Bird flu in Thailand: "no" means "yes"

The return of H5N1 to Thailand we were pretty sure was underway has now been confirmed. Our real question is whether it is new or just poking its head above water after having been there all along without being "detected." We put that in scare quotes because we suspect the surveillance system in Thailand isn't very sensitive, so its alleged absence over the last year is suspect.

Poultry deaths have been reported to outsiders for about a month, but the authorities have been denying H5N1 was involved. Thailand is blaming imports from neighboring countries and has instituted an import ban. Authorities are still saying there are no human cases but this is unlikely. Suspect cases are being reported, including two people in Uttaradit province who dined on spotted doves and three cases in Phichit province, the site of the acknowledged poultry outbreak. If these cases are indeed bird flu, which they have a high probability of being, they are older than most other reported cases. The Uttaradit cases are 67 and 35 year old males while the Phichit cases are 59 and 86 year old males, with the third case being a boy of 7. This is the reverse of the age distribution seen so far, which does make one pause about the diagnosis. The Phichit cases were said to have had contact with dead chickens and are being treated as bird flu cases in a hosptial isolation ward while the diagnosis is confirmed or disconfirmed. CIDRAP cites press reports that three young girls (ages 3, 4 and 11) were hospitalized with suspected bird flu.

CIDRAP also reports that 15 other patients were removed from a suspect watch list because tests "came back negative."

Meanwhile, Thailand's public health establishment breathed a collective sigh of relief Monday as laboratory tests confirmed that no new cases of H5N1 bird flu virus has been transmitted to humans in recent months. (XinhuaNet)

What we know so far is that the poultry deaths previously denied to be avian flu now are being acknowledged as being caused by the virus and suspect human cases are appearing. Thus a familiar pattern is repeating itself:

"Medical doctors believe the H5N1 virus has already arrived in Thailand, but no one wants to confirm it," said the source, who asked not to be named.

On Friday (July 21) a leading virologist from Siriraj Hospital, Professor Prasert Thongcharoen, expressed doubt about the accuracy of official reports on bird flu. He said that in his experience when livestock officials said "no" it meant "yes". (The Nation [Thailand])

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It is both sad and ironic that during the time that Thailand was engaged in actively covering up new H5N1 outbreaks in the country, the country was hosting a US / WHO coordinated _First International Rapid Response Training for Avian and Pandemic Influenza_ that reportedly included more than 100 participants from 14 countries

http://bangkok.usembassy.gov/news/press/2006/nrot031.htm

Local host for the conference was the U.S. CDC International Emerging Infections Program laboratory in Thailand whose explicit mission is to combat and detect emerging infectious diseases, especially viruses, and performs research research on the H5N1 virus.

http://www.cdc.gov/ncidod/global/ieip/thai-index.htm

http://www.cdc.gov/mmwr/preview/mmwrhtml/su5501a2.htm?s_cid=su5501a2_e

I suppose it is too much to hope that this instructive episode would be included in the LESSONS LEARNED write-up for this _Rapid Response_ training program ....

Surely they ate the spotted doves cooked. Why wouldn't the cooking have killed the virus?

By Joe in Australia (not verified) on 25 Jul 2006 #permalink

Joe: we don't know the details. There seem to be three possibilities. The doves were not cooked or insufficiently cooked (raw blood is used in some dishes in southeast asia, although it is duck blood I have heard about; I don't know enough about how doves are eaten); infection occurred during preparation or slaughter; they got it from something else.