Honk Kong Flu News

ProMED-mail posts from January 6-10, 1997

Chinese offical disputes report that chicken deaths due to avian flu

Agence France Presse reported today that an agricultural official in Guangdong province said that the 1.7 million chickens that died there between Nov 1996 and Apr 1997 died "from bacteria and diarrhea" due to farm mismanagement and inexperience, and their deaths "had nothing to do with bird flu."

Hiroshi Kida, a WHO official in Taiwan had said last week that China had covered up an outbreak of avian influenza. The Guangdong province is in southern China, bordering the administrative region of Hong Kong.

Hysteria reigns

The January 5, 1998 edition of the South China Morning Post reported that airports in the Philippines have begun screening and interviewing all arrivals from Hong Kong for "bird flu". Staff there have been put on alert for smuggled chickens. A Philippine Airlines spokesman said he was unaware of such a move. This news came as Indonesia announced it had banned poultry imports from Hong Kong and China (Hong Kong has not exported poultry in recent years, so this will cause no economic damage). Several other countries in the region have announced similar bans. The Indonesian Health Minister said the government had taken strong measures and the disease had not been reported in Indonesia (nor have polar bears). Also, after the press reported dogs and rodents eating the culled chicken carcasses, people in Hong Kong started killing their pets. Now the United Arab Emirates has confirmed it has banned imports of poultry from Hong Kong (doesn't export poultry), China, and Australia, although the UAE has never imported Australian produce. Yesterday, Romania's veterinary authority said the deaths of hundreds of chickens there was due to a toxin, not to "Hong Kong's bird flu"; "specialists" there initially had speculated that a mystery virus was being spread by wild doves and crows. Today a pro-democracy politician in Hong Kong, Martin Lee, accused the Hong Kong government of a cover-up over the "bird flu" crisis and called for an independent inquiry into its handling of the problem. That's a bit difficult to believe, given the entree WHO and CDC people have had and all the media access.

Jim Chin, who has forwarded many reports has noted: "It seems that the development of ineffective draconian measures to prevent the spread of the "chicken flu" may not be restricted to Hong Kong - panic and hysteria are spreading rapidly even, if H5N1 isn't!". Of course, we agree. Personally, I find these responses fascinating and wonder whether there isn't a psychologist somewhere who might want to study these illogical responses or a student looking for a good term paper subject. Rather than post the details of all these reports, ProMED-mail is posting only reports that appear to be relevant to the emergence or apparent and potential emergence of a disease. Below are the relevant reports as well as some interesting responses from Jim Chin to questions posed to him by Jack Woodall. Others are invited to comment but we will not drag this out beyond interesting and useful. - Mod.CHC]

Virus spreads slowly

Scientists believe the virus lives in the guts of chickens and ducks and is passed on to people who handle the birds. But they still don't know how the virus is transmitted, leaving open the possibility that it can be contracted through person-to-person contact...

Meanwhile, the virus appears to be slowly spreading. Doctors at Queen Elizabeth Hospital [Hong Kong] say the number of walk-in patients has increased by 20% since the [first cases were recognized]. "People here have a lot of demands. They don't just want advice, they want admission -- for bird flu, or something," Dr. Lee Chi-keung said. Lee says hospital emergency rooms were "quite chaotic" until a few days ago when the government issued new guidelines for treating possible bird flu victims. Now, patients who are panicked or show serious symptoms are given a blood test and a throat swab for a viral culture. The tests are fairly reliable, but take weeks, so doctors also conduct a rapid test for influenza A. Any patient who tests positive for influenza A is hospitalized.

However, because the government doesn't require all patients to be tested, and because not every patient shows severe symptoms, some patients who may have the flu may escape an early diagnosis, Lee said. Lee noted that there are probably bigger social dangers than bird flu. "I would say that traffic accidents kill much more people than this," he said. "but people are not worried about walking across the street."

Chinese deny bird flu originated in southern China

Chinese authorities on Monday maintained that the bird flu virus, which has killed four people in Hong Kong, had not spread to the rest of China, and that new tests on chicken farms in the south had revealed no cases of virus infection. Experts conducted more tests on 1,087 blood samples taken last month from chicken farms and wholesale markets in the southeastern province of Guangdong, the China Daily newspaper quoted Ministry of Agriculture official Chen Guosheng as saying. Chen said there was still no sign of the H5N1 virus, commonly known as bird flu, which triggered the slaughter of more than a million chickens in Hong Kong, which neighbors Guangdong province. Farms and markets in the city of Shenzhen and the Guangdong provincial capital of Guangzhou -- known in the West as Canton -- have been given a clean bill of health by animal health authorities. "According to the results of our testing, as of now, there is no bird flu in Guangdong," a health department official assured CNN earlier.

