Nepal - Human H5N1 avian influenza infections ? Government says no

[Gert van der Hoek]

Bird flu suspected in two deaths? no test conducted

2013-08-26


SURYA PS.KANDEL

NARAYANGADH: Bird flu has been suspected in the deaths of two women, who suffered from common cold and fever, at the Teaching Hospital of College of Medical Sciences in Bharatpur.

The hospital has written a letter to the District Public Health Office (DPHO) after the twin deaths on Saturday, suspecting that the victims were infected with the avian influenza virus (H5N1). However, no sample was collected from the deceased for further laboratory test.

Another patient suffering from common cold, cough and fever is receiving treatment at the ICU of the same hospital. She is given Tamiflu, the antiviral medicine used to treat bird flu.

According to Public Health Inspector Ram K.C., nasal and throat swabs collected from her have been sent to the National Public Health Laboratory in Kathmandu for the confirmation of suspected virus.

He further said that it would be wrong to say that humans have contracted bird flu just on the basis of usage of Tamiflu and the DPHO providing the medicine to the hospital.

DPHO Chief Kehar Singh Godar said that the test results will confirm if the suspected patient has contracted the avian influenza virus.

The results are likely to come in a week.

The suspected woman patient is a resident of Kawasoti of neighbouring Nawalparasi district.

The bird flu spread in different poultry farms in Chitwan and Nawalparasi also.

No bird-to-human bird flu transmission has been reported so far in Nepal.

The Himalayan Times

 

[sharon sanders]

Re: Nepal - Human H5N1 avian influenza infections ?

Re: Nepal - Human H5N1 avian influenza infections ?

Please see these threads for recent H5N1 outbreaks in poultry:


Nepal: H5N1 Bird flu outbreaks in poultry farms of Kavre

Nepal: H5N1 in poultry in Sindhupalchowk district

Nepal: avian flu emergency in Kathmandu too

Nepal: H5N1 in poultry in Bhaktapur / Nangkhel

Nepal: H5N1 suspected in poultry deaths in Makwanpur district

Nepal: Six more Valley farms in flu ( H5N1 ) grip

Nepal: H5N1 in poultry in Lalitpur

 

[sharon sanders]

Re: Nepal - Human H5N1 avian influenza infections ?

Re: Nepal - Human H5N1 avian influenza infections ?

Monday, August 26, 2013

Nepal: Human H5N1 Testing (Or Lack Thereof)

# 7601


At the risk of sounding like a broken record, we really don?t know the true number of H5N1 (or MERS-CoV, H7N9, et al.) infections around the world. The quality, availability, and consistency of lab testing varies considerably between (and indeed, even within) countries.

Many nations must send samples to a reference lab outside their borders in order to test for exotic viruses.

As of the 23rd of August, the official World Health Organization count puts the number of H5N1 cases at 637, with 378 fatalities (CFR 59.3%).

Butover the years we?ve seen a number of `suspected cases? around the world that were either never tested, or whose negative test results were suspect.
​

In many places people succumb to diseases without ever seeing the inside of a hospital, much less having lab tests run. Which may - at least partially - explain why some places report H5N1 in poultry, but have yet to report a human case.

As Dr. Ian Mackay already stated in his blog this morning:

Don't test, don't find. Know nothing.

​

Today we?ve a report out of Nepal (h/t Gert van der Hoek on FluTrackers) ? a nation which is currently embroiled in a major outbreak of H5N1 in its poultry - that suggests they may have recently missed two recent H5N1 fatalities.

But since they didn?t test (or even collect samples), we will probably never know. A third case is being tested, and we should have results in a week.
​

First the report from the Himalayan Times, then I?ll return with more.

Bird flu suspected in two deaths? no test conducted

2013-08-26 2:27
SURYA PS.KANDEL
No bird-to-human bird flu transmission has been reported so far in Nepal.

NARAYANGADH: Bird flu has been suspected in the deaths of two women, who suffered from common cold and fever, at the Teaching Hospital of College of Medical Sciences in Bharatpur.

The hospital has written a letter to the District Public Health Office (DPHO) after the twin deaths on Saturday, suspecting that the victims were infected with the avian influenza virus (H5N1). However, no sample was collected from the deceased for further laboratory test.

