China - Boy 16, Confirmed H5N1, Died - Guizhou Province Case

[AlaskaDenise]

Re: China - boy 16, Confirmed H5N1, Died - Guizhou Province

Re: China - boy 16, Confirmed H5N1, Died - Guizhou Province

There is a possibility of human bird flu (spreading) in the near future, but it will not be a large-scale outbreak...

New song - H2H may happen, but not to worry - it is manageable.

.

 

[HenryN]

Re: China - boy 16, Confirmed H5N1, Died - Guizhou Province

Re: China - boy 16, Confirmed H5N1, Died - Guizhou Province

16-year-old Chinese boy dies from H5N1 bird flu

By AUDRA ANG ? 26 minutes ago
BEIJING (AP) ? A 16-year-old boy infected with the H5N1 bird flu virus died Tuesday in central China, the country's third fatality from the disease this month.
Authorities also stepped up bird flu precautions on fears the virus can survive longer in cold weather as tens of millions of people travel between cities and rural hometowns for the Lunar New Year holiday, which typically includes feasts with poultry.
The student surnamed Wu, who had been in critical condition, died Tuesday morning in Huaihua, a city in Hunan province, the official Xinhua News Agency said. He fell ill on Jan. 8 in his hometown in the neighboring province of Guizhou and was transferred to a hospital in Huaihua on Jan. 16, when his condition worsened.
He had contact with dead poultry, the report said without giving other details.
The two other bird flu deaths were a 27-year-old woman in Shandong province in the country's east who died on Saturday and a 19-year-old woman who died in Beijing on Jan. 5.
Also Tuesday, a 2-year-old girl who had been critically ill with the H5N1 virus in Hunan was in stable condition and returned to her home in the north, China Central Television said in its noon newscast. The state television report said the girl had been to live poultry markets "many times" but did not elaborate.
The girl's mother died earlier this month from pneumonia after being exposed to poultry, a Hunan health bureau official said in an interview published Tuesday in the state-run China Business News newspaper. However, the official surnamed Peng could not confirm a link to H5N1.
Most bird flu cases stem from exposure to sick birds, but human-to-human transmission of bird flu has happened about a dozen times in the past in countries including China, Cambodia, Thailand, Vietnam, and Turkey. In nearly every case, transmission has occurred among blood relatives who have been in close contact, and the virus has not spread into the wider community.
"Whenever there is a case of humans contracting the H5N1 virus, there is a concern," said Nyka Alexander, a Beijing-based spokeswoman for the World Health Organization. "As long as H5N1 continues to circulate in poultry, there is the risk of human infection. This is why it is so important to treat each case seriously."
While the disease remains hard for humans to catch, scientists have warned if outbreaks among poultry are not controlled, the virus may mutate into a form more easily passed between people. A new influenza virus could quickly turn into a pandemic, infecting millions of people with no immunity.
No sick poultry has been found in the areas where the four people fell ill this year, despite officials inspecting hundreds of thousands of birds. This could mean that surveillance needs to be tightened or that poultry may be carrying the virus but not showing symptoms or falling sick. Vaccinations also reduce the amount of virus circulating, but low levels of H5N1 may still be causing outbreaks ? without the obvious signs of dying birds.
Until this month, no new human cases had been reported in China since February 2007. Shu Yuelong, a flu expert at China's National Center for Disease Control and Prevention, said a spike in infections was likely because the H5N1 virus is more active in lower temperatures.
The cases come as an estimated 188 million people travel between cities and rural hometowns for Lunar New Year, the country's biggest holiday, which begins next week.
Celebratory family meals often include dishes made from freshly slaughtered chicken and duck feature, meaning a potentially greater risk of exposure to sick birds as people shop in markets for poultry or when the birds are transported to be sold.
The Agriculture Ministry has ordered tighter monitoring of disease outbreaks at all levels and proper vaccination of all poultry. It would also increase checks across the country and at borders.
According to the WHO, bird flu has killed 249 people worldwide since 2003. The tally does not include Tuesday's death in China, where a total of 34 infections have been reported.

