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Wednesday, December 07, 2005

Thailand Public Health Doc On H5N1

This is what the doctors in the Thailand are saying about H5N1:

Dr Charoen Chuchottaworn, a bird-flu expert at the Public
Health Ministry’s Department of Medical Services, said doctors concluded after
reviewing the history of the past two cases that both victims presented very
mild symptoms of avian influenza and neither had any physical contact with
chickens or birds.
This left doctors no clues as to where the patients became infected with the H5N1 virus and showed that the avian influenza had moved from causing severe human infection to milder cases.
Signs of possible human-to-human transmission were closely observed in Vietnam, where 10 clusters of probable human transmissions were detected in which the victims had no contact with infected poultry, Charoen said.

Thailand and Indonesia had one official cluster, he said, but the Indonesian cluster showed clear-cut evidence because a child contracted H5N1 without going to an infected area, as her father had.

Not all doctors agree. Some believe the virus is endemic in the environment, so people can get it without direct exposure to birds. That, however, does not explain at all the reports of health care workers becoming ill after treating H5N1 cases.

I am not sure that all of this illness is actually arising from H5N1, however. There are consistent reports of foot and mouth disease in many of the same areas. FMD can occasionally infect humans. The reports of mass illness from Boxun (the ones not associated with infected wild birds) in the summer described one of the symptoms of the disease in humans as skin peeling off their hands and feet. That sounds more like FMD than flu. In 1997 there was a type O FMD that infected humans in Asia.

I wonder if people are ignoring the obvious. The birds may be carrying FMD as well.

A double barrel shotgun, pointed our way.

Why is the Thai press the source of this information?

I don't like that, not one bit. As it is, we're being kept in the dark.
No one can know for sure. The only way to know would be to do widespread testing and to sequence the viral strains found in people, comparing them to the ones found in the local bird population. If you found different sequences it would make it clear that the virus was travelling in the human population.

Remember, the Indonesian government shut down several zoos after zoo workers (one was a food-stand operator) who did not have contact with birds contracted bird flu, and the first diagnosed cases in Indonesia were the Jakarta man and his two children. They were urban and no environmental H5N1 contamination was found near their house.
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