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Post-Tsunami Flu Fatalities in Sri Lanka

Recombinomics Commentary

January 1, 2005

>>Already, there are fears of an outbreak of disease. On Thursday three people died of a strange flu that was resistant to any antibiotics and the rebels want to get rid of the bodies as quickly as possible<<

Post-tsunami flu fatalities in Sri Lanka are a significant concern.  Media reports of December 20 initially cited an influenza A diagnosis and the culling of 100 chickens.  These reports raised fears of bird flu.  However, initial reports also indicated that fatal flu case was negative for avian influenza (presumably H5N1).  Subsequent reports indicated that two patients had In influenza B and the outbreak was similar to a 1998 Influenza B outbreak that killed 5 in Sri Lanka.

The initial cases from last month were in Matara, Padanangala and Embilipitiya, all of which are in the south.  There were 3 deaths on December 16 at the Matara Base Hospital.  2 of the 3 victims were brothers of the same family from the Kuttigala area, while the other, a relative of the other victim was a native of Beliatta. They were initially admitted with a fever and treated at the ICU for 3 days before their death.

The number of cases rose to 75 and 3 fatalities were diagnosed as influenza B.  On December 24 officials called for school closures in Sabaragamuwa Province and Embilipitiya and more than 80 fowl in the Mahaweli Farm in Embilipitiya died due to a mysterious illness.

All of the above locations are in the south and developed prior to the tsunami.  The three flu deaths post tsunami are in Mullaittivu, which is in the northeast corner of Sri Lanka. 

Influenza is not treated with an antibiotic, but there are several anti-viral treatments that either target M2 (ion channel blockers are amantadine and rimintadine) or NA inhibitors, oseltamivar (Tamiflu) and zanamivar (Relenza) .  However, H5N1 isolates from Vietnam and Thailand are resistant to the anti-virals that target M2 as are H1N1 WSN/33 isolates from swine in Korea.  Tamiflu has weaker activity against N1 (H5N1 or H1N1) than N2 (H3N2).

The reports of additional influenza deaths are a concern because they are in the northeast instead of the south. Post-tsunami living conditions are less than ideal and the health care systems are over taxed.

Additional information on the human and animal influenza infections prior to the tsunami would be useful.

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