October 21, 2005
New H5N1 infections in Avians in Romania, Russia, China, Thailand, and in birds smuggled into Taipei, China; First new human infection in Thailand in 12 months; No evidence of “P2P” or “P5P” transmission
The Paris-based World Organization for Animal Health (OIE) reported on 21 October that H5N1 influenza virus had been confirmed in avians (not humans) in multiple new locations in European and Asian Nations where it has previously been found, emphasizing the tenacity of the virus and the ongoing risk of avian-to-human infection as the flu season approaches north of the equator.
In Romania, the OIE reported H5N1 in the villages of Maliuc and Vulturu in addition to the original outbreak diagnosed in Ceamurlia-de-jos. The avians include chickens, ducks, and a swan. The hemagglutinin and neuraminidase genes have been sequenced and found to be same as the recent H5N1 isolate from Turkey and Central Asia. All H5N1 tests were confirmed at the OIE Reference Lab in VLA Weybridge, United Kingdom.
In Russia H5N1 virus was confirmed in Jandovka village, Efremov district, in the Tula region. Ducks, geese, turkeys, chickens, and Muscovy ducks in backyard farms had mortality rates ranging from > 4% for ducks to 100% for turkeys. A lake bordering the village with migratory ducks (probably mallard) were linked to this outbreak. The date of the start of this outbreak was reported as 14 October.
In Inner Mongolia, China H5N1 was confirmed in Tnegjiaying village, Huhehot municipality division, starting on 14 October. Chickens and ducks were infected. Migrating birds are noted to pass or congregate at a nearby lake. A monovalent H5N2 vaccine was administered to 166,177 birds as part of the response to the outbreak.
In Thailand, new H5N1 outbreaks were reported in several villages in the province of KamphaengPhet involving native poultry and fighting cocks (in village No. 4 only). No vaccinations were given (prohibited). OIE reports that in this third wave of avian outbreaks (the 2nd wave ended April 12th) there have been 59 confirmed outbreaks in 7 provinces, all in the Central Poultry Zone of Thailand. The animals involved were reported to OIE as having been farm-raised poultry or free-range poultry with traditional husbandry practices including poor sanitation and inadequate biosecurity.
On October 14 the Taipei China Coast Guard intercepted a cargo boat from the People’s Republic of China and found smuggled birds (and mice and turtles). 46 samples were obtained from the 1,037 birds, and some tested positive for H5N1 virus. All the smuggled animals were killed on 15 October.
Dead birds in multiple other locations have been or are still being tested for H5N1. These locations include Kosovo, Croatia, Greece, Macedonia, and Nepal. In Macedonia, Newcastle disease was reported by the OIE October 21st, although “one serum gave a positive result to the serological test” for the 16 different avian influenza viruses tested. Samples were then sent to the OIE reference lab in VLA Weybridge, UK, and are pending.
Not surprisingly, with the ongoing outbreaks in avians in Europe and Asia, the risk of avian-to-human infection continues. Thus, the risk of dual infection with both an avian and a human influenza virus is increased as the human influenza season begins now in the northern hemisphere.
The WHO reported on 20 October that the Ministry of Public Health (MOPH) in Thailand confirmed the first human infection with H5N1 in more than one year (since October 8, 2004). The 48-year-old man died after slaughtering diseased poultry in Kanchanaburi province in the Central Poultry Zone of Thailand. This man, the 18th confirmed human infection in Thailand and the 13th fatal infection, had a 7-year-old son who was also reported hospitalized with an influenza-like illness. Preliminary reports suggested that the son had also been infected during close contact with infected poultry and not by person-to-person spread.
We should anticipate more avian infections as the virus spreads further in Europe and into Africa and the Middle East, as well as recurring in Asia. More human infections from avians and non-sustained person-to-person (“P2P”) infections in small clusters in humans are predictable this winter.
Surveillance for more extensive, sustained, person-to-person-to-person-to-person-to-person (“P5P”) transmission is essential if any realistic hope is to be maintained that a nascent pandemic can be identified and mitigated by public health intervention by national and WHO response partners.
Daniel R. Lucey, MD, MPH
Director, Center for Biologic Counterterrorism and Emerging Diseases
ER One Institutes, Washington Hospital Center
Adjunct Professor, Department of Microbiology and Immunology
Georgetown University School of Medicine
Website: www.BePast. Org