27 February 2006
H5N1 spreads to Niger, to more areas in Egypt and Nigeria, to turkeys in France. China warns of “massive outbreak,” and WHO expands website with maps, key documents in Arabic, and updated Hospital Infection Control Guidelines.
The rapid pace of new information on the avian spread of H5N1 continued over the past week with reports this morning that domestic ducks in southern Niger, near the town of Magaria, close to the border with Nigeria, have tested positive for H5N1. Reuters, AP News, and CNN cite OIE today as confirming this initial H5N1 outbreak in Niger. In Nigeria, at least seven of the 36 states, along with the central Federal Capital Territory, are reported to have H5N1 outbreaks, with two more states undergoing tests. Multiple governates (provinces) in Egypt have also reported H5N1 this month.
Updates on H5N1 in Egypt, with at least eight (8) key documents in Arabic, can be found on the Eastern Mediterranean Regional Office (EMRO) website: www.emro.who.int . This information can be found in a newly optimized WHO website section on avian and pandemic influenza begun last Friday, February 24th. This new website also contains excellent color maps illustrating outbreaks in humans, wild birds, and poultry. These maps can be found at: http://gamapserver.who.int/mapLibrary/app/searchResults.aspx
The Western Pacific office of the WHO, also listed on this newly consolidated WHO website, includes an important updated article (as of February 9th) on Infection Control for hospitals, including use of fit-tested N-95 respirators for health care personnel. The 58 page document, at the following URL is titled: “Avian Influenza, including Influenza A (H5N1), in Humans: WHO interim Infection Control Guideline for Health Care Facilities.” www.wpro.who.int/health_topics/avian_influenza/publications.htm
Over the past week France has reported an outbreak of H5N1 in turkeys, and decided to begin vaccination against H5N1. Japan announced it will ban poultry imports from France.
In the past 48 hours the State Agriculture Minister of China, Mr. Du Qinglin, reported another poultry outbreak and two more human cases (one in a pregnant woman). He is also quoted as saying “In light of the current situation, the possibility of a massive bird flu outbreak cannot be ruled out,” according to today’s South China Morning Post (Feb 27 by Bill Savadove in Shanghai). This comment was also carried in the China Daily, and China View (www.chinaview.cn).
In Indonesia today, the WHO confirmed the 20th fatality of the 27 laboratory-confirmed patients with H5N1 infection. This brings the WHO total global number of deaths due to H5N1 virus to 93, from a total of 171 WHO lab-confirmed patients (54%) in seven nations.
This highly accelerated pace of H5N1 spread from Asia to multiple nations in Europe and Africa is likely to continue as migratory birds transport the H5N1 virus to further regions over the next three months.
In addition, the potential role for human transportation of H5N1-infected poultry and exotic birds is emphasized by the two reports 21 February in ProMED Mail (Archive Number 20060221.0565) item #4: ”Spain, smuggled Chinese poultry meat.” 21 tons of poultry was confiscated by police in the coastal town of Benidorm in the province of Alicante, Spain. The meat included chicken and duck, “thought to have been imported from China illegally.” It is thought that the meat was to have been brought to Spain by lorry, and that its final destination was to have been Chinese restaurants across the Province of Alicante.”
Immediately following this report, the moderator noted that “2 days ago, 20kg of chicken tongues from China were intercepted at Rio de Janeiro’s international airport, presumably destined for Chinese restaurants in Brazil.”
Sooner or later, one way or another, the H5N1 highly pathogenic avian influenza virus (HPAI) will arrive in the Americas. If the USA fails to prepare comprehensively for avian and pandemic influenza, then it will not be a ‘failure of imagination” (to use the term applied by some to the 9/11 attacks) or a “failure of initiation” (to use the term applied by some to the Hurricane Katrina disaster), but a “failure of implementation” because the warning has been years in coming and a national and international response initiated.
The catalyst to implement comprehensively the international global partnership on avian and pandemic influenza, admirably begun in the autumn of 2005, should not have to be the arrival of the H5N1 virus in the USA.
Daniel R. Lucey, MD, MPH
Director, Center for Biologic Counterterrorism and Emerging Diseases
ER One Institutes, Washington Hospital Center
Co-Director, Master of Science Graduate Program in Biohazardous Threat Agents and Emerging Infectious Diseases, Georgetown University Medical School, Washington, DC
website: www.BePast.org e-mail:Daniel.R.Lucey@Medstar.net