Bird flu in Africa - - or not

Four months ago Nigeria had its first cases of avian flu in poultry. None since. We think. Or maybe we should say, we hope. Because as experts gather this week in Mali, no one seems to be that confident there's nothing there, or anywhere else in Africa:

Health experts say insufficient surveillance means they don't really know the true level of bird flu. The two-day conference that opens Wednesday in Mali, and follows similar international meetings in China and Austria, will focus on preparedness as the next bird flu season approaches, including marshaling financial and other resources to fight a disease experts fear could transform into a human pandemic.

At the last official count, the H5N1 strain had been confirmed in 14 of Nigeria's 36 states.

The 46,000 chickens slaughtered at Sambawa Farms, where H5N1 was first detected in Africa in January, have been replaced by 50,000 new birds, said farm manager Muhammadu Sambawa.

Cases of bird flu were later reported in neighboring Niger and Cameroon and farther afield in Ivory Coast, Burkina Faso, Egypt, Djibouti and Sudan. The World Health Organization says there have been scores of avian influenza cases and deaths in humans, most of them in Asia. There have been human cases - and deaths - identified so far only in Egypt and Djibouti in Africa. (AP)

One of the main ways human cases have been discovered is by having the index of suspicion raised by nearby poultry outbreaks. If you don't find infected poultry, chances are good you won't recognize the human cases either. That's just the way it works most of the time. But a staffed African network of bird flu laboratories and surveillance systems is still in the future. At the same time the schemes to compensate farmers for culling their flocks have run out of money, with preferences going to large firms rather than small farmers. The requirements also demand a degree of literacy and trust in government officials in short supply among Nigeria's poor.

At Birnin Yero Gari, a small rural village that lies next to Sambawa Farms on gently sloping brush, villagers recount what they consider the government's failings.

Every family in the village of about 2,000 people lost an average of 10 birds each to bird flu, which they believe came from the nearby big, commercial farm, but got no compensation, said 55-year-old village shopkeeper, Mohammed Shuaibu.

"Government officials came here, took blood samples from our birds and from people, but we never saw them again," Shuaibu said. "They don't care for us."

The village is shrouded in a mist of dust and a cold, dry wind blew southwards from the Sahara. Some of the villagers recalled it was the time of the year when chicken plagues strike.

One of them, 26-year-old Lawal Shittu, said he bought a cock from a market a few weeks ago and days later it sickened and died. His other fowls also started sickening and dying one after another, making him fear the disease had returned.

"It also affected some neighbors' chickens, but it hasn't spread like the last time," Shittu said.

Those deaths, the villagers said, were not reported to the authorities.

So Nigeria is officially free of bird flu. But is it really? I'd put a small stake on a wager that says we'll see bird flu reports from Nigeria within three months.

If, that is, they ever get a surveillance system working.

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I've been wondering to what degree bird flu might be disguised in Africa if it becomes a contributing factor to deaths from AIDS and TB, among other things. If people are already very ill with one of these diseases that is quite prevalent in a number of the African countries, might a secondary infection with influenza go unnoticed or unmentioned, just chalked up to a sudden turn for the worse in the existing disease, leading to death? Only if it then started being transferred to HCW or healthy relatives would it become apparent, IMO.

By mary in hawaii (not verified) on 06 Dec 2006 #permalink

One of the people at Fedex here in Memphis is a native Nigerian and from the area around Kano Reservoir. He speaks via E to his family there every day. He has reported to me that the government there has stopped compensating for bird deaths because they are out of money. Amous is a very well educated person and he is very aware of bird flu and said that his family says that there are birds everywhere that are dead and dying. The hyena population is down as well he said because they apparently took sick. No one will approach them or the birds for fear of infection. Is bird flu there I asked him and he said that the government acknowledges the problem but speaks only about prevention, not whether there are cases or not.

By M. Randolph Kruger (not verified) on 06 Dec 2006 #permalink

To me, the introduction of H5N1 to the African continent is one of the more disheartening outcomes to obtain, to date. When the pathogen enters areas that we cannot directly access, for observation, at least, then it seems that we are left with little other than "vicarious" observation, through watching what "it" is doing in regions where we do have direct access. We're forced to extrapolate. That's less than ideal, obviously.

In the areas we have direct access to, no increase in size, or distribution, of clusters might translate into similar outcomes in the areas that we have no access to. But there is no guarantee of complete accuracy, here. And that -- to the extent that we can achieve it -- is what we really need; faced with something as potentially destructive as an H5N1 pandemic. Any lack of clarity has to be viewed as potentially catastrophic. Because it is.

There may be something going on in Africa. Notice :
"There have been 250 cases of bird flu in humans in Asia since 2003, plus suspected human cases in Somalia and South Korea. "
http://www.sundaymirror.co.uk/news/tm_headline=britain--closed-off--in-…

Notice the Suspected human cases in Somalia. That was not widely reported and I have no more information. However, it may signal that there are cases that are going unreported.

DennisC: Thanks for the comment. NB The Mirror is a tabloid and an unreliable source, however.

Revere, your surveillance comment is good. They do have a surveillance program, the only problem is that they acknowledge it when people and poultry start dropping like flies. If this shit gets into Ibadan or Lagos it will cover Africa in a week via the Trans African Highway.

By M. Randolph Kruger (not verified) on 06 Dec 2006 #permalink