Diann Prosser / USGS

This bar-headed goose (Anser indicus) was marked with a satellite transmitter at Qinghai Lake, China, in an effort to understand the role that wild birds play in avian influenza.

They were once featured on the show “Dirty Jobs” but the wildlife experts who spend weeks each year wrestling wild birds to swab their behinds for avian flu don’t mind. They’re happy to be on the front line, keeping an eye out for infected birds that might bring new and deadly strains of influenza to the United States.

The program’s been dialed back a bit since it started in 2005, but the U.S. Geological Survey and Fish and Wildlife Service experts are paying close attention to reports of a new and deadly strain of bird flu – the H7N9 virus. It’s infected 102 people in China at last count, and killed 20 of them.

No one is sure where, exactly, it’s coming from. Domestic chickens don’t seem to be a source, nor do pigs, and the virus has been traced to pigeons and finches. It doesn’t seem to be spreading from person to person easily.

“Right now the situation in China seems to be more of a public health situation than a wildlife situation,” says Hon Ip, who has been working on the avian surveillance program since it started up in 2005.

AFP - Getty Images

An H7N9 bird flu patient is escorted after his recovery and approval for discharge from the hospital in Bozhou, central China's Anhui province .

“We are going to see whether it really is going to be extensively in wildlife before we ramp up our surveillance in this country.”

The bird surveillance program started as concern grew over H5N1 – the other bird flu virus – which has spread to 15 countries since 2003, infecting more than 600 people and killing about 60 percent of them.

Ip and his colleagues showed the H5N1 virus was definitely spread by migrating birds, but they’ve also shown, so far, that the highly pathogenic type has not yet come to the U.S.

Just about every other type of bird flu has, however. Birds can carry dozens of different varieties of influenza, and some make them sick, while others don’t. There’s highly pathogenic influenza – high-path for short – that can sweep through a flock of chickens in days. Other types don’t seem to cause so much as a sniffle in birds.

And different species are infected differently. Dometic ducks don’t seem to be bothered by H5N1, but they can give it to chickens which, in turn, can sometimes infect people.

The best way to check is to test the birds. This is where “Dirty Jobs” comes in. People are tested for flu with a nasal swab. You can test birds this way, too, but they also spread flu in their feces. So they need a swab of the cloaca – the all-purpose opening that birds have on the back end.

“Yes, it’s a dirty job,” Ip says, laughing. The Discovery Channel show featured the USGS and Fish and Wildlife Service project during season 3 in 2007.

The team has tested more than 450,000 migratory birds from 284 different species in all 50 states. Now they focus on Alaska, Maine and Iceland. The USGS National Wildlife Health Center also tests sick and dead migratory birds, especially ducks, geese and swans.

Du Yu / Zuma Press

A staff member wears a protection suit while spraying disinfectant to the hen house whose proprietor tested positive for H7N9 virus in Tianchang, China

“We are working a lot smarter. We kind of know which locations are better,” Ip says. Waterfowl were especially likely to carry H5N1. But H7N9 looks different.

Genetic tests suggested one ancestral carrier was a finch, and other tests suggested pigeons might carry it. “Should it ever be in wild birds, there is a possibility it may be in species other than waterfowl.  We need to know that,” Ip says.

The finch species is found across the northern hemisphere, in Asia, Europe and North American. “It is called a brambling,” Ip says. “There are some bramblings that come straight into Alaska and into the lower 48. These little birds are just amazing. They are so small and yet able to migrate these incredible distances.”

The little orange and gray birds have not been shown yet to carry H7N9. Instead, genetic tests showed they may have carried some of the genes that mixed with genes from other bird flu viruses to create H7N9. Flu viruses do this kind of thing all the time – an animal can be infected with more than one type of flu strain at once, and the viruses meet up and swap genetic material.

That is what happened with the 2009 pandemic of H1N1 swine flu. The new virus was an indirect descendant of the 1918 “Spanish Flu” that killed upwards of 50 million people. Over the decades, it picked up genes from various types of bird and pig influenzas.

“It was a virus that ultimately came from birds but it evolved in swine before it became a human pandemic virus,” Ip says. “Maybe new mammalian viruses can arise when mammals are directly infected by birds.”