http://www.google.com/hostednews/ap/article/ALeqM5ghdkIg5knBtGcVm1UfEwvXSnaAPAD95QQB2G0

 

[sharon sanders]

Re: China Human Cases Jan 21 + & Boy 16, Confirmed H5N1, Died - Guizhou Province Case

Re: China Human Cases Jan 21 + & Boy 16, Confirmed H5N1, Died - Guizhou Province Case

For the 2 year old (possible cluster case) from Human, please see this thread:


http://www.flutrackers.com/forum/showthread.php?t=91522



For the 27 year old woman case from Shandong, please see this thread:


http://www.flutrackers.com/forum/showthread.php?t=91617


For the 19 year old woman from Bejing, please see this thread:


http://www.flutrackers.com/forum/showthread.php?t=90425


For general China news and animal/poultry/wild birds outbreaks, please see this thread:


http://www.flutrackers.com/forum/showthread.php?t=91832

 

[Sally Furniss]

Re: China Human Cases Jan 21 + & Boy 16, Confirmed H5N1, Died - Guizhou Province Case

Re: China Human Cases Jan 21 + & Boy 16, Confirmed H5N1, Died - Guizhou Province Case

Guizhou home of the deceased bird culled poultry
2009-1-22

On the 20th and was informed that the membership of Guizhou bird flu patients who died in Hunan Province, the hometown of the deceased Qiandongnan Prefecture of Guizhou Province in Liping County high屯镇eight Zhou Village, culling all poultry, the villagers from the village are not allowed. 【Reporter on the 21st郭朝阳Guiyang Xinhua】

High屯镇said of the eight boat blockade measures taken by the village, the villagers were not allowed out of the village recently. In this case before the emergence of the village was part of the poultry disease situation, but no attention. To January 20, the sick, regardless of all poultry not ill, have all been culled.屯镇high incidence of points within the region has also been culling chickens and ducks. As the prevention and control measures are effective, patients with the location of the masses as well as the mood of the masses around the Jeonju stability, does not appear abnormal.

Eight villagers Zhou said that the deceased prior to the onset of eating at home is not cooked chickens and ducks. Qiandongnan Prefecture has dispatched health, agriculture, animal husbandry and other departments as well as the counties to prevent and control centers and related experts, rushed to the Liping county, to carry out investigations and medical observation.

Lin asked the governor of Guizhou, Guizhou Province Health Department prepared in accordance with the requirements of the disposal of the Ministry of Health, which announced to the public of the epidemic to the public, it is necessary to conscientiously carry out the source of the disease investigation, prevention and control to take effective measures to prevent the spread of the epidemic.

Old Carey hole professional wholesale market of live birds is Qiandongnan Prefecture's largest live poultry wholesale markets, wholesale sales of live chickens and ducks normal. Said the market, the wholesale poultry market from across the country and all regions of Qiandongnan Prefecture, market transactions every day there are tens of thousands of chickens and ducks, the sale of normal and not be affected. 18, Carey received a livestock market on the strengthening of fisheries sector, such as epidemics of highly pathogenic avian influenza prevention and control of the emergency notice, 24 hours on the market carry out stringent measures to prevent and control and monitoring.

Buy red rooster is过大年Carey local people had the custom of the Spring Festival. Carey II in shopping malls, stalls selling red rooster increasing red rooster came to the purchase of the New Year still a lot of people.

Nanchang to prevent human avian influenza

【Reporter into the 21st Xinhua】 Jiankang Nanchang Nanchang City Health Bureau issued an emergency circular calling on the medical and health departments and units to strengthen the human avian influenza prevention and control work. The circular called for disease prevention and control institutions at all levels of the epidemic Mobile Brigade 24-hour duty, fever of suspicious cases of pneumonia or fever coughing remain highly vigilant and do a good job in cases of pneumonia of unknown causes screening work. Nanchang Nanchang City Health Bureau also requested the ninth hospitals, county District People's Hospital of Infectious Diseases in advance to do a good job related to the patients admitted to ward, technology, materials, equipment ready.

