Where in the world is the H5N1 virus?

It most likely was transmitted through a housefly. It has been confirmed that houseflies can be carriers of H5N1.

300 meters (yards) is in our perception 'close contact'. The boy wasn't fixed/glued etc on one place and the poultry either.
Infected poultry droppings plus virus material can be spread by walking thru it, when dry mixed with dust and spread for 1 km at least without a problem.
Virus can spread by infected materials like a barrelwheel, bucket, boots so footsteps.

This is again a sample of suggestive communication, and giving food for wrong thoughts.
300 meters/yards is CLOSE contact.
No contact means NO contact, which implicates a New York citizen who lives in the centre and works in the centre and has no relatives on the countryside for example.

In Indonesia (my father originates from that country) poultry and people live together for centuries. It's part of culture. The region where the poor boy lived is known for infected poultry.

If you kept an eye on the news you know in Indonesia lots of infected chickens display no symptoms, just like infected ducks and geese. So they become immune for the virus. That's a normal development. The strongest survive, reproduce and give offspring that's no longer sensitive to the bug.
Also chickens shed the virus like the waterfowl and poop out small amounts of virus material. It is in certain regions not longer to tell if H5N1 is present because the birds don't fall ill or die anymore. Unfortunate people who are vunerable to the virus will become ill and the cause is 'not to be found'.

H5N1 was once a low pathogenic field virus first sequenzed in the late seventies in wild geese. None became seriously ill, just a small influenza infection. It mutated in a high pathogenic virus, most likely in large stables domesticated poultry and first appeared in semi-wild conditions kept waterfowl. It was spread by transport and people and thus infected more and more domestic poultry.
If H5N1 was so terribly deadly there wouldn't be flying around a wild bird anymore.
Therefore the 'title' High Pathogenic is only applicable to industrial poultry or wild and backyard poultry with some kind of illness or parasite investation so it's the last strike to kill such a bird.
Accept for bioindustry poultry like broilers and layers who are bred for production and not for disease resistance, not much birds and backyard poultry dies of H5N1.
It's less than 10% of the chickens in villages (kampongs) in Indonesia (that are never cured for worm infections like our poultry) that fell ill or died. Most deaths of poultry are caused by culling to prevent the spread in the backyard poultry. Yes, broilers and layers in industry die within 4 hours - 7 days when infected. Their deaths mean economical loss and that's very important! Don't mix up poultry deaths with the danger of H5N1. Like in people not every bird will become ill or die. It just depends.

H5N1 is therefore not that dangerous as the media will let you believe. It's part of the 'pandemic-game'.
Like I wrote in my posts on your topic 'bird's eye view' this week, the hysteria is fed by this kind of 'news'.
Speaking about 300 meters/yards as 'having no contact', is for every reasonable thinking person nonsense.
Compare the virus spread with the smoke of fire. On a distance of 300 meters you still smell the smoke.

You are correct about the spread in the wild fauna. That is happening too in Europe.
The infected litter of the stables in the east is dumped in the wetlands of the Donau and thus it infected the wild bird population. Because wild birds are not sensible to the virus they can have it without signs. There are a lot very healthy wild birds who won't become ill as long as they are fat enough.
At the end of the coming winter when eg spring is late and the birds consumed their fat, they will become ill and maybe die when they have internal parasites like worm infections too. That's what caused the death of young swans on the Isle of Rügen in 2005. Those young swans have never left the place where they were born, they were still wearing their juvenile feathers, a sign they didn't migrate at all. How became those infected? By their parents perhaps. But only when their immunesystem got less, they became ill. They were as skinny like hell because spring came late and winter was bad.

This might explain some.

Sigrid van Dort
Holland

It has already been established that the virus has spread from person to person. The death rate is extremely high. The real problem arises if it mutates into a form that spreads more easily. Some think this is just a matter of time, given the nature of flu viruses.
For those that are interested, the free guide to pandemic bird flu preparedness can be downloaded at: http://www.pandemicinfosite.com

Sorry Revere...testing post

The 'human to human' transmission of H5N1 was between two sisters who both died on Java.
The other 'human to human' transmission occured in one family, that's called a cluster-infection, on Sumatra, five died or four and one survived I can't remember. There was also last year an infection from father to son but the boy recovered, the father died age 32.

