все голуби, которых мне приносили, умирали. Недавно ко мне пришел молодой человек, который принес голубя с теми же симптомами. Сейчас он сам смотрит за птицей, пытается ее вылечить. Теща этого парня - патологоанатом, если голубь умрет, она сможет провести вскрытие, и мне сообщат о результатах», - рассказала Елена Филиппова, передает «Обком».
Филиппова также сообщила, что многие болезни передаются человеку от птиц, особенно от голубей. Но голуби ее не заразили, поэтому Елена Владимировна считает, что болезнь для человека не опасна.
По словам заведующей инфекционным отделением феодосийской городской больницы №1 Лидии Демешиной, есть такое заболевание «орнитоз», которое передается человеку от птиц, в основном голубей.
«Проявление клинического орнитоза - пневмония, - сказала она. - Я не думаю, что сейчас голуби болеют именно этой инфекцией. За 19 лет моей работы в Феодосии, я ни разу не сталкивалась с подобными случаями».
>> The genetic changes they have seen in the northern Vietnam viruses are in the gene that codes forthe spike, a molecule called haemaglutinin, in a part that controls how well the spike fits into the receptor…….
One final surprise too. One recent sample from Vietnam proved to be, in part, resistant to the drug mainly used to treat victims of H5N1.
Chances are it's a one-off - the patient was being treated with the drug - but the WHO scientists warn that if further samples are found, it would have serious implications indeed. <<
The above comments on changes in HA suggest that the protein that is missing one amino acid is HA, and the missing amino acid is in the poly-basic cleavage site. If so, it is likely that the missing amino acid matches the missing amino acid in H5N1 found in Shanghai and other provinces in eastern China. These data suggest that the new H5N1 in northern Vietnam is indeed a recombinant between the H5N1 in Vietnam and the H5N1 in China.
The data also suggests that H5N1 in China is being under-reported, adding to the misinformation provided by the poor surveillance of H5N1. China, like all Asian countries that had H5N1 last year or this year, has not submitted any publicly available 2005 H5N1 sequences to GenBank. The sequences held by WHO consultants, but not shared with therest of the scientific community, may indeed provide clues that WHO appears to have trouble interpreting beyond a funny noise in a car.
Thus, media reports suggest that significant changes are occurring in HA and NA. NA is targeted by the only available H5N1 antiviral, Tamiflu. The above report suggests that an H5N1 Tamiflu-resistant strain has evolved. Widespread use of Tamiflu will generate selection pressure forresistance. The comments above imply that such resistance is relatively easy for H5N1, since the number of H5N1 confirmed patients treated with Tamiflu has been exceedingly low. Tamiflu is the antiviral drug being stockpiled by many countries.
However, because surveillance of H5N1 in mild cases in northern Vietnam has been virtually absent, the possibility of Tamiflu treatment of mild human cases is quite real, since the drug has been approved for treatment and prevention of influenza. Widespread treatment with Tamiflu will likely generate widespread resistance.
Scientists are warning that the virus which causes bird flu could soon be able to pass between humans.
New evidence seen by Channel 4 News points to an increased risk of a global flu outbreak because of the way the virus has started to mutate.
It has killed 52 people in Asia in the last two years, and despite the slaughter of millions of birds has not stopped spreading. Now we've seen a report by World Health Organisation scientists which warns that the risk of a global flu outbreak is increasing.
These are the first signs thebird flu virus H5N1 is evolving and evolving in ways that make a global pandemic more likely.
Deep in northern Vietnam, scientists have noticed localised changes in the patterns of infection.
In the lab, they have seen genetic changes too that suggest the virus in northern Vietnam is different: changes that may affect how the disease will spread.
Scientists at the World Health Organisation monitoring avian flu in South East Asia say they are seeing what they call a "worrisome development".
Recent cases have started appearing in clusters and the disease is getting a little milder - signs, they say, the virus may be adapting to humans: changing genetically to transmit more easily between people at the cost of losing a little of its virulence.
Professor Maria Zambon from the Health Protection Agency, told Channel 4 News: If you have a virus which is more virulent for humans it may be less transmissable. But if the virus is better able to transmit within humans it may be less virulent.
Even a weakened H5N1 virus will still be very dangerous. A flu virus infects human cells when a protein spike on the virus binds with a receptor on the cell surface.
The genetic changes they have seen in the northern Vietnam viruses are in the gene that codes forthe spike, a molecule called haemaglutinin, in a part that controls how well the spike fits into the receptor.
The report we've seen recommends immediate steps should be taken to step up surveillance in countries where H5N1 is present and they say there's an urgent need for up-to-date information on the genetics of the virus.
Constant monitoring of virus from new victims is the key: the WHO denies reports south-east Asian countries have failed to provide samples - Vietnam alone has supplied over a hundred - but it does admit it's been hard to extract virus from many of them, hampering research.
H5N1 is proving to be a virus full of surprises. The original jump from wild ducks - where it doesn't cause illness - to domestic chickens where it kills - was a genetic leap akin to a jump from a cat to a horse. The leap from chickens to humans was even bigger.
The nastiest surprise would be what's called reassortment - if a completely new virus emerged after H5N1 got into someone already infected with conventional human flu.
So news today three pigs in Indonesia have tested positive for H5N1 is a warning. There aren't many pigs in this largely Muslim country, but as a precaution pigs are being quarantined and tested before they're slaughtered.
And the news there are signs of genetic shifts in the virus in northern Vietnam could affect the plans of some governments to control a pandemic with vaccines.
Many that are now being stockpiled are based on British research that took a virus from Vietnam last year and genetically engineered to make it safe. The man who did it admits genetic shifts since then could make the stockpiles redundant.
One final surprise too. One recent sample from Vietnam proved to be, in part, resistant to the drug mainly used to treat victims of H5N1.
Chances are it's a one-off - the patient was being treated with the drug - but the WHO scientists warn that if further samples are found, it would have serious implications indeed.
WHO report charts disturbing changes in avian flu virus, urges preparations
Helen Branswell Canadian Press
Wednesday, May 18, 2005
TORONTO (CP) - The World Health Organization urged countries to make full haste with pandemic influenza preparations Wednesday as it released a report outlining disturbing changes to the H5N1 virus circulating in Asia.
Among therecent findings is evidence the virus's genetic makeup appears to be altering in a way that may make H5N1 better adapted for spread among people.