Lu patients with non-contact birds

Ta Kung Pao inquiry】 【Xinhua on the 21st from Shandong Provincial Health Department learned about the latest situation arising from infection of the avian flu virus in 17 patients with the death of Zhang Jinan no clear history of exposure to poultry.

It is understood that the recent incidents in the Mainland of China 4 cases of human bird flu cases, two cases (Beijing, Shanxi Province) has a clear history of exposure to live poultry markets, one cases (Hunan) there is a history of exposure to poultry, which took place in Shandong cases, according to the survey do not have a clear history of exposure to poultry.

To experts, around the world have occurred in cases of human avian influenza, 1 / 4-1 / 3 of the cases there is no clear source of infection. Recently diagnosed four cases of this occurred with the previous cases of human avian influenza similar epidemiological characteristics.

http://www.takungpao.com.hk//news/09/01/22/ZM-1022082.htm

 

[Rwilmer]

Re: China Human Cases Jan 21 + & Boy 16, Confirmed H5N1, Died - Guizhou Province Case

Re: China Human Cases Jan 21 + & Boy 16, Confirmed H5N1, Died - Guizhou Province Case

Does this mean eight people are suspected?

 

[sharon sanders]

Re: China Human Cases Jan 21 + & Boy 16, Confirmed H5N1, Died - Guizhou Province Case

Re: China Human Cases Jan 21 + & Boy 16, Confirmed H5N1, Died - Guizhou Province Case

Does this mean eight people are suspected?

It is typical to monitor people who have been in close proximity to infected poultry.

 

[HenryN]

Re: China Human Cases Jan 21 + & Boy 16, Confirmed H5N1, Died - Guizhou Province Case

Re: China Human Cases Jan 21 + & Boy 16, Confirmed H5N1, Died - Guizhou Province Case

AVIAN INFLUENZA, HUMAN (12): CHINA (GUIZHOU)
***********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

[1]
Date: Wed 21 Jan 2009
Source: Associated Press report [edited]
http://www.google.com/hostednews/ap/article/ALeqM5ghdkIg5knBtGcVm1UfEwvXSnaAPAD95QQB2G0


China's top health official on Tuesday [20 Jan 2009] ordered stronger
measures to prevent the spread of bird flu, as the country announced
its 3rd fatality from the H5N1 [avian influenza] virus in a month.

The World Health Organization, meanwhile, said the cases were a
"perfectly normal occurrence" during colder months. Chinese Health
Minister Chen Zhu said health departments across the nation need to
pay "great attention" to stepping up efforts to stop the disease
before it sickens more people, especially at the peak of the Lunar
New Year travel rush, when tens of millions of people were making
their way home to rural areas. "It is the high season for human cases
of bird flu. There is a severe need for the prevention of more
cases," Chen said in a conference call to ministry officials. He said
health officials need to be made fully aware of the risk and harm
associated with bird flu, increase monitoring, strengthen clinical
diagnoses and treatment, and report outbreaks in a timely manner.

His call to action came as state media announced the death of a
16-year-old student in Hunan province in central China. The boy had
been in critical condition and died Tuesday [20 Jan 2009] morning,
the official Xinhua News Agency said. He fell ill on 8 Jan 2009 in
his hometown in the neighboring province of Guizhou and was
transferred to a hospital in Huaihua, a city in Hunan, on 16 Jan
2009, when his condition worsened. He had contact with dead poultry,
the report said without giving other details.

The 2 other bird flu deaths were a 27-year-old woman in Shandong
province in the country's east who died on Saturday [17 Jan 2009] and
a 19-year-old woman who died in Beijing on 5 Jan 2009.

Until this month [January 2009], no new human infections had been
reported in China since February 2007 [This should read 2008. -
Mod.CP]. Peter Cordingley, the WHO's Asia spokesman, said the latest
cases were a "perfectly predictable event. The virus always starts to
get active this time of year," he said. According to the WHO, bird
flu has killed 249 people worldwide since 2003. The tally does not
include Tuesday's [20 Jan 2009] death in China, where a total of 34
infections have been reported.