So far, neither H5N1 nor H7N9 seems to have developed the ability to pass easily from one person to another.  If one or the other does, however, experts worry. “Whenever a new type of influenza virus infects humans it is a cause for concern,” says Jim Pipas, a virologist at the University of Pittsburgh. “First, because H7N9 is so different from influenza viruses currently circulating in the human population, humans are likely to lack an effective immune response to the virus. … This is why it is so important to maintain surveillance and to be ready to produce a vaccine if necessary.”

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New flu has public health experts worried about resources

A vaccine clinic closed. One mosquito spraying program eliminated. A mother-child health program outsourced. The public health department in Harris County, Texas, has been hit hard by state, federal and local budget cuts and there’s no end in sight.

And now everyone’s talking about a new strain of bird flu in China that may or may not threaten the United States.

Dr. Herminia Palacio isn’t happy.

“I do worry about if it comes here, how long are we going to be able to sustain a response,” says Palacio, who is executive director of Harris County Public Health and Environmental services. “What resources are going to be available at the federal level in the current environment? These things are very troubling.”

Local health departments have been forced to cut 39,600 jobs since 2008, according to the National Association of County and City Health Officials (NACCHO).

“Preparedness programs have been among the hardest hit,” says Alisa Blum, a spokeswoman for the organization. Its 2012 survey of public health departments found about 24 percent of local health departments cut emergency preparedness programs in 2011.

“More than half of local health department in 17 states lost staff, including Idaho, Florida, Mississippi, and Maryland, where more than three-fourths of local health departments experienced work force reductions,” the report reads.

Harris County, which surrounds and includes Houston, was one of them.

“We have gone from a staff of 700 in 2009 to a current staff of just over 500. We have lost about 230 people total,” Palacio said in a telephone interview. “It was kind of a perfect storm – we had local, state and federal (budget) cuts all simultaneously coming down on us.”

So the agency, which provides childhood vaccines, family planning services, inspects restaurants, responds to hurricanes and floods, watches out for people when it gets too hot or too cold, helps warn people of food poisoning outbreaks, tests bats for rabies, works to control outbreaks of West Nile virus, and plans for terrorist attacks, chemical disasters and epidemics, had to decide what to cut.

“Should food be 30 percent less safe?” Palacio asked. Food inspectors were kept on, but anything that could be outsourced was.

“We had to dramatically reduce the number of family planning patients that we see because of budget cuts at the state level. We had to transition maternity care. We don’t see prenatal patients any more due to combined budget cuts at the state level,” Palacio said.  It was all outsourced to the county’s indigent care services at county hospitals.

 “As much as we could, the department took a very hard strategic look and tried to reduce our work force and cut back to our very core public health mission. That being said, even at baseline we felt like there was much more we could be doing from a public health perspective. More important – this really erodes our emergency response capability.”

The department cut back from five vaccine clinics to four, and now none operates five days a week. In 2009 the department administered 111,742 shots; in 2012 this was cut by more than 80 percent to 19,823. In 2009, county public health clinics saw more than 45,000 patients; this dropped to 7,400 in 2012.

Harris County staffers worked full-tilt for 18 months straight when H1N1 swine flu broke out in 2009, the first new influenza pandemic since 1968. “We had been preparing for an avian influenza pandemic since as early as 2004,” Palacio says.

“So we were in response mode when H1N1 actually hit.”  And the department was fully staffed. “At the end of March 2010, we got hit with the first wave of layoffs. I laid off 56 people,” Palacio says.

“Unfortunately, preparedness is usually one of the first places to get cut,” says Andrew Roszak, who directs pandemic preparedness for NACCHO.

Preparedness always scores more funding after a big national event, such as the 9/11 attacks, he said. Then the cuts start as the years pass. “Especially in this fiscal backdrop,” Roszak says.

“We have fewer epidemiologists to track these outbreaks and track the spread of disease,” he said. That means fewer feet on the ground to test patients for new diseases. It was local public health officials who first detected H1N1 swine flu in patients in California in 2009, and who caught the first cases of a new kind of H3N2 swine flu that eventually sickened more than 300 people who caught it from pigs at state fairs last summer.

