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Casual Transmission of H5N1 in Thailand and Indonesia
October 26, 2005
The three French tourists who tested positive for H5N1 after visiting a bird park in Thailand clearly show that H5N1 in Thailand is transmitted by casual contact. H5N1 positive data suggest that hundreds or thousands of visitors would have also been infected by the H5N1 at the zoo. However, these infectiosn produced mild cases, which were tested early because they had returned to the French Island of Reunion from Thailand.
The index case was weak and had a headache. When he tested positive, other members of the 19 person tour group were questioned and two had bird flu symptoms. They too tested positive for H5N1.
The testing on the three tourists was similar to nephews in Indonesia who also were H5N1 positive, although they had mild cases. They were tested because their aunt or uncle has already tested positive for H5N1. Both nephews recovered and have been discharged.
The testing of the above positive cases is in marked contrast to how most testing is done. Most cases are first seen by a doctor, and if hospitalized, they are not tested initially. Only those that don't quickly recover are sent to infectious disease hospitals, but when samples are collected there the H5N1 has been cleared of the nose and throat so the swabs are negative. This happened to a number of visitors to the Ragunan Zoo in Jakarta. However, a much larger group was turned away and not tested because their symptoms were mild.
Thailand claims to have has 1134 suspect bird flu cases but not positives for H5N1 until last week. Clearly their testing is systematically generating false negatives by collecting samples at the wrong time.
The familial and geographic clusters in Thailand and Indonesia support widespread transmission of H5N1 that produces mild cases. The true extent of the spread of H5N1 in human populations is unknown because of the systematic generation of false negatives. Moreover, the refusal to test symptomatic patients because of a lack of contact with poultry excludes detection of human-to-human transmission.
The export of H5N1 by commercial jet liner is a serious threat to the world's health and the requirement for contact with poultry screens out the human-to-human cases.
WHO has been able to maintain the false pandemic phase 3 by systematically screening out examples of human-to-human transmission.
These activities endanger the world's health and these methodologies should be subject to outside review.
The three tourists clearly demonstrate the abuse of the screening of human-to-human transmission of H5N1, which is designed to minimize or eliminate the detection of human-to-human transmission of H5N1, especial when the transmission produces mild cases.
The 2005 pandemic is at phase 5 or 6 and appropriate action is warranted.