There are no known nor confirmed cases of human to human without being family related.
So: is it the same source of did the others caught it from an ill relative?
The two sisters, they lived apart, the younger got the virus from the elder when she took care of her, both same genes. Both sister's children did not get it, nor husbands or other relatives.
The family on Sumatra had two ill people, the other three fell ill in the next 3 weeks. There was a lot of infected poultry around.
The father of the boy was working with poultry on the market so was infected by poultry. The 4 yo boy recovered: half good genes.

The website 'pandemic info site' is fun and will generate good money by advertisements etc. Think its more profitable at this time than a site about alien invasions.
I now understand all the fear. Sites that reflect news thats less coloured are not interesting, people like to fear danger that isn't there. Just like horror movies. Safe fear but it 'could' be possible.

In Europe such a site would be laughed away and marked as: nonsense.

Who proves vampires don't exist?
Who proves H5N1 will lead to a pandemic flu?

Both: nobody there is not much difference between the two, isn't it?
Both likely but unproven, just guessing.
The so called prove on the pandemic info site isn't prove at all when you know the facts.
Pandemic = business.
It feels to me the Americans LOVE the threat of a pandemic flu, otherwise there is no explanation for this fad.

That might explain there is so little protest against the Iraq war too, where your children, husbands and wives, sisters and brothers die for a bunch of wild tribes who kill eachother anyway as they do already for centuries.
The amount of American victims in Iraq far exeeds the amount of worldwide victims of bird flu.

Where is your sense of reality?

Forgive me if I offend you, this is absolutely not mentioned insulting or rude.
We're allowed to speak about everything here, also sensitive matters.
I love my American friends and am worried when their loved ones have to go to Iraq for 15 months after only a 5 weeks of intensive training. THAT is threatning and scary.

Sigrid van Dort
Holland

Sigrid: We have posted on the alleged family relationship issue. That is not likely valid although the data are too sparse. See our post here.

Everyone seems to have a theory about where this boy got his H5N1 (assuming the diagnosis is correct, of course). There is virus in the environment (dust from birds and feces of birds) but is it infective? Houseflies are known to carry this virus (and many other viruses) mechanically, but how is it transmitted to people? Are there other animate reservoirs? We don't know the answers to the question of "Where in the world is H5N1" yet.

Crawford Kilian's H5N1 Croftsblogs and the Effect Measure are two of my favourite sounding boards, for all matters regarding the Bird-Flu virus.

Refreshingly, almost all of the posts as well as the comments of the visitors to these two sites are well thought out and reasonable.

Even though the Boffins on the Effect Measure do have their shin dings every now and then, it is almost always based on facts and not fiction.

Of course there are exceptions.

So as I was going through the Effect Measure blog today about the really interesting problem, of the apparently invisible source of the H5N1 virus, that seems to appear out of no where, causes a certain number of human infections and then promptly vanishes as quietly as it had arrived.

I was impressed with the bit at the end of the post saying:

"Maybe it's not true that almost all cases are from infected birds. Maybe there are other reservoirs in the environment, animate or inanimate. There is some equivocal data from feral cats. What else? There has been very little systematic surveillance of wildlife other than birds for infection with this virus. Maybe it's time to do it. Just a thought."

Revere, I believe that you are absolutely correct.

This is exactly the conclusion that I have arrived at after having monitored the ongoing Bird-Flu saga over the last 3 years.

It is true that every now and then there is a small "cluster" of Bird-Flu fatalities resulting in banner headlines in the main line media, as well as in the flubie blogs, declaring a mutation of the virus enabling it to jump the species barrier from birds to humans.

If you examine all the statements closely however, you will find that there was never a definite positive confirmation of a human to human infection at the time of any of these clusters.

Instead, there is always a "negative proof" (such as there were no birds near the victim) provided for the perceived human to human infection of the virus.

There is ample proof on the other hand, of other reservoirs of the H5N1in the environment.

