In comparison to malaria and diarroeal diseases, which together kill over 3 million people every year, bird flu has killed very few people. However, the World Health Organization (WHO) has warned that the H5N1 virus may mutate into a new human flu virus against, which humans have no immunity. The emergence of such a virus would cause a flu pandemic, and kill millions of people around the world. So bird flu needs to be taken seriously.

History of avian influenza A (H5N1)

According to WHO, in 1997, the first cases of human infection with the avian influenza A (H5N1) virus were reported in China, Hong Kong Special Administrative Region (Hong Kong SAR). These 18 cases included 6 deaths and coincided with outbreaks of H5N1 in poultry on farms and in markets selling live poultry. In February 2003, 2 further human cases, with 1 death, were confirmed in a family in Hong Kong SAR who had recently taken a trip to China.

In mid of 2003, this H5N virus started to move widely in poultry in parts of Southeast Asia, spreading within months to affect 8 countries in an outbreak unprecedented in its geographical extent. In December 2003, the first human cases associated with this outbreak occurred in Viet Nam. The disease remained confined to animals and humans in South-East Asia until mid-2005, when the virus expanded its geographical range through parts of central Asia to Europe, Africa and the Middle East. Between 1 December 2003 and 30 April 2006, 205 laboratory-confirmed cases and 113 deaths were reported to WHO from 9 countries. During that same period, the World Organization for Animal Health reported outbreaks of H5N1 infection in domestic or wild birds in approximately 50 countries.

What is avian influenza (bird flu) H5N1?

According to CDC, H5N1 is an avian influenza virus subtype Avian influenza is an infection caused by avian (bird) influenza (flu) viruses. These flu viruses occur naturally among birds. Wild birds worldwide carry the viruses in their intestines, but usually do not get sick from them. However, avian influenza is very contagious among birds and can make some domesticated birds, including chickens, ducks, and turkeys, very sick and kill them.

How do people become infected with avian influenza viruses?

According to CDC, Most cases of avian influenza infection in humans have resulted from direct or close contact with infected poultry (e.g.,domesticated chicken, ducks, and turkeys) or surfaces contaminated with secretions and excretions from infected birds. The spread of avian influenza viruses from an ill person to another person has been reported very rarely, and transmission has not been observed to continue beyond one person. During an outbreak of avian influenza among poultry, there is a possible risk to people who have direct or close contact with infected birds or with surfaces that have been contaminated with secretions and excretions from infected birds

At present, WHO said, bird flu remains an animal pandemic that very rarely infects humans, and that there is no sign that the virus is changing in order to spread more easily from animal to human or from human to human. It stressed that detection of the virus in new regions does not mean that a human pandemic has started. The great concern is that the virus could mutate into a type that spreads easily from person to person. The so-called Spanish flu pandemic that broke out in 1918 is estimated to have killed from 20 million to 40 million people worldwide by the time it had run its course two years later.

What are the symptoms of avian influenza in humans?

According to CDC, Symptoms of avian influenza in humans have ranged from typical human influenza-like symptoms (fever, cough, sore throat, and muscle aches) to eye infections, pneumonia, severe respiratory diseases (such as acute respiratory distress syndrome), and other severe and life-threatening complications. The symptoms of avian influenza may depend on which specific virus subtype and strain caused the infection.

Is there a risk for becoming infected with avian influenza by eating poultry?

According to CDC, There is no evidence that properly cooked poultry or eggs can be a source of infection for avian influenza viruses.

Meanwhile some precautionary measures have been suggested by certain national and international health organizations which include : (i) eating properly boiled (700C) chickens and eggs, (ii) washing eggs and chickens before refrigeration, and (iii) washing hands, utensils with soap and warm water.

Oseflu capsule

As reported in the Press (New Nation, 2006), the Beximco Pharmaceuticals Ltd. of Bangladesh has recently launched "Oseflu" capsule for the prevention and treatment of human cases of Avian influenza (H5N1) causing Bird Flu. The Oseflu capsule is reportedly effective against other types of influenza, that is, Type A and Type B.