But sources with access to internal government health records in Guangzhou told CNN that at least three people had died and that others were sick in local hospitals because of the virus. Some experts believe that the bird flu originated in southern China -- a theory the authorities reject -- and an inspection team from the World Health Organization plans to travel to Guangdong province in the coming days.

CDPC Note: It may be more accurate to say that the Chinese authorities have not found H5N1in the chickens they have tested to date. The probability that H5N1 originated in southern China has not been ruled out.

Some Q & A (by Jack Woodall and James Chin)

W: What is the likelihood that when the flu season kicks off in Hong Kong next month we'll see dual infections in humans of H3N2 and H5N1. Do you see any danger in that leading to reassortment in the human?

C: This potential has always existed. This is the prevailing theory, and I believe in it, but how predictable and what the probability of this turning out to be the next pandemic strain is the $64 question. It may be that such episodes occur periodically in southern China and this is one of the first documentation of such transmission of an animal flu virus to humans, although it seems likely that the swine flu virus was also probably transmitted from swine to human and then minimally from person to person 1976. This is all like predicting the next major earthquake in San Francisco from a few minor tremors. The big public health question is whether identification of animal flu outbreaks and then mass slaughter of the implicated animal(s) can prevent the next major human pandemic. I doubt that there is the political will to continue this. Perhaps we should focus surveillance on the emergence of a flu strain that is easily transmitted from person to person?

W: What might you suggest for the current situation?

C: There seem to be too many unknowns to justify further draconian measures. I would suggest close surveillance on the emergence of a very transmissable flu virus. I would release statistics as to the proportion of severe flu-like illnesses that may be due to H5N1, now probably just a very small percent of all severe flu-like illness.

Influenzaviruses, Reassortment Potential

[Influenza viruses have been placed (International Committee for Taxonomy of Viruses) in the family Orthomyxoviridae. Influenzavirus A is in the genus _Influenzavirus_ A,B. All viruses of this family have multi segmented RNA genomes, influenzavirus A having 8 segments. Differences in hemagglutinins (H) and neuraminidases (N) are used to characterize and describe isolates. Thus, there is considerable potential for reassortment of RNA segments in hosts simultaneously infected with more than one virus of the genus. - Mod.CHC]

Medical experts said on Thursday that Hong Kong must stamp out a deadly new "bird flu" virus before the peak influenza season [is reached] in March. [Under optimum transmission conditions it is increasingly likely] that it could mutate into a more easily transmitted human strain. "The potential exists for influenza viruses to mix with one another to exchange their genes," said Malik Peiris, Associate Professor of microbiology at the University of Hong Kong. "There is a possibility that the genes of this avian H5 virus might mix with one of the existing human viruses, like the H3 virus, and you might have a virus that is more efficiently transmitted person to person," he said in a radio interview. John Tam, a virology professor at the Chinese University, said the strain needed to be eradicated before March. "If the H5 virus hangs around until March, there is a chance that a person will be infected by the human flu virus and the H5 virus," he said in the South China Morning Post. With such a combination, Tam said: "You'd have a new virus which would have the ability to spread among humans easily."

CDPC Note: The potential for dual infections in humans of H3N2 and H5N1 is present in southern China and in other areas of the world where there are large numbers of birds, including chickens. But how predictable and what the probability may be that such mixing of influenza viruses will result in the next human pandemic strain is the $64 question. Such episodes [might] have occurred periodically in southern China and in other parts of the world. The finding of human cases of H5N1 infections in Hong Kong is one of the first solid documentation of the transmission of an animal flu virus to humans. However, it seems likely that the swine flu virus was also transmitted from swine to human and then minimally from person to person in 1976. For influenza "experts" to predict that the current situation in Hong Kong will almost certainly lead to the next human influenza pandemic strain is like predicting the next major earthquake in San Francisco based on a few minor tremors detected in Berkeley. The big public health question is whether identification of animal flu outbreaks and then mass slaughter of the implicated animal(s) can prevent the next major human pandemic. Outbreaks of fowl influenza virus have been well documented in many parts of the world over the past decades and control programs have been directed at eliminating the virus because of it's devastating impact on the economics of chicken farming, not because of concerns and hysteria regarding the development of the next human pandemic influenza virus.

[Sad but true: No one ever gets (or can take) the credit for preventing an epidemic. We must be satisfied that it did not occur. - Mod.CHC]

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