Posted on 01/30/2006 4:13:39 PM PST by Mother Abigail
WHO to send team to Iraq to investigate possible bird flu case cluster
HELEN BRANSWELL
(CP) - It appears H5N1 avian influenza has spread to war-torn Iraq, a most unwelcome twist on the evolving path of this worrisome virus.
A U.S. military laboratory in Cairo confirmed a 15-year-old girl from Kurdistan in northern Iraq who died on Jan. 17 was infected with H5N1 avian flu, Iraqi authorities announced Monday. Earlier testing by the Iraqi national laboratory and another in Jordan concluded she did not have the virus.
H5N1 is also suspected as the cause of death for the girl's 50-year-old uncle, who became ill after nursing the dying teenager. He died last Friday. Confirmatory testing on samples from both is being conducted at Britain's National Institute for Medical Research, a collaborating laboratory for the World Health Organization.
"We're classifying this as a preliminary positive case, which is what we're using to describe the cases in Turkey, so that we can react as if it is a confirmed H5N1 case," WHO spokeswoman Maria Cheng said from Geneva.
"But we'd still like the results to be confirmed by the WHO collaborating centre in the U.K."
There is a possibility this is a case of limited human-to-human spread of the virus, Cheng acknowledged. "Based on the evidence we have right now, I don't think we can rule it out."
"We still don't have a lot of details about the context of these cases; whether or not they both had contact with sick chickens or just how much contact they had. But given that he was said to have taken care of her when she was ill, that certainly does raise our level of concern."
There have been several reported cases of what was thought to be limited, inefficient person-to-person spread, where people caring for an H5N1 case developed infection themselves. To date, the WHO has seen no evidence of the sustained human-to-human transmission.
If confirmed, these will be the first H5N1 human cases recorded in the Middle East. They represent not merely a expansion of the virus's geographic range, but a logistical nightmare for the WHO and sister UN agency the Food and Agriculture Organization, which would have a lead position for any response to outbreaks in poultry.
"What I think is probably most significant with regards to the situation in Iraq is just the security context in which this outbreak would need to be investigated," said Dr. Eric Toner, a senior associate with the Center for Biosecurity at the University of Pittsburgh Medical Center.
Toner noted the WHO teams that responded to the recent H5N1 outbreak in remote eastern Turkey encountered significant hurdles. Blizzards forced the cancellation of flights and poor roads slowed ground travel. But there were no security concerns in Turkey, where officials co-operated fully with the international team of experts.
"Getting people into the Kurdish areas of Iraq has all kinds of new challenges," he said.
A team of four or five WHO experts - epidemiologists, clinicians and a lab technician - is being drawn up. It's hoped they can be on the ground in northern Iraq later this week, "but there is a security situation which is going to make the team getting in and out a bit more difficult," Cheng admitted.
At least 240 foreigners in Iraq have been kidnapped in the past two years, some for ransom, and others, including currently held Canadians James Loney and Harmeet Sooden, for political purposes. At least 40 kidnapping victims have been killed.
"Westerners in general are targets of opportunity for people who use this is a business opportunity and sometimes sell them on to politically motivated groups. It's a very complex, complicated mess," noted Dr. David Fedson, a flu expert and retired academic.
Dr. Richard Waldhorn, a colleague of Toner's and a distinguished scholar at the centre, said from the point of view of the threat of igniting a flu pandemic, densely populated places with avian flu outbreaks - places like Indonesia - continue to pose the highest risk. But from the point of view of mounting a response, Iraq poses unique difficulties for the World Health Organization.
"I think there are worse spots. Epidemiologically worse. (But) I can't think of anything worse politically and mechanically for WHO to navigate," Waldhorn said from Baltimore, where the centre is based.
"With a politically unstable and militarily unstable situation, I can't imagine that would make it any easier for them to conduct their usual investigative work."
How much work there is to be done remains unclear. Iraq has not reported cases of avian influenza to the Food and Agriculture Organization, said Dr. Juan Lubroth, head of the organization's emergency prevention system.
Lubroth said a local consultant who works with the organization has said there don't appear to be outbreaks in commercial poultry operations. But the state of backyard poultry flocks may be a different matter.
Turkish authorities said last week they believe a number of neighbouring countries have unreported outbreaks of H5N1 in poultry. Lubroth said his agency believes that's likely true.
"We highly suspect that there is highly pathogenic (H5N1) avian influenza in the countries neighbouring Turkey, also including Romania and Ukraine, not to forget those. So therefore we've sent out messages of alert to those countries to do better investigations, to do better surveillance and to take on preventive actions so that the disease is not spread further," Lubroth said.
