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Poor Surveillance Limits Pandemic Containment Strategies
June 13, 2005
>> David Melville, a New Zealand-based ornithologist not affiliated with any research institute who studies migratory bird routes in Asia, says there is now a real possibility that these birds could carry the virus to their wintering grounds in India and Bangladesh, where there are no confirmed findings of H5N1. <<
Although there are no confirmed cases of H5N1 in India and Bangladesh, the bar headed geese that were found dead on May 4 at Qinghai Lake winter in Bangladesh and India. They can fly to Qinghai Lake in 24 hours. Thus, they likely brought H5N1 to Qinghai Lake from India and Bangladesh.
Antibodies in 2002 sera from poultry workers in India indicate H5N1 is present in India and can cause an immune response in exposed workers. Since there are no reported cases in India, but the poultry workers had not traveled outside of India, it seems likely that unreported H5N1 exists in India and Bangladesh.
Since the sequences in Qinghai Lake are similar to those in southeastern China it seems likely that H5N1 infections in birds and people are simply not being detected or reported.
A recent report in Promed described dying geese in Fujian Province. Although the geese had bird flu symptoms, they were not tested, so the etiological agent remains unknown, even though geese have been dying in Fujian province since the fall of 2003.
The poor surveillance/detection throughout southern and eastern Asia severely limits containment strategies. Unfortunately these are not new issues and there is little evidence of efforts to correct these glaring deficiencies.