The H5N1 has infected not only birds and humans, but also many other mammals over the last few years.

It has been found in creatures, ranging from shrews, pigs, cats, dogs to even tigers and leopards!

See: http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_ui…

(Moreover, a close look through the very large archived data, comprising of Bird-Flu News as well as Blogs at the www.birdflubreakingnews.com, will show that these non-bird-H5N1 cases have been more frequent than is realised by most of us.)

I have lived in South East Asia for a while and can tell you that the flocks of poultry are not the only form of life, in constant and close contact with humans, in the rural settings in that area.

So I thought that the post by Revere was really informative.

A responding comment from Sigrid van Dort of Holland was also very interesting.

He is from the why-panic-about-the-bird-flu camp and presents fairly reasonable arguments for the same.

I think that he is wrong about many things but his posts are worth reading.

But then, along came JOHN, the exception that I had mentioned.

There was this post that began with the very firm and apparently absolutely true statement:

"It has already been established that the virus has spread from person to person." said John, adding that "The death rate is extremely high".

"The real problem arises if it mutates into a form that spreads more easily." John informed us, "Some think this is just a matter of time, given the nature of flu viruses." he said, sounding now very much like the phseodo bird flu sites that are really pointers to a bird flu related product for sale.

Sure enough in the next line John invited us all to go to his site where he is offering all kinds of goodies, including a guide to the Pandemic Bird Flu!

John, I agree that there is nothing at all wrong in trying to promote any products, could I please respectfully try to persuade you not to peddle your goods at this blog, as there is very little chance of any one here receiving the undoubted benefits of these goods and services.

Sigrid, I can not agree with you more about "John's Pandemic bird flu site".

However:

"Who proves vampires don't exist?
Who proves H5N1 will lead to a pandemic flu?"

Come now.

That kind of argument is surely not worthy of you!

You're correct, taking it out of the context it sounds crazy.
When you put it back, give it a serious thought.
I think catching flies is below this blogs level.
Thanks,

Sigrid van Dort

Sigrid van Dort.

What happens if you are wrong?

While not minimizing the horror of a potential pandemic, I ask your indulgence in using my necessarily long comment to ask colleagues for suggestions on dealing with another eminent catastrophe, whose end point, in the worse case, would be a spasm nuclear war ending in omnicide.

My alarm is compounded by the fact that a search of DOD's MHAT-IV, across all of the science blogs, turned up no hits.

MHAT-IV is an unclassified DOD study of troops in Iraq which for the first time asked Army and Marine troops if the committed abuse/torture and if they would report on fellow troops who participated in torture/abuse.

On finding that a significant percent of the troops interviewed admitted that they had engaged in abuse/torture and that a very substantial proportion said that they would not turn in any trooper who committed abuse/torture, MHAT-IV makes several recommendations to alleviate this potentially massive lethal problem. Alas, commonsense as well as the empirical literature suggest that the recommendations, even if carried out, would be all but worthless. Interestingly, General Petraeus was sufficiently alarmed by the findings of MHAT-IV that he issued a letter to all troops under his command in Iraq. Tragically, his letter is so unpersuasive that it cannot be expected to be of any real use.

It is not hard to see that unless the scientific community very quickly does a critical analysis of the report's recommendation and develops remedies that are likely to solve both problems (this is the relatively easy part) and builda enough political pressure to force the military to undertake these measures (this is the harder part), it is highly predictable that the abuse/torture will continue leading to more military actions against U.S. troops by the resistance resulting in massive blood letting (think Black Hawk Down in which the deaths of a couple of dozen Americans resulted in a rescue which killed hundreds and probably 1000s of civilians).

By not dealing effectively with torture/abuse while ignoring MHAT-IV's profoundly inadequate "remedies", we risk a disaster orders of magnitude greater than Black Hawk Down. And unlike the pandemic that we prudently fear, but may not be able to prevent, an entirely preventable incident ripe for precipitating spasm nuclear exchanges may lead to the death of us all.