As well the report documents a case where the virus showed partial resistance to the main drug the wealthy countries of the world are stockpiling to combat it, oseltamivir.
While experts cautioned that finding is not necessarily surprising, it does raise questions about whether an oseltamivir-resistant strain of the virus could propagate and spread. The report notes that scenario, if it were to occur, would have "significant implications for . . . H5N1 prevention and control."
A leading infectious disease expert said the evidence in the report is limited, but paints a worrisome picture of a changing pattern of infection and disease in northern Vietnam.
"I think it tells us that everything about H5N1 is headed in the direction that none of us would like to see it go," said Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
"Do I say that that's going to mean there's an impending pandemic? I don't know that. Does it tell me that . . . there's a growing concern about it? Absolutely."
Evidence in the report was drawn from a recent WHO fact-finding mission to Vietnam and from a meeting of influenza experts in Manila last week.
The WHO admits the implications of the changes in both disease patterns and viral makeup are not fully clear, but suggests the viruses "pose a continuing and potentially growing pandemic threat."
"Based on these concerns and findings, it would be prudent to . . . implement or complete pandemic preparatory actions as soon as possible, even if current H5N1 outbreaks in Asia cease or diminish during thesummer," it states.
In recent weeks flu experts have been sounding the alarm aboutthe changing pattern of infection in northern Vietnam.
This spring there has appeared to be more clusters of cases, possibly theresult of more limited human-to-human spread, and a greater age range of cases. As well the case fatality rate has dropped - something experts had anticipated would have to happen if H5N1 were to become a pandemic strain.
The report combines information about those changes with disturbing laboratory findings. Some viruses are showing genetic changes near what's known as the "receptor binding site" - the point where the invading virus attaches to the cell walls of a host.
Flu viruses made entirely of avian influenza genes don't tend to bind well to human receptor binding sites. But these changes may indicate the virus is evolving to be a better fit.
Science is not currently capable of predicting what, if anything, these changes mean, especially with the limited data that has emerged so far, said Dr. Earl Brown, a virologist at the University of Ottawa who specializes in flu evolution.
"It's incomplete science," he said.
More evidence may emerge in coming weeks.
Canada's National Microbiology Laboratory has sent a team of three scientists to Hanoi to help scientists there analyse blood samples from contacts of H5N1 cases. The goal is to try to get a sense how many have developed antibodies to the virus - a sign they were infected, possibly by human-to-human spread.
"It will help a lot in, I think, clarifying the extent of infection," said Dr. Frank Plummer, scientific director of the national lab. Theteam, led by Dr. Yan Li, chief of the influenza laboratory, left for Hanoi on Wednesday.
WHO: flu pandemic threat may be growing
May 18, 2005 (CIDRAP News) – The H5N1 avian influenza virus is evolving and poses "a continuing and potentially growing pandemic threat," say experts who were convened recently by the World Health Organization (WHO) to study the pathogen.
Changing patterns of cases, particularly in northern Vietnam, may indicate the virus is becoming more infectious for humans, the WHO said in a report on an international meeting of experts held May 6 and 7 in Manila. In addition, genetic analysis indicates that H5N1 viruses are becoming more antigenicallydiverse.
The report cites several differences between epidemiologic features of human cases this year in northern Vietnam and those in southern Vietnam this year and overall last year:
* Northern Vietnam has had eight case clusters this year, versus only two in the south. * Case clusters in northern Vietnam this year have lasted longer than did clusters last year. * The average age of infected people in northern Vietnam rose from 17 to about 31 years between 2004 and 2005, but it stayed aboutthe same in southern Vietnam (15 to 18 years). * The case-fatality rate has dropped to 34% this year in the north but is 83% in the south.
In addition, the report says therecent discovery of three asymptomatic cases in Vietnam suggests that milder infections are occurring. A few asymptomatic cases also were found in Japan and Thailand in the past year, and others were discovered in Hong Kong after the H5N1 outbreak in 1997.
The report says the longer duration of recent clusters may signal a growing number of ways in which people contract the virus, including exposure to sick birds, environmental infection, lengthy exposure to asymptomatic birds that are shedding virus, and person-to-person transmission.
The avian virus had already vaulted to the top of the pandemic threat list because it had developed the ability to sicken and kill humans. The virus's inability to cause efficient, ongoing human-to-human transmission is the last barrier to a pandemic. Now experts appear worried that the barrier is crumbling.
"Investigators were not able to prove that human-to-human transmission had occurred. However, they expressed concerns, which were shared by local clinicians, that the pattern of disease appeared to have changed in a manner consistent with this possibility," the assessment states.
At the same time, it says that in places where the disease in poultry has been controlled or eliminated, human cases have stopped. And thus far, the first case in most of the human clusters in Vietnam followed the person's exposure to infected poultry.
For now, "Prevention of H5N1 avian influenza in humans is best achieved by controlling infection in poultry," the document states. "As already recommended by FAO and OIE [the United Nations Food and Agriculture Organization and the World Organization for Animal Health], control strategies for this disease should consider vaccination of poultry, which has been used successfully before."
A team of WHO expert consultants studied Vietnam's outbreak at that country's request from Apr 15 through 25, the report says. That study showed H5N1 could be changing more in the northern region, which prompted a second expert consultation.
This second meeting was held May 6 and 7 at the WHO regional office in Manila. Representatives from Vietnam, Cambodia, and Thailand presented details aboutthe epidemiologic, clinical, and virologic findings regarding H5N1 in people and poultry. Other data were included from the WHO Global Influenza Network and other countries.
The experts make a number of recommendations, including increasing efforts to improve risk assessment, to boost the ability of affected countries to address outbreaks, and to speed the pace of pandemic planning.
The 14 recommendations include the following:
* WHO should convene its Pandemic Task Force to meet regularly, assess the data, and determine the risk for pandemic flu. * All nations should move as quickly as possible to complete "practical operational pandemic preparedness plans." * WHO should explore "all possible mechanisms" to make H5N1 vaccine available to the Asian countries affected before a pandemic. It should bring together technical experts, countries, manufacturers and possible donors to find ways to boost global H5N1 vaccine production. * Coordination of animal and human surveillance and viral information must be improved from the ground level to the national and international level, and data must be exchanged quickly. * The WHO should complete a handbook on how to investigate possible H5N1 clusters. * The WHO should explore building a stockpile of antiviral drugs that could be used to respond to early signs of a potential pandemic. * Countries needing funding and agencies that may provide funding must coordinate their efforts to avoid redundancy and eliminate gaps
As the experts call for greater international effort to address the escalating threat, they also acknowledge the difficulties of preparing for a possible pandemic:
"Evolution of a pandemic strain of virus may be preceded by numerous small steps, none of which is sufficient to signal clearly that a pandemic is about to start. This poses a difficult public health dilemma. If public health authorities move too soon, then unnecessary and costly actions may be taken. However, if action is delayed until there is unmistakable evidence that the virus has become sufficiently transmissible among people to allow a pandemic to develop, then it most likely will be too late to implement effective . . . responses."