Iraqi health authorities began killing domestic birds in northern Iraq, which borders Turkey, where at least 21 cases of the deadly virus have been detected. Turkey and Iraq also lie on a migratory path for numerous species of birds.
"We regretfully announce that the first case of bird flu has appeared in Iraq," Iraqi Health Minister Abdel Mutalib Mohammed told reporters in the Kurdistan city of Sulaimaniyah, 260 kilometres northeast of Baghdad.
"The results show the infection with the deadly H5N1," he said. "We appeal to the World Health Organization to help us."
The girl, Abdul Qader, died after developing severe pneumonia in the Kurdistan village of Raniya, about 100 kilometres south of the Turkish border and just 24 kilometres west of the border with Iran. She had an aortic aneurysm and a history of cardiac problems. The girl's mother rejected the bird flu results, but acknowledged that a number of her chickens had mysteriously died before her daughter's death.
"My daughter did not die from bird flu," Fatima Abdullah, 50, told The Associated Press. "She did not like chickens nor had anything to do with them. She did not take care of these birds."
Kurdistan Health Ministry official Najimuldin Hassan said 14 people have recently been admitted to local hospitals exhibiting bird flu symptoms, but just two remain in Sulaimaniyah Teaching Hospital suspected of possibly having the disease.
The U.N. official, who refused to be named because of the sensitivity of the issue, said testing on blood samples from the girl, who died Jan. 17, were done at the U.S. Navy Medical Research Unit in the Egyptian capital.
The official had been supervising the examination of samples sent by the regional government in northern Iraq. He said 30 other samples from northern Iraq were being tested.
I apologize for my earlier copyright infringement.
Thank you for being so alert and in the future I hope to be more cautious.
MA
Thanks for posting.
H5N1 False Negatives in the Middle East
Recombinomics Commentary
January 30, 2006
"As this has occurred in a region next to a country identified with a H5N1 outbreak, it would not be surprising" that it has shown up in Iraq, WHO spokeswoman Maria Cheng said.
Although the above comment by WHO is true this week, it also was true last week when WHO "discounted" the report that the index case in Iraq had died from bird flu.
Media quotes from the physician at the scene indicated the girl had symptoms that matched the fatal cases in Turkey. The large number of confirmed H5N1 cases in birds and humans in Turkey left little doubt that neighboring countries, including Iraq, were reporting false negative reports. WHO now says the basis of the discount was the false negative in Iraq.
However, as WHO knows, every new outbreak in a new country has had at least one false negative. The initial reported cases in Cambodia, Indonesia, China, and Turkey all were clusters with likely human-to-human transmission which included untested or false negative cases that were excluded by WHO, which eliminated the record of the cluster and the human-to-human transmission.
In Cambodia the index case died. His sister developed symptoms and tested positive after she died in Vietnam. WHO excluded the index case because samples were not collected.
In Indonesia the index case was diagnosed with bacterial pneumonia. After her sister and father were hospitalized the father tested positive for H5N1.
All three family members died, but the younger sister was excluded because samples were not collected and the index case was excluded because the difference in titer between her two strongly positive serum samples was not a four fold difference.
In China two siblings developed bird flu symptoms after an outbreak in their village. The index case died, but was excluded because samples were not collect.
The sibling was H5N1 positive.
In Turkey all four siblings initially tested negative. Three siblings died and were H5N1 confirmed, but the fourth sibling was excluded because of a false negative test. The fourth sibling still has not been retested to show that he was H5N1 positive.
All of the above clusters had a time gap between disease onset dates of the index case abd other family members. However, WHO exclusions eliminated clusters in all countries except Turkey.
However, in Turkey WHO eliminated the disease onset date.
WHO's omissions in Turkey were quite remarkable. Normally, WHO updates on H5N1 positive patients include disease onset dates as well as information on relatives. This information was glaringly absent in updates in Turkey.
WHO officials were well aware of the fact that the initial cases in Turkey were largely composed of relatives.
Officials were quoted in media reports shortly after the oldest Kocyigit sibling died and they indicated that two large families were involved. The two large families were Kocyigit and Ozcan, but WHO failed to indicate that the two large families were related to each other.
When WHO published updates on the deaths of the three oldest Kocyigit siblings, they failed to mention that 10 Ozcan cousins were in the same hospital and two were H5N1 positive. They also failed to give disease onset dates for the Kocyigit siblings.