“Maybe we need to buy big red trucks and ride around in them like the fire department does,” Roszak said, only half-joking. Public health, Roszak says, is largely invisible.

If and when a new pandemic of disease hits, county health officials will be at ground zero for delivering vaccines, for handing out drugs and for helping to distribute face masks and other protective equipment.

Emergency funding and staffing is likely to come in case of a true medical emergency, but Palacio says it’s not always enough to just throw money and people at a problem. Her department lost years of training. “If you lose 50 people and you get back 50 people, it’s different,” she said. “You don’t get back the same wealth of experience and expertise.”

And, she says, staff are worn out. “People are weary,” Palacio said. “People have been doing their own jobs and trying to pick up the jobs of the colleagues that we have had to let go.”

It’s a lot to ask, she says. “Eventually, you can only do less with less,” she said.

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Six more people have been diagnosed with a new strain of bird flu in China , officials said, and one of them has died, bringing the death toll from the new outbreak to three.

That makes nine human cases of H7N9 bird flu, all in the eastern part of the country around Shanghai. This is a different strain of bird flu from H5N1 avian influenza, which has killed 371 people out of 622 infected in 15 countries since 2003.

The new cases are reported in China's eastern Jiangsu Province, including a woman in Nanjing who works killing poultry. All are in critical condition, according to the official Chinese news agency Xinhua. It quotes officials as saying more than 300 people who were in close contact with the six new victims don’t appear to have any flu symptoms.

That suggests -- but doesn’t prove -- that the virus isn’t passing from person to person.

The World Health Organization says genetic studies suggest the virus has mutated slightly, to make it more easily able to infect mammals, including humans.

On Sunday, China reported three H7N9 bird flu infections: two in Shanghai and one in Anhui. The two Shanghai victims died and the third patient is in critical condition, Xinhua says. There’s no suggestion yet that they infected any of their friends or relatives, either, Chinese officials have said.

"These are the first reported cases of A(H7N9) in humans. That makes it a unique event, which the World Health Organization is taking seriously," WHO said in a statement posted on its website. "WHO is working closely with the national authorities to better understand the situation and will communicate important updates as they become available."

Other H7 type viruses have infected people on very rare occasions, WHO says.

"From 1996 to 2012, human infections with H7 influenza viruses (H7N2, H7N3, and H7N7) were reported in Netherlands, Italy, Canada, USA, Mexico and the United Kingdom. Most of these infections occurred in association with poultry outbreaks," WHO said in a statement posted on its website Wednesday.

"The infections mainly resulted in conjunctivitis and mild upper respiratory symptoms, with the exception of one death, which occurred in the Netherlands. Until now, no human infections with H7 influenza viruses have been reported in China."

Doctors keep a very close eye on cases of animal flu that pass into humans. Seasonal flu causes an annual pandemic that kills tens of thousands of people globally every year. But if a new virus starts passing from animals to humans, it can cause far more serious disease.

For instance, H5N1 kills about 60 percent of the people it infects. Luckily, it doesn’t pass easily from person to person, either, and most people who got it appear to have been directly infected by sick chickens.

But flu can mutate very quickly and it’s possible that a bird or animal strain of flu could develop the ability to pass quickly from one person to another. H1N1 swine flu appears to have done this in 2009. It killed a greater than usual number of young adults and children that year, and has now joined the mix of annual human flu strains.

And H1N1 is an indirect descendant of the 1918 “Spanish flu”, which killed anywhere between 50 million and 100 million people. So public health experts take the risk of another such pandemic seriously.

Chinese officials have not said what they are doing to see if the H7N9 virus is spreading among poultry flocks. H5N1 pops up among chickens regularly, forcing mass culls.

“Since its widespread re-emergence in 2003 and 2004, this avian virus has spread from Asia to Europe and Africa and has become entrenched in poultry in some countries, resulting in millions of poultry infections, several hundred human cases, and many human deaths,” the World Health Organization says.

“Outbreaks in poultry have seriously impacted livelihoods, the economy and international trade in affected countries.”

H5N1 infects ducks without causing any symptoms. As long as an influenza virus exists in an animal, it will be steadily mutating and also swapping genes with other viruses.