According to WHO, as of July 29, 2006, 231 human cases of avian influenza had been reported worldwide and 133 of them proved fatal. The diseases, he said, had been characterized by a high rate of mortality that is over 50 per cent.

Bird flu in Asia

As reported in the Press (Daily Starr, 2006), as of February 19, 2006, bird flu has killed at least 91 people -- mostly in Asia – since 2003, according to World Health Organization. Sick birds have directly infected most victims, but scientists fear the H5N1 virus could change to a form easily passed between humans and spark a pandemic (Washington Post, 2006a). As of March 20, a total of 177 confirmed human cases of AI (H5N1) and 98 deaths were reported to WHO, having 55.4 percent Case Fatality Rate globally, the press release added.

Situation in Bangladesh

Bangladesh at extreme risk of bird flu epidemic

Although Bangladesh continues to be a low prevalence area, but high prevalence countries surround it, as bird flu has already entered in India. According to latest report (Washington Post, 2006), a bird flu case has been detected in India. India reported its first case of the deadly H5N1 strain of bird flu after chickens were found to have died from the virus. At least 30,000 chickens have died in Navapur, a major poultry-farming region of Maharashtra state, of which Mumbai the country's commercial hub, is the capital

Susceptible birds become infected when they have contact with contaminated secretions or excretions or with surfaces that are contaminated with secretions or excretions from infected birds. The H5N1 virus is transmitted between affected poultry. People, vehicles, and other non-living objects such as cages can be vectors for the spread of the virus from one farm to another. When this happens, Bird-flu outbursts can take place among poultry.

We however must not adopt a complacent attitude in this respect as our country has all the determinants for an explosive outbreak of bird flu epidemic. As Bangladesh consists of Wetlands, it engages hundreds and thousands of migratory birds. Therefore Bangladesh is also exposed to a possible risk. The healthcare system is inadequate and over-strained and living is crowded, especially is Dhaka city (The capital of Bangladesh). If the bird flu enters in Bangladesh, it will spread like fire. We still have time for thorough watchfulness, only if we can raise a strong and effective role of Public Administration.

Policy implications

It is important to increase awareness of the population and health care staff of the characteristic symptoms and the need to seek prompt medical attention. All ports and borders of Bangladesh should need to have strict scrutiny and need to approve a plan to boost screening all borders of Bangladesh, bar travelers with bird flu symptoms, and require health declaration forms visitors from affected countries. The border guards needs to be extra vigilant to prevent the smuggling of live birds or poultry products from neighboring countries. Totally stop selling live chicken in Dhaka, Sylhet, and Chittagong. The same sort of awareness building campaign needs to be started through media. Needs to explore the possibilities of import of vaccines in huge amount to vaccinate poultry birds. Additionally we need to establish facilities for diagnosing this virus in various diagnostic laboratories as soon as possible.

The screening centre at ZIA International Airport must clear all travelers arriving from bird flu affected countries before entering Dhaka. All passengers arriving here are also required to monitor their health for few days and report symptoms to ensure the disease has not been carried into the country. Bangladesh has already banned the import of live chickens from seven East Asian countries because of fears over bird flu. And, also, we need to have separate hospital and technical assistance to combat this deadly disease. It is not only quarantining but the entire building, clinic or health facility in which the patient along with the persons that came in contact with the patient are lodged, has to be sealed for a certain number of days. Some scientists suggested that it might be helpful if Bangladesh health ministry to have stocks of other drugs from the same family such as Relenza, or Tamiflu. The farmers who raise ducks in the wetlands needs to safe guard their birds from getting contacted with the migratory birds (wild birds or seasonal birds) by using gill nets.

The border defenders, the Bangladesh Rifles (BDR) need to be especially motivated to be extra vigilant and determined to stop and destroy consignments of poultry and poultry related foodstuff from infiltrating into Bangladesh.

