Bird flu spreads westward in TurkeyISTANBUL: As a flurry of new reports of avian influenza in humans and in animals emerged Sunday from disparate parts of Turkey, international health officials said they now believed that the disease had been simmering in the eastern part of the country for months, even though it was first reported there only in late December.
A team of experts, including specialists from the World Health Organization and accompanied by the Turkish health minister, was scrambling to determine the full extent of the outbreaks. The officials made their way by bus Sunday to the worst-hit areas in and around the city of Van, whose airport was closed by severe winter weather.
Four children from villages near Van in remote eastern Turkey have now been officially confirmed by the WHO to have been infected with the H5N1 strain of the flu - the first human cases outside East Asia - and at least 30 people are hospitalized in Van City as possible victims. Like many people in these poor villages, the four children - two of whom have died - had close contact with sick birds, health officials said, and probably became infected as a result. A sibling of the two victims has also died, although tests for the virus so far have been negative.
In addition, Turkish officials announced Sunday that tests had confirmed five more cases of H5N1, two in Van and three from around Ankara - two young brothers and an elderly man, according to Turan Buzgan, the Health Ministry's basic sciences director.
The Ankara cases have the most alarming implications since bird flu has never been reported in that part of the country. It is a relatively well-off area, where it is not the norm for humans and animals to live under one roof. The boys infected had contact with dead wild ducks, said a ministry spokesman, and the man with a dead chicken.
The WHO said it had not yet been notified of the latest test results, and so could not confirm the cases, said Maria Cheng, a spokeswoman in Geneva. But she added that international scientists now studying the H5N1 virus samples from Turkey had so far detected no changes that might make it more contagious to humans. "It seems very much like the virus we've seen in western China," she said.
New reports of animal outbreaks across Turkey were also rapidly increasing with 6 of 81 provinces now reporting ongoing disease in birds, up from three just a few days ago. By Sunday evening, the Agriculture Ministry said the count was up to 10.
"Things are unfolding quickly, but we do not yet know how extensive the outbreaks are," said Juan Lubroth of the United Nations Food and Animal Organization.
He said the organization now believed the outbreaks had been occurring "for some time," starting perhaps as early as October or November.
In light of the nine human cases over the last four days, the failure of the Turkish officials to quickly detect and publicize animal outbreaks could have been a deadly oversight.
Humans almost always acquire bird flu through close contact with sick birds. In areas with known outbreaks, all birds are supposed to be quickly culled to contain the disease, and farming families in the surrounding area must take extreme precaution in handling poultry to prevent human infections. Because there were no reports of bird flu in the area, the patients in Van and Ankara had no way of knowing they were at risk.
In one village near Van, Dogubayazit, four children from the same family apparently came down with the disease, after playing with chicken heads. Two, who were confirmed to have H5N1, have died. A third also perished although her first test was negative. Cheng said it was being repeated because the test is "complicated and sometimes falsely negative" and circumstances implicate the H5N1 virus.
Although H5N1 does not now readily spread between humans, scientists are worried it might obtain that capability through biological processes, setting off a worldwide pandemic.
The officials said that while Turkey had responded swiftly to its first outbreak of bird flu, which occurred in the more developed western part of the country in October, government officials had been far less efficient in dealing with the disease in the impoverished eastern parts of the country.
"The veterinary structure is weak there," said Lubroth, who added that the United Nations had offered its assistance. "I'm not sure if officials in the capital were even aware for a long time that there was a problem."
A total of 50 patients are in hospitals in Van and Ankara with possible bird flu, said a Health Ministry spokesman, all of whom had close contact with birds and all of whom have respiratory symptoms, coughing and a fever.
Many "are not highly suspected cases, but given the risk of avian flu in the region, doctors prefer to monitor the patients at the hospital," he said.
He added that the two brothers diagnosed with H5N1 in Ankara - Muharrem Canal, 5, and his brother Iskender, 2 - were both in good condition, with symptoms "no more serious than a cold."
They had contact with dead ducks found by their father - who turned in the animals last week; the father is well and tested negative for the virus. Scientists have long known that the virus could produce mild symptoms in some individuals, while quickly killing others.
The family, which lives in a village 100 kilometers, or 60 miles, from Ankara, could not have know the behavior was risky, since bird flu had never been reported in the province.
The cluster of cases in Turkey is extraordinary and concerning, scientists said. In all of East Asia, where the disease has been running rampant in birds for years, only about 140 people have ever become infected and there has never been this kind of grouping.
Scientists are exploring various theories to explain the Turkish clusters, including biological changes in the virus and behavioral risks.
"When the temperatures drop below zero - as they do frequently around Van in the winter - people may be more likely to bring the chickens indoors, and that could increase exposure," Cheng said. "That's not something we'd expect in Vietnam, where it's much warmer."
Russia issues tourist warning
Medical authorities in Russia warned Russian citizens on Sunday against traveling to Turkey and unveiled prevention measures, Agence France-Presse reported from Moscow.
"I urge Russian citizens to abstain from trips to the Turkish republic and especially the province where this alarming situation is developing," Gennady Onishchenko, the chief doctor in Russia, was quoted by Interfax news agency as saying.
Onishchenko said he had ordered doctors across Russia to keep government officials, tour operators and transport authorities informed about possible bird flu outbreaks in Russia and Armenia.
Tourism industry experts say about 1.5 million Russians visit Turkey every year. Russia was the second-largest source of foreign tourists after Germany for Turkey in 2004.
However, in contrast to Onishchenko's warning, a spokesman for Russia's federal tourism agency said there was "no need for the moment to advise Russian tourists to not travel to Turkey," Interfax reported.