I urgently request help. It seems up to us, since no one else will tackle, or even take notice of this thrat to our survival. Plainly this is a classical multidisciplinary problem. I can furnish a good bit of knowledge of the problem itself, law and ethics and pragmatics of torture, relevant social science, public health and military research. But I cannot possible succeed without the help of others with these and allied skills + media and political contacts if the a preventable disaster is to be averted.

Help! Help with your suggestions, work and contacts!

Tom
Thomas J. Nagy, Ph.D.
tom500k@yaho.com

former NIH Postdoctoral Fellow in Psychiatric Epidemiology and Biostatistics, Johns Hopkins.

former invited lecturer at the National Defense University, Washington, D.C.
etc.

H5N1 bird flu: Spread by drinking water
Risk evaluations of the German authorities BfR/FLI and UBA are fundamentally wrong

The lethal H5N1 bird flu virus will be transferred to humans via drinking water also in Germany, as with the birds.

Recent research results must worry: So far the virus had to reach the bronchi and the lungs of humans in order to infect man. Now in Indonesia it infects the upper respiratory system (mucous membranes of the throat and mucous membranes of the nose e.g. when drinking and probably also the conjunctiva of the eyes as well as the ear drum skin diaphragm e.g. at showering).

In three cases (Viet Nam, Thailand) stomach and intestine by the H5N1 Virus were stricken, not however the bronchi and the lungs. The virus must have been thus orally taken up, e.g. when drinking contaminated water.

The performance to eliminate viruses of the drinking water processing plants in Germany regularly does not meet the requirements of the WHO and the USA. The performance of flocculation and filtration to eliminate viruses from surface water reaches maximally 99.5%. The WHO demands 99.9999% to 99.999999%. The ventilation and high-speed filtration from groundwater to eliminate iron and manganese do not eliminate any viruses. The USA requires 99.99%. Conventional disinfection procedures by chlorine are poor, because viruses are chlorine tolerant and occur in the raw water not individually, but clumped and therefore by chlorine cannot be achieved.

Contact: soddemann-aachen@t-online.de

@ Tom DVM:
My problem is that I always stay calm and let my brain do the work, not emotions.
Looking at all the facts, not the interpretations which are subjective, I can't see a connection between H5N1 and a pandemic human flu.
To me Sars is far more dangerous, based on facts. That could spark a pandemia more likely when it escapes from wherever it is now.
TBC is dangerous too, there is a variety that does not react on medication.

And if I'm wrong, at least I have still my brain, not affected by fear or other emotions and I will take measurements if there are any.
I still live in peace and enjoy life without being bothered about what 'might' can happen.

Therefore I say all the time: vaccinate all domesticated poultry (and pigs if there is a vaccin for) and there is no problem. The poultry is the source. Raise worldwide funds, stop crazy wars and use all the money available to stop the spread of H5N1 in BIRDS.
Also in the poor countries. You don't want to know about the amount of infections in Egypt and Africa, they are not in the news.
If all poultry is vaccinated the virus will die in the wild bird populations within a few years, as normal.

There are too many and too large concentrations of weak industrial poultry, that gives mutations of harmless field viruses. Perfect example is the H5N1 low pathogenic strain found in Massachusets turkeys. There is a harmless variety too, but it easily can mutate in such mass stables. Therefore: vaccinate all poultry (for H5 and H7).

Think it's not too late but time is running out. H5N1 seems to become endemic in the east of Europe like in Asia. It takes 2 jabs and 2 weeks for poultry to become immune.
Guess we've to wait for some more serious outbreaks before trade is less important than health.

The solution is so simple and I wonder why nobody sees it.
Guess money/economics/trade blinds.

Sigrid van Dort
Holland

<>

Sigrid,

In trachoma it's been found that flies are definitely a vector. This was accomplished by PCR testing.

Marissa, flies spread the virus to the eyes? E.g. the Ethiopian child we always see covered in flies in and around the eyes? Havent heard that, but I would buy it just on knowing what those flies already carry.

Any definitive studies?

Trachoma is caused by Chlamydia trachomatis (bacteria like organism so big one) says the Dutch Health site of the government. Easily to be treated with antibiotic eye drops (based on 'ordinairy' tetracycline).

