Weighing the U.K. Avian Flu Outbreak Agricultural workers in the United Kingdom kill thousands of turkeys, seeking to block the spread of bird flu. Meanwhile, investigators try to trace the source of the infection. How should the United State react if faced by an outbreak of influenza on the scale of the 1918 epidemic?
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Weighing the U.K. Avian Flu Outbreak

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Weighing the U.K. Avian Flu Outbreak

Weighing the U.K. Avian Flu Outbreak

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A little bit later in the hour we'll be talking about quantum physics and storing light. But first, this week health experts in the United Kingdom are trying to track the source of an outbreak of avian influenza, bird flu, on the biggest turkey farm in the U.K.

The outbreak at the Suffolk farm led to the slaughter of a 160,000 turkeys in an effort to block the spread of the disease. Government investigators are said to be investigating whether there was a possible connection to an outbreak in Hungary last month after they found that the strain of flu virus involved was the same.

There were also reports that the company involved, Bernard Matthews, had imported tons of partially processed turkey meat from Hungary. Investigators are trying to figure out if that may have been the source of the infection. Company officials said that the meat did not come from the affected area of Hungary. So we'll be talking about that outbreak.

And also, we'll talk about that last week, the CDC - that's the Centers for Disease Control and Prevention - issued guidelines of some of the steps that should be taken in the event of a major flu outbreak in this country. Many experts believe it's not a matter of if there will be an outbreak, but when.

We'll be talking about flu this hour, about the avian outbreak in the U.K. and plans for the pandemic, possible pandemic flu here. So, if you'd like to talk about it, give us a call. Our number 1-800-989-8255, 1-800-989-TALK. As always, you can surf over to our Web site at sciencefriday.com for links to this topic.

Freda Scott-Park is past president of the British Veterinary Association. Dr. Scott-Park joins us by phone from London. Good evening. Thanks for staying up, working late for us today, Dr. Scott-Park.

Dr. FREDA SCOTT-PARK (Former President, British Veterinary Association): I got that it's good afternoon to you, but it's good evening for me. And you're welcome.

FLATOW: Thank you. Arnold Monto is professor of epidemiology at the University of Michigan School of Medicine in Ann Arbor and chaired a conference last week on pandemic flu preparations. Dr. Monto joins us from the studio of WUOM in Ann Arbor. Welcome back to the program, Dr. Monto.

Dr. ARNOLD MONTO (Epidemiology, University of Michigan): Thank you. And I'm at the School of Public Health.

FLATOW: You are?

Dr. MONTO: Right.

FLATOW: All right, not the School of Medicine anymore. Okay.

Dr. MONTO: Well, not the School of Medicine.

FLATOW: I stand corrected. Well let me ask what Dr. Scott-Park to give us an update, what is the latest on the outbreak over there?

Dr. SCOTT-PARK: I think you actually summarized it quite well, Ira. We have a situation where now we knew last week that we had H5N1. This is the first really big outbreak we've had of H5N1 for over 10 years. And we now know, as of yesterday, that the strain is identical to the virus that has just been recently seen in geese in Hungary. And of course all our efforts are now being concentrated on how the virus came to the U.K.

FLATOW: What about it coming in from - allegedly from the meat imported from Hungary?

Dr. SCOTT-PARK: Well, let's think about the situation in Hungary. There was an outbreak in Hungary reported two weeks ago. And Bernard Matthews, which is the infected unit down in Suffolk in England, they have a plant - a processing plant in Hungary but it is over 160 miles away from the outbreak of avian influenza in Hungary. Therefore, Bernard Matthews was not, you know, the unit in Hungary was not under any restriction. They weren't in the restriction or the protection zone.

And therefore they were still free to move poultry product out of Hungary to the U.K., and indeed it is that angle that our officials will be examining very carefully over the next couple of days to see if it would be - there's a possibility that the virus was carried in partly processed poultry meat.

FLATOW: Now this poultry meat farm is - were there 22 sheds of sealed in with a - the birds are sealed in, correct?

Dr. SCOTT-PARK: Yes, the farm in Suffolk. And it's getting quite confusing as to know which side of the, you know, the continent was speaking about. Now the farm in Suffolk where we had the outbreak of the virus is a huge farm, 22 very large sheds with approximately 2,000, I gather, turkeys, and perhaps more in some sheds. It was in one single unit that the birds became ill just about 10 days ago. And what happened initially was that the veterinary surgeon was called in because some of the birds weren't looking terribly well and there was a low level of mortality.