ВОЗ: Птичий грипп может передаваться от человека к человеку Корреспондент.net
19 Мая 2005, 16:04
Последние исследования подтвердили возможность передачи вируса птичьего гриппа от человека к человеку. Об этом в четверг, 19 мая, в Женеве, Швейцария, объявила Всемирная организация здравоохранения (ВОЗ).
Ранее эксперты уже выражались обеспокоенность по поводу возможной мутации вируса птичьего гриппа, из-за чего он в ближайшем будущем будет легко передаваться от человека к человеку, что неминуемо обернется миллионами жертв.
До последнего времени считалось, что смертельно опасный вирус не передается подобным образом, однако последние исследования, проведенные во Вьетнаме, доказали обратное, заявила сегодня ВОЗ.
Эксперты организации уже выразили опасения по поводу возможной пандемии птичьего гриппа.
"Мы считаем, что будет пандемия, но не знаем когда", - заявил в четверг глава отдела по надзору за инфекционными заболеваниями ВОЗ Геналь Родье.
С конца 2003 года опасный для человека штамм вируса птичьего гриппа H5N1 уже унес жизни более 50 человек в Юго-Восточной Азии. Наибольшее количество погибших зарегистрировано во Вьетнаме – 37. Кроме того, 12 человек погибли в Таиланде и 4 – в Камбодже.
WHO warns of bird flu mutation The World Health Organisation has been warning for several months now that the avian influenza virus could combine with a human flu strain – making it resistant to any existing human flu vaccine and creating a worldwide human flu pandemic.
Now, clusters of human bird flu cases indicate the deadly virus may have mutated into a germ more easily passed between people.
Last week, a Vietnamese female nurse who cared for her bird flu patients was hospitalised with bird flu symptoms despite having no known contact with fowl and other birds, according to wire service reports. Although tests haven't confirmed this diagnosis yet, a 26-year-old nurse, who cared forthe same patients, has already tested positive forbird flu.
Red alert No one can say with certainty that an H5N1 flu pandemic is on the cards. But there are several warning lights flickering: the virus keeps popping up in different areas despite vigorous efforts to contain it; certain animals with which humans have frequent contact have become hosts; and it looks like H5N1 is becoming more aggressive.
Experts reckon that, with global travelling being what it is, an outbreak could spread around the world within a month. And, as the avian H5N1 strain seems to be extremely infective, a large-scale outbreak of the virus could be a lot more serious than the Sars pandemic of 2003.
Situation carefully monitored Despite these reports, "South Africans have no need to panic at the moment," says virologist Dr Gert van Zyl from the Department of Medical Virology, University of Stellenbosch.
To date, no cases of human-to-human transmission of bird flu have occurred in Africa.
And "The World Health Organisation is monitoring the situation in the East carefully," Van Zyl says. If the H5N1 virus should ever spread to South Africa, our government would work closely with the WHO to contain the virus.
In the past, flu pandemics have hit so fast, that scientists didn't have a chance to keep up with them. But surveillance of the virus has become good enough to enable health officials to come up with a vaccine fast enough to limit a pandemic's path of destruction.
Get your flu shot At this stage, South Africans should make it a priority to get their annual flu shots. Note, however, that these injections protect only against the influenza viruses A and B. Vaccines that protect against H5N1 are only in the early stages of development.
The WHO and the National Health Authority this winter recommend vaccination against the A/Wellington (H3N2)-, A/New Caledonia (H1N1)- and B/Shanghai-like strains for South Africa.
Although "there is no indication that this year's strains are more aggressive than previous ones," Van Zyl still recommends that people should go for a shot at the end of March or early April – especially if you fall into a risk group:
Risk groups include:
People of all ages with chronic debilitating disease, especially those with chronic cardiac, pulmonary, renal and metabolic disorders. People over 65 years of age. People receiving immunosuppressive therapy. Women who would be in the second or third trimester of pregnancy during the flu season. Pregnant women with medical conditions which place them at risk for flu complications should be immunised at any stage of pregnancy. Medical and nursing staff responsible forthe care of high-risk cases. Children on long-term aspirin therapy. The first flu outbreaks usually start occurring late in April. – (Health24)
Nature 435, 400-402 (26 May 2005) | doi: 10.1038/435400a
Avian flu special: The flu pandemic: were we ready? Top of pageAbstractWelcome to my weblog. I'm Sally O'Reilly, a freelance journalist based in Washington DC. I've been researching a book on pandemic preparedness. But now the time for preparation has run out.
26 December 2005 It's an emergency — official President George Bush has just addressed the press in the East Room of the White House. Here's the transcript: "At this hour, the World Health Organization has declared a full-scale pandemic influenza alert, with person-to-person spread lasting more than two weeks in Cambodia and Vietnam. During previous influenza pandemics in the United States, large numbers of people were ill, sought medical care, were hospitalized and died. On my orders, the Department of Homeland Security and the Department of Health and Human Services have today implemented the nation's draft Pandemic Influenza Response and Preparedness Plan. It will serve as our road map, on how we as a nation, and as a member of the global health community, respond to the pandemic. We are ready. Thank you, and may God bless America."
PORNCHAI KITTIWONGSAKUL/AFP/GETTY IMAGES/KIN CHEUNG/REUTERS/CORBIS Ready, my ass! I've reported on avian flu for almost a decade. The first thing I did on hearing Bush's address was to get on my cellphone to my husband, Jonathan. I told him to pack some bags and get ready to take the kids to my mother's house in Florida. "Remember all that stuff I told you about how a bird flu pandemic might hit the United States? Well, I think it's about to happen."
