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WHO Requests Site Visit of Qinghai Lake Bird Flu Outbreak
June 9, 2005
>> "We are worried," says Noureddin Mona, representative in Beijing of the Food and Agriculture Organization of the United Nations. "We should be prepared for the worst." He and other officials from the World Health Organization sent a letter to Chinese health officials on Wednesday requesting to visit the site of the outbreak of bird flu in Qinghai province, to see firsthand how the situation has been dealt with. <<
A visit by WHO to Gangcha County, Qinghai Province in China would be a positive step toward addressing a host of issues linked to the Qinghai Lake Nature Reserve H5N1 infections. The reports by China are of concern because waterfowl are not usually susceptible to H5N1 and the die-off has been unprecedented. Initially 178 bar headed geese were described. This report was of concern because the bar headed geese winter in northern India and can fly from India to Qinghai Lake in 24 hours, suggesting they may have brought H5N1 from India, where it has never been reported, although poultry workers have tested positive for H5N1,
The initial report was followed by an OIE report on May 21 which described 519 dead birds including the bar headed geese and four additional species. H5N1 was isolated from the birds, grown in chicken eggs and used in two tests to determine pathogenicity. One test sequenced the HA cleavage site while the other infected chickens with H5N1. Both tests verified that the H5N1 was highly pathogenic.
The OIE report was followed by a press conference that indicated over 1000 birds had died. These reports were followed by Abundant News reports indicating that over 8000 birds representing 12 species had died. In addition reports indicated several mammalian species, including domestic animals and humans had died.
The additional reports were not specifically addressed. Official statements indicated no human cases had been reported or confirmed and there were no pneumonia cases, but the Abundant News reports of 200 infected and 121 dead were not addressed specifically. All nature reserves in China had been closed, new fever clinics had been set up, 3 million doses of vaccine had been sent and mandatory vaccination of poultry in Qingahi, Xinjiang, and Tibet was ordered. In addition, a survey of 2 million birds in Qinghai was cited as evidence that the outbreak had been contained and was isolated.
However, on June 8 China filed another OIE report on approximately 2000 domestic geese on a backyard farm in Tachen city in Xinjian. About half of the geese were H5N1 positive and half of the positives had died. Although Tachen city is almost 1000 miles west of Qinghai Lake, both outbreaks involved large die-offs of geese and both were in migratory routes of bar headed geese which leave Indian in May and June and head for Qinghai Lake and locations further north.
The Xinjian geese were subjected to the same tests by the same Harbin lab, and the same results were reported. For the Qinghai outbreak the first deaths were noted on May 4, 17 days prior to the OIE report. The delay was due to time necessary to ship specimens across China, isolate virus, grow virus, and run a biological test to see how many laboratory infected chickens die.
The Xinjian outbreak was reported on June 8, indicating the outbreak was detected at about the same time as the May 21 OIE report. This would have been prior to official comments indicating the earlier outbreak was isolated and did not affect domestic poultry. Those announcement were carefully worded to address testing in Qinghai and exclude data on the known outbreak in domestic poultry in Xinjian. The exact date of the deaths is not public because a copy of the submitted June 8 OIE report did have the fields for date of first death or estimated time of the start of the outbreak filled in. The report does have an arrow in the left margin pointing at the missing data. Similarly, the official report at the OIE site leaves out those two fields.
Thus, although China has promptly filed two OIE reports on the two outbreaks, questions remain regarding the scope of the outbreaks, involvement of other mammals, including humans, and use of the emergency fever clinics set up to handle bird flu cases. Reports of human deaths also included tourists. More detail on these reports would be useful.
Therefore, an on-site visit by WHO would help dispel rumors over an outbreak that would be classified as phase 6 in the 2005 flu pandemic.