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  • AFD - Pakistan Outbreaks

    Pakistan Reporting New Bird Flu Outbreak In Poultry

    # 2096

    We've heard relatively little about bird flu out of Pakistan since last February's outbreaks, when we were treated to blatantly false assurances from the poultry Industry that the H5N1 virus posed no threat to humans.

    A sample of that propaganda follows:

    ?Poultry safe for use, no threat of bird flu outbreak?

    Wednesday, February 06, 2008

    ISLAMABAD: Poultry meat and eggs are safe for use and there are no threats of bird flu outbreak, said World Poultry Science Association, Pakistan Branch President Dr Mohammad Sadiq in a press conference here on Tuesday.
    He said that there was not a single case in the world where a person was reported to have died after touching the affected poultry meat.

    This quiescence in reporting has been broken by today's story detailing the sudden deaths of 4,000 birds and positive tests for the H5N1 virus.

    Pakistan reports new bird flu outbreak

    Posted: 23 June 2008 0034 hrs
    PESHAWAR, Pakistan - Pakistani authorities Sunday reported a new outbreak of avian flu at a commercial poultry farm in the country's northwest, killing thousands of birds, officials said.

    Tests conducted at a government-run laboratory in Islamabad confirmed the presence of the deadly H5N1 strain of bird flu at a farm in Swabi district, local livestock department chief Ibrahim Khan told AFP.

    "The virus was detected after the owner of the farm informed us on Friday that some 4,000 birds had died within the past few days," he said.

    "We got the confirmation on Saturday, sealed the farm and culled around 2,000 birds," he said.

    All workers on the affected farm were examined by the ministry of health but none was found to have been affected by the virus, he added.

    Local health officials are monitoring surrounding farms and advised them to take precautionary measures including vaccination of birds, he said.

    posted by FLA_MEDIC @ 12:55 PM

  • #2
    Re: AFD - Pakistan Outbreaks

    Pakistani Poultry Industry Disputes Govt Tests

    # 2104

    In an interesting turn of events, the Swabi Poultry Association (SPA) in Pakistan is disputing government tests that confirmed the presence of the H5N1 virus in chickens at a Swabi poultry farm several days ago.

    The SPA insists that the poultry were infected with H5N9, not the H5N1 bird flu virus, and is demanding the government repeat the tests.
    It should be noted that Pakistani Poultry Industry spokesmen have a history of being less than forthright about H5N1 bird flu, downplaying the dangers at every turn.

    This report from last February is but one example.

    Whether this is another example of over zealous protection of their industry, or a real instance of misidentification of the virus by government labs, is impossible to know at this time.

    Thus far, there has been no reported response from Pakistani authorities.

    Swabi Poultry Association says H5N9 mistaken for H5N1

    Staff Report

    SWABI: Swabi Poultry Association (SPA) on Wednesday staged a protest demonstration against District Livestock and Dairy Development Department and National Research Institute (NRI), Islamabad, for what they called ?mistaking an H5N9 strain for H5N1? that caused bird flu.

    The authorities had detected H5N1 strain at a poultry farm in Swabi three days ago and ordered immediate closure of the farm and culling of 2,000 birds.

    The association?s office-bearers said that they had conducted their own test at the Poultry Research Institute (PRI), Rawalpindi, where the strain was identified as H5N9.

    The association?s president, Zabiullah, demanded that the government constitute an impartial committee that should take samples for fresh tests. He warned that if the government failed to listen to their demand till June 30, they would hold a hunger strike camp in front of the NWFP Assembly.
    posted by FLA_MEDIC @ 6:05 PM


    • #3
      Re: AFD - Pakistan Outbreaks

      No Good Deed Goes Unpunished

      # 2011

      A minor soap opera with major implications has been going on in Pakistan the past couple of days.

      As my readers are well aware, officials of the Pakistani Poultry Industry apparently carry significant sway with some Pakistani government officials.

      Together, they've been very protective of the industry.

      Three days ago news broke that a provincial livestock officer has been suddenly transferred as `punishment' for revealing that bird flu had broken out at a farm in the Swabi district.

      This is from Pakistan's Dawn newspaper.

      PESHAWAR: Official made scapegoat in bird flu controversy
      By Ashfaq Yusufzai
      PESHAWAR, June 26: The provincial government has transferred an official of the livestock department from Swabi to Mardan as punishment for allegedly disclosing that H5N1 strain of bird flu influenza had been detected in a poultry farm of the district, sources told Dawn.