According to the studies by the World Health Organization on avian influenza outbreaks in other regions, backyard farming was the source in many cases. Due to space constraints, backyard poultry owners could not install bio security measures to prevent cross infection (Info, HK, 2006). It is therefore necessary for us to ban such activities to reduce possible infection among poultry, which might eventually cause human infection. No government could bear to ignore the threat of avian influenza. Instead, all are racing against time to prevent any occurrence of human infection cases. It is a matter of fact that backyard poultry keeping activities have posed an immediate and very serious threat to the public health in Hong Kong as well other countries like Bangladesh.

Daily Star mentioned that The UN agencies think there is a pressing need to educate the people of Bangladesh to ensure that they take personal protective measures when dealing with poultry and other birds. They also need to be alert about signs of dead or sick animals in their surroundings for rapid containment poultry outbreaks.

Bangladesh should urgently approve and implement the 'National Preparedness and Response Plan for Avian Influenza and Human Pandemic Influenza', developed with technical assistance from the World Health Organisation (WHO) and the Food and Agricultural Organisation (FAO), to effectively and efficiently respond to the impending crisis. (Daily Star, 2006b)

Therefore, it is very important to take the bird flu threat very seriously and prevention of the disease ought to be the main focus of policies.

Above all, we need to plan policies to prevent spread of bird flu.

Prevention of Avian Influenza in Schools

The school authorities, staff members and students should pay heed to the following:

1. Schools must not keep poultry in the school premises and should refrain from keeping live birds where possible;

2. Establish barriers to prevent children from touching live birds;

Avoid organizing activities that may expose children to live birds;

3. Do not touch live birds, poultry and their excreta (Wash hands with soap and water immediately after contact with live birds or surfaces contaminated by bird droppings). Schools should call the concerned authority for advice on handling sick, wounded or dead birds found on school premises. The Agriculture, Fisheries and Conservation Department will collect the birds for laboratory examination, where necessary.

4.Cover nose and mouth when sneezing or coughing and wash hands with soap and water afterwards;

5.Keep hands clean and wash hands properly, use liquid soap for hand washing and disposal towel for drying hands, do not share towels;

6.Cleanse used toys and furniture properly;

7.Maintain good ventilation;

8.Keep sufficient stock of face masks in the school for staff/students who may need one; and

9.If any students/staff develop respiratory symptoms, they should consult their doctor promptly, wear a surgical mask, and take rest at home and refrain from going to school as advised by their doctor.

Schools should also visit the web site of the Centre for Health Protection of the Department of Health (http://www.chp.gov.hk) for more information on the prevention of avian influenza. (Info, HK, 2006). Further, the children must be kept away from poultry birds and people engaged in poultry activities should take proper safety care so that they might not get themselves infected by the virus. (New Nation, 2006)

Prevention of Avian Influenza in Public Places

(Info, HK, and CDC, 2006)

The public should adopt the following measures to reduce the risk of being infected:

1.Step up hygienic practices like washing hands and keeping the environment clean and maintain good ventilation.

2.Cover nose and mouth while sneezing or coughing. Dispose sputum or secretions wrapped in tissue paper into rubbish bins with lids and wash hands as soon as possible.

3.Avoid crowded or poorly ventilated places.

4.Wear a mask if they develop flu-like symptoms, when caring for the sick, and when visiting hospitals and clinics.

5.Watch out for the latest situation of the influenza pandemic and further announcements from the government.

6.Pay attention to and comply with guidelines issued by the government with respect to prevention of avian flu, traveling and port health control.

Ban on the importation of birds (including pet birds ) and bird products from H5N1-affected countries in Asia and Europe.

7.Ban the importation of birds from areas where H5N1 has been documented

8."Frequent and proper hand washing is of paramount importance".

CDC is taking part in a number of pandemic prevention and preparedness activities, including the following:

1.Providing leadership to the National Pandemic Influenza Preparedness and Response Task Force, created in May 2005 by the Secretary of the U.S. Department of Health and Human Services.

2.Working with the Association of Public Health Laboratories on training workshops for state laboratories on the use of special laboratory (molecular) techniques to identify H5 viruses.

