- New H5N1 Clinical Presentation in Northern
- By Dr. Henry L. Niman, PhD
- Two more Vietnamese have contracted bird flu in the country's
north, a state-run newspaper reported on Monday, as more than 6,000 chickens
were slaughtered in the southern Mekong Delta following a fresh outbreak.
- The two were among five people admitted to a hospital
in Hanoi with sore throat or bronchitis, the Saigon Giai Phong daily quoted
hospital officials as saying. <<
- The above description may signal a new clinical presentation
signaling efficient transmission of bird flu. A sore throat and bronchitis
were not among the symptoms reported for 10 cases from last years outbreak,
as reported in the New England Journal of Medicine. Similarly, a recent
report on the autopsy of a patient who died of bird flu in Thailand last
year also noted the absence of virus in the upper respiratory system.
- The H5N1 from last season had a high case fatality rate,
but was poorly transmitted. Sore throat and bronchitis are symptoms of
human flu, which is efficiently passed from human to human. Th alarming
increase of human cases in northern Vietnam has suggested the pandemic
may be evolving into phase 6.
- The sore throat and bronchitis in bird flu patients in
northern Vietnam may reflect an improved ability of H5N1 to grow in the
upper respiratory tract, leading to more efficient spread of the virus
including human to human transmission.
- Avian Influenza - Autopsy Report
- By Helen Branswell
- In a soon-to-be-released issue of a scientific journal,
researchers from Thailand and Hong Kong will report the findings of an
autopsy of a 6 year old Thai boy who died from avian influenza. Scheduled
for publication in the July 2005 issue of Emerging Infectious Diseases
http://www.cdc.gov/ncidod/EID/index.htm, their findings of an atypical
pattern of infection -- deep in the lungs, away from the tracheal lining
where virus could easily be coughed out at others -- may help explain why
avian H5N1 influenza virus doesn't yet spread easily among people.
- But the very fact that a paper containing autopsy data
from a single case is still desirable to journal editors a year-a-half
into the H5N1 avian influenza outbreak underscores a problem that has been
plaguing the scientific world's pursuit of knowledge about this [potentially]
dangerous strain of avian influenza virus. While at least 54 people have
died from H5N1 infections since December 2003, autopsies have been performed
on fewer than a handful of cases. For cultural and other reasons, body
after body has been buried or cremated, robbing pathologists of the precious
chance to chart the havoc the virus wreaks on its victims.
- "That's one of the reasons why it's so difficult
to understand what the virus does in the body," says Dr Klaus Stohr,
who heads the World Health Organization's global influenza program. "Did
it do more damage on the intestine? Is the heart affected? Encephalitis:
Yes? No? What is the damage in the lung? That's why postmortems are so
important. But ... there are less than 5 done, I think, so far. And all
in Thailand." Thailand hasn't reported a human case in the most recent
wave of infections, which began in December 2004. That means science has
no autopsy data with which to try to explain the worrisome changes in infection
patterns that have been observed over the last 6 months in Viet Nam, changes
which flu experts fear mean the virus is becoming more transmissible and
more likely to spark an influenza pandemic.
- Without information that can only be gathered through
autopsies, scientists devising treatment options and potential vaccines
are working, if not in the dark, then in a dim light, experts say. "If
we want to test vaccine or antiviral strategies for intervention, we would
like to know what the disease looks like in humans," explains Ab Osterhaus,
head of virology at the Eramus Medical Center in Rotterdam, the Netherlands.
Drugs and vaccines are tested in animals before being administered to people.
But without having a clear picture of what the disease does in humans,
it's difficult to select the appropriate animal model, Osterhaus says.
Animals used as models must experience a pattern of infection that closely
mimics human disease in order for scientists to feel secure that what they
are learning might apply to people. Determining which organs the virus
is attacking is also crucial from an infection control point of view, because
it helps identify possible modes of transmission. In some [avian] species,
massive amounts of the H5N1 virus are excreted in feces, Osterhaus notes.
- Excreted virus isn't a threat with human flu viruses.
But if H5N1 replicates in the human gastrointestinal tract, patients who
experience diarrhea could contaminate their environments in ways health
care workers might not expect from a respiratory virus. "So that's
very important information," Osterhaus says.
