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Meningococcemia / Meningitis Deaths in the Philippines Bird Flu?

Recombinomics Commentary
February 16, 2005

>> These cases emphasize that avian influenza A (H5N1) should be included in the differential diagnosis of a much wider clinical spectrum of disease than previously considered and that clinical surveillance of influenza H5N1 should focus not only on respiratory illnesses, but also on clusters of unexplained deaths or severe illnesses of any kind. Awareness of the full clinical spectrum is essential to appropriate management of the illness, since treatment with antiviral agents is likely to be beneficial only when it is started early in the course of illness.<<

The meningococcemia clusters in The Philippines clearly fall into the "clusters of unexplained deaths" category.  Meningococcemia cases are usually under 4 and require close physical contact. However, in the Philippines in and around Baguio City, there were several clusters of cases that involved brief encounters. 

One striking example was the five deaths linked to a funeral. The index case had died of meningococcemia and four who came to the funeral were dead 10 days later.  There were several clusters in the Philippines this season and the case fatality ratio was around 70%, the same as bird flu.

The Philippines are in the flight path of migratory birds.  Meningococcemia is a secondary infection in influenza patients, but there were no reports of any of the cases being tested for H5N1, even when 5 deaths were linked to a funeral.

There were also a series of deaths in the Cebu City jail in the Philippines, and again no testing for bird flu.

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