# 2696
China's bird flu woes continue to mount with the announcement of a 4th fatality, and fifth officially recognized H5N1 infection this month; this time a 31 year-old woman from China's Northwest Xinjiang region.
First, this report from Reuters, then a bit of discussion.
China reports fourth bird flu death in a month
BEIJING (AFP) – A 31-year-old Chinese woman has died of bird flu, becoming the country's fourth victim of the disease this year, the state Xinhua news agency said on Saturday.
The woman fell ill on January 10 after visiting a poultry market and died early on Friday in northwest China's Xinjiang region, Xinhua said, citing local health authorities.
Tests confirmed she was suffering from the deadly H5N1 strain of the virus, it said.
The woman was China's third avian flu victim in seven days -- a 16-year-old boy died on Tuesday in the central province of Hunan and a 27-year-old woman succumbed to the disease last Saturday in the eastern province of Shandong.
The first fatality of 2009 occurred on January 5 when a 19-year-old woman died in Beijing, while a two-year-old girl who fell critically ill with the disease in Shandong was on Friday said to be out of danger.
The latest cases have prompted fears of a bird flu outbreak during next week's Lunar New Year holiday, when many of China's 1.3 billion people hit the roads and consume poultry in vast quantities.
China's agriculture ministry warned earlier this week of an increased risk as poultry sales rose ahead of the holiday period.
As you can see by the map below, these 4 cases are widely scattered across the country, and have no apparent epidemiological links.
All things considered, that's pretty good news.
It has never made any sense to me that China, with perhaps the longest history of H5N1 outbreaks of any country in the world, has one of the lowest per capita incidences of human infection in all of Asia.
Up until this month, China had only reported 30 human infections. That out of a population of 1.3 billion people. Or roughly 1 for every 43 million people.
Vietnam, with a population of 88 million, has reported 106 infections over roughly the same time period, or 1 in every 800,000 persons.
Why is there a 50 fold difference in reported attack rate between China and Vietnam?
Obviously, I don't know.
But I suspect a good portion of it may simply come down to surveillance and reporting.
Much of China remains remote and rural, and medical care - particularly in the interior sections of the country - is often provided by local herbalists instead of medically trained doctors.
Medical care in China is not free.
A night in a hospital can cost a month's wages, or more. So it is understandable why the majority of Chinese prefer to go to an herbalist if they are ill.
For 50 or 75 yuan they can get a sympathetic ear, some medicinal tea, or perhaps some antibiotic pills.
Even those who go to hospitals, particularly away from the industrialized regions along the eastern seaboard, are likely to find facilities with limited laboratory resources.
Many H5N1 cases may simply go undiagnosed. Mistaken for community acquired pneumonia, seasonal flu, or some other common malady.
Plus, at the local level, any admission of bird flu cases would bring close scrutiny from Beijing - and that is something that few local officials would seek to encourage. It can be bad for one's career.
The one rule in China that seems universal is - Don't rock the boat.
It may be, that in some cases, local officials have simply turned a blind eye to sporadic cases.
Earlier this month, Beijing was shaken by news that the bird flu virus had been acquired by a 19 year-old girl from a local market. Suddenly the virus was on the doorstep of their Mandarin power base.
Bird flu was no longer an abstract problem relegated to the more rural regions of the country.
Beijing immediately ordered increased surveillance and enhanced reporting nationwide. Hospitals were told to take a closer look at any `atypical pneumonia' cases.
Since then, we've learned of 4 additional cases - with a fifth fatality, that of the mother of the 2-year-old now recovering in Shanxi - strongly suspected to have been due to the virus.
We are also told that we should expect to hear of more cases over the next few months. That makes sense, given the virus likes cooler weather.
With the lunar New Year celebration underway, and the largest migration of humans on the planet ongoing for the next 30 days or so, the conditions are also ripe for more cases.
We are either seeing an unusual spike in the number of Chinese bird flu cases, or . . . we are simply seeing a more accurate reporting of what has been going on for years.
My guess is that the newly mandated surveillance and reporting requirements from Beijing are turning up cases that might have been under reported in the past.
Of course, that's just a guess on my part.
Your mileage may vary.
