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[EXCERPT: Iran closed part of its border with Turkey. A senior Russian health expert has suggested citizens should stay away from Turkey, a favourite holiday haunt at this time of year. Italy's health minister is ready to discourage anyone from travelling to the country, if the European Union (EU) does not act first.]

Turkey takes fright as bird flu heads towards Europe

From The Economist Global Agenda
Jan 16th 2006

The deaths of four people from bird flu in eastern Turkey—the first outside East Asia—and confirmation that some 20 Turks are infected with the deadly H5N1 strain of the virus have spread anxiety in Europe and the Middle East. Though there is still no sign of human-to-human transmission, governments in the region are taking precautions

AFTER the first humans outside East Asia died of a strain of bird flu—three young siblings succumbed in a small village near Van in eastern Turkey, followed by a fourth confirmed death announced on January 16th—nearby countries are scrambling to put up defences. Iran closed part of its border with Turkey. A senior Russian health expert has suggested citizens should stay away from Turkey, a favourite holiday haunt at this time of year. Italy's health minister is ready to discourage anyone from travelling to the country, if the European Union (EU) does not act first.

Closing borders and the like will have limited impact as, thankfully, there is no evidence that H5N1 has yet been passed from human to human, a necessary requirement for a flu pandemic to break out. An official of the World Health Organisation (WHO) who is investigating the outbreak said that there is no sign of human-to-human transmission in Turkey, adding that the virus is "typically similar" to that seen in Asia. But governments evidently want to show that they will act early against the risk of a pandemic after the first discovery of birds infected with the virus in Europe—notably in Romania—last year.

It should be no surprise that a small number of Europeans have finally become infected, after larger numbers caught bird flu in Asia. The WHO has recorded nearly 150 cases of humans with the virus in Asia since 2003, of whom roughly half have died (see chart). On Monday Indonesian officials reported another human death - the 13th in that country - from bird flu. China confirmed the eighth case of a human infected by the H5N1 strain, and the WHO confirmed that two people had died of bird flu in China in December.

What is unsettling in Turkey is that efforts to discourage contact with birds proved ineffective, and that the number of human infections is subsequently rising fast. The children who died near Van, close to the border with Iran, had apparently been playing with the severed heads of infected chickens in the poultry farm where their family lived and worked. Some others who are reported sick were in contact with wild birds (or their carcasses).

Turkish officials are now taking other steps to contain the spread of the virus. A mass cull of domesticated birds has been under way for weeks and the infected area near Van is quarantined. By Monday over 900,000 birds had been killed. Officials have asked residents to dig pits and bury their own birds. But many villagers who depend on raising poultry have been reluctant to do so, fearing their livelihoods would be destroyed. It is especially hard to enforce a cull when birds are not obviously ill. Special flu centres have been set up in hospitals. A belated education campaign is calling on people to avoid exposure to live birds. The WHO has praised Turkey's efforts but another UN agency, the Food and Agriculture Organisation, has given a warning that bird flu could become endemic in the country.

Turkey's government says a total of 20 people (including those who died) have been infected. Among these are three people from villages close to Ankara. The capital is some 1,000km (620 miles) further west than the site of the first human cases in the country and the cases there are thus the clearest sign that the virus is moving towards Europe-proper. This has caused widespread anxiety, and flu-like symptoms have been reported in areas across the country. Hundreds have rushed to hospital for tests. Italy's health minister, Francesco Storace, called the news from Turkey "very serious" and "much more worrying than what happened in previous months".

A joint response from EU member states is now expected, with countries near Turkey also likely to take individual action. The EU has banned the import of untreated feathers from Turkey and six countries around it. International experts have been sent to the affected territory to see what help might be offered and to advise on what steps to take next. On Friday, the EU pledged $100m to help countries to deal with bird flu. The UN hopes to raise a total of around $1.5 billion at an international donors' conference in China on Tuesday. Anti-flu drugs, which shorten the duration of the symptoms of the disease, have been stockpiled in many countries. Also on Friday, Roche, which makes Tamiflu, the best-known defence against the H5N1 strain, said it was in talks with health officials about donating more pills to Asian countries.

Experts fear that as the number of humans infected with the H5N1 strain increases, the opportunity for the virus to mutate also grows. A laboratory in Britain found that two of the Turkish victims were infected with a strain that was slightly mutated, though apparently no more dangerous than known ones. One worry is that mutations make it easier for birds to pass the flu on to people; a bigger concern is that changes in form allow it to be spread directly between humans—in which case, millions could become infected quickly. Researchers suggested last week that some people have been infected with H5N1 without developing symptoms, possibly indicating that bird flu is less deadly than feared. If so, however, it may also mean the flu has been spreading faster to humans than earlier suspected.

The history of the deadly H5N1 strain has been traced back to infected geese in Guangdong province in China, in 1996. It then transformed so that chickens could serve as host and scientists say it continues to change. It has also become more deadly for mammals as the years pass. While there is no sign that the outbreak in Turkey is speeding such development, it is a reminder of the wide threat that a general epidemic would pose.