That’s what happened with H1N1 swine flu in 2009. It was a never-before-seen mixture of human, pig and bird viruses. It wasn’t nearly as deadly as other new flu viruses that cause pandemics, something that could lead people to believe that flu pandemics aren’t that big a deal. But H5N1 and H7N9 are completely new to the human body and appear to be more deadly than seasonal flu.

While there are vaccines against seasonal flu, there are only experimental human vaccines for H5N1 and none for H7N9. Flu mutates so quickly that it’s impossible to formulate vaccines until a strain is actually circulating. Researchers are working to develop a universal flu vaccine that could protect people against a range of strains, or even all strains of influenza.

But most types of flu, including H7N9, appear to be helped at least a little by two antiviral drugs -- oseltamivir or Tamiflu, and zanamivir or Relenza. Neither is a cure, but given early enough can relieve the worst symptoms, WHO says.

Influenza A viruses are named based on two of their genes - the hemagglutinin, or H gene, and neuraminaiase, or N. Human seasonal flu has been caused by H1N1, H3N2 and H2N2 type viruses, as well as influenza B.

Related:

• China reports two deaths from new bird flu strain
• Scientists prepare to re-start bird flu experiments
• Officials warn of bird flu pandemic

Hotli Simanjuntak / EPA file

A strain of H5N1 virus is believed to have caused the deaths among poultry in Jakarta last fall. Here, traders sell chickens in the Keutapang market, Aceh, Sumatra, Indonesia, on Dec. 12, 2012. Researchers announced Wednesday they will resume controversial research on how H5N1 can transmit through the air.

Scientists said Wednesday they are re-starting some of the controversial research in which they managed to make H5N1 bird flu viruses transmit though the air -- but not in the U.S., where safety concerns haven't been fully addressed. They say they need to understand this in case it starts happening in nature, causing a pandemic.

Since 2003 H5N1 bird flu has infected 610 people globally and killed 360 of them, according to the World Health Organization. While this might not sound alarming, flu experts say it could mutate at any time into a form that passes easily from one person to another, causing a deadly pandemic. But their studied worried a board of U.S. government advisers, which asked them to hold up. They have done so for a year now.

“The risk exists in nature already, and not doing the research is really putting us in danger,” Dr. Yoshihiro Kawaoka of University of Wisconsin-Madison, one of the top influenza researchers in the world, told reporters in a telephone briefing.

Kawaoka was among 40 flu researchers who signed a letter published jointly in the journals Nature and Science on Wednesday, saying they were ready to start their work again.

The 40 scientists have been working for years to figure out just which mutations would give H5N1 the ability to spread easily from one person to another, while also staying deadly.

They mostly work with ferrets, which get infected with flu in a way very similar to how people get infected.

In one of the studies that caused concern, researchers created mutant versions of H5N1 that became airborne, spreading from one ferret to another without any physical contact.

Last December a committee called the National Science Advisory Board for Biosecurity asked two teams of researchers to hold off on publishing their findings. The U.S. government also asked all flu researchers to agree to a moratorium on genetically changing flu viruses until ground rules could be agreed on. The worry was that the virus could escape and accidentally cause a pandemic or, worse, that terrorists could somehow get hold of the work and use it to make a biological weapon.

The researchers say they’ve addressed the concerns in several countries, including Canada and the Netherlands. “Scientists should never conduct this type of research without the appropriate facilities, oversight, and all necessary approvals,” they wrote in their letter.

“The USA is still under final consideration for biosecurity,” said  Dr. Ron Fouchier, who works at Erasmus University in Rotterdam, Netherlands and who conducted one of the controversial genetic engineering studies. Fouchier gets some money from the U. S. federal government but says he can re-start research using funds from the European Union and elsewhere.

H5N1 is still evolving, said Fouchier, and it’s important to understand how and when it might change. They say they can use their findings not only to keep an eye out for when the virus is beginning to get dangerous, but also to help design good vaccines and better drugs to treat flu.

“It is our opinion that in those countries where the research can be done safely, the research should start,” Fouchier said. “We simply need to re-start our research.”

