[Congressional Record Volume 152, Number 89 (Tuesday, July 11, 2006)]
[House]
[Pages H5042-H5044]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                            AVIAN INFLUENZA

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 4, 2005, the gentleman from Texas (Mr. Burgess) is recognized 
for 20 minutes.
  Mr. BURGESS. I thank the Speaker for that consideration.
  Mr. Speaker, I wanted to come to the floor tonight to speak just a 
little bit about a situation that we have had to address here in 
Congress, and we likely will have to think about it some more over the 
coming year or years, and that is the issue of avian influenza.
  The important thing to remember when we talk about bird flu, or avian 
influenza, is, there are different types of flu. We are all familiar 
with the common type of influenza, the one that we all get a flu shot 
for or should get a flu shot for every year. And the reason we have to 
be vaccinated every year is because there are modest changes that occur 
in the genetic makeup of this virus year in and year out, a so-called 
genetic drift.
  Avian flu refers to a virus that is currently present only in birds, 
but has on occasion made the transition to a human host with rather 
significant effects. This reflects a bigger genetic change than can 
occur in the flu virus from time to time, a so-called genetic shift. 
This could become a major health threat to humans.
  As of June 20, 2006, the World Health Organization has confirmed 228 
human cases with 130 deaths. It doesn't take much to do the math to see 
that that is a mortality rate in excess of 50 percent for this virus.
  Now, the trouble signs that are already present. We do have the virus 
present in birds; there is a wide geographic setting with involvement 
of other animals, including cats and tigers. Bird-to-human transmission 
has occurred, but it has occurred only with inefficiency; and there has 
been on occasion, through close household contact, inefficient human-
to-human transmission.
  Steps one through four have occurred since 1997, and I must stress, 
they have occurred in the Eastern Hemisphere of the world. There have 
been no reported cases in birds or humans in the Western Hemisphere.
  The last step in this process, the efficient human-to-human 
transmission of this virus, has not occurred. If that step does occur, 
and it is certainly not certain that it will, but if that step does 
occur, that would trigger the onset of the possibility of pandemic flu.
  One of the big problems that we have with this virus, as humans, is 
that we have no underlying immunity to this virus, so that if the virus 
is introduced to the community where it can spread easily from person 
to person, it could progress very rapidly through the population.
  Now, pandemics are not new phenomena; they occur and have occurred 
over the centuries. They happen about every 35 years, approximately 
three per century. And, indeed, in the 20th century there were three 
such epidemics. In 1918, the so-called Spanish flu killed 50 million 
people worldwide. In 1957, the Asiatic flu killed 170,000 people in the 
United States. And, in 1968, the Hong Kong flu killed 35,000 people in 
the United States.
  What would happen if a pandemic flu were to reemerge? The Department 
of Health and Human Services estimates that for a moderate outbreak 
like the Asian flu pandemic in 1957, we could see over 200,000 deaths 
in this country. In a worst-case scenario, such as the Spanish flu 
pandemic in 1918, almost 2 million deaths would be estimated to occur 
in the United States.

                              {time}  2030

  Mr. Speaker, I have a couple of maps that show some of the 
progression of this illness across the globe. Looking here at this 
first map, the eastern part of the world, avian flu cases are depicted 
in blue, human cases in black. On this map you will see almost 50 
countries that have been involved with avian flu in bird populations 
and a smaller number, 10 countries, have reported human cases which 
have moved with some difficulty from birds to humans.
  Looking at a map that shows the progression of this illness in birds, 
we see that in Hong Kong in 1997 when the disease was first reported, 
there has been a gradual progression westward since that time. June of 
2004, the disease had progressed to Vietnam. June of 2005, the disease 
was reported in Iraq. In 2006, Turkey. In March of 2006, it had made an 
appearance in Egypt, and the progression is westward.
  This inset map on the bottom, the orange lines, and it is difficult 
to see, but that outlines the places where bird populations, domestic 
bird populations, poultry populations and human populations tend to 
overlap. You can see in the areas in China and Vietnam and Southeast 
Asia where that appears to have been a significant issue, and you can 
see some areas of the United States that would be at risk if bird flu 
actually spread to this country.
  To date, the disease has been endemic in birds and over 200 million 
birds have been culled in the last 3 years. This is significant in that 
there are many parts of the world that rely on poultry as literally a 
means of currency, and this has been a very difficult thing for some 
countries to accomplish. But a critical aspect of the prevention of the 
disease is if we can stop it in birds and never have to worry about it 
in humans, it is going to be much, much better for us as a people.
  Let me take these out of the way for a moment and demonstrate one of 
the issues that is so striking about this illness because it does occur 
in wild birds. This is a map that shows the migratory flyways across 
the world. It is thought that this virus is spread by migratory birds 
to poultry populations. The countries with outbreaks in general have a 
high concentration of poultry. There is some concern because there are 
two of these flyways, as you can see, the East Atlanta Flyway which 
goes from the African continent up into the polar regions of Canada, 
and then the East Asia Flyway which comes up through Australia and 
comes into Canada and Alaska.
  Now, it is unknown whether the virus will make a transition to the 
Western Hemisphere by these routes, but the routes suggest there could 
be some risk. And for that reason, there has been increased testing 
across the United States starting in Alaska with nearly 100,000 samples 
taken from live and dead wild birds, and 50,000 samples from water from 
high-risk waterfowl habitats to be tested in 2006 alone.
  The World Health Organization has identified six levels of pandemic 
alert, and we are currently at level 3 with limited human-to-human 
transmission.

