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Health officials would normally look to vaccines and antiviral drugs to control a pandemic, but in this case, those tools have yet to be fully developed and tested. Conventional flu vaccines are not believed to provide any protection against A(H5N1) avian influenza. Human trials of the new vaccine ordered by the U.S. government are not expected to begin until the end of this year, at the earliest

P/>BANGKOK, Thailand - A day after national and international officials confirmed the first probable human-to-human transmission of a virulent strain of avian influenza in this country, public health systems around the globe were scrambling to prepare for a possible pandemic.<P/>Scientists say they can't predict how quickly, if at all, the strain may develop the ability to spread easily among people, or whether it will remain as lethal as it has proved so far.<P/>The strain, A(H5N1), has killed 30 of the 42 Southeast Asians it infected in the past year, and millions of chickens and wild birds, across wide areas of Asia.<P/> It also has infected pigs, household cats and even zoo tigers.<P/>A handful of cases of human-to-human transmission may have occurred during bird flu outbreaks in Hong Kong in 1997 and in Europe a year ago, but neither resulted in a pandemic.<P/>Nevertheless, public health experts say it would be irresponsible not to prepare for a worst-case scenario.<P/>The so-called Spanish Flu pandemic of 1918 to 1919 - believed, like the current strain, to have been a mutant virus that jumped from animals - killed an estimated 20 million to 100 million people.<P/>And that was before the development of the modern transportation system, with its fleets of jets linking remote..

Health officials would normally look to vaccines and antiviral drugs to control a pandemic, but in this case, those tools have yet to be fully developed and tested. Conventional flu vaccines are not believed to provide any protection against A(H5N1) avian influenza. Human trials of the new vaccine ordered by the U.S. government are not expected to begin until the end of this year, at the earliest. The United States -- like governments in Australia, Japan, New Zealand and a small number of other countries -- is also stockpiling the only antiviral medicine that may work against the strain, Tamiflu, but there have been too few human cases to document its effectiveness. The symptoms of human bird flu appear to be indistinguishable from severe cases of conventional flu, with fevers, sneezing, coughing and aches

Other drug makers have given several reasons for not making vaccines: that production is expensive and investment may not be recouped if there is no pandemic, and that intellectual property rights on new techniques used to make the vaccine remain unsettled. The standard method for making flu vaccines -- growing virus in chicken embryos -- does not work because the A(H5N1) virus is so deadly that it kills the developing chicks before they can grow enough virus to be worth harvesting. The new techniques alter the strain's genetics so it can be grown in the fertilized eggs. Tamiflu is made only by Roche Holding, a Swiss company, at a single small factory in Europe, although the company has said in recent months that it plans to build another production line in the United States. Some public health experts are strongly critical of Roche for not increasing production of Tamiflu sooner, saying the company should have expanded production early this year, when avian influenza started becoming a problem across much of Asia. ''You're dealing with very conservative Swiss bankers -- to me, they don't see the opportunity yet,'' said Arnold Monto, a University of Michigan influenza expert, pointing out that Tamiflu not used for an avian influenza pandemic could be used instead to make human influenza less severe

BANGKOK, THAILAND - A day after Thai and international officials confirmed the first probable human-to-human transmission of a virulent strain of avian influenza in this country, public health systems around the globe were scrambling to prepare for a possible pandemic. The United States, like governments in Australia, Japan, New Zealand and a small number of other countries, is also stockpiling the only antiviral medicine that may work against the strain, Tamiflu, but there have been too few human cases to document its effectiveness. The symptoms of human bird flu appear to be indistinguishable from severe cases of conventional flu, with fevers, sneezing, coughing and aches. Only Aventis Pasteur Inc. of Swiftwater, Pa., and the Chiron Corp. of Emeryville, Calif., are braving a thicket of patent issues and financial feasibility concerns to try to use advanced genetic techniques to develop vaccines against so-called bird flu. And they have proceeded only with National Institute of Health contracts to do so

On Wednesday, the World Health Organization convened a meeting in Geneva of representatives of the drug industry to demand that they speed vaccine production. In the United States, scientists with the federal Centers for Disease Control and Prevention in Atlanta are racing to complete a genetic sequence of the virus from the case. If the virus has acquired any mammalian influenza genetic material, it could make it more transmissible. The U.S. government has also ordered two million doses of experimental vaccine. The United States, like governments in Australia, Japan, New Zealand and a small number of other countries, is also stockpiling the only antiviral medicine that may work against the strain, Tamiflu, but there have been too few human cases to document its effectiveness. The symptoms of human bird flu appear to be indistinguishable from severe cases of conventional flu, with fevers, sneezing, coughing and aches. 'You're dealing with very conservative Swiss bankers to me, they don't see the opportunity yet,' said Arnold Monto, a University of Michigan influenza expert, pointing out that Tamiflu not used for an avian influenza pandemic could be used instead to make human influenza less severe

The World Health Organization said it planned to find every child younger than 5 in 23 African countries -- more than 80 million in all -- and immunize them against polio starting on Oct. 8

While no specific examples of gouging were cited at the news conference, Dr. David Lang, a pediatric infectious disease specialist at Children's Hospital of Orange County in California, said in a telephone interview that a vendor had called a pharmacist at his hospital offering to sell the flu vaccine made by Aventis for 10 times the usual amount. On Tuesday, the British government halted vaccine shipments to the United States because of concerns about contamination at a factory owned by the Chiron Corporation of Emeryville, Calif. Now health officials are trying to ration the flu shots, asking healthy people to let the vaccine go to those who need it more

To show his full recovery from the orthopedic surgery that he underwent last spring to repair tears in a biceps tendon and a muscle in his right shoulder, [John Kerry] thrust both arms straight up as if to signal a touchdown and smiled. Before the operation, pain and weakness hindered him from raising his right arm overhead or lifting an object. CT scan X-rays taken at Massachusetts General Hospital in Boston, however, show two pieces of metal shrapnel embedded in Kerry's left thigh, next to the femur, said Dr. Gerald Doyle, Kerry's personal physician in Boston. Doctors treating the wound in 1969 decided to leave the shrapnel in place

Until 1997, scientists had not believed it was even possible for an avian influenza virus to pass directly from birds to people without first combining with a mammalian influenza virus. Pigs can harbor avian and mammalian influenza viruses while showing no ill effects, and have been blamed for periodically allowing new avian influenza viruses into human populations that have little if any immunity to them. Many mammalian influenza viruses have already mastered the tricky secret of passing easily from person to person. These viruses kill 36,000 people a year in the United States. The ideal strategy for the A(H5N1) virus would be to infect a person already carrying a human influenza virus and then swap genetic material with it. Because pigs can readily carry human and avian influenza viruses, they could also be the mixing vessels for a new virus. Thai and Vietnamese officials have said they are testing pigs extensively. The virus has been detected in at least two pigs in southeastern China. Dr. Klaus Stohr, the W.H.O.'s top influenza expert, said that while recombination of the avian influenza virus would probably be a slow process, a reassortment of genes by human and avian influenza viruses could happen ''very rapidly, practically within days.''