Cambodia's stock of Tamiflu, an anti-viral drug used to hinder the spread of influenza

viruses in the human body, would be inadequate in the case of a domestic bird flu

outbreak, government and international health officials have warned.

Dr Ly Sovann, deputy director of the Center for Disease Control, said on Wednesday

that the Ministry of Health has just over 100 treatment courses of Tamiflu available

in the country - and only a single course of Tamiflu in each province outside Phnom

Penh.

"We have distributed Tamiflu to 24 provinces, but because of limited numbers

we just provided one course per province." Sovann said.

"We need at least twenty [anti-viral courses] in each province to be able to

adequately deal with an outbreak."

Tamiflu, also known as oselta-mivir phosphate, belongs to a group of virus-battling

medicines called neuraminidase inhibitors. Taken orally over a course of five to

seven days, Tamiflu is approved by the US Food and Drug Administration to alleviate

influenza symptoms. It is not a vaccine, and its efficacy in the case of a bird flu

outbreak is unknown.

Still, health officials believe that Tamiflu may be the best option in stemming any

potential human-to-human transmissions of the deadly H5N1 virus strain that would

mark a potential global pandemic. Vietnamese health officials last week told The

Associated Press that their country's stock of 60,000 Tamiflu courses was a woefully

short safeguard for Vietnam's population of 78 million.

"In Cambodia at present the WHO has about 1,600 treatment courses, or enough

to treat 1,600 people," said Megge Miller, technical adviser to the World Health

Organization, who estimates that the total amount of Tamiflu presently available

in Cambodia is fewer than 2,000 courses.

"At the moment I don't think there are sufficient doses [to prevent an epidemic]

in Cambodia."

According to Miller, Tamiflu is available to Cambodia in large quantities in the

case of a large-scale outbreak, but this resource is part of an international WHO

stockpile and is not stored in Cambodia.

Roche, the Swiss manufacturer of Tamiflu, has an agreement with the WHO to make three

million courses available at short notice - intended as rapid intervention in any

country where an outbreak occurs.

"Should the virus spread from person to person in whatever country, the WHO

will mobilize all available Tamiflu to that country in an attempt to control the

virus," Miller said.

However, it is not known how quickly the medicine could be distributed to an affected

area and the first batch of the three million courses will not be available until

the end of this year, she said.

The H5N1 strain of the virus, which has recently been found in Europe, has health

officials worried that the virus may mutate into a form that could allow human-to-human

transmission and trigger a pandemic.

British, American and Australian embassies have issued updates of the bird flu threat,

and have been supplied with Tamiflu courses for their front-line staff. At present,

the three countries' governments have no plans to issue Tamiflu to foreign nationals

in Cambodia.

Australia's Department of Foreign Affairs and Trade issued a travel advisory on October

27, urging its citizens to leave a foreign country immediately if a human-to-human

outbreak occurs, or risk being stranded abroad under quarantine.

Donor countries are aware of the potentially devastating situation in Cambodia. The

United States recently agreed to give nearly $2 million to Cambodia to bolster its

surveillance of bird flu.

An interagency mission meeting in Phnom Penh last week highlighted the need to implement

a preparedness plan and outline the government's specific response to an outbreak.

Miller said one of the main problems surrounding identification of an outbreak is

educating the rural population about the virus, especially when birds suffer from

seasonal mortality rates.

"The farmers that we encountered earlier this year say that they accept that

chickens die at this time of year, and they have always been safe to eat. They ask

why there is a problem now," Mil-ler said.

Although there have been no new reports of suspected poultry mortality in recent

weeks, Yves Froelich from the UN Food and Agriculture Organization said the virus

has circulated in previous months and the risks remain high.

"Wild birds have the main role in spreading the virus, which may appear in Cambodia

again this winter," Froelich said.

According to Froelich, monitoring bird populations remains the most effective form

of identifying the presence of the virus. But with wild birds migrating through region,

bird flu could emerge in Cambodia at any time.

"If we are to stamp out H5N1 in the region we have to remain vigilant to the

possibility of the virus being re-introduced into the area all the time," Miller

said.