When the two Ozcan cousins were described in WHO updates disease onset dates were not given, nor were the 8 family members hospitalized in the same hospital mentioned. The relationship of the positive Ozcans to the deceased Kocyigts was also not given.
Similarly, when a second set of Ozcan cousins were admitted and tested positive there was no mention of relationships to the deceased Kocyigits or the H5N1 positive or hospitalized Ozcans, even though the update indicated no additional family member had symptoms.
Thus, after the above commissions by omission, WHO "discounted" the now confirmed H5N1 index case in Iraq. These misrepresentations encourage neighboring countries to misrepresent the H5N1 situation.
No country in the Middle East has filed an OIE report on H5N1 in poultry and the index case in Iraq is the only reported human H5N1 case in the Middle East
The false negatives on H5N1 in people and birds in Europe, the Middle East, and Africa are predictable, as is WHO's inability to convince countries to transparently report H5N1 infections.
Let the fleecing of the American taxpayer begin!
Meanwhile:
-- Elsewhere in the Middle East, Saudi Arabian authorities have tested a number of falcons and found evidence of infection of an H5 strain of avian influenza.
The official Saudi Press Agency reported over the weekend that five falcons have been tested for avian flu and that 37 falcons, including the five tested, have been culled as a preventive measure.
Although the presence of an H5 strain of the virus has been detected, authorities are still awaiting confirmation of the "N" subtype. This is the first time an H5 strain of bird flu has been detected in Saudi Arabia.
-- European Union authorities Sunday confirmed the presence of H5N1 in samples taken from poultry stocks in Cyprus.
The European Commission has sent a team of veterinary experts to Cyprus and has offered the assistance of the EU in surveillance, should it be needed.
Cypriot authorities have issued instructions that all poultry be kept indoors, and stringent checks are taking place at crossings between the Greek and Turkish sides of the island.
"The European Union is the best prepared area in the world to confront a deadly virus pandemic, and this also covers Greece and Cyprus," EU Health Commissioner Markos Kyprianou told Greek news agencies last week.
-- Following the emergence of avian influenza on its doorstep, EU regulators are considering allowing member states to make their own decisions -- pending application and justification -- considering the precautionary vaccination of poultry flocks.
"With H5N1 on Europe's borders for several months now, there is an ongoing risk. It's a new situation, and in a new situation, new approaches may have to be considered," a European Commission official said.
"Until now, it (vaccination) has been allowed for emergency vaccination but not preventive.
Now, preventive vaccination could be allowed based on the risk and an analysis of the risk. It's an option that could be considered."
EU officials have shied away from preventative vaccinations in the past as regulations concerning the separation and identification of vaccinated and non-vaccinated birds make the area a bureaucratic minefield.
-- Romanian health officials have announced that a woman originally admitted to hospital with suspected avian-influenza infection is clear of the virus.
Although results from the blood tests have yet to be confirmed, initial signs indicate that the woman, who was hospitalized last week, is most likely ill with bronchitis.
-- Officials in northeastern Bulgaria discovered more than 100 dead birds near the Durankulak and Shabla lakes Saturday. The dead birds were found frozen.
Samples taken from the birds are currently being tested for signs of H5N1 as a precautionary measure, although it is likely that the birds died as a result of the extreme low temperatures in eastern and central Europe last week.
Until the test results are returned, the area around the lakes has been cordoned off, and movements have been restricted.
-- An Oriental Magpie Robin, a popular breed of household pet, was confirmed by Hong Kong authorities Sunday to have died of avian influenza.
The bird, which was found dead in a private hut near the Chinese border, is the second Oriental Magpie Robin to have died of avian influenza in Hong Kong this month.
-- Algerian Health Ministry officials announced Monday that a poultry breeder who died under suspicious circumstances earlier this month was not infected with avian influenza.
"There is no sign of bird flu. The tests were negative," a Health Ministry official told reporters.
No cases of avian influenza in humans or birds have been confirmed in Algeria.
Thanks for keeping us informed of this very troubling situation.
In our local newspaper this morning was an article about what the South Dakota medical community is doing in the way of "pandemic preparedness". I'm glad to know that they are doing something..............anything. At least they seem to be aware of the potential.
pANDEMIC my ever expanding ass!
Hundreds Worldwide Killed! MSM Hype!
Not having DDT has killed Millions and crippled Millions more.
Screw the Bird Flu, the hell with AIDS and all of the other MSM darlings, if we are serious about saving Human lives bring back DDT!