28 December 2005 Journey to the source Hanoi, Vietnam. I'm exhausted, and I can still taste the disinfectant they sprayed inside the Doctors Without Borders plane. I'm at the Bach Mai Hospital. It was here, three weeks ago, that what they're calling the 'Hanoi index case' fell sick. A Malaysian on business, he was transferred to a hospital in Hong Kong, where he died. Samples sent to labs in the WHO Global Influenza Surveillance Network showed he was infected with an H5N1 avian flu virus, but one that differed from earlier isolates. It had mutated.
But he won't have been the first patient with this mutated strain. As early as October there were hundreds of human H5N1 cases in the countryside south of here, but only a handful got picked up. Most went unnoticed by health authorities. Surveillance for human cases of flu in Vietnam has been patchy, and DNA diagnostic tests unreliable. WHO calls for more international funding were ignored. Now the virus has had three months to spread, pick up mutations and get better and better at jumping between humans.
What's weirdest is that there weren't any declared outbreaks of bird flu in chickens here recently. Farmers weren't exactly queuing up to declare cases, though. There'd been talk of setting up a global fund to help them cope with eradicating avian flu, to compensate them for lost trade. But it came to nothing. Then again, perhaps the virus came from ducks, which can be infected without showing symptoms.
29 December 2005 Life behind the mask Today, I hooked up with the 15-person international team from the WHO's Global Outbreak Alert and Response Network. They're like the cast in that movie Outbreak, about some monkey virus.
We've got epidemiologists from the CDC — the US Centers for Disease Control and Prevention — along with mathematical modellers from Imperial and Emory, and virus hunters from the Pasteur Institute in Paris and the Robert Koch Institute in Germany. They're here to help hospitals control infection, and strengthen surveillance for human cases. Another team is doing the same in Cambodia. Acrossthe world, health authorities are ramping up surveillance, trying to spot and isolate any exported cases as quickly as possible. They've grounded all commercial flights to and from the region. The chaos is way worse than with SARS.
Second evening here. The N95 face masks, which the WHO has advised us to wear, are the worst part. Your glasses steam up and you feel half-suffocated. I only take mine off to eat and drink. Theteam has a web video conference via a high-bandwidth satellite connection with WHO headquarters in Geneva. Its Department of Communicable Disease Surveillance and Response is coordinating the international response. Poor guys, there's just a handful of them.
They run through the latest stats. Here we go: 1,800 cases in Cambodia, 1,100 in Vietnam. Uh, oh ... six suspect cases in Tokyo and Johannesburg. So much forthe flight bans. Overall, the mortality rate is 9%. That's nasty — worse than 1918. But it'll come down, as there's probably loads of asymptomatic cases.
The labs have finished sequencing the virus and we now have a template for an H5N1 vaccine. But it won't be ready for months. So for now, the WHO is trying a long shot, known as targeted antiviral prophylaxis.
Basically, the idea is to blanket bomb all index cases, their households and people in the immediate vicinities with antiviral drugs such as Tamiflu. Computer models predict that if we do this, we might just stop the pandemic in its tracks. But there hasn't been enough modelling, and now we're doing the experiment for real.
Continued modelling will be vital, though, to work out how to deploy the limited supplies of Tamiflu we've got, and how long we need to treat people forthe drug to work. Geneva informs us that the WHO international stockpile contains just 120,000 pills. WHO officials have been on the phone today with countries that have national stockpiles.
The politicians know that stopping the pandemic at source would be the best solution. But they're reluctant to donate drugs, as they'll have less fortheir own citizens if this approach fails. No point asking the United States — they've only got enough pills for 1% of thepopulation. Britain and France have enough for a quarter of their populations. Will they spare us any? Will they hell.
30 December 2005 Getting to know the enemy Geneva announces that the latest epidemiological studies say that the virus seems to have a 'basic reproductive number', or R0, of between 1.4 and 2.0. This means that one case on average infects only one or two people. So if we can detect cases quickly and treat them and their contacts, themodels suggest we could contain the virus most of the time. At the least, that might slow the pandemic and corral it in that region for a few months. That would win time to get a vaccine.
But we know there is a very short window. As time goes by, this virus will get better and better at transmitting between humans, and the R0 will increase. If it goes above 3, there's no way we'll contain it.
The latest news from Cambodia cheers us up. There's a slowdown in new cases. Control efforts seem to be keeping the lid on the virus there. But here it's a different story: theteam is having difficulties finding and isolating contacts of patients in this crowded city.
This flu moves much faster than SARS because its incubation period is just two days. People are spreading the virus the day before they get sick, and asymptomatic patients without even being visibly ill. Tamiflu needs to be administered within two days of anyone showing symptoms.
As I wandered through the streets this afternoon, it wasn't looking good. People are walking around Hanoi coughing and spluttering. They've closed the schools, which is the right thing to do, but what are all the kids doing? Hanging out downtown enjoying the unexpected holiday.
31 December 2005 Six months to a vaccine! Vaccine teleconference. There are 125 people — companies, regulators, scientists — hooked in, each with their own agenda. It's impossible. There's a lot of talk on whether the six-month delay before there is any vaccine can be shortened. Scientists had been working on methods of growing virus forthe vaccine in large vats of cultured animal cells instead of eggs. That could cut the delay to maybe three months. But progress had been held up by US Food and Drug Administration concerns over thesafety of the cell lines. In any case, it would probably take at least two years before the existing factories could be switched over.
So we're stuck with eggs. A fast-track FDA approval for an H5N1 vaccine is under way. Fortunately, the US Department of Health and Human Services last year funded Sanofi-Pasteur to test a 'mock' H5N1 vaccine, using antigens from an earlier strain. So we don't need to start the approval procedure from scratch forthe pandemic strain. We've gained some time.
But US production capacity — one factory — is only enough to cover up to 90 million people. The situation is better in the European Union: it can probably produce enough to cover 30% of its 450 million people. The predictable news is that every vaccine-producing nation has just nationalized its supply to serve its own citizens first. The 'have-not' countries aren't going to get any vaccine.
There's a lot of hindsight and recrimination at this meeting. The United States only tested vaccines at standard doses. Testing a vaccine containing an immune-boosting adjuvant might have allowed it to be diluted eightfold. Even with existing world production capacity, that would have let us produce 7.2 billion shots, enough to treat half the world's population. Now it's too late.
