#18,400
Overnight the India press has lit up with multiple reports (hat tip FluTrackers and @vinodscaria) on the death - two weeks ago - of a 2-year-old child from H5N1 in Andhra Pradesh. A quick tour of the local AP MOH website and twitter account, however, turns up no confirmation of the story.
The Indian press, admittedly, has a history of `jumping the gun' when it comes to reporting H5N1 cases (see 2007's India Admits 8 Boys to Hospital With `Bird Flu' Symptoms) - while the government is often slow to confirm - but this one sounds plausible.
While we've seen many false alarms, there are precedents.
In the summer of 2021, after several days of unconfirmed newspaper reports, we saw India: MOH Statement On Investigation Of 1st Human H5 Avian Flu Infection. The patient, an 11-year-old boy with acute myeloid leukemia, was infected with the clade 2.3.2.1a virus, and died after a week in the hospital.An in-depth interview with family members indicated that the patient often frequented a family-owned poultry business and may have been exposed to birds with undetected infection, although no infected domestic or wild avian sources or any environmental contamination had been reported in or around the residence of the child.Last May Australia reported their first H5N1 case (see Australia: Victoria Reports Imported H5N1 Case (ex India)) in a 2 year-old child who recently traveled from India. The virus was originally identified as clade 2.3.2.1a virus, which is known to circulate in poultry in Bangladesh and India.
Last December the CDC's EID Journal published a dispatch which revealed this older clade was actually a new genotype, with contributions from newer clade 2.3.4.4b viruses.
And given the number of confirmed human cases in neighboring Bangladesh (n=8) and Pakistan (n=3) over the years - which are likely undercounts - it seems likely that some actual cases in India have been missed.
According to the following English Language report from the Deccan Chronical (see AP Reports First Bird Flu Death as 2-Year-Old Succumbs to H5N1) the child was admitted to the hospital on March 4th after falling ill after consuming a small piece of raw chicken.
The child died 12 days later. Swab samples initially tested positive for Influenza A, but were later confirmed to be H5N1 by AIIMS and the National Institute of Virology (NIV), in Pune. So far, we have no indication of the clade.
It is worth noting that India has been reporting as surge in H5N1 in recent months, in poultry, wild birds, and even cats. Last week Andhra Pradesh reported 8 outbreaks (see WOAH report) in poultry, although none appear to be near to where this child was infected.
Hopefully we'll get some better information in the next few days.
Stay tuned.
