Commentary
H5N1 H2H Under-reporting Supports Complacency
Recombinomics Commentary 16:03
June 22, 2008
U.S. Centers for Disease Control and Prevention director Julie Gerberding said bird-flu fatigue among countries and the public is a growing concern.
Doctor Gerberding told a news conference in Malaysia Saturday that when it comes to news, people have very short attention spans. She said it's up to governments and leaders "to be very strategic" in dealing with problems like flu in order to "fill in for the tendency toward complacency."
The above comments discuss bird flu fatigue, which is created in part by a lack of coverage of human H5N1 clusters and human to human (H2H) transmission. This is due largely to under-reporting by H5N1 hit countries, which is enabled by a lack of WHO oversight and long standing efforts at reducing reports on H2H transmission.
H2H transmission is at the core of the current pandemic alert system. The current phase 3 is linked to no or low H2H transmission. Phase 4 represent increased transmission, while phase 5 is significant transmission, and phase 6 is sustained transmission. There has been increased H2H transmission since 2005, as measured by virtually any parameter (number of H2H clusters, size of H2H clusters, length of H2H transmission chains, or expended global reach of H2H clusters).
However, raising the pandemic level to 4 would initiate a large number of costly pandemic preparedness measures, so the WHO has used a number of approaches to minimize the number of such clusters, which has been actively embraced by a number of affected countries. The activities have been ongoing for several years, but have become the subject of recent media coverage due to Indonesia’s decision to reduce reporting on confirmed or fatal H5N1 cases, at a time when glaring H2H clusters were being under-reported by Indonesia with support in WHO updates which failed to describe the fatalities in relatives with bird flu symptoms.
Although WHO maintains that they have a good relationship with Indonesia and engage in joint investigations, the absence of the fatal cases in the updates raises concerns regarding the relationship and associated transparency in the WHO updates, which are factually correct, but highly misleading. None of most recent five confirmed cases in Indonesia are described as clusters or linked to relatives who died or were hospitalized with bird flu symptoms, which is true for three of the five cases. These relatives are almost certainly H5N1 cases, so the number of recent cases is nine instead of five, and seven of the nine are linked to H2H clusters.
Thus, the number of H2H is difficult to determine from WHO updates or media coverage, and the number of unreported cases and clusters remains unclear, which contributes to bird flu fatigue because much of the important H2H activity remains below the radar.
The new pandemic alert level combines all H2H which is not sustained into the new level 3, reserving level four for sustained H2H, which is the current definition of the final pandemic phase 6.
Thus, WHO should have more latitude in acknowledging the large number of H2H cluster, which will represent a major surprise for most of the public and popular press. Reporting of these clusters will have a significant effect on complacency and lead to the realization that the current phase is very close to the sustained H2H phase, which is another fact that is not well appreciated by the public, media, or relevant agencies.
Media Links
Recombinomics Presentations
Recombinomics Publications
Recombinomics Paper at Nature Precedings