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Email received February 11 2007 from Dr Ruth Watkins

Today's food programme 11 Feb

I would like to comment on Professor Oxford's remarks and David Milliband's response.
David Milliband and officialdom in general are looking for advice from scientists for their briefing when they should be looking for advice from clinical virologists experienced in outbreak management.  With respect to John Oxford he is a scientist but he is not a clinician nor is he a scientist with clinical responsibilities at The Royal London and Barts. 
The key to a disinterested and balanced briefing for ministers is that the advice should come from someone with clinical experience in outbreaks as well as virus expertise, and this may involve a professional group rather than COBRA. 
John Oxford has investigated historical outbreaks, the 1918 flu, but not outbreaks in the present where there is a problem now: outbreaks of diarrhoea or respiratory infection, chickenpox, hepatitis B in hospitals or the community and with problems of contact and exposure between individuals and travellers.
Human clinical virologists are dealing with these problems everyday.  They keep themselves up to date with the literature and with the epidemiology of outbreaks, via the communicable disease surveillance centre and meetings.  In the case of Avian flu there has been a lot of information for years on the Promed site and the professional ornithology societies as well as articles in magazines.  Is there a veterinary equivalent of the clinical virologist and communicable disease consultant?
It is clinically naive of John Oxford to claim that because he was told there was no international trade connection with Bernard Matthew's operation that he was justified in ruling this out, in his Q and A section published on the web where he only mentions wild birds as a possible source.  I don't believe a practising virology clinician would have been persuaded to fall for the story of the wild bird even though at that time no business connection was known with a source of avian flu abroad.
Also the story about vermin or birds spreading the avian flu virus within the Holton plant, from the improperly stored imported turkey offcuts to a turkey shed or between turkey sheds is not as likely as the agency of human spread on hands or feet or clothes etc.  John Oxford did mention this to give him credit in his interview on the programme.
As you know when I was asked to comment for BBC News 24 on the first Saturday of the Matthew's outbreak on the 3rd Feb, I said that the main cause in spread of avian flu had been via humans, trading poultry and its products legally or illegally and in using poultry manure to feed warm fish farms etc. 
My clinical experience has made me wise to the many surprises that are thrown up when investigating outbreaks and the relevance of past experience that others have had, in this case Nigeria, Egypt, Pakistan and Vietnam for example.
It is vital that advice in controlling outbreaks is given by professionally qualified clinical virologists (in human medicine and ideally veterinary medicine as well of course) in conjunction with scientists. This is an animal virus with important human health considerations.  There is a large body of appropriately qualified and experienced people in human medicine in contrast to veterinary medicine.
Just as in the case of DNA fingerprinting of humans to catch out criminals or Polonium 210 leaving a trail of contamination, sequencing extensive parts of or the whole of a virus, which can be done quite quickly now, gives essential information.  Mother to baby pairs of herpes simplex virus transmission as distinct from transmission from staff to babies on neonatal units, or the source of a hepatitis B or HIV outbreak from a surgeon to his or her patients, or infection pairs such as needlestick donor and recipient in the case of an accidental needle prick and so on.  If the source of this avian flu outbreak had been trade with China we would not have had a virus to compare with the Holton turkey virus and would have been none the wiser except perhaps circumstantial evidence of trade via a paper trail. 
We are fortunate to be in a position to recognise the truth and to learn the lessons and put these into practice for ourselves and the world by the thorough investigation DEFRA are in the process of doing, even if it has been a little slow or less than transparent at times. 
Ruth Watkins



































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