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Paradigm Shift Intervention Monitoring
A 13-month-old girl was detected with
bird flu virus in the capital yesterday.
The girl, however, is not having any serious breathing problem, which is normally the case.
The symptom is so mild that it has been detected because of the extensive surveillance, Mahmudur said, adding that proper treatment of the girl has been ensured.
"She is fine now and will recover soon."
The above comments describe a mild H5N1 case in Dhaka, Bangladesh. This case follows the first confirmed case in Bangladesh (also in Dhaka), who had symptoms in January, 2008, but was not reported until May, 2008.
Like this year’s case, a link to birds was not described, and treatment with an antiviral was not stated. These two cases strongly suggested that H5n1 infections in Bangladesh and India are far more widespread than the two confirmed cases in Bangladesh (and no confirmed cases in India).
Recently Israel also reported a suspect case with mild symptoms that was not lab confirmed. However, the frequent reports of human cases in Egypt strongly suggest that the lack of confirmed cases in Israel is surveillance / reporting related, which is also the case for India.
Testing for H5N1 in humans remains abysmal. Many countries with high levels of H5N1 in poultry, like Egypt or Indonesia, rarely test symptomatic cases that do not have a poultry link. Milder cases, such as the above case, would rarely seek medical attention, and most who did would rarely be tested for H5N1.
The recent receptor binding domain change (S227R) reported in H5N1 in Japan continues to increase concerns that H5N1 in humans is widespread in patients who are not tested.