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Ventilator Shortage For Hospitalized Bird Flu Patients
Recombinomics Commentary
January 4, 2006
Eight other people, most of them members of the same family, are hospitalized with flu-like symptoms in the city of Van in eastern Turkey, and the head doctor of the facility said he is in urgent need of more respirators to be able to treat all the patients.
Dr. Huseyin Avni Sahin, head of the hospital, said the children's family reported that some of their chickens began dying late last year, and that the family cooked the remaining chickens for dinner.
Shortly after that, he said, four children in the family began feeling ill and were brought to the hospital with flu-like symptoms. Then, a parent and another child from the same family were also admitted to the hospital, Sahin said.
Another three people from a family in the same area and one person from Van were also hospitalized around that time with flu-like symptoms. The patients have all been isolated from other patients in the hospital, according to Sahin.
Of the nine remaining patients, all are in serious condition -- two of them more seriously ill than the others, according to Sahin. He said the hospital is using all of its ventilators and it needs more to treat everyone.
Although the above descriptions are somewhat confusing on the total number of patients hospitalized and their relationship to the confirmed cases, the hospitalized patients appear to also be H5N1 infected and have already created a shortage of ventilators. This number of seriously ill H5N1 infected people form a small area would be without precedent and signal a major change in the efficiency of transmission of H5N1 to humans.
This change is of concern, because dead poultry has been reported in four adjacent provinces and prior bird deaths in adjacent countries have not be convincingly explained. This large cluster of human cases in Turkey raises the possibility that H5N1 transmission to humans has become more efficient.
Acquisition of S227N via recombination with H9N2 in the Middle East would likely generate a more efficiently transmitted H5N1. Since all H5N1 wild bird sequences since Qinghai Lake also have PB2 E627K, the potential for a more efficiently transmitted H5N1 which is more virulent in mammals is a serious concern.
Media reports have also indicated that treatment with Tamiflu has been delayed because of a lack of supplies. These reports fail to mention use of the much more widely available amantadines. Thus far all H5N1 wild bird flu sequences since Qinghai Lake have been amantadine sensitive. Failure to consider this treatment option, especially when Tamiflu was unavailable is cause for serious concern.
The proximity of the outbreak relative to the Haj in Saudia Arabia creates more concerns. Media reports have indicated H5N1 is in Kuwait and Libya, although neither country has filed an OIE report. Moreover, no other country in the Middle East has acknowledge H5BN1 infections, although birds from the H5N1 infected regions in the Volga Delta, Crimea Peninsula, and Danube Delta migrate through the Middle East to Africa at this time of the year.
The monitoring of H5N1 in the Middle East and Europe appears to be as scandalously poor as the monitoring in Asia.
The ventilator shortage and lack of anti-virals raises additional preparedness concerns.
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