Trachoma is caused by bad hygienic circumstances and you can get it from dirty towels etc when in the Middle East or Asia. Tourists are warned for it. Guess flies are to be counted also under bad hygienic circ. too.
As Mr. Kruger says, flies can carry a lot of ugly things.

Don't know what that has to do with H5N1 that needs to enter the respiratory system. Guess if you inhale a fly just flewn away from a H5N1 corps and it has virus in its trachea he might maybe possibly infect you?

The way a virus has to go in order to infect people is rather complicated. It has to be digested or inhaled from the air. Don't know if a fly is enough.

In the beginning of the Aids Scare there was also such a story that muskitos who bite a HIV positive person could carry the virus to healthy persons when penetrating their stinging nose into them. Never proven, you have to do more to get HIV. Even tears of a patient were not enough to infect others.

Always when there is a Scare these kind of strong stories appear.

It's known you can get an eye infection from some strains of bird flu, like H7N7 we had here in 2003, the recent outbreak in Wales also induced eye infection. Squeezed some oranges extra at that time, lol.

Did not read any report from WHO or any other org. about the minor symptoms of an H5N1 infection, we only hear the cases that are hospitalized. Guess the amount of bird flu victims triples when counting the people who did not reach a hospital in time and died at home of pneumonia. The same amount or even more who recovered, which influences the statistics dramaticly. But what we don't know, we can't use as an objective.

Sigrid van Dort
Holland

With high path H5N1 in Hunan, and a few extra billion rats kicking around Dongting lately http://tinyurl.com/3ycrzt between increased waterfowl feces being tracked everywhere and a possible rodent reservoir, I wonder if we'll see some accelereated avian flu activity in the next month thereabouts.

H5N1 bird flu: Spread by drinking water
Risk evaluations of the German authorities BfR/FLI and UBA are fundamentally wrong. The lethal H5N1 bird flu virus will be strong seasonal in the cold transferred to humans via cold drinking water also in Germany, as with the birds.
Recent research results must worry: So far the virus had to reach the bronchi and the lungs of humans in order to infect man. Now in Indonesia it infects the upper respiratory system (mucous membranes of the throat and mucous membranes of the nose e.g. when drinking and probably also the conjunctiva of the eyes as well as the ear drum skin diaphragm e.g. at showering).
In three cases (Viet Nam, Thailand) stomach and intestine by the H5N1 Virus were stricken, not however the bronchi and the lungs. The virus must have been thus orally taken up, e.g. when drinking contaminated water.
Ground water in Germany used for drinking water is not free from viruses as the German authorities BfR/FLI and UBA wrong insist. The performance of the drinking water processing plants to eliminate viruses in Germany regularly does not meet the requirements of the WHO and the USA. The performance of flocculation and filtration to eliminate viruses from surface water reaches maximally 99.5%. The WHO Drinking Water Guidelines (2004) demands 99.9999% to 99.999999%. The ventilation and high-speed filtration from groundwater to eliminate iron and manganese do not eliminate any viruses. The US Ground Water Rule requires 99.99%. Conventional disinfection procedures by chlorine are poor, because viruses are chlorine tolerant and occur in the raw water not individually, but clumped and therefore by chlorine cannot be achieved.
Contact: soddemann-aachen@t-online.de