      They claimed that on the advice of a local MPA, who favoured the poultry farm owners, Basic Livestock Officer Mohammad Ibrahim was made a scapegoat for revealing the information and ?transferred within a day as the process usually takes a month?.

      Earlier, the livestock department had conducted a test of poultry samples at the National Research Institute Islamabad that reportedly detected H5N1 virus in the poultry samples taken from a poultry farm in Tordher, Swabi.

      In contrast to this report, the Poultry Association Swabi claimed that they had conducted a similar test of the poultry sample at the Poultry Research Institute Rawalpindi, which identified the virus as H5N9, which was not dangerous for human beings.

      I reported on the testing by the Poultry industry here, and thus far, there is nothing but their statement to support their claim.

      The immediate, and very public, punishment of this livestock officer for revealing the Truth is no doubt intended as a signal to others who might be similarly inclined. A shot across their collective bows, warning them to keep their mouths shut.
      This sort of suppression of the truth isn't exactly new, nor is it exclusive to Pakistan. It happens all over the world.

      The stakes here, however, are enormous. Turning a blind eye to outbreaks of H5N1, or disguising them as something more `convenient' places the world at risk.

      Fortunately some officials, including representatives from WHO, have come to the defense of District Livestock officer Dr Mohammad Ibrahim.

      This from yesterday's Dawn Newspaper.

      SWABI: WHO, federal secy against livestock officer?s transfer

      By Our Correspondent
      SWABI, June 28: The World Health Organisation and the federal secretary for agriculture want cancelled the transfer of the district livestock officer to make the drive against bird flu in Swabi more result-oriented after detection of H5N1 in a poultry farm in the district?s Tordher village a week ago.

      Sources told Dawn on Saturday that the federal secretary, WHO officials and all staff concerned stood against what they called the unjust transfer.

      District livestock officer Dr Mohammad Ibrahim was made ?scapegoat? for his action against a bird flu-hit poultry farm which was immediately closed and about 2,000 birds were culled by officials of livestock and the WHO with the help of the local administration. Poultry farmers, however, have rejected reports of bird flu detection in the district as wrong.

      When contacted, Dr Zia, WHO chief for the National Programme for Control and Prevention of Avian Influenza in the NWFP, told Dawn by phone from Peshawar that the transfer of the livestock officer was disturbing because under his supervision acquiring samplings from the H5N1 detecting region was vital.

      ?He was threatened with dire consequences when we reached for culling last Sunday. Despite the threat from poultry farm owners he moved forward and completed the culling operation within no time,? said Dr Zia.

      ?The H5N1 is very dangerous and the transfer of the livestock officer was a conspiracy. This was not the time to target him on the political ground and keeping in mind the track-record of H5N1 it is high time of coordination and cooperation to get rid of the virus.?

      As we watch on this quiet Sunday morning, with little or no bird flu news to report, we should remember that many nations are not terribly transparent when it comes to reporting outbreaks.

      In addition to attempts by local officials to suppress bird flu news in Pakistan, we also have Indonesia which no longer reports incidents in `real time', and China - where the Olympics are just over a month away - that has never been a leader in transparency on this issue.

      Many other countries simply don't have a testing or surveillance program. This is particularly true in sub-Saharan Africa.

      So yes, the news is quiet. And perhaps that's an accurate reflection of recent bird flu activity. I hope so.
      But in a world where expedience often trumps the truth, it is sometimes hard to know for sure.
      posted by FLA_MEDIC @ 9:04 AM


      • #4
        Re: AFD - Pakistan Outbreaks

        Thursday, September 11, 2008

        Pakistan Bird Flu Jitters

        # 2292

        After the furor over the first confirmed human cases of H5N1 infection in Pakistan late last year the poultry industry, and the Pakistani government, both seemed intent on playing down bird flu concerns.

        Some of these reassurances were little more than blatant propaganda, as evidenced by reports here, here, and here.

        Today, both the Dawn and the International News are carrying vague reports of new bird flu fears, and of the ordered activation of local surveillance committees.

        Exactly what has prompted this reaction isn't stated.

        KARACHI: Bird flu alert sounded

        KARACHI, Sept 10: Sindh Minister for Health Dr Saghir Ahmed has issued directives for immediate activation of the District Bird Flu Committees in view of apprehensions about a possible outbreak.

        Chairing a meeting in his office on Wednesday, the minister asked all EDOs of health in the province, particularly those of the coastal cities to remain alert and keep a vigil on occurrence of any incident relating to the deadly virus with their respective jurisdiction.

