# 1140
Nearly a year ago, in blog #198 entitled Not Your Father's Influenza I outlined some of the early findings presented in a WHO (World Health Organization) document that made it clear the H5N1 virus wasn't just another influenza virus.
Quoting from Influenza Research At the Human and Animal Interface:
The disease caused in humans by the H5N1 virus was described as fundamentally different from that caused by normal influenza. In H5N1 infection, the disease syndrome typically shows progressive primary viral pneumonia, acute respiratory distress, marked leukopenia and lymphopenia, and (in some cases) diarrhoea and liver or renal dysfunction. What might explain this severity?
Some limited findings suggest that the virus might cause disseminated infection, affecting multiple organs. In some patients with a fatal outcome, virus has been detected in faeces, serum, and blood plasma. However, respiratory pathology remains the primary cause of death.
Tomorrow, the Lancet will publish a study by researchers at the Infectious Disease Center at China's Peking University that gives further credence to the idea that the H5N1 virus infects humans in ways not normally seen in influenza viruses.
Bird Flu May Pass to Fetus via Womb
Bird Flu Virus May Not Stay Only in the Lungs, Researchers Report
By Miranda Hitti
WebMD Medical NewsReviewed by Louise Chang, MD
Sept. 27, 2007 -- The H5N1 bird flu virus may be able to pass from a pregnant woman to her fetus via the womb.
That news appears in tomorrow's edition of The Lancet.
The researchers -- who included Professor Jiang Gu, MD, of the Infectious Disease Center at China's Peking University -- studied autopsy results from a Chinese woman who died of bird flu when she was about four months pregnant.
Gu and colleagues found traces of the H5N1 bird flu virus in the woman's fetus.
The pregnant woman -- and an unrelated Chinese man who also died of bird flu -- had the bird flu virus in their lungs. They also had the bird flu virus in other parts of their bodies, including their trachea, brain, and lymph system.
"In addition to the lungs, H5N1 influenza virus infects the trachea and disseminates to other organs including the brain," Gu's team writes, adding that "the virus could also be transmitted from mother to fetus across the placenta."
The new molecular techniques used by Gu and colleagues "have pitfalls," so the findings should be checked in lab tests, write Wai Fu Ng, MD, and colleagues in an editorial published with the study.
Ng works in the pathology department of Hong Kong's Royal Margaret Hospital.
Although the number of autopsy's that have been conducted on H5N1 victims has been small, primarily due to cultural and religious barriers to conducting post mortem examinations in Moslem and Asian countries, the few that have been completed paint a grim picture of a virus that doesn't play by the rules.
Those of us who have been watching the clinical picture of this virus unfold over the past year or two probably aren't terribly surprised by the revelations from this new study. We've had bits and pieces of supporting information, and hints along the way.
This is more of a confirmation of what many of us have long suspected.
The 60% CFR (Case fatality ratio) among identified H5N1 victims is a pretty strong indication that we aren't dealing with a standard, run of the mill, influenza virus. While we hope the lethality and virulence of this virus will attenuate, so far it hasn't shown any signs of doing so.
For better or worse, pandemic planners around the world have latched onto the idea that the worst case scenario is a 2% CFR, and in some cases, they aren't even planning for that.
Maybe we get lucky. Maybe the H5N1 virus never acquires pandemic capability, or maybe somehow it loses 90% of it's lethality before doing so. In which case, we may be semi-prepared for the next pandemic.
The question is, do you feel lucky?
Well, do you?
