A new and potentially deadly infectious disease emerges somewhere in the world every year, threatening "devastating consequences" across the globe, warns the Lords intergovernmental organisations committee. Its report, published today, criticises Britain's "poorly coordinated" disease control systems.

Reform of the World Health Organisation (WHO) is "essential", as the global health agency is "dysfunctional" and lacking the organisation and resources to curb a major outbreak, it says.

The committee calls for new international disease surveillance systems in developing countries. The report says peers were given the following "sobering" advice by government ministers: "While there has not been a pandemic since 1968, another one is inevitable … Estimates are that the next pandemic will kill between 2 million and 50 million people worldwide and between 50,000 and 75,000 in the UK. Socio-economic disruption will be massive."

Three-quarters of new human diseases originate from animals, but experts have warned they are currently identified only after people are infected. The committee chairman, Lord Soley, said: "The last 100 years have seen great advances in public health and disease control through the world, but globalisation and changes in lifestyles are giving rise to new infections and providing opportunities for them to spread rapidly.

"We are particularly concerned about the link with animal health."

The virus is endemic in Java, Sumatra, Bali and southern Sulawesi with sporadic outbreaks reported from other areas, the FAO said.

By June 2008, more than 2,000 surveillance and response teams will be active in more than 300 districts in areas of the country where the disease is endemic, Mr Domenech said.

But that may not be enough.

"Indonesia is facing an uphill battle against a virus that is difficult to contain. Major human and financial resources, stronger political commitment and strengthened co-ordination between the central, provincial and district authorities are required to improve surveillance and control measures," Mr Domenech said.

More than 30 countries have reported outbreaks in the past year, in most cases involving wild birds such as swans.

The virus has killed at least 201 people since 2003, according to the WHO. Countries with confirmed human deaths are: Azerbaijan, Cambodia, China, Egypt, Indonesia, Iraq, Laos, Nigeria, Thailand, Turkey and Vietnam.

In total, the virus is known to have infected 329 people since 2003, according to the WHO. Many of the dead are children and young adults.

The WHO says that Vietnam and Indonesia have the highest number of cases, accounting for 132 of the total deaths.

The H5N1 virus is not new to science and was responsible for an outbreak of highly pathogenic avian influenza in Scotland in 1959. Britain confirmed new cases in birds in Scotland in April 2006 and in eastern England in February 2007.

H5N1 is not the only bird flu virus. There are numerous strains. For example, an outbreak in 2003 of the H7N7 bird flu virus in the Netherlands led to the destruction of more than 30 million birds, around a third of the country's poultry stock. About 2.7 million were destroyed in Belgium and around 400,000 in Germany. In the Netherlands, 89 people were infected with the H7N7 virus, of whom one (a veterinarian) died.

The H5N1 virus made the first known jump into humans in Hong Kong in 1997, infecting 18 people and killing six of them. The government ordered the immediate culling of the territory's entire poultry flock, ending the outbreak.

Symptoms of bird flu in humans have ranged from typical influenza-like symptoms, such as fever, cough, sore throat and muscle aches, to eye inflammations (conjunctivitis), pneumonia, acute respiratory distress, viral pneumonia, and other severe and life-threatening complications.

A mathematical analysis has confirmed that H5N1 avian influenza spread from person to person in Indonesia in April, U.S. researchers reported on Tuesday.

They said they had developed a tool to run quick tests on disease outbreaks to see if dangerous epidemics or pandemics may be developing.

Health officials around the world agree that a pandemic of influenza is overdue, and they are most worried by the H5N1 strain of avian influenza that has been spreading through flocks from Asia to Africa. Photo

It rarely passes to humans, but since 2003 it has infected 322 people and killed 195 of them.

Most have been infected directly by birds. But a few clusters of cases have been seen and officials worry most about the possibility that the virus has acquired the ability to pass easily and directly from one person to another. That would spark a pandemic.

The cluster contained a chain of infection that involved a 10-year-old boy who probably caught the virus from his 37-year-old aunt, who had been exposed to dead poultry and chicken feces, the presumed source of infection. The boy then probably passed the virus to his father. The possibility that the boy infected his father was supported by genetic sequencing data. Other person-to-person transmissions in the cluster are backed up with statistical data. All but one of the flu victims died, and all had had sustained close contact with other ill family members prior to getting sick -- a factor considered crucial for transmission of this particular flu strain.

In an attempt to contain the spread of the virus, the local health authorities eventually placed more than 50 surviving relatives and close contacts under voluntary quarantine and all, except for pregnant women and infants, received antiviral medication as a precaution.

