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H5N1 Confirmed In Another Bangladesh Toddler
Recombinomics Commentary 16:35
March 16, 2011

Another human case of avian influenza has been detected in the Kamalapur area of the capital, two days after a 13-month-old girl was found carrying the H5N1 virus in the same locality.

IEDCR director Prof Mahmudur Rahman told that a 31-month-old boy had been detected carrying the virus in their lab.

They tested nasal as well as throat swab and blood to confirm the case. The boy showed up with mild symptoms including fever and cough at the IEDCR and ICDDR,B joint surveillance site at Kamalapur, the director said.

Prof Rahman, however, said that the boy was not related to the earlier case.

The above comments on a second confirmed H5N1case (2M) in the same region of Dhaka, Bangladesh (Kamalapur area) raise pandemic concerns.  Both cases were mild and not linked, suggesting the number of H5N1 infections is markedly higher than the two confirmed cases. 

This epidemiology is similar to the initial H1N1 cases in southern California in the spring of 2009, where the absence of linkage or swine contact indicated the number of unreported cases was large.

Both cases were detected via surveillance and involved swabs from the upper respiratory tract, which would increase the potential for human to human transmission.  Neither report mentioned contact with birds, increasing concerns that H5N1 is transmitting in humans in Bangladesh.

Recently released H5N1 sequences from wild birds in Japan (Hokkaido and Fukushima) have receptor binding domain change S227R, in addition to V223I and M230I, has raised concerns of human transmission.

More detail on symptomatic contacts and sequences from the confirmed cases in Bangladesh would be useful.

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