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Human to Human Transmission of H5N1 Bird Flu in Asia

Recombinomics Commentary

July 15, 2005

The victims, a 38-year-old man and his two girls, ages nine and one, would be the country's first human fatalities linked to the virus. They lived in a suburb of Jakarta and all died in the last week and a half, Health Minister Siti Fadilah Supari said.

But Dr. Georg Petersen, a WHO representative, said that while the three Indonesian family members had no known contact with poultry, a more thorough investigation could turn up evidence to the contrary.

"In other countries, this is often the case," he said.

The comments above by yet another WHO representative misrepresenting the data on human-to-human transmission of H5N1 bird flu in Asia is unfortunate, but not unexpected.  Today's Science has a figure showing that WHO places the flu pandemic at stage three, which was also stated last week in a Nature news story on the Qinghai sequences.  Clearly, WHO is misrepresenting the stage of the current flu pandemic.

Stage four of the pandemic is represented by small dead end human-to human transmission.  There have been over a dozen of such H5N1 clusters beginning in early 2004 in Vietnam.  These clusters are characterized by a bimodal distribution, which is present in virtually every familial H5N1 cluster in Vietnam, Thailand, and Cambodia.  This is true in the current cluster in Indonesia.  Both the husband and one-year-old sister developed symptoms after the index case was hospitalized last month.  The two secondary transmissions were hospitalized on July 7.  This 5-10 day gap between the index case and subsequent infections in family members is the hall mark of familial human-to-human transmission of H5N1.  It has been laboratory confirmed in Vietnam, Thailand, and Cambodia.

WHO disregards the fact that virtually all familial clusters have been bimodal and instead tries to find alternative explanations, which make little sense epidemiologically, but are fed to the media and even the top peer reviewed scientific journals.  They then faithfully publish the data, misrepresenting the true stage of the 2005 flu pandemic.

One bimodal distribution within a family is highly suggestive of human-to-human transmission.  Two such clusters move human-to-human transmission to near certainty.  Over a dozen such familial clusters leave little doubt, yet WHO has told the media that the pandemic is at stage 3. The familial clusters are clear examples of limited human-to-human transmission, which is the definition of stage 4.

The expansion of these clusters has happened in northern Vietnam, signaling stage 5 and if reports out of Qinghai are accurate, then the stage has already moved to phase 6, the final stage.

The listing of the pandemic stage at 3 in today's Science is beyond scandalous.  It is a clear misrepresentation of the facts.  Such misrepresentations by WHO encourage countries to issue misleading information, as happened once again in Indonesia. 

The latest misrepresentations extend the commission by omission statements throughout Asia, including the lack of 2005 OIE reports on H5N1 in China.  Widespread 2005 H5N1 infections in China were demonstrated by sequence data from 2005 isolates in Fujian, Shantou, Hunan, and Yunnan provinces.

The human-to-human transmission in Indonesia now represents the fourth country with reported human-to-human transmission of H5N1.  Vietnam and Thailand reported such clusters in 2004   Vietnam and Cambodia had familial human clusters in 2005.  Third party reports indicate China had much larger clusters in 2005 

The real question of stages is if the true level is 5 or 6.

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