[[Page H5043]]

As of June 20, 2006, the World Health Organization has confirmed 228 
human cases, 130 deaths. The disease was first found in Hong Kong in 
1997, and 18 human cases were encountered in that outbreak, six of whom 
died, and there was significant poultry culling from that population. 
The disease was almost arrested at that point.
  There is a high incidence of the disease in a few countries. Vietnam 
has had 40 percent of the human cases, and Indonesia has had 20 percent 
of the human cases. The problem is in Indonesia, the virus has not been 
contained compared to Vietnam. And Indonesia has had outbreaks since 
early 2004, and new outbreak reports occur with some frequency. As of 
June 20, the 51st case of human infection, which was fatal, was 
confirmed.
  Let's look at a map of Indonesia. There has been a steady rise of 
reported cases and a high correlation between poultry populations and 
human outbreaks.
  The little triangles on the map represent human cases. It is 
misleading because the triangles overlap so there are more case than 
there are actually triangles because some of these cases do occur in 
clusters and are very close in a geographic footprint.
  In some of the larger cities, notice how close some of the triangles 
occur. Indonesia is the fourth most populous country. In many ways 
Indonesia is still suffering from the tsunami that hit there the day 
after Christmas in 2004. In May they had a major earthquake in the 
central Java region with as many as a million and a half people left 
homeless, and Indonesia raises about a billion and a quarter chickens 
per year. That is about 7 percent of the global total. It has 70,000 
villages spread across its 17,000 islands. Many of the poultry raised 
in Indonesia are raised in the backyards of people's houses, and about 
80 percent of the country's 55 million households actually have close 
proximity to poultry. And that makes the presence of the disease in 
Indonesia a little more troubling.
  A chart that is fairly busy but I think important to look at depicts 
some of the cases that have occurred in Indonesia. This is information 
that has been confirmed by scientists and field researchers from the 
World Health Organization. This is a recent family cluster that 
occurred in the Kubu Simbelang village in North Sumatra.
  Many of the recent news headlines had to do with the fact concerning 
the avian flu virus may have become efficient in going from human to 
human, but the outbreak investigation showed that this is indeed, 
although there is a high number of cases, it is indeed what is known as 
a contained cluster, meaning no others, no health care workers, no 
neighboring villagers, were being infected.
  The initial case, the index case of a 37-year-old woman, was most 
likely infected by her sick and dying backyard chickens. She kept them 
indoors at night. No specimen was taken from this patient before she 
was buried so it cannot be confirmed that she was infected with the 
H5NI virus. However, seven of her relatives did test positive for the 
virus. The relatives most likely became ill because of close contact 
with the initial illness. Six of the seven relatives have died, so 
currently limited inefficient human-to-human transmission of the H5N1 
virus that causes the avian flu.

