H5N1 Spreading - May
Be Becoming Easier
To Transmit

From Patricia Doyle, PhD
New H5N1 Clinical Presentation in Northern Vietnam
By Dr. Henry L. Niman, PhD
Recombinomics Commentary
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
Canadian Press
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, 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 norm.
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 as saying.
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 the virus.
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.
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 fowl-farms.
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 Eastern Asia.
Update On The Avian Influenza Situation
FAO AIDE News - Issue no.

3 6-20-5
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 central Asia.
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 [2004]. 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. - Mod.AS
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Zhan le Devlesa tai sastimasa
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