"The containment strategy was implemented late in the game, so it could have been just luck that the virus burned out," Longini said. "It went two generations and then just stopped, but it could have gotten out of control. The world really may have dodged a bullet with that one, and the next time we might not be so lucky," he said.

"The next pandemic will certainly happen," Margaret Chan told reporters following a forum on the need to improve international health security, noting it was impossible to guess when it might happen or how severe it might be.

Since late 2003, the H5N1 strain of bird flu has prompted the slaughter of millions of birds across Asia and caused the deaths of more than 170 people worldwide, about one-third of them in Indonesia, according to WHO.

The virus has been identified in Europe, Africa and the Middle East, in what Chan called an unprecedented spread.

"We cannot let our guard down," Chan said. "My advice for all member states is to maintain vigilance, to prepare for the pandemic. One thing we know for certain is that any country that is prepared will see less damage."

Meanwhile, in this country the new CDC guidelines that now rank pandemics in terms of categories 1 through 5, similar to hurricanes, are making the rounds in the media, and working its way through the government bureaucracy down to the states. The meat of the proposal? if there's a category 4 or 5 pandemic (H5N1 or some other), the schools in your town will close for up to three months, and large public gatherings will be canceled. That's because kids are a major vector in spreading flu and other respiratory diseases (ask any parent of a second grader or day care kid).

Did you know that? Would that affect you or your kids in any way? You bet it would. The task now is to figure out how to mitigate the consequences of such a move. For example, in addition to whether you can afford to stay home, the schools may have to turn to long distance learning. Businesses would have to telecommute where possible. And the kids, now being home and unable to go to the mall, would have to figure out how to entertain themselves.

Any chance thay'd - uh - want to use the internets? And would it be prepared for the onslaught of Kids At Home?

The world is years away from stamping out bird flu in poultry, and the threat of a human pandemic will remain until it does, the head of the World Health Organization (WHO) said on Monday.

Addressing the U.N. agency's 34-state executive board, WHO Director-General Margaret Chan said that in the past three years the H5N1 bird flu virus had proven virulent.

"As long as the virus continues to circulate in birds, the threat of a pandemic will persist. The world is years away from control in the agricultural sector," she said.

"Influenza viruses are notoriously sloppy, unstable and capricious. It is impossible to predict their behavior," she told the board, which meets twice a year.

"The message is straightforward: we must not let down our guard," she said.

The deadly H5N1 strain of avian influenza is making a seasonal resurgence in Asia and could easily spread to Europe again this year, the World Health Organisation warned on Sunday.

The alarm follows four human deaths in Indonesia in the last five days, the first human case in China for six months (though the infected man has since recovered) and new poultry outbreaks in Vietnam – despite a huge campaign against it – and northern Nigeria.

"We are convinced that we're in a repeat of last year and the year before when the virus began to get very active again [in the northern hemisphere winter] and spread from Asia into the Middle East and beyond," said Peter Cordingley, the WHO spokesman for the western Pacific region.

Indonesia, where 61 people have died since 2005, remained the "biggest flashpoint" but nowhere in the region "has got it licked". "Most countries are becoming better prepared and the countries that were caught out last year, especially wealthier ones in Europe and close to Europe, we hope are going to be better prepared," he said. "But we're still losing more than we're winning."

Half of the cases occurred in people under the age of 20 years; 90% of cases occurred in people under the age of 40 years.

The overall case-fatality rate was 56%. Case fatality was high in all age groups but was highest in persons aged 10 to 39 years.

The case-fatality profile by age group differs from that seen in seasonal influenza, where mortality is highest in the elderly.

The overall case-fatality rate was highest in 2004 (73%), followed by 63% to date in 2006, and 43% in 2005.

Assessment of mortality rates and the time intervals between symptom onset and hospitalization and between symptom onset and death suggests that the illness pattern has not changed substantially during the three years.

Deaths from the disease surged in the winter for the last three years, the report released Friday said, so a rise in fatal cases can be expected late this year even if the virus does not mutate into a form more easily transmitted.

Moreover, the report warned, the risk of the virus becoming more transmissible remains high "because of the widespread distribution of the H5N1 virus in poultry and the continued exposure of humans."