Grippe de l'oiseau H5N1 transmise par l'eau potable.
Les évaluations de risque des administrations allemandes BfR/FLI et UBA sont fondamentalement faux que le virus mortel de grippe de l'oiseau H5N1 sera transféré aux humains également en l'Allemagne exact saisonnier pendant le froid par l'intermédiaire de l'eau froid potable, comme avec les oiseaux.
Les résultats de la recherche récents doivent s'inquiéter: Jusqu'ici le virus a dû atteindre les bronches et le poumon des humains, afin de coller dessus. Maintenant il infecte en Indonésie le système respiratoire supérieur (membranes muqueuses de la gorge par exemple en buvant, les membranes muqueuses du nez également et probable également la peau obligatoire des yeux aussi bien que le diaphragme de peau de tambour d'oreille par exemple à la douche).
Dans trois cas (Vietnam, Thaïlande) l'estomac et l'intestin étaient par le H5N1-Virus frappé, pas cependant les bronches et le poumon. Le virus doit avoir été oralement pris ainsi, par exemple quand l'eau souillée potable.
Leau du sous-sol en Allemagne utile comme eau potable nest pas ainsi de quelle pureté et sans virus comme les administrations allemandes BfR/FLI et UBA faux prétendre. La performance delimination virus des installations de transformation d'eau potable en Allemagne ne remplit pas régulièrement les conditions de l'OMS et des Etats-Unis. La floculation et la filtration atteint lelimination virus au maximum de 99.5%, l'OMS exige pour leau surface 99.9999% à 99.999999%. La ventilation et la filtration à grande vitesse des eaux souterraines à l'elimination de fer et de manganèse n'apportent pas du tout de performance delimination virus. Les Etats-Unis exigent 99.99%. Les procédures conventionnelles de désinfection comme avec chlore apportent peu, parce que virus sont chlore tolérant et se produisent dans leau pas individuellement, mais groupé en masse compacte et donc par le chlore ne peut pas être réalisé.
Contact: soddemann-aachen@t-online.de

H5N1 Vogelgrippe durch Trinkwasser übertragbar
Die Risikobewertungen von BfR/FLI und UBA sind grundlegend falsch. Das lebensgefährliche H5N1 Vogelgrippe-Virus wird auch in Deutschland streng saisonal zeitgleich mit dem Maximum der Kältesumme des Winters auf die Menschen via kaltem Trinkwasser übertragen werden, wie bei den Vögeln. Jüngste Forschungsergebnisse müssen beunruhigen: Bisher musste das Virus die Bronchien und die Lunge der Menschen erreichen, um anzustecken. Jetzt infiziert es in Indonesien auch die oberen Atemwege (Schleimhäute des Rachens beim Trinken, Schleimhäute der Nase und vmtl. auch die Bindehaut der Augen sowie die Ohrtrommelfellmembran z.B. beim Duschen). In drei Fällen (Vietnam, Thailand) waren Magen und Darm durch das H5N1-Virus befallen, nicht jedoch die Bronchien und die Lunge. Das Virus muss also oral aufgenommen worden sein, z.B. beim Trinken von kontaminiertem Wasser.
Das in Deutschland als Trinkwasser genutzte Grundwasser ist bei weitem nicht virenfrei, wie BfR/FLI und UBA falsch behaupten. Die Vireneliminationsleistung der Trinkwasseraufbereitungsanlagen in Deutschland erfüllt regelmäßig nicht die Anforderungen der WHO und der USA. Die Flockung und Filtration von Oberflächenwasser erreicht eine Virenelimination von maximal 99,5%, die WHO fordert 99,9999% bis 99,999999%. Die Belüftung und Schnellfiltration von Grundwasser zur Enteisenung und Entmanganung bringt keine Virenelimination. Die USA verlangen 99,99%. Herkömmliche Desinfektionsverfahren wie die Chlorung bringen wenig, weil Viruspartikel chlortolerant sind und im Rohwasser nicht einzeln, sondern verklumpt vorkommen und deshalb vom Chlor nicht erreicht werden können.
Kontakt: soddemann-aachen@t-online.de

