- The Chinese government has not provided information requested
urgently by international health experts about recent avian flu outbreaks
in birds, which now threaten to spread the highly lethal virus to previously
unaffected countries, according to U.N. officials and independent researchers.
- World Health Organization officials and other international
health organizations have asked the Chinese government for details about
three outbreaks in the remote western provinces of Qinghai and Xinjiang.
In seeking to head off a potential human pandemic, international health
experts said they require samples of the bird flu virus, analyses of its
genetic makeup and specifics about the extent of the infection and efforts
to contain it.
- The delay in the approval of a WHO request to visit the
two sites of H5N1 outbreaks in Xinjiang Province is cause for concern.
After a three week delay, WHO did visit the site of the H5N1 outbreak
at Qinghai Lake Nature Reserve. Recent publications in Nature and Science
describe Qinghai isolates that are unusually virulent. The original OIE
report by China describe 519 migratory birds that had died from H5N1.
The dominant species was bar headed geese, but four other species were
described. Migratory birds are usually resistant to H5N1 infections and
the size of the H5N1 outbreak was unprecedented.
- Shortly after the Qinhai outbreak China reported two
additional outbreaks in neighboring Xinjiang province. The two reports
cited migratory birds as the source of the H5N1. WHO's request to add
Xinjiang to their Qinghai visit. The request was denied and a request
for a second visit has not been answered.
- The on site visit is important for several reasons.
Third party reports indicated there had been fatal human infections associated
with the Qinghai outbreak. China denied that there were human H5N1 cases,
indicating there were no reported human positives. However, WHO was told
that only two patients were tested, and the probes used in the test were
questionable. Although 600 others had been exposed, they were not tested
because they were "dispersed".
- Additional reports by boxun indicated H5N1 infections
in humans were widespread. 10 strains of H5N1 were detailed and 8 had
been detected in human cases. The most virulent was RX7 which appears
to be the same as the isolates described in nature and Science. However,
boxun reports described at least two additional strains from Qingahi, indicating
dual or even triple infections were occurring in poultry. The dual infections
can lead to new reassortants and recombinants, leading to further destabilization
of the H5N1 gene pool.
- In addition there were reports of pneumonia clusters
in Tacheng, site of the first reported outbreak in Xinjiang. Reports described
an isolation ward for patients and health care workers because of bacterial
pneumonia. However, bacterial pneumonia is generally not very infectious
or serious, raising suspicions of H5N1 infections in Tacheng, located 5
miles from the Kazakhstan border and about 100 miles from borders with
Russia and Mongolia.
- After the Qinghai visit, WHO recommended that China share
sequences and samples and aggressively collect samples from asymptomatic
birds at Qinghai Lake before they return to India, Europe, and southeast
Asia. It is unclear if samples were collected, but new samples or sequences
from China have not been provided, raising additional concerns that the
boxun reports of widespread human infections in China are correct. China
has never reported any H5N1 infections in humans.
- The migration of H5N1 infected waterfowl could spread
H5N1 worldwide, and China's failure to cooperate is cause for concern.
- Patricia A. Doyle, PhD
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