- The autopsy on the Thai boy found viral replication in
the intestine. Autopsies could also show whether the virus is being spread
through the blood supply to other organs, says the Toronto pathologist
who performed the 1st autopsy done on a SARS patient in Canada. "You
want to see whether the cause is in the blood supply and therefore may
be a systemic or body-wide problem, or if it's organ-specific," explains
Dr Jagdish Butany, who insists autopsies provide a wealth of information
for those who treat patients and those who study viruses. "The information
we continue to get out of autopsies is totally unbelievable [sic!],"
says Butany, a pathologist at the city's University Health Network. But
he acknowledges that, in certain cultures and religions, getting permission
from relatives to conduct autopsies is virtually impossible. And in steamy
climates like that of Southeast Asia, prompt disposal of corpses is the
- Even if more people were willing to authorize postmortems,
there is another problem, notes Earl Brown, a virologist who specializes
in influenza virulence at the University of Ottawa. H5N1 influenza isn't
claiming its victims fast enough. "The problem is you have to wait
for the people to die, and they're just not dying early enough," Brown
explains. "They die after several weeks in intensive care, and all
the (viral) tracks are gone. Getting people who die from rapid, fulminant
disease early to look at when everything's sort of fresh is the trick."
- This article contains arguments for and against the value
of autopsies in understanding disease processes following infection of
humans by avian influenza viruses. As a virologist, the constraints expressed
by Dr Earl Brown seem to me to have the most relevance. Others may come
to different conclusions. - Mod.CP
- Viet Nam - 2 More Avian Influenza Patients
- (Reuters) 2 more Vietnamese residents have contracted
avian influenza in the country's north, a state-run newspaper reported
on Mon 20 Jun 2005, as more than 6000 chickens were slaughtered in the
southern Mekong Delta following a fresh outbreak. The 2 [avian influenza
patients] were among 5 people admitted to a hospital in Hanoi with sore
throat or bronchitis, the Saigon Giai Phong daily quoted hospital officials
- The latest cases took the number of Viet Nam's avian
influenza patients since December 2004 to 64, 18 of whom have died. The
disease has also killed 12 Thais and 4 Cambodians.
- Health workers slaughtered and buried more than 6000
chickens last week [3rd week June 2005] at a farm in the province of Ben
Tre in the Mekong Delta, after the birds were found to carry the H5 component
of the bird flu virus, a state health official said. The tests were conducted
after the farm owner reported that more 3000 of his chickens had died,
Mai Van Hiep, director of the provincial animal health department, told
Reuters. Ben Tre is one of the areas where the virus 1st emerged in late
2003 then spread to the northern region, where the virus appears to develop
rapidly during the winter. "We do not exclude the possibility of an
outbreak," Hiep said by telephone from the province, 85 km (55 miles)
southwest of Ho Chi Minh City.
- Scientists fear that avian flu, which is infectious in
birds but does not spread easily among humans, could mutate into a form
capable of generating a pandemic in which millions of people without immunity
could die. Last week [3rd week June 2005], a Vietnamese doctor who treated
bird flu patients tested positive for the virus. [A 2nd test failed to
confirm the initial diagnosis. - Mod.CP]. But the Health Ministry insisted
that there has so far been no evidence of human-to-human transmission of
- Viet Nam - 2 More Avian Flu Cases In North
- ABC News
- 2 more people from northern Viet Nam have contracted
avian influenza, and thousands of chickens have dropped dead in the south,
officials said on Mon 20 Jun 2005. The poultry outbreak is the country's
1st in 3 months.
- The 2 new victims tested positive for the virus after
being admitted to Bach Mai Hospital in Hanoi over the weekend, said hospital
director Tran Quy. That brought the number of human cases to 13 over the
past 2 weeks, he said, adding that the patients, all from the northern
provinces, are in stable condition.
- Bird flu began ravaging poultry farms across Viet Nam
in late 2003, killing or forcing the cull of more than 45 million birds.
The virus began jumping to humans at about the same time, and has killed
38 people in Viet Nam, 12 in Thailand and 4 in Cambodia.
- Meanwhile, more than 4000 out of 6700 chickens on a farm
in the southern province of Ben Tre died suddenly on 9 Jun 2005, said Mai
Van Hiep, director of the provincial animal health bureau. The authorities
killed the remaining chickens 2 days later, and tests showed they were
infected with the H5N1 [serotype] of avian influenza, he said. Hiep said
it was the 1st reported outbreak in the province since March 2005.
