JOINT COMMITTEE ON AGRICULTURE AND FOOD díospóireacht -
Wednesday, 25 Jan 2006

Avian Flu: Presentation.

Chairman

I welcome Mr. Dermot Ryan, Mr. Seamus Healy and Mr. Billy McAteer of the Department of Agriculture and Food. I also welcome Mr. Gavin Maguire and Dr. Dorina O'Flannagan of the Health Service Executive and Dr. Theresa Cody of the Department of Health and Children. We will hear presentations on the outbreak of avian flu, first from Mr. Healy and then from Dr. Cody. Each presentation will be followed by a question and answer session.

Before asking Mr. Healy to commence his presentation, I draw members' attention to the fact that, although they have absolute privilege, the same privilege does not extend to witnesses who give evidence to the committee. Members are reminded of the long-standing parliamentary practice whereby they should not comment on, criticise or make charges against a person outside the House or an official by name in such a way as to make him or her identifiable.

Mr. Seamus Healy

We are pleased to have the opportunity to make this presentation to explain the role of the Department of Agriculture and Food in dealing with the risk of avian flu being introduced into Ireland's poultry flock. As the Chairman said, we are joined by colleagues from the Department of Health and Children and the Health Service Executive who have responsibility for the human health aspects associated with any human influenza pandemic.

As this is the first occasion on which we have formally given evidence to the committee, it will be useful to provide some background information on the current international situation. Avian flu is a highly infectious disease that affects normally only birds and, less commonly, pigs. As we have seen elsewhere, however, in certain circumstances people can also become infected. All birds are thought to be susceptible to infection but some species are more resistant to infection than others. Migratory waterfowl, notably wild ducks, are the natural reservoir of avian influenza viruses but such birds are also most resistant to infection. Domestic poultry, including chickens and turkeys, are particularly susceptible to epidemics of rapidly fatal influenza.

Avian flu viruses are classified by reference to their ability to cause disease. High pathogenic viruses cause severe disease and mortality, whereas low pathogenic viruses generally cause only mild disease or none at all. Over the years, outbreaks of both classes have been reported in many countries. In Ireland, the most recent confirmed outbreak of high pathogenic avian flu occurred in 1983 but the disease was successfully eradicated at that time. In the European Union, the most recent outbreak of a high pathogenic strain - the H7N7 strain - occurred in the Netherlands in 2003, resulting in one death and mild illness in 83 other humans.

A particularly virulent high pathogenic strain of avian flu - the H5N1 virus - has affected countries in South-East Asia since mid-December 2003. Between then and early February 2004, outbreaks of the virus were reported in eight Asian countries. In late July 2005, Russia reported its first outbreak, which was followed by reports of the disease in neighbouring Kazakhstan in early August 2005 and in Mongolia almost simultaneously. Last October, H5N1 was confirmed in poultry in Turkey and Romania and, subsequently, in wild birds in Croatia. The only incidence of the virus identified within the EU occurred on 23 October 2005, when it was reported to have been found in a consignment of imported Taiwanese birds that was being held in a quarantine facility in the United Kingdom. However, this is not regarded as having compromised the avian flu-free status of either the United Kingdom or the European Union as a whole.

The recent sad events in Turkey do not alter the risk of the virus being introduced into Ireland. The available evidence indicates that the virus was introduced into domestic poultry in Turkey by migrating wild birds. There are suggestions poultry movements may have contributed to its spread within that country, where the human cases all appear to have resulted from direct contact with infected poultry, either alive or dead. All of the evidence to date indicates that close contact with dead or sick birds is the principal source of human infection with the H5N1 virus. Our current assessment of the risk is shared by the Department for Environment, Food and Rural Affairs in the United Kingdom which has concluded that recent events in Turkey do not materially alter the assessment that the likelihood of the imminent introduction of the H5N1 virus into the United Kingdom is low.

Representatives from the Department of Health and Children are present, but I will make a number of points regarding the human cases in the pandemic. The latest official figures from the WHO, dated 23 January, indicate 151 laboratory confirmed human cases. There have been some 82 deaths from the H5N1 virus in six countries. There have been four deaths in Cambodia, all in 2005; six in China, with five occurring in 2005; 14 in Indonesia, with 11 occurring in 2005; 14 in Thailand, with 12 occurring in 2004; four in Turkey; and 42 in Vietnam, of which 20 occurred in 2004 and 19 in 2005. An updated WHO situation report from Turkey on 18 January indicated a total of 21 confirmed human cases, of which four had been fatal. Two appeared in official figures, but there may well be more.

The WHO pandemic alert remains unchanged at phase 3 which is defined as a virus, new to humans, causing infections but which does not spread easily from one person to another. Until there is evidence of sustained human to human transmission of a new influenza virus, the threat of an influenza pandemic remains unchanged. I will leave it to my colleagues in the Department of Health and Children and the HSE to elaborate further on pandemic issues.

With regard to inquiries about advice on travelling to Turkey and other countries affected by the avian flu virus, and to those advocating that people should be advised to avoid such countries, it should be repeated that we have not changed our advice to those travelling to Turkey and other affected countries. At this time we are not advising people to avoid particular parts of Turkey. We advise people travelling to an affected country to avoid contact with wild birds and poultry, as well as live bird markets, farms and other places which may be contaminated by bird faeces. Other sensible precautions should be taken, including seeking advice on eating and handling poultry and poultry dishes. This travel advice was reissued in national newspapers last Friday. It is worth pointing out that people have been travelling to and from affected countries in South-East Asia, notably Thailand, for the past two years without introducing the virus into Ireland. At no point in the past two years did we advise people to avoid affected countries.

The recent coverage of events in Turkey serves to highlight the need for continued vigilance in the fight against this disease. The Department has at no time been complacent in its approach and has put in place a series of measures aimed at minimising the risk of the virus entering the country. Unfortunately, given the role played by wild birds in the transmission of the disease, we can only act to minimise rather than eliminate the risk. Since last summer, when the presence of the virus was first confirmed east of the Urals and subsequently in parts of Russia, Ukraine, Romania, Croatia and Turkey, the European Union and the Department have put in place a series of measures to deal with the risk. These have included, among others, a ban on the importation of live poultry, unprocessed poultry products and feathers from affected countries or, in certain cases, the regions of affected countries at risk. There is a Commission ban on the importation of captive and pet birds from outside the European Union, except where they comply with certain conditions, including a 30-day quarantine period.