The veterinary surgeon came to the farm and tested the birds and found quite a high level of E. coli infection and suggested antibiotic treatment. A day later, there was a little bit more mortality, and at that point the veterinarian, who is a junior veterinarian in the practice, asked his senior veterinarian colleague to visit, which he did the following afternoon, by which time the mortality has jumped.

And by that stage the senior veterinarian, who has seen avian influenza twice before both H5 and H7, he knew immediately that we were dealing with something serious here and said he had to contact our government officials. And at that point our government officials were called in, and from that moment on we had a crisis situation.

FLATOW: Now there are reports saying that the virus has spread to four sheds. Can you confirm that?

Dr. SCOTT-PARK: No. Well the situation is - when they came to cull the birds in the infected shed, whether it's a high mortality, because we have a stamping out policy in the U.K. it means that only infected premises or birds must be culled. So what happened was that every single shed had to be slaughtered out, not an easy job to do. But what the government vets did as they were slaughtering the other sheds was taking serology, blood samples to make sure that they were determining whether they was a virus existing in those sheds as well but perhaps not being shown up in mortality rates.

There's always a concern in avian influenza that the virus might be existing as a low pathogenic form which doesn't cause high mortality in birds.

FLATOW: This sort of indicates to me that there's a breakdown in the system some place, is there not? I mean the whole idea of keeping the birds isolated is, one, to keep out any bird passing over or migratory bird who might be spreading the disease.

Dr. SCOTT-PARK: Absolutely. And, you know, in many ways in the U.K. we've been saying thank goodness the outbreak was in a unit which has very good bar security. But of course the very fact we've had an outbreak means that the bar security was not 100 percent. And I can imagine that the Bernard Matthews team will be looking extremely closely to see where the breakdown has occurred, because this sort of thing is devastating for a company.

But having said that, and bear in mind I'm not party to the serology yet from the other sheds, it seems to me that this outbreak was confined to one shed. And at the moment we haven't got any confirmed cases of any more outbreaks, which means we do seemed to have followed our line of identification, containment, and stamping out.

FLATOW: Arnold Monto, are you alarmed at this case or any case like this one?

Dr. MONTO: No, I'm not alarmed because this is occurring in a country which has a well defined policy for stamping out infection. I think what we are dealing with and the thing that frightens me is that we have most of our Avian influenza occurring in poultry in parts of the world where they are unable to follow this kind of a policy. And we continue to see infection in birds in rare but occasional infections in humans. I think that's where the real danger is.

FLATOW: But you have a case here where 160,000 birds had to be killed. I mean, there may be other parts of the world where you have smaller farms and they're not taking as many, you know - as much precaution to keep them in the isolation, but here is a case that's 160,000.

Dr. MONTO: Yeah, but how many cases are we going to see in the poultry workers? They're all using protective equipment. I don't know if they're on antivirals or not. This will happen occasionally. It happened last year. There were cases in France and in some other European countries. We had predicted that with colder weather we were going to see an upsurge in avian influenza in poultry. We can contain this. What is the frightening aspect of this disease, this infection is its continuing occurrence in places where we are seeing human cases and the possibility for mutation.

FLATOW: Dr. Scott-Park, do you agree?

Dr. SCOTT-PARK: Absolutely. Arnold makes a very good point here. We also have a concern that we've been talking, as you said in your introduction, that it was very much when the virus arrives, not if. And we were highly suspicious that the very first sign would be in a wild bird. And I don't know if any of your listeners would know, but last April we had a dead swan arrive on the coastal region in Fife in Scotland which was diagnosed with H5N1. And we thought that might have been the start of our problems. It turned out to be an isolated case.

Now should the virus arrive in the wild bird population, that is going to be far more difficult to control. Like I said earlier, we're reassured that at the moment it seems to have come into an intensive flock and remain there, and we've been able to stamp it out.

FLATOW: But is the public reassured? Are they going to stop eating turkeys the way they stopped eating, you know, cows when you had mow cad disease?

Dr. SCOTT-PARK: You know, it's quite interesting. In October 2005, H5N1 started moving out of Southeast Asia and there was enormous media interest at that time. One might say that it hadn't come anywhere close to (unintelligible) the newspapers and the televisions got hold of this disease, you know, they talked about human pandemics and there was (unintelligible) weeks (unintelligible) calmed down a bit over the Christmas season in 2005, 2006. And then in March we had another scare as it moved into Western Europe. And for the first time it was in Germany, France, so that's just on our doorstep. You know, we have a barrier of border but it's right on our doorstep. We had two weeks of intense activity.

