Anjulika Thingnam
IMPHAL, Manipur, Aug 7 2007 (IPS) – For the past fortnight, the menu on the Manipur state government s table has changed from the staple of fighting HIV infections to stamping out an outbreak of avian influenza.
That effort has paid off. On Monday the state, which shares a 1,600 km-long border with Burma, was confident enough to lift a ban on the import of poultry feed.
With a population of 2.2 million people Manipur already has and estimated 15,000 HIV positive people and 800 full-blown AIDS cases keeping the health department on a high alert. The state government additionally grapples with a long-standing armed separatist insurgency.
Eleven days after the bird flu outbreak was made public, around 350,000 birds, including some of the state governor s imported ducks, had been slaughtered and stamping out operations carried out. Around 30,000 eggs and 23,000 bags of chicken feed were also destroyed.
Nearly 1,700 state health and veterinary personnel divided into 74 Rapid Response Teams (RRT) mounted a surveillance programme covering 60,000 households (300,000 people) across 86 villages within a five km-radius of the focus of the outbreak, Chingmeirong village outside Imphal. Over 40,000 households have been covered by the surveillance teams till date.
Participating are 34 RRTs of the state veterinary and animal husbandry services and another 40 run by the health department, each comprising one medical officer, three health supervisors and 30 health workers.
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The possible presence of the virus came to the notice of the state veterinary and animal husbandry services department on Jul. 10 when a poultry farmer, Sagolsem Irananda, reported the death of about 132 chickens within a span of six days in his farm at Chingmeirong.
A fortnight later, on Jul. 25, the Manipur government declared the outbreak of the disease after samples sent to the high security animal disease laboratory in Bhopal (Madhya Pradesh) and the National Institute of Virology, Pune (Maharashtra) were found carrying the H5N1 strain of avian influenza.
Action to control the spread of the virus drew from the experience of an outbreak in western Maharashtra state last year. The state animal husbandry department had already released an action plan to tackle a possible outbreak by November 2006.
Following confirmation, both the state and central government swung into action. The central government quickly sanctioned Rs four million (99,000 US dollars) for immediate relief and two respiratory ventilators were flown into Imphal from the National Institute of Communicable Diseases (NICD), located in the national capital of New Delhi.
The prestigious Regional Institute of Medical Sciences (RIMS) hospital here already has seven such ventilators but requests were made to the central government for eight more as a precautionary step.
Apart from officials of the central government, health personnel from the neighbouring states of Sikkim, Arunachal Pradesh, Nagaland, Meghalaya, Tripura, West Bengal as well as Maharashtra joined the surveillance teams.
The first phase of culling within the five km-radius of Chingmeirong was completed on Aug. 1 and stamping out operation began the next day. The culling will continue for another ten days, while the monitoring will continue for three months from the day the outbreak was detected, state health secretary P. Vaiphei told IPS.
The culling process is taking time because we have to focus not only on poultry farms but also on backyard poultry through house-to-house surveys, Vaiphei added.
Delays were also caused by poultry farmers and some non-government organisations (NGOs) protesting against inadequate compensation. The state government is paying Rs 30 per broiler (75 cents), although the market rate per kg is two dollars.
We re ruined, all the chicks are gone, said Irananda (one name) in whose farm the virus was first detected. His entire family had been heavily dependent on the poultry farm which has no insurance cover. Other poultry farmers around Imphal who had taken loans to run poultry farms were also affected.
Estimates made by the Northeastern Poultry and Egg Federation (NEPEF), the poultry sector in Manipur state, worth 250 million dollars, has suffered losses of 165 million dollars. Despite the economic loss, Manipur health services minister Pheiroijam Parijat was satisfied that the situation was well under control .
Meanwhile, authorities are yet to discover the source of the outbreak although neighbouring Burma and Bangladesh were strong suspects.
It s hard to find out the source as yet, said Dr Dorendra, director, state veterinary and animal husbandry department. Dorendra, who has been supervising the entire culling and stamping out processes, said: It might have come across the porous Indo-Burma border.
Burma first reported an outbreak in March 2006. Fresh outbreaks were identified in the country early this year too, the latest being in July on a farm northwest of the commercial capital of Rangoon around the same time as the outbreak in Manipur.
Following the outbreak in Burma the state government banned poultry products from the country as early as March. But poultry traders in Imphal confided that around a hundred chickens and quantities of eggs continued to be brought over the border routinely every day.
One question that has come up is if the H5N1 bird flu-causing virus mutates into a variety that is able to be transmitted easily between humans, could it cause a pandemic of disastrous proportions in Manipur where there are large numbers of people living with HIV/AIDS and having compromised immunity?
Though the H5N1 strain remains largely a bird virus, experts are apprehensive that its mutating ability might spark off an influenza pandemic in which millions could die. The virus is known to have infected at least 319 people worldwide since 2003 and has killed at least 192, according to the World Health Organisation (WHO).
Manipur health secretary Vaiphei however ruled out any report of human transmission in the state. There have been very few cases of human infection all over the world. We have been conducting health monitoring surveillance too. The clinical samples of four persons who were earlier suspected of having contracted bird flu and were quarantined have been declared negative for avian influenza virus by RT-PCR (Reverse Transcriptase Polymerase Chain Reaction) test, he said.
A 2005 BBC news report cited well-known virologist Dr Robert Webster of St Jude Children s Research Hospital in Memphis as saying that bird flu could readily mutate into a pandemic form if it infects people with AIDS. He said it was possible that people with AIDS who have depressed immune systems could harbour the deadly H5N1 strain of bird flu.
When contacted recently on e-mail Webster however clarified that the issue of the vulnerability of people with HIV/AIDS at this time is theoretical. We know that humans on immunosuppressant drugs can shed influenza viruses for prolonged periods. However, if those persons with HIV/AIDS are infected with H5N1, they could be more vulnerable .
Dr Priyokumar, who is in charge of Antiretroviral Therapy (ART) at the state-run JN Hospital says, What you have to basically realise is that bird flu will affect a healthy person and a person with HIV/AIDS in the same way.
Vaiphei adds, Bird flu does not spread from human to human in the same way as HIV/AIDS. When the virus was detected in Maharashtra earlier, there was no human infection. So it would be rather premature to speculate on that (the vulnerability of HIV/AIDS infected people to bird flu). Even if human infections do occur, it doesn t spread from man to man. So we can take comfort on that. The infection may be restricted and controlled. There is no cause for alarm or panic.
Rajkumar Tiken, secretary general of the Social Awareness Service Organisation (SASO), a leading voluntary agency that works with HIV positive people, explained: Being HIV positive doesn t always mean that your immune system is weak. The strength or weakness of your immune system will be shown by your CD4 count.
According to WHO guidelines when the CD4 count falls below 200, the patient is to be put on ART. Normal CD4 counts in adults range from 500 to 1,500 cells per cubic mm of blood. The CD4 count also shows how far AIDS disease has advanced (the stage of the disease), and helps predict the risk of complications and debilitating infections.
Yes, there are a host of opportunistic infections which an HIV positive person has to guard against. But we are not aware of any link or greater susceptibility to bird flu, Tiken said.