We have put in place a range of biosecurity measures aimed at reducing the risk of transmission from wild birds to poultry and other captive birds, as well as an early detection system. We have placed a ban on the collection of poultry for poultry markets and other events, although we are prepared to licence other events classified as being low risk. These include caged birds, showing birds bred in captivity from aviaries in Ireland and the United Kingdom, as well as pigeon shows. We have also introduced a registration system for all individuals and companies which keep domestic poultry, however small such stocks may be. This also covers those who own, handle or trade in domestic poultry or other captive birds for sale or sports purposes. This includes enterprises such as aviaries, pet farms, game clubs or pigeon breeders. It does not include pet birds kept in domestic households. There has been a very good response to the registration arrangement and to date, over 6,300 flock owners have registered, in addition to the approximately 1,100 commercial poultry flock owners, whose details we already had. The Commission is drafting a series of separate decisions providing for interim protection measures where there is a suspicion of highly pathogenic AI in wild birds or poultry. These are under ongoing review in Brussels.

In addition to these specific measures, we have issued a series of advice and information notices in national newspaper advertisements or posters on biosecurity, symptoms of avian flu and travel to and from affected countries. In addition, a booklet providing comprehensive biosecurity advice will be posted to almost 7,500 poultry flock owners for whom we have contact details before the end of this week. We have put in place an early warning system with the assistance of the national parks and wildlife service, the National Association of Regional Game Councils and BirdWatch Ireland.

In recent months a small number or suspect cases of avian flu have been investigated and all proved to be negative. In all cases staff in local offices, as well as the laboratory on the Backweston campus, moved very quickly to secure and analyse samples and rule out the possibility of avian flu as a cause of mortality. The Department also undertook a successful trial slaughter of a flock of poultry using the method of slaughter which would be used in the event of a poultry cull.

Apart from this, close contacts is being maintained with a number of Departments and bodies, particularly the Department of Health and Children, the Department of Agriculture and Rural Development in Belfast and the Department for Environment, Food and Rural Affairs in London on issues of mutual interest. In particular, a number of meetings have taken place with our colleagues from Northern Ireland and a further meeting is to be arranged early next month. These colleagues are at work in Agriculture House dealing with, among other items, avian flu. We are closely monitoring the spread of the virus in consultation with international organisations such as the World Organisation for Animal Health, the World Health Organisation, and the United Nation's Food and Agriculture Organisation. We are also in close contact with the European Commission and our EU partners.

While offering advice on a number of issues, the Department has attached particular significance to the availability of accurate and up-to-date biosecurity advice for poultry flock owners, including advice on measures to be taken to reduce the risk of the introduction of avian flu, the housing of poultry, cleaning and disinfection, as well as advice for employers. As a Department, we are satisfied the biosecurity arrangements are robust and work effectively to combat the threat of animal and plant health disease. It is our view, based on the Department's experience, that our biosecurity regime is highly effective and serves the consumer and producer well. Our commitment to the application of very high farm hygiene standards is demonstrated by the production of a booklet containing a wide range of bio-security measures which is being posted this week to every registered poultry flock owner in the country.

The recent events in Turkey have heightened awareness of the issue and, notwithstanding our view that nothing significant has changed in terms of the country's current exposure to the virus, a number of initiatives are under way. These include a series of advice and information notices in the national newspapers, beginning with travel advice last week; a notice on bio-security to appear this Friday and an advice notice to employers to appear next week; and a local radio campaign aimed at encouraging those poultry flockowners who have not yet registered to do so promptly. We are also providing material to provincial newspapers with local contact numbers for reporting unusual patterns of wild bird mortality or registering with the Department. We are contributing to wildlife and agriculture programmes on national and local radio stations and are holding ongoing meetings with our colleagues in the Department of Health and Children to discuss issues of mutual interest. We will issue a comprehensive bio-security information pack this week and have provided poster material in additional languages, such as Turkish, Romanian and Russian, for use at ports and airports.

The Department's consistent position has been to act proportionately in our actions and reactions to developments. The measures introduced since last autumn are a combination of EU-Ied measures and domestic measures. As the risk assessment changed, so too did our approach and, where appropriate, additional precautionary measures were added. The Department continues to assess the risk and will not hesitate to take any additional appropriate veterinary or scientific measures that would assist in minimising the risk of the introduction of avian flu.

I emphasise that the Department's role is to minimise the risk of the disease being introduced into the poultry sector here and, in the event of an outbreak, to ensuring its early detection and speedy eradication. Public health issues are proper to our colleagues in the Department of Health and Children and the Health Service Executive, with whom we continue to work very closely.

We could well be affected by a human flu pandemic without birds ever having contracted avian flu. Likewise, we could well have an outbreak of avian flu without ever being affected by a human flu pandemic. We maintain a high level of vigilance and constantly revise our contingency arrangements in light of any emerging information. We are confident that the measures already taken are proportionate to the current level of risk and we will not hesitate to put in place any such additional measures as are appropriate to any change in the risk of the disease.

I thank the committee again for the opportunity to make this presentation. We will be happy to answer any questions.

Chairman

I thank Mr. Healy and his colleagues for a comprehensive presentation.

Deputy Naughten

I thank Mr. Healy for his comprehensive synopsis of the present position and of the steps being taken by the Department of Agriculture and Food. I give credit to the Department for its co-operation with authorities north of the border and in the UK. It seems we cannot do anything more.

We will soon witness the spring migration of birds. Does Mr. Healy believe there will be an increased risk because of birds travelling from north to south and east to west? Will that be a potential vector for the disease in western Europe, including Ireland?

Can Mr. Healy outline the steps being taken by the Department to assure consumers that there is no risk associated with consuming poultry products, particularly those from Ireland?

I will ask two questions on the measures taken at European level and on the role of Department of Agriculture and Food. What steps have been taken by the EU to assist Turkey to reduce the risk of further contamination of flocks and the infection of humans? There is a bank of vaccine in member states. Has that been made available to the Turkish authorities? Have expertise and skills available to us in the EU been made available to the Turkish authorities? The best step we can take is to give the Turkish authorities as much assistance as possible to ensure the virus does not spread across its border into the EU.

I am alarmed by comments made by the Turkish Minister for agriculture on national television that adjoining countries are covering up the problem. The EU is taking all possible steps but what action is being taken to restrict the importation of product from Turkey into adjoining countries such as Romania and Russia? Has it been possible to substantiate the Turkish Minister's comments and, if so, what steps are being taken to protect the EU from imports from these suspect countries? The biggest danger lies in countries adjoining Turkey continuing to import product, which could be the vector for the disease in the EU.