H5N1 and Drinking Water - References
Dinh PN, Long HT, Tien NTK, Hien NT, Mai LTQ, Phong LH, et al. Risk factors for human infection with avian influenza A H5N1, Vietnam, 2004. Emerg Infect Dis [serial on the Internet]. 2006 Dec [date cited]. Available from http://www.cdc.gov/ncidod/EID/vol12no12/06-0829.htm
EFFECT MEASURE, Bird flu in water. How big a problem? Available from http://www.agoravox.com/article.php3?id_article=5455
Walker K on Webster RG, H5N1 Adapts To Summer Water Heat, TERRA DAILY, Oxford, England (UPI) May 03, 2006. Available from http://www.terradaily.com/reports/H5N1_Adapts_To_Summer_Water_Heat.html
RIVM NL, Schijven FJ, Teunis PFM, Roda Husman AM de, Quantitative Risk Assessment of Avian Influenza Virus Infection via Water. Available from http://www.rivm.nl/bibliotheek/rapporten/703719012.html
BfR/FLI, Zum Risiko der Übertragung des Vogelgrippevirus über Trinkwasser, Gemeinsame Stellungnahme Nr. 017/2006 des Friedrich-Loeffler-Instituts und des BfR vom 22. März 2006. Available from http://www.bfr.bund.de/cm/208/zum_risiko_der_uebertragung_des_vogelgrip…
UBA, Keine Gefahr für Trinkwasser aus den öffentlichen Leitungsnetzen durch Vogelgrippe, Hinweise für Trinkwassernutzer, Stand 19. April 2006. Available from http://www.umweltbundesamt.de/uba-info-presse/hintergrund/vogelgrippe-t…
UBA, Trinkwasser und Aviäre Influenza A/H5N1, Hinweise für Wasserversorger, Stand 19. April 2006. Available from http://www.umweltbundesamt.de/uba-info-presse/hintergrund/trinkwasser-a…
WHO, Questions & Answers on potential transmission of avian influenza (H5N1) through water, Sanitation and Hygiene and ways to reduce the risks to human health. Available from http://www.who.int/water_sanitation_health/emerging/AI_WASH_working_gro…
WHO, Review of latest available evidence on potential transmission of avian influenza (H5N1) through water and sewage and ways to reduce the risks to human health, Last updated 30/05/2006. Available from http://www.who.int/water_sanitation_health/emerging/h5n1background.pdf
WHO, Guidelines for drinking-water quality, third edition, incorporating first addendum, 7, Microbial aspects, 131-141. Available from
http://www.who.int/water_sanitation_health/dwq/gdwq0506_7.pdf
U.S. EPA, Ground Water Rule (GWR). EPA published the Ground Water Rule in the Federal Register on November 08, 2006. Available from http://www.epa.gov/safewater/disinfection/gwr/
SODDEMANN W, Influenza in Deutschland: Als Zoonose durch Trinkwasser übertragbar? Hinweise und Indizien, umwelt-medizin-gesellschaft 18 (1): 49-60. Available from http://www.umg-verlag.de/umwelt-medizin-gesellschaft/105_sodd.html

http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/jun060…
CIDRAP
Indonesia suspects ominous H5N1 mutations

Wayan Teguh Wibawan, a microbiologist from Indonesia's avian flu commission, told Reuters that the suspicions are based on preliminary results of genetic tests at laboratories in Indonesia. The amino acid structure of poultry H5N1 samples is becoming increasingly similar to that seen in human H5N1 samples, he said.
The similarity in amino acid structure makes it easier for the virus to attach to receptors on cells that line the throat and lungs, Wibawan told Reuters. The virus would have to attach readily to human cell receptors in order to easily pass from birds to humans, he said.

http://www.who.int/mediacentre/factsheets/avian_influenza/en/index.html…
WHO, Avian influenza (" bird flu") - Fact sheet

THE DISEASE IN HUMANS

The second mechanism is a more gradual process of adaptive mutation, whereby the capability of the virus to bind to human cells increases during subsequent infections of humans.

Swimming in water bodies where the carcasses of dead infected birds have been discarded or which may have been contaminated by faeces from infected ducks or other birds might be another source of exposure. In some cases, investigations have been unable to identify a plausible exposure source, suggesting that some as yet unknown environmental factor, involving contamination with the virus, may be implicated in a small number of cases.

For unknown reasons, most cases have occurred in rural and periurban households . Again for unknown reasons, very few cases have been detected in presumed high-risk groups, such as commercial poultry workers, workers at live poultry markets, cullers, veterinarians, and health staff caring for patients without adequate protective equipment. Also lacking is an explanation for the puzzling concentration of cases in previously healthy children and young adults. Research is urgently needed to better define the exposure circumstances, behaviours, and possible genetic or immunological factors that might enhance the likelihood of human infection.
Assessment of possible cases. Exposure to an environment that may have been contaminated by faeces from infected birds is a second, though less common, source of human infection. To date, not all human cases have arisen from exposure to dead or visibly ill domestic birds. Research published in 2005 has shown that domestic ducks can excrete large quantities of highly pathogenic virus without showing signs of illness.

