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A Billion Bird Flu Human Fatalities?

Recombinomics Commentary
January 13, 2005

>> At issue is H5N1, a new strain of bird flu that so far has killed a few dozen people in Asia -- nearly three quarters of the number of people known to have been infected. Scientists fear the virus will spontaneously mutate or swap parts of its genetic code with another virus, and thereby become more transmissible. They hope that in doing so, it also will become less lethal. But there is no way to know.<<

The above quote in The Wall Street Journal raises the same issue that had been raised before.  Can H5N1 efficiently transmit and retain its 70% lethality in humans?  Applying that kill ratio to WHO estimates of infections in 20 to 50% of the world's population generates a figure of over 1 billion human fatalities.

As noted earlier, if H5N1 recombined with a virus that is efficiently transmitted human to human, it could become more efficient at transmitting human to human. It could pick up the human receptor binding domain and by keeping the rest of the genome intact, its case fatality rate could remain at approximately 70%.

Until now such a possibility has been theoretical because H5N1 human to human transmission has not been efficient in Vietnam or Thailand.  However, the etiological agent that is causing the meningococcemia-like deaths in The Philippines has met that definition.  There is circumstantial evidence that this infectious agent is bird flu.  The symptoms are similar to those described for the 1918 pandemic flu.  Baguio City is in the flight path of migratory birds, which transport and transmit H5N1.  The cases of meningoccemia-like illness follow the same seasonal pattern as H5N1 human infections.  Most remarkably, there is little or no mention of avian influenza testing in the fatal cases in the Philippines.

However, regardless of the identity of the infectious agent, it has a case fatality rate of approximately 70% and its reported transmission human to human is more efficient than the reported transmission of H5N1 in Vietnam and Thailand.  The response to this agent may be too little too late, although the transmission rate seems to still be a notch below what is required for infection of 20 to 50% or the world's population.

Regardless of the identity of the agent, the preparedness of the world is far from adequate, and as noted in this week's Nature editorial entitled Dangerous State of Denial, "Despite the warning shots of SARS and last year's Asian outbreak of avian flu, governments are still not doing enough to monitor and prepare for the next viral pandemic. This inaction is scandalous."

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