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Avian Flu - H5N1 - Report

Avian Flu Extends Its Reach To Iraq

By Elisabeth Rosenthal International Herald Tribune


ROME A 15-year-old Iraqi girl has died of the H5N1 bird flu virus, Iraqi and international health officials confirmed Monday, indicating the arrival of disease in yet another country - one that, in its current war-torn state, may be ill prepared to control spread of the disease. 

More alarming still, officials said, the finding suggests that the disease may be spreading widely - and undetected - among birds in countries of Central Asia that are poorly equipped to pick up or report infections. Bird flu has never been reported in animals in Iraq. 

As in Turkey earlier this month, the spread of bird flu to a new part of the world was heralded by a human death, a death that was most likely avoidable. Bird flu only rarely infects humans, late in the course of an animal outbreak, and then only after intense contact with sick birds. 

"We shouldn't be seeing human cases first, and this points to serious gaps in surveillance," said Maria Cheng, a spokeswoman for the World Health Organization in Geneva. "But given the situation in Turkey, I don't think we'd be surprised to see isolated humans cases in surrounding areas."  

The girl, Shengeen Abdul Qadr, died earlier this month in Sulaimaniya, in the Kurdish region of northern Iraq, three days after touching dead birds infected with the virus, the Iraqi health minister said Monday. Her uncle, who died last week, is also presumed to have succumbed to the disease, although test results are pending.  

A serious bird flu outbreak has killed four people and hundreds of thousands of birds in the Kurdish part of neighboring Turkey over the past six weeks. Trade routes, traversed by trucks and mules, crisscross national borders in a large ethnic Kurdish area, which includes portions of several different countries. 

Officials at the UN's Food and Agriculture Organization in Rome, which tracks the spread of the disease, warned last week that bird flu had quite likely already spread from Turkey into neighboring countries - and specifically warned Iran, Iraq, Syria and Armenia to be on high alert. But until Monday there had been no hard evidence of such movement.  

"It makes biological sense that there is a problem across the border - markets cross borders - which is why we encouraged the countries to increase surveillance," said Juan Lubroth, the organization's senior animal health officer. 

"But I'm not a policeman. What I can do is to ask governments to be more vigilant and to encourage them to tell us if they need help." 

He said that monitoring systems for disease in animals were weak in much of the area and that governments needed to be more transparent - both in acknowledging outbreaks they had detected as well as admitting if they lacked the capacity or financing to detect the disease, which requires complicated laboratory testing. 

For example, the local government in Sulaimaniya is monitoring commercial poultry flocks, "but they don't really have the ability to monitor what's going on in village flocks," said Rod Kennard, who is managing a year-old UN project to rebuild veterinary services in Iraq.  

He said that "it is a really big question" whether a country in the throes of conflict could coordinate a response to a complicated problem like bird flu, although he noted that the northern provinces were "not as troubled" as some of the areas in central Iraq.  

"The ministries are starting to work together," he said. "There has been some public awareness about avian influenza, and there is some border control of livestock and birds. But I'm not sure how effectively they can do it." 

The Kurdish authorities on Monday quarantined four villages because of suspicion that birds, and possibly people, in the areas might be infected. Teams moved through the areas destroying birds, Kurdish officials said.  

To contain bird flu outbreaks, sick birds must be rapidly identified and culled, along with any poultry in a surrounding safety zone. A slow start in Turkey allowed the disease to spread throughout the country, and the government is now struggling to contain 55 outbreaks in 15 provinces.  

Dr. Abdul Mutaleb Mohamed Ali, the Iraqi health minister, appealed for help, noting that two other people in distant parts of Iraq had also been tested for bird flu. "We ask the international community to move fast and send our country technical assistance and health equipment," he said in Sulaimaniya. 

At present, humans can contract bird flu only through close contact with infected poultry, and about 150 people worldwide have come down with the disease. But scientists worry that the virus might acquire the ability to spread from human to human though naturally occurring genetic shuffling, setting off a devastating worldwide pandemic.  

The test on samples from the Iraqi girl were performed at a lab in Cairo this weekend, and samples are being sent to the official World Health Organization reference lab in England for confirmation. Because of this, the organization considers the result a "preliminary positive." But in Turkey all "preliminary positives" were all later confirmed. 

Over the past few months, there have been occasional reports of large-scale bird deaths occurring in both Iran and northern Iraq, countries that veterinary officials had tagged as high risk because they are on bird migration routes.  

Such deaths are often the first indication that H5N1 has arrived in a country, since the virus is very contagious and lethal to poultry. But they can occasionally be caused by other diseases or by poisoning. And H5N1 was never implicated in such deaths in Iraq or Iran. 

In October, there were many deaths on commercial farms in northern Iraq, Kennard said. Birds were tested and "we were told it was negative, but we're not entirely sure how reliable that is," Kennard said. 

In most countries with serious bird flu outbreaks, including Turkey, the army has provided the massive manpower required for containment, going door-to-door to find chickens to cull, for example. That is obviously not an option in Iraq.  

Also, much of the trade in the region is informal and unregulated, so that border control of animals is difficult in the Kurdish region. 

"Markets go throughout Kurdistan and occur on mules and donkeys who cross borders here and there," said Lubroth. "And chickens are small. It's quite difficult to control." 
Sabrina Tavernise of The New York Times contributed reporting from Iraq.


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