It is an all too familiar pattern.
We saw it in China, Vietnam, Thailand, Turkey . . . and now Iraq.
Suspicious deaths. Negative tests for H5N1. Government denials. And then, weeks later, the admission that those early tests were `faulty’.
Yesterday, an unnamed UN official leaked to an AP reporter that the 15-year-old girl who died in Iraq on January 17, despite strident assurances by WHO and the Iraqi Health Minister to the contrary, actually died of avian flu. Her uncle died last Friday of a respiratory illness, and the assumption is that he too, had H5N1.
Within a couple of hours of hitting the newswires, WHO and the Iraqi Health Minister confirmed that new tests had revealed the girl died of Avian Flu. The first two negative tests were wrong. The Iraqi Health Minister publicly appealed for International help in combating this threat.
Like I said, a familiar pattern. But this time with a couple of twists.
First, the Health Minister alluded to the fact that there were other `suspicious’ cases in the country. As many as thirty.
And, for the first time, we have an admission from WHO that this may be a case of limited H2H transmission. Maria Cheng of the World Health Organization said yesterday:
There is a possibility this is a case of limited human-to-human spread of the virus, Cheng acknowledged. "Based on the evidence we have right now, I don't think we can rule it out."
"We still don't have a lot of details about the context of these cases; whether or not they both had contact with sick chickens or just how much contact they had. But given that he was said to have taken care of her when she was ill, that certainly does raise our level of concern."
Given the World Health Organization’s strident reassurances that H5N1 has up to now, only been contracted from direct contact with birds, this is a significant announcement.
That this should happen in Iraq is particularly troubling. We have 160,000 American Troops stationed there, and many areas of the country are not only remote, they are unsecured. Getting epidemiologists and doctors into the countryside safely, will be a challenge.
While we will have to see a much larger cluster, or multiple clusters, of patients before H2H transmission can be documented, it is hard to find a worse place, geo-politically, for this outbreak to fulminate.
Containment, with warring factions all around, will be difficult. Getting timely information, doing sereoprevalence studies, and providing medical care will be nearly impossible.
While it’s too soon to jump to the conclusion that H2H has actually occurred, Iraq needs to be watched closely over the next few weeks.
