Sunday, March 29, 2015

More Than One Way to `Contain An Outbreak’


Credit WHO



# 9879


Until the middle of January, Egypt’s Ministry of Health got good marks in reporting this winter’s surge in H5N1 cases, publishing frequent updates that included YTD numbers for cases, deaths, hospitalizations, and recoveries. 


That streak ended on January 22nd, when Egypt’s MOH Confirms their 21st H5N1 Case of 2015.


Since then, as has been noted often (see The Silence Of The Egyptian MOHMedia: WHO H5N1 Mission To Egypt), the Egyptian MOH has ceased to report most cases on their website and the YTD numbers attributed to MOH spokesmen in the Egyptian media have been `fanciful’ at best.

As a result, we continue to see reports like the one below – published today - which cherry picks a single recent H5N1 case, while at the same dramatically downsizing the YTD impact of this year’s H5N1 outbreak.  


While never directly mentioning 2015’s YTD numbers, by admitting to 16 deaths and referring to a CFR of 37.4%, the reader is left with the idea that there have been perhaps 43 or 44 cases this year.  


A far cry from the latest World Health Organization numbers (as of March 17th) of 116 cases and 36 deaths for the year (see Avian influenza A (H5N1) in Egypt update, 21 March 2015).


Egypt bird flu death toll at 16 in 2015

Sun, 29/03/2015 - 11:43

A 27-year old woman who raised birds in her home in the Sohag governorate, died of bird flu on Sunday.

Tahta Fevers Hospital received the victim, who was suffering from bird flu symptoms, before she was transferred to Assiut Fevers Hospital upon the request of her family, according to a medical source at Tahta hospital.

A medical team inspected the woman's house in Tahta and conducted tests on those who were in contact with the woman as a preventive measure.

(Continue . . .)

Although local media reports are sporadic, and are unlikely to represent the true burden of this year’s outbreak,  FluTracker’s conservatively curated Egypt - 2015 WHO/MoH/Provincial Health Depts H5N1 Confirmed Case List  continues to add cases, with at least 120 cases logged for the year.

Fortunately,  Egypt continues to report cases to the World Health Organization under the IHR (International Health Regulations) - which requires countries to develop mandated surveillance and testing systems, and to report certain disease outbreaks and public health events to WHO – so we are not completely in the dark regarding this H5N1 outbreak.


While we don’t have a recent WHO update to compare it to, China’s recent silence on H7N9 is also suspect, with no new cases reported now for 20 days (see last week’s HK CHP Avian Flu Report: 2 Weeks Without An H7N9 Case Report and  H7N9: No News Is . . . . Curious).  


This dramatic halt in reporting comes – perhaps coincidentally – at the same time we saw a major study appear in the Journal Nature  (see Dissemination, Divergence & Establishment of H7N9 In China) warning that the H7N9 virus was evolving rapidly, and that it posed a growing pandemic threat.

A search on Xinhua’s English language news site for the term `H7N9’ returns their last article on March 12th of this year, which (again, perhaps coincidentally) dealt with the Nature study above (see Scientists call for effective measures amid H7N9 mutation Xinhuanet 2015-03-12 14:13).



The Chinese language IFENG search engine does return more recent `H7N9’ articles, but they all refer to cases in February and/or steps local and national health officials are taking to prevent new cases.  


But if there have been any H7N9 cases detected since early March, they aren’t being reported in the media, or on provincial MOH websites.


It is certainly possible that fewer infections are being recorded this winter, and interventions such as the closing of live poultry markets have dramatically reduced transmission.  That all cases should halt abruptly, this early in the year, and across the entire region would be remarkable, however. 

We’ll have more to go on when the next WHO update on China is released.


Since China and Egypt are both dealing with high-profile infectious disease outbreaks, their `management’ of the news understandably draws a good deal of attention, but they are far from being the only nations who indulge in `creative disease reporting’.  


All governments have an aversion to mobs bearing pitchforks and torches, and therefore want to project the image that they are competent, in control, and (most importantly) vitally important to the people they supposedly serve. 


Even in this country I see a number of state and local health and agricultural department websites which seem far more concerned with extolling their services and achievements, than they are in addressing local problems.  Of course, none of them are dealing with a deadly avian flu outbreak, so direct comparisons are hard to make.


While it may seem an odd bit of logic, as long as governments can control the message - as we are seeing in Egypt – it is a pretty good sign that avian flu infections remain sporadic and that efficient transmission of the virus is not happening.   


So, in a sense, no news can be `good news’ – at least in the short run. 


The problem is, the less we know about the early trajectory of an outbreak, the less lead time we’ll have to prepare - if and when something does start to change.

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