“We want the world to be better prepared than we currently are when the  H5N1 virus causes a pandemic,” Kawaoka agreed. “We believe the benefits of H5N1 research outweigh the risks and that is why we need to resume.”

Arthur Caplan, the head of the Division of Medical Ethics at NYT Langone Medical Center and an NBC News contributor, said it's important for researchers to learn what can make H5N1 more virulent or contagious to be better prepared in the case of a pandemic but "the real issue is where they are publishing it and who gets to see it. I have no issue with restarting the research but some issue with where they are going to publish it and where they present it because bad guys can use it too."

One thing the controversial studies found was that it only takes nine genetic mutations for H5N1 to turn from a virus that mostly infects birds into one that can easily infect mammals – including, almost certainly, humans. “Nine mutations for influenza viruses is almost none,” Kawaoka said.

While H5N1 rarely infects people, it causes regular outbreaks among chicken flocks in Asia and the Middle East, and it infects many ducks without causing any symptoms at all. As long as an influenza virus exists in an animal, it will be steadily mutating and also swapping genes with other viruses.

That’s what happened with H1N1 swine flu, which caused a pandemic in 2009. It was a never-before-seen mixture of human, pig and bird viruses. It wasn’t nearly as deadly as other new flu viruses that cause pandemics, something that could lead people to believe that flu pandemics aren’t that big a deal. But H5N1 is a completely new virus to the human body – one reason it kills such a high percentage of its human victims.

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Don't miss the latest health news at NBC News.com

Scientists who are experts at understanding how the flu works are convening in New York this week to make a very important decision.  They are going to decide whether to restart potentially risky research on flu viruses that has been on hold for many months.

Some argue that before they begin there ought to be a lot more involvement of the public in granting permission for this work.  I completely disagree.  There are plenty of oversight groups in place already that are charged with protecting public health and safety in the U.S. and worldwide.

Still, I think a few strict requirements ought to be in place before the flu manipulators get back in business in their labs.  They are needed to help protect the scientists, you, me and everyone else on this planet should the dangerous bugs they seek to create get in the wrong hands or places.

Last January a huge controversy broke out over the wisdom of publishing two very detailed papers in leading scientific journals that involved the engineering of H5N1 bird flu viruses by labs in Wisconsin and the Netherlands.  H5N1 normally infects ducks, and it can wipe out flocks of chickens. It occasionally infects people – about 600 so far and it’s killed 358 of them. Scientists are afraid slight changes in its genes would make it more infectious to people.

They’ve been tinkering with the virus to see what it would take.  Each study showed how to create flu strains that were easier to transmit than the ones that usually occur in nature.  Ferrets – the animals that most closely resemble humans when it comes to catching flu -- could get infected by one of the engineered viruses simply through breathing and sneezing.

No physical contact was required. 

This work suggested ways in which nasty, highly contagious forms of the flu evolve naturally every once in a while and shows why pandemic flu clobbers human beings every couple of decades.   But, the papers also showed how to artificially gin up highly transmissible strains -- something that might be of keen interest to terrorists and other bad guys. 

Many people, including me, wondered about the wisdom of publishing formulas for making highly contagious types of flu in a world where accidents and attacks are both all too real.  Censorship, however, turned out to make no sense.  By the time a paper is ready to go into a major scientific journal, secrecy has long since left the building.

When the stink over publishing broke out seven months ago, more than 30 of the world’s flu mavens agreed to put a hold on their research until the publication battle had been resolved.  Originally the self-imposed moratorium was to last 60 days. Even though both papers have been published, the moratorium has gone on for more than 6 months.  Many of those who do this work say it is time to get back to the business of understanding the basic biology of the flu virus.

Why do risky research on the flu?  Those who want to argue that it is important to understand how flu viruses can become more easily transmissible, or lethal, or both.  There is a lot of swine flu and avian flu around every year but luckily it comes in forms not easy to transmit from animals to people or among people.  But, with the right mutations, as the two published papers showed, the flu can get a lot more contagious.  Add in a few more changes and you can make the flu much more deadly.  If we knew from lab manipulations what strains of flu were the worst, we could monitor for them and maybe even get a leg up on creating a vaccine if one suddenly popped up someplace.