- ProMED-mail email@example.com
- It is not clear whether these cases of avian influenza
have been confirmed by laboratory test or whether the information has been
communicated to the World Health Organization. The 1st report fails to
state that a 2nd test of the doctor in the Bach Mai Hospital did not confirm
that he had contracted avian influenza (see: Avian influenza, human - East
Asia (90): Viet Nam 20050617.1707). - Mod.CP
- Severe Bird Flu Registered In China 25 km
From Kazakhstan Border
- By Nazym Shakhanova Kazinform
Kazach Information Agency
- A large outbreak of bird flu among birds has been registered
in the People's Republic of China, 25 km from the border with East Kazakhstan.
According to WHO, 1042 ducks [they might mean geese, as also officially
reported by the Chinese authorities; see item 2 and 20050608.1591. - Mod.AS]
were detected with symptoms of bird flu, and 406 of them died. This has
been said by the deputy health care minister, chief state sanitary inspector
of Kazakhstan, Anatoliy Belonog.
- According to the Chinese veterinary services, at one
of the private farms of Chuguchak (Tacheng) in SUAR province, 13 000 birds
have been destroyed. Other control measures include isolation and disinfection.
In addition, emergency poultry vaccination was carried out at all neighboring
- According to the view of the Chinese experts, bird flu
virus spread in western China is related to its carry-over by migrating
birds from South Asia via Tibet and the Himalayas.
- To date, 54 fatal cases of bird flu have been registered
among the population of Viet Nam, Cambodia, and Thailand. Consequently,
necessary measures are being undertaken by the Kazakh Ministry to prevent
the introduction of disease into the territory of Kazakhstan. In all regions,
stricter sanitary-quarantine control measures are undertaken at all crossing
points along the border and at international airports with traffic to South
- Update On The Avian Influenza Situation
FAO AIDE News - Issue no.
- Country situation - China
- The 519 wild bird deaths, including bar-headed geese,
great black-headed gulls, brown-headed gulls, ruddy shelducks, and great
cormorants, at the Qinghai Lake Nature Reserve in Gangcha County, Qinghai
Province were confirmed by the National AI Reference Laboratory (Harbin)
to be due to H5N1 avian influenza (AI) strain infection. The government's
control measures included compulsory vaccination around the outbreak areas
and along migration routes and the nearby regions. More than 3 million
doses of vaccine against the H5N1 strain of the avian influenza virus were
dispatched to Qinghai Province. Qinghai Province adopted a series of measures,
such as sealing off the epidemic area, the use of disinfectants in the
affected zones as well as the administration of vaccines. Death of migratory
birds was 1st reported in Naisuoma Village in Gangcha County on 4 May 2005.
The 0.27 square kilometre island where the dead birds were found is home
to more than 100 000 birds, including rare species, such as swans, black-necked
cranes, and brown-headed gulls. The Chinese government has temporarily
banned visitors from nature reserves.
- Another outbreak of HPAI H5N1 was reported on a farm
in Tacheng city, Tacheng district, Xinjiang Province on 8 Jun 2005. The
index farm had 2177 geese, and 1042 were positive for H5N1, and, as of
8 Jun 2005, 460 had died. More than 13 000 birds were culled in order to
contain the new outbreak. Xinjiang authorities have adopted various control
measures, including modified stamping out and vaccination.
- From Joseph Domenech Chief, Animal Health Service Animal
Production & Health Division Food and Agriculture Organisation of the
United Nations Rome _____
- The concern of the Kazakh authorities is justified, since
the spread of H5N1 into Tacheng means a significant leap of the virus into
- The 31st update of FAO AIDE (Avian Influenza Disease
Emergency), from which the 2nd item above was derived, includes the following
statement: "Overall numbers of outbreaks have decreased, a pattern
sim ilar to that observed last year
. This is a good opportunity for all the affected and at risk countries
to review contingency plans and be prepared for possible outbreaks that
might occur in the forthcoming cooler months." One cannot but agree.
- Patricia A. Doyle, PhD Please visit my "Emerging
Diseases" message board at: http://www.clickitnews.com/ubbthreads/postlist.php?
Zhan le Devlesa tai sastimasa
Go with God and in Good Health