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.

He said the quarantine would last for "a period of a week to 21 days and all the institutions in this quarter will be closed".

"About 2 500 birds from this area will be slaughtered as rapidly as possible," said the mayor.

A neighbourhood on the northern outskirts of the capital was put under quarantine on Sunday evening with fences blocking a dozen streets and police preventing anyone from going in or out, except for medical emergencies.

"This is the first time that we've been completely stumped about possible single-source infection," Peter Cordingley, spokesman for the West Pacific region of the World Health Organization, said Wednesday.

Six of the seven people in an extended family in northern Sumatra who caught the disease have died, the most recent on Monday.

Cordingley described the cases as the most important development in the virus since it began ravaging Asian poultry in late 2003.

The large cluster of human cases of H5N1 avian flu being investigated in Indonesia may represent the first time the virus has been seen to ignite two successive waves of human-to-human spread, the WHO said.

The agency has not yet started the process of reviewing whether the global pandemic alert level should be raised to Phase 4 from the current Phase 3, a spokesperson said Tuesday.

According to the WHO's six-level pandemic staging plan, Phase 3 is no human-to-human spread, or only on rare occasions after close contact with a sick individual. Phase 4 is a small cluster or clusters of limited and localized human-to-human spread, a pattern suggesting the virus had not yet become fully efficient at infecting people. Phase 6 is a pandemic.

WASHINGTON (Reuters) - Dr. D.A. Henderson, who helped wipe out smallpox around the world, has a little piece of advice for governments fighting bird flu -- don't use the military or police to enforce public health.

Henderson, who likes to describe how he was vaccinated thousands of times against smallpox to demonstrate the immunization's safety to wary villagers, says it is much easier to halt epidemics by winning the trust of community leaders and making use of gossipy schoolchildren.

He is critical of parts of the U.S. national pandemic plan that call for the use of quarantine and other imposed types of enforcement should influenza or any other infectious disease bring on a pandemic.

"Never use the police or the military," Henderson told a meeting organized by the University of Pittsburgh Medical Center's Center for Biosecurity, where he works.

"Once we brought military or police in, we found many citizens retired to the woods," Henderson told the meeting on Tuesday.

And when the health teams tried to quarantine families, they found a similar response. "People hid," he said. "They didn't want to be quarantined so they hid cases."

As H5N1 avian influenza spreads in birds across Asia, Europe and into Africa, global health officials are trying to switch into high gear to control it. But they are running into problems with local residents in many places, including most recently the village of Kubu Simbelang on the Indonesian island of Sumatra, where six people died from H5N1 infection.

"They are not angry, just unfriendly. They are unfriendly to the people from the central government, the provincial government," said Sidharta Pinem, head of animal husbandry in the region.

WINNING TRUST

Henderson said the drive to eradicate smallpox, which was eliminated in 1979, relied heavily on winning the trust of just such people.

"What was the most effective was the support from religious leaders and village leaders," he said.

For instance, they found they could train villagers to administer the vaccine, which is given using a fork-like needle that scratches the vaccine fluid into the skin.

"How responsive and enthusiastic and reliable these people were," Henderson said. "The only thing we could pay these people with was a thank you."

And an unexpected resource came from the youngest citizens.

"For detection of cases we relied on schoolchildren," Henderson said. "What is remarkable is how much 9- to 12-year-olds know about what is going on in their communities, and how willing they are to tell you."

Last week, a meeting in London of CFS specialists heard from Jonathan Kerr of St George's, University of London. Kerr and his team used two techniques to look at differences in the expression of 47,000 genes and their variants in people with CFS and a group of unaffected people.

They used a DNA microarray chip to examine gene expression in 27 people with CFS and 54 controls. They also used "massive parallel signature sequencing" to assess gene activity in 20 people with CFS and 20 without by measuring the amount of mRNA each gene produces. The team ended up with about 100 genes where differences in expression between CFS patients and controls were most striking. Last year a pilot study identified 35 faulty genes (New Scientist, 21 July 2005, p 9).

"Most of the abnormally expressed genes are involved in the immune system," says Kerr, although he points out that the exact pattern of gene expression varies between sufferers.

Both over and underactive immune expression have been blamed for the symptoms of CFS in the past, but the lack of a single marker has hampered diagnosis. Kerr's work, though preliminary, could herald two breakthroughs: a treatment for the illness based on immune therapy, and a diagnostic test based on a broad spectrum of proteins.

Kerr is in the process of setting up clinical trials using beta interferon, a treatment for multiple sclerosis. It boosts the immune system by enhancing the activity of natural killer cells, which fight viruses. Since viruses are believed to play a role in triggering CFS in many people, beta interferon might clear the infection and help them to shake off CFS.

A test for a disease as misunderstood as CFS would also be invaluable. Kerr's team has developed one that uses mass spectrometry to find proteins that are present in people with CFS but not healthy controls. A pilot study, currently being repeated, shows clear differences between the two groups.

Meanwhile, Raymond Perrin, an osteopath from Manchester, who also attended the meeting, says he has identified other physical manifestations of the disease. Perrin thinks overloading of the lymph ducts can be a factor leading to CFS in some people. Postural problems, damage to the brain from a bang to the head, for example, or chemical or emotional trauma, can place extra stress on the sympathetic nervous system, he says. This can cause the lymph ducts to become overloaded or engorged, contributing to the fatigue and pain suffered by CFS patients. In more than 1000 cases of CFS he has seen, all patients appeared to have problems with their lymphatic glands. "You can't always see the swollen lymph vessels, but you can feel them under the surface of the skin," he says.

Perrin uses soft tissue massage to treat CFS, which encourages lymph to drain back into the bloodstream, and has submitted the results of clinical trials demonstrating the success of the technique to the journal Clinical Rehabilitation. "Every little helps," says Kerr. "There is a rationale for why it works. It's non-specific, but manual lymphatic drainage is a good thing."

Other "complementary" techniques may also be helpful, says Basant Puri, a CFS specialist at Hammersmith Hospital, London. In some sufferers, a deficiency of fatty acids such as omega-3 and omega-6 has been implicated in the disease. A poor diet can lead to deficiencies, but crucially, so can viral infection, which can also depress the immune system. Puri says many patients respond well to a combination of the fatty acids EPA and evening primrose oil. "Fatty acid supplements should be available on the National Health Service," he says.

Yet one of the biggest challenges facing those involved in CFS research is that the underlying causes may vary from person to person and one solution is unlikely to fit them all.

What is needed is more funding for further research into the condition, says Ian Gibson MP, who chairs the UK parliamentary group for scientific research into CFS/ME. The group is encouraging people who have had CFS to write in with their stories. "We hope to form a true picture of ME sufferers' hopes and concerns over the current work being undertaken in the treatment and research of ME," says Gibson.

From issue 2552 of New Scientist magazine, 20 May 2006, page 10