The latest deaths last week from bird flu in Indonesia have spread alarm across the globe that the world is on the brink of a pandemic.

Reports of the latest deaths have come along with suspicion that inadequate health practices and resources in the area are contributing factors.

Thirty seven people have now died from the virus in Indonesia and 7 of those, living in a village in North Sumatra, were in one family and represents the largest cluster of deaths from the H5N1 strain of avian flu to date.

One survivor of that cluster remains in hospital but has apparently refused all treatment.

Many in the village maintain the belief that the disease is the result of some sort of curse which in their minds explains why no one else in the village has become infected.

Such ill-formed views only serve to hinder any attempts to deal with the outbreak.

The World Health Organisation (WHO) has yet to identify how the first family member was infected as none of the animals in the vicinity of the village has tested positive for H5N1 antibodies.

However in other clusters of the disease only blood relatives have been affected which may indicate some form of genetic susceptibility.

Concern that the spread of the H5N1 virus among the family members was an indication that the virus had mutated was subsequently ruled out after tests showed that there had been no significant genetic changes and that the virus had not become more dangerous to humans.

Cambodia too is struggling to cope with bird flu because of limited resources which has meant some areas have missed out on receiving essential information and methods of disease prevention.

Experts in the area say there is clearly a lack of awareness in the community about bird flu.

The WHO has issued a step-by-step plan for containing a bird flu outbreak, including the rapid mass use of the antiviral Tamiflu if the virus starts to spread rapidly among humans.

The “rapid response and containment strategy” will apparently only work if people in the risk area receive massive doses of the drug within three weeks of a confirmed outbreak.

This means a country must notify WHO of a cluster of suspicious cases suggesting sustained human-to-human spread of the virus within 24 hours of detection.

A WHO-approved laboratory then has another 24 hours to confirm that the H5N1 bird flu virus has changed, either through mutation or through re-assortment with human influenza.

The strategy relies heavily on WHO’s global stockpile of three million treatment courses of Tamiflu, donated by Swiss drug maker Roche.

Although bird flu remains essentially an animal disease, it has to date killed 127 people in 10 countries since 2003.

The WHO at present considers Tamiflu to be the frontline drug against the H5N1 bird flu strain, but says more clinical studies are needed.