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NEWS: Michael Day East Asia is most at risk of human flu epidemic, experts say BMJ 2005; 331: 921 [Full text]

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East Asia : a place to prevent the pandemic

Wenbin Liang   (21 October 2005)

Avian Flu Hyperbole

Christopher Buttery   (22 October 2005)

Avian flu- keep human influenza away from birds

William R Keatinge, Gavin Donaldson   (27 October 2005)

East Asia : a place to prevent the pandemic 21 October 2005
Wenbin Liang, taking master of public health Curtin University of Technology Send response to journal: Re: East Asia : a place to prevent the pandemic	Dear Editor, As a public health issue, East Asia would be “most at risk of human flu epidemic”. However as an issue to myself or to a person, I would consider the risk of being infected by the deadly disease is similar among everyone in the world if there were a pandemic. On some level East Asia would be more suitable to consider as a place to prevent the disaster rather than a place at highest risk. Competing interests: None declared
Avian Flu Hyperbole 22 October 2005
Christopher Buttery, Clinical Professor Virginia Commonwealth University Send response to journal: Re: Avian Flu Hyperbole	Your story states that just over 100 people in Asia have contracted avain flu, and approximately 55% have died. How many million birds have the virus (what is its prevelance?) How many humans are at risk of exposure to these birds? it must be in the millions. Thus the relative risk of disease is very small. This does not suggest a pandemic like that in the 1918-19 era, unless there is significant further mutation of the current virus and evidence of human to human spread, rather than bird to human spread. Further, it seems that Tamiflu may not protect so why waste limited public resources storing it? I, and others, look to the BMJ and other recognized journals for scientific analyses, not media hyperbole. Can we tone it down until we get better data? Competing interests: None declared
Avian flu- keep human influenza away from birds 27 October 2005
William R Keatinge, Emertus Professor Univerisity College London, Royal Free and UCL Medical School, Rowland Hill St, London, NW3 2PF, Gavin Donaldson Send response to journal: Re: Avian flu- keep human influenza away from birds	The main risk from avian H5N1 influenza is that interaction of the virus with human influenza could produce a strain both highly infectious and highly lethal to man. Efforts to prevent this happening have focussed almost entirely on destroying infected birds. This is unlikely to provide full security on its own, when the avian virus is so widespread. Contact of the two viruses could be minimised if anyone with symptoms of human influenza avoided all contact with live or dead birds. This would require world wide co-operation to be fully effective. It could be formally required for anyone working with live or dead birds. It would cost nothing but salaries of temporary replacements for staff off work or moved to other duties because of possible influenza. New strains of influenza that regularly caused around 40,000 deaths in Britain every two or three years largely died away after 1976 (1,2). This was due to reduced appearances of new and lethal strains of influenza virus (3). The most plausible explanation for that is that birds and other domestic animals no longer shared human living spaces as life became more settled and prosperous, particularly in the Far East, reducing the mingling of human and animal viruses. The development of large specialised chicken farms is an aspect of this separation, but allows lethal avian viruses to spread to very large flocks of chickens. There is obvious risk if someone with human influenza is working with a flock when that happens, or is involved in culling diseased birds afterwards. Immunisation against influenza should not exempt staff from the ban on contact, as immunisation reduces the severity of influenza rather than preventing it. 1. Keatinge WR, Coleshaw SRK, Holmes J. Changes in seasonal mortalities with improvement in home heating in England and Wales from 1964 to 1984. Biometeorology 1989;33:71-76. 2. Donaldson GC, Keatinge WR. Excess winter mortality; influenza or cold stress? Observational study. BMJ 2002;324:89-90. 3. Stuart-Harris CH, Schild GC, Oxford JS (1985) Influenza. The viruses and disease. Edward Arnold. Baltimore Competing interests: None declared