Deputy Upton

I also thank Mr. Healy and his colleagues for coming before the committee today to make the presentation to us. It was a structured and concise account of what the Department is doing. I acknowledge that aspects of this issue are very difficult to manage. If somebody has two or three chickens or ducks in the back garden, will they need to register them? If that person does not register them, what can the authorities do about it? The registration process is good because there will be a group of people who can be identified if something goes wrong.

China and other countries Deputy Naughten mentioned are not known for being open and forthcoming with information. What confidence do we have in information they might supply? This might be a question for the medical people later but is there any risk of low-grade infection, where people recover? I have come across recent reports that earlier incidences of the virus were being investigated in the UK, which points to mutations occurring. It is not clear whether those mutations will be significant in terms of the spread or virulence of the disease. Does Mr. Healy have any comment on that?

I have also read comments that the virus has stable characteristics and that it can survive for a long time in dried and faecal matter and in a frozen state. It appears to be fairly robust and capable of surviving for a long time. While the main area of focus in this regard has been on live poultry and feathers, we must now concentrate on the risk of bird droppings and the ability of the virus to survive in the soil being further sources of infection.

The information provided on the Department's website is very comprehensive. Are the disinfectants listed equally effective? How does one compare a particular disinfectant with another? Does the Department recommend the use of a particular disinfectant? If I remember correctly, viruses can be fairly resistant to the average disinfectant.

I have two other questions for the delegation. Approximately two weeks ago at a meeting in Beijing there was great support and financial input in respect of the management of avian flu. Does Mr. Healy have an update on how that resource will be managed, where it will be directed and which countries are likely to benefit from it? What monitoring will take place on the effectiveness of the input of those resources into those countries about which we are most concerned in terms of their inability to cope with the virus from the point of view of their technology and infrastructure? While it appears a substantial amount of financial aid has been made available, it is important that we establish how it will be monitored.

I will direct my final question to both groups. What type of formal arrangement exists, in terms of structures, between the two Departments? I believe the Departments of the Environment, Heritage and Local Government and Foreign Affairs also have a role to play in this area. What structure brings both Departments together? The delegation may be aware from my previous comments that I would prefer if one unit had overall responsibility in terms, at least, of the co-ordination of our approach to dealing with avian flu should there be an outbreak here.

Deputy Carty

I join my colleagues in welcoming the representatives from the Departments of Agriculture and Food and Health and Children and thank Mr. Healy for his presentation. I have two brief questions.

Paragraph 5 states that the only incident of the virus identified within the EU was confirmed on 23 January. I presume the birds in question were alive. Were they subsequently destroyed? What is the position as regards poultry imported to the EU, particularly from Thailand? Many reports in the past 18 months to two years have suggested that poultry imports from other countries are being repackaged in and sold throughout the EU. This issue has been highlighted by many of those involved in the poultry industry in Ireland. I presume that strict precautions are being taken to prevent that from happening. I would like to hear the official position in that regard.

Deputy Wilkinson

I also thank Mr. Healy and his colleagues for attending and for the comprehensive presentation. I congratulate them on what they have done and the plans they have to deal with this virus. It is good to know that we are on alert in light of the fact that the disease is spreading. The reaction of the Department of Agriculture and Food to the outbreak of foot and mouth disease was top class and saved many animals. I have the utmost confidence in the Department to tackle this virus, although it will be a much more difficult task in view of the fact that birds can fly from place to place.

I have received requests from many of those who raise chickens to meet departmental officials and the Minister. Members may be aware of the problems encountered by the chicken factory in my constituency. It is good to hear that problem has been resolved. I was delighted to hear that booklets on the matter are this week being sent to growers and registered owners. It is vital that those involved in poultry farming remain on full alert to this virus.

Poultry imports represent a particularly contentious issue for poultry farmers. We are constantly told that our standards are far higher than in other countries that may pose a risk in this regard. Can Mr. Healy say if that is true? If so, what plans has the Department in place to deal with such imports in light of the threat of avian flu in Ireland?

Deputy Ó Fearghaíl

Like my colleagues, I thank Mr. Healy for his highly informative presentation. I want to pick up on his point that migratory waterfowl and wild ducks, in particular, are a natural reservoir of avian flu viruses. To what extent has the Department looked at the country of origin of those birds that will migrate into Ireland on an ongoing basis? Is the national parks and wildlife service actively engaged with the Department in monitoring such birds? Are particular parts of Ireland more at risk as a result of the migratory pattern of these type of birds?

Deputy Hoctor

I welcome the officials from the Departments of Agriculture and Food and Health and Children. I am also interested in hearing the reply regarding the pattern of migratory birds.

Are the eggs of birds that have been deemed to be infected seen as a clear source of direct contamination for consumers?

Chairman

Perhaps Mr. Healy would like to respond to those queries.

Mr. Healy

I thank members for their questions. There is a general acceptance that what we have done so far is good and that we should maintain our efforts.

I am not an expert on migrating wild birds, although I know somebody who is such an expert. The Department avails of the expertise of the national parks and wildlife service, Birdwatch Ireland and the game council. I understand that we are in a lull period between the migrating seasons, namely, between the autumn-winter and spring migrations. In the spring migration, birds will return from the south and north. That migration will commence in February and continue through May. In addition, breeding birds will be arriving in Ireland from March to June, in particular from the south. The opposite will happen at the other end of the cycle.

There will be some additional risk later on particularly if the virus has gone, for example, into Africa. We have no information to the effect that this has happened. If it has not happened, the risk will not be significant. Scientific evidence is that the virus thrives in cold conditions. Ornithologists in the UK are much less concerned about the risks associated with the introduction of the virus from birds returning from warmer climates. That is not to suggest that we will lower our level of vigilance. We will not do so; we will continue to remain vigilant and will continue to utilise the services of experts in this area.

As regards food safety, the Department does not claim to have the final word on the safety of poultry or eggs and, in that regard, it utilises the services of bodies such as the Food Safety Authority of Ireland, the European Food Safety Association and the food safety authorities in the UK. The information available is that as long as the normal precautionary measures are taken, normal cooking temperature will inactivate the virus. Therefore, the consumption of properly cooked poultry meat and eggs presents no risk. There is no virus in the EU at present so there is currently no risk in any event. However, we will continue to avail of the guidance of organisations such as the FSAI, the European Food Safety Authority and other international bodies. We will continue to provide information and links to the relevant websites so that the general public can be aware of the official advice.

