Alan Sipress - The Fatal Strain

76 On the third day of the slaughter:“Tung Handling of Flu Crisis Attacked,” South China Morning Post, Jan. 1, 1998.

76 In a front-page editorial:“Only Time Will Prove Wisdom of Dramatic Move,” South China Morning Post, Dec. 29, 1997.

76 the “botched” operation:“Taking Charge,” South China Morning Post, Jan. 3, 1998.

76 nearly 350 chickens:Kennedy F. Shortridge, “Poultry and the Influenza H5N1 Outbreak in Hong Kong, 1997: Abridged Chronology and Virus Isolation,” Vaccine 17 (1999): s26-s29.

76 more widespread than expected:Kennedy F. Shortridge et al., “Characterization of Avian H5N1 Influenza Viruses from Poultry in Hong Kong,” Virology 252, no. 2 (Dec. 20, 1998): 331-42.

77 a pandemic had been averted:Kennedy F. Shortridge, J. S. Malik Peiris, and Yi Guan, “The Next Influenza Pandemic: Lessons from Hong Kong,” Journal of Applied Microbiology 94 (2003): 70S-79S.

77 its most successful:Several researchers have held up Hong Kong as the model. See, for example, Robert Webster and Diane Hulse, “Controlling Avian Flu at the Source,” Nature 435 (May 26, 2005): 415-16. Yet the model may be hard to apply elsewhere. See Les Sims, “Achievements, Issues and Options on Strategies for HPAI Control and Prevention,” Background Paper at the Technical Meeting on Highly Pathogenic Avian Influenza and Human H5N1 Infection, June 27-29, 2007, Rome.

78 Their main exposure:Anthony W. Mounts et al., “Case-Control Study of Risk Factors for Avian Influenza A (H5N1) Disease, Hong Kong, 1997,” Journal of Infectious Diseases 180 (1999): 505-8.

78 would resurface in 2001:On this outbreak and Hong Kong’s response, see Yi Guan et al., “Emergence of Multiple Genotypes of H5N1 Avian Influenza Viruses in Hong Kong SAR,” PNAS 99, no. 13 (June 25, 2002): 8950-55; and N. Y. Kung et al., “The Impact of a Monthly Rest Day on Avian Influenza Virus Isolation Rates in Retail Live Poultry Markets in Hong Kong,” Avian Diseases 47 (2003): 1037-41.

78 the virus struck yet again:For an overview of the poultry outbreaks in 2001–2002, see L. D. Sims et al., “Avian Influenza in Hong Kong 1997-2002,” Avian Diseases 47, no. s3: 832-38; L. D. Sims et al., “An Update on Avian Influenza in Hong Kong 2002,” Avian Diseases 47 (2003): 1083-86; and Kennedy F. Shortridge, J. S. Malik Peiris, and Yi Guan, “The Next Influenza Pandemic: Lessons from Hong Kong,” Journal of Applied Microbiology 94 (2003): 70S-79S.

This chapter draws on interviews with WHO infectious disease specialists and other officials in both Geneva and Asia, public health officials and medical professionals in Thailand, and internal documents from WHO.

81 “Influenza has been an epidemic illness”:Prasert Thongcharoen, Influenza (Bangkok: Mahidol University, 1998).

82 blame the spiraling death toll on the weather:Newin Chidchob, deputy agriculture minister, is quoted in “Thailand Declared Free of Bird Flu,” Nation (Thailand), Jan. 15, 2004. Yukol Limlamthong, director-general of the Livestock Department, is quoted in “Bird Flu: Govt to Sue over ‘False Report,’” Nation (Thailand), Jan. 17, 2004.

85 researchers had confirmed:Arthit Khwankhom and Sirinart Sirisunthorn, “Govt Ignored Chula Warning,” Nation (Thailand), Jan. 30, 2004.

86 “We were fighting”:“What Happened When the H5N1 Virus Visited Thailand,” lecture at the Asia Medical Forum, Lancet 2006, Singapore, May 4, 2006.

87 “Irresponsible media”:Tini Tran, “WHO Says SARS Helped Asia Prepare for Bird Flu; Poultry Culls Continue,” Associated Press, Jan. 16, 2004.

