# 616
A conference on Bird Flu has just ended in Indonesia, and the message that emerged is that the H5N1 virus remains mysterious and baffling.
‘Random’ bird flu baffles Indonesian scientists
Web posted at: 4/1/2007 11:48:27
Source ::: AFPJAKARTA • Indonesian scientists said they remained baffled by the “random” behaviour of the bird flu virus afflicting the country, after a top-level meeting here yesterday.
About 40 scientists from all over the country met to discuss the disease which has claimed 69 deaths in Indonesia, making it the world’s worst-hit country.
“The random aspect of the disease ... unfortunately led scientists to say that (the behaviour of) the virus remains a mystery,” said Bayu Krisnamurthi, head of the national commission on bird flu control.
Indonesia’s deaths came from 89 reported cases. The WHO says the deadly H5N1 strain has infected 284 people worldwide and killed 169 of them, mostly in Southeast Asia, since the end of 2003.
Wide differences were seen in the patterns of human infections and development of various stages of the disease, making it difficult to predict, said Krisnamurthi.
“There was no correlation found between (a patient’s) age, sex, genetics, and other (attributes),” he said.
“What is clear is the risk factors, such as contact with sick birds, sanitation, and so on, but this is very general.” Krisnamurthi gave an example where three members of a family showed similar symptoms this year, but only the mother and son tested positive. The mother later died of the disease and the son survived.
“All we know is that patients died of multi-organ failure at the late stages of the illness,” he said.
Krisnamurthi said more in-depth study was needed out on human infections “and the only way to do this is by carrying out autopsies on fatal human victims.” Less than 10 fatal cases worldwide and none of the victims died in Indonesia have undergone autopsies, he said.
In conversations I've had with doctors, one of their overriding concerns has been the lack of good information about patient treatments, outcomes, and the mechanism of death among those who lost their battle with the virus.
There are deep cultural and religious barriers in many Asian and Islamic countries, places hardest hit by this virus, to doing autopsies. Immediate burial is the norm, and that precludes any in depth examination of the body or tissues for clues as to how to treat this threat.
For two years or more, we've known that multi-organ failure has been a hallmark of this disease, but we really don't know why. Influenza is primarily a disease of the lungs, and rarely attacks other organs. Bacterial pneumonia however, a common complication, often results in sepsis, and that can lead to organ failure.
Without pathology reports, we don't know if these multi-organ failures are the result of direct attack by the virus, or a secondary septic shock due to a bacterial infection. Organ failure could also be brought on by low blood pressure, or ischemia (low oxygenation levels), or as the result of the long suspected cytokine storm.
And that makes a big difference when you are treating a patient.
If autopsies are out of the question in these countries, then at the very least, doctors need to release all pertinent treatment information on patients they've seen.
What antibiotics have been tried? At what doses? When were they started? Did they try steroids? Again, when and how much? Have they tried higher doses of antivirals? Have they tried a cocktail of Tamiflu and Amantadine? What about Relenza? Again, when and how much?
We can learn much from this data, even when a treatment fails.
We need to know, in detail, what they have tried, and what has, or hasn't worked. Otherwise, should this virus breakout more widely in humans, doctors around the world will be starting from square one.
