Anxiety as avian influenza reaches humans in Turkey

Fears over the spread of avian influenza to humans have escalated following four confirmed cases of infection with the H5N1 strain in Turkey.

The cases have resulted in two confirmed deaths in Van, about 800km (500 miles) east of the capital Ankara, although attempts by the World Health Organisation (WHO) and bird flu experts to reach the area have been hindered following the closure of Van airport due to severe winter weather.

The two confirmed victims, both members of the same family, dealt closely with birds, but there are now rumours of three cases in Ankara, unconfirmed by WHO. If this is the case, it could mark a major development in the spread of the disease, which has still not been seen to pass from human to human, as Ankara is a relatively affluent, previously unaffected area, where victims are less likely to have been in direct contact with birds than the victims in Van. There have been, again unconfirmed, reports of ducks in Ankara having the virus.

Turkey's Ministry of Health has announced a third death in Van, which WHO describes as 'presumably caused by the H5N1 virus', that of a 12-year-old girl, a sibling of the two confirmed H5N1 victims. A fourth child in the family, a six-year-old boy, has also been hospitalised, with around another 30 patients, most of whom are understood to be children, undergoing treatment and evaluation for H5N1 at a hospital in the area.

According to WHO: 'Based on experiences during the avian H5N1 outbreaks in Asia, behaviours that carry an especially high risk of infection include the slaughtering, defeathering, butchering, and preparation for consumption of diseased poultry. These behaviours tend to occur most frequently in rural areas where populations traditionally slaughter and consume birds once deaths or signs of illness are seen in poultry flocks.

'Outbreaks of highly pathogenic H5N1 avian influenza have now been confirmed in six provinces in the eastern and south-eastern part of Turkey [Turkey is made up of 81 provinces]. Outbreaks at additional sites in the area are under investigation.

'Avoidance of high-risk behaviours remains the most important way for local populations to protect themselves from infection.'

Turkey's Prime Minister, Tayyip Erdogan, has appealed to Turks to help in a mass cull aimed at stemming the advance of the virus and promised adequate compensation to farmers and families who rely on poultry for their living. However, Turkish officials have reported problems in persuading people in poorer rural areas to pass on all of their birds for slaughter.

Iran, which borders eastern Turkey, has closed one of its border crossings, while Indonesian authorities have confirmed a 39-year-old man who died 1 January to have been a victim bird flu. He had come into contact with chickens that had died from the disease.