Over the past three months, 16 people have died in Sindhudurg, India, due to an illness with symptoms of fever and shortness of breath that the local authorities cannot diagnose:
http://www.flutrackers.com/forum/showthread.php?t=174208
According to the above thread, they seem to have ruled out malaria, dengue, chikungunya, and leptospirosis. Those aren't exactly the first things I would think of for a respiratory outbreak. No mention of influenza testing at all. Given the location, H1N1 and H5N1 should both be investigated. Perhaps influenza isn't being mentioned because it was obviously ruled out (although I would have the same questions about false negatives, rapid tests, and novel strains that we encountered in 2009)?
If it isn't flu, there are plenty of other respiratory pathogens that should be investigated, such as Legionella, which has indeed been reported ex India recently. In fact, no respiratory pathogens are even mentioned as under suspicion in any of the articles. The articles also suggest the victims have had contact with animals, possibly including mice. India has reported pneumonic plague in the past (http://promedmail.org/pls/apex/f?p=...CHECK_DISPLAY,F2400_P1202_PUB_MAIL_ID:X,12162), and the articles also consider hantavirus pulmonary syndrome as under investigation. The rare Indian tick typhus has already caused more cases this year than in all of previous recorded history combined (http://promedmail.org/pls/apex/f?p=...CHECK_DISPLAY,F2400_P1202_PUB_MAIL_ID:X,88281) and does have a respiratory presentation.
If one considers the possibility that shortnesss or breath is not a correct report (given that the diagnoses under investigation included malaria and chikungunya, neither of which is respiratory), the list of high CFR fevers reported recently in India is quite long and includes CCHF (http://promedmail.org/pls/apex/f?p=...CHECK_DISPLAY,F2400_P1202_PUB_MAIL_ID:X,86798), Chandipura encephalitis (http://promedmail.org/pls/apex/f?p=...CHECK_DISPLAY,F2400_P1202_PUB_MAIL_ID:X,27506), and possibly even Nipah virus (which could even be respiratory).
More alarming still, is the report in the most recent post that the NIV, which is a highly competant lab (it was able to diagnose the CCHF outbreak in less than 24 hours), is testing for pathogens by injecting the blood from the human victims into mice to see if it kills them. I'm not sure what that would accomplish as far as diagnosis (most of the above etiologies would kill the mouse anyway), but it suggests that the NIV has no clue what is causing this as this testing seems like it would be done as a last resort only after PCR testing for known agents fails. Perhaps this is an errant report, though, and the real test involves simply PCR testing the mice the patients had contact with for known agents?
One article in the thread indicates that some ill contacts of the patients may have tested positive in another lab for leptospirosis. If this is indeed correct, it would be very embarrassing for the NIV to have been unable to detect it and would call into some question the position of the NIV that the undiagnosed AES outbreaks are not due to known viruses such as JE, Chandipura, and Nipah. Seems unlikely given the apparent quality of the NIV, but would be revolutionary if it were true.
All I know is that it only took 1 or 2 undiagnosed respiratory fatalities in Oaxaca to tip us off to H1N1 in April 2009, and about 5 in Guangdong in February 2003 to tip off ProMED on SARS (http://promedmail.org/pls/apex/f?p=...CHECK_DISPLAY,F2400_P1202_PUB_MAIL_ID:X,20658), so these reports of 16 undiagnosed respiratory fatalities coming out of Sindhudurg deserve some serious attention either way.
http://www.flutrackers.com/forum/showthread.php?t=174208
According to the above thread, they seem to have ruled out malaria, dengue, chikungunya, and leptospirosis. Those aren't exactly the first things I would think of for a respiratory outbreak. No mention of influenza testing at all. Given the location, H1N1 and H5N1 should both be investigated. Perhaps influenza isn't being mentioned because it was obviously ruled out (although I would have the same questions about false negatives, rapid tests, and novel strains that we encountered in 2009)?
If it isn't flu, there are plenty of other respiratory pathogens that should be investigated, such as Legionella, which has indeed been reported ex India recently. In fact, no respiratory pathogens are even mentioned as under suspicion in any of the articles. The articles also suggest the victims have had contact with animals, possibly including mice. India has reported pneumonic plague in the past (http://promedmail.org/pls/apex/f?p=...CHECK_DISPLAY,F2400_P1202_PUB_MAIL_ID:X,12162), and the articles also consider hantavirus pulmonary syndrome as under investigation. The rare Indian tick typhus has already caused more cases this year than in all of previous recorded history combined (http://promedmail.org/pls/apex/f?p=...CHECK_DISPLAY,F2400_P1202_PUB_MAIL_ID:X,88281) and does have a respiratory presentation.
If one considers the possibility that shortnesss or breath is not a correct report (given that the diagnoses under investigation included malaria and chikungunya, neither of which is respiratory), the list of high CFR fevers reported recently in India is quite long and includes CCHF (http://promedmail.org/pls/apex/f?p=...CHECK_DISPLAY,F2400_P1202_PUB_MAIL_ID:X,86798), Chandipura encephalitis (http://promedmail.org/pls/apex/f?p=...CHECK_DISPLAY,F2400_P1202_PUB_MAIL_ID:X,27506), and possibly even Nipah virus (which could even be respiratory).
More alarming still, is the report in the most recent post that the NIV, which is a highly competant lab (it was able to diagnose the CCHF outbreak in less than 24 hours), is testing for pathogens by injecting the blood from the human victims into mice to see if it kills them. I'm not sure what that would accomplish as far as diagnosis (most of the above etiologies would kill the mouse anyway), but it suggests that the NIV has no clue what is causing this as this testing seems like it would be done as a last resort only after PCR testing for known agents fails. Perhaps this is an errant report, though, and the real test involves simply PCR testing the mice the patients had contact with for known agents?
One article in the thread indicates that some ill contacts of the patients may have tested positive in another lab for leptospirosis. If this is indeed correct, it would be very embarrassing for the NIV to have been unable to detect it and would call into some question the position of the NIV that the undiagnosed AES outbreaks are not due to known viruses such as JE, Chandipura, and Nipah. Seems unlikely given the apparent quality of the NIV, but would be revolutionary if it were true.
All I know is that it only took 1 or 2 undiagnosed respiratory fatalities in Oaxaca to tip us off to H1N1 in April 2009, and about 5 in Guangdong in February 2003 to tip off ProMED on SARS (http://promedmail.org/pls/apex/f?p=...CHECK_DISPLAY,F2400_P1202_PUB_MAIL_ID:X,20658), so these reports of 16 undiagnosed respiratory fatalities coming out of Sindhudurg deserve some serious attention either way.