Scott McPherson's Web Presence

... and the world's "best practice" for bird flu eradication moves back three spaces.

The second death from H5N1 in Vietnam in the past ten days underscores the incredible difficulties in containing the H5N1 virus.  It was just this past November when President George W. Bush toured the Pasteur bird flu research facility in Ho Chi Minh City, and the WHO held Vietnam up as the best example of a nation's ability to eradicate bird flu.

Now, just a few months later and despite all the best practices Vietnam can perform, bird flu is back with a vengeance.  Several provinces are overrun with the virus in poultry, and now two people are dead -- the first and second deaths in over a year.

Vietnam is not necessarily to blame.  And we all agree that it is one heckuva lot easier to contain a virus in a totalitarian state than a democratic one!  But first: Vietnam has no control over its own borders (sound familiar?).  H5N1 has come across the border with China time and again, making a mockery of well-intentioned Vietnamese efforts at containment and eradication.  This is due to the smuggling of poultry INTO Vietnam, from China.  Chicken farmers found it was cheaper to smuggle poultry (photo at left) than to pay higher prices.  Market forces brought H5N1 back into Vietnam. 

Second, H5N1 is tough and stubborn.  These are important words when describing influenza.  As I explain it, flu plays "King of the Mountain."  The stronger strains survive, the weaker ones disappear or go to ground.  A perfect example is H2N2, the source of the 1957 pandemic.  It appeared, and H1N1 disappeared.  H3N2 appeared, and H2N2 disappeared. It was only since 1977 that two strains of influenza A (H3N2 and H1N1) have been able to coexist -- and that, at least explained via the rumour mill, was because of a Soviet mistake in a research lab.

There is no H2N2 anywhere in the world, except on ice in various research labs (remember the scare when H2N2 was sent out with a flu detection kit last year?) and in the belly of some birds somewhere.  Now, the theory that all pandemic viruses are "recycled" would hold that one day, H2N2 would reemerge.  But that is fodder for another blog.  Tests will tell us if the H5N1 that killed the two victims is the same strain as what has always been there (known as Clade 1), a different existing strain (Clade 2.3, also called Fujian, recently identified by Dr. Robert Webster and others and whose existence was denied by Chinese authorities), or a totally new clade that might have emerged via recombining with itself. 

But it allows us to draw several unsettling conclusions.  They are:

1.  H5N1 is nowhere near going away.  In fact, despite the fact surveillance has gotten magnitudes better in the past eighteen months, the virus continues to spread.

2.  H5N1 is one tough SOB.  It refuses to play king of the mountain.  It IS the mountain.

3.  However the virus is getting around, be it via migratory wildfowl, smuggling, current poultry factory practices or all of the above, it continues to spread and all attempts to beat it back fail eventually.

4.  We must keep beating it back, as a delaying tactic if for no other reason, to forestall the next pandemic. 

5.  Does Dr. Margaret Chan get ANY credit for delaying the pandemic back when she was Hong Kong health officer in 1997?  She may have single-handedly saved the planet with her decisive actions in the first outbreak of H5N1, ten years ago.  That is precisely why the WHO made her its head after the unfortunate and sudden death of the Korean guy.  I thought I would throw that one in as a shout-out to Dr. Chan.

From the ZImbabwean press:

Hanoi - A 28-year-old woman has died of bird flu in Vietnam, the second person there to succumb to the deadly H5N1 strain in just 10 days, after one-and-a-half years with no deaths, an official said on Thursday.

She died on Wednesday two weeks after being admitted to a Hanoi hospital that specialises in tropical diseases, said Nguyen Tran Hien, director of the state-run National Institute of Hygiene and Epidemiology.

Her death brings to 44 the number of people who have died of bird flu in Vietnam. Last weekend authorities reported the death of a 20-year-old man, who was the first fatality to be announced since November 2005.

Since last month, five human cases of bird flu have been reported in Vietnam, two of whom have died. Two others who had contracted the virus have already been released from hospital.

Communist Vietnam, once the nation worst hit by avian influenza, contained earlier outbreaks through mass vaccination campaigns, the culling of millions of poultry, and public education campaigns.

But the virus has come back strongly this year, hitting scores of poultry farms in an unusual summer-time outbreak.

Read the full article:  http://www.iol.co.za/index.php?set_id=1&click_id=143&art_id=nw20070621152503650C807795