Whatever is going on in Thailand, everybody seems uncomfortable with it. After being praised by WHO for its bird flu measures because the country had not reported cases since last December, the virus has come roaring back, as if to remind us it isn't going to be so easy. Which most of knew, of course. Now WHO is telling Thailand to reassess the bird flu program it had formerly lauded:
The World Health Organisation (WHO) on August 9 warned the government to urgently review measures taken to control the H5N1 bird flu virus, both in poultry and humans, to tackle the spread of the disease in the country. Somchai Peerapakorn, the WHO Thailand office medical officer, said with the current outbreak still at an alarming scale, it was necessary for the authorities to rethink measures taken over the past three years to stop the virus spreading to people.
''The government should seek out more effective measures to control the outbreak since people are at risk of contracting the virus,'' he said. (Advisen Front Page News)
One issue in Thailand is the use of illegal vaccines smuggled in from China and India. Thailand relies on culling, not vaccination, so it is true the vaccines are illegal there. But neighboring Vietnam relies on vaccines, so it isn't clear to us why this is a problem for WHO in Thailand and not in Vietnam or elsewhere. The vaccine issue concerns whether vaccination prevents or is merely masking infection, allowing birds to be infected and shed virus but not appear sick. Since the index of suspicion for human cases frequently rests on finding severe pneumonia -- not uncommon from other agents besides avian influenza -- in close relationship with sick or dead poultry, vaccination might also be failing to signal human infections. This issue has also been raised in Vietnam, where we have suggested H5N1 cases could be hiding in an outbreak of dengue fever, which presents with similar symptoms.
Meanwhile, in Thailand there are confirmed human cases along with a nationwide poultry outbreak. Many suspect human cases are under observation, including four in Bangkok.
Deputy city clerk Pitinan Natrujirote said the 47-year-old man was admitted to Lat Phrao hospital in Wang Thonglang district after he developed flu-like symptoms.
He was said to have bought chicken slices from a fresh market near his home last Thursday.
Paijit Warachit, Department of Medical Sciences director-general, said two suspected H5N1 cases - a six-year-old girl and a four-year-old boy at Pranangklao Hospital - had only tested positive for the H1 flu strain and had recovered quickly. (Advisen Front Page News)
Is this recognition that eating or preparing infected poultry is a risk factor? It sounds like it to us. It also raises the old questions about the consequences of reassortment of H5N1 with human adapted viruses. This report and others imply there is an H1N1 outbreak in southeast asia. We know nothing about the consequences of co-infecting a cell with H5N1 and H1N1, either for reassortment (the recent paper from CDC reassorted with H3N2) or recombination (a nod to the Nimanite caucus; we remain neutral on this).
Always more questions than answers.
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So basically. The WHO has no idea what they're doing, and we should not believe the corrupt governments of third-world countries?
Nothing new here. Move along...
Am I the only one feeling the H5N1 situation is moving rapidly out of human control?
Niman said today,(I being a member of the Niman caucas, even though I too am neutral on Recombination):
"There are already at least 4 versions (of H5N1) that have caused human fatalities and are currently circulating. (Clade 1 in Southeast Asia, Fujian in China and southeast Asia, Indonesian in Indonesia, and Quinghai worldwide.)"
There is a 5% mortality rate, 300 people; among the 6000 pneumonia patients in Thailand. This is an extremely high mortallity rate; and it is very possible a large number of the 6000 patients had bird flu.
With 4 versions of H5N1, you would probably need 4 different vaccines; one vaccine for each version. How can 4 different versions be produced? And what happens, with the wide dispersion of H5N1 over an increasingly large geographical regions; if many more versions of the virus evolve? There are not enough facilities to produce even one version of a vaccine now; and a vaccine would require extensive testing over a period of several years. If this sounds like an out of control situation to you, if H5N1 goes H2H, you may very well be correct.
