Air Date: Week of February 4, 2005

Since last year, 36 people have died from a virulent strain of bird flu, transmitted largely from infected poultry stocks. Now there's evidence that the virus can jump from human to human, and health officials worry that it's only a matter of time before the flu evolves its transmission mechanism and starts a worldwide pandemic. Guest host Bruce Gellerman speaks with Dr. Jeremy Farrar, who's treating patients with symptoms of the avian flu in Vietnam's Ho Chi Minh City.

Transcript

GELLERMAN: I'm Bruce Gellerman. In Southeast Asia, a deadly strain of avian influenza seems to be mutating and now can be spreading from person to person and nation to nation. The outbreak has public health officials fearing the start of a global flu pandemic.

FARRAR: When we think of flu, we generally think of something which keeps us off work for a day or two. I mean, this influenza is a very horrible infection because probably none of us have any immunity to this type of virus.

GELLERMAN: Coming up, the doctor on the front lines in the battle against avian flu. And, here we go again. The White House launches a new offensive to open the Arctic National Wildlife Refuge to oil drilling. Opponents counterattack.

BOXER: And what we're very worried about is if you do it here, then what about all the other wildlife refuges. They're going to be next.

GELLERMAN: And why the Super Bowl won't be a gas. This week, on Living on Earth. Stick around.

ANNOUNCER: Support for Living on Earth comes from the National Science Foundation and Stonyfield Farm.

GELLERMAN: From the Jennifer and Ted Stanley Studios in Somerville, Massachusetts, this is Living on Earth. I'm Bruce Gellerman, sitting in for Steve Curwood.

In an average year, 20,000 Americans die from the flu. Last year in Southeast Asia, just 36 people died from a new strain called Avian influenza. But it's this bird flu, known as H5-N1, that keeps public health officials up at night because like a nightmare, they worry that their worst fears are about to come true. There's evidence the avian flu, first discovered in 1997, is no longer transmitted just from birds, ducks and chickens to people but has mutated. It can now spread person to person.

Ground zero of this year's outbreak is Ho Chi Minh City, Vietnam. Dr. Jeremy Farrar is director of the Oxford University Clinical Research Unit at the Hospital for Tropical Diseases there. Dr. Farrar, thank you very much for joining us. Hello.

FARRAR: Hello, it's good to speak to you.

GELLERMAN: Doctor Farrar, in your hospital you're seeing patients with avian flu, right?

FARRAR: Yes, we started a few weeks ago now. We actually don't have any patients, we haven't had any patients for a few days now. So, one could be optimistic and think that maybe we've seen the worst of it. But, certainly, going back for the last month or so, we've had a steady stream of patients with H5M1 as you describe.

GELLERMAN: Well, are you optimistic?

FARRAR: By nature, yeah, I'm very optimistic. I think your introduction was very fair. I think there are often major worries in terms of global health and often it's crucial to keep these in perspective. I think the greatest fear facing the world in terms of a major outbreak is influenza. The devastation of 1918, the 1950s and the 1960s, when millions of people died from this disease, teaches us that it's very likely to occur again in the 21st century.

The only thing I would take a little issue with in the introduction is the case of the human to human transmission. Clearly, that is the crucial factor. The virus does go between poultry. The crucial issue is whether when one human being gets it whether he or she is capable of passing it to another. And as you rightly say, there has been a report of a case from Thailand, where it seems very clear that a child passed it to the mother. I think that was a special case. The mother was very intimately involved with caring for the child in the last few hours of its life and had very extensive exposure to the child.

I think we're not in a situation, at the moment, where the virus transmits between humans with any degree of efficiency. If that were to occur, in other words, the virus was then able to go from you to me or me to you or from somebody to somebody else, then that is really a terrible scenario where we will see many, many million people die, I suspect, if that were to happen.

GELLERMAN: The influenza outbreak in 1918, the Spanish flu, is now seen to be avian flu, am I correct?

FARRAR: Essentially yes, yeah.

GELLERMAN: So, is that the flu that we now have?

FARRAR: No, it's not. But it's very close. The avian flus are, occur in chickens, occur in ducks. Chickens get sick with it; often, ducks are not very sick with it, in fact, can display no symptoms at all. When it jumps into humans, it's a very, very nasty virus. It causes a huge amount of destruction of the lung tissue and when we think of flu, we generally think of something that keeps us off work a day or two. I mean, this influenza is unbelievably unpleasant. It's a very horrible infection because probably none of us have any immunity or very limited immunity to this type of virus which is why the available flu vaccines won't work to protect you against this infection.

GELLERMAN: I understand that there was a woman, a Cambodian woman, who came to Vietnam and died of the disease. She was seeking medical attention and then some other members of her family may have gotten the disease, too. And the suggestion there is that because of the timeline is that, in fact, it was human-to-human contact.

FARRAR: The case from Cambodia, I think, remains unclear at the moment whether this represents common exposure or human to human transmission. It's absolutely crucial to know the difference between those two. You have to remember, many people in Cambodia, Vietnam, live very closely with their poultry in their house or in their yard at the back of the house. And multiple members of families may be exposed to the virus at the same time

GELLERMAN: It's not just in birds. It's in domestic cats, leopards.

FARRAR: Yes, it seems to…one of the most worrying features over the last few years is its apparent ability to have spread in terms of the animals that it can infect. So, what maybe used to only infect chickens and ducks now seems to be able to infect cats. As you say, there were leopards in Thailand that were infected, different varieties of birds, not just chickens and ducks but also wading birds and migrating birds. And that, of course, is an enormous worry because it's difficult enough to control the chicken population where chickens are farmed or kept by households; but to control birds that migrate, is impossible as America's found out with the spread of West Nile which have been carried, probably, by migrating birds.

GELLERMAN: I understand they've been culling, killing these ducks and chickens in the city there.

FARRAR: Yeah, that's right. There's been a mass media campaign and the Vietnamese government has announced in Ho Chi Minh City that all ducks are to be culled as soon as possible.

GELLERMAN: This week, it's the Tet New Year. It's the year of the rooster, ironically, and I understand that in Vietnam, there's a lot of eating of duck and chicken.

FARRAR: Yeah, there would normally be at Tet. Tet is a major festival here. I guess, the closest thing it would come close to is Thanksgiving in the States. I mean, it's a great occasion and it's one that's very important in the Vietnamese cultural life and, of course, chicken and duck are both a major feature of that usually but certainly not this year. I've not seen any chicken or duck being served as part of Tet celebrations so far and I'm sure they won't be.

GELLERMAN: So, what is the atmosphere on the streets of Ho Chi Minh City now?

FARRAR: It is worrying; it's very worrying and everybody knows about it. School children know about it. People are going into schools to educate people about it, but life goes on and, I think, banning chickens and ducks from a city has been a major step forward. People are getting ready for Tet and desperately hoping that this disappears. As you know, the virus particularly likes colder weather and it actually is quite cold in Vietnam at the moment. Hopefully, as the warmer weather comes in the next month or so, we will see less, fewer cases. But, yes, everybody is talking about it. It's in the newspapers daily and there is great concern. But the Vietnamese are incredibly phlegmatic people and tend to take things in their stride.

GELLERMAN: Dr. Jeremy Farrar is Director of the Oxford University Clinical Research Unit at the Hospital for Tropical Diseases in Ho Chi Minh City, Vietnam. Dr. Farrar, thank you very much. Stay well.

FARRAR: Okay, and you. Thanks.

[MUSIC: Sanpi Winpeng "Melody to Welcome Guests" The Chinese Deep South Ensemble: China - Many Faces (Ellipsis Arts) 1998]