Thailand is bubbling

Thailand seems to have gone from "no bird flu in the country" two weeks ago to having the whole nation on alert.

As the number of suspected bird-flu cases increases nationwide, Thailand Agriculture Minister Sudarat Keyuraphan declared Monday (July 31) all 76 provinces of the country animal epidemic control areas, with stricter rules on the transport of poultry and handling of dead birds.

The move follows the mass culling of 300,000 chickens at 78 farms in Nakhon Phanom province on the weekend. (The Nation [Thailand])

Even more interesting is that they are following a godawful number of people for possible bird flu. The number seems to fluctuate up and down from 45 to 113 and in between. The government is saying many or all aren't bird flu but "ordinary" human influenza. This suggests they have detected influenza A infection (probably by one of the non-specific quick tests for viral antigen) and are saying (or hoping) it isn't the H5N1 subtype of influenza A. After the first confirmed human case in 9 months last week one might expect the index of suspicion to be ramped up considerably and many cases of pneumonia and respiratory disease with fever are now being placed in the "rule out bird flu" category to make sure, accounting for the sudden appearance of these cases.

But there are other things that give one pause.

The Public Health Ministry is closely monitoring 765 people who took part in the slaughtering, fearing they might have been exposed to the potentially deadly bird-flu virus.
Caretaker Public Health Minister Pinij Charusombat said all 633 people involved in the culling, plus 111 farm workers, 18 people in the families that operated the farms and three other villagers were put on the provincial bird-flu watch list.

The minister was speaking during a trip to Na Klang district in the north-eastern province where the H5N1 virus was detected.

All 765 people on the list would be monitored for 14 days.

So far, six people had developed a high fever, Pinij said. Two of them had influenza symptoms and had received oseltamivir, the only anti-viral drug that can be used to treat people infected with H5N1. The other four had tested negative for the influenza virus.

Hmmmm. Of the six with "high" fever, two have "influenza symptoms" and are being treated with oseltamivir. The other four are said not to have influenza, on what basis we don't know. Meanwhile we'll await news.

Just over the border, in Laos, there is a new confirmed outbreak in poultry. The Laotians don't have the awareness or infrastructure of the Thais, so all bets on whether there are also human cases there are off.

Looks like we can add southeast asia again to Indonesia and China for bubbling cauldron status.

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I am not generally very complimentary about states openness about what is going on within their boarders and Thailands track record does not merit much praise. That said I am provisionally - pleasantly surprised by what is going on at the moment. When news began to leak they did try to play it down but once the cat was out the bag and their bird flu free status was blown they suddenly started posting enormous, and very scary, numbers of suspected case. Most of these have now been changed to negatives. This change of approach where large numbers of flu & pneumonia case are put in the suspect column until proved otherwise is commendable and in stark contrast to the normal MO of blaming illness on every thing and anything else until WHO reference lab confirmation of post mortem samples leaves no other option. Let us hope this methodology continues and spreads and that they do not back down under the backlash form the tourism & poultry industry. Personally I would be much happier taking a holiday in a country with that policy (large numbers of suspected being tested) than in Indonesia where there are so few suspected case and yet strangely the chicken coops are empty in many areas after wide spread deaths of unknown cause.