The disease remains hard for humans to catch, but scientists have
warned if outbreaks among poultry are not controlled, the virus may
mutate into a form more easily passed between people, potentially
sparking a pandemic.

[Byline: Andrea Ang]

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

******
[2]
Date: Wed 21 Jan 2009
Source: Agence France-Presse (AFP) report [edited]
<http://www.google.com/hostednews/afp/article/ALeqM5jsEhZC8Kj_VGJEltw0sx4xIh7GMg>


China sought Wednesday [21 Jan 2009] to allay fears over the threat
of a bird flu pandemic after 3 people died from the disease this
month [January 2009] and a 4th person remained critically ill. There
was no evidence that the potential for an outbreak of the disease was
on the rise, China's health ministry said in a statement faxed to
AFP. "The 4 cases separately came from different provinces; there is
no epidemiological connection between them; they are sporadic cases,"
the ministry said.

A 16-year-old boy died on Tuesday [20 Jan 2009] from the H5N1 strain
of avian influenza in the central province of Hunan [See above,
infection contracted in Guizhou province.].

A 27-year-old woman also succumbed to the disease on Saturday [17 Jan
2009] in the eastern province of Shandong, while the 1st fatality
occurred on 5 Jan 2009 when a 19-year-old woman died in Beijing.

A 2-year-old girl, meanwhile, is still critically ill in the northern
province of Shanxi, the health ministry said. The toddler's mother
died this month [January 2009] of severe pneumonia, sparking concern
that she may actually have had bird flu and passed it on to her
daughter. The health ministry said it was unable to do tests to
confirm whether the mother had died of avian influenza, as no samples
were collected when she passed away. But it added it was unlikely the
girl caught bird flu from her mother. "We cannot be sure that the
patient's mother had bird flu, and investigations show the patient
had been exposed to live poultry markets," the statement said.
"Therefore, we believe the patient's infection most likely came from
a live poultry market or another unknown exposure."

China is considered one of the nations most at risk from bird flu
epidemics because it has the world's largest poultry population, and
many chickens in rural areas are kept close to humans.

The World Health Organisation says about 250 people have died from
bird flu worldwide since 2003. The total number of reported deaths in
China since the virus re-emerged in 2003 now stands at 23.

--
Communicated by:
ProMED-mail Rapporteur Dan Silver

[The 4 human cases of avian influenza reported during the 1st 3 weeks
of January 2009, the 1st in China since February 2008, occurred in 4
different provinces and appear to be unconnected. In all cases, there
is evidence of contact with diseased poultry. There is no evidence of
human-to-human transmission of infection from affected individuals to
their contacts or care givers. The question of whether the 2-year-old
child may have contracted infection from her mother remains
unresolved, since no clinical samples from the mother are available.

The death of the 16-year-old boy reported above is the 23rd fatality
among the 34 cases of avian A/H5N1 virus infection recorded in China.
Three of the 4 cases identified in the 1st weeks of 2009 have died,
and the 4th remains in critical condition.

A map of the provinces of China is available at
<http://www.sacu.org/provmap.html>, and the HealthMap/ProMED-mail
interactive map of China is available at
<http://healthmap.org/promed/en?v=36.5,103.9,4>. - Mod.CP]

[see also:
Avian influenza, human (11): China, WHO Update 20090119.0240
Avian influenza, human (10): China (GZ), SD) 20090119.0230
Avian influenza, human (08): China (HN) 20090118.0217
Avian influenza, human (03): China (Beijing), WHO 20090107.0064
Avian influenza, human (01): China (Beijing) 20090106.0047
2008
----
Avian influenza, human (83): H9N2, China (Guangdong) 20081230.4111
Avian influenza, human (43): China, Egypt WHO 20080408.1292
Avian influenza, human (31): China, Egypt, Viet Nam, WHO 20080226.0784
Avian influenza, human (30): China, WHO 20080225.0758
Avian influenza, human (29): China, Indonesia, Viet Nam, WHO 20080221.0710
Avian influenza, human (28): China (Hunan) 20080218.0656
Avian influenza, human (05): China, Pakistan 20080110.0134]
...................................................cp/msp/mpp

