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China Fails to Respond to WHO H5N1 Bird Flu Requests
July 19, 2005
The Chinese government has not provided information requested urgently by international health experts about recent avian flu outbreaks in birds, which now threaten to spread the highly lethal virus to previously unaffected countries, according to U.N. officials and independent researchers.
World Health Organization officials and other international health organizations have asked the Chinese government for details about three outbreaks in the remote western provinces of Qinghai and Xinjiang. In seeking to head off a potential human pandemic, international health experts said they require samples of the bird flu virus, analyses of its genetic makeup and specifics about the extent of the infection and efforts to contain it.
The delay in the approval of a WHO request to visit the two sites of H5N1 outbreaks in Xinjiang Province is cause for concern. After a three week delay, WHO did visit the site of the H5N1 outbreak at Qinghai Lake Nature Reserve. Recent publications in Nature and Science describe Qinghai isolates that are unusually virulent. The original OIE report by China describe 519 migratory birds that had died from H5N1. The dominant species was bar headed geese, but four other species were described. Migratory birds are usually resistant to H5N1 infections and the size of the H5N1 outbreak was unprecedented.
Shortly after the Qinhai outbreak China reported two additional outbreaks in neighboring Xinjiang province. The two reports cited migratory birds as the source of the H5N1. WHO's request to add Xinjiang to their Qinghai visit. The request was denied and a request for a second visit has not been answered.
The on site visit is important for several reasons. Third party reports indicated there had been fatal human infections associated with the Qinghai outbreak. China denied that there were human H5N1 cases, indicating there were no reported human positives. However, WHO was told that only two patients were tested, and the probes used in the test were questionable. Although 600 others had been exposed, they were not tested because they were "dispersed".
Additional reports by boxun indicated H5N1 infections in humans were widespread. 10 strains of H5N1 were detailed and 8 had been detected in human cases. The most virulent was RX7 which appears to be the same as the isolates described in nature and Science. However, boxun reports described at least two additional strains from Qingahi, indicating dual or even triple infections were occurring in poultry. The dual infections can lead to new reassortants and recombinants, leading to further destabilization of the H5N1 gene pool.
In addition there were reports of pneumonia clusters in Tacheng, site of the first reported outbreak in Xinjiang. Reports described an isolation ward for patients and health care workers because of bacterial pneumonia. However, bacterial pneumonia is generally not very infectious or serious, raising suspicions of H5N1 infections in Tacheng, located 5 miles from the Kazakhstan border and about 100 miles from borders with Russia and Mongolia.
After the Qinghai visit, WHO recommended that China share sequences and samples and aggressively collect samples from asymptomatic birds at Qinghai Lake before they return to India, Europe, and southeast Asia. It is unclear if samples were collected, but new samples or sequences from China have not been provided, raising additional concerns that the boxun reports of widespread human infections in China are correct. China has never reported any H5N1 infections in humans.
The migration of H5N1 infected waterfowl could spread H5N1 worldwide, and China's failure to cooperate is cause for concern.