25 January 2006 Escaping from hell Apologies forthe long delay in posting. The past few weeks have been chaos. I was out with WHO teams from dawn to dusk as they tried in vain to stamp out the outbreak with drugs. People fell sick all over Hanoi and 1 in 50 of them died. Many of the worst affected felt fine in the morning, but were dead by lunchtime — blue in the face, gasping for air. At the overcrowded hospital, I saw victims collapsing, suffocating in their own lung fluid, blood streaming from their noses and gums. Others had longer ordeals, tortured by encephalitis as the virus ate into their brains, or overwhelmed by multiple organ failure. Panicky authorities transported corpses out to the fields by truck and burnt them on open pyres.
P. BRONSTEIN/GETTY IMAGES In a desperate last attempt to quell the outbreak, the WHO took what drugs it had left here and blindly treated whole sections of the city where transmission was most severe. The army was supposed to enforce quarantine, but many of them were sick as well, or had joined the exodus from the city. The fleeing people inevitably spread the disease to the countryside.
In a few days' time, the Vietnamese are supposed to celebrate Tet, the lunar new year festival. It's traditional to eat chicken — but not this year. My plane leaves tonight. I feel like I'm escaping from hell.
2 February 2006The virus spreads Today, I was at a press conference at the National Institutes of Health in Bethesda. A guy from the CDC pointed to a giant screen, a map of the world dotted with red pixels. He said that they'd reckoned the virus might hit in two or more waves up to eight months apart, as in past epidemics. They'd hoped the first pandemic strain of H5N1 might be poorly contagious, and come back again with a vengeance after it had picked up more infectivity. By that time we might have had a vaccine. That was just a hunch, though. And it was wrong.
The mild pandemic in 1968 took almost a year to cross the globe. This one probably started around October. So we're now almost four months in. Look at that map! With the huge increase in passengers travelling by air, it's already lodged in 38 cities around the globe. The outline of Asia is barely visible beneath the swarm of red pixels.
Now the virus is in coastal cities on both sides of South America. It hit Europe two weeks ago, ripping through Paris in just 11 days. In the French capital alone, there were 2.5 million cases and 50,000 dead. That's par forthe course — infection rate 25% and mortality 2%, similar to the 1918 pandemic. Extrapolate these numbers, and we're going to have over 30 million dead worldwide. In poor and densely populated countries like India, it could be worse.
Where's next, I asked. Based on passenger data — which had to be prised from the airlines — one epidemiologist was willing to make a guess. "Within two weeks, there." He traced his finger from San Diego to Los Angeles, up to San Francisco. Within another three to four weeks, it'll be the turn of the conurbations alongthe eastern seaboard.
18 February 2006 This can't be happening The United States is battened down before the storm. The government has outlawed all gatherings in public places. In past pandemics that never worked. But epidemiologists say that if we do it early on, it might slow the spread. Modelling also suggests that closing schools and universities is especially important as teenagers and young adults are among the worst hit. We just need to stop them from hanging out elsewhere. Stay at home, is the message blaring from every TV screen.
On CNN it's now round-the-clock coverage, with a red 'Pandemic' banner running acrossthe bottom of the screen. "We're in the twenty-first century, and they're telling us about how to wash our hands properly, and practise 'respiratory etiquette'," exclaims Jonathan. "Why aren't there drugs? And I can't believe there's no vaccine. This can't be happening in America."
20 February 2006 America shuts down The Commissioned Corps of the US Public Health Service, the nation's uniformed force of health professionals, has just been mobilized. The US Northern Command is in charge of the military response. Soldiers are setting up triage centres, anticipating overflowing emergency rooms and morgues. Images are coming in of tent cities being erected in New York's Central Park. Wards are being installed in schools and churches. Troops are on the streets. "There's going to be civil unrest," a general informed me on the phone this morning.
J. S. APPLEWHITE/AP The CDC is in charge of national influenza surveillance, but it's a nightmare now. This is the peak season for ordinary flu, sparking false alarms and panic. Scant supplies of Tamiflu are being reserved for medical first responders, and essential services. (Stocking cash machines is an essential service, we learn.)
There's a lot of looting going on in pharmacies, but to no avail. The drugs are being distributed in convoys, with military jeeps in front and behind. Masks costing a dollar are being sold on street corners for $20. E-mailed ads for counterfeit drugs are filling up my inbox.
27 February 2006 Everyone forthemselves I watch the scenes of a society descending into chaos from the relative security of my mother's isolated home. Red tail lights snake to the horizon as people pour out of the cities. Half the doctors haven't turned up for work; many are either ill, or caring for loved ones.
Who should get the few mechanical respirators that can mean the difference between life and death? The youngest, or those with the best chances of pulling through? "Our leadership must be prepared to make calculated decisions that will force raw prioritization of life-saving resources," explains a colonel on CNN.
17 MAY 2006The dust settles The pandemic was declared over today. H5N1 will be back next year, or before that, as it replaces the existing seasonal flu strains. But by then, those who have recovered from this bout will have immunity, and we will have a vaccine. Pandemics move faster than governments or international bureaucracies, and the cost is hundreds of billions of dollars more than it would have been had we tackled avian flu in Asia in the first place, and invested in flu research. For millions of families, the cost isn't measured in dollars.
Watching all that military hardware on the streets made me think. We imagined we could encourage pharmaceutical companies to develop innovative vaccines and drugs by offering 'incentives' or modest subsidies. When the military knows it needs a fighter aircraft, it doesn't offer incentives to Lockheed Martin or Boeing. It pays them through procurement to develop the weapon to the specifications it wants.
Were we ready? Ready, my ass!
Sally O'Reilly's blog was written by Declan Butler, Nature's senior reporter in Paris.
Возможно, уже начинается 6-я фаза - т.е. уже фактически реальное начало пандемии по классификации ВОЗ...
Boxun Human Bird Flu Cases in Gangcha County Qinghai China
Recombinomics Commentary June 1, 2005
>> China reported last week that a couple of hundred wild geese had died of avian flu in China's remote Qinghai province, north of Tibet. Niman didn't just speculate aboutthe implications. He went to a Chinese-language news source and used Babelfish, an online translation service, to get more aboutthe story.
What he got was not just a couple of hundred dead geese, but a thousand wild birds from five different species. And he obtained reports of 121 human deaths in 18 villages near the site of thebird deaths. Coupled with reports of 200 unusual illnesses, this began to look to Niman like human-to-human transmission of avian flu, with a catastrophic 60 percent case mortality rate. <<
A few clarifications on the commentary on the commentaries are in order. The information on the over than 1000 dead birds near Qinghai Lake comes from many sources. Initial wire service reports described the deaths of 178 bar headed geese. These initial reports clearly indicated that the deaths were not linked to bird flu.