Deputy Naughten will be aware that the European Commissioner has been in Turkey for the past few days to offer advice as well as assistance in the form of manpower and financial resources to help the Turkish authorities counter the outbreaks that have occurred.

The funding promised or pledged at Beijing will, I understand, be channelled through the normal official bodies such as the FAO. Those resources will be targeted mainly at building up infrastructure in South-East Asian countries where veterinary infrastructures do not currently exist. It is true that, unless we can tackle the disease and eradicate it in the countries in South-East Asia to which I refer, there will continue to be a risk. Efforts are being made and resources are being provided by the EU and others - Ireland made a direct donation at Beijing - to eradicate the disease from areas in which it is currently endemic.

On the comments of the Turkish agriculture Minister, I do not know whether those were correct but the Union moved quickly to ban imports of products that were previously allowed to be imported from the countries surrounding Turkey. Several weeks ago, the Union moved immediately to ban any remaining products that might pose a risk and that ban is now in place, including in Ireland.

On registration, Deputy Upton is right that ensuring everybody is registered will be an ongoing problem. However, I am reasonably happy with the progress made so far, as I did not think we would reach 6,500 so soon. Obviously, we will continue with our efforts but we will welcome any help other services can give to encourage the registration of the last few remaining stragglers.

Deputy Naughten

We should quickly introduce a subsidy for them, perhaps.

Mr. Healy

Or perhaps the opposite of a subsidy.

Deputy Upton also asked about China. There are suggestions that the Chinese authorities have not disclosed everything but I think they probably learned their lesson from the roasting they received on their handling of severe acute respiratory syndrome. I do not believe the Chinese authorities are involved in an enormous cover-up but that is not to say they have notified every case that has occurred.

I will leave the issue of mutation to my health colleagues and I will ask Mr. McAteer to deal with the survivability or robustness of the virus. As regards the disinfectants, all those on the list have been authorised and approved but we cannot say that one disinfectant should be used rather than another.

On the co-ordination issue, Deputy Upton's specific proposal about the need to appoint a single authority was addressed by the Minister in the Dáil a couple of months ago, when she outlined the arrangements currently in place and confirmed her satisfaction with those. In the event of an outbreak, we would activate measures such as those put in place during the outbreak of the foot and mouth disease to co-ordinate the actions of all agencies, not just those dealing with health, environment and justice. Equally, we would have an advisory committee of the type we had during the foot and mouth disease outbreak. Somebody reminded me that it is almost five years to the day since that outbreak occurred, although it seems like only yesterday.

As regards the Netherlands, when the outbreak occurred in that country three years ago literally millions of poultry had to be slaughtered. However, I think the Netherlands learned lessons from that. The virus certainly did not spread beyond the immediately surrounding countries such as Belgium, where some outbreaks were associated with the original Dutch outbreak.

On imports, we have obviously banned the bringing into this country of birds, unprocessed bird meat and feathers from all the countries - and, in a few cases, regions - where the recent outbreaks have taken place but other products from those countries can be imported provided they follow clear rules. The legal position is the imports from those countries are required to meet conditions equivalent to those that apply to EU countries but they must be specifically approved and appear on an approved list. Likewise, the exporting plants need to be approved. Both the countries and the plants are inspected on an ongoing basis by the Food and Veterinary Office.

Labelling is a real issue, as the Minister has frequently said, but we hope it can be addressed in the reasonably near future. The Minister for Health and Children introduced amending legislation in both Houses that will make provision for improved labelling, not just of beef but of all meat including poultry. Our Minister is committed to pursuing those improvements in the labelling regime. In her view, the current system is unsatisfactory and she is determined to take steps to improve the situation.

I think I have dealt with most of the issues and I hope I have not missed out anything. Mr. McAteer will deal with the issue of the robustness of the virus.

Mr. Billy McAteer

On the question of survivability, I should explain that the virus can survive for several days in carcases at ambient temperature and up to 23 days if the meat has been refrigerated. That applies only to contaminated products, which we do not have in Ireland, but in the event of such contamination the virus can persist in poultry by-products for several weeks unless the products are properly treated. However, poultry offal in pet foods is normally cooked at temperatures above 100° Celsius for several minutes or even more than an hour. That is sufficient to kill off the virus.

On the question of eggs and egg products, eggs laid in the early phase of an outbreak could contain the avian influenza virus in the albumen, the yolk or the surface of the egg. That is partly why, in the event of any outbreak, all birds, bird litter and eggs on the premises would be stamped out as part of the disease control process.

The virus can be inactivated by exposure to temperatures of 56° Celsius for three hours or 60° Celsius for 30 minutes. It is also inactivated by acid pH and by a variety of chemicals, such as formaline and iodine disinfectants. However, the virus can survive for long periods in tissues, including manure, and it can survive in water. As regards the approved list of disinfectants about which Deputy Upton asked, as Seamus Healy mentioned, all the disinfectants that appear on the list are capable of killing off the virus. It is not our policy to promote one disinfectant over another.

Deputy Upton

For developing countries in particular, in so far as they have a role the Departments must ensure the message goes out that those people who are required to get rid of their poultry will be properly compensated for the loss of what they see as their livelihood, even if that is only a couple of chickens. We saw a film which showed people hiding chickens because they did not want them slaughtered as they were their only means of income. We must get that message across if we are to achieve the longer term effect.

I note the Dutch authorities is considering the introduction of vaccinations in this area. Is the Department considering or making plans to introduce vaccination here? Is such an idea worthy of consideration? I appreciate to do so would be an enormous task. Am I correct that the Department of Agriculture and Food is the lead Department in this area?

Mr. Healy

Yes, it is in terms of avian flu in birds but not in terms of public health issues.

Deputy Upton

Mr. Healy has indirectly answered another question for me.

Mr. Healy

On vaccinations, that is an issue which the Department is keeping under review. There is no approved vaccination on a prophylactic basis though there are vaccines on the market which could be used under the new directive for stamping out the virus.

Deputy Upton

I appreciate the significance of such a task.

Mr. Healy

I am not sure if it could be done, although such a programme would create much employment. It would not be the first line of defence. As Mr. McAteer said, the first line of defence would be to stamp out the virus. However, it is possible to vaccinate in certain circumstances subject to plans being approved by the EU Commission and Community.

Deputy Upton

I raised the matter in light of the Dutch authorities considering vaccination of the huge numbers of poultry there. I accept Mr. Healy's answer that it would be an extremely difficult task.