Doctors were completely unable to stop or slow its spread; the killer flu eventually traveled to the general population and worked its way from East to West across the United States. The influenza spread so fast that hospitals and morgues were quickly overrun. People were often forced to live with the dead bodies of family members because there were so many dead and dying that the health system and city morgues were completely overwhelmed. Many health workers were also sick and dying themselves. Coffins quickly became unavailable and bodies were stacked up on porches and next to houses. Symptoms of the disease were terrifying and violent: incredible pain, blood pouring from noses and eyes, intense fever, headache, weakness, body aches and delirium. People often died after gasping for breath for hours trying to clear a red, frothy liquid from their lungs. Mayors in cities lied to their citizens and said the plague would not come. But it came and even during the epidemic many newspapers reported that there was no cause for alarm or told people the virus had peaked when it had not. In 1918, influenza was a killing machine that raged from coast to coast, killing over 600,000 Americans. In October, 1918 influenza killed 195,000 Americans in a single month.

About 13 000 people were quarantined in the Romanian capital on Monday as troops and police sealed off streets in response to the city's second bird-flu outbreak, said officials.

The mayor of the southern fourth district, Adrian Inimaroiu, said residents would be cut off and all businesses in the area would be closed during the quarantine period of up to three weeks.

The move came after the agriculture ministry earlier on Monday confirmed the presence of the H5 bird-flu virus in dead chickens found in the neighbourhood, the latest of dozens of outbreaks of avian flu in Romania this spring.

Inimaroiu said, urging residents to stay calm, that "about 40 streets have been blocked" in the Luica quarter.

All seven people infected with bird flu in a cluster of Indonesian cases can be linked to other patients, according to disease trackers investigating possible human-to-human transmission of the H5N1 virus.

A team of international experts has been unable to find animals that might have infected the people, the World Health Organization said in a statement today. In one case, a 10-year- old boy who caught the virus from his aunt may have passed it to his father, the first time officials have seen evidence of a three-person chain of infection, an agency spokeswoman said. Six of the seven people have died.

Almost all of the 218 cases of H5N1 infections confirmed by the WHO since late 2003 can be traced to direct contact with sick or dead birds. Strong evidence of human-to-human transmission may prompt the global health agency to convene a panel of experts and consider raising the pandemic alert level, said Maria Cheng, an agency spokeswoman.

"Considering the evidence and the size of the cluster, it's a possibility," Cheng said in a telephone interview. "It depends on what we're dealing with in Indonesia. It's an evolving situation."

"There's no supporting evidence to suggest that this is a continuing environmental source that we've uncovered yet in the investigation," said WHO spokesperson Dick Thompson.

"The investigation is still ongoing. We wouldn't discount the possibility that it is human-to-human transmission."

Limited spread of the virus among people is believed to have happened on several previous occasions. But in each of these suspected cases, transmission of the virus petered out. Sustained human-to-human spread of the virus would be needed to trigger a pandemic.

Meanwhile, an Indonesian official revealed that the man who died Monday refused treatment and fled from authorities after falling ill - behaviour that highlights the difficulties of disease containment in settings where an unfamiliar disease is extracting a high death toll.

In North America we have an expression: "Give it the old college try."

In other words, when the other team is leading and the game is almost lost, don't give up. Make one more attempt to score a goal and win the game.

Since last summer, health authorities have considered the chance of smothering a pandemic outbreak in its cradle: Identify a real human-to-human spread. Send in an army of medical experts. Give Tamiflu or some other antiviral to every human being you meet in the neighbourhood. Kill every duck and chicken. Then hope you stamped it out.

Given the ominous outbreaks in Tanah Karo and Surabaya, I can well imagine that the Americans would ship Tamiflu to Indonesia. It would probably do more good there than in Los Angeles or Miami.

The UK's chief veterinary officer, Debbie Reynolds, said bird flu could stay in Britain for some time.

"We simply don't know, but of course that's why we've got our programme of wild bird surveillance.

"It's been very extensive; over 3,000 wild birds tested already this year, and over 400 swans.

"There are more under way, being tested at the moment, and any wild swan that's reported found dead should be collected and tested," Dr Reynolds said.

"So the arrival of one bird in Scotland does not really add to the risk of this virus emerging as a human strain.

"I will be eating chicken tonight but it will be well-cooked chicken. The evidence from the Food Standards Agency is that in properly cooked meat the virus is killed."

Following the detection of bird flu, the Afghan government has put an immediate ban on poultry imports from neighbouring Pakistan.

Nine hundred chicken farms have been closed in Jalalabad and the government and the UN plan to begin culling birds in the affected areas.

The BBC's Bilal Sarwary in Kabul reports that chicken has started disappearing from markets in Jalalabad and Kunar but are available elsewhere in Mazar-e-Sharif and Herat.

UN and Afghan government officials say a public awareness campaign about the virus is going to be launched.