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Bird Flu Case Fatality Rates Exceed 60% in Qinghai China?

Recombinomics Commentary
May 26, 2005

>> In the meantime, no response has been received to recent allegations of the occurrence of human cases of avian influenza in Qinghai province. We repeat our request for official, 1st-hand information; alternatively, scientifically-based data from non-official, reliable sources. The rumors might be false; there is no way to verify them, or to prevent further dissemination of inaccurate data and their damaging consequences -- except by providing accurate data on avian influenza in animals and humans, according to international codes and in a timely manner. - Mod.AS] <<

The above commentary by ProMed emphasizes the need for reliable information from Gangcha County in Qinghai province.  The descriptions of the human cases were quite detailed.  Initial reports described the deaths of six tourist, points of orign, and names of four fatalities..

The report on the 18 locations in Gangcha County was also quite specific, including the number of infections and deaths for each region.  The ratios of deaths to infections were striking (8/14, 6/15, 12/21, 11/14, 12/15, 6/13, 9/15, 8/11, 6/9, 3/5, 9/12, 7/9, 1/4, 3/5, 3/9, 1/4).  Thus, the case fatality rates ranged from 25% to 78% based on all infected patients recovering.  Since there were no reported discharges, the case fatality rates could go to 100%.  This number and frequency of deaths in a region with confirmed H5N1 deaths of migratory birds demands a detailed explanation.

If these 121 deaths did not happen, some sort of explanation is required.  If the deaths did happen, then more details on the cause of the deaths is required.  Blanket denials will not end the rumors or spread of the information.

In addition to these 200 cases in Gangcha Country, there were small numbers of infections and deaths in surrounding communities.

The coincidence of the human cases and H5N1 bird flu deaths requires detailed disclosures, not news blackouts..  The Chinese media reports suggested additional deaths in Tibet, but many of the deaths were in the homes of residents.  Thus, the range and extent of the reported deaths is quite alarming. 

The largest confirmed cluster in Vietnam was a family of five in Haiphong.  Some neighbors had symptoms and test results were not released, but the family of five recovered and deaths of neighbors were not reported.  Even cases in southern Vietnam and Cambodia, where case fatality rates approach 100%, the clusters are limited to 2 or 3 family members.

In contrast, the cases in Gangcha Country represent large cluster with frequent death.  The cause of this sudden increase in fatalities in the localized regions needs to be explained, even it is not associated with H5N1. 

However, since the time and location matched the confirmed H5N1 infections in five species of waterfowl, the suspicion level is extremely high.  The news and speculation will build and spread, until specifics are released.

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