Ms Theresa Cody

The Department of Health and Children and the Health Service Executive welcome this opportunity to discuss human health concerns regarding avian flu and the threat of a human flu pandemic. Our colleagues from the Department of Agriculture and Food have already outlined the situation regarding avian flu and the ongoing outbreaks of the H5N1 strain.

The persistence of H5N1 in poultry populations causes two main risks for human health, the first being a risk of direct infection when the virus passes from poultry to humans resulting in very severe disease. Of the few avian flu viruses that have crossed the species barrier to infect humans, H5N1 has caused the largest number of cases of severe disease and death. Unlike normal seasonal flu, where infection causes only mild respiratory symptoms in most people, the disease caused by H5N1 follows an aggressive clinical course with rapid deterioration and high fatality. Primary viral pneumonia and multi-organ failure are common.

In the present outbreak, more than half those infected with the virus have died. Most cases have occurred in previously healthy children and young adults. A second risk of even greater concern is that the virus, if given the opportunity, will change into a form that is highly infectious for humans and spreads easily from person to person. Such a change could mark the start of a global pandemic. In this context, Dr. O'Flannagan will respond further to Deputy Upton's questions regarding mutation of the virus.

Direct contact with infected poultry or surfaces and objects contaminated by their faeces is currently considered the main route of human infection with avian flu. To date, most human cases have occurred in rural or peri-urban areas where many households keep small poultry flocks which often roam freely, sometimes entering homes or sharing outdoor areas where children play. As infected birds shed large quantities of virus in their faeces there are many opportunities for exposure to infected droppings or to environments contaminated by the virus under such conditions. Also, because many households in Asia depend on poultry for income and food, many families sell, slaughter and consume birds when signs of illness appear in a flock. This practise has proved difficult to change. Exposure is considered most likely during slaughter, defeathering, butchering and preparation of poultry for cooking.

As already mentioned, the latest official figures from the World Health Organisation indicate there have been 151 confirmed cases of avian flu H5N1 in humans of whom 82 have died. This number includes four confirmed cases and two deaths from H5N1 in Turkey. A total of 21 human cases have been confirmed by laboratory tests in Turkey of whom four have died. These figures have not changed since 17 January. The World Health Organisation may update its cumulative total if required following further verification by an external reference laboratory.

The World Health Organisation has stated that all available evidence indicates no sustained human to human transmissions have occurred. As in Asia, contact with infected birds is the principal source of infection. The situation regarding travel to countries affected by avian flu has been already outlined. Essentially, there are no special travel restrictions to countries affected by avian flu but normal precautions should be adhered to.

The food safety aspects were referred to earlier. I will repeat the World Health Organisation's advice that conventional cooking, namely, temperatures above 70o celsius in all parts of the food item, will kill the H5N1 virus. Properly cooked poultry meat is, therefore, safe to consume. The World Health Organisation is emphasising the importance of good hygiene practices during the handling of poultry products, including hand washing, prevention of cross-contamination and thorough cooking of all food from poultry, including eggs.

I will now address the contingency actions taken in the health sector in relation to avian flu. The Department of Health and Children and the Health Service Executive are monitoring the spread of avian flu in consultation with our colleagues in the Department of Agriculture and Food and relevant international organisations. On the health side, this includes the World Health Organisation, the European Centre for Disease Prevention and Control, the European Commission and our EU partners. The health sector has taken a number of steps which will be activated if the H5N1 virus appears in this country.

The Health Protection Surveillance Centre has published a number of guidance documents for the health system for use in the event of an avian flu outbreak in animals or birds in Ireland. Guidance on the investigation and management of suspected human cases of avian flu has been also developed. In addition, it was decided at the end of October that all poultry workers should be actively offered seasonal flu vaccines. This was a public health measure, the purpose of which was to prevent the possibility of an individual being infected by both avian flu and human flu. This campaign has been implemented and vaccinations were available in all parts of the country. Due to the high density of poultry farms in the northeast and midwest, specific clinics were offered to the poultry industry in these areas. A further effort aimed at increasing uptake of the vaccine in these areas is about to commence.

I will now deal with human flu. As members may be aware, human flu is an acute respiratory illness caused by infection with an influenza virus. It is characterised by sudden onset of symptoms including a temperature of 38o celsius or more with a dry cough, headache, sore muscles and sore throat. The cough is often severe and protracted but otherwise the disease is self limiting and recovery normally takes place within two to seven days. The most frequent complication is pneumonia, most commonly secondary bacterial pneumonia. Primary influenza viral pneumonia is an uncommon complication but is associated with a high death rate. Other complications include worsening of pre-existing chronic medical conditions such as chronic bronchitis or chronic heart failure. Death is reported in 0.5 to 1 per thousand cases of influenza.

An epidemic is the occurrence of more cases of disease than expected in a given area or among a specific group of people over a particular period of time. Flu epidemics can occur annually during the winter months and last on average between six to eight weeks. According to the World Health Organisation, these annual epidemics are thought to result in between three and five million cases of severe illness and between 250,000 and 500,000 deaths every year around the world. Most deaths currently associated with flu in industrialised countries occur in those over 65 years of age. Currently, the level of seasonal flu activity is low in Ireland and in Europe generally.

A pandemic can commence when three conditions have been met, namely, a new flu virus sub-type emerges, it infects humans causing serious illness and it spreads easily and sustainably among humans. The H5N1 virus meets the first two conditions. It is a new virus for humans and it has infected more than 150 people, killing more than half of them. As all prerequisites for the start of a pandemic, save the establishment of efficient and sustained human-to-human transmission of the virus, have now been met, the risk of pandemic flu is serious. According to the World Health Organisation, the spread of H5N1 to poultry in new areas is of concern, as this increases the opportunities for further human cases to occur. Although neither the timing nor the severity of the next pandemic can be predicted, the probability that a pandemic will occur has increased. Nevertheless, the WHO level of pandemic alert remains unchanged at phase 3, which means a virus new to humans is causing infections but does not spread easily from one person to another.

On preparedness for pandemic flu, let me start at the European level. In the course of Ireland's Presidency of the European Union in 2004 the then Minister for Health and Children took the initiative by calling a special informal meeting of health Ministers to address the issue of avian flu to ensure it was kept high on the political agenda of member states, the Commission and the health Council. In the intervening period Ireland has been actively involved with other EU member states, the Commission and the World Health Organisation in efforts to improve flu pandemic preparedness planning. In November the Commission organised a command post exercise on pandemic flu to test communications, exchanges of information and interaction among the competent authorities at European level and the co-ordination and interoperability of national plans. Ireland took part in that exercise and a similar smallpox exercise that took place in October. An international evaluation report on these exercises is being drafted and will be presented to EU health Ministers.