Another patient suffering from common cold, cough and fever is receiving treatment at the ICU of the same hospital. She is given Tamiflu, the antiviral medicine used to treat bird flu.

According to Public Health Inspector Ram K.C., nasal and throat swabs collected from her have been sent to the National Public Health Laboratory in Kathmandu for the confirmation of suspected virus.
(Continue . . . )
​

It is a bit difficult to understand why samples weren?t collected - even post-mortem - but this story indicates they were not. An opportunity lost.

To be fair - it doesn?t matter where in the world you are, or what disease you are interested in ? we really can only guess at its true incidence. Our own CDC can only roughly estimate the number of cases of diseases we have each year.

As the pyramid chart above indicates, only a tiny fraction of infectious disease cases are actually reported to health authorities. - Credit CDC
​

It was just a week ago, in CDC: Estimate Of Yearly Lyme Disease Diagnoses In The United States, that we learned the true burden of Lyme disease in this country may be as much as 10 times greater than are reported.

And just about 2 months ago, in CID Journal: Estimates Of Human Infection From H3N2v (Jul 2011-Apr 2012), we saw a study that estimated that in 2011 ? a year where there were only 12 cases of H3N2v reported ? the real number of cases was probably in excess of 2000.

While it is clearly impossible to test everyone for everything, the more testing that we can do, the better will be our understanding of the burden of, and threat posed by, these emerging viruses.
​

For more on the difficulties in assessing the incidence (and mortality/morbidity rates) of emerging diseases, you may wish to revisit:

Lancet: Clinical Severity Of Human H7N9 Infection

H7N9: CFR Considerations

The Great CFR Divide
Revisiting The H5N1 CFR Debate
​

Posted by Michael Coston at <a class="timestamp-link" href="http://afludiary.blogspot.com/2013/08/nepal-human-h5n1-testing-or-lack-thereof.html" rel="bookmark" title="permanent link"><abbr class="published" title="2013-08-26T07:56:00-04:00">7:56 AM</abbr>

 

[Treyfish]

Re: Nepal - Human H5N1 avian influenza infections ?

Re: Nepal - Human H5N1 avian influenza infections ?

Bird flu wary public throng Teku hospital
KATHMANDU, Aug 25: A man wearing face mask arrived at Sukraraj Tropical and Infectious Disease Hospital (STIDH) and urged the doctors to treat him for bird flu infection. The man told doctors that he might have contracted bird flu.

When the doctors asked what made him think that he might be suffering from bird flu, he said he was suffering from common cold and his throat ached as well. Doctors asked him whether he was a poultry farmer or was exposed to chickens at cold store. The man said he was neither a poultry farmer nor did he work at a meat shop, but that he had eaten chicken the previous night at a restaurant...

...Doctors counsel and send the patients home as they said that a lot of patients do not show any signs of infection. "When they insist on check-up, we send them to the National Public Health Laboratory (NPHL)," said Rajesh Shah, a doctor at the hospital. NPHL is the only lab in the country with a facility for testing bird flu.
He said bird flu patients suffer from high fever, severe pain in the muscle, throat swell and difficulty in breathing.

NPHL officials said that every day about 30 such patients have been visiting the laboratory since the last one month. "We have conducted tests on over 500 people but we have not found a single case of human infection," Bishnu Prasad Upadhya, a microbiologist at the NPHL, said. He said that the laboratory conducts tests only on those people who show symptoms of bird flu infected people.

All hospitals in the capital send patients to the NPHL when they suspect bird flu infection in any patient. Upadhya said that people should not worry about normal fever, common cold and throat problems as season is changing. He, however, cautioned the people to be conscious about the possible infection of the disease. "People who remain in close contact of chickens, work in poultry farms and cold stores are most vulnerable to the disease, so they should apply precautionary measures," he added....

Published on 2013-08-26 05:53:45
:tiphat:http://www.myrepublica.com/portal/index.php?action=news_details&news_id=60176
​

 

[sharon sanders]

Re: Nepal - Human H5N1 avian influenza infections ?

Re: Nepal - Human H5N1 avian influenza infections ?

