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Bird flu victims under scrutiny
International health authorities are scrutinizing several newly discovered patients with avian influenza H5N1, unsettled by reports that the victims may have been infected by other people rather than by poultry and other birds.
There is no evidence that the virus has gained the ability to move in a sustained way from person to person, a development that would allow it to travel rapidly across the globe. But Asian health authorities cannot say with confidence that the new cases --- a boy and a young man in Thailand and three family members and a nurse in Vietnam --- do not represent an interim step on that path.
The cases were revealed as fresh outbreaks of the virus were discovered or suspected in birds in Romania, Ukraine and Ethiopia, and as U.S. officials called state health workers to Washington to launch a series of meetings to prepare for the virus's arrival.
Avian influenza H5N1, commonly called bird flu, has sickened at least 133 people in five Asian countries --- killing 68 of them, according to the World Health Organization --- and has killed or prompted the preventive slaughter of approximately 150 million poultry and other birds since December 2003.
Almost all known human cases of bird flu can be traced to direct exposure to chickens.
Planners believe that some person-to-person transmission has occurred but say limited health care resources in Asia make it difficult to detect clustered cases.
"It is always difficult to be sure if you have a couple of cases in a family, because generally speaking, members of a family have been exposed to the family's chickens as well as to each other," said Dr. Scott Dowell, who leads the global disease detection effort at the Centers for Disease Control and Prevention.
Even when health care workers appear to have been infected by patients, "some of those health care workers have been exposed to household chickens, sometimes in the same village," Dowell said.
Vietnam said its latest cluster might include five health care workers: the nurse who cared for a known bird flu patient and who is hospitalized in critical condition, and two other nurses and two doctors who have no symptoms but are being watched.
Indonesia reported its eighth avian flu death but said five additional patients were hospitalized and recovering.
Health authorities kept watch for human illness in quarantined villages in both Ukraine and Romania, and Ethiopia began analyzing a rapid die-off of several hundred birds.
In Washington, several hundred state and local health officials peppered federal planners with questions about vaccine availability and support of home health care in a meeting called by Health and Human Services Secretary Michael Leavitt.
"We are able to fight pandemic flu," Leavitt said. "Through preparation, we can be ready."
But Dr. Eduardo Sanchez, public health commissioner of Texas, said spot shortages and confusion about vaccine for this year's "seasonal flu" epidemic should be a warning about the importance of details in preparing for a pandemic.
"Right now, the very people we want to help in a pandemic are confused when flu vaccine is available at the local supermarket and they can't get it at their doctor's office," said Sanchez.
Meeting with Homeland Security Secretary Michael Chertoff, White House director of biodefense and health Rajeev Venkayya, CDC Director Julie Gerberding and others, the state officials voiced concerns on bioterrorism planning requirements, business community involvement and local needs.