Like the Department of Agriculture and Food, our Department is maintaining close contact with its counterparts in the United Kingdom, including Northern Ireland. In particular, we have had several meetings with the Northern Ireland Department of Health, Social Services and Public Safety and will have another in March.

Pandemic planning aims to reduce mortality and morbidity and minimise the resulting disruption to society. The consequences of a global pandemic are still likely to be serious, but pandemic planning can mitigate the effects. The Department of Health and Children and the HSE are working closely together on pandemic planning. In 2002 a model plan for influenza pandemic preparedness was finalised. It was based on best practice at the time and the flu pandemic expert group is now updating the expert guidance contained in the plan. In addition, in 2004 a generic public health emergency plan for the health system was prepared, which included disease-specific operational response plans for SARS, pandemic flu and smallpox. These plans identify key actions that must be undertaken before and during a major public health threat, with the responses structured under the following functional areas: surveillance, health services, public health measures, vaccines and anti-virals, communications, laboratories and materials management. The pandemic flu operational response plan is being updated to reflect the most up-to-date advice of both the flu pandemic expert group and the World Health Organisation.

In addition, the Department of Health and Children is in the process of establishing a standing interdepartmental committee to consider issues that go beyond the health aspects of a flu pandemic such as border controls, suspension of travel, travel advice, school closures, suspension of other gatherings and possible security issues. The committee will assist the Department in planning for such an emergency and will be available in the event of an emergency arising. I think that answers one of Deputy Upton's earlier questions.

Vaccination will be the primary public health intervention in the event of a flu pandemic and our plans for dealing with a pandemic call for the provision of vaccines to the entire population as soon as a vaccine is available. However, as pandemics often occur after the emergence of a new flu virus to which people have no immunity, it may be that a vaccine can be manufactured only once the new strain emerges. At international level developments are taking place to expedite the pandemic vaccine production process, but the development and manufacture of a vaccine are still anticipated to take at least four to six months from the time a pandemic flu strain emerges. Therefore, the Department is actively pursuing advance purchase orders for a pandemic strain vaccine.

A vaccine that could offer some protection against the H5N1 flu strain is in development. International experts consider that a stockpile of such a vaccine could be used as a first line of defence for key health care and other workers while a vaccine against the exact pandemic flu strain was being manufactured. Again, the Department is actively pursuing the purchase of a limited supply of this vaccine.

Anti-viral drugs are the main treatment for pandemic flu. While anti-virals can shorten the duration of the disease and alleviate symptoms, they are not usually considered effective after 48 hours since the onset of the illness. An emergency supply of more than 45,000 treatment packs of tamiflu anti-virals was purchased in 2004 and a further 1 million treatment packs of tamiflu are being stockpiled. This quantity is sufficient to treat 25% of the population, which is in line with international trends. Some 600,000 packs have already been delivered and the remaining 400,000 will be delivered this year. It is has also been agreed in principle to stockpile additional supplies of relenza, the other suitable anti-viral drug, as there is growing evidence it would be prudent to have a supply of both drugs in case of drug resistance.

Treatment with anti-viral drugs will play an important part in the response to a flu pandemic, but such treatment is not the only response. Non-pharmaceutical public health interventions aimed at reducing the spread of infection will also have an important role. The flu pandemic expert group is updating the guidance on such interventions with reference to the latest recommendations from the World Health Organisation.

I emphasise that the health sector's role in dealing with avian flu relates to the human health implications arising from an outbreak of the virus in this country, but the Department of Health and Children and the Health Service Executive are working closely with the Department of Agriculture and Food. Although the risk of avian flu is currently low, vigilance is essential and plans are continuously kept under review.

I thank the committee for giving me the opportunity to make this presentation. I will be happy to answer any questions members may have.

Chairman

I thank Ms Cody for the comprehensive document and presentation she has provided.

Deputy Naughten

I thank Ms Cody for her presentation. Although not everything is in place at this point in time, the Department of Health and Children seems to be taking steps to ensure an outbreak of avian flu in this country can be addressed quickly.

In the European context, I want to ask a question similar to the one I asked the officials from the Department of Agriculture and Food. Has the European Union ensured adequate availability in Turkey of the anti-viral drug tamiflu? Given the importance of reducing the risk of the disease entering the European Union in the first instance, what role do the Department of Health and Children and its European counterparts have in the work being done in Turkey?

Ms Cody mentioned that a vaccine would be made available to critical health care workers. When does the Department hope to have a supply of that vaccine in place?

At the moment tourists returning from affected countries seem to present the only risk that the virus will spread. We have had reports to this effect in various continental European countries, including France and, I think, Denmark. In the light of the Turkish agriculture Minister's comments and given the risks associated with some Asian countries, Turkey, Russia and others, what steps have been taken to make tourists aware of the potential threats in countries surrounding Turkey? The Turkish Minister's comments may not yet have been substantiated, but we need to ensure visitors to those countries are made fully aware of the facts. Although we perhaps do not have huge numbers queuing up to visit some of them, it is important that advice is available. If someone returning from one of the potentially high risk countries arrived at Dublin Airport tomorrow morning with flu-like symptoms, what steps would be taken? To which hospital in the city would the person be brought for treatment? Have regional centres been designated to deal with those who may present to their general practitioners or at local accident and emergency units on their return from one of the countries affected? To where would they be referred? This appears to be the greatest risk at present.

In terms of food safety, what advice would Ms Cody give consumers on the handling of chicken? I am aware that standard procedures have been developed. Can consumers take additional steps to reduce the potential threat in the event that infected poultry were to enter the European Union and be purchased by them, notwithstanding the fact that the probability of such an eventuality is extremely small?

On the pathogenicity of the virus, we were initially informed, via reports emerging from Asia, that the death rate among those infected was 100%. The figures from Turkey paint a different picture in that the majority of those infected have survived. What is the probability of death for those infected with the virus?

Deputy Upton

I thank Ms Cody and her colleagues for their presentation. They have provided straightforward information on important technical definitions and have been up-front with regard to risks. For example, the presentation clearly states that the World Health Organisation is concerned about a pandemic. Members appreciate openness on the issue of dealing with potential events.

It is interesting that healthy children and young adults appear to be most at risk from infection. Will Ms Cody comment on this from a medical point of view, given that it runs counter to trends?