3.Working with the Council of State and Territorial Epidemiologists and others to help states with their pandemic planning efforts.

4.Working with other agencies, such as the Department of Defense and the Veterans Administration, on antiviral stockpile issues.

5.Working with the World Health Organization (WHO) to investigate influenza H5N1 among people (e.g., in Vietnam) and to provide help in laboratory diagnostics and training to local authorities.

6.Performing laboratory testing of H5N1 viruses.

7.Starting a $5.5 million initiative to improve influenza surveillance in Asia.

8.Holding or taking part in training sessions to improve local capacities to conduct surveillance for possible human cases of H5N1 and to detect influenza A H5 viruses by using laboratory techniques.

9.Developing and distributing reagent kits to detect the currently circulating influenza A H5N1 viruses.

As a general rule mentined by CDC, the public should observe wildlife, including wild birds (seasonal birds) from a distance. This protects us from possible exposure to pathogens and minimizes disturbance to the animal. Avoid touching wildlife. If there is contact with wildlife do not rub eyes, eat, drink, or smoke before washing hands with soap and water. Do not pick up diseased or dead wildlife. Contact with the appropiate natural resource agency if a sick or dead animal is found.

Few comments from private and public actors

Professor Mahmudur Rahman Director, Institute of Epidemiology Disease Control and Research (IEDCR) told BSS that the government had already made a three-year plan titled 'National Avian Influenza and Pandemic Influenza Preparedness and Response Plan Bangladesh 2006-08' to prevent the outbreak of bird flu. (New Nation, 2006)

IOM panel member and professor of International Health and Epidemiology at the Bloomberg School of Public Health, John Hopkins University, Donald S. Burke, commented on the usefulness of surgical masks. "Even the best respirator or surgical mask will do little to protect a person who uses it incorrectly, and we know relatively little about how effective these devices will be against flu even when they are used correctly."

(Newsblaze 2006).

The UN representative in Bangladesh, Louis-George Arsenault, urged the government to participate in a bird flu preparedness program to “efficiently respond to the impending crisis.” He also mentioned “I am in constant fear it may break anytime in Bangladesh,” said Abdullah-Al Noman, the fisheries and livestock minister. Khaleej Times (2006).

The UN Resident Coordinator, Louis-Georges Arsenault, has urged the Government of Bangladesh to approve and implement the National Avian Influenza and Human Pandemic Influenza Preparedness & Response Plan (hereafter referred to as “the Plan"), which has been prepared with WHO and FAO assistance. (Daily star, 2006b)

Director Administration of the Livestock Directorate Motalib told, “Now the winter has ended and most guest birds have gone back to their home countries and Bangladesh is in the routes of the guest birds. That is why Bangladesh is in the potential threat of being attacked by the flu. (English People, 2006). He also mentioned that "We are not leaving any stone unturned to prevent the bird flu's entry into Bangladesh." (English People, 2006).

UN Resident Coordinator ad interim to Bangladesh, Louis-Georges Arsenault, as saying, "Now that we have an outbreak of the Highly Pathogenic Avian Influenza (H5N1) in the western state of Maharashtra in India and also in Myanmar, there is heightened concern among development partners and government officials within Bangladesh regarding a potential and imminent threat of Bird Flu, which could have the most devastating consequences." (Daily Star, 2006)

Health and Family Welfare Minister of Bangladesh, Khandaker Mosharraf Hossain said that Bangladesh, “so far, remained free from bird flu, but seasonal visits of migratory birds and geographical proximity with some highly infected countries posed a threat” (Daily Star, 2006)

WHO Regional Director Samlee Plianbangchang said, the virus H5N1 had crossed the species barriers and already infected human beings in 10 countries globally. He described the threat of avian flu, coming in the wake of outbreaks of Nipah and Sars, as a formidable challenge of diseases. (Daily Star. 2006)
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Shakeeel Ahmed Ibne Mahmood writes from Bangladesh
E Mail : shakeel.mahmood@gmail.com