There are about 46 people in Thailand, with bird flu symptoms, that are under observation. Quarantine rooms are being installed in hospitals. Almost every day there are reports of people dying of bird flu in China, Thailand, and Indonesia. Does this indicate to you the situation is under control?
There is now a mild version of bird flu in the US. What happens if it, through reassortment, merges with H5N1?
In the Netherlands, in 2003, H7N7 killed a veterinarian and infected 83 poultry workers, and 8 members of their families. H7N7 caused serious eye infections in humans.
If H7N7 merged with H5N1, it might cause blindness, among other things.
H9N7 was co-circulating with H5N1 in West Java. Also there are at least 2 other stains of bird flu that have caused illness in humans. In 1999 two children became infected with H9N2, and became mildly ill. And H7N7 spread rapidly in the Netherlands, probably through casual contact,
to infect humans.
It appears there is just too much about H5N1 that virologists do not understand; and the fact so many people are infected, or have died recently, from H5N1 infections, with there probably being many that are not officially recognized; is not a positive development.
The H5N1 situation in poultry has effectively been out of control in SE Asia, China and Indonesia for several years now. The H5N1 virus has become endemic in domestic duck populations in many areas of the region, and firmly entrenched in the commercial poultry rearing and egg-production industries.
Vaccination appears to have encouraged the spread of the H5N1 virus because vaccinated poultry can apparently become infected and shed virus without presenting any disease symptoms.
It is particularly sad and ironic that during the time that the agriculture department in Thailand was most recently engaged in covering up new H5N1 outbreaks in poultry, Thailand and WHO and CDC were hosting the "First International Rapid Response Training for Avian and Pandemic Influenza", an event that reportedly had more than 100 attendees from 14 countries (see press release at http://bangkok.usembassy.gov/news/press/2006/nrot031.htm)
Apropos the various sorts of H5N1 and how little we know about any of them, what did you make of the report of avian flu in mute swans in Michigan? I saw one report and nothing since.
Aunt Deb: Reported to be low path, which is the type of H5N1 seen before in North America (1975, 1986, 2005). Supposedly sequenced in the Ames lab but I think they are doing the i.v. pathogenicity test for confirmation.
william and Zo Kun. Your posts are well written by persons who are obviously very knowledgable. Thanks!!
About that Michigan H5: is it H5N1? Or is the neuraminidase variant different? I seem to recall reading something recently about the Canadian low path avian flus being H5N2.
Charles: We'll have to await the results from Ames. There was some talk that there was H5 and there was N1 but the question was if they were in the same virus, i.e., it could be H5N2 and HxN1 coinfection. We'll just have to see.
Charles. After suggesting it would not happen, the regulators appeared quite surprised by their H5N1 findings last summer. It should be remembered that these strains are low path.
The H5N1 in Michigan is not a suprise. In August, 2005 H5N1, H5N2, H5N3, and H5N9 were identified in young healthy mallards in southern Canada, which were banded and released.
The only real question is why it took the US a year to discover these infections.
http://www.recombinomics.com/News/08140604/H5N1_Michigan_Sequence.html
Today Thailand acknowledged a "new" H5N1 strain. This is almost certainly the Fujian strain first identified ina duck in Fujian province in 2005. It is in all public H5N1 human sequences from China in 2005 and 2006. Early this year it was in Laos and Malaysia, based on sequences released at Los Alamos in February.
Recently, Hong Kong released the sequences in wild birds in Hong Kong, also detected much earlier this year. All isolates from Homg Kong were also the Fujian strain
http://www.recombinomics.com/News/08100602/H5N1_Fujian_HK.html
These polymorphsims are now showing up in Indonesia along with Qingahi sequences.
H5N1 continues to recombine and place various H5N1 sequences on various genetic backgrounds (Indonesian isolates have polymorphisms from Qinghai, Fujian, Vietnam Clade 1 and Thailand Clade 1).
H5N1 evolution via recombination continues.
H5N1 does not read press releases.