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See previous letter from Dr Watkins

Follow-up received Jan 15 2006

My suggestion applies to the situation in Turkey. I am not sure how rubber boots and netting would be deployed in the conditions we have seen on TV in the villages where the poultry roam free in the streets, and return to little ramshackle buildings at night next to their owner's house. The poultry forage for food eating weeds, food scraps as well as worms and insects, cockroaches etc I should imagine and their owners would purchase little food for them (hence the economy of free range poultry in that environment). The idea that the impoverished villagers would be able to erect bird proof buildings (wild birds should not be able to defecate through the netting nor get into the enclosure), which would then entail the provision of feed, is out of the question for most poor people I imagine.

My suggestion is to restock with vaccinated domestic birds once the village or area has been completely culled to control the outbreak of H5N1 in domestic poultry in that village or area. It is possible there may be H5N1 infection in some of the local wild birds or that infected wild birds or even infected poultry are reintroduced to that village or area. However the vaccinated domestic birds would be protected from infection so there would be no outbreak in the domestic flock. The few infected individuals would die and education should ensure safe disposal of dead birds or their referral to the local veterinary service.

It would be important to maintain vaccination, for example an annual vaccination of all adult and all young domestic birds in the summer if the vaccine gives protection for 12 months. Unfortunately, the apparent local elimination of H5N! from infected domestic poultry by culling all poultry is not enough to ensure the infection will not re-emerge in domestic poultry 6 months or one year later in the same or neighbouring area, as unfortunately experienced in China and SE Asia.

Whether the virus is introduced by wild birds or poultry is irrelevant to my proposal. It is likely that in an outbreak the virus circulates between wild birds and domestic birds, even felines and pigs may be infected too. The most important measure other than controlling new outbreaks is to prevent their reoccurrence thus reducing the opportuniteis for the virus to infect humans and mutate or reassort to produce a pandemic strain for humans.

It would seem that Turkey's exit strategy could be to eliminate the keeping of domestic poultry altogether- I have seen this on the latest ProMed bulletin. This may be very unfortunate for the nutrition and health of its poorer population who- if they ever get the meagre monetary compensation proposed- may be hard pushed to find it would cover another long term source of nutrition as valuable as poultry. They may become like the Maltese and attempt to catch and kill every migrating bird that passes through Turkey- a disaster for wild birds.