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Bird flu pandemic in Bangladesh: Red alert!
Special Correspondent

          For those tracking bird flu, the latest development is a serious cause of worry. In a small village in Sumatra, seven villagers died of bird flu recently, and they were all from the same family. Scientists have not been able to link all of the patents to infected birds, leading them to believe that some of the patients got the disease from their own relatives, the disease has been able to achieve human to human transmission.
This has been proven to be true in latest tests also. This would mean that a pandemic involving human for such a pathogenic (highly likely to cause infection) strain of a virus is now within the realms of immediate matter for consideration.
This would also mean that the task of creating a vaccine is also now even more important, if it was not an urgent task already. Some experts had been suggesting that the world could wait a little bit and that worst-case scenario of a pandemic was only scare mongering. These people actually have not got the real reason behind this so called "scare mongering". There are experts who have called for restraint in talking about bird flu. These experts, this writer believes, do not understand the reason behind the urgent utterances of all other experts who warn people and governments to be aware of the dangers and to work at full swing to make sure that we do not go even close to having a pandemic. The Spanish flu pandemic of 1918-1919 caused an estimated 40-50 million deaths.
The "pragmatists" state that the world is now much more able to treat flu patients simply on the basis of symptoms. Much less people will die. In Bangladesh, we have a proof of what they are talking about and it deals with the outbreak of Dengue .Not many died in the very second year of the outbreak of Dengue. Doctors now know that the symptoms can be treated and they have perfected ways to comfort the patients, keep the disease under check and eventually allow the immune system to fight of the infections with help of drugs.
The name bird flu is derived from Avian Influenza, Avian refers to birds, and flu is the common name of Influenza. There are 15 subtypes of influenza virus A, of which two subtypes cause bird flu. They are the well-known H5 and H7 variety. It is a highly pathogenic type virus meaning the virus is highly likely to cause disease that is why the sobriquet highly pathogenic avian flu (HPAI) is used to denote the virus. The full name given to the virus is H5N1.
How is the bird flu virus passed from humans to people? The virus stays in the intestines of the infected bird. The infected bird passes the virus though feces, saliva and mucus. Eating or inhaling the virus infects other birds. The disease may travel to human bodies through dry specs of feces or by eating infected birds. Quarantining of patients has been done to be just on the safe side. But such a measure is smart because once you allow infected patients to be close to other human beings, the virus may to travel from one human to another via known ways that a disease can travel, drinking from the same glass causing infected saliva to transmit etc.
The common sense approach to talking about bird flu belies the possible danger of this highly pathogenic disease. The nature and course of the infection through the human body, the type of infection, the rate of fatality and the treatment all add together to make the scenario extremely worrisome. The biggest worry is the possibility of a highly contagious disease taking hold in humans and then spreading through a certain population. The terms pathogen and "human to human contagion" are the two terms that constitute all the worries of a pandemic.
The virus meets two of the three conditions necessary to cause pandemic -- it can cross into human beings to cause infection, and it can cause destruction of any antibody in the human population. The third condition -- the ability to transmit from human -- to human is not yet totally established. Once that takes place, the disease would move quickly through a human population and kill thousands. So far, the disease has been contained in the places it has broken out by quick and decisive measures. The infected person or people have been quarantined and the known source of the disease like birds or chickens have been culled or killed en masse. We know that the bird flu does not travel between humans, therefore culling birds and containing the disease has been effective in containing outbreaks.
The pragmatist's logic is that the world is prepared and our own example of dengue actually only serve to dilute the possibility of large scale and absolutely catastrophic possibility of a very serious pandemic involving bird flu. The world is better prepared granted, with antibiotics and modern methods of care giving. However, the bird flu infection is so serious that once there is an outbreak, it will quickly overwhelm the population and the limited number of good hospitals that exists in a city will not suffice to deal with it. Large scale deaths cannot be ruled it.
The lasts news that the virus H5N1 has transmited to humans -- albeit in a limited way is a dangerous news. The human body does not have natural defense against bird flu, and there is no known vaccination as yet. As any outbreak will cause many deaths because the symptoms are multifarious and very strong, any delay in treatment will cause deterioration and death very quickly, it seems.
Currently, four-limited action anti-viral drugs is available. They are Oseltamivir, Zanamivir, Amantadine and Rimantadine. Only Oseltamivir has been given approval by the United States Food and Drug Administration (USFDA). In Bangladesh, the well-known pharmaceutical company Eskeyef, owned by the Transcom group, has come up with a drug called Oseltamivir. Beximco Pharmaceuticals also released their own version of drug with which is called Oselflu capsule. Beximco has even exported the drug in a very limited way. We are happy that the drugs available to treat bird flu are available in Bangladesh. Yet, the drugs are not known to be totally effective, and if the infection is not anticipated or if the infected person does not take quick remedial treatments and drug like Oseltamivir, then death is rather quick. Symptoms range from fever, cough, sore throat, and muscle aches and these are all common influenza type symptoms. Eye infections, pneumonia, and other severe respiratory illness are also reported. In fact, most deaths attributed to bird flu are caused by severe respiratory failure.
A virus first appeared in Hong Kong around 1997. The virus re-emerged, after the Hong Kong episode, as a highly potent pathogen -- disease-causing virus, in 2003 and it spread being carried by migratory birds. Outbreaks have happened in China, Indonesia, Vietnam, and Thailand and with severe causalities, and lesser ones in Japan, South Korea, Canada, Thailand and Cambodia. The first wave resulted in 35 cases and 24 deaths in Vietnam and Thailand. The second wave again in these two countries caused nine cases of infection, eight of which were fatal. The third and largest wave began in December 2004 and as of November 8 resulted in 80 human cases and 31 deaths in Indonesia, Vietnam, Thailand and Cambodia. As of February 2006, we have 165 laboratory confirmed cases. Fatality remains high with at least 50 per cent casualty rate even when the patients have mostly been young and able bodied. With recent outbreaks in Kazakastan, Mongolia, England, Romania, Turkey -- with at least 2 deaths, Malta and India, Bangladesh need to keep a high degree of vigilance.
We hope that when winter comes, Bangladesh will have taken enough measures to track guest birds that may carry bird flu with them. We have supplies of Oseltamivir. However, we also need a plan with documented command centre and medical centres with specially trained teams of doctors and nurses who may be told that they would be expected to take in the first batchers of patients, train other health workers and doctors and generally be in the forefront of the fight against any outbreak of bird flu .The disease may not travel between humans as yet, but in a country like Bangladesh, a colony of infected bird may infect domestic chickens. And that would mean large scale deaths if we are not careful. Red Alert from Now.


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