A Worrisome New Front (NY Times on the Nigerian situation)
A Worrisome New Front (NY Times on the Nigerian situation)
February 12, 2006
News Analysis
A Worrisome New Front
By ELISABETH ROSENTHAL and DONALD G. McNEIL Jr.
As epidemics go, it was a relatively small outbreak: 40,000 chickens died in mid-January on a commercial poultry farm in Nigeria. No humans seemed to have been infected. But to many experts on avian flu, it was the outbreak they had been dreading for months.
It was the first time the fast-moving A(H5N1) virus had been reported in Africa. And while United Nations agencies are now scrambling to form medical and veterinary response and surveillance teams, scientists say its appearance there is deeply worrisome for two reasons.
First, the continent is ill prepared to deal with epidemics, whether human or animal. Second, the Nigerian outbreak comes only a month or two before birds begin migrating north from Africa to Europe, which has so far been largely untouched by the virus.
"These are horrendous developments, whether you're a human or if you're a bird," said John Oxford, a professor of virology at Queen Mary's College in London. "Everyone wondered what would happen if avian influenza came to Africa, but no one really prepared. They waited. Now it's there — and this is not the most organized continent in the world."
World health officials say they have not had the cooperation they needed from many poor countries, even those on the flight paths of migrating birds known to carry flu. They got lab samples weeks or months after problems began — and for that reason, they worry that the disease is already much more widespread.
As late as Monday, Nigerian veterinary officials were assuring the nation that the disease was not in their country. But Juan Lubroth, a senior veterinarian at the United Nations Food and Agriculture Organization in Rome, said in an interview that there was
strong evidence that bird flu took root in Nigeria "a few months ago." While the outbreak took place on a commercial poultry farm, he said, the virus may well have been percolating for months in backyard flocks.
"How long has it been trickling around, with five deaths here and five deaths there, and owners would possibly not be aware of the problem?" he asked.
The problem of sluggish reporting is not limited to Africa. It was common in the early months of the outbreaks in Asia, in 2003. In Azerbaijan, which reported its first cases last week, bird flu was only "picked up because of international pressure to come clean," Dr. Lubroth said, adding: "We've been repeating over and over to countries that they have to be vigilant, but in most countries, it's business as usual. They say, 'Avian influenza isn't here now — we'll deal with it when it arrives.' But then it's too late."
Maria Cheng, a spokeswoman for the World Health Organization, said her agency suspected that there might be human cases of A(H5N1) flu in Africa, but had no way to confirm that yet.
"We're getting a team ready to go," she said, "but we're waiting to get the invitation from Nigeria."
And even when scattered United Nations teams are in place, the disease could spread faster than they can track it. The health care systems of most of the continent's 52 countries are so broken down that most are unable to vaccinate children or distribute AIDS drugs without Western financial aid and technical advice.
The only laboratories on the continent with licenses from the W.H.O. and the ability to run the necessary sequencing tests on flu viruses are in Egypt and South Africa, 4,000 miles apart.
And little is known about the spread of even regular seasonal flu, said Dr. Michael L. Perdue, a scientist with the W.H.O. influenza program in Geneva. "We get samples that South Africa takes from neighboring countries," he said, "but we know very little about central Africa."
Confusion about avian flu is rife in Nigeria.
On Monday, the chief of veterinary services in Kano State assured the country that the disease that by then had killed 60,000 chickens was avian cholera — a disease with symptoms different from those of avian flu, and caused by a bacteria, not a virus. Testing in an Italian lab determined that the disease was indeed avian flu.
On Wednesday, an Agence France-Presse reporter interviewing traders in the Kano markets found that the price of chickens had dropped to $2 from $6 because farmers were dumping their birds on the market before they died or were culled.
By Friday, The Daily Sun, a large national newspaper, was reporting under the headline "Bird Flu Scare Grips Nigeria" that government ministers were shunning chicken in favor of beef and fish at banquets, apparently unaware that cooked chicken is safe.
The paper also interviewed five Nigerian doctors, all of whom said there was no treatment for the disease. That is not correct, though the usual treatment, the antiviral drug Tamiflu, is expensive and in short supply.
Also on Friday, a BBC News reporter visited one of the northern farms where 20,000 birds had died. Although the Nigerian Health Ministry had announced that the farms were quarantined and being disinfected, he reported that basic safety measures were being ignored. Carcasses were being burned in the open, letting infectious feathers and dander spread downwind. The farm workers doing the culling wore their regular overalls and had no protective gear. Villagers were still entering the property to draw well water.
Northern Nigeria is one of the world's last outposts of endemic polio, in part because people in Kano were long told by local leaders that the vaccine was unsafe. The polio eradication drive going on there now could be a boon in the effort to counter avian flu.
Dr. David L. Heymann, who is in charge of the W.H.O. antipolio campaign, said the 300 Nigerian health workers now trained to spot paralysis cases in children and collect fecal samples for polio tests could be retrained to look for cases of flu and pneumonia and possibly collect nasal swabs.
"They have vehicles and cellphones, so they're a valuable resource," he said. "It's a logical piggyback."
http://www.nytimes.com/2006/02/12/international/africa/12assess.html