When the dead swan arrived in (unintelligible) in Fife with H5N1 for the first time, the public was very much more informed and we had a very mature attitude to the fact that the disease had arrived. And in fact at that time we noticed only the tiniest fraction of effect on poultry meat consumption.

FLATOW: All right. Doctor, I have to tell you to hang on because we have to take a short break. We'll come back and talk more with Freda Scott-Park and Arnold Monto and take your phone calls and talk about preparations for an outbreak of a pandemic in this country soon. Don't go away. We'll be right back after this short break.

I'm Ira Flatow and this is TALK OF THE NATION: SCIENCE FRIDAY from NPR News.

(Soundbite of music)

FLATOW: You're listening to TALK OF THE NATION: SCIENCE FRIDAY. I'm Ira Flatow.

We're talking about bird flu this hour and the outbreak that just occurred in Great Britain with my guests Freda Scott-Park, past president of the British Veterinary Association, Arnold Monto of the University of Michigan. Our number: 1-800-989-8255. We're going to talk a little bit about preparations for an outbreak in this country, but first let's go to the phones: 1-800-989-8255. Let's go to Joel(ph) in Swoope, Virginia. Hi, Joel.

JOEL (Caller): Hi, Ira. Thank you for having this wonderful topic on the radio. As a pastured poultry farmer of literally decades with outdoor poultry, having been called a bioterrorist because our chickens commensurate with redwing blackbirds when we land-filled a thousand tractor-trailer loads of turkeys here in 2002 in Virginia, and having read Jared Diamond's book "Guns, Germs and Steel", my comment is that the avian flu as we're dealing with it is simply a symptom of a depressed immune system. We've had avian flu since the, what, 1880s?

And if it's just a symptom of depressed immunological function, it seems like we would be doing something to try to bolster our immune systems; which means we would be reducing the factory farming situation we have, reducing the global transport of poultry, unprocessed poultry products, and start doing some things that we know would help our immune systems, like eating good food.

FLATOW: For - as a citizens' farmer, do you think that your birds in the wild are safer than the ones cooped up in these giant pens?

JOEL: Oh very, very much so because they're not ingesting fecal particulate dust all day.

FLATOW: Let me ask my guests. Freda Scott-Park, Arnold Monto, any comment?

Dr. SCOTT-PARK: Who would you like to start?

FLATOW: You can start.

Dr. SCOTT-PARK: Well I think it's an interesting comment, and to some extent I completely understand where Joel's coming from. We've had a lot of questions recently from our press saying, for goodness sake, isn't this exactly what we deserve from intensification of all our farm animals? Now, I happen to be a dairy farmer's wife. We happen to farm organically, so I understand exactly what the difference is between intensive and extensive organic farming.

However, I do know that we really probably wouldn't be able to feed or, you know, feed the demand for poultry meat by extensive systems in this country. And I think to some extent we have to exist shoulder to shoulder. Our free-range birds, I would suggest, are at greater risk from ingress by avian trends on the back of wild birds, and we do have some concerns for our organic and our free-range flocks.

FLATOW: All right.

Dr. MONTO: I agree. Paradoxically, it's our free-range poultry that are at greater risk in the developed world, where the high intensity raising of poultry goes on. But if you look at the developing world, those places where there are mainly backyard flocks, they have had a continuation - continuing spread of avian influenza and part of the traditional poultry industry there is involved. Ducks are asymptomatically infected and they maintain the continued existence of these viruses. They are moved from farm to farm and they have been responsible for the spread. So it's a very complicated situation.

JOEL: Well the backyard flocks, though, you're not saying that those are sanitary. I mean, if you study the reason that this is emanating from Asia is because when you go there, even a backyard flock is far more unsanitary than an American Tyson house because of theft. And they burn all their carbons so they don't have litter or bedding so the birds, even a backyard flock, are kept, you know, 200 in an eight foot by eight foot wire cage padlocked to the backdoor. And the chickens are off and actually roosting in the kitchen overnight so the neighbors don't steal them. So I would suggest that labeling clean, rotated, pastured poultry with an elevated immune system, equating that with the filthy, unhygienic, unsanitary Asian backyard flocks is an incredible misnomer.

Dr. MONTO: Well, all I'm pointing out is that this is the most traditional way of raising chickens, and basically it's a leap to say that it's what's responsible here is battery raising of poultry. I think it's a very complicated situation.