Ms Cody stated that the Department is actively pursuing an advanced purchase order. What exactly does this entail? How advanced is the order and how active is the Department in this regard? She also mentioned that consideration would be given to other public health interventions that are not based on vaccines or Tamiflu. Will she elaborate on the nature of these interventions? I presume they cover matters such as hygiene.

With regard to airports, are checks being carried out or questionnaires circulated? Should we be concerned about people returning from any of the countries affected by the virus?

While I hope we will never have a pandemic, in the event that one does arise, what is our capacity to deal with it in terms of the ability of our hospital system to provide medical services, support and so forth?

Ms Cody

I am glad my colleagues from the Health Service Executive are present, as Dr. O'Flannagan will respond to many of the medical-epidemiological questions, including Deputy Naughten's queries on the availability of Tamiflu and other support in Turkey.

On the availability of vaccine supplies, an issue also raised in the context of advanced purchase agreements, the H5N1 vaccine is in development. Until recently, I would have said it would not be available before March or April 2006 but the date is likely to be pushed back further to September or thereabouts. Although we have entered into arrangement under which we hope to be able to secure a supply of H5N1 vaccine, as the papers are not signed or sealed, we are not yet in a position to elaborate further on the matter. We have, however, entered into commitments to procure sufficient supplies for 200,000 people, which would cover key health care staff and workers in essential services in the event that we need to protect them while we wait for the pandemic influenza strain vaccine to be developed. As indicated, the H5N1 virus may not be the culprit, as it were, if the pandemic flu occurs but given the extent of its spread at present, it is a prudent precaution to procure some H5N1 vaccine which might be able to provide some protection.

On the pandemic flu vaccine, its manufacture cannot begin until such time as the pandemic strain is identified, which would take six to nine months. In this context, a number of countries are considering entering into what are known as advance purchase orders as a form of insurance policy to guarantee access to the vaccines when developed. The Department is actively engaged in following up this possibility with the vaccine companies. It is also examining the possibility of taking a joint approach with other countries. The latter is also work in progress.

The issue of travel advice was raised. I understand that the Department of Agriculture and Food has issued advice, while the Department of Foreign Affairs provides advice on its website. The website of the Department of Health and Children features links to different sources of advice. Those travelling to countries affected by avian influenza are not subject to restrictions. In response to inquiries we have received from people intending to backpack through Thailand and other countries, we have advised that they take normal, sensible precautions and steer clear of poultry markets.

We already referred to the World Health Organisation's advice on food safety. The websites of the various expert groups, including the Food Safety Authority, Safefood, the Department of Agriculture and Food, the World Health Organisation and the FAO, all feature references to the food safety implications and all offer similar advice, namely, that properly cooked poultry meat is safe to consume.

If I am correct, most of the other issues raised will be handled by Dr. O'Flannagan, while Mr. Maguire will discuss some of the operational issues, including the facilities available in the event of a pandemic occurring.

Dr. Dorina O’Flannagan

Deputy Upton had a question on the European context and the situation regarding the availability of Tamiflu in Turkey. My understanding is that sufficient doses of Tamiflu have been received from the European Union and that Roche may have provided additional supplies.

The WHO is in the process of sending teams to surrounding countries in order to assess the situation and to ensure that appropriate advice is given on the management of poultry outbreaks and human cases that might arise from association with those outbreaks. A colleague of mine in the health protection surveillance centre will leave for Azerbaijan on Friday to join one of the teams providing assistance to the WHO.

On the issue of returning tourists, we sent an algorithm in 2004 to all GPs and accident and emergency departments on the signs and symptoms of people who may be infected with avian flu, the tests that needed to be undertaken and the infection control procedures that should be followed by hospitals. We updated that in mid-2005 and more recently. General practitioners and accident and emergency departments, therefore, have information regarding the kinds of tests and infection control precautions to be taken in the case of encountering someone with suggestive symptoms and a history of exposure.

With regard to the cases in the countries mentioned, including Belgium, I understand that the people involved had ordinary flu. The risks involved for people travelling to Turkey or the South-East Asian countries concerned are very remote because most of the human cases occurred among people with direct exposure to sick or dead poultry, whether through de-feathering, butchering or preparing for cooking. Tourists do not face such exposures and are unlikely to be personally involved in the preparation of poultry products. The virus is not transmissible between humans, so it cannot be contracted from someone in Turkey who exhibits respiratory symptoms.

A question was asked regarding what consumers can do to reduce the threat here. The Food Safety Authority of Ireland and the Food Safety Promotion Board have given much advice on how people can reduce the risk of cross-contamination from salmonella, campylobacter or any other organism found in poultry. Their advice is sound and pertains to anybody handling poultry. Hands should be frequently washed and cross-contamination with other utensils avoided. In the unlikely event that infected poultry arrive in this country, general consumer advice is that one should be careful when handling poultry and ensure that products are well cooked. The Department of Agriculture and Food published advice in newspapers to the effect that when people travel to other countries, they should not visit live markets or eat raw or inadequately cooked poultry and should avoid contact with poultry or surfaces that may be contacted with animal faeces. I would also advise people to avoid products such as tiramisu, which may contain raw eggs. When travelling anywhere, including in Ireland, frequent handwashing is one of the best ways to prevent infection by any organism.

Deputy Upton inquired about the possible non-pharmaceutical public health interventions that could be made here. The kinds of simple advice being developed in terms of pandemic flu materials, such as, how to cover a cough or dispose carefully of tissues and to frequently wash hands, can be applied in this instance. A pandemic flu virus is easily transferable and can be found on many surfaces, for example, on door knobs. It is also important for sick people to stay at home and in bed until they have fully recovered. Unfortunately, too many people heroically struggle into work when infected with the flu, which is not in anybody's interest.

A question was asked regarding the lower fatality rate in Turkey. The authorities of that country tested some people who were exposed but who exhibited no symptoms. Two of the cases they identified involved children who told their mothers that they had contact with sick poultry and were immediately brought to health centres. They were started on a course of Tamiflu but, when swabs were taken from them, they turned out to be asymptomatic. The lower fatality rate in Turkey may in part be a reflection of the increased testing carried out by authorities on people who had histories of exposure but did not exhibit symptoms. In South-East Asia, the people tested were already sick and in hospital.

The issue of healthy children and young adults is interesting and, as yet, unexplained. With the recent drop in temperatures in Turkey to -30° Celsius, people brought chickens indoors because they were afraid they would die in the cold weather. As the children were then playing with the chickens, the issue may reflect an increased exposure among children. A major campaign has been conducted in Turkey advising children and young people to stay away from chickens.

