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.
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.
What do you consider the reason/s for WHO's activities in this regard?
Sad but true !
Your post in Response #20 was removed because it contained a complete New York Times article.
Please do not bypass copyright restrictions again.
Please provide the correct source name, a working link and correct title for all news articles and excerpts of news articles which you post, whether the articles or excerpts are posted in responses or as the basis for a thread.
These posts from today all need correct source names and working links.
Thanks.
http://www.freerepublic.com/focus/f-news/1568286/posts?page=4#4
http://www.freerepublic.com/focus/f-news/1568286/posts?page=6#6
http://www.freerepublic.com/focus/f-news/1568286/posts?page=9#9
http://www.freerepublic.com/focus/f-news/1568286/posts?page=10#10