        He advised the general public to report to the bird flu committee concerned immediately upon noticing wild birds, chicken or Siberian migratory birds lying dead in a large number.—APP
        Bird flu fear

        Activation of surveillance committees ordered

        Thursday, September 11, 2008
        By our correspondent

        Minister for Health, Dr Sagheer Ahmed on Wednesday instructed for activating ‘district bird flu committees’ set up three years ago when the bird flu was feared.

        Chairing a meeting at his office, the minister said that the executive district officers (EDOs) of coastal areas especially Karachi, Hyderabad, Badin, Thatta and Sanghar have been instructed to remain alert about the possibility of bird flu. He instructed the general public that if they find dead birds, chickens from Siberia at any place, they should inform the district bird flu committee, EDO agriculture and wildlife office in order to ascertain its causes and take precautionary steps.

        He also asked the people to get their domestic animals vaccinated, adding he said all the poultry farm owners should ensure proper vaccination of birds in order to protect them from bird flu.

        He asked the people to avoid swimming in coastal areas, lakes and other spots where birds are found and not to touch any dead bird.

        Special secretary health, Dr Captain Abdul Majid, Additional secretary Zubair Ahmed Khan and Dr Jamal of Qatar Hospital attended the meeting.

        Posted by FLA_MEDIC at 2008-09-11T08:24:00-04:00


        • #5
          Re: AFD - Pakistan Outbreaks

          WHO: Unraveling the 2007 Pakistan H5N1 Cluster

          # 2355

          Last December the world learned that there were several confirmed and suspected human cases of H5N1 in the NWFP (North West Frontier Province) of Pakistan.

          Early reports were murky, with conflicting data regarding the number of victims, their relationships, and their illness onset dates.

          While these cases reportedly began in late October of 2007, it wasn't until December that the WHO was notified, and the first official word was released from the WHO on December 15th.

          Avian influenza ? situation in Pakistan

          15 December 2007
          The Ministry of Health in Pakistan has informed WHO of 8 suspected human cases of H5N1 avian influenza infection in the Peshawar area of the country. These cases were detected following a series of culling operations in response to outbreaks of H5N1 in poultry. One of the cases has now recovered and a further two suspected cases have since died.

          Samples taken from the suspected cases have tested positive for H5N1 in the national laboratory and are being forwarded to a WHO H5 Reference Laboratory for confirmation and further analysis. The MoH is taking steps to investigate and contain this event, including case isolation and contact tracing and monitoring, detailed epidemiological investigations, providing oseltamivir for case management and prophylaxis, reviewing hospital infection control measures and enhancing health care-based and community-based surveillance for acute respiratory infections.

          WHO is providing technical support to the MoH in epidemiological investigations, reviewing the surveillance, prevention and control measures that have been implemented and carrying out viral sequencing of avian and human isolates.

          Multiple poultry outbreaks of H5N1 influenza have been occurring in Pakistan since 2006. In 2007, there have also been outbreaks in wild birds. A majority of the outbreaks discovered have been in the ?poultry belt? of North-West Frontier Province, particularly in the Abbottabad and Mansehra area and cases of infection in wild birds have been identified in the Islamabad Capital Territory.

          Up until today, the last update came in April of 2008, with this summation.
          Avian influenza ? situation in Pakistan - update 2

          3 April 2008
          Two additional H5N1 cases were confirmed by serological testing, thus providing final H5N1 infection test results on a previously reported family cluster in Peshawar.

          These tests were conducted by the WHO H5 Reference Laboratory in Cairo, Egypt and the WHO Collaborating Centre for Reference and Research on Influenza in Atlanta, USA. The table below summarises the testing results of the confirmed/probable cases in the family cluster.

          • The preliminary risk assessment found no evidence of sustained or community human to human transmission.
          • All identified close contacts including the other members of the affected family and involved health care workers remain asymptomatic and have been removed from close medical observation.

          These laboratory test results support the epidemiological findings from the outbreak investigation in December 2007, and the final risk assessment that suggested limited human to human transmission likely occurred among some of the family members which is consistent with some human-to-human transmission events reported previously. This outbreak did not extend into the community, and appropriate steps were taken to reduce future risks of human infections.

          Today we get a far more detailed look at the events that transpired in Pakistan late last year, and a much clearer understanding of the chain of transmission of the virus via this review in the WHO's Weekly Epidemiological Record 2008,83, 357-364 for the week of October 3rd, 2008.

          A hat tip goes to Ironorehopper on Flutrackers for posting this account.

