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Lack of Transparency in Pakistan Increases Pandemic Concerns

Recombinomics Commentary
December 21, 2007

Rainford declined to predict today how soon confirmatory testing in the eight cases, which were identified in preliminary tests by Pakistan's national lab, will be completed. He said some samples from the patients would be sent to London for analysis.

The above delays raise pandemic concerns.  These delays parallel the situation in Turkey, almost exactly two years ago.  Media reports indicated there were two large clusters in Turkey.  The first family involved four siblings and the were already unconscious when transferred to a larger hospital in Van.  Initial reports indicated all four were H5N1 negative, but the three that were unconscious never regained consciousness and died one after the other.  Fluid from the lungs of each fatal case came back positive for H5N1.  Ten members of the other family were hospitalized.  Local media reports indicated the two families were related.  Only two of the ten were confirmed positive, but their cousins were hospitalized a few days later and both were positive.  Twenty one cases were H5N1 confirmed and virtually every case was a cluster.

Up to that point, WHO had issued a situation update for each confirmed case.  The updates would include the age and gender of the confirmed case, the disease onset date, the date of hospitalization, the date of death, and the relationship to other confirmed or suspect cases.  The specific information was absent in WHO updates.  The updates were very general and lacked virtually all of the above detail.

Prior to the outbreaks, a change in the receptor binding domain was predicted based on the Qinghai H5N1 sequences and donor sequences in H9N2, which was endemic in the Middle East.  At the time of the prediction, there had been no reported human cases involving the Qinghai H5N1 sub-clade (2.2).  The first case in Turkey had the predicted  S227N receptor binding domain change.  Additional receptor binding domain changes were found in clusters in Iraq and Azerbaijan.  However, the sequences with these additional changes were withheld until they were mentioned in a publication almost a year later.  After that disclosure, the sequences were released.  However, sequences from birds in H5N1 outbreaks in 2005 and early 2006 still have not been released.

The withholding of this information increases pandemic concerns.

The current outbreak in Pakistan appears to be sustained for the longest period on record.  The initial cases were laboratory confirmed in October.  The lab confirmed cases were re-confirmed a week ago.  There has been no WHO updates on these cases.  The quote above promises more delays, which are almost certainly due to detection of receptor binding domain changes.

The lack of transparency increases pandemic concerns.

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