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Paradigm Shift Intervention Monitoring
Poultry Contact for H5N1
Bali Indonesia Fatality
The above translation, describing the recent fatal case near Bali, Indonesia notes the lack of a reported bird contact. This case follows a cluster of three with disease onset dates which supported human to human transmission, which was also supported by the recombinant H5N1 sequence from the mother (39M) of the first two cases (5F, 10M).
These lab confirmed cases increase concerns that the H5N1 in Indonesia is evolving toward efficient transmission. Clade 2.1 was the source for the H5N1 used by Ron Fouchier. After 10 passages in ferrets the virus had 5 changes in 2 genes and 4 of the 5 changes have been found in published sequences.
This alarming development has been overshadowed by concerns of bioterrorism and an NSABB recommendation to withhold details. This recommendation has been rejected by scientisis meeting in Geneva last week, who were given the details on the tranmssion studies.
The relative ease in the creation of a transmitting H5N1 or an H5 reassortant highlights the lack of preparation for a transmitting H5N1.
The current vaccine program has largely stockpiled older isolates, and although newer targets have been selected. Pandemic preparedness lags, and the only clade 2.1 vaccine target is the 2005 isolate from the initial Tangerang cluster.