 

[Rwilmer]

Re: China Human Cases Jan 21 + & Boy 16, Confirmed H5N1, Died - Guizhou Province Case

Re: China Human Cases Jan 21 + & Boy 16, Confirmed H5N1, Died - Guizhou Province Case

does it say if any of the people have symptoms?

It is typical to monitor people who have been in close proximity to infected poultry.

 

[HenryN]

Re: China Human Cases Jan 21 + & Boy 16, Confirmed H5N1, Died - Guizhou Province Case

Re: China Human Cases Jan 21 + & Boy 16, Confirmed H5N1, Died - Guizhou Province Case

AVIAN INFLUENZA, HUMAN (12): CHINA (GUIZHOU)
***********************************************

[The 4 human cases of avian influenza reported during the 1st 3 weeks
of January 2009, the 1st in China since February 2008, occurred in 4
different provinces and appear to be unconnected. In all cases, there
is evidence of contact with diseased poultry. There is no evidence of
human-to-human transmission of infection from affected individuals to
their contacts or care givers. The question of whether the 2-year-old
child may have contracted infection from her mother remains
unresolved, since no clinical samples from the mother are available.


<http://healthmap.org/promed/en?v=36.5,103.9,4>. - Mod.CP]

CP has a rather curious definition of "evidence".

 

[sharon sanders]

Re: China Human Cases Jan 21 + & Boy 16, Confirmed H5N1, Died - Guizhou Province Case

Re: China Human Cases Jan 21 + & Boy 16, Confirmed H5N1, Died - Guizhou Province Case

The Ministry of Health announced an " emergency fat" on January 19th which called for strengthening the classification of pneumonia cases based on May 2007 guidelines -

http://www.flutrackers.com/forum/showpost.php?p=203018&postcount=1

 

[Giuseppe]

Re: China - Boy 16, Confirmed H5N1, Died - Guizhou Province Case

WHO | Avian influenza ? situation in China - update 2

Avian influenza ? situation in China - update 2

24 January 2009 --

The Ministry of Health in China has announced the death of a previously confirmed case of H5N1 infection.

The 16 year old male from Huaihua City, Hunan Province died on 20 January.

Of the 34 cases confirmed to date in China, 23 have been fatal.
-
​

<cite cite="http://www.who.int/csr/don/2009_01_24/en/index.html">WHO | Avian influenza ? situation in China - update 2</cite>

 

[HenryN]

Re: China Human Cases Jan 21 + & Boy 16, Confirmed H5N1, Died - Guizhou Province Case

Re: China Human Cases Jan 21 + & Boy 16, Confirmed H5N1, Died - Guizhou Province Case

AVIAN INFLUENZA, HUMAN (12): CHINA (GUIZHOU)
***********************************************

[The 4 human cases of avian influenza reported during the 1st 3 weeks
of January 2009, the 1st in China since February 2008, occurred in 4
different provinces and appear to be unconnected. In all cases, there
is evidence of contact with diseased poultry. There is no evidence of
human-to-human transmission of infection from affected individuals to
their contacts or care givers. The question of whether the 2-year-old
child may have contracted infection from her mother remains
unresolved, since no clinical samples from the mother are available.

The death of the 16-year-old boy reported above is the 23rd fatality
among the 34 cases of avian A/H5N1 virus infection recorded in China.
Three of the 4 cases identified in the 1st weeks of 2009 have died,
and the 4th remains in critical condition.

A map of the provinces of China is available at
<http://www.sacu.org/provmap.html>, and the HealthMap/ProMED-mail
interactive map of China is available at
<http://healthmap.org/promed/en?v=36.5,103.9,4>. - Mod.CP]

Now there are two confirmed cases in Guizhou, one in Hunan, and the mother of the confirmed Hunan case died from pneumonia but wasn't tested for H5N1.

