WHO H5N1 Situation Update on Pakistan Overdue
Recombinomics Commentary
December 24, 2007
"Since there are no symptoms, no new cases or correlation among these people, they say it's not human-to-human bird flu but maybe bird-to-human," said Maqbool Jan Abbasi, a bird-flu spokesman for Pakistan's Health Ministry.
He said 63 people who were in contact with the nine patients tested negative for the virus and that a final report on the findings would be released next week.
The above comments provide more contexts for the Pakistan Health Ministry denial of evidence for human-to-human transmission of H5N1 in Pakistan, which now appears to be a denial of sustained transmission beyond the family members. Thus, the reasons behind the delay in a WHO situation update and additional testing in London remain unclear.
Media reports had indicated that the initial positives had been confirmed by Pakistani labs over a week ago, and independent confirmation by the NAMRU-3 mobile lab was expected last week. However, instead of issuing a report on confirmed cases detailing age, gender, disease onset dates, hospitalization dates, date of death, and relationship to other confirmed or suspect cases in Pakistan, WHO said samples were being sent to London for more information.
The dates of disease onset for the index case, October 25, coupled with the dates of death of two of his brothers, November 19 and 29, plus comments that the most recent case was on December 6, suggested that the transmission chain was among the longest record for H5N1. The likelihood that receptor binding domain changes were present in the sequences from patients in the clusters was likely, and samples in London could be used to see how such changes affected the affinity of the H5N1 for human receptors.
Similarly, samples may have been sent to either get more sequence data, or test contact samples, which may have had lower levels of H5N1 because some or most of the samples were collected after the start of Tamiflu treatment.
The two month delay between disease onset and a report with some specific on the confirmed cases increases pandemic concerns.
A situation update with specifics as well as sequence data, would be useful.
Media Links
Recombinomics Presentations
Recombinomics Publications
Recombinomics Paper at Nature Precedings