  Another thing that is striking about this, we all think of flu as 
being an illness that strikes the very young or very old. But look at 
the age distribution in this family, in this village. Basically young 
healthy people were the ones that were infected. Now, it is not known 
whether that is significant or that just was the cluster that 
unfortunately got infected by that incident of infection, but it is 
striking that so many people were in the age group where you would 
think they would be young and healthy with a good immune system that 
could ward off this virus.
  In general, 3 to 5, 10 days elapse between the time of symptoms to 
death with this illness.
  Now several things separate the situation that is present today from 
that which existed in this country in 1918, and the first has been the 
introduction of antivirals and vaccines. Antiviral agents are able to 
actually attack part of the virus itself and work like an antibiotic 
and prevent the virus from replicating, and prevent the viral infection 
from being so severe.
  Antivirals do have to be administered within the first 24 hours of 
the onset of symptoms in order to be effective. For that reason, we 
have to have an adequate stockpile of antiviral medications, and there 
has to be the distribution network to get the antiviral medications to 
the areas where they would be required should an outbreak occur.
  Tamiflu is probably the most famous of the antivirals. Relenza is 
another one proprietary name for one of the antivirals. Again, if 
administered during the first 12 to 24 hours, these have the 
possibility of not stopping the illness, but moderating the course of 
the disease.
  Vaccines are historically our major line of defense against viral 
illnesses. One of the problems we have is we have not had a great deal 
of secure vaccine manufacturing within our borders for a number of 
years. We have to have that ability to manufacture the vaccine within 
the United States.
  One of the other problems is this virus is constantly evolving. It 
has not yet evolved from a state where it can go easily from human to 
human. There has been a vaccine developed to the current H5N1 virus, 
but if it changes yet again to the efficient human-to-human form, the 
vaccine may not be as effective. To some degree, you almost need to 
wait until the pandemic occurs before you can actually develop the 
vaccine.
  But the good news is that there has been a vaccine that has been 
developed that seems safe. It does seem effective against the current 
strain of bird flu. One of the difficulties occurs, since we have no 
native immunity to this virus, it does take a lot of this vaccine to 
render someone immune to the virus. Normally you take a flu shot that 
is 15 micrograms of material to develop immunity. With this vaccine, it 
requires two doses of 90 micrograms in order to get someone to develop 
the appropriate immunity.
  The other thing that has to happen, vaccine manufacturers that do 
exist manufacture vaccines by an old method, an egg-based method. If 
the disease is in chickens and we are having to cull poultry from the 
population, you don't want to depend upon an egg source for your 
vaccine, and newer cell-based technologies certainly need to be 
developed.
  Surge capacity within the health care system is going to play a key 
role. We are going to have to be certain that we protect first line 
responders with whatever vaccine is available. If the virus hits, 
antivirals have to be available for first line responders. It is going 
to be important to rotate health care workers so they don't become 
overwhelmed in dealing with the disease, and we are going to have to 
offer mental support services, not just for health care workers, but 
for patients and their relatives who are charged with caring for them. 
This could be a disease that will take a very heavy emotional toll on 
the population.
  In order to minimize the economic impact, we have to implement 
business continuity plans. This is being done in many communities. 
Certainly my communities back in Texas have looked into how they will 
handle some of the other things that local and county and State 
governments are supposed to do if faced with a pandemic outbreak.
  Mr. Speaker, I will wrap this up. I do want to mention that I spent a 
day last week in Geneva with some individuals at the World Health 
Organization. Dr. Michael Ryan was kind enough to spend some time 
talking with me on the global perspective. I have been focused 
primarily on preparedness within this country, and Congress 
appropriately has been focused on preparedness in this country. But I 
want to make mention of some of the things being done by the World 
Health Organization in order to make certain that the virus is either 
arrested in its initial outbreak or that the disease is mitigated 
because people have been on top of it.
  Dr. Ryan works at a place called the Strategic Health Operations 
Center that is part of the World Health Organization in Geneva. The 
purpose of that organization is to provide strategic support, in this 
country to provide that strategic support to the Department of Health 
and Human Services, but they also have a global response network that 
is responsive to the World Health

[[Page H5044]]

Organization as well as the CDC and Health and Human Services 
Department here in this country.
  The concept is to control this virus at the source, and that is 
really what is one of the critical features of this. That is how they 
were able to gain control in Vietnam and Hong Kong. To some degree, 
culling of poultry populations is something that we may see more of as 
time goes by, as well as isolation and quarantine of infected 
individuals coupled with vaccination and antivirals.
  Intelligence is of course a key to this whole process. And then 
verification of that intelligence, assessment of the situation on the 
ground and then a response to the situation as it occurs. All of these 
are parameters that the World Health Organization is monitoring through 
the Strategic Health Operation Center in Geneva.
  Countries need to know that they just are not able to hide a problem 
like this and that officials at the World Health Organization consider 
this a reportable illness with or without the permission of the host 
government of the country. That, I think, is a terribly important step.
  We have a lot of work yet to do in Congress as far as national 
preparedness. A good deal of work has already been done as far as the 
request for proposal for vaccines that went out earlier this year 
through Secretary Leavitt and the Department of Health and Human 
Services. A lot of preparatory work is taking place on the State, 
local, and county levels.
  Every one of our committees in Congress has a role to play in 
preparedness for the possibility of this pandemic.
  In the final analysis, is a pandemic going to occur? No one knows the 
answer to that question. It could be an illness of such severity that 
preparedness is something we are all going to wish we spent more time 
doing.

                              {time}  2045

  Or it may have come across as something more like the Y2K phenomenon 
where nothing much happens.
  It will be in our best national interest, though, to focus on some of 
these preparedness aspects to work with some of our partners at the 
World Health Organization, be certain that we keep this virus under 
surveillance, be certain that we develop the vaccine capability, the 
surge capacity within our health care system and the development and 
stockpiling of antivirals within our country.
  Mr. Speaker, you have been very indulgent.

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