Cases "appear to be unconnected" in CP's "Hopes and Dreams".

 

[HenryN]

Re: China - Boy 16, Confirmed H5N1, Died - Guizhou Province Case

AVIAN INFLUENZA, HUMAN (18): CHINA, WORLD HEALTH ORGANIZATION
***********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Sat 24 Jan 2009
Source: World Health Organization (WHO), EPR, Disease Outbreak News [edited]
<http://www.who.int/csr/don/2009_01_24/en/index.html>


As of 24 Jan 2009, The Ministry of Health in China has announced the
death of a previously confirmed case of H5N1 infection. The
16-year-old male from Huaihua City, Hunan Province died on 20 Jan 2009.

Of the 34 cases confirmed to date in China, 23 have been fatal.

--
Communicated by:
ProMED-mail Rapporteur Marianne Hopp

[see also:
Avian influenza, human (17): China (XC, SD) 20090124.0321
Avian influenza, human (15): China, transmission questions 20090122.0281
Avian influenza, human (12): China (GZ) 20090121.0263
Avian influenza, human (11): China, WHO Update 20090119.0240
Avian influenza, human (10): China (GZ), SD) 20090119.0230
Avian influenza, human (08): China (HN) 20090118.0217
Avian influenza, human (03): China (Beijing), WHO 20090107.0064
Avian influenza, human (01): China (Beijing) 20090106.0047
2008
----
Avian influenza, human (83): H9N2, China (Guangdong) 20081230.4111
Avian influenza, human (43): China, Egypt WHO 20080408.1292
Avian influenza, human (31): China, Egypt, Viet Nam, WHO 20080226.0784
Avian influenza, human (30): China, WHO 20080225.0758
Avian influenza, human (29): China, Indonesia, Viet Nam, WHO 20080221.0710
Avian influenza, human (28): China (Hunan) 20080218.0656
Avian influenza, human (05): China, Pakistan 20080110.0134]
...................................................mpp/cp/msp/mpp

 

[HenryN]

Re: China - Boy 16, Confirmed H5N1, Died - Guizhou Province Case

Commentary

http://www.recombinomics.com/News/01260903/H5N1_China_H2H_Evidence.html

 

[AlaskaDenise]

Re: China - Boy 16, Confirmed H5N1, Died - Guizhou Province Case

Commentary

http://www.recombinomics.com/News/01260903/H5N1_China_H2H_Evidence.html

Commentary



Evidence for Human to Human H5N1 Transmission in China
Recombinomics Commentary 16:41
January 26, 2009


The 4 human cases of avian influenza reported during the 1st 3 weeks
of January 2009, the 1st in China since February 2008, occurred in 4
different provinces and appear to be unconnected. In all cases, there
is evidence of contact with diseased poultry. There is no evidence of
human-to-human transmission of infection from affected individuals to
their contacts or care givers.

The above remarks from a ProMED commentary on the cases in China are curious and unfortunate. ProMED is an infectious disease newsletter that is widely read by media writers and the lay public, who have minimal background in infectious diseases. As the commentator knows, the strongest data for human to human transmission are gaps in disease onset dates between two or more contacts who have symptoms and/or are lab confirmed.

The evidence for human to human transmission is the same evidence that has been repeated dozens of times since H5N1 exploded out of China in late 2003. The clusters of human H5N1 have obvious gaps in disease onset dates and have been reported dozens of times. Testing remains at the abysmal level. Samples are frequently not collected from the index case, and false negatives and misdiagnosis are common. In the latest cases, discussed above, the child (2F) from Hunan developed symptoms when her mother died of pneumonia. The child was H5N1 lab confirmed. In Beijing, multiple media reports indicated the nurse linked to the fatal H5N1 case (19F), developed symptoms, but recovered. One media report indicated the nurse was confirmed and none of the reports indicated the nurse tested negative for H5N1. Moreover, extensive testing failed to identify diseased poultry. The last confirmation of H5N1 in poultry in China was in December in Jiangsu, which was not directly linked to any of the subsequent confirmed cases in China.