FLATOW: All right, Joel, thanks for calling. 1-800-989-8255 is our number. Arnold, let me talk to you about the CDC currently coming out with guidelines for communities to use in the event of a flu pandemic, and including sort of a hurricane scale-like ranking system from one to five of how bad this pandemic is once it breaks out.

For an example, schools don't close for Category One hurricanes, schools don't close for Category One flu pandemics. But if the next pandemic appears to be a Category five, the guidelines recommend states close schools for up to three months. This is an effort to try to get communities to be - to start taking and prepare on their own. Is that correct, Dr. Monto?

Dr. MONTO: Well that's part of it. The whole strategy is based on the fact that if a Category four or five - and you're absolutely right, this was purposely chosen because of the familiarity with the hurricane categories. If we have that kind of a pandemic and the famous 19 - or infamous 1918 pandemic was at the margins between Category four and Category five, if we have something like that and in the situation where we don't have as yet vaccines and we are short on antivirals, only these community mitigation approaches are going to be possible.

FLATOW: Non-drug related? In other words, they don't…

Dr. MONTO: Non-drug related.

FLATOW: They stay away from - let me read from some of the categories of the pandemic: voluntary isolation, voluntary quarantine, child social distancing, keeping people away, things like that, from each other. But nowhere does it have - I couldn't find in here - does it call for a nickel or a dime from the federal government to help bring these programs about.

Dr. MONTO: Well, I think that is in part a separate issue. The funding of these kinds of approaches really needs to be worked out, as does the purchase of antivirals. The purchase of antivirals is also split between the federal government and the states, but I think the important component here is it gives a rational approach to some of these strategies which cannot be tested. Some can and some cannot in terms of what will work in seasonal influenza. Closing schools, for example, which is the lynchpin of the strategy, is something that you can't do outside a major pandemic.

FLATOW: Well don't you think once even a Category One pandemic breaks out parents are going to keep their kids home from school anyhow? People are not going to go to the office on their own?

Dr. MONTO: Well I think that's - a Category One pandemic - In 1968, we had probably a Category One pandemic, which was about maybe twice as bad as the seasonal outbreak. I think people will react very differently to that than a 1918-like scenario where 500,000 Americans died. If we equate that to our current population we're almost at two million deaths. That is something different. And what the approach that's suggested here entails is closing schools early because what we've had in the past, even in severe seasonal outbreaks, is reactive closing of schools. But we realize that this has consequences.

If children in the inner cities are getting their lunches in school, we have to figure out how to handle that. And that is why we want to be clear that it's only in the most severe pandemics that these kinds of proactive approaches would be necessary.

FLATOW: Well I mean, in Level two and three you say that they should consider - people should consider staying off public transit, stop taking the buses and the subways; modify, postpone or cancel selected public gatherings to promote social distance, in other words, indoor skating events or theater performances; modify their workplace schedules and practices. Does it also say how, you know, public service people who are in charge of making the governments and the public places run how they should be compensated or, you know - or be brought into the situation once these people start staying away from where they're working and where they're playing and where they're going to school?

Dr. MONTO: It's even more complicated than that because we have at the bottom of the social scale people who don't have health insurance, who work hourly and who will not get compensated if they stay home from work. We have to work these things out. But these people in a severe pandemic, the jobs will just evaporate. 1918 is the case in point, and we've learned a lot by studying what happened in 1918.

FLATOW: So you don't deal with what happens with the people who gets sick in the hospitals, beefing up the hospitals and the social services and finding places to store all the dead people, well, the bodies once they start dying.

Dr. MONTO: Well, that's an issue and you can't look at this in isolation. We will have antivirals. The antivirals will probably work. They are being stockpiled. And for example, when it's suggested that families with a sick individual stay home, what I would like to see is these individuals be put on targeted antiviral prophylaxes.

In other words, they would be given the effective antiviral drug to take while they are keeping themselves at home voluntarily and taking care of the sick individual. So one aspect of pandemic control relates to another. The other reason - another reason for this approach is to try to reduce the peak of the pandemic.

What we're going to have if we don't control the peak is an enormous surge and demand for beds, for health care workers and the rest who will themselves be sick. So what we're trying to do is to slow it down.

FLATOW: How do you slow it down? Are there provisions in here for calling in the National Guard, for example, to control the panic that might ensue?

Dr. MONTO: Well, I think you need to speak to somebody who actually wrote the plan. I think what is very interesting with this plan is, if you look at the cover, you will see the seals of something like 10 federal departments and agencies. So the government is working together on this.