TT
Lethal H5N1 Bird Flu Strain Confirmed In Cyprus
The European Commission has confirmed that the lethal H5N1 bird flu virus strain has been found in the Turkish part of Cyprus. Cyprus is divided into two parts, the Greek and the Turkish parts.
Greece is part of the European Union while Turkey is not, therefore only the Greek part of Cyprus is part of the EU. Turkey is in talks with the EU about accession.
The border between the two parts of Cyprus is known as The Green Line. The EU says no animal products can cross the Green Line - this includes any kind of bird. Obviously, wild birds come and go as they please and there is nothing authorities can do about them.
The northern part of Cyprus is Turkish while the southern part is Greek.
The EU is sending scientists to the Turkish part of Cyprus to study the disease more carefully.
Over the last two years bird flu (avian flu) has made its way from south east Asia, to Siberia, down to Turkey and now to Cyprus - an island in the Mediterranean sea.
The EU is bracing itself for the arrival of bird flu.
Military lays out plans should avian flu break out in Europe
Goal is to protect troops, dependents while continuing mission
By Charlie Coon, Stars and Stripes
European edition, Tuesday, January 31, 2006
http://www.estripes.com/article.asp...4&article=34684
STUTTGART, Germany — The U.S. military in Europe would consider restricting the movement of troops, families and civilians as a way to combat the outbreak of the avian influenza, in the event the virus mutates and starts spreading from human to human.
The military's plan, as discussed at a conference earlier this month in Stuttgart, would be orchestrated with host nations and U.S. embassies.
It strives to shield troops and families from the disease while also allowing U.S. military missions to continue unfettered.
Most cases of bird flu, which was first discovered in late 2003, have been found in Southeast Asia, where farm workers were infected by the virus due to direct contact with infected, domestic fowl.
Of the approximately 140 cases of bird flu found in humans, more than 80 have been fatal.
Though the vast majority happened in Southeast Asia, two children in Turkey and one girl in Iraq
recently died from bird flu.
Cases of the flu have also been confirmed in poultry in Romania, but no humans have contracted the disease there.
Health experts fear that the virus, called H5N1, could mutate into a human-borne virus that could be carried around the world by unwitting victims, much like the common flu.
"The concern is that the mortality rate of this mutated flu would be considerably higher (than that of common influenza)," said Dr. (Army Col.) Edward Huycke, command surgeon for the Stuttgart-based U.S. European Command.
Huycke declined to speculate on the likelihood of the bird-borne virus mutating into one that could be spread by humans.
"I don't think anyone would hazard a guess," Huycke said.
"There is a concern, based on the past history of flu viruses, that a mutation could occur, but I don't think anybody would lay odds."
Medical personnel are working on a plan if a human-to-human form of the virus is found, officials say.
Victims would be given medical treatment, and people with whom they'd had contact would be identified.
The hospitalized victims would have oral and nasal swabs taken as well as blood, which would be rushed to scientists who'd begin developing a vaccine, Huycke said.
Reaction could possibly include isolation and quarantine of victims, to decrease the chance of the flu spreading.
Plans are already in place in the U.S. and elsewhere to facilitate the speedy development and distribution of a vaccine, according to Air Force Maj. Dana Dane, EUCOM's chief of force health protection.
"Part of the big-picture response has been the priming of that system," Dane said.
EUCOM officials stressed that the plan is part of a larger U.S. government plan being led by the State Department, since a pandemic could cross many borders.
Representatives from the United Kingdom, Italy and Germany also attended the conference.
According to Air Force Lt. Col. Ron "Grumpy" Sanders, the European Plans and Operations Center's contingency response chief, in case of an epidemic, the military's priorities are to protect its people, carry out missions as usual, and help others cope, if possible.
"Our planning effort is not to contain the avian flu," Sanders said.
"It's to manage the environment if it (becomes) a sustainable, human-to-human pandemic, if it comes to that."
The military is also planning a medical-response exercise in May or June to test its capabilities, Sanders said.
There it is. If we don't subscribe to evolution we have little to worry about.
"My daughter did not die from bird flu," Fatima Abdullah, 50, told The Associated Press. "She did not like chickens nor had anything to do with them. She did not take care of these birds."
I don't like the 'sound' of either of these statements.
It seem as though there are hints of H2H transmission showing up quite often now. I'm quite concerned abouth the "unreported" cases.
Adding to the above.............
I well remember when reports of HIV Aides were in the "hint" stage.
What do you consider the reason/s for WHO's activities in this regard?
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