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Monday, May 15, 2006

Bird Flu Update

Things are really not getting more positive on the bird flu front. The only good news is that neither Thailand or Vietnam, two of the countries hard hit by H5N1 early on, are reporting new cases. As of Friday the WHO case count from 2003 on stands at 208 cases and 115 dead. The latest cases are of course not yet included.

The WHO case count is a significant undercount, since for example it does not include one of the five siblings in Turkey who died. Turkey confirmed 21 cases, and WHO counts only 12 of those. WHO's numbers for Indonesia show 33 cases and 25 deaths since last year. Indonesian officials are saying:
...158 cases of bird flu in Indonesia, respectively in the stage confirm (the Hong Kongese Lab) 35 cases (26 died), the stage probable 19 cases (9 died) and the stage suspect 103 cases (36 died), and that not AI 356 cases.
There have been several disturbing developments over the last few weeks:
1) Egypt earlier reported an outbreak of FMD in an area infected by bird flu. The local reports stated that cattle were dying, which is extremely unusual in FMD. Usually ruminants (cows, water buffalo) are culled to stop the spread of the disease. However now they are saying that the disease acts like FMD but is an "unknown virus". This corresponds to reports of FMD following the Qinghai trail from last year, beginning in Tibet, proceeding to northern China and Laos, moving to Russia and then reports of cattle becoming ill in the Ukraine. This picked up again with reports from Africa and now Egypt.

2) The latest Indonesian cluster is both large and unaccounted for by exposure to poultry, not for the first time in Indonesia. Eight members of one family became ill. Four died last week and preliminary tests (NAMRU) have confirmed exposure to H5N1. An unrelated person from the same area is also being treated in the same hospital for suspected bird flu. Two more people from Karo, Indonesia died in the same hospital over the weekend. The local authorities now believe that the disease came from exposure to bird-flu infected manure imported from another area, since they have been unable to detect bird flu in the poultry. They are now testing other animals such as dogs and pigs. Also, there are reports that one of the health-care workers in the hospital is ill with flu symptoms. This is not the first such report from Indonesia.

3) The first human case was reported in Djibouti, and two of the dead girl's siblings are reported to be ill. Additional suspected outbreaks in the last few weeks have occurred in Romania, and Novosibirsk (Russia). Nabarro of WHO recently announced that they were hopeful that China had "turned the corner", and this article from May 15th notes that Hong Kong is trying to find out about the death of 30,000 birds on a Chinese poultry farm. This would not come as a surprise to anyone who reads Boxun.

Could we be seeing other diseases piggybacking on H5N1?

Talking M-o-M's report last month of skin blisters followed by two days severe respiratory illness after watching a local bird die-off, I heard from someone raised in a rural area that this sounded like some sort of "bird pox" instead of true Bird Flu.

Could there be several "bird plagues" hitting the bird population at the same time? And could the others reduce the bird population enough to slow the spread of H5N1 though lack of vectors?

The Headless Unicorn Guy
Sure could be.

It's just like humans - when you get a bad cold your resistance is down, and you are more likely to get the flu, and vice versa.

I think a lot of H5N1 infections in poultry have originally been thought to be Newcastle - and there probably were two or more viral strains circulating at the same time.

Indian villagers were complaining about a viral fever with blisters too.
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