Follow-up reports indicated dead birds had tested positive for H5N1, although the number and relationship to the 178 previously reported deaths was unclear. Clarification came from the initial report filed by China to the OIE, which described 519 dead birds representing 5 species in Gangcha Province, Qingahia Province. These deaths were laboratory confirmed. In the weekly OIE report the 519 were again listed but the report indicated that the virus isolated from thebirds was H5N1 and was highly pathogenic in laboratory infected chickens.
The official report was followed by a news conference, which was widely reported. At the news conference the deaths of over 1000 birds were reported and one media report indicated most were in Qinghai Province, suggesting thebird deaths might be widespread.
Forthe human cases, the initial report came from Promed, who had translated the Abundant News story. That reported indicated six tourists had died. Four were named and three of the four were from Chengdu, Sichuan Province (about 400 miles southeast of Qinghai Lake). The clustering of three deaths of three tourists from the same location would be cause for concern. These initial reports were followed by a report of 121 deaths in 18 communities in Gangcha Province, along with 79 infections generating a case fatality rate of over 60%.
Follow-up reports included a smaller number of cases in more distant communities as well as a news blackout, checks of computer, difficulties connecting to the Internet, and related issues centered on limiting news.
All of the reports linked to the human cases come from the same source and have not been independently verified. However, these reports are quite specific and the severity of the reported events is quite clear and not lost in translation. If verified, these reports would dwarf prior reports on human H5N1 cases and move the 2005 flu pandemic from phase 5, which involve an increase in human-to-human transmission, to the final phase 6, which is sustained and widespread human-to-human transmission.
Although not verified, the reports via Abundant News are quite specific and consistent. The disease described is somewhat atypical, involving fever and vomiting, but not respiratory illness. The specifics in the series of reports are not adequately addressed with blanket denials by official sources in China.
Итак, обстановка похоже накаляется, но в этой теме опубликовано очень много материалов на англицкой мове. Переводить или даже давать выжимки времени у меня нет. Но есть хорошый сервис с переводом с English-Russian (сегодня обнаружил) -
Хм, утверждают, что ниже - фотографии массовой гибели птиц в Китае на острове Boxun. В принципе, возможно - в воздухе нет ни одной (хотя на фото вечер или утро), на второй фотографии (видно с сильныи телеобъективом) видно всего 2 или 3 птицы, держащиеся на ногах
Итак, темой будущей (весьма вероятно) пандемии avian flu заинтересовались в Foreign Affairs и собираются все лето публиковать материалы. Если кто не знает, Foreign Affairs - самое крутое аналитическое издание в США, которым руководствуются в Белом доме.
Preview of a special section coming in the July/August issue of Foreign Affairs.
International health officials are warning that a deadly avian influenza virus may soon spread rapidly, overwhelming unprepared health systems in rich and poor countries alike. If the virus mutates to become easily transmittable among humans, the death toll of the resulting global pandemic could number in the millions.
As a call to action, the July/August issue of Foreign Affairs will be publishing a special set of articles written by Laurie Garrett of the Council on Foreign Relations, Dr. Michael Osterholm of the University of Minnesota and the Department of Homeland Security, and Drs. William Karesh and Robert Cook of the Wildlife Conservation Society. Special condensed versions of the essays by Garrett and Osterholm, along with a Web-only Q & A with Garrett, are available on theForeign Affairs website today.
Nature magazine is providing additional information on the medical and scientific aspects of the H5N1 virus. The coverage of both magazines is being coordinated to assist efforts of the Royal Institution World Science Assembly to spur preparations by governments and international organizations.
Since it first emerged in 1997, avian influenza has become deadlier and more resilient. It has infected 109 people and killed 59 of them. If the virus becomes capable of human-to-human transmission and retains its extraordinary potency, humanity could face a pandemic unlike any ever witnessed.
Preparing forthe Next Pandemic - сцылка by Michael T. Osterholm
If an influenza pandemic struck today, borders would close, the global economy would shut down, international vaccine supplies and health-care systems would be overwhelmed, and panic would reign. To limit the fallout, the industrialized world must create a detailed response strategy involving the public and private sectors.
Laurie Garrett is Senior Fellow for Global Health at the Council on Foreign Relations. She has won the Pulitzer, Polk, and Peabody prizes for her journalism and is the author of The Coming Plague: Newly Emerging Diseases in a World Out of Balance and Betrayal of Trust: The Collapse of Global Public Health. Here she answers questions relating to her current research on the danger of an avian flu pandemic.
Coming in the July/August issue The Human-Animal Link by William B. Karesh and Robert A. Cook
Recent outbreaks of avian flu, SARS, the Ebola virus, and mad cow disease wreaked havoc on global trade and transport. They also all originated in animals. Humanity today is acutely vulnerable to diseases that start off in other species, yet our health care remains dangerously blinkered. It is time for a new, global approach.
Coming in the July/August issue The Lessons of HIV/AIDS by Laurie Garrett
To get a sense of the broader damage a new pandemic might do, it helps to consider the one the world is currently enduring: HIV/AIDS. Because this deadly scourge moves slowly, many of its social, political, and economic effects have yet to be understood. But the impact is hard to overstate. And it is growing.
IN A BULLETIN ISSUED by The World Health Organization May 1, a possible avian flu pandemic was called “unpredictable but potentially catastrophic,” capable of killing millions of people around the world.
Outbreaks of influenza H5N1 have occurred among poultry in countries in Asia, while there have been human cases in Thailand, Vietnam, and Cambodia. According to the U.S. Centers for Disease Control and Prevention, the spread of the virus from person to person has been rare.
“However,” the CDC reports, “because all influenza viruses have the ability to change, scientists are concerned that the H5N1 virus could one day be able to infect humans and spread easily from one person to another.”
A scenario like this would have tragic human consequences, as well as a profound economic impact. Travel would be disrupted, a major blow to a sector such as the meeting industry. As president of Ottawa, Ontario-based Infolink: The Conference Publishers, Mitchell Beer was able to observe the effects of SARS on Toronto — and Canadian tourism — in 2003. “The outbreak was very isolated, yet we heard about people internationally canceling plans to go to Prince Edward Island because of an outbreak in Toronto,” Beer says. “It really underscores the interest an industry like ours has in knowing prevention plans [are prepared].”
