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H5N1 Spread in Poultry and People in South Korea

Recombinomics Commentary 13:05
April 22, 2008

The two farms, which reported the deaths of 2,500 and 450 chickens, respectively, are located around 25 kilometers from an area where a bird flu outbreak was confirmed last Thursday, the ministry said. Samples tested positive in preliminary tests but the ministry said further investigation is required.

The latest cases in Iksan brought the number of suspected avian influenza outbreaks to 49 as of Tuesday morning. Of them, 26 have been confirmed to be related to a highly pathogenic bird flu virus, according to authorities.

The above comments describe further spread of H5N1 in South Korea (see satellite map).  However, the parsing by the ministry raises additional concerns of additional poultry and human cases.

Concern over the wording of statements became clear in the most recent OIE report on April 15.  At that time there were 11 confirmed outbreaks, but the report was careful to distinguish between the 6 H5N1 confirmed outbreaks and the 5 outbreaks that were HPAI H5 confirmed. 

However HPAI H5 confirmed indicates an HA cleavage site sequence has been generated, which is not only definitive for H5 and HPAI, but also indicates that the infection was due to H5N1 and probably the Uvs Lake strain of H5N1.  However, distinguishing between H5N1 and HPAI H5 allows the total number of cases to be split into the two categories.  Operationally, there is no difference since all birds are culled regardless of the state of characterization of the H5 infection.

However, the parsing of statements regarding H5N1 in birds also raises issues regarding H5N1 in soldiers culling the birds.  There appears to be one hospitalized culler with symptoms and two initial positive tests, which would indicate lab confirmed H5N1.  However, the issue of bacterial pneumonia has been raised, but bacterial pneumonia is a secondary infection associated with influenza, so the detection of bacteria or improvement after antibiotic treatment does not eliminate a primary diagnosis (or positive lab tests) of H5N1.

In addition to the cited 22 year old soldier, local media reports suggest as many as 20 additional suspect cases are hospitalized.  Concerns are also increased by the decision of the military to withdraw from culling operations.

More information on the hospitalized suspect cases would be useful.

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