Officials in at least two nations now suspect the avian flu bug has mutated into a virus that is being transmitted from human to human – a development world health authorities have estimated could result in the deaths of tens of millions.

Thai health officials have expressed concern that the country’s two latest confirmed victims may be the beginning of the much feared human-to-human transmission.

Dr. Charoen Chuchottaworn, an avian-flu expert at the Public Health Ministry, said doctors reviewing the cases were alerted by the very mild symptoms present in both patients, neither of whom had had any recent contact with birds or poultry.

The doctors are unsure as to how either of the infected contracted the disease and have raised the possibility that the virus has traded its pathogenicity for ease of transmission.

Meanwhile, in Indonesia, the disease is spreading so rapidly, particularly in the capital of Jakarta, some health officials strongly suspect the long-dreaded mutation has already occurred.

“There are just too many people who have it,” said one doctor. “In many cases, it is difficult to establish any contact with birds.”

Another official said the flu has “spread all over the city.”

The latest victim confirmed officially by the Ministry of Health is a 25-year-old woman. She was treated at Tangerang Hospital before being transferred to Sulianti Saroso. The woman had difficulty breathing and a breathing tube had to be inserted.

The World Health Organization-sanctioned laboratory in Hong Kong has so far confirmed 13 bird flu cases in humans in Indonesia, with eight people dying from the virus.

Separately, Minister of Health Siti Fadila Supari said Swiss pharmaceutical company Roche had given Indonesia approval to produce its antiviral drug Tamiflu to fight bird flu in humans.

So far the government has relied on donors such as Singapore, Japan and Australia for its supply of Tamiflu.

The government also said it would launch a yearlong operation against bird flu, involving the military, house-to-house checks and mass culls of birds across the country.

“The president has said that until 2006, for one year, we will intensively eradicate bird flu virus,” said Minister of Agriculture Anton Apriyantono.

He said the yearlong program would include weekly checks of backyard farms and larger farms in Greater Jakarta for infected birds.

The Jakarta Animal Husbandry, Fisheries and Maritime Affairs Agency today destroyed some 500 chickens and pet birds in Utan Kayu, where a number of infected birds have been found.

From about 2,000 tests conducted by the agency in 30 of the capital’s 267 subdistricts, dozens of infected birds were found in the subdistricts of Ceger, Utan Kayu, Pondok Kelapa, Duren Sawit and Cipinang Melayu, all in East Jakarta, as well as in Sunter Jaya and Cilincing in North Jakarta, Kapuk in West Jakarta, and Petojo in Central Jakarta.

With one small genetic adjustment in Influenza A, or H5N1, millions of people could die, warns World Health Organization Regional Director for the Western Pacific Shigeru Omi. Omi has called for health ministers and representatives to launch an all-out war on the deadly strain.

If the virus acquires sufficient human genes, allowing transmission from one person to another, an estimated 2 million to 7.4 million people around the world could die, the WHO estimates.

Some health officials make even more dire predictions. They point to the great flu pandemic of 1918-1919, which killed far more people worldwide than died in World War I – an estimated 40 to 50 million people.

There are more signs the virus is spreading – outward from Asia and through Europe. Romania appears to be the hardest hit.

Three more villages in eastern Romania have been quarantined following the discovery of an H5 strain of avian influenza in poultry in one of the villages. The Romanian Ministry of Agriculture suspects the presence of bird flu in the other villages but is awaiting confirmation of test results from the United Kingdom.

Culling has begun in the area, and authorities estimate that 9,500 birds will be killed.

Romanian Agriculture Minister Gheorghe Flutur said today that 10,000 birds have been slaughtered following the discovery this week of three cases of avian flu in the Danube Delta.

“The villages of Periprava as well as Dudescu and Bumbacari have been placed under quarantine and the soil has been disinfected,” he told journalists. “We have also alerted the Ukrainian authorities, since the village of Periprava is only three kilometers (two miles) from the frontier.”

Although the latest cases have been identified as the H5 variety, more tests are being carried out to find out if the virus belongs to the deadly H5NI strain that has killed more than 60 people in Asia and is feared as a possible source of a human flu pandemic.

A member of the national animal health authority, Florica Durlea, warned that the risk of avian flu remained, because new waves of migratory birds are expected as a result of mild temperatures.

The Danube Delta is a stopping off point for birds flying from central Asia and Russia.

So far, 12 outbreaks of bird flu have been detected in Romania.

In China, a team from the World Health Organization investigating the deaths from avian influenza said the extent of the problem in the country — and elsewhere — may be worse than initially thought.

Dick Thompson, a WHO spokesman in Geneva, told the New York Times, “In some cases the surveillance system may not be there. We’re not nosing around, but we may be able to provide (China with) some technical expertise.”

The H5N1 bird flu virus has killed at least 68 people in Asia since 2003.

U.S. Department of Health and Human Services Secretary Mike Leavitt announced the purchase of additional vaccine that could be used in the event of a potential influenza pandemic.

The department has awarded a $62.5 million contract to Chiron Corp. to manufacture an avian influenza vaccine designed to protect against the H5N1 influenza virus strain. The number of individuals who could be protected by the newly contracted vaccine is still to be determined by ongoing clinical studies.

“An influenza vaccine effective against the H5N1 virus is our best hope of protecting the American people from a virus for which they have no immunity,” said Leavitt. “This contract will increase our stockpile of the vaccine and is a continuation of our aggressive multi-pronged approach to a potentially critical public health challenge.”

This purchase builds on the department’s current plans to buy enough H5N1 influenza vaccine for 20 million people and enough influenza antivirals for another 20 million people. These supplies of vaccine and antiviral treatment will be placed in the nation’s Strategic National Stockpile where they will be available for use should an influenza pandemic occur. Recently, HHS awarded a $100 million contract to sanofi pasteur, the vaccines business of the sanofi-aventis Group, for avian flu vaccine.

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