Clinical features.
Initial symptoms include a high fever, usually with a temperature higher than 38°C, and influenza-like symptoms. Diarrhoea, vomiting, abdominal pain, chest pain, and bleeding from the nose and gums have also been reported as early symptoms in some patients. Watery diarrhoea without blood appears to be more common in H5N1 avian influenza than in normal seasonal influenza. The spectrum of clinical symptoms may, however, be broader, and not all confirmed patients have presented with respiratory symptoms. In two patients from southern Viet Nam, the clinical diagnosis was acute encephalitis; neither patient had respiratory symptoms at presentation. In another case, from Thailand, the patient presented with fever and diarrhoea, but no respiratory symptoms.

H5N1 and Drinking Water - References
Dinh PN, Long HT, Tien NTK, Hien NT, Mai LTQ, Phong LH, et al. Risk factors for human infection with avian influenza A H5N1, Vietnam, 2004. Emerg Infect Dis [serial on the Internet]. 2006 Dec [date cited]. Available from http://www.cdc.gov/ncidod/EID/vol12no12/06-0829.htm
EFFECT MEASURE, Bird flu in water. How big a problem? Available from http://www.agoravox.com/article.php3?id_article=5455
Walker K on Webster RG, H5N1 Adapts To Summer Water Heat, TERRA DAILY, Oxford, England (UPI) May 03, 2006. Available from http://www.terradaily.com/reports/H5N1_Adapts_To_Summer_Water_Heat.html
RIVM NL, Schijven FJ, Teunis PFM, Roda Husman AM de, Quantitative Risk Assessment of Avian Influenza Virus Infection via Water. Available from http://www.rivm.nl/bibliotheek/rapporten/703719012.html
BfR/FLI, Zum Risiko der Übertragung des Vogelgrippevirus über Trinkwasser, Gemeinsame Stellungnahme Nr. 017/2006 des Friedrich-Loeffler-Instituts und des BfR vom 22. März 2006. Available from http://www.bfr.bund.de/cm/208/zum_risiko_der_uebertragung_des_vogelgrip…
UBA, Keine Gefahr für Trinkwasser aus den öffentlichen Leitungsnetzen durch Vogelgrippe, Hinweise für Trinkwassernutzer, Stand 19. April 2006. Available from http://www.umweltbundesamt.de/uba-info-presse/hintergrund/vogelgrippe-t…
UBA, Trinkwasser und Aviäre Influenza A/H5N1, Hinweise für Wasserversorger, Stand 19. April 2006. Available from http://www.umweltbundesamt.de/uba-info-presse/hintergrund/trinkwasser-a…
WHO, Questions & Answers on potential transmission of avian influenza (H5N1) through water, Sanitation and Hygiene and ways to reduce the risks to human health. Available from http://www.who.int/water_sanitation_health/emerging/AI_WASH_working_gro…
WHO, Review of latest available evidence on potential transmission of avian influenza (H5N1) through water and sewage and ways to reduce the risks to human health, Last updated 30/05/2006. Available from http://www.who.int/water_sanitation_health/emerging/h5n1background.pdf
WHO, Guidelines for drinking-water quality, third edition, incorporating first addendum, 7, Microbial aspects, 131-141. Available from
http://www.who.int/water_sanitation_health/dwq/gdwq0506_7.pdf
U.S. EPA, Ground Water Rule (GWR). EPA published the Ground Water Rule in the Federal Register on November 08, 2006. Available from http://www.epa.gov/safewater/disinfection/gwr/
SODDEMANN W, Influenza in Deutschland: Als Zoonose durch Trinkwasser übertragbar? Hinweise und Indizien, umwelt-medizin-gesellschaft 18 (1): 49-60. Available from http://www.umg-verlag.de/umwelt-medizin-gesellschaft/105_sodd.html