The Asian outbreak has been limited to rural areas, and there has been no indication that meeting planners are looking to pull the plug on meetings there anytime soon.
Joan Eisenstodt, founder of Washington, D.C.-based Eisenstodt Associates and moderator of the MIMList, the Meetings Industry Mall listserv, recently tried to get a conversation going on the subject of the avian flu and didn't get many takers. She wonders if the threat is still too remote to have planners thinking about its potential impact. “What I'd like to see,” Eisenstodt says, “Is that any issue, whether condo conversion of hotel rooms, or bird flu, or tsunamis, is viewed as part of the big picture — connecting the dots and looking at the ‘what ifs.’”
“If a planner is taking a major meeting off site,” Beer says, “that planner should know the questions to ask to make sure, for example, that the audiovisual equipment is set up properly and ready to roll.” The same applies to something such as a possible pandemic, he believes. “We have an interest as an industry, and as individuals, to make sure that something like a pandemic flu is being planned for before it's too late.”
Spurred by the 2003 SARS outbreak, Toronto officials are preparing for a possible avian flu pandemic. In a report to the Toronto Board of Health in May, health officials estimated a pandemic could result in up to 5,000 deaths in Toronto alone, and sicken close to 1 million residents. For its part, the CDC is increasing its influenza surveillance capabilities in Asia, working on antiviral stockpile issues, and coordinating with state agencies to help with planning efforts.
Москва готовится к возможной пандемии смертельно опасного гриппа.
"В связи с вероятностью пандемии гриппа, возникла необходимость внесения корректив в организацию профилактических и противоэпидемических мероприятий с целью снижения ущерба здоровью населения и экономике города от распространения нового высоко патогенного вируса", - говорится в подписанном сегодня постановлении главного государственного санитарного врач по городу Москве Николая Филатова.
"Всемирная организация здравоохранения прогнозирует появление в ближайшие годы нового антигенного варианта вируса гриппа, что может привести к развитию крупной пандемии гриппа с 4-5 кратным ростом заболеваемости и 5-10 кратным ростом смертности", - отметили в Госсанэпидслужбе Москвы.
В последние годы в мире регистрируются локальные очаги гриппозной инфекции среди людей, имевших контакт с инфицированными птицами, напомнили в службе, сообщает ИТАР-ТАСС.
"Заболевания гриппом среди людей отличались крайне тяжелым клиническим течением и высокой летальностью: в Таиланде и Вьетнаме 70 процентов заболевших умерли", - отмечают врачи.
По их мнению, "биологических свойств птичьих вирусов меняются и становятся смертельно опасными для человека".
Филатов, в частности, распорядился "подготовить в каждом административном округе план подготовки к пандемии гриппа, а также произвести предварительный расчет необходимого количества вакцин и препаратов экстренной профилактики".
>> Location of the outbreak: Xinjiang autonomous region,Tacheng district, Tacheng city.
Description of affected population: geese. Total number of animals in the outbreak: susceptible: 2,177 cases: 1,042 deaths: 460 destroyed: 13,457 <<
Today's OIE report from China demonstrates how quickly the H5N1 infections are spreading. On May 21, the OIE report detailed 519 dead waterfowl (5 species) in and around Gangcha County and Qinghai Lake Nature Reserve. Thebirds were killed by H5N1 that was HPAI ( Highly Pathogenic Avian Influenza) base on the sequence of the HA cleavage site as well as a biological assay showing that isolated virus could kill laboratory infected chickens.
Vaccines were rushed to Qinghai Province as well as Xinjiang to try to control the spread by waterfowl. All nature reserves in China were closed and the outbreak was said to be limited to wild birds. However, today's report includes the biological assay, suggesting China knew of this outbreak 1-2 weeks ago and this outbreak clearly affects domestic geese.
China had indicated other provinces in China were not threatened, but that was because thebirds were migrating to the north and west, toward Russia and Europe.
Today's report indicates the outbreak was in Tacheng city, which is on the border with Kazakhstan and only about 100 miles from borders with Mongolia and Russia. Tacheng city is almost 1000 miles west of Qinghai Lake. Since today's OIE report includes the biological assay which includes isolating, growing, and infecting the virus into chickens and then waiting forthe chickens to die, it seems likely that H5N1 has already moved into the three adjacent countries.
None of the three adjacent countries have previously reported H5N1 HPAI (bird flu). The rapid movement of H5N1 to the north and west is cause for concern.
Although China has promptly notifies OIE of the wild and domestic bird deaths, they have not provided any specific data on the reported human or other mammalian deaths.
U.S. Officials and Experts Complain of Catastrophic Danger
By Todd Zwillich WebMD Medical News Reviewed By Michael Smith, MD on Thursday, June 16, 2005
June 16, 2005 -- U.S. health officials and infectious disease experts have been sounding the alarm for more than a year on the deadly potential of a widespread pandemic of thebird flu troubling Southeast Asia.
But their warnings have become unmistakably ominous as they struggle to convince the public and policy makers of the need to prepare forthe mass casualties, chaos, and devastation that will likely result if the disease spreads acrossthe world.
As of June 14, 103 people have been infected with bird flu in Vietnam, Thailand, and Cambodia, according to the World Health Organization. Officials yesterday also disclosed the first reported case in Indonesia.
Normally, 104 cases of any disease would hardly grab the attention of public health experts. But bird flu is different. More than half of the cases have been fatal, suggesting an unprecedented level of harm for a modern flu. Humans have no natural immunity to the virus causing the disease, known as H5N1, and no vaccine is available.
In congressional hearings and on television, officials have repeatedly advised the public of the potential for millions of casualties if bird flu gains the ability to easily spread from birds to people or between humans themselves.
Bird Flu Warnings Get Stronger
But the warnings have now become decidedly darker as officials warn of a catastrophic economic shutdown and a global political crisis if bird flu strikes an unprepared world.
"This is much larger than a public health threat. The vast majority of the world just doesn't get how vulnerable we are," says Michael Osterholm, MD, associate director of the National Center for Food Protection and Defense in the Department of Homeland Security and a former bioterrorism advisor to the Bush administration.
Federally run tests of an experimental bird flu vaccine are under way and due to yield preliminary results later this summer. Even if it's effective, no one expects manufacturers to be able to quickly make enough to protect the U.S. population.
