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Paradigm Shift Intervention Monitoring
H5N1 Cases In Dhaka Bengladesh
The above comments describe three confirmed H5N1 cases in wet market workers in Dhaka, Bangladesh. The first case has been WHO confirmed and has recovered, but the three 2012 cases has doubled the number of H5N1 confirmed cases in Bangladesh. This significant up tick is almost certainly due to clade 220.127.116.11 which has now expanded its geographic spread and was confirmed in crows in India earlier this season. New sub-clade migrate into India and Bangladesh each season, which are closely related to each other.
The first human clade 2.3.2 was described in media reports in the spring of 2008 when a culler (soldier) developed symptoms and was H5 PCR confirmed. However, South Korea denied the culler was infected with clade 2.3.2 because prior human infections in China were clade 2.3.4. Moreover, South Korea used the failure to isolate the H5 virus as an excuse for not filing a report. However, the sequence had V223I and M230I, which were in the Gharbya cluster and fatal clade 18.104.22.168 cases were subsequently reported in China, including the recent case from Shenzhen who had no reported poultry contact (but had wild bird exposure).
The appearance of clade 2.3.2 in south Asia raised concerns of additional human cases, and the three confirmed cases in Bangladesh are likely confirmation of the realization of such concerns.