[Ip-health] AP: WHO Puts Roche on Alert for Tamiflu Stockpile

[Thiru Balasubramaniam]

WHO Puts Roche on Alert
For Tamiflu Stockpile
*Associated Press*
May 28, 2006 4:09 a.m.

KUBU SIMBELANG, Indonesia =96 The biggest case yet of humans possibly
infecting others with bird flu prompted the World Health Organization to
put the maker of the antiviral drug Tamiflu on alert for possible
shipment of the global stockpile for the first time, officials said
Saturday.

No further action on the emergency supply was expected for now,
according to the U.N. health agency, which called the alert part of its
standard operating procedure when a case arises like that in Indonesia.
"We have no intention of shipping that stockpile," WHO spokesman Dick
Thompson cautioned. "We see this as a practice run."

Meanwhile, Indonesia confirmed three more bird-flu deaths as the country
grapples with an increase in human cases. Bird flu is known to have
infected 48 people in Indonesia, with 36 deaths -- second highest after
Vietnam's 42 deaths.

A precautionary 9,500 treatment doses of Tamiflu from a separate WHO
stockpile, along with protective gear, were flown into Indonesia on
Friday. The tablets will likely be handed over to the Indonesian
government, WHO spokeswoman Maria Cheng said in Geneva.

Officials revealed the stockpile alert came last Monday as experts
puzzled over why six of seven Indonesians from a family in a North
Sumatra village died after became infected by the H5N1 virus. An eighth
was buried before tests could be done, but she is believed to have been
infected.

Despite the cluster of deaths, the virus hasn't mutated into a form
easily passed among humans, experts said. Scientists have seen examples
of bird flu passing between family members in a handful of smaller cases.

"If this virus had evolved into a form that is more easily passed
between people, you would have seen some other cases (outside the
family) by now," Ms. Cheng said. "The virus hasn't passed beyond the
family."

No health workers could be seen Saturday in the family's village of Kubu
Simbelang, where dozens of chickens ran among houses and through
backyards framed by high mountains and surrounded by rich fields of
chilies, oranges and limes. The family infected by the virus lived in
three houses near the church in the Christian village.

Indonesia's number of human bird-flu cases has jumped this year, but
public awareness of the disease remains low and government efforts
appear not to have equaled that of other countries. Indonesia's reaction
has raised concerns it is moving slowly and ineffectively in containing
the disease. Vietnam, the country hit hardest by bird flu, has been
hailed for controlling the virus through mass poultry vaccination, among
other measures. 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 -- a basic
containment guideline -- saying it can't afford to compensate farmers.
And bio-security measures are virtually nonexistent in the densely
populated countryside, with its hundreds of millions of backyard chickens.

WHO officials in Jakarta received word about the Kubu Simbelang cluster
from the Indonesian Health Ministry on Monday. That led the Geneva-based
agency to alert the Swiss pharmaceutical company Roche Holding AG within
hours about possible Tamiflu shipments, said Jules Pieters, director of
WHO's rapid response and containment group.

"We were quite keen to inform Roche quite timely," Mr. Pieters said. "We
knew Thursday would be a holiday in Europe and wanted to make sure Roche
warehouses would be open." He said Roche would remain on alert for
approximately the next two weeks, or twice the incubation period of the
last reported H5N1 case.

Roche spokesman Baschi Duerr said the emergency stockpile, which
consists of three million treatment courses, is ready to be shipped
wherever it is needed.

Meanwhile, Nyoman Kandun, a senior official at Indonesia's health
ministry, said a WHO laboratory in Hong Kong had confirmed five more
cases of human bird flu, three of which were fatal. All five had earlier
tested positive for the virus in a local laboratory. The latest
confirmed deaths were a 39-year-old man from Jakarta, a 10-year-old girl
from West Java and a 32-year-old man, who on Monday became the last to
die in the Kubu Simbelang cluster.

Experts have been unable to link the cluster family members to contact
with infected birds, and tests on poultry in their village have come
back negative. No one else in the village has fallen ill.

So far, most human cases have been traced to contact with infected
poultry. But there is evidence of isolated cases of limited transmission
between people in very close contact with each other. Scientists are
unsure how this occurred, but they theorize the virus may pass from one
person to another through droplets sneezed or coughed into the air or
onto food or other surfaces. It has been suggested some people may have
a genetic susceptibility to the disease. In all, WHO has recorded four
family clusters of bird flu so far and only direct blood relatives --
not spouses -- have become ill.

Experts are exploring whether the first woman sickened in the Kubu
Simbelang family may have had contact with sick or dead chickens. She
worked at a market where chickens are sold and may have used chicken
feces as a garden fertilizer, WHO officials said.

Bird flu has killed at least 124 people world-wide since the virus began
ravaging Asian poultry stocks in late 2003.