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Pneumonias in
Bird Flu Patients Becoming Complex

Recombinomics Commentary
January 22, 2005

>> According to the Health Ministry, pneumonia caused by H5N1 has been developing and becoming complex. To take urgent prevention measures, the PM assigned the Health Ministry to cooperate with other ministries, services and localities to immediately discover how the H5N1-infected patients contracted the disease; and urgently work out a plan to mobilise all existing resources, workforces and equipment to treat patients when an epidemic occurs, and submit it to the PM before Jan. 27 <<

The statement by the health Ministry that the pneumonia caused by H5N1 was becoming complex is unclear,  It may signal a genetic change that has affected the clinical presentation.  In the 1918 pandemic the influenza took on many forms that were frequently misdiagnosed as cholera, dengue fever, and typhoid.  One of the most striking complications was hemorrhaging from mucous membranes.

A new flu season brings in new sequences and the grey herons in  Hong Kong last month had new reassortments and novel genes.  Novel genes usually mean recombinants, and a recombinant that swapped the receptor binding domain of a human H1 or H3 with the avian binding domain on H5 could create a recombinant with efficient human to human transmission and a high case fatality rate.

The concern over the source of some of the infections raises the possibility of contamination of the food supply or more human to human transmission.  Earlier reports also indicated that pets in Ho Chi Minh City were dying from H5N1 infections.

Sequence information on new isolates would be useful as would more information on the complex pneumonias.
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