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WHO Update on H5N1 in Pakistan Lacks Detail

Recombinomics Commentary 16:20
December 27, 2007

The first case of human infection with H5N1 avian influenza has been confirmed in Pakistan. Laboratory tests conducted by the WHO H5 Reference Laboratory in Cairo, Egypt and WHO Collaborating Center for Reference and Research on Influenza, in London, United Kingdom have confirmed the presence of avian influenza virus strain A(H5N1) in samples collected from one case in an affected family. Additional laboratory analysis, including gene sequencing, is ongoing.

The above comments from the WHO update confirm H5N1 in a large cluster in Pakistan.  Media reports indicated the index case developed symptoms on October 25 and two brothers died on November 19 and 29.  The December 27 WHO update has no specific information on disease onset dates, hospitalization dates, dates of death, or relationships between confirmed cases.  WHO has indicated notification of the outbreaks were delayed until after the news of the cluster was widely discussed on the internet, the week of December 10.

The delays in notification, coupled with the delays in confirmation after notification, remains causes for concern.

The number of H5N1 cases in Pakistan remains unclear.  Media reports have described a case on December 6 and recent reports describe a new suspect case.  Pakistan has had H5N1 cases throughout 2006 and 2007 in poultry, but no H5N1sequences from the outbreaks have been made public.  Similarly, outbreaks have also been reported in Afghanistan and India, and no 2007 sequences from either country have been made public.

The lack of transparency has been a cause for concern, and the growing turmoil following the assassination of Benazir Bhutto in the region increases concerns with regard to information flow.

A detailed WHO update on information and samples gathered last week would be useful.

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