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Suspect H5N1 Patient in Rimouski Quebec Canada?
Recombinomics Commentary
November 29, 2006

Recombinomics has received several independent reports of a nine year old boy hospitalized in Rimouski, Quebec.  The patient has pneumonia and is in isolation.  More information on H5N1 testing on this patient would be useful.

NOTE: Recombinomics could not confirm the above patient.

Patients with H5N1 symptoms in this area are cause for concern.  In June, four goslings died on a farm on Prince Edward Island.  The birds had H5N1 symptoms and died suddenly.  One duck was PCR tested and was confirmed to be H5 positive.  The size of the insert was withheld and the Canadian National Labs in Winnipeg failed to confirm the confirmed PCR test on Prince Edward Island and failed to isolate the virus, so no mandatory OIE report was filed.

The refusal to disclose the size of the insert is cause for concern.  The Qinghai strain of H5N1 has four additional amino acids in its HA cleavage site, so the insert would be 12 BP larger than low path H5N1.  This difference should be apparent in the insert generated by the PCR test, but was not disclosed.

The symptoms associated with the fatal infections in the geese strongly suggested that the H5 was from high path H5N1, since waterfowl are generally resistant to low path H5,

Low path H5 has been isolated throughout Canada and the United States.  However, these isolates have been from healthy or hunter killed waterfowl.  The testing of dead or dying wild birds in the United States has been minimal.  Although 35,000 live or hunter killed birds have been tested, less than 1000 dead or dying wild birds in the continental United States, Alaska, and Hawaii have been tested.

In Canada, over 50% of the live birds tested on Prince Edward Island are positive for avian influenza, but only 106 live birds have been tested (54 positive).  This rate is twice as high as 2005 when 61/212 were positive. Prince Edward Island also has the highest percentage of avian influenza in dead birds (39/176). 

These high levels of avian influenza raise questions about the sensitivity of the serotype and isolation tests.  Details on testing in the United States show that the detection and isolation in live birds is low, and there have been no reports of H5N1 in the summary table of the US program.

The low numbers of tested birds in regions that are linked to H5 positive dead farm geese are cause for concern, as is the hospitalized pneumonia patient.

More data on the testing of this patient would be useful.

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