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H5N1 Spread in Humans in Iraq and the Middle East
Recombinomics Commentary
January 31, 2006
In addition, at least other two people receive treatment in hospitals of the center and the south of Iraq, the sanitary authorities have nevertheless not been able to confirm until the moment if it is the same virus.
After confirming the information, the sanitary authorities of the Kurdistán announced that they began a campaign to sacrifice the birds of three localities: Dukan, Qaladaza and Ranya, of where she was the victim.
The above translation suggests bird flu victims are being hospitalized throughout Iraq and not just in the Kurdish north, near Turkey and Iran. The spread throughout Iraq and the Middle East is not a surprise.
Although negative reports from the area are highly suspect, the positive reports show two clear waves of H5N1 infections. The initial wave is bird infections by the Qinghai strain of H5N1. Although H5N1 in domestic poultry in western Turkey was reported in October, there were reports of widespread die offs in eastern Turkey at the time. H5N1 in that region was denied, but such avian infections in both wild and domestic birds were reported throughout the Middle East.
When human H5N1 cases were reported at the beginning of January, Turkey filed additional OIE reports indicating that H5N1 had been detected in eastern Turkey in mid-November, and similar outbreaks have been reported throughout the country, including an explosion of reports in January.
These more recent OIE reports leave little doubt that H5N1 was present throughout Turkey and the Middle East since October and it has also spread into Africa, where H5N1 reports are also denied. These denials suggest that the affected countries either cannot or will not provide accurate and transparent reporting of H5N1. None of the countries in the Middle East or Africa have filed OIE reports on the detection of H5N1.
The second wave of H5N1 infections in the area began in humans at the beginning of 2006, although initial symptoms may have been as early as mid-December. These human cases are linked to the HA S227N genetic change identified in the index case in Turkey. This genetic change allows H5N1 to more efficiently infect humans and less efficiently infect birds, although bird infections are clearly possible. The simultaneous reporting of human cases throughout Turkey earlier this month indicates the H5N1 capable of readily infecting humans is being transmitted by wild birds.
The human cases are spreading south and east from Turkey into neighboring countries based on bird outbreaks in Turkey. The confirmation of H5N1 in a fatal case and strong suspicion of H5N1 in a fatal case of a relative suggests such human cases are present well beyond Turkey’s borders. The failure to report or confirm such cases is not a surprise. In Turkey there has been a sharp drop in reported human cases even though the bird outbreaks continue. Turkey’s failure to confirm H5N1 in symptomatic relatives of bird flu positive patients indicates the downturn in human cases in Turkey is driven by a lack of testing and/or reporting. Dozens of patients are in hospitals throughout Turkey. These patients have symptoms, are in isolation, and are being treated with Tamiflu.
It is likely that similar cases will appear throughout the Middle East in the near term. The failure to report the bird cases since October raises serious transparency issues which WHO has failed to address. Moreover the withholding of disease onset dates and infected relatives in Turkey has seriously damaged WHO’s appeal for transparency.
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