Health officials are concerned that resources to detect and deal with bird flu

are inadequate after Cambodia confirmed its first human death caused by the

avian influenza.

A fresh outbreak of bird flu in chickens was also

recorded February 7 near the town of Takhmao in Kandal province, 10 kilometers

from Phnom Penh.

Ly Sovann, chief of the Disease Surveillance Bureau of

the Ministry of Health, said attempts to make people aware of the warning signs

of bird flu have fallen short.

"We are trying to get information out to

the villagers via radio, newspaper, any means possible, but we are still not

confident that all people know," said Sovann.

However, the Ministry of

Health insisted the situation was under control and the funding package it

received in February last year was enough for education and surveillance of

outbreaks.

Yves Froehlich, of the Food and Agriculture Organization, said

the $1 million provided by international donors a year ago to cope with bird flu

was almost gone.

Donors said they were waiting on an official request

from the government for more funding.

The concerns came days after a

Cambodian woman, Tit Sokhan, 25, was confirmed as the country's first human

victim of avian influenza earlier this month.

Her 14-year-old brother,

Tit Chiang, died from respiratory failure on January 24 but was cremated before

authorities could test him for the virus.

None of the birds tested around

Sokhan's home in Kampot showed positive results for the disease and the dead

woman had little contact with poultry, causing speculation that she contracted

the disease from her brother.

Sokhan died on January 30 in a Vietnamese

hospital.

Before going to Vietnam, Sokhan's family had become

increasingly worried about her condition and sought help at the Kampong Trach

district health center.

A doctor was unable to identify her illness and

sent her home, suggesting she may have angered the spirits of her grandparents.

Health workers advised her to perform a ceremony to appease the spirits.

When Sokhan failed to recover, she sought treatment in Vietnam, but the

highly pathogenic strain of avian influenza A/H5N1 had spread to her lungs and

she died soon after.

Sokhan is survived by her husband and two young

children. Their mother, Tim Ran, 42, said she did not know about the bird flu

until after her children had died. Ran said she was shocked to learn bird flu

could affect humans.

A week after the death in Kampot, Cambodia's 14th

confirmed outbreak of avian influenza was reported in Prek Russei village,

Kandal province.

Ouch You, 58, who owned the infected chickens, reported

the death of 70 birds to the village chief in late January. He thought they had

died from Newcastle disease, a poultry disease that occurs at this time of year

and resembles the symptoms of bird flu.

Ouch You said he didn't know

anything about bird flu until the animal health department officials arrived to

take samples from his remaining chickens. Two tested positive.

"I found

two or three dead chickens every morning. I buried them and took the healthy

looking ones to the markets," he said.

He said he now knows more about

the human symptoms, "a bad cough", but he is not completely sure.

San

Ton, village chief of Prek Russei, said he had been informed about bird flu by

leaflets distributed by the government one month ago. He distributed the

leaflets to villagers, but there were not enough for everyone. Ton said he hoped

word-of-mouth would do the rest.

The World Health Organization and other

international organizations are watching the bird flu situation in Southeast

Asia.

WHO reports that all available evidence points to an increased

risk of human-to-human transmission of the disease when outbreaks of H5N1

influenza are widespread in poultry, and such an event could mark the start of

an influenza pandemic (see related story, page13).

To date, 29 people

have died in Vietnam, 12 in Thailand, and one in Cambodia from the H5N1 strain

of avian flu since January 2004. Three of these cases, including the death of

Tit Sokhan and her younger brother, are particularly alarming to health experts

as family members appear to have contracted the disease from a relative, not

contact with infected poultry.

There is no vaccine available for the H5N1

strain.

Hitoshi Oshitani, head of the WHO for the western pacific based

in Manila, said they have developed a seed virus for vaccine production, which

was distributed to vaccine manufacturers.

Once a vaccine is developed,

clinical trials could take up to two years. An influenza vaccine would need to

be administered to people at least 14 days prior to infection to be effective.

"Even if vaccines are developed, the supply of vaccines is expected to

be very limited, and countries like Cambodia where there is no vaccine

production capacity may not be able to obtain vaccines," Oshitani

said.

Tamilflu (also known by its pharmaceutical name oselta-mivir) is

the primary treatment for bird flu infection, with one dose administered within

48 hours of symptoms.

Ly Sovann said Cambodia has between 300 and 400

doses of Tamilflu in the country.

"There is one dose for one person per

province. The rest is stored in Phnom Penh because there is a shortage and there

is not enough to waste," he said. "Some provinces will get more if there is

suspected human bird flu, for example in Kampot."

Oshitani agreed

Cambodia needs increased funding, surveillance and education if it is to combat

bird flu outbreaks.

"Cambodia doesn't have any experience with human H5N1

infections because they did not have any human cases last year. They still need

some support from WHO and other international organizations," he said.

Sorn San, Head of the National Animal Health and Production

Investigation Centre (NAHPIC) said they did a very good job last year in

educating and training provincial animal health staff.

The Agriculture

Productivity Improvement Project trained 5,000 villagers in detection and

identification of bird flu.

San said that each village has one unpaid

animal health worker that villagers can alert.

In response to a bird flu

report, San said each province dispatches three taskforce teams: one to

investigate and take samples, another to collect information and communicate to

back to the government, and one more to disinfect the area and control movement

of poultry between farms and markets.

He said staff was very busy with

the outbreaks.

"We only have three people in NAHPIC, not enough people to

keep up with [testing] the chickens coming in."