- The Washington Times - Sunday, April 9, 2006

RICHMOND, Calif. (AP) — The middle-aged man with fever, cough and shallow breath told his doctor that he had just returned to Northern California from a chicken farm in Vietnam.

That rang the first alarm bell. Then came the initial tests from a local public-health laboratory: a positive result for influenza A, the virus family that includes bird flu. A swab from the man’s throat was rushed to the state lab in Richmond.

The man was one of about three dozen Californians who were strongly suspected of being infected with bird flu and were tested here. About a dozen cases were “very worrisome” because of the patients’ travel histories and symptoms, said Dr. Carol Glaser, chief of the virus lab at the California Department of Health Services’ Richmond campus.

All tested negative in the end. Yet each case served as a practice run of sorts for the disease’s arrival.

“Because there are so many travelers into California, we could very well see a case tomorrow,” said Janice Louie, a medical officer at the lab.

The nation’s most populous state is uniquely vulnerable to the germ arriving via birds or people. Dr. Glaser and the lab’s assistant deputy director, Paul B. Kimsey, have bet a cup of coffee on which they think it will be. Mr. Kimsey’s wager is with the birds. California has a $2.5 billion poultry industry, and millions of birds migrate along its flyways.

Dr. Glaser is betting on the human path. About 11,000 people arrive each day from Southeast Asia alone, officials say. Nodding her head at a map of the 54 countries and territories afflicted with bird flu, Dr. Glaser said: “I don’t even want to know the numbers” of people entering California from other regions.

At least 109 persons worldwide have died from bird flu since outbreaks of H5N1 swept through Asian poultry populations in late 2003, according to the World Health Organization. Health officials fear that the H5N1 virus will mutate into a form that spreads easily among people, which likely would spark a global epidemic.

Doctors in California have received urgent pleas from health officials to be vigilant about asking patients with certain symptoms about their recent travels. Did the patient visit a country with reported bird flu cases? Was there exposure to sick poultry?

The “hot cases” are patients who have visited regions with reported cases of avian flu and are sick within 10 days of returning. That sparks a chain of events that usually ends on the computer monitor of microbiologist Hugo Guevara. The goal: to determine whether the patient has garden-variety flu or bird flu.

A sample is obtained by swabbing the patient’s throat or nose and shipped to a local laboratory that can determine whether a virus belongs to the influenza A family. Simultaneously, a second sample from the patient is driven or flown to the Richmond lab, where it is greeted at the gate by a staffer who rushes it into testing.

In the hot cases, the patient goes into an isolation room during the testing to prevent any spread of the disease.

The Richmond facility northeast of San Francisco is a cluster of labs protected by motion-sensing gates, cameras and security guards. The lab can produce results using the latest tests in a matter of hours, as opposed to several days in less sophisticated facilities.

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