#575
BBC Radio Channel 4 ran an excellent overview of the H5N1 problem in Egypt yesterday. It features interviews with officials, scientists, and with residents of the Nile Delta that raise chickens.
Among those interviewed are Dr. Michael Osterholm, of CIDRAP, who warns us of Pandemic Flu Fatigue, and Dr. David Nabarro of the United Nations, who discusses the monetary needs to fight the avian flu threat.
One of the more remarkable segments was with Dr. Zuhair Hallaj, Acting WHO Representative, who stated:
Dr. Hallaj: "In all the six cases which died lately in Egypt - in five of them we have seen this multi-organ failure. We cannot say whether this is due to a delay in coming to the hospital and accordingly the anti-viral we have against the disease might not work if it is given after 48 hours of the appearance of symptoms -- or it is to a more virulent virus -- but most probably it is a more virulent virus because clinically we have seen a new picture. We have a multi-organ infection - a multi-organ failure - it is not only the respiratory tract."
Q: "So the nature of the symptoms has changed?"
Dr. Hallaj: Yes, to some extent the severity and the nature -- of course there is respiratory infection and there is the pneumonia -- the viral pneumonia -- but in addition to that we have seen renal failure -- we have seen bone marrow supression -- and we have seen liver failure. But still we haven't seen such a clinical picture in the early cases although they were late in coming to the hospital, too."
Q: "That makes you worry that the virus may be changing and becoming more aggressive?"
Dr. Hallaj: Yes, yes, yes. I don't have any evidence, but I think this virus is being studied more in depth in the four WHO reference laboratories.
To listen to this 40 minute long program click here. A hat tip to Theresa42, on the Wiki, for transcribing this segment and posting it.
The H5N1 virus, now spread over 50 countries around the world, is not a single entity. The virus is mutating constantly in each infected host. The H5N1 virus carried by a Falcon in Kuwait isn't exactly the same virus that is carried by a duck in Egypt.
It is simply the nature of influenza viruses that as they replicate in a host, they make `mistakes' in copying themselves. That's why we get a slightly different seasonal flu strain every year.
Each infected host is a unique viral mutation factory, capable of creating a new strain of the H5N1 virus.
Most of the time, these changes are insignificant. The fear is that one of these days a mutation will occur that will enable the virus to be more readily transmitted between humans. But there is also the fear that the virus may mutate into a more efficient killer, or that it may pick up resistance to our arsenal of antivirals.
We are dealing with a multi-headed Hydra, constantly evolving, and learning new tricks. As the number of hosts increase, whether it be in birds, cats, or humans, the greater the chance we have of seeing a serious mutation.
In Vietnam, back in 2005, doctors saw a couple of patients with a Tamiflu resistant strain of the virus. Then, for more than a year, we only saw infections that appeared sensitive to the antiviral. Earlier this year, once again we saw a couple of Tamiflu resistant cases, this time in Egypt.
The presentation of symptoms among patients has varied considerably around the world. In Vietnam there were some cases where the respiratory symptoms were secondary, and greater neurological and gastrointestinal symptoms were observed.
While our understanding of this virus is still very limited, it is obvious that officials are continually watching, and worrying over these changes.
