Scott McPherson's Web Presence

Last week marked the 200th death worldwide (that we know of) from H5N1 avian influenza, and the 100th case in the nation of Vietnam.  In fact, last week the WHO had what we in IT would call a "true-up" of H5N1 influenza cases, confirming five cases with four deaths since May of this year.  The notice can be found, among other places, at the CIDRAP site at http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/aug3107vietnam.html .

The "true-up" came once the WHO published its new criteria for accepting positive test results from other labs.  Quoting from the CIDRAP release:

In a statement yesterday about new criteria for accepting positive H5N1 findings, the WHO said it will now accept positive polymerase chain reaction (PCR) results from national reference laboratories that (1) have participated successfully in the WHO's new External Quality Assessment (EQA) project and (2) have accurately identified H5 flu viruses in at least three previous cases.

I believe this new criteria is designed to speed up the ability to identify H5N1 positive cases and circumvent any reporting delays due to government restrictions regarding the actual transhipment of live virus samples.  It would be better for the WHO and its proxies, such as the CDC, to have the live virus specimens to analyze.  However, in this case, knowing where the new cases are and knowing they are, in fact, H5N1, will be helpful.  Not the best case scenario, because those nations with a proclivity against swift shipment of live virus (Indonesia, China, Vietnam) are also where the most significant chances are for mutation/evolution of the virus into something more easily spread person-to-person.  In that case, the world needs to know what changes took place within the virus' RNA itself.  And you can't know that without having the virus, or having access to the sequencing data, line by line.

What is so ironic about the Vietnamese cases is the probable source of infection.  Vietnam has been hailed for years as the world's Best Practice for H5N1 eradication.  Yet no matter how hard the nation tries, the virus reappears over and over and over again.  Scientists now believe that chicken smuggling from China explains a vast number of these repeat infestations.  You see, a kind of "Ho Chi Minh Trail" exists at certain border points with China (photo at left).  Since Vietnam does such a good job at culling poultry, it is cheaper to smuggle Chinese chickens across the border than it is to try and raise Vietnamese poultry.  So the forces of supply-and-demand, compounded by an artificially low price paid by the Vietnamese government for culled poultry per head, force the Vietnamese farmer to risk imprisonment (or worse) by smuggling chickens across its border.

What is plaguing Vietnam is not unique.  We also see examples of farmers skirting H5N1 culls in Egypt, Nigeria and elsewhere.  This practice will keep H5N1 moving and thriving unless/until farmers are paid more for each bird killed in the name of global public health.