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WHO Will Clarify Stages Of Pandemic-Alert System
posted by admin on 30/05/06

WHO to write out the phases and explain things so it's simpler for people to understand 

The World Health Organization plans to clarify its influenza-pandemic alert system after a cluster of human bird-flu cases in Indonesia, and the WHO's response to it, sent ripples through markets and media around the world last week. 

The move highlights the challenges the United Nations health agency faces in keeping the public alert to the possibility of a human pandemic without panicking, or wearying, people. 

"What we're going to fundamentally try to do is just to write out the phases and explain things so it's simpler for people to understand," Keiji Fukuda, coordinator of the WHO's global influenza program, said in an interview yesterday. "What's become clear to me over the past several weeks is that there's a lot of confusion." 

The WHO has spent more than a year working to raise global awareness about bird flu, in hopes of preventing or limiting any world-wide human outbreak, while stressing that the virus hasn't yet acquired the ability to pass easily among people. But last week, the group found itself striving to tamp down concerns and explain why the Indonesian case cluster didn't necessarily mean the virus was now capable of sparking a human pandemic. 

In that unusually large cluster, seven of eight relatives who fell ill died, and at least six of those seven fatalities were bird-flu cases. The Indonesian cluster briefly raised the possibility that the health agency might consider raising the alert level, which can trigger certain public-health responses and to which some companies have keyed employee-evacuation plans. At present, the alert level is at stage three of six, six being the full pandemic alert. 

So far, the deadly virus has passed from birds to people in a relatively small number of cases and, even more rarely, may have passed among people. In the Indonesian case cluster, the virus may for the first time have set off a three-person chain of human transmission, from a woman to her nephew and then from the nephew to his father. 
Such an event might signal an incremental advance in the virus's ability to pass from human to human. 

The WHO is still investigating the case. But last week the group decided against convening a global task force of experts to consider raising the alert level, even though the current guidelines outlining a change in the alert stages could, on their face, have fit the Indonesian cluster. 

Dr. Fukuda said he doesn't expect any fundamental or wholesale changes to the alert system, which was introduced last year, after being revised from its 1999 form. He said he expects just further explanation and clarification. 

The move to revise the system includes the distinction it makes between the virus's ability to pass between humans who have been in very close contact with one another -- caring for a dying family member, for example -- and its ability to pass easily between people who may have only sat next to one another at a restaurant and been exposed to a cough. 

Stage three indicates that there have been human infections, "but no human-to-human spread, or at most rare instances of spread to a close contact," according to the WHO's guidelines. Stage four describes a small cluster or clusters "with limited human-to-human transmission, but spread is highly localized, suggesting that the virus is not well adapted to humans." 

The difference between stages three and four hinges on how easily the virus can be passed between humans. But that has proved a subjective and difficult call to make. 

Write to Nicholas Zamiska at

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