Pandemic risk rises as bird flu spreads

The fact that the flu has reached Africa , the globe's poorest continent - already heavily burdened with AIDS and malaria - is extremely worrisome, the experts said.

United Nations agencies are scrambling to form medical and veterinary response teams and to reorient a polio surveillance network they have created in Nigeria to search for avian flu.

"These are horrendous developments, whether you're a human or if you're a bird," said John Oxford, professor of virology at Queen Mary's college at the University of London . "Everyone wondered what would happen if avian influenza came to Africa , but no one really prepared. They waited. Now it's there - and this is not the most organized continent in the world."

Most bird flu cases have been in Asia . On Sunday, Indonesia said two women had died last week from bird flu, pushing the death toll from the disease there to 18, The Associated Press reported from Jakarta .

European officials announced Saturday that the deadly H5N1 strain of the virus had been detected in wild birds in Italy and Greece , the first time its presence has been detected in the European Union, and also had been found in Bulgaria .

"The bird flu virus has arrived in Italy ," Francesco Storace, the Italian health minister, said at a news conference, announcing that 17 swans had been found dead in three southern regions: Calabria , Sicily and Puglia . Tests on samples from the swans at the Italian National Avian Influenza Lab in Padua were positive for bird flu, he said.

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

World health officials said they have not had the cooperation they need from many poor countries, even those on the flight paths of migrating birds known to carry flu.

Because of poor surveillance and rudimentary laboratory capabilities, they often receive lab samples for testing weeks or months after problems begin. For that reason, they worry that the disease is already much more widespread than they can prove.

"We are fighting the good fight, but to win it we'll need a lot more proactive surveillance and prevention," said Juan Lubroth, a senior veterinarian at the UN Food and Agriculture Organization in Rome .

There is strong evidence that bird flu took root in Nigeria "a few months ago," Lubroth said, even though it was confirmed only last week, after veterinary officials there had said last Monday that bird flu was not in the country.

The outbreak gained official attention only after 40,000 birds died on a commercial poultry farm in January. But such farms are generally the last place to have outbreaks, Lubroth said, because they are relatively isolated from the general poultry stock.

The virus may have percolated in backyard flocks for months, he said.

"How long has it been trickling around, with five deaths here and five deaths there, and owners would possibly not be aware of the problem?" he asked.

In Azerbaijan , which reported its first cases on Friday, bird flu was only "picked up because of international pressure to come clean," Lubroth said.

There may be more unreported outbreaks in Africa and the Caucasus , he said.

"We've been repeating over and over to countries that they have to be vigilant, but in most countries it's business as usual. They say, 'Avian influenza isn't here now. We'll deal with it when it arrives.' But then it's too late."

Maria Cheng, a spokeswoman for the World Health Organization, said the agency suspected there might be human cases of bird flu in Africa, but had no way to confirm that yet.

"We're getting a team ready to go," she said, "but we're waiting to get the invitation from Nigeria ."

Thanks to a massive infusion of cash from a World Bank donors conference on bird flu in Beijing last month, the UN food and agriculture agency now has almost 30 million to help poor countries combat the disease.

But even when scattered UN teams are in place, the disease could spread faster than they can track it, experts said. The health care systems of most African countries are so broken down that most are unable to vaccinate children or distribute AIDS drugs without Western financial aid and technical advice.

The only WHO-licensed laboratories in Africa that are sophisticated enough to sequence flu viruses are in Egypt and South Africa .

Little is known about the spread of even regular seasonal flu, said Michael Perdue, a scientist with the World Health Organization influenza program in Geneva .

"We get samples that South Africa takes from neighboring countries," he said, "but we know very little about central Africa ."

Also, confusion about avian flu is clearly rife in Nigeria .

On Monday, the chief of veterinary services in the Nigerian state of Kano assured the country that the epidemic, which had killed 60,000 chickens in mid-January, was avian cholera - a disease with different symptoms that is caused by bacteria, not a virus.

The Nigerian government announced Saturday that the U.S. Embassy had promised 25 million in aid and 2,000 protective suits for use in fighting the outbreak. Northern Nigeria is one of the world's last outposts of endemic polio and a major eradication drive is going on there now.

David Heymann, who is in charge of the World Health Organization polio campaign, said the 300 Nigerian health workers now trained to spot paralysis cases in children and collect fecal samples for polio tests could be trained to look for cases of flu and pneumonia and possibly to collect nasal swabs.

"They have vehicles and cellphones, so they're a valuable resource," he said. "It's a logical piggyback."

With little accurate information about the disease's spread, scientists have been left to speculate about the possible impact of the disease in Africa .

Population density is lower than in Asia , Heymann noted, which could slow the spread.

"Flu could wipe out all the chickens in a village, but there's still savannah or jungle between the villages," he said. Also, living with birds under the same roof is somewhat less common than in Asia .

But Africa also has the worst AIDS epidemic in the world in some countries nearly a third of the adult population is infected.

In the initial stages, having a depressed immune system could have a protective effect, said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, because virulent flus set off a powerful immune reaction that can drown the lungs in fluid.

However, he added, it would probably hurt patients trying to fight off secondary immune reactions.

But HIV-infected people who managed to fight off bird flu would become ideal crucibles in which the H5N1 virus could exchange genes with other viruses, dramatically increasing the likelihood of a bird flu strain that could readily infect humans.

"If H5N1 gets into people with AIDS it would likely persist and throw off mutants left, right and center," Oxford said.