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US to Lead Delegation to SE Asia to Increase H5N1

Recombinomics Commentary

September 17, 2005

Leavitt said he would next month lead a delegation to Southeast Asia, where half of the 112 people affected by the disease had died, for talks with government leaders to seek "their critical involvement and personal commitment to preparedness and response."

During the visit to Thailand, Cambodia, Laos and Vietnam, Leavitt said he would be "negotiating agreements with the most affected nations to offer assistance to build their capacity, to identify outbreaks and respond rapidly when needed."

"We feel a common and genuine sense of urgency," he said, adding that his delegation could include World Health Organization (WHO) chief Lee Jong-wook as well as the heads of the UN Food and Agriculture Organization and World Animal Health Organization.

A day after Bush launched an international blitz to check avian flu's spread, the WHO, UN Food and Agriculture Organization and at least 16 nations agreed to join the campaign, US officials said.

They include Argentina, Australia, Britain, Cambodia, Canada, China, India, Japan, Malaysia, New Zealand, Nigeria, Russia, Singapore, Thailand and Vietnam.

The trip to southeast Asia is another step in the right direction.  The four countries on the itinerary all have endemic H5N1 that have proven fatal in humans.  The failure to report any cases in Thailand or Laos this year is almost certainly due to reporting or testing problems that have led to an under-reporting of cases.  In Laos and Cambodia, surveillance programs lack funding.  The lack of bird flu human cases in Thailand is highly suspect because of the large number of outbreaks in birds with H5N1 that is very similar to H5N1 from human cases in Vietnam and Cambodia.

An increased surveillance network in these critical countries is essential for early interventions and the cost is a tiny fraction of the damage that would be created by a pandemic.

It would also be useful to launch serious screening programs in Indonesia, Nepal, and India where under-reporting is likely to be high. These programs may indicate that even wider screening is required, but the sooner the better.  At this time, the extent of human infections is largely unknown and the new cases in Indonesia suggest many versions of H5N1 can infect humans.  More transparency in China is also required.  Samples from fatal cases in Sichuan province should be independently tested and sequence data in general should be made public more quickly.

The sequence data from southeast Asia from 2005 is extremely low.  There have only been two sequences from Thailand and for Vietnam there have been less than a dozen sequences and only H and N are available.  Similarly, there are no 2005 swine or poultry sequences from Indonesia.  These sequences exist and should be made public immediately.

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