Imphal, August 06: With the first phase culling of birds and the moping process on, it looks like the outbreak of Avian Influenza in Manipur would soon be contained, if not immediately.

However the presence of the deadly and highly mutating H5N1 strain has raised several apprehensions.

Not the least being whether the outbreak in a State where there are a large number of people living with HIV/AIDs mean a pandemic of disastrous proportion should the virus start crossing over to humans ? In a 2005 BBC news report, well known virologist, Dr Robert Webster of St Jude Children's Research Hospital in Memphis cautioned that bird flu could readily mutate into a pandemic form if it infects people with AIDS.

He said it was possible people with AIDS, who have depressed immune systems, to harbour the deadly H5N1 strain of bird flu.

Dr Webster was speaking at a conference organized by the Council on Foreign Relations in New York.

Though the H5N1 strain remains largely a bird virus, experts are apprehensive that its mutating ability might spark off an influenza pandemic in which millions could die.

The virus is known to have infected at least 319 people worldwide since 2003 and has killed at least 192, according to the World Health Organisation.

Manipur Health Secretary, P Vaiphei, however, ruled out any report of human transmission in the State.

"There have been very few cases of human infection all over the world.

We have been conducting health monitoring surveillance too.

The clinical samples of four persons who were earlier suspected of having contracted bird flu and were quarantined have been declared negative for Avian influenza virus by RT-PCR (Reverse Transcriptase Polymerase Chain Reaction) test," he said.

When contacted recently on e-mail Dr Webster clarified, "The issue of the vulnerability of people with HIV/AIDS at this time is theoretical.

We know that humans on immuno suppressant drugs can shed influenza viruses for prolonged periods.

However if those persons with HIV/AIDS are infected with H5N1, they could be more vulnerable".

Dr Priyokumar who is in charge of Antiretroviral Therapy (ART) at the State JN Hospital says, "What you have to basically realize is that bird flu will affect a healthy person and a person with HIV/AIDS in the same way.

So there is no hard and fast rule that a person with HIV/AIDS would be more vulnerable or susceptible to bird flu".

P Vaiphei adds, "Bird flu does not spread from human to human in the same way as HIV/AIDS.

Though human infection does occur it is very low.

When the virus was detected in Maharashtra earlier, there was no human infection.

So it would be rather premature to speculate on that (the vulnerability of HIV/AIDS infected people to bird flu).

Even if human infections do occur, it doesn't spread from man to man.

So we can take comfort from that.

The infection may be restricted and controlled.

There is no cause for alarm or panic".

Rajkumar Tiken, secretary general of the Social Awareness Service Organization (SASO) explained, "Being HIV positive doesn't always mean that your immune system is weak.

The strength or weakness of your immune system will be shown by your CD4 count.

According to WHO guidelines when your CD4 count falls below 200, then you are put on ART".

Normal CD4 counts in adults range from 500 to 1,500 cells per cubic millimeter of blood.

The CD4 count also shows how far HIV disease has advanced (the stage of the disease), and helps predict the risk of complications and debilitating infections.

"Yes, there are a host of opportunistic infections (OI) as well as Pneumocystis Carinii Pneumonia (PCP) which an HIV positive person has to guard against.

But we are not aware of any link or greater susceptibility to bird flu," he added.

While it is heartwarming to be reassured against such a tragedy as outlined earlier, it doesn't mean that the threat is non-existent.

What is needed is closer survelliance and detailed studies to ensure that the first mutation of the H5N1 virus strain does not occur in Manipur, or for that matter, anywhere else in the world.

Surveillance area expanded : The State Health Department has expanded its surveillance exercise to 10 kms radius from Chingmeirong where the bird flu was first detected at a farm there.

Forty teams that have been conducting health surveillance exercise since July 16 within 3 kms radius from the Bird flu hit spot have now expanded their exercise upto 10 kms radius, officials in the State Health Department said.

This exercise will be continuing till August 12, they said, adding that so far the Central Health team with the support of the State Government have culled atleast 30 blood samples from persons having similar symptoms of Avian Influenza.

The samples have been sent to both the National Institute of Communicable Disease (NICD) at New Delhi and the National Institute of Virology at Pune for testing and out of the total number four samples were found to be negative of Bird flu, according to the officials.

Blood sample collected from a minor boy from Kshetrigaon hours before be died at Shija Hospital on July 29 has also tested negative, they added.

When inquired about the results of the sample collected from the deceased boy, Health Secretary P Vaiphei said NICD officials informed him that it tested negative.

The Health Secretary reiterated that there is no single case of the H5N1 virus infecting human life and appealed to the people not to panic over the matter.

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