87 “There’s absolutely no evidence”:Alisa Tang, “Thai Cabinet Seeks to Boost Confidence of Chicken-Wary Public,” Associated Press, Jan. 19, 2004.

88 a confidential tip:Internal WHO report, Jan. 20, 2004.

90 broader resurgence of infectious disease:For an excellent exploration of what was optimistically called the Health Transition and subsequent setbacks, see Laurie Garrett, The Coming Plague (Penguin: New York, 1995).

91 Storm clouds were gathering:See, for example, David L. Heymann and Guenael R. Rodier, “Hot Spots in a Wired World: WHO Surveillance of Emerging and Re-emerging Infectious Diseases.”

91 WHO’s rapid response:David L. Heymann and Guenael Rodier, “Global Surveillance, National Surveillance and SARS: Commentary,” Emerging Infectious Diseases 10, No. 2 (Feb. 1, 2004); and David L. Heymann, Mary Kay Kindhauser, and Guenael Rodier, “Coordinating the Global Response,” in SARS: How a Global Epidemic Was Stopped (Manila: WHO Western Pacific Regional Office, 2006).

93 Subsequent study:Kulkanya Chokephaibulkit et al., “A Child with Avian Influenza A (H5N1) Infection,” Pediatric Infectious Disease Journal 24, no. 2 (Feb. 2005): 162-66; and Mongkol Uipprasertkul et al., “Influenza A H5N1 Replication Sites in Humans,” Emerging Infectious Diseases 11, no. 7 (July 2005): 1036-41.

94 followed right behind:For a synopsis of Thailand’s experience with avian flu in 2004, see Thanawat Tiensin, et al., “Highly Pathogenic Avian Influenza H5N1, Thailand, 2004,” Emerging Infectious Diseases 11, no. 11 (Nov. 2005): 1664-72.

95 “It’s not a big deal”:Sutin Wannabovorn, “Thailand Confirms Two Human Cases of Bird Flu as Infection spreads Through Asia,” Associated Press, Jan 23, 2004.

97 teams were running short:Tipawayan Kwankhauw, “Anger and Tears as Thailand’s Farmers Cull Millions of Chickens,” Agence France Presse, Jan. 25, 2004.

100 mixing vessel:See, for instance, S. Scholtissek et al., “The Nucleoprotein as a Possible Major Factor in Determining Host Specificity of Influenza H3N2 Viruses,” Virology 147 (1985) 287-94; H. Kida et al., “Potential for Transmission of Avian Influenza Viruses to Pigs,” Journal of General Virology 75, no. 9 (Sept. 1994): 2183-88; and Ian H. Brown, “The Epidemiology and Evolution of Influenza Viruses in Pigs,” Veterinary Microbiology 74, nos. 1-2 (May 22, 2000): 29-46.

101 “Are the doctor and the media”:“PM Derides Doctor over Pig Comments,” Nation (Thailand), Jan. 28, 2004.

This chapter draws on interviews with current and former infectious-disease specialists, investigators, and other officials at WHO and CDC in the United States, Geneva, and Asia, with Vietnamese, Thai, and Hong Kong disease specialists, and on documents from WHO and CDC and personal notes kept by participants in the events described.

104 When SARS broke out:The results of the outbreak investigation in Vietnam are discussed in Hoang Thu Vu et al., “Clinical Description of a Completed Outbreak of SARS in Vietnam, February-May 2003,” Emerging Infectious Diseases 10, no. 2 (Feb. 2004): 334-38; and Mary G. Reynolds et al., “Factors Associated with Nosocomial SARS-CoV Transmission Among Healthcare Workers in Vietnam, 2003,” BMC Public Health 6 (2006): 207.

109 The flu outbreak that began that fall:For more discussion, see Niranjan Bhat et al., “Influenza-Associated Deaths Among Children in the United States, 2003-2004,” NEJM 353, no. 24 (Dec. 15, 2005): 2559-67; and Laura Jean Podewils et al., “A National Survey of Severe Influenza-Associated Complications Among Children and Adults, 2003-2004,” Clinical Infectious Diseases 40 (June 1, 2005):1693-96.