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Lack of Poultry Link In Bangladesh H5N1 Cluster
Recombinomics Commentary 01:45
March 18, 2011

The case is a 16 month old female from Kamalapur, Dhaka. She presented at a influenza sentinel surveillance on 8 March with a history of cough and fever and subsequently recovered.
A detailed epidemiological investigation and contact follow up is being conducted by a team of epidemiologists from IEDCR, ICDDRB and WHO Bangladesh.

[The 2 human cases of avian influenza A/H5N1 virus infection
identified recently in the Kamalapur area of Dhaka (only the 2nd and
3rd cases ever recorded in Bangladesh) are unusually in that both are
young children with mild symptoms of respiratory infection. Exposure
to infected poultry is a common feature, - Mod.CP]

The above WHO comments on the first H5N1 case in Bangladesh in 2011 clear do not cite a link between the confirmed case and poultry.  Similarly, the media reports on both cases fail to cite any link between the two H5N1 confirmed cases and poultry. 

Both patients presented at a surveillance center in Kamalapur, Dhaka with flu like symptoms,  This surveillance center typically takes samples from every fifth patient with flu-like symptoms, which are initially tested for influenza A.  Positives are sub-typed and those that are not sub-typable for H3N2 or H1N1 are then tested for H5N1.  In both cases, the H5N1 was detected via routine surveillance.  The above Promed comment (in brackets) on exposure to infected poultry is not supported by any public documents, and is rather misleading.  If ProMed has such evidence it should be cited specifically.

In the absence of such documentation, the two cases in Kamalapur bear a striking resemblance to the first two US H1N1 cases in the spring of 2009.  Like the Kamalapur cluster, the clustering was in time and space, but was not associated with contact with each other or an animal source. 

As happened in 2009 with H1N1, an epidemiological investigation is currently being conducted by WHO.

Test results on symptomatic contacts would be useful.

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