HEALTH: India Caught Unready for Bird Flu

Sandhya Srinivasan

MUMBAI, Feb 20 2006 (IPS) – India s first confirmed cases of the highly pathogenic avian influenza or bird flu surfaced in western Maharashtra state, over the weekend, catching authorities unprepared and threatening the livelihoods of hundreds of thousands of poultry workers, in this populous, farming country.
On Feb.18, the High-security Animal Disease Laboratory (HADL) in Bhopal, central India, announced that the H5N1 virus was found in samples from birds, following mass poultry deaths late January. Since 2004, the laboratory has been testing samples obtained both routinely and from bird deaths, for the highly pathogenic avian influenza strain.

Some 40,000 chickens have died on poultry farms in Nandurbar district, a tribal area in Maharashtra, 460 km from this city, the provincial capital. There are 60 poultry farms in the region, mostly layers or egg-laying chickens.

H K Pradhan, director of the HADL, confirmed to IPS over telephone on Monday that samples of birds from the recent poultry deaths in Maharashtra were found to be infected with H5N1. He was responding to the poultry industry s challenges that findings so far were not confirmed to be of the H5N1 strain.

India s health minister Anbumani Ramadoss told parliament on Monday that things were under control and that there is as yet no confirmed case of human avian influenza . Eighty human blood samples have been sent for testing and eight people with flu symptoms hospitalised for observation.

The Maharashtra government quickly announced plans to cull between 400,000 and 800,000 birds in the alert zone , three km around the affected farms and vaccination of poultry in farms within the surveillance zone of 10 km radius.
Farmers are to be compensated at between Rs 20 and Rs 40 (seven- 14 US cents) per chicken a gross underestimate of the cost which should be around 70 cents if feed, vaccine and other inputs are included. No compensation was announced for the thousands of workers rendered jobless as farms are shut down.

Poultry farm owners in the region believe they will suffer losses worth at least five million dollars. Government teams in some places were met by belligerent farmers, angry at the prospect of losing their livelihoods overnight.

Media reports indicate that World Health Organisation (WHO) precautions for slaughter and disposal of poultry are not being followed. Reporters have seen birds being slaughtered and disposed of without basic protection to workers or the environment.

There exists no systematic screening of poultry farm workers. There are also reports that no action has been taken in the farm where the deaths were first reported from.

India s 8.5 billion dollar poultry industry has contested the government s announcement that birds died of avian flu and has turned to union agriculture minister Sharad Pawar of the National Congress Party (NCP) for support.

The NCP is part of the Congress party-led coalition government in Maharashtra. Even as the state chief minister (Congress) Vilasrao Deshmukh spoke to the press on the ongoing culling and disinfection programme, Pawar agreed to send bird samples abroad for further testing, effectively questioning the government lab s results.

Anuradha Desai, chairperson of the National Egg Coordination Committee (NECC) and Venkateshwara Hatcheries, which supplies 75 percent of chicks sold to farmers in India, argues that the birds died of Ranikhed (Newcastle) disease because of poor farm practices. Unlike H5N1, Ranikhed disease does not affect humans.

The poultry industry in the country is at risk, said T Jacob John, an internationally-noted virologist, famed for his work on the polio and the human immunodeficiency viruses. If the virus has been traced in one group of poultry farms in India, it could be anywhere else as well, he told IPS.

While WHO representative, Subhash Salunke (former director of Maharashtra state s health services), has stated that the virus was imported from migratory birds landing in the region, John believes commercially transported chicks most likely brought the virus in and this could have happened anywhere else in the country, though the government banned import of chicks in February 2004.

India is the second largest egg producer and the fifth largest broiler producer in the world, according to NECC, employing more than three million people, mostly in the rural areas.

Outbreaks of highly pathogenic avian influenza caused by the H5N1 virus have occurred in South Korea, Vietnam, Japan, Thailand, Cambodia, Laos, Indonesia, China and Malaysia. The infection has spread to Russia, Kazakhstan, Mongolia, Turkey, Romania, Nigeria, and now India.

So far, these outbreaks have resulted in the deaths of more than 1.5 million farm birds, through disease or through culling for outbreak control. Despite these measures, bird flu is now considered endemic (not eradicated, and occurring routinely) in some parts of South-east Asia. It has also been found among migratory birds.

When humans have been infected through close contact with poultry, they have suffered an aggressive illness, damaging the lungs, with a case fatality of more than 50 percent. The poultry workers in Nandurbar are mostly impoverished tribals whose malnourished condition increases their risk of infection and the severity of illness.

A few humans will inevitably become infected; this is a huge epidemic in birds, said John. The amount of virus in the environment would be so high that most likely several people will be infected. At first it was presumed that the birds were dying of Ranikhed, which is not infectious in humans, so no precautions were taken.

The H5N1 strain is likely to be highly virulent, said John. The virus is spreading all over this region and human to human infection is eventually likely to start happening and when it does, we face a worldwide catastrophe.

As of Feb. 13, 2006, the WHO recorded 170 laboratory-confirmed cases of human infection, and 92 deaths a case fatality rate of more than 50 percent. The most recent death was in Iraq on Feb. 17, 2006. Clinically diagnosed cases without laboratory confirmation are not included in the WHO records.

Human to human influenza will spread rapidly through droplets, says Ashok Mahashur, pulmonologist at the PD Hinduja Hospital. In an overcrowded city (like Mumbai) it would be a calamity. If a case is identified they need to isolate the case and all contacts.

About the only silver lining in an otherwise grim prospect is the strength of India s powerful generic drugs industry.

India s health ministry has 750,000 doses of the main antiviral, oseltamvir and is placing further orders. The Swiss patent holder Roche has licenced manufacture to a local company, Hetero, but two other Indian firms, Cipla and Ranbaxy, have started manufacture apparently in defiance of current patent law and in anticipation of a public health emergency.

Cipla can make 150,000 doses per week, enough to treat 35,000 people at a cost of 25 dollars per course of treatment. We have raw material stocks enough to provide 150,000 doses a week for the next few weeks, said Jaideep Gogtay, spokesman for Cipla. The company is also ready to supply the government at the wholesale rate of 16 dollars per course.

In November 2005, Cipla declared intention to challenge the patent application filed by Roche for oseltamivir. Roche s patent application is in the patent mailbox in India and Yusuf Hamied, chairperson and managing director of Cipla, has said there is no clarity on the patent.

Since India has not yet granted a patent to the drug, Cipla and other companies seem confident of manufacturing it without serious legal opposition.