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Health and medicine

Concern grows with bird flu cases in Turkey

The outbreak outside Southeast Asia has officials on alert, but also finding some encouraging signs.

By LISA GREENE
Published January 12, 2006

As cases of bird flu spread around Turkey this week, signs of increasing fear spread around the globe.

Greek workers are disinfecting cars at the Turkish border. A Russian legislator urged people to grab rifles and shoot birds from the sky. American companies are talking about banning feathers as decorations for greeting cards.

In the United States, health officials worked on two fronts Wednesday: taking new steps to prepare for the possibility of a worldwide flu epidemic, but calling for calm.

"We're very concerned," said Dave Daigle, spokesman for the federal Centers for Disease Control and Prevention in Atlanta. "Now we've seen an outbreak outside Southeast Asia, which we had not seen before."

The CDC is sending two people to Turkey to help investigate the outbreak, Daigle said. Investigators want to review lab work on the flu and more testing needs to be done.

But Daigle and other health officials stressed that bird flu has yet to show any sign of spreading person to person, and said the latest cases in Turkey offer some encouraging signs.

"Everything we've heard so far looks like contact with sick or infected birds," Daigle said.

That contact is key because health officials' greatest fear is that this lethal strain of bird flu, known as H5N1, could mutate, allowing swift human-to-human transmission around the globe, potentially killing millions.

Turkey has reported 15 human cases of bird flu this week, including two children who died. The worldwide death toll stands at 78.

But U.S. doctors said Wednesday they're intrigued by two other cases. Two Turkish boys have confirmed cases of H5N1 but have yet to show any symptoms of the disease.

World Health Organization officials say the boys are the first to be diagnosed so early. U.S. doctors said Wednesday the boys offer hope that bird flu might not be as deadly as feared. Reported cases in Southeast Asia have been devastating, with the disease killing half of those it infects.

"With every new disease, the most severe cases come to initial attention, and then as we look harder, we see milder cases," said Dr. William Schaffner, chairman of preventive medicine at Vanderbilt University and board member of the National Foundation for Infectious Diseases.

"We've always wondered that," Daigle said. "Is this disease really lethal, or is it a matter of not finding the folks who didn't have symptoms, or who recovered very quickly? This is something we've got to figure out."

CDC officials want to do blood tests in areas with outbreaks, Daigle said, to see if there are people who have antibodies to the virus, indicating they were infected but recovered after mild or no illness.

The cases so far are scattered around Turkey, an indicator that they really do come from direct contact with birds, said Dr. Doug Holt, infectious disease professor at the University of South Florida and director of the Hillsborough County Health Department.

"I'd be more alarmed if they were all happening in one village," he said. "It seems to suggest that the birds in a large area are infected . . . and it's not a matter of it passing person to person."

Even though the illness is halfway around the world, it already has had an impact on Holt and other local health officials. Holt's staff has rehearsed for a worst-case scenario of worldwide flu, and Holt has met with several local hospital leaders.

Hillsborough County emergency officials plan their annual mass casualty drill for late May or early June. This year's scenario: pandemic flu.

Emergency workers will be deployed around the county to set up distribution centers for vaccines and other medicine. Hillsborough emergency manager Larry Gispert said they might be thrown a few worst-case challenges.

Imagine, for instance, that 75 percent of police officers are gravely ill and can't go to work.

It's too soon to know whether such preparation will ever be needed, Schaffner said. Some flu specialists are starting to believe that the H5N1 strain won't mutate, since it hasn't yet.

"It's always an uncertainty," Schaffner said. "We're always at the infectious disease roulette table."

So far, Turkey's bird flu cases appear to have had little effect on Tampa Bay residents' travel plans. Three agencies said they haven't had any cancellations.

"I had someone yesterday who had planned a trip" to Turkey and Greece, said Binnie Coopersmith, international specialist at Westshore Travelworld. "I guess people are getting kind of immune to all these various scares, both medical and terrorism."

Closer to Turkey, fears are greater. Across the border in Georgia, villagers slaughtered chickens, geese and ducks en masse Wednesday, while in neighboring Greece, Georgia and Syria, authorities beefed up border inspections.

In Russia, nationalist lawmaker Vladimir Zhirinovsky even urged men to grab rifles and shoot migratory birds to keep the virus at bay.

The European Union announced it would keep monitoring wild and domestic birds around the 25-nation bloc until the end of the year, and a Swiss soccer club canceled a trip to Turkey.

The measures were taken despite World Health Organization assurances that there is no evidence of person-to-person infection.

"There is no reason to panic," said Dr. Marc Danzon, the WHO's regional director for Europe.

Health officials again urged Turks to avoid touching or playing with fowl - a common factor in all 15 cases. (Cooking kills the virus.) Turkey's government ordered more than 300,000 fowl destroyed as a precaution.

Times staff writer Bill Varian contributed to this report, which used information from Times wires.

[Last modified January 12, 2006, 01:26:11]