Another bird flu death has occurred in the same village where two other cases were recently reported. This one is a nine year old girl. The others were the 17 year old we discussed in a recent post, who left the hospital against medical advice and is reported to be recovering at home, and his deceased 20 year old cousin. Cikelet village is in West Java, 990 km from the city of Bandung. Authorities say the village is rife with bird flu, with dead or sick chickens common (Reuters).
Health authorities say they are on top of this outbreak, have taken blood samples from neighbors and relatives and are treating contacts with Tamiflu. We take these assurances with a grain of salt. We doubt the ability of the Indonesian central government to impose any conditions or carry out any systematic measures. And the village is probably one of many similarly afflicted villages in this two hundred some odd million person archipelago of 17,000 islands. It's just one they know about.
As usual, the source of the human infection is said to be sick poultry. Given the known susceptibility of poultry to this virus and close contact between humans and poultry in Indonesia and other areas where human cases have appeared, this remains a highly plausible proposition. But it remains only a reasonable assumption, and even if true, sidesteps another important issue: what is the full range of animal reservoirs of this virus?
West Nile Virus appears most dramatically in corvid species (crows and ravens) because these large black animals are highly susceptible and their corpses are easily detected. But the West Nile Virus infects hundreds of species of birds, some of them very commonly found near human settlements, like robins and house sparrows. Which one is the most important reservoir for the virus for public health purposes depends on other factors related to exposure, such as whether there is a suitable mosquito bridge vector species, i.e., mosquitoes that bite both the infected bird reservoir and humans. Crows are not the most important reservoir for the virus, but they are good signals of its presence. The situation for poultry and H5N1 is probably different, in that poultry is very likely also an important source of infection because of the close contact with humans. But is there another one (or more)?
Of course H5N1 could be infecting many other animal species (cats, rats, etc.) but they still might not be important sources of human infection if the virus is not easily transmitted from them to humans. But some of them might be important, depending on the various modes and pathways of infection. Moreover, a virus which currently is not easily transmitted from some non-poultry source could become so as it adapts to its new biological and ecological environment. More information on viral survival in the environment, transmissibility by other routes than inhalation, and a broader consideration of affected species is urgently needed. Efforts might usefully be concentrated on animal species commensal with humans, such as companion animals and domesticated livestock and small rodents that live in human settlements.
Influenza has always been considered an avian virus, but we know it has a larger repertoire. It is time to speak openly and urgently about this and turn more hands to the effort.
- Log in to post comments
Revere,
Thank you for bringing the reservoir question to the public's attention.
Upon observing Cikelet village cluster, and as you have implied, there may be many villages in Indonesia with the same problem. How could we determine if the mammal we are looking for, where the reservior exists, it the human mammal? Is it possible the first victim in the village became infected through sick poultry, and then the virus went human to human in regard to the rest of the victims?
Two women went to the funeral of the mother of the dead 9 year old boy, and became infected. Would it be logical to assume this was a case of human to human contagion? Would that not imply the virus is possibly airborne?
In the news on bird flu today, doctors in Thailand stated one problem in that country is administrators in private hospitals do not want to report they have bird flu patients in their hospitals; because it may cause a panic within their hospitals. If patients in hospitals in the US become ill with bird flu; would you recommend they keep secret the existence of bird flu patients in their hospitals in order the avoid a panic? I have a good idea what you might say, but I just wanted you to state it; in case it becomes a problem in the US.
A doctor in Thailand also said the tests for H5N1 are now less effective, since the frequent use of Tamiflu in Thailand has caused the virus to go deeper into the lungs. So when tests are done in the area of the lungs where the virus perviously existed; the patient's test results are negative for H5N1. Now doctors must test deeper levels of the lungs. And he said the disease has now become more complex in its presenting symptoms. If the tests are less effective, would this imply we might have to assume patients have bird flu if bird flu symptoms are present, even though the first tests are negative?
And if the use of Tamiflu has now caused the virus to become more dificult to detect, how can the doctors at the Cikelet village determine how many people are infected, and how can they locate the unknown reservoir?
Doctors in Indonesia say the strain in the Chikelet village may be a more deadly strain.
How could doctors in Indonesia determine that there is human to human transmission on a sustainable basis, in other words, stage 6?
Sorry for the correction:
How could we determine if the mammal we are looking for, where the reservoir exists, is the human mammal?
I forgot to say that if the answers to all my questions cannot be immediately answered, I plan to present the same questions to the Wizard of Oz, meaning Dick Cheney. Vice President Cheney is very smart and may be able to stop a pandemic by shooting everybody.
We have tallked more than a few times in past about the need for Goldilocks testing, and one wonders how much of that is current problem in Indonesia. Anyone know in detail the current sampling techniques being used? Serotesting 2+ weeks after infection would be useful.
Cikelet village is NINETY kilometers from Bandung---not 990. Bandung is a metro area of 2 million people. This alarming human bird flu cluster of cases in Cikelet, Garut District/Regency is 54 miles from Bandung.
Bandung is 180 kilometers southeast of Jakarta----a city of 8.5 million people.
So, this alarming cluster is only about 162 miles from Jakarta.
I am alarmed. This cluster is too close to millions of uninformed and vulnerable people.
If I remember correctly, Java is the most populated island in the world with an average of more than 200 people per square mile. That means that regardless of where you are on the island, you are likely pretty close to one or more major population centers.
Lovely.
WHO has come H5N1 vaccine targets (including Indonesia) and phylogentic tree
http://www.recombinomics.com/phylo/HA_Vaccine.html
More on targets
http://www.recombinomics.com/PR/081806.html
Maybe we should cancel/prevent all flights, ships and other movement from Indonesia to the other parts of the World? Would slow the plague down even a little bit.
The following may be of interest.
In a news item from Recombinomics, Inc., a company involved in the research of viral evolution, newly released data clearly indicates that H5N1 has been rapidly spreading and evolving via recombination.
analysis of recently released H5N1bird flu sequences from Indonesia and Hong Kong has revealed the geographic movement and recombination of H5N1 in Southeast Asia.
Indonesia's Health Minister recently approved the release of over 400 human sequences dating back to July, 2005.
Similarly, Hong Kong University released sequences from Hong Kong dating back to February 2006.
The sequences from Hong Kong were the Fujian strain, which has caused the recent reported human infections in China. That strain has now spread throughout Southeast Asia.
The sequences from Indonesia indicated that all but one case outside of Karo have a novel cleavage site that does not match public poultry sequences.
Moreover, the human sequences in Indonesia contain genetic sequences from both the Fujian and Qinghai strains, which are accelerating the evolution of the H5N1 viruses. Recently, a new cluster in Garut Indonesia has been identified.
Recombination is used by all rapidly evolving viruses, which creates a major challenge in vaccine development as well as the timing of vaccine production and distribution.
Recombination is used by all rapidly evolving viruses, which creates a major challenge in vaccine development as well as the timing of vaccine production and distribution.
Well! Now that that's settled, let's have a beer!