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Acute Hemorrhagic Fever in Angola and Bird Flu Similarities

Recombinomics Commentary
March 18, 2005

>>  Jose Caetano, a WHO spokesman in Angola, said most of the victims were children with symptoms including fever, vomiting and diarrhea. He said at least 77 of the total of 83 people believed infected had died…..

Caetano said Angola's limited laboratory facilities had hampered identification of the disease and that samples had been sent to the U.S. Centers for Disease Control in Atlanta and the Pasteur Institute of Dakar in Senegal.

He said the first case had been detected in November.  <<

There are a number of parallels between the mystery Ebola / dengue hemorrhagic fever-like disease in Angola and bird flu.

Like the hemorrhagic fever disease in Angola, H5N1 in Vietnam began as a mysterious disease primarily infecting children.  After several deaths, the victims were initially described as Influenza A positive.  When H5N1 infections in poultry were reported in the Mekong Delta in the south, the children in Hanoi were said to have H5 infections.  Ultimately it was acknowledged that the infections were H5N1.  The virus was isolated and sequenced and found to be virtually identical to H5N1 in the south.

The cases were primarily respiratory, but there were examples of children presenting with gastro-intestinal illness as well as dengue fever symptoms.  The dengue fever diagnosis for the index case (11F) in Thailand led to unprotected visits by the mother, because dengue fever is not transmitted human-to-human.  The daughter was reported to have vomited blood while being held by her mother, who subsequently was also infected and died.  The aunt was H5N1 positive, after initially testing negative.  The aunt survived.  In the 1918 flu pandemic, dengue fever was a misdiagnosis for pandemic flu.

In Vietnam, the first reported infection in a health care worker was last month, as was a second health care worker with symptoms this month (the second health care worker tested negative, but the PCR assay only picks up 20% of H5N1 infections).

In Angola the identification of the infectious agent has taken a long time.  The first case was in November and dozens have died.  The WHO rushed in a team when health care workers began to show signs of infection.  In Vietnam, the initial cases appear to have been children because they were more likely to touch dead birds or care for the birds.  However, the familial clusters have been bimodal for disease onset dates indicating further human-to-human transmission.

Thus, in many respects Angola is like northern Vietnam in December, 2003.  Cases have been confined to a specific region and have predominantly affected children.  The cases are more like the gastro-intestinal version in Vietnam with associated bleeding, another common feature found in the flu pandemic of 1918 as well as H5N1 infections in Vietnam, especially in poultry.

The response has been slow in Angola, but now that health care workers have become ill, there should be more rapid progress.  Unfortunately, there have been no reports of Influenza A testing even though WHO has indicated previously that unexplained clusters of deaths would be tested for H5N1.

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