Friday, November 18, 2005

China's Avian Flu Outbreak

OSM carries a report from AP Worldstream delivered by Newstex, entitled "WHO says it sees no sign of human-to-human transmission in China bird flu cases". Key grafs:
"[Henk] Bekedam [the chief WHO representative in Beijing] said there was no sign in China that bird flu was being passed from person to person.

"There is not any evidence for human transmission so far," he said. "If there would be something like that, we would expect more people would be unexpectedly dying of very severe pneumonia."

Asked whether there was any sign that China was at risk for a pandemic, Bekedam said, "If there's evidence of human-to-human transmission, there will be small clusters. We are not at that stage."

While China is "extremely committed" in its fight against bird flu, he said it was necessary to be vigilant.

"We need to closely monitor the virus," Bekedam said. "The key is that at a certain moment, there will be changes, that we will be able to detect it early."

That means strong surveillance systems and quick responses, he said.

"That's also a challenge not only for China, but a challenge for the whole world," he said.'
Sounds good, but a look at the related WHO report, linked by Recombinomics had a slightly less definitive assertion:
An additional two possible human cases have been investigated in Hunan Province. The first is the boy’s 12-year-old sister. She was hospitalized on 16 October and died the following day of severe bilateral pneumonia and acute respiratory distress syndrome. Samples from the girl are inadequate for testing, and the cause of her death will probably never be known with certainty. Although evidence pointing to H5N1 infection is considered substantial by Chinese experts, WHO reports only laboratory-confirmed cases.

The additional case under investigation in Hunan is a 36-year-old schoolteacher. He was hospitalized with pneumonia on 24 October. Definitive test results are pending. A WHO team with expertise in virology and laboratory diagnosis has collaborated with national experts in the investigation of the cases in Hunan.
Signs versus evidence; substantial versus laboratory-confirmed. Recombinomics (link above) notes:
"Media reports indicate that family's chickens began to die on 6 October and the sister developed symptoms a few days later. Thus, the brother did not develop symptoms until 5-10 days after his sister. This gap in disease onset dates is a common feature of human-to-human transmission, and supports boxun reports that indicate human-to-human transmission is widespread in China. Moreover, the cases cited by boxun are in the same provinces that have been reported to have H5N1 outbreaks in birds."
There is also a concern that H5N1 has spread to pigs, though reports to that effect seem conflicting and as a result, hazy.

The bottom line is, for the past couple of years WHO's investigation and reporting, first with Sars and then with early Avian flu cases, was taken with a few gains of salt for several well founded reasons. Is it now time to swallow it whole?

Keeping a close eye on this story will be important for next couple of months and we may find out sooner rather than later if there is human to human transmission.

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