This is a result of awareness of how bad a pandemic can be. The strategy in terms of the categorization is to make it sure that people don't think that these severe measures are being recommended casually, that this is only going to be implemented in terms of major control measures in the most severe pandemics.

FLATOW: Dr. Monto, I say this often and I say it will all due respect, talk is cheap. There's not a penny in here to carry out any of these things you're asking for.

Dr. MONTO: Well, here I am…

FLATOW: I know it's not your plan…

Dr. MONTO: Here I am in Ann Harbor, Michigan, in the so-called the Ivory Tower, fortunately.

FLATOW: I know it's not your plan but, you know, how - you didn't address how we pay for any, bringing in this extra people to take care of all the sick people. All right, I'll let you go. I know - and there's no answer for it because it's not your problem.

Dr. MONTO: There is no answer. I think the…

FLATOW: Well, if someone says here's the federal plan. We've taken your plan and now we're going to make an action plan out of it with real money.

Dr. MONTO: Well, the harder part of this, it's relatively easy and I don't have to appropriate the money. But it's relatively easy to appropriate the money. The social burdens included in telling people to stay home from work, closing schools and the rest are much more difficult to accommodate, and those are things which we really have to look at.

FLATOW: 1-800-989-8255 is our number. We're talking about bird flu and possible pandemic outbreak this hour in TALK OF THE NATION: SCIENCE FRIDAY from NPR News.

Let me go to the phones. Let's go to Linda in South Florida. Hi, Linda.

LINDA (Caller): Hi. I know that the food service industry at present in the South Florida area requires anyone who has a sore throat, fever, or diarrhea to inform their supervisor and stay home. And yet a lot of times people simply don't do that, they go to work anyway, often because it's a choice between going to work and paying the rent, and staying home and defaulting. And I'm wondering if there's any kind of enforcement set up so that in the event of a pandemic people will be forced to stay home if they're sick.

FLATOW: Quarantine. Dr. Monto, is that a good idea?

Dr. MONTO: Well, I don't think it's a very good idea. We would recommend the people to stay home. I study seasonal influenza, and this is one of the ways that influenza gets transmitted in the workplace. And we have developed a culture where it's not acceptable to stay home except if you're so sick that you can't get out of bed.

Eighty percent or so of influenza cases are not that sick and people with influenza go into work and they do spread the infection. So we've got a problem here in terms of spread of seasonal influenza. One of the things that we have to remember is that when we focus on pandemic influenza we need to think that everything we do for pandemic influenza will also pay off in terms of controlling the seasonal influenza.

Thirty-six thousand Americans die every year because of seasonal influenza, and this is preventable.

FLATOW: Let me ask our friend across the pond. Dr. Scott-Park, does Great Britain have any plans?

Dr. SCOTT-PARK: Yes, we do. I mean, obviously, my area of expertise are contingency plans for the disease in our poultry industry because I'm a veterinarian. However, our Health Protection Agency has quite considerable plans based exactly along the lines that you've mentioned.

However, just say evidence that veterinarians, they are far more, far better informed than many of our medical friends. I think it's - really, we've got a way to go, to be quite honest, to be absolutely prepared for a human pandemic.

FLATOW: Let me ask Dr. Monto. I know that you're running an experiment now on flu prevention using college students as your guinea pigs on this. Tell us about that.

Mr. MONTO: Well, we are trying to evaluate a couple of the non-pharmaceutical interventions you can evaluate in the seasonal pandemic, and that is hand hygiene and wearing face masks. And we've asked students in several of our dorms to either wear facemasks, to wear facemasks and use hand hygiene, or to serve as controls. And we're actually asking them to provide a specimen, which we will then work on in our laboratories to identify if they're influenza infected.

This will inform some of the recommendations that are included in the plan, which is marked draft. I mean this is a work in progress, and part of the problem in coming up with these recommendations is the lack of data. And we're trying to get data on this. Other - in other areas, such as closing schools, it's impossible to come up with data, so we're relying on history and epidemic models.

FLATOW: Well, good luck to you, Dr. Monto and also to you over there in Great Britain. Thank you both for taking time to talk with us. Freda Scott-Park and Dr. Arnold Monto talking with us about the possible epidemic - pandemic that might break out.

We'll take a short break and we'll be right back. Don't go away.

I'm Ira Flatow. This is TALK OF THE NATION: SCIENCE FRIDAY from NPR News.

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