          The WHO's Weekly Epidemiological Record (WER), which is released each Friday, is described by the WHO as follows:

          The Weekly Epidemiological Record (WER) serves as an essential instrument for the rapid and accurate dissemination of epidemiological information on cases and outbreaks of diseases under the International Health Regulations and on other communicable diseases of public health importance, including emerging or re-emerging infections.

          This is a lengthy report, and so I've only posted some of the more relevant snippets. Interested parties will want to read it in its entirety.

          Following a detailed account of each of the 5 brothers involved in this family cluster, including onset dates, testing, and outcomes the following discussion and conclusion are offered:


          After thorough epidemiological investigation by the international investigation team and confirmatory testing of clinical specimens by WHO influenza A/H5 reference laboratories, 3 cases were confirmed as avian influenza A(H5N1) infection.2 The 3 confirmed cases were brothers aged between 25 and 32 years. One of the cases died within 7 days of onset of illness; the other 2 cases recovered.

          In addition, the investigation detected 1 probable case of H5N1 infection and 1 asymptomatic seropositive case within the same family. These are the first human cases of influenza A(H5N1) virus infection documented in Pakistan.

          Case 1 is also the first person to have documented influenza A(H5N1) disease following occupational exposure during poultry culling.

          With respect to the chain of transmission, evidence gathered during the investigation supports the theory of initial transmission from poultry to humans followed by human-to-human transmission involving a third generation.

          Only 1 of the brothers (the first to become ill) had a clear history of contact with sick or dead poultry (the poultry had been laboratory-confi rmed as being infected with H5N1 virus); the other brothers who became ill had not been working in occupations related to the poultry industry or farming.



          The illnesses of the 4 brothers are consistent with influenza A(H5N1) virus infection. After considering the information gathered during investigation of this cluster of cases, evidence supports a chain of transmission beginning with poultry-to-human transmission followed by human-to-human transmission for 3 generations of transmission.

          Despite thorough investigation and active surveillance, there was no evidence of sustained transmission in the community. Contacts in the immediate and extended family and health-care workers received follow-up clinical and laboratory testing, but there was no evidence of further influenza A(H5N1) infection.

          Evidence gathered during the investigation supports the hypothesis that this outbreak of influenza A(H5N1) infection was limited to a family cluster and was not sustained in the community.

          Human-to-human transmission probably occurred, but only after prolonged and intimate contact among family members.

          Other than filling in the gaps, and strongly suggesting 3 generations of transmission, the biggest news here is the addition of a 5th brother, one who apparently experienced an asymptomatic seroconversion to the H5N1 virus.
          * Case 5

          Case 5 was a 33-year-old brother of Case 1. He was asymptomatic but clinical specimens were collected from him owing to the close and prolonged contact with his ill brothers. Initial testing at the National Institute of Health yielded positive results for H5 RT?PCR on a throat swab collected on 29 November.

          When serum specimens were tested by microneutralization assay, a specimen collected on 8 December yielded an H5 antibody titre of 1:320 and a positive western blot assay.

          Asymptomatic seroconversion, where someone can be exposed to the virus and develop antibodies against it - without getting ill- is something we've seen on rare occasions in the past with the H5N1 virus. As the report notes:
          Case 5 had had frequent close contact with all 4 of his brothers when they were ill, and infection may have occurred after exposure to any of them. Case 5 had no known contact with sick or dead poultry.

          Asymptomatic seroconversion in household contacts has been documented previously in a study in Hong Kong SAR conducted after the 1997 outbreak of influenza A(H5N1)

          The identity of the fifth brother isn't readily apparent from this report, but it may be the brother who returned to the United States in December, and who was declared `not infected' by local health officials upon his arrival.

          There is, however, a discrepancy in the ages given the news accounts of the returning brother (38) and the 5th brother in this report (33). (Hat tip Laidback Al on FluTrackers)

          A person can seroconvert, carry the antibodies to a virus, without being infected or contagious. The presence of such antibodies only indicate an exposure in the past.

          We are still left with a few unanswered questions here. Early reports had as many as 8 people supposedly testing positive for the virus, and here we have only 5 accounted for.

          Early reports are often confused, and that may explain the discrepancy.

          The WHO is also only counting 3 of the 5 brothers as definitely infected with the H5N1 virus, even though 4 tested positive for antibodies to the virus. Perhaps a semantical difference, as the fifth victim never showed clinical signs of the illness - only antibodies.

          The 2nd brother (who died) was never tested for the virus, although he remains a highly probable infection.

          In any event, we have a good deal more detail today than we've seen before regarding this cluster, and the evidence is pretty strong that there was human-to-human-to-human transmission of the virus.