That makes sense.  What would also make sense would be to restrict the number of scientists and labs and locations doing this risky work, having hyper-strict safety rules that everyone around the world is expected to follow and a system of inspection to make sure no especially awful bugs can escape and that no one can break in to let them out. 

We don’t need public hearings to get this done.  We need specific rules.

There are requirements in place now for doing risky biological work.  But they are not tough enough for mucking around with a killer with a proven history like the flu.  Sadly, more restrictions are needed in a world where terrorists, crazies and accidents happen. 

The moratorium needs to end.  Figuring out more about the flu in the lab makes us all safer.  Ending it means knowing when experts agree that the experiments are needed, all information about such research is encoded and restricted and the labs where risky flu work is done are safe and secure. 

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Experts agree to let scientists publish H5N1 studies

By Maggie Fox

Remember bird flu? New studies show you should still worry.

Bird flu is still out there and mutating into dangerous forms, but there’s good news too – the changes that could make it spread more easily could make it less deadly, researchers reported on Thursday.

Flu experts funded by the U.S. government published a long-awaited a study on H5N1 bird flu on Thursday, and some of their findings are sobering. It only takes a handful of mutations for the virus to become airborne and easily transmitted from one animal to another. And a second study shows those mutations not only can easily occur in nature – they have already started to do so.

“We now know that we're living on a fault line,” Derek Smith of Cambridge University in Britain, who worked on one of the studies published in the journal Science, told reporters in a teleconference. “It's an active fault line. It really could – it really could do something.”

Now here’s the reassuring part – the mutations that make the virus pass easily from one animal to another also make it a little less dangerous. Instead of taking root deep in the lungs, causing a hard-to-treat pneumonia, the mutated version of H5N1 likes to live in the upper respiratory tract.

“And so it's less likely to cause pneumonia,” said Ron Fouchier of Erasmus Medical Center in Rotterdam, the Netherlands. And, Fouchier and colleagues reported in Science, drugs used to treat flu worked against the mutant version.

H5N1 bird flu has been circulating on and off since 1998, and it has killed nearly 60 percent of nearly 600 people reported infected, according to the World Health Organization. It mostly kills chickens and rarely infects people, but when it does, little can be done for the victims. Many experts believe H5N1 could be the source of the next big deadly pandemic, like those that struck in 1918, 1957 and 1968.

The last pandemic of a new flu was the H1N1 swine flu in 2009. It wasn’t nearly as deadly as other new flu viruses that cause pandemics, probably because it was a mutated form that included bits and pieces of flu viruses that had been infecting people for decades. That could lead people to believe that flu pandemics aren’t that big a deal. But H5N1 is a completely new virus to the human body – one reason it kills such a high percentage of its human victims.

Luckily, the infection doesn’t spread well from birds to people or from one person to another. But like all versions of the flu virus, it evolves and mutates in several different ways. Scientists have been working for years to figure out just which mutations would give H5N1 the ability to spread easily from one person to another, while also staying deadly. The latest work uses ferrets, which get infected with flu in a way very similar to how people get infected.

The work concerned some experts, and last December a committee called the National Science Advisory Board for Biosecurity asked two teams of researchers to hold off on publishing their findings. The U.S. government also asked all flu researchers to agree to a moratorium on genetically changing flu viruses until ground rules could be agreed on. The worry was that the virus could escape and accidentally cause a pandemic or, worse, that terrorists could somehow get hold of the work and use it to make a biological weapon. But the restrictions caused a furor among researchers, who are used to freely sharing their research.

The biosecurity board agreed earlier this year to let the researchers publish their findings.

“It's our hope that (Thursday’s) publication will help to make the world safer, particularly by stimulating many more scientists and policymakers to focus on preparing defenses,” Bruce Alberts editor-in-chief of Science, told the teleconference.

Some of the conclusions from the batch of studies: governments need to loosen rules for drug companies to make it easier and faster to make vaccines against flu; researchers – most funded by governments – need to keep a closer eye on bird flu around the world to watch for the mutations; and the benefits of flu research far outweigh the risks.

“The reason that we accelerated research on influenza is because there's a real threat,” said Dr. Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases, which paid for the controversial flu studies.

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