A theory which is currently being studied but which has not yet been proven is whether the N1 component will provide any protection. Members will be aware that H1N1 has circulated for many years. While the general opinion is that we will all be susceptible to H5N1, a greater occurrence among young people has been an outstanding feature in South-East Asia and Turkey and the possibility remains that some element of immunity may exist among older age groups.

Ms Cody discussed the uptake in poultry workers.

Ms Cody

We need to refer back to it because I did not expand upon the Deputy's question. The reason for offering the normal flu vaccine to poultry workers was to protect against the possibility of individuals contracting normal flu if the avian flu virus appeared at the same time because that would present an opportunity for the viruses to mingle and possibly spark a mutation. The vaccine has been provided free of charge in all parts of the country but the focus has been on those areas in which the Department of Agriculture and Food agrees the poultry industry is concentrated. I do not have figures for the entire country at present because the uptake can only be measured when returns come through from general practitioners. A local campaign has been organised in Cavan-Monaghan to encourage workers to come forward for the normal flu vaccine and I gather the HSE will provide a free clinic in Monaghan town on 18 February.

Dr. O’Flannagan

The vaccine is not to protect against H5N1 but to provide protection against normal human seasonal influenza. We would not like people to become confused.

Mr. Gavin Maguire

Deputy Upton asked about the capacity of the system in the event of an influenza pandemic. As we all know, the capacity of the health service is under strain in many areas at any given time. It is important to note, however, that emergency planning - as with any organisation - is a function of the health service. It is a question of concentrating and diverting resources to meet an immediate emergency, which is what we in the HSE are working on with our colleagues in the Department of Health and Children.

It is important to emphasise that there is no way of projecting with any accuracy the number of people who would become ill or die in the event of a pandemic arising from H5N1 avian flu. While there is a significant worldwide death rate from avian flu currently, history tells us that for a virus to mutate to allow easy interhuman transmission and trigger a pandemic involves an inevitable weakening of its severity. The high death rate one sees with H5N1 would almost certainly not exist in an influenza pandemic arising from it. That said, the figures could be enormous. There were three pandemics in the 20th century. These occurred in 1918, 1957 and 1968. As most people now know, the pandemic of 1918 killed an estimated 30 million to 50 million people worldwide. The pandemics of the 1950s and 1960s were relatively minor in comparison. In the first instance, there is no way to predict the likelihood of the current H5N1 bird flu virus becoming the next pandemic but history tells us there will be more pandemics. In the second instance, there is no way to tell how severe the next pandemic will be in terms of illness and deaths.

It is incumbent on us to plan for the worst scenario as well as the various levels below that, which is what we are doing. The approach in emergency planning is to divert resources at whatever capacity one has to meet a particular threat when it arises. In the case of the HSE, this means all non-essential hospital activity would cease during the period of the first wave, which could last anything from eight to 21 or 22 weeks. The level at which normal hospital activity would be suspended would depend on the rates of infection and death associated with the virus. General practitioners' efforts would also be devoted largely to dealing with the pandemic. We are working on the best way to manage the potentially very large numbers of affected people. It is possible that in the peak of the first wave, upwards of 200,000 would fall ill in Ireland, which is an enormous figure. While managing such numbers would be very difficult, we are implementing measures with a view to attempting to do so.

It is acknowledged internationally that if a significant pandemic occurs in which 25% of the population becomes ill, with a death rate of 2% to 3%, the consequences would be such that no health system could cope. Ms Cody pointed out that the potential of an influenza pandemic for the world is extremely severe. We are trying to put mechanisms in place whereby we can keep the maximum number of facilities operational and devote as much of the resources under our control as possible to dealing with a pandemic. While our work in this area is not complete, it is at an advanced stage. An important element of any plan is a communications strategy, which Dr. O'Flannagan touched on when she spoke about the various types of information we need to transmit to the general public on public health interventions, hand washing, staying at home, etc. We are compiling the information to be provided to the public on that matter but it is too early to disseminate it. The information will be issued if the WHO advises us of evidence of easy human-to-human transmission.

While we are putting in place measures to maximise the capacity of the Irish health system to manage a pandemic, it will be very difficult to cope if that pandemic is very significant. A scenario may arise in which upwards of 25% to 40% of the population would not turn up for work. If there is a 25% infection rate, schools will close and people will be obliged to stay at home to mind children. If a significant number in Ireland and the rest of the western world cannot go to work, our hospitals and general practitioner surgeries will be affected. People in the health sector will get sick at the same rate as the rest of the population, which will constitute a significant obstacle to maintaining health services. The plans we are formulating are attempting to anticipate that scenario and address it.

Deputy Upton

Is it the case that only Roche is able to produce the vaccine or has the availability been expanded? I recall that, in the early days, Roche had a monopoly but that may no longer be the case.

Ms Cody

The producer of the current anti-viral, Tamiflu, is Roche. A similar drug, Relenza, has come on the scene recently and is being considered. Roche is making efforts to increase production and is examining the possibility of franchising. It has produced what has been the drug of choice to date.

Deputy Upton

Who has the capacity to develop a vaccine if a virus emerges? Will there be a selective or exclusive approach in that case also?

Dr. O’Flannagan

A number of companies, many of which are undertaking trials, will develop a vaccine but full production capacity to meet the international demand a pandemic would create does not exist. The vaccine companies are trying to persuade people to increase their normal human influenza vaccine consumption in the inter-pandemic years so they will be able to meet demand in the pandemic years. That is an issue for all countries. It is probably a good idea to do that.

The Deputy asked about mutations. There is some information on the HPSE website about it. The UK reference centre has as yet only received a small number of samples which have been confirmed as H5N1 and one of those showed a mutation whereby the binding site showed an increased binding for human cells as opposed to avian cells. That is obviously a cause for concern but the comment from the centre was that it had seen these mutations previously, in Hong Kong in 2003 and Vietnam in 2005. It is not necessarily the case that all the currently circulating strains have this improved capacity but obviously the centre wishes to see more samples. The interpretation of the significance of it would depend on the epidemiological findings, in other words, if there was any evidence of improved human to human transmission. As yet, that has not happened. All the cases there are ones where direct contact with poultry occurred.

Chairman

I thank Dr. O'Flannagan. On behalf of the committee, I also thank the officials from both Departments for responding to the queries raised by members. As there is no other business, the committee will adjourn.

The joint committee adjourned at 4.42 p.m. until 3 p.m. on Wednesday, 8 February 2006.