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Pandemic Preparedness: A Failure to Monitor Bird Flu
January 20, 2005
>> As of 5 January 2005, the H5N1 virus has caused 45 confirmed human cases, of which 32 were fatal. Among all these cases, two features are striking: the overwhelming concentration of cases in previously healthy children and young adults, and the very high mortality. No explanation for this unusual disease pattern is presently available. Nor is it possible to calculate a reliable case-fatality rate, as mildly symptomatic disease may be occurring in the community yet escape detection. <<
The problem with calculations of case fatality rates is the lack of testing. The case fatality rate has been quite consistent in Vietnam and Thailand (official and unofficial confirmed) for the early part of last year, over the summer in both countries, and now in Vietnam this year. The rate is above 70% and higher than that found in Ebola infections. An extensive review of severe flu-like cases that survived in Thailand failed to come up with a significant number of cases that tested positive for H5N1.
Thus, there has been little evidence of H5N1 infections in milder cases in Thailand and no reports in Vietnam to support the speculation by WHO. However there are cases that may be H5N1 that are not being tested. The most striking is in the Philippines, where cases with meningococcemia have generated a high case fatality rate, but have not been tested for avian flu even though meningococcemia is a secondary infection of patients with colds and influenza. Most of these patients are negative for the bacteria, yet have petechial rashes and fever, symptoms associated with pandemic flu of 1918 including being misdiagnosed as typhoid cases.
Pandemic flu of 1918 was frequently misdiagnosed as cholera, dengue, and typhoid. Fatal cases, including H5N1 avian influenza have been misdiagnosed. The most notable case was the index case of the strongest example of bird flu transmission from human to human in Thailand. The index case was initially diagnosed as dengue fever.
The failure to test patients in regions with pandemic H5N1 influenza does NOT buy time to develop vaccines. It allows for spread of H5N1 infections in areas at high risk for such spread including tsunami stricken areas.
The failure of governments to recognize the looming flu pandemic and commit appropriate resources is still scandalous.