FluTrackers.com ‏@FluTrackers 1h
#Nepal - Human #H5N1 avian influenza infections ? http://www.flutrackers.com/forum/showthread.php?t=210445 @GertvanderHoek @Fla_Medic #fb


FluTrackers.com ‏@FluTrackers 8m
#Nepal - A wary public asking hospital for #H5N1 testing due to numerous outbreaks in poultry http://www.flutrackers.com/forum/showthread.php?p=507911#post507911 @Treyfish #fb


Satish Pandey
‏@SatishKTM
@FluTrackers @Treyfish yes, so far no human cases seen in #Nepal.
9:18 AM - 26 Aug 13


FluTrackers.com ‏@FluTrackers 6m
@SatishKTM @Treyfish Thank you for the information. #H5N1 #fb

 

[Treyfish]

Re: Nepal - Human H5N1 avian influenza infections ?

Re: Nepal - Human H5N1 avian influenza infections ?

EDCD denies H5N1 caused deaths

KATHMANDU: The Epidemiology and Disease Control Division stated on Monday that it did not consider it necessary to conduct lab tests on the throat swabs, as the two women had died from pneumonia and not from bird flu. ?Because the hospital made it clear that the deaths were caused by pneumonia, we did not think it was necessary to test the samples,? said Kumar Dahal of the Department of Health Services. ?We would have conducted tests to confirm whether they had died of H5N1 virus had they been suspected of having epidemiological link with bird-flu.? According to the standard operating procedures that the DHS has circulated, epidemiological links may be established under two key circumstances: people should come from bird-flu hit area and they have to have contact with poultry products within the past two weeks. ?Any suggestion that they died from bird flu is but a baseless rumour.?? HNS:tiphat:http://www.thehimalayantimes.com/fu...+after+two+women+die+in+Chitwan&NewsID=388795

 

[Treyfish]

Re: Nepal - Human H5N1 avian influenza infections ?

Re: Nepal - Human H5N1 avian influenza infections ?

...Both were admitted to the hospital after they suffered from common cold and fever.
After the hospital wrote a letter to the District Public Health Office (DPHO) of Chitwan to confirm whether the victims were infected with Avian Influenza (H5NI) virus, rumors about their deaths, possibly from Bird Flu, spread rapidly early on Monday, causing panic among people.
However, in its statement, the EDCD maintained that bird flu was yet to spread to human population. In Nepal, even though bird flu outbreaks recently surged in the Kathmandu valley and surrounding districts, no one has been tested positive for H5NI.

According to Thakur, a team was mobilized by the Chitwan DPHO immediately after the two women?s deaths to confirm whether they died of bird flu. The team, Thakur informed, found out that none of the victims had been in contact with chicken or any other birds in the last two weeks, which ruled out possibilities that they were infected with H5NI virus.

In addition, according to Thakur, a laboratory report prepared by the hospital, where the two women died, also confirmed that the victims had not been infected with H5NI virus./...:tiphat:http://www.myrepublica.com/portal/index.php?action=news_details&news_id=60243

 

[Treyfish]

Re: Nepal - Human H5N1 avian influenza infections ? Government says no


No human tested positive for bird flu‚ claims EDCD Last Updated At: 2013-08-27 11:24 P\

KATHMANDU: The Epidemiology and Disease Control Division today said bird flu has not been detected in the human population to date, but seven persons — six from Bhaktapur and one from Lalitpur — were found to have been affected by pandemic influenza A(H1N1), commonly known as swine flu, this month. All eight, however, returned home safe after being treated for pandemic and seasonal influenza.

The EDCD had tested influenza samples collected from suspected cases in Bhaktapur, Kathmandu, Lalitpur and Hetauda between August 4 and August 20, said Kumar Dahal, a public health inspector at the EDCD. None of the samples tested positive for bird flu, avian influenza A (H5N1), said Dahal, adding that 13 samples, recently taken from Kavre, are under lab test. “It will take 72 hours for the results. The EDCD will make public the current status of avian influenza in humans in a couple of days.”...
:tiphat:http://www.thehimalayantimes.com/fullNews.php?headline=No+human+tested+positive+for+bird+flu%26sbquo%3B+claims+EDCD&NewsID=388895