WHO: Tamiflu maker on alert for H2H transmission

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WHO puts Tamiflu maker on bird flu alert

By MARGIE MASON, AP Medical Writer Sat May 27, 10:20 AM ET

KUBU SIMBELANG, Indonesia - The World Health Organization put the

maker of the global stockpile of the anti-bird flu drug Tamiflu on

alert for the first time after human-to-human transmission was

suspected in Indonesia, officials said Saturday.

The organization said that a precautionary 9,500 treatment doses,

along with protective gear, were flown into Indonesia on Friday, but

the shipment was not expected to be followed by further movement of

the drug.

" We have no intention of shipping that stockpile, " WHO spokesman Dick

said.

An Indonesian health official, meanwhile, said tests had confirmed

five more cases of bird flu, three of them fatal.

One of those cases was of a 32-year-old man who on Monday became the

last fatality in a human cluster in Kubu Simbelang, a village of

about 1,500 people in North Sumatra.

No health workers could be seen Saturday in the village, where dozens

of chickens and geese ran among houses and through backyards framed

by high mountains and surrounded by rich fields of chilis, oranges

and limes.

The family infected by the virus lived in three houses near the

church in the Christian village.

The WHO in Jakarta received word from the Indonesian Health Ministry

about the cluster on Monday. The Geneva-based organization put Swiss

drug maker Roche Holding AG on alert hours later, said Jules Pieters,

director of WHO's rapid response and containment group.

Roche spokesman Baschi Duerr said the stockpile, which consists of 3

million treatment courses kept in Europe and the United States, is

ready to be shipped at any time to any place.

" We are in very close contact with WHO, even today, and our readiness

is geared to be able to deliver, " Duerr said. " We are ready to fly it

wherever and whenever it's needed. "

Pieters stressed the alert was part of standard operating procedure

when WHO has " reasonable doubt " about a situation that could involve

human-to-human transmission. He said Roche would remain on alert for

approximately the next two weeks, or twice the incubation period of

the last reported case.

" We were quite keen to inform Roche quite timely, " Pieters said. " We

knew Thursday would be a holiday in Europe and wanted to make sure

Roche warehouses would be open. "

On Saturday, Nyoman Kandun, a director general at Indonesia's health

ministry, said a WHO laboratory in Hong Kong has confirmed five more

cases of human bird flu, three of which were fatal.

All five had earlier tested positive for the H5N1 virus in a local

laboratory. Bird flu has now infected 48 people in Indonesia, and

36 of them have died.

Indonesia's number of human bird flu cases has jumped rapidly this

year, but public awareness of the disease remains low and government

commitment has not equaled that of other countries. Indonesia's

reaction has raised concerns it is moving slowly and ineffectively in

containing the disease.

Vietnam, the country hardest-hit by bird flu, has been hailed for

controlling the virus through strong political will and mass poultry

vaccination campaigns. No human cases have been reported there since

November.

Indonesia, a sprawling nation of 17,000 islands, has refused to carry

out mass slaughters of poultry in all infected areas — one of the

U.N. Food and Agriculture Organization's most basic containment

guidelines — saying it cannot afford to compensate farmers. And bio-

security measures are virtually nonexistent in the densely populated

countryside, home to hundreds of millions of backyard chickens.

Bird flu has killed 124 people worldwide since the virus began

ravaging Asian poultry stocks in late 2003.

The latest confirmed deaths were a 39-year-old man from Jakarta, a 10-

year-old girl from West Java and the 32-year-old man in the North

Sumatra cluster.

He was among six members of an extended Indonesian family who caught

bird flu and died. Another family member who died was buried before

tests could be done, but she was considered to be among those

infected with bird flu.

Health experts have been unable to link the family members to

infected birds, leading them to believe the virus may have passed

among them. None of the poultry in the village have tested positive

for the virus.

But health officials have struggled to gather information or take

blood samples from villagers, many of whom believe black magic is

responsible for their neighbors' deaths.

The WHO has stressed the virus has not mutated into a version easily

passed between people, which would trigger a potential deadly

pandemic, or shown any sign of spreading outside the family — all

blood relatives who had very close contact with each other.

So far, the virus remains hard for people to catch and most human

cases have been linked to contact with infected birds.

The organization has said that limited human-to-human transmission is

believed to have occurred in about four previous clusters. It was not

immediately clear why WHO had not ordered previous alerts for the

global stockpile.

But the most recent and largest human cluster comes after the

organization developed important new protocols for mobilizing

reserves of the drug.

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