# 387
The discovery of the H5N1 virus in humans in Nigeria is about as surprising as Claude Rains’ discovery that there was gambling going on in Rick’s Café American in Casablanca. Official denials aside, this has been long anticipated by flu watchers. How long it has been going on is anybody’s guess.
Probably for some time.
The other announcement today is that another family member has tested positive for the virus, but is responding to treatment. This from PUNCH, Nigeria's most widely read newspaper.
He added that another female member of the victim‘s family, earlier diagnosed with the clinical presentation of the type H5, was responding to treatment.
Nweke said, ”The result of the tests conducted by Nigerian scientists, using in-country laboratory facilities, confirmed the first human case of Avian Influenza fatality in a 22-year- old female, who died in Lagos, Nigeria on January 17, 2007.
That would indicate authorities have known, or at least strongly suspected, they were dealing with a cluster for some time. Details on how long they’ve known were not disclosed.
For now, we have precious few details. But we would likely have even less if the husband and father of two of the victims hadn’t taken it upon himself to have autopsies performed to determine the cause of death of his loved ones. How many cases have simply been declared atypical pneumonia, and quickly buried in that country, will never be known.
The initial denials of the Nigerian government were almost classic in nature. No country, of course, wants to admit they have the H5N1 bird flu virus. It’s bad for business, it’s expensive to try to track and control, and it brings bad publicity and the international spotlight. On Monday, for example, we were treated to this `explanation’.
A statement from Information Minister Frank Nweke said that preliminary tests appeared to indicate common influenza rather than avian influenza.
"Tissue samples obtained from the suspected victims have tested positive to Influenza virus type A which is the same virus that causes the common cold," the statement said.
This official press release set off a fresh round of speculation in the flu community, as nearly everyone realized that the `common cold’ is caused by a rhinovirus, not the influenza A virus. It seemed a ham handed attempt to deflect questions by reporters.
Also on Monday, Reuters reported that:
In Geneva, a WHO official said all 14 samples had tested negative for the H5 strain of flu but positive for another type. Samples from the 14 have been sent to London for a second check, the U.N. agency said.
If repeats of these tests should show concurrent infections by two strains of flu, a scenario long worried about by scientists that could result in the exchange of genetic material between viruses (reassortment), then this could be potentially an even bigger story. Hopefully, this was simply a problem with the lab tests or the collection methods.
Credit should be given to the local press, which didn’t let this story die. I can imagine there may have been some pressure not to run with this story.
The backtracking began in earnest yesterday, when reports that the samples were being sent off for additional tests because of `inconclusive results’. Given that at least one other family member was symptomatic, that isn’t surprising. Prior to the announcement this morning, officials were promising an investigation into the deaths. A pretty good `tell’ of what was about to be announced.
The question of course is: Where do we go from here?
Nigeria, with a population of 131 million people, many of who live in abject poverty and have no access to medical care, would be a fertile breeding ground for the H5N1 virus. Already dealing with malaria, lassa fever, meningitis, AIDS, and a host of other tropical and exotic pathogens, Nigeria suffers from an average life expectancy of only 47 years. Detecting sporadic bird flu cases, amid the thousands of patients and hundreds of deaths each day will be an extreme challenge.
Through the efforts of the International community, and agencies like the UN’s FAO (Food and Agriculture Organization), the ability to conduct surveillance in livestock has improved, but is still far from ideal. To their credit, progress is being made, but they are battling overwhelming odds in Nigeria and around the world, and doing so with relatively meager resources.
Nigeria is in the spotlight today, but it is by no means alone. It is likely that other nations in Sub-Saharan Africa, and around the world, are missing H5N1 cases. There is an almost universal reluctance to look too hard to find them, as once you do; it means you have to deal with it, which opens a whole new universe of problems.
The war against this virus, through happenstance, must be fought, and won or lost in developing countries around the world. Failure to contain the H5N1 virus there will mean it will spread to other nations and increase the risks globally. It may one day achieve the ability to spread H2H (human-to-human), and produce a pandemic. Until that happens, there is still a chance of containment.
Hopefully Nigeria will be a wakeup call; to nations to look more closely at their own risk factors, and to the International community to do more to support their efforts.
The time has come though, to stop looking the other way.
