Human bird flu cases: another country heard from (Burma)

As noted yesterday, it's flu season. That includes bird flu. So we are seeing cases pop up. Yet another in Indonesia and the father-son cases in China. Then reports out of Pakistan of the first human cases on the Indian sub-continent. Those case are as yet unconfirmed. Now WHO is confirming cases in Burma (aka Myanmar), the first in that military dictatorship not known for being open about what goes on there:

The World Health Organisation (WHO) announced Myanmar's first human case of bird flu, the victim a seven-year-old girl who survived the disease.

The girl, from the northeastern Shan state, developed symptoms of fever and headache on November 21 in an area where there had been an outbreak of the H5N1 virus in poultry, and was taken to hospital six days later, the United Nations agency said.

"She has now recovered," it said in a statement quoting the Ministry of Health in Myanmar as having confirmed the case. (Reuters via TV New Zealand)

This case was said by authorities to have been picked up via "routine national surveillance" prompted by recent poultry outbreaks and bird die-offs near her home. The infection was confirmed at the WHO reference laboratory in Japan. Burma is now the 13th country with confirmed cases of human H5N1 infection. There is more coverage on Scott McPherson's blog (h/t Crof).

The infected father of the fatal Chinese case is now said to be recovering after having been treated with Tamiflu. No poultry outbreaks have been reported in the vicinity, although the suspicion as always falls on poultry, sick or not:

The two were believed to have eaten a traditional dish known as "beggar's chicken," in which the bird is wrapped in lotus leaves and baked. However, the cause of infection remained unclear.

Most human cases have been linked to contact with sick birds, and experts say that no human bird flu cases have ever been traced to eating properly cooked poultry or eggs. (AP via USA Today)

Since poultry dishes are exceedingly common, the fact that both ate a baked chicken dish doesn't seem to make a firm connection to poultry in this way. Maybe the chicken was undercooked, but baking isn't exactly a once over lightly. It's baking. So as of now these cases were infected in an unknown way by an unknown source or sources.

News of the reported cases in Pakistan is still sparse. Additional reporting suggests that there were three cases, of which one is still alive:

Sources told The Post on Mon [12 Dec 2007] that 3 suspected cases of human-to-human transmission of bird flu virus have been detected in North West Frontier Province (NWFP). Of these 3 cases, 2 people died and the Ministry of Health has collected samples to determine the cause of their deaths.

Sources said about 3 weeks ago the Ministry of Health obtained blood samples of people suspected of being infected with bird flu virus, but their results have yet to be announced. Ministry officials said on 21 Oct [2007], bird flu virus H5N1 was confirmed at Ijaz Shah Poultry Farm in Abbotabad and a veterinarian, Dr Ishtiaq Durrani, from the NWFP Livestock Department was tasked with culling as many as 3000 hens in Abbotabad from 21 to 23 Oct 2007. (The Post, Islamabad via ProMed)

Pakistani authorities are awaiting confirmation of infection from a WHO reference laboratory. The speculation this was person to person transmission between the brothers remains speculation at this point. As always we will await more information. ProMed notes that the poultry outbreaks began in Pakistan last February. With the coming of "flu season" it is not surprising to see human cases, although as always, the ability of authorities to detect these cases varies widely.

Expect to see reports of human cases with greater frequency. While "normal" at this time of year, this also represents the bubbling pot we all worry will boil over at some point.