- Recombinomics Commentary
- By Dr. Henry L. Niman, PhD
- March 18, 2005
- Jose Caetano, a WHO spokesman in Angola, said most of
the victims were children with symptoms including fever, vomiting and diarrhea.
He said at least 77 of the total of 83 people believed infected had died.
- Caetano said Angola's limited laboratory facilities had
hampered identification of the disease and that samples had been sent to
the U.S. Centers for Disease Control in Atlanta and the Pasteur Institute
of Dakar in Senegal.
- He said the first case had been detected in November.
- There are a number of parallels between the mystery Ebola
/ dengue hemorrhagic fever-like disease in Angola and bird flu.
- Like the hemorrhagic fever disease in Angola, H5N1 in
Vietnam began as a mysterious disease primarily infecting children. After
several deaths, the victims were initially described as Influenza A positive.
When H5N1 infections in poultry were reported in the Mekong Delta in the
south, the children in Hanoi were said to have H5 infections. Ultimately
it was acknowledged that the infections were H5N1. The virus was isolated
and sequenced and found to be virtually identical to H5N1 in the south.
- The cases were primarily respiratory, but there were
examples of children presenting with gastro-intestinal illness as well
as dengue fever symptoms. The dengue fever diagnosis for the index case
(11F) in Thailand led to unprotected visits by the mother, because dengue
fever is not transmitted human-to-human. The daughter was reported to
have vomited blood while being held by her mother, who subsequently was
also infected and died. The aunt was H5N1 positive, after initially testing
negative. The aunt survived. In the 1918 flu pandemic, dengue fever was
a misdiagnosis for pandemic flu.
- In Vietnam, the first reported infection in a health
care worker was last month, as was a second health care worker with symptoms
this month (the second health care worker tested negative, but the PCR
assay only picks up 20% of H5N1 infections).
- In Angola the identification of the infectious agent
has taken a long time. The first case was in November and dozens have
died. The WHO rushed in a team when health care workers began to show signs
of infection. In Vietnam, the initial cases appear to have been children
because they were more likely to touch dead birds or care for the birds.
However, the familial clusters have been bimodal for disease onset dates
indicating further human-to-human transmission.
- Thus, in many respects Angola is like northern Vietnam
in December, 2003. Cases have been confined to a specific region and have
predominantly affected children. The cases are more like the gastro-intestinal
version in Vietnam with associated bleeding, another common feature found
in the flu pandemic of 1918 as well as H5N1 infections in Vietnam, especially
- The response has been slow in Angola, but now that health
care workers have become ill, there should be more rapid progress. Unfortunately,
there have been no reports of Influenza A testing even though WHO has indicated
previously that unexplained clusters of deaths would be tested for H5N1.
- Henry L Niman, PhD
- Founder, President
- Recombinomics, Inc
- Patricia A. Doyle, PhD
- Please visit my "Emerging Diseases" message
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- Go with God and in Good Health