A strain of bird flu known as H5N1 has been spreading across Asia and recently was detected in Russia and Indonesia. So far, the strain has shown only a limited ability to spread from person to person, but more than 50 people have died from it and disease experts worry the virus could adapt to humans and cause a worldwide pandemic that in a worst-case scenario could kill millions.

"Avian influenza has become endemic in Indonesia and it is continuing to spread," said Joseph Domenech, chief veterinary officer of the U.N. Food and Agriculture Organization.

"In view of the worrying situation, it is necessary for the government to improve its virus control policies and strategies," Domenech said.

Four people have died from the disease since July, and officials have tested three children who died this week to determine if they were infected. Authorities suspect more people who have fallen ill also might be infected.

The Indonesian government recently announced plans to kill chicken flocks in infected areas and to hospitalize people suspected of being infected in an effort to limit the spread of the disease.

The FAO said controlling the disease should become a national priority, and efforts should entail vaccination and culling of poultry flocks and launching public-awareness campaigns so farmers know how to keep the disease in check.

"More financial resources should be made available for the control of bird flu in animals to prevent a human pandemic," the FAO said in a statement. The statement added that the FAO is helping Indonesian officials develop a national avian influenza control project that will cost approximately $11 million.

Although vaccines and anti-viral medications can help prevent and fight flu infection, two studies published in The Lancet on Thursday suggest such treatments might be less effective than previously thought.

A study spearheaded by officials at the Centers for Disease Control and Prevention in Atlanta found worldwide resistance to two drugs used to treat influenza - amantadine and rimantadine - has increased 12 percent over the last 10 years.

Most countries, including the United States, are focusing on stockpiling two different drugs - Roche's Tamiflu and GlaxoSmithKline's Relenza - to help ward off a bird-flu pandemic.

In the study, most of the virus samples collected since 2003 and deemed to be resistant to the drugs came from people in Asia. In some Asian nations the frequency of drug-resistant virus samples was higher than 70 percent.

"We were alarmed to find such a dramatic increase in drug resistance in circulating human influenza viruses in recent years," Rick Bright of the CDC said in a statement.

"Our report has broad implications for agencies and governments planning to stockpile these drugs for epidemic and pandemic strains of influenza," Bright said, adding the drugs "will probably no longer be effective for treatment or prophylaxis in the event of a pandemic outbreak of influenza."

In a second study, Tom Jefferson of the Cochrane Vaccine Field in Rome and colleagues combined data from many previous studies of the effectiveness of flu vaccines in people 65 or older.

Seniors living in long-term-care facilities got the most protection from the vaccines, but those living in the community only showed a modest benefit.

Vaccination prevented 42 percent of deaths due to flu and pneumonia among the elderly living in long-term-care facilities. In those in the community, vaccination was not effective at preventing influenza infection or pneumonia, but it did prevent up to 30 percent of hospitalizations for pneumonia.

"We need a more comprehensive and perhaps more effective strategy in controlling acute respiratory infections," Jefferson said in a statement. This should involve "several preventive interventions that take into account the multi-agent nature of infectious respiratory disease and its context, such as personal hygiene, provision of electricity and adequate food, water and sanitation," he added.

Sanofi-Pasteur is developing a vaccine to specifically protect against bird flu, and the United States recently made plans to stockpile the medication, but it is still in the testing stage.

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