No human cases of influenza A H5N1, or "bird flu," have been reported in the United States, but experts warn that despite the millions of dollars invested in preparedness, we are unprepared for what many say is an inevitability.

Worldwide, 258 people had been infected with H5N1 as of November 13, 2006, according to the World Health Organization, and 153 (59%) had died. Late in 2006, a virulent new strain of H5N1 began infecting poultry and people in rural southern China, renewing fears that the virus could mutate and pass easily among people. The Infectious Diseases Society of America recommends that enough antivirals to treat at least half of the U.S. population be stockpiled, that all health care workers who have contact with patients be given mandatory annual flu vaccines, and that health care workers and facilities be protected from liability claims during outbreaks. The U.S. Department of Health and Human Services is stockpiling a first-generation, "prepandemic" H5N1 vaccine-that is, one that is effective against the current strain but not necessarily against a new variant-and has committed more than $1 billion during 2005 and 2006 to improving vaccine production.

Carol Potera