who sees big gaps in bird flu surveillance

Third last paragraph is interesting


WHO sees big gaps in bird flu surveillance
Tue Dec 6, 2005 12:58 PM ET

By Mia Shanley
SINGAPORE (Reuters) - The World Health Organisation's top bird flu expert in Asia said on Tuesday that a lack of equipment and expertise in the region's rural areas was limiting efforts to curb the spread of the disease.

Laboratory facilities were limited in many countries, especially Cambodia, Laos, Vietnam, Indonesia and China where humans live in close contact with domestic and wild fowl, Hitoshi Oshitani, the WHO's communicable disease expert in Asia, told Reuters.

The H5N1 avian flu virus has infected more than 130 people in five Asian countries and killed 69 of them since late 2003. Scientists fear the virus may mutate into a form that could be easily transmitted between humans, sparking a global pandemic.

"We have to strengthen these capacities," said Oshitani, who is in Singapore to attend a WHO meeting to discuss responses to pandemics. He warned of more bird flu cases as colder weather sets in this year.

Oshitani, who told Reuters in September that there was a slim chance of preventing a bird flu pandemic, said surveillance was still a problem and that Asian governments needed to raise awareness of the virus in rural areas through public health campaigns.

"The big, big challenge is to expand the surveillance network in the rural areas," Oshitani said. "We have to provide some training and equipment and build new facilities to improve the testing capacities."

BACKYARD BIRDS

China, which has already admitted that ill-equipped local doctors may be unable to detect H5N1, faces a huge challenge in curbing the spread of the virus due to millions of "backyard birds" such as free-roaming ducks and chickens.

Oshitani said these backyard birds also posed a major problem in many Southeast Asian countries and that farmers and health workers in rural areas needed better training to detect the virus.

Laos, Cambodia, Myanmar and Vietnam desperately need better access to testing equipment to be able to respond to an outbreak, he said.

Many Asian countries have to send their test samples to Hong Kong, Japan or the United States for detailed analysis -- a process that can take days.
We have to shorten this process," Oshitani said.

He also said he feared funds dedicated to affected countries were not reaching rural areas fast enough. Countries like Indonesia lacked compensation for farmers, so there was no incentive for farmers to report cases of bird flu that were likely to result in widespread culling of birds, he said.

Oshitani said he had doubts about the use of commercial test kits and whether these should be used in remote rural areas.

Rapid tests could not always differentiate between the sub-types of influenza, were less sensitive than laboratory tests, and were still too expensive, he said.

He also said it was still not clear how effective Tamiflu, an anti-flu medicine produced by Roche AG, could be in the treatment of humans with bird flu, or in preventing the spread of the disease in communities which have come into contact with the virus.

Still, the WHO hopes that Tamiflu will at least help contain any outbreak. It has secured one million courses, or 10 million tablets, as a donation from Roche and will secure 2 million more by the middle of 2006.

Oshitani said he will fly to Geneva later this week to discuss the logistics of any release of those drugs with Roche