As public health ministers and officials from 13 Asian countries conferred in Bangkok last week on how to prevent the spread of H5N1 avian influenza, experts offered troubling predictions.

The highly lethal H5N1 strain, which has claimed tens of millions of poultry across eastern Asia this year, is the world´s likeliest candidate to cause global devastation in the form of a human flu pandemic, according to experts from the World Health Organization (WHO).

While acknowledging that all estimates are essentially guesses, WHO experts have predicted in recent weeks that a pandemic could kill anywhere from 2 million to 100 million people.

Confirmed H5N1 avian flu has already killed 32 people and sickened 12 more in Vietnam and Thailand this year. What is keeping the disease in check, for now, is the virus´s inability to spread easily from person to person.

Under the shadow of that threat, the Association of Southeast Asian Nations (ASEAN) and other Asian countries sought to reach agreements on how to collaborate to prevent the spread of the disease at a conference that ended Nov 26.

In a joint closing statement, delegates pledged to collaborate through prompt and open communication, research, and allocation of resources, according to a press release from the WHO´s Western Pacific Region Office. The nations also agreed to prepare contingency plans for a human flu pandemic.

"We believe a pandemic is highly likely, unless intensified international efforts are made to take control of the situation," said Dr. Shigeru Omi, WHO western Pacific regional director, in the press release. "When I contemplate the ´where, how, and when´ of a possible influenza pandemic, I find myself faced with an inescapable conclusion—that we who are assembled in this room have an historic role to play in addressing a global health threat that continues in our region."

In a Nov 29 speech in Hong Kong, Omi predicted that a pandemic could cause 20 million to 50 million deaths, or possibly up to 100 million, according to a Nov 29 New York Times report.

Omi´s opinion that a pandemic is highly likely was echoed in a report released recently by the Institute of Medicine (IOM) of the National Academies. "The danger mounts as the world´s capacity to produce vaccines shrinks and H5N1 reaches endemic levels in poultry in many parts of Asia," says the report, titled "The Threat of Pandemic Influenza: Are We Ready?" The 300-page report is a summary of a conference held in June.

Meanwhile, members of ASEAN are addressing local avian flu problems.

Thai government officials made several recent announcements about progress against H5N1, although they encountered setbacks as well. They announced that a vaccine to protect humans against avian flu is expected to be ready by 2007, following clinical trials in Thailand, according to an Associated Press story Nov 24. A Dec 1 story from the Thai News Agency said the government was claiming success in efforts to prevent the H5N1 virus from mutating. The same story noted the plans have not worked everywhere because villagers sometimes hid news of dying birds for fear of having their flocks culled.

In addition, the story said authorities in northern Thailand´s Chiang Mai province will meet with owners of cock-fighting rings later this month to discuss reopening rings and how to prevent fighting cocks from spreading H5N1. An 18-year-old Thai man who often sucked fluids from the mouths of his fighting birds died from H5N1, according to a New York Times story on Nov 7.

Thailand reported to the World Organization for Animal Health (OIE) that between Nov 18 and 25 it logged 17 new H5N1 outbreaks, leading to the deaths of more than 16,000 fowl.

Hong Kong authorities said on Nov 29 they may bar shopkeepers from slaughtering poultry, a popular practice for assuring shoppers that their purchases are fresh, according to a story compiled from news agencies and published on the China Daily web site yesterday.

Scientists have struggled against the practice of killing chickens at markets since Hong Kong´s first bout with human H5N1, which killed six people in 1997. The poultry industry has strongly opposed the ban in the past, the China Daily report said. However, the government is pursuing the plan, which could include creating one large central slaughterhouse or limiting the slaughter to a few areas, the story said.

See also:

WHO Western Pacific Region news release
http://www.wpro.who.int/public/press_release/press_view.asp?id=468

IOM report "The Threat of Pandemic Influenza: Are We Ready? Workshop Summary"
http://www.nap.edu/books/0309095042/html/