However, the history of H5N1 clusters since late 2003 provides the most compelling argument that the recent clusters in China are virtually identical in time and space to prior clusters.

One of the first reported clusters was in Vietnam in early 2004. A recently married groom developed symptoms and died with bird flu symptoms in the hospital, but was never tested. His two sisters who cared for him developed symptoms on the same day, initially tested as “inconclusive”, were hospitalized on the same day, were retested and H5N1 confirmed on the same day, and died within an hour of each other. The gap in disease onset dates indicated both were infected by their brother, although the index case was not confirmed.

Later that year one of the most cited clusters was in Thailand and written up in the New England Journal of Medicine. The index case was living with her aunt, hundreds of miles from Bangkok, where her mother worked in an office and had no exposure to poultry. The index case developed symptoms after burying a pet bird, but was diagnosed as dengue fever. Consequently, the mother had no protection during hospital visits. After the index case died, the mother returned to Bangkok and developed symptoms, but also was not tested, even though her daughter had just died with symptoms. The aunt also developed symptoms and also tested negative, but was positive on a re-test. The mother was serendipitously identified just before cremation, and fixed tissue yielded H5N1 sequences. The index case was never tested for H5N1.

The index case for the first confirmed case in Cambodia collected dead chickens in early 2005. He developed symptoms and died, but was never tested. His sister subsequently developed symptoms and subsequently was hospitalized in Vietnam, where she was lab confirmed after she died.

In 2005 there were multiple clusters in Vietnam. The clusters in 2004 and 2005 were written up and published by the CDC. The vast majority of the clusters had gaps in disease onset dates.

The first confirmed case in Indonesia was also a cluster. The index case was initially diagnosed as having bacterial pneumonia. When she was finally tested for H5N1, her titter had already risen to 64, as confirmed by the CDC and Hong Kong. A second sample, collected three days later had an even higher titer, 128, but since the titer wasn’t four fold higher than the initially collection, which should have been collected on admission, the case was not confirmed. Her sister subsequently developed symptoms and died, but was never tested. Her father was PCR confirmed and the isolated H5N1 is the current vaccine target for clade 2.1.

Clusters are common in Indonesia, and all initial confirmations were from clusters. The Tangerang cluster above was followed by a cluster involving an index case and her nephew. The aunt died and H5N1 was isolated, but her nephew’s case was mild. H5N1 was detected because he was among contacts tested, but H5N1 wasn’t isolated. That cluster was followed by a mild cluster on Sumatra, but virus was not isolated from any of the confirmed cases, and most were confirmed by antibody level. These three clsuters were also reported in the New England Journal of Medicine.

Subsequent reported cases from Indonesia had a higher case fatality rate. On Sumatra in 2006 six of seven members of the Karo cluster died. That cluster involved the index case infecting five family members including a brother who infected his son. That H2H2H cluster was easily identified, but no sample was collected from the index case.

An even larger cluster was a Garut the following year. Three independent clusters were identified with an H5N1 confirmed case in each cluster. However, none of the index cases fro the three clusters were tested and all died. Subsequent contacts developed symptoms and were hospitalized, but use of a Tamiflu blanket lowered viral loads and all symptomatic contacts tested negative.

More recently, Indonesia has ignored obvious misdiagnosis in cluster members, even after H5N1 has been confirmed. A series of such clusters involving fatal infections in index cases as lung inflammation, dengue fever, and typhus preceded the news blackout and reporting delays for H5N1 cases.

False negatives have also been generated by degraded samples. In Turkey, almost all 21 cases confirmed locally were in clusters, but only 12 were confirmed in England. Similarly, only one of the cluster members in Pakistan tested positive by PCR, but four were subsequently confirmed by antibody increases.

Thus, the number of negatives due to failures to collect or preserve samples or limits in testing procedures, coupled with misdiagnosis has led to a gross undercount of official clusters.

