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Another Confirmed H5N1 Case in Hunan China Raises Concens
Recombinomics Commentary 13:53
January 31, 2009

female, 21 years old, farmers, who lives in Hunan Province溆浦县. Patients January 23, 2009 in the incidence溆浦县whose condition had worsened in the January 26 People's Hospital溆浦县treatment, January 29 transferred to Changsha Xiangya Hospital, Central South University hospital. At present, the basic stability of patients, clinical symptoms improved significantly and are actively in treatment.

results for the birds H5N1 influenza virus nucleic acid positive. Epidemiological survey found that patients had come into contact with dead poultry

The above translation from the Ministry of Health website describes the eighth H5N1 confirmed case in the past several weeks (see updated map).  Unlike the earlier cases, this victim is not in critical condition, but the treatment location is near two earlier Hunan cases.  One (2F) was H5N1 confirmed and recovering.  Her mother died with bird flu symptoms, when her daughter developed symptoms, confirming that the mother infected her daughter, as indicated by matching symptoms as described by the husband/father of the victims.  However, no sample was tested from the mother, so she is not listed as a confirmed case by the WHO, and in fact is ignored in the WHO statement that all contacts linked to the confirmed case were "healthy".  This denial of H2H transmission is repeated by comments in ProMED as well as subsequent statements by WHO, which have no credibility or scientific basis.

The above translation also notes positive H5N1 poultry linked to the latest case, which is contradicted by statements associated with the earlier Hunan cases which noted that no H5N1 positive poultry was found in Hunan or Shanxi.  The absence of H5N1 in poultry is supported by the absence of any recent OIE H5N1 reports from China, other than the two vaccine resistant December outbreaks in Jiangsu.

Thus, China has not filed any OIE reports on H5N1 positive poultry linked to the eight confirmed cases, including the most recent case.  The clustering of three cases in Hunan, and the spate of confirmed cases throughout the country signal a more efficient transmission of H5N1.

Sequence data has not been released for any of the confirmed cases.  The poultry outbreak in Jiangsu is said to be related to earlier outbreaks in Shanxi, which was clade 7.  However, specifics on the isolate from the case in Beijing, A/Beijing/1/2009 have not been released.  It was said to be similar to H5N1 isolates in China collected between 2005-2008, but that description would apply to clade 2.3.4, which has been linked to the majority of prior human infections in China, but the description would also apply to clade 7, which was isolated in Hunan in 2006, as well as multiple northern locations in China, which had multiple poultry outbreaks in 2005/2006 which were not controlled by the poultry vaccines

A poor match between vaccines directed against clade 2 and clade 7 is expected.  WHO has selected a clade 7 vaccine target from a 2008 isolate in Vietnam, and WHO has acknowledged that the cross reactivity between clade 1 and 2 vaccine with clade 7 is poor, but WHO has withheld the sequence of the vaccine target, which is indefensible.

Release of the sequences from the human and poultry outbreaks in China, as well as outbreaks in Vietnam, including the clade 7 vaccine target are long overdue.

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