Osterholm complains that U.S. officials and companies have not planned forthe widespread logistical disruptions that would result if bird flu were to spread within the next couple of years. His warnings range from inadequate planning for hospital overcrowding to the fact that the U.S. market has only 2.5-week supply of caskets.
Local and federal agencies have not planned for widespread disruptions to schools and workplaces as the public is told to stay home and gymnasiums are converted to emergency medical facilities, he says. Travel restrictions and a run on vital supplies, such as masks able to filter flu viruses, would "no doubt" lead to an economic shutdown, he adds.
What to Do?
What to Do?
Asked at a Thursday forum hosted by the Council of Foreign Relations what can be done to immediately prepare for a bird flu outbreak, Osterholm says there's probably little we can do at this point.
What can the U.S. do to prevent the continued spread of flu from billions of Asian chickens and ducks? "The bottom line message is: almost nothing," says Osterholm, who is also a professor at the University of Minnesota.
World Community Unprepared
Others offer equally stark warnings that the U.S. has not engaged foreign governments over how nations will react in the event of a global pandemic and economic standstill. Poor and middle-income governments have already begun to complain that they are being left out as industrialized countries make deals to buy stockpiles of antiflu medications, says Laurie Garrett, the council's senior fellow for global health and a former journalist.
"We have no agreed-upon mechanisms of any kind," Garrett says. "This could turn into a big, bloody mess."
Bush administration officials told lawmakers two weeks ago that they are hard at work completing a national flu response plan governing issues such as quarantines, hospital capacity, and distribution of emergency pharmaceuticals.
Anthony Fauci, MD, director of the National Institute for Allergy and Infectious Diseases, acknowledged in an interview that officials' public statements aboutbird flu have become unusually stark. He attributes the warnings to concerns over bird flu's apparent harm and to the lack of human immunity.
Officials are also trying to galvanize support for new laws that would give pharmaceutical companies incentive to produce large amounts of vaccine against bird flu and other more common types of flu. "That's the thing that we keep trying to drill at," he says.
Fauci says that "the administration is very much up there" in its level of activity in flu planning.
Meanwhile, other experts remain largely unconvinced.
Steven Hoffman, an audience member at the Council forum, rose to say that the experts' stark warnings had convinced him "to get in my car and move to Montana or something."
SOURCES: World Health Organization, bird flu update, June 14, 2005. Michael Osterholm, MD, associate director, National Center for Food Protection and Defense, U.S. Department of Homeland Security; professor, University of Minnesota. Laurie Garrett, senior fellow, Council of Foreign Relations. Anthony Fauci, MD, director, National Institute of Allergy and Infectious Diseases.
Добавлено в 07:29 Avian flu: 'We're screwed' if it hits soon
Posted 6/16/05 By BetsyQuerna
Health experts and officials shook up a breakfast meeting in Washington this morning with more alarm over what they see is an inevitable avian influenza pandemic and public-health emergency. Also today, World Health Organization officials confirmed the first case of avian flu in a farmworker in the island nation of Indonesia. Known as avian flu because it infects primarily chickens and waterfowl, the officials fear that the virus will mutate and become a human disease. Because this strain has never circulated through the human population, people would have no innate immunity if they were infected. Officials compare the virus to the 1918 pandemic that hit one third of thepopulation and killed between 1 and 5 percent of those infected. This strain, known as H5N1, could be at least that deadly and perhaps more so, especially for young and healthy people who would very likely die from an immune system reaction to the disease, as happened in 1918. Today, if the pandemic hit, the number of dead could be as high as 360 million worldwide.
"You can get rid of the 'if' because it's going to occur," said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. It may not occur this year, or next, he said, "but [the threat] is not going to go away." The disease has currently crossed over to humans in Asia, but only among people who have very close contact with chickens or who take care of the sick. It has killed at least 54 people in Asia but is not now communicable in the way that the more common and less lethal human influenza viruses are.
The virus "is due to spin out of this birdpopulation" that it currently infects, said Michael Osterholm, the director of the Center for Infectious Disease Research at the University of Minnesota. When it does, the fast pace of global transportation and trade is sure to carry it around the world in a matter of days if not hours, the officials said. And while most states have plans in place to deal with public-health emergencies, many of those plans have yet to be tested in real or simulated situations. If the pandemic were to hit today, said Osterholm, "I don't know what we could do about it except say, 'We're screwed.'"
snip: "Today, if the pandemic hit, the number of dead could be as high as 360 million worldwide."
They are finally starting to come to terms with the order of magnitude of possible deaths... but I think the number is still on the bottom end of the scale. One Russian scientist was estimating 1 billion deaths. Can't remember his name or the article... but his math was probably just as good as the next persons until the flu hits and we actually see what happens.
16-06-05 Миру угрожает пандемия смертельного гриппа
Распространение в Азии птичьего гриппа грозит миру пандемией, чреватой гибелью многих миллионов человек и тяжелейшим экономическим кризисом. К такому выводу пришли ведущие эпидемиологи США, передает ИТАР-ТАСС. Директор Национального института аллергических и инфекционных заболеваний Энтони Фаучи и вирусолог из Миннесотского университета, помощник директора центра защиты населения и продовольственных ресурсов при министерстве национальной безопасности США Майкл Остерхолм выступили сегодня с предупреждением.
Ученые считают, что эта проблема требует безотлагательных совместных усилий всего мирового сообщества.
По их мнению, источником угрозы является вирус H5N1, выявленный 8 лет назад в Гонконге и Китае, а позже пришедший также во Вьетнам, Таиланд и Камбоджу. К настоящему времени им заразились свыше 100 человек, более половины из них умерли.
По словам специалистов, вирус чрезвычайно опасен прежде всего тем, что против него ни у кого нет иммунитета, поскольку прежде он людям не передавался. К тому же он, насколько можно судить, гораздо смертоноснее знаменитой "испанки", унесшей в 1918 -19 гг от 20 млн до 40 млн жизней.
В ближайшее время инициаторы кампании подготовки к будущей пандемии гриппа планируют организовать совещание на эту тему со своими коллегами в странах Азии.
ЗЫ - судя по последним данным из Вьетнама и Китая, уже начинается 6-я фаза (финальная) препандемического состояния, характеризующаяся высокой способностью вируса передаваться от человека к человеку - сейчас заболевают уже врачи и др. медперсонал.