However, recent clusters such as those in Hunan and Vietnam have clear evidence of human to human transmission, even though the samples from the index cases were not collected.

These H2H clusters are further supported by the explosion of confirmed cases in China (see updated map), which are causes of increased concern.

 

[sharon sanders]

Re: China - Boy 16, Confirmed H5N1, Died - Guizhou Province Case

As usual, during a controversial outbreak, I get complaints about Niman.

Some people think he makes claims that are not supported by the facts.

Well - he is entitled to his opinion.

Three years ago FluTrackers offered him a "safe haven" on the internet to express his opinions and this policy continues today. From a post I made in November 2006:

"...I want to separate the man from the recombination theory that he promotes. I personally do not know if his theory, random mutation, reassortment, or other processes are at work in the evolution of viruses. What I do know is that this man has educated many in the issues of genetics, H5N1, wild birds, geography, WHO procedures, vaccines, sequences, peptides, and numerous other related subjects. Many experts and public health officials have been drawn to this site due to the information and discussion that his posts generate. He is one of a few in the world who have worked for years to educate on the threat of a potential pandemic. It has been a long journey for him. He will be considered one of the leaders of the movement to help lessen mobidity and mortality in a pandemic. We all owe him our thanks for this effort.

Have we seen the last of H5N1 rumours? Hardly. Are we served by those who "knew better"? Or are we better served by those who push, investigate, and question? We will always support those who pursue the knowledge that may save millions. We support "risk takers" whether they are investigating new treatments, vaccines, therapies, or pandemic strategies. We are willing to make mistakes. We support those who dare to care."


If you do not agree with Niman, challenge him.

Maybe you will get a "Please" too. I think Gsgs has the most.

Thank you to everyone who participates and lurks here to illuminate the dark.


:applause:

 

[Laidback Al]

Re: China - Boy 16, Confirmed H5N1, Died - Guizhou Province Case

As usual, during a controversial outbreak, I get complaints about Niman.

Some people think he makes claims that are not supported by the facts.

Well - he is entitled to his opinion.

Three years ago FluTrackers offered him a "safe haven" on the internet to express his opinions and this policy continues today. From a post I made in November 2006:

"...I want to separate the man from the recombination theory that he promotes. I personally do not know if his theory, random mutation, reassortment, or other processes are at work in the evolution of viruses. What I do know is that this man has educated many in the issues of genetics, H5N1, wild birds, geography, WHO procedures, vaccines, sequences, peptides, and numerous other related subjects. Many experts and public health officials have been drawn to this site due to the information and discussion that his posts generate. He is one of a few in the world who have worked for years to educate on the threat of a potential pandemic. It has been a long journey for him. He will be considered one of the leaders of the movement to help lessen mobidity and mortality in a pandemic. We all owe him our thanks for this effort.

Have we seen the last of H5N1 rumours? Hardly. Are we served by those who "knew better"? Or are we better served by those who push, investigate, and question? We will always support those who pursue the knowledge that may save millions. We support "risk takers" whether they are investigating new treatments, vaccines, therapies, or pandemic strategies. We are willing to make mistakes. We support those who dare to care."


If you do not agree with Niman, challenge him.

Maybe you will get a "Please" too. I think Gsgs has the most.

Thank you to everyone who participates and lurks here to illuminate the dark.


:applause:

"Some people think he makes claims that are not supported by the facts."

I am not sure what they may be referring to. The discussion about human clusters in post #35 is fact based. There have been over 50 geographically defined human H5N1 clusters since 2003. Each of these clusters includes at least one WHO confirmed human case. Over 100 WHO confirmed human cases (along with 56 other suspected cases) are represented in these clusters, most of which probably result from human to human transmission.

In any case, this is a news thread about the 16 year old male who died after being infected in Guizhou Province. Discussions about Niman's posts, including rebuttals or challenges, should be posted at The Pandemic Discussion Forum at http://www.flutrackers.com/forum/forumdisplay.php?f=36