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Vigilance Lacking in Bird Flu Monitoring

Recombinomics Commentary
February 20, 2005

>> Thailand and Vietnam have ordered the slaughter of millions of chickens and the alteration of centuries-old farming methods, with mixed results. There is no vaccine, but, even if one could be produced to fight the constantly evolving strains of the virus, it would be impossible to meet the overwhelming demand. "Vigilance," Specter writes, "is one of the few weapons available." As one senior official at the Thai Ministry of Public Health says, "We are certainly better than we ever were at detecting viruses. But we are also much better at spreading them." <<

Although detection of H5N1 is better than ever, there is still much room for improvement, especially when so little testing is done.  Thailand had 17 cases and 12 official bird flu deaths last season, and no reported cases this season, but both numbers lack credibility.  A review of some of the most obvious cases last season identified 12 laboratory confirmed cases.  8 died, so those cases alone would almost double the cases from last season, yet they are not included in the official tally. The index case for the most widely cited example of human-to-human transmission is also not in the official tally because she was misdiagnosed as dengue fever and never tested for bird flu..  The same report found 21 more suspect cases, but lack of clinical samples precluded confirmation.

This season there have been two recent likely H5N1 cases.  One was reported to be positive for influenza A but negative for H5N1.  There have been no follow-up reports on either case, and the lack of any human cases in Thailand seems unlikely.

Moreover, the recent New England Journal report on cases that had fatal H5N1 infections but failed to initially show respiratory symptoms raises the specter of more untested and / or unreported cases, which may extend well beyond the borders of Vietnam or Thailand.

In view of the fact that vigilance is one of the few weapons available, the failure to monitor H5N1 avian influenza remains scandalous.

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