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Mysterious Disease Kills 22 in Western Nepal

Recombinomics Commentary
June 16, 2005

>>  At least 14 people died of diarrhea and eight others died of undiagnosed disease in two different districts of far-western Nepal, the Source reported Wednesday.

"More than 14 people died of diarrhoea in Toleni village of Doti district in the last three weeks," it quoted Hikmat Bahadur Bogati, an official at district health office as telling reporters.

About 80 people in the village are seriously ill and there is no medicine for them, he noted.

"A health worker team has already been dispatched to the epidemic affected area," he added. Xinhua also reported that eight civilians died from an undiagnosed disease in Bajura district in the past one week. <<

Mysterious fatal diseases in Nepal at this time are cause for concern.  The H5N1 infected bar headed geese found dead in Qinghai Lake Nature Reserve in May winter on the northern plains of India.  Thus, these birds would fly over Nepal when migrating from India to China.

In Vietnam, H5N1 bird flu infections can be found in asymptomatic ducks and geese.  These birds excrete large amounts of stable H5N1, causing potential pollution problems. The H5N1 in fatal humans infections in Vietnam can produce these asymptomatic conditions in laboratory ducks.

Thus, it is possible that H5N1 infected geese from India could spread human disease linked to their migratory flight path.  After H5N1 was discovered in patients with gastro-intestinal or neurological conditions, WHO had indicated that H5N1 testing of cluster of unexplained deaths would begin.

The 22 deaths described above would clearly meet that definition, but there are no hints of H5N1 testing of these cases or meningitis cases in northern India, which is very close to these two outbreaks in western Nepal.

Although WHO has expressed concerns about delayed reporting of H5N1 cases in Vietnam, surveillance of H5N1 outside of Vietnam also appears to be lacking.  A much more aggressive surveillance program is required to understand exactly where H5N1 is and isn't in human and animal populations in Asia.

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