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Bird Flu in Kampot Cambodia - A Scandalous Failure
February 1, 2005
>> Officials in Cambodia and Laos likewise have reported no new outbreaks, but monitoring is notoriously incomplete in those countries, said Henry L. Niman, an infectious-disease expert who maintains an Internet mailing list on avian flu.
"All these numbers are artificially low," he said.
One sign that there may be unreported cases is the death of a 25-year-old Cambodian woman in Vietnam on Sunday. She had traveled to a Vietnamese border town seeking medical help.
Health officials have not confirmed that she had avian flu, but her symptoms were consistent with infection. <<
The numbers are not just artificially low, they represent a scandalous failure to monitor and test the most obvious bird flu cases. The most important concern regarding the current pandemic is the ability of H5N1 to acquire efficient human to human transmission. This is hard to evaluate because many patients do not get tested.
The Cambodian cases are striking examples. The index case is not the 25 year old Cambodian who has now been confirmed on Feb 1. The index case is her 14 year old brother who died Jan 18. Cambodian and Vietnamese officials say they will now look closer at other cases because this is the first case in Cambodia. However, the patient is the first confirmed case. Her brother is clearly a bird flu case and many more are likely.
Although media reports indicate chickens and ducks began dying a month ago, no reports of these deaths in Cambodia have been filed with OIE. Moreover, even though the brother died Jan 18 with bird flu symptoms, his sister was not tested at the clinic in Cambodia. She was tested in Vietnam.
The case clusters have become so common now, that a negative test on the sister would have indicated that there was a testing problem, not that she was H5N1 free,
There is clearly an increased incidence of human to human transmission, but media reports continue to cite common sources. The most striking was the raw duck meal of Dec 25 in Hanoi. The index case developed symptoms the following day which is too soon and his brother developed symptoms Jan 19, which is too late. A third brother may have developed antibodies a month later, and the other guests at the funeral apparently have no symptoms and tested negative for H5N1, but media reports indicate that the source of the infection from the meal was "equally likely" as the index case infecting his caregiver brother.
Relatives that develop symptoms a week or two apart are unlikely to have developed infections from a common source. The second infection is most likely human to human transmission from the first infection.
The failure to test these likely bird flu patients remains scandalous. In November there were reports of patients with flu-like symptoms crossing the Thai border from Laos and Cambodia for treatment and more recently of Cambodians crossing the Vietnamese border seeking treatment in Ha Tien. Rather than test the patients, officials were waiting for H5N1 confirmation in the patient described above
They need not wait any longer. Testing of patients and contacts for H5N1 avian influenza transmission in Cambodia and border towns is long overdue.
Index case, brother (14M) of Soc Khol. He had developed high fever, bad cough, and breathing problems and died Jan 18. Sister, Soc Khol, (25F) admitted to hospital in Vietnam on Jan 28, died Jan 30. Confirmed positive on Feb 1 Reports of dying chickens and ducks in Dec in area. Additional reports of many patients in Kampot traveling to Ha Tien town for treatment.
Suspect cases will be added to tallies and be considered "still unconfirmed" until two laboratory results suggest that the cases are NOT H5N1 positive. Thus, both cases from Kampot are considered positive for H5N1.