The major H5N1 news over the weekend was the new Indonesian case, their first confirmed human case of 2007. The major H5N1 news of the end of the year was the absence of any human cases in Vietnam. The Indon case has been well covered on the newswires. It's a 14 year old boy, hospitalized on New Year's Day. He is said to have had contact with a dead duck. On the other hand, they always say something like that in Indonesia. Their previous case was five weeks earlier. But it's winter and flu season. Expect more.
Now, Vietnam. First, after no reported outbreaks in poultry for over a year, the place is suddenly awash with poultry outbreaks, with 33 communes in three provinces reporting infected birds. When the first outbreak occurred in December, it was portrayed as an aberration, the result of a farmer not taking the necessary precautions. Given the extent of the new outbreaks and the difficulty in controlling the situation, this seems a bit harder to swallow as an explanation. It's winter and flu season. Expect more.
Which brings me back to the suspected cases in Vietnam at the end of last year, a family of four (mother and three children), all of whom were said to have slaughtered and eaten a sick chicken in one of the areas now aflame with H5N1 poultry disease. They were hospitalized in a provincial hospital with pneumonia and further tests done for influenza and H5N1. Later word was received from the Pasteur Institute in Hanoi that they were "negative" for H5N1, although no details were given and the cases have receded into the background. We don't know if they have been discharged or what their condition is, only that they were suffering from ordinary pneumonia.
I'm not usually very eager to claim a cover-up, but I can't shake the feeling that these were really H5N1 cases. Everything points to it: contact with sick poultry in an area with H5N1 infected poultry, the apparent simultaneous cases as from a common source (although the timing isn't as clear from the reports) and pneumonia, the usual presentation for bird flu. At this point, however, we have no choice but to assume that everything was done right and H5N1 truly ruled out. In some respects, the overall situation wouldn't change much if it turned out they did have H5N1 infection. I wouldn't consider the threat of a pandemic to be either more or less than if they didn't.
It's winter and flu season. Expect more.
Addendum: This morning (8 January) another Indonesian case was reported with six others said to be under investigation.
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Maybe Vietnam has learned the lesson well from their neighbour, who of course didn't have a human case of H5N1 until last year (1996-2005) while at the same time 'seeding' most of their neighbours and the rest of Asia with H5N1...including human cases in most of those countries.
Why would Vietnam or other poor countries in the region bother to acknowledge future H5N1 cases with this behavior as precedent.
China suffered no consequences as a result of their actions. On the contrary. They have been repeatedly praised for their transparency by the World Health Organization no less.
All nations save Egypt and the hapless Indonesia have learned that clusters tend to be small, confined to a family.
If they cover one up, what's the loss?
If they don't, they put to risk their national poultry and tourism industries.
An easy call.
We will know H5N1 is coming for us bigtime when the clusters are too big to be covered up, when they spread beyond the confines of a home or family.
The WHO knows this: That's when it will raise the alert level and we will be cooked.
The above applies to sub-Saharan Africa by nature. A family cluster from H5N1 won't be covered up; it will be assumed to be the result of dengue fever or another pathogen.
Until the clusters grow too big to be ignored locally.
The world has turned its back on H5N1 until the pandemic raps sharply on our heads.
Stay well, DA
We will know that they have it in country (VN) the day the scream for help and more money than they already have. Quite a bit of the first load was stolen flat out. Then remember if you go back a year point five when suddenly they were getting 1500 cases per week in the Tropical Disease Hospital (owned for all intents and purposes by Wellcome) of respiratory disease and a couple of bird flu cases. Then ZAP Ho Chi Miinhs ghost appeared and there were no more bird flu's, only general pneumonia. But that equated to a couple of thousand percent increase in pneumonias per week. Hmmmmmmmmmmmmmmmm...............
As with Revere, Tom and DA I guess I am just too stupid because when you praise the country that hid it for five years, well I think we will find out fast how transparent they are when the poo-pooh hits the rotary grinder. By then, it will be too late.
Be advised I have governmental problems too. Now one of the chief science advisors to the boss says that everyones prediction of a 1918 type event might be too optimistic and that 1/3rd of the population may not only get sick but a bigger proportionate scale of death will occur. 2 million was the original call, now they arent so sure. My question to them today was whether we would wait it out or fight it out?. All extraordinary measures to be taken to preserve, feed, and keep the infrastructure up? I got a long sigh on the other end and was again told to prepare for the worst imaginable circumstances and then hope for the best.
So once again into the breach we go. Kind of like riding an iceberg out of the North. You know its going to melt, just not when.
"Kind of like riding an iceberg out of the North. You know its going to melt, just not when."
Good one MRK.
By the way, their original estimate was 3-7 million worldwide.
AFP-Today
"The woman, 37 years, come from Serpong and had become ill after cooking and eating a chicken she had bought live at a local market on December 30," government health official I Nyoman Kandun told AFP Tuesday
Confirmation of positive on an H5N1 case in Indon.... Notice the cooked chicken thing. Now my little firends at one of the Indon news services says that they are very concerned about this woman and the vectors that gave it to her. NO contact with the bird. She did no cooking of it. She simply ate it. Nor was she in direct contact with the 14 year old or so I was emailed this afternoon. So is our goose cooked? Can it bypass the cooking process or if its in the slightest undercooked as a lot of poultry is, can we get it?
"WINTER" ?? IN INDONESIA ?? GIMME A BREAK ......
In a country like Indonesia that straddles the equator and sits in the balmy tropical South Seas, seasons are determined by rainfall and wind patterns that are completely independent of the seasonal temperature changes of higher latitude continental land masses ...
January average high temperature in Jakarta is 84 F and low 73 F, in June it is high 88 F and low 73 F.
Better look for something other than "winter season" as an explaination in variation of bird flu prevalence in Indonesia.
In Vietnam and Hong Kong, the human bird flu cycle was originally tied to seasonal surges poultry consumption and marketing tied to the Tet New Year celebrations, again -- nothing to do with "winter" per se or the nasty cold and flu season of intemperate higher latitude climes in Europe and North America...
Trouble is, now it doesn't really seem to be going that way anymore and nobody really knows why
ZoKun: Of course I should have been more precise: flu season in the northern hemisphere (accurate in this case despite the equatorial setting as it is epidemiologically connected to the north). Winter is a surrogate for whatever the driver is -- if there is an external driver and not a qualitative feature of the dynamics (periodic solution or a limit cycle). Lots of people (including you, apparently) have speculations on the driver, if there is one. The simple fact is, however, that we don't know but know it is seasonal.