Re: Suspected Bird Flu Outbreak in Indonesia Hospitalizes 13, 3 Suspected Deaths
Re: Suspected Bird Flu Outbreak in Indonesia Hospitalizes 13, 3 Suspected Deaths
I thought it might be useful to post a quick summary of what has been reported through the media sources to date, and highlight possible implications, as I perceive them.
1. Three people sickened and died in the village, and it is not clear if the poultry in the village started to die before or after this event. If before, it is probable that the infection pathway was from bird to human, and possibly with a wild bird or contaminated meat or illegally imported poultry, or poultry derived products such as fertilizer as the origianl viral source. If however, it was the humans that sickened first (as per one report) or both events happened concurrently then the implication may be a highly contagious and infectious virus and that the infection pathway was (unknown vector: wild bird, mammal or other) to humans and birds at or about the same time. In this scenario a virus that passes from humans to birds is also a possibility.
2. Reports on the poultry infections are conflicting, with some indicating that the birds have tested postive, and others suggesting that formal testing was not done as it was 'obvious'.
3. There are some statements saying that the H5N1 human tests have come back negative. However, it is worth noting that because of the clinical presentation in the two children (which was fairly textbook in the early stages for H5N1 infections by all accounts), the hospital teams are still treating them as 'suspect bird flu'.
4 There are two options here:- we know (I think) that the rapid tests for flu A were positive here, so we ARE dealing with a flu in one form or another. So negative testing could be because
a) the virus has changed significantly in its genetic make up producing false negatives. As we do not have viral samples from the virus ciruclating in Indonesia, (on the assumption the Indonesia does not have the capability to produce these itself, and has to import) test kits that are an accurate match cannot be properly produced or kept updated in this region. Therefore testing in Indoneisa is bound to be inaccurate to at least a degree.
b) we have an outbreak in a rural area with pigs, poultry and humans all living close together in the beginnings of their upswing in 'normal' flu season. It is therefore possible that we have a reassortant virus in one shape form or another: this influenza has caused 3 deaths in a very short space of time already, not to mention the two serious hopitalisations, so whatever it is... it is nasty and a cause for concern in its own right, no matter what the final verdict is on its N or H type.
5) A WHO team has gone into the area to conduct investigations. This is worthy of note, given the Indonesian stance towards WHO - especially over the NAMRU 3 and virus sharing dispute.
6)We cannot accurately determine the answer to points 4a) & b) until full genetic sequencing of the viurs is conducted. I dont believe that Indonesia has the capability to carry this work out, and if it does, how accurate or rapid it might be. Therefore, IF THIS ASSUMPTION IS CORRECT, for this work to be carried out, Indonesia will need to agree to send the sample to NAMRU 3 or authorise its release to a WHO laboratory. This raises interesting political questions, as the need to determine answers to these questions is clearly urgent.
7)It will be at least another 10 days before we can all be sure that any potential infectious outbreak (if this is indeed one) has been contained.
Have I missed anything?
Correction - that should have been Namru 2
Re: Suspected Bird Flu Outbreak in Indonesia Hospitalizes 13, 3 Suspected Deaths
I thought it might be useful to post a quick summary of what has been reported through the media sources to date, and highlight possible implications, as I perceive them.
1. Three people sickened and died in the village, and it is not clear if the poultry in the village started to die before or after this event. If before, it is probable that the infection pathway was from bird to human, and possibly with a wild bird or contaminated meat or illegally imported poultry, or poultry derived products such as fertilizer as the origianl viral source. If however, it was the humans that sickened first (as per one report) or both events happened concurrently then the implication may be a highly contagious and infectious virus and that the infection pathway was (unknown vector: wild bird, mammal or other) to humans and birds at or about the same time. In this scenario a virus that passes from humans to birds is also a possibility.
2. Reports on the poultry infections are conflicting, with some indicating that the birds have tested postive, and others suggesting that formal testing was not done as it was 'obvious'.
3. There are some statements saying that the H5N1 human tests have come back negative. However, it is worth noting that because of the clinical presentation in the two children (which was fairly textbook in the early stages for H5N1 infections by all accounts), the hospital teams are still treating them as 'suspect bird flu'.
4 There are two options here:- we know (I think) that the rapid tests for flu A were positive here, so we ARE dealing with a flu in one form or another. So negative testing could be because
a) the virus has changed significantly in its genetic make up producing false negatives. As we do not have viral samples from the virus ciruclating in Indonesia, (on the assumption the Indonesia does not have the capability to produce these itself, and has to import) test kits that are an accurate match cannot be properly produced or kept updated in this region. Therefore testing in Indoneisa is bound to be inaccurate to at least a degree.
b) we have an outbreak in a rural area with pigs, poultry and humans all living close together in the beginnings of their upswing in 'normal' flu season. It is therefore possible that we have a reassortant virus in one shape form or another: this influenza has caused 3 deaths in a very short space of time already, not to mention the two serious hopitalisations, so whatever it is... it is nasty and a cause for concern in its own right, no matter what the final verdict is on its N or H type.
5) A WHO team has gone into the area to conduct investigations. This is worthy of note, given the Indonesian stance towards WHO - especially over the NAMRU 3 and virus sharing dispute.
6)We cannot accurately determine the answer to points 4a) & b) until full genetic sequencing of the viurs is conducted. I dont believe that Indonesia has the capability to carry this work out, and if it does, how accurate or rapid it might be. Therefore, IF THIS ASSUMPTION IS CORRECT, for this work to be carried out, Indonesia will need to agree to send the sample to NAMRU 3 or authorise its release to a WHO laboratory. This raises interesting political questions, as the need to determine answers to these questions is clearly urgent.
7)It will be at least another 10 days before we can all be sure that any potential infectious outbreak (if this is indeed one) has been contained.
Have I missed anything?
Correction - that should have been Namru 2
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