The Coming Influenza Pandemic?

January 30 Flu Update

So there you have it. The Fourth Horse of the Apolcalypse is cantering towards a war torn area with a destroyed civil infrastructure, overwhelmed medical facilities and 160,000 foreign occupiers poised to become global vectors.

A Reuters report from Geneva today said Iraq is investigating a possible third human case of H5N1 infection. That case involves a 54-year-old woman who was hospitalized on Jan 18 with respiratory symptoms and is still being treated, World Health Organization (WHO) officials told Reuters. She is from the same area in northern Iraq, near the city of Sulaimaniya, as the girl and her uncle.

In addition, the Times quoted health minister Dr. Abdul Mutaleb Mohamed Ali as saying that two other people in other parts of Iraq had been tested for H5N1 infection, but the story gave no results or details in those suspected cases.

Confirmation of the teen-aged girl's infection prior to discovery of poultry outbreaks in Iraq suggests that H5N1 may be spreading stealthily, under the radar of existing surveillance systems, the newspaper noted.

"We shouldn't be seeing human cases first, and this points to serious gaps in surveillance," WHO spokeswoman Maria Cheng said in that story. "But given the situation in Turkey, I don't think we'd be surprised to see isolated human cases in surrounding areas."

Even if the London lab confirms all 21, the evidence from the outbreaks in Southeast Asia and China paints a different picture: a high death rate and very little sign of the type of mild infections that might initially evade detection.

"The evidence for widespread asymptomatic infections is just not there," says Michael Perdue, a scientist with the World Health Organization's global influenza program in Geneva.

Certainly the odd case here and there probably went unnoticed, the experts assume. Mild cases are more likely to fall through the surveillance net than severe ones.

But a number of studies have been done in Vietnam, Thailand and Indonesia looking for antibodies to the virus in the blood of people who were exposed but who didn't show signs of being ill, including chicken cullers, relatives of known cases and hospital staff who cared for H5N1 patients.

"And they essentially found zero. They haven't found any," says Dr. Scott Dowell, director of global disease detection and preparedness at the U.S. Centers for Disease Control in Atlanta.

Keeping the taps flowing, the lights glowing, and food on the shelves may be a higher priority than caring for the ill during an influenza pandemic, the United Nations' coordinator for avian and pandemic flu has said.

"It may be more important to concentrate on the essentials of life for those who are living than it is to focus on the treatment of those who are sick," said David Nabarro, as quoted in a Jan 28 Reuters report following a pandemic simulation exercise.

posted by Orange @ 10:19 PM