#1355
Even though we've seen two deaths this week in Indonesia, a recent death and a possible H2H transmission in China, and large outbreaks of the H5N1 virus in poultry all around the world, all eyes right now are focused on Pakistan.
The reports we are getting are often confused, inconsistent, and at times bewildering. There are major gaps in the story, dates and details that don't make sense, and likely some degree of `spin' being administered by local authorities.
So far, what we believe we know is that 2 Pakistani's have died from the H5N1 virus, and at least two others have been infected.
These would represent the first reported human cases on the Indian Subcontinent.
Many of the details are unfortunately mangled and confused. Yesterday the news reports indicated that one of these victims died `Monday last', which would indicated December 10th, but it now appears that both died in mid to late November.
For the past 12 hours or so, newshounds on the flu forums have been going through and dissecting the wire reports, trying to piece them together into some coherent timeline. Much of my understanding comes from the hard work of people like Theresa42, Niman, Niko, Laidback Al, Frenchiegirl, and yielddude on Flutrackers and Okieman, DennisC and pugmom on the Wiki.
Kudos to all doing this exhausting, but vital, work.
Here is the tentative timeline.
- On or about October 21st, Dr. Ishtiaq Durrani (a veterinarian) was involved in a culling operation of H5N1 infected chickens. He reportedly did not take proper precautions, and became infected with the virus.
- A second victim from that culling, a day laborer working without protective gear, also became infected.
- The day laborer's daughter, along with long with `another male', are also under observation at a hospital in Abbottabad. (Note: Given the onset dates, it is unclear if they are still under observation).
- Dr Durrani's two brothers- both of who were attending him at the Khyber Teaching Hospital during his illness - died in mid to late November from the disease.
This is a (long) article in The News, innocuously titled Education for Poultry workers Stressed, containing details on this likely h2h transmission of the virus.
(Note: This report has the brother's exposure through attending their infected brother (Dr Durrani), while other reports suggest they had contact with infected chickens. Clarification would be helpful.)
Education for poultry workers stressed
Islamabad
The deaths of two brothers of a veterinarian, who acquired the deadly H5N1 Avian Influenza virus after coming into contact with infected poultry at a farm in Abbottabad late-October, and the recent hospitalisation of a Mansehra-based poultry handler who has also tested positive for the disease, provide sufficient evidence for the government to institute concrete measures for interruption of human transmission of the disease from birds to poultry handlers and their close contacts.
Of the 40 suspected human samples collected from Peshawar and Abbottabad in the wake of the first-ever confirmed human transmission of H5N1 in Pakistan, 36 have tested negative, while four are positive, investigations conducted by ‘The News’ have revealed.
This is the first time that human cases have been reported in Pakistan, placing an onerous responsibility on the government and its partners to eradicate some of the dangerous trends in the poultry industry that could spell disaster for the country.
It is learnt that both the veterinarian, Dr. Ishtiaq Durrani, who is working as livestock production officer at the Department of Livestock and Dairy Development, NWFP, as well as the poultry handler from Mansehra, did not follow the recommended protective measures while handling infected birds. They may either have come into contact with the saliva, nasal excretions and faeces of the infected birds, or the feed and water that are given to them.
Dr. Ishtiaq was involved in culling of 3,000 birds following the October 21 outbreak of bird flu at a poultry farm in Abbottabad. The other victim from Mansehra happens to be a daily wage labourer who was commissioned for culling without being advised on how he should protect himself. The labourer’s daughter, along with another male, is also under observation at a hospital in Abbottabad.
While Dr. Ishtiaq himself is on the path to recovery, his brothers Mohammad Ilyas Durrani and Mohammad Owais Durrani — both of who were attending him at the Khyber Teaching Hospital during his illness — died on November 19 and November 29, respectively. The symptoms of avian flu infection in humans include muscle aches, fatigue, fever, coughing, sneezing, sore throat and eye infections. In severe cases, infection may lead to fatal pneumonia, blood disorders and multiple organ failure.
One should note that these cases all are from a month or more ago. The first brother died on November 19th, the culling operation in question was in late October.
And we are just now hearing about all of this. So much for timely notification and transparency.
Meanwhile, hospitals across Pakistan have now (finally) been put on alert.
By Muhammad Qasim
12/14/2007Rawalpindi
The National Institute of Health (NIH), Islamabad, has advised health departments at both provincial and federal levels to be ready to deal with any untoward situation after confirmation of avian influenza virus in birds in various parts of the country.
The letter that Rawalpindi General Hospital has received from NIH says that during last two to three weeks, a number of avian influenza outbreaks have been reported from Islamabad, Murree, Abbottabad, Mansehra and adjoining areas. “The environmental sampling shows high concentration of H5N1 influenza virus which posed a serious threat to human health as well,” stated the letter.
A top official, who wanted his name not to be mentioned, told ‘The News’ on Thursday that the NIH has advised hospitals to be ready for any untoward situation and ensure all necessary measures including facilities for effective management and care of expected bird flu victims.
“Adequate stock of Tami flu, ventilators, nursing and personal protective equipment should be ensured,” adds the letter. Tami flu can reduce severity and duration of illness caused by avian influenza.
Rawalpindi General Hospital (RGH) Chief Dr. Habib Ahmed Khan, when contacted by ‘The News,’ confirmed that the hospital had received directions from the NIH for clinical management of avian influenza and infection control. “I am about to circulate among staff a protocol for handling and treatment of patients with strain of avian influenza. We would soon identify wards which would be isolated in case of bird flu outbreak in the city,” he said while responding to a query.
The greatest disaster involving the virus was the ‘Spanish flu’ outbreak in 1918 that claimed 20 million to 50 million lives around the world. The most effective way of fighting avian influenza at present available to man is destruction of infected birds or those at risk of infection.
The tone of this last article indicates that officials in Pakistan aren't convinced that this incident is over. There are apparently ongoing outbreaks of H5N1, and the medical community is being warned to prepare for `expected bird flu victims'.
Pakistan has recently undergone severe political upheaval, and that may be part of the reason why this story remained hidden for so long.
But the stakes here are enormous, and should sustained H2H transmission break out anywhere in the world, the WHO needs to be on the ground and working to contain it within days, not weeks. Obviously, the government of Pakistan needs to work on their surveillance and notification skills if that is to happen.
Quite literally, the fates of millions of lives all around the world rest on how well officials in far off lands like Pakistan, China, Indonesia, and Vietnam do their jobs.
This latest example from Pakistan isn't terribly encouraging.
