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H5N1 returns with a vengeance in poultry -- and in people.

It didn't take long for H5N1 avian influenza to re-establish itself as the dominant disease in the global press. Just a few scant months ago, we were wondering (some silently, some aloud) if bird flu had gone away.

Now, with simultaneous events taking place over two continents and several thousand miles, we can say the answer is a resounding "no." Bird flu has not gone away. If anything, it has roared back with a terrible vengeance.

Look at the distribution of cases. Hong Kong slaughters 80,000 domestic fowl after several chickens turn up positive for high-path H5N1. China then finds H5N1 intwo different areas northwest of Shanghai in the province of Jiangsu, and orders the culling of more than 300,000 chickens.

Two Indonesians die and a third is treated. A 19-year old Cambodian tests positive for H5N1 for the first time in a year and a half, and culling ops ramp up in the affected province. In India, two entire provinces (Assam and West Bengal) are on alert after bird flu is found among poultry in both states, and humans in Assam are reporting "flu-like" symptoms, prompting quick medical response from field doctors. Some 300,000 Indian chickens will meet an inglorious fate at the hands of cullers.

Finally, in Egypt, a 16-year old teenage girl dies of H5N1. Her domestic poultry were infected, and she apparently caught the deadly disease from them. It is the first human case in Egypt since April.

All in all,it appears that H5N1 has begun its global march reinvigorated. Additionally, all these cases -- in humans and in poultry -- are happeningsimultaneously.

Of course, as we all know, Indonesia and Egypt have declared H5N1 to be endemic to fowl, and both nations have stopped reporting individual cases of H5N1 in poultry. Egypt continues to report human cases immediately; Indonesia only reports on a quarterly basis or if the situation is important enough to disclose it early.

Now Chinese scientific hero Guan Yi has theorized that the H5N1 virus has begun to mutate yet again, possibly explaining the simultaneousappearances in Egypt and China. here is the story, from China Daily and with bold highlights from me (and a tip o' the cap to Crof:):

Farms may not be using 'right vaccines' (China Daily)
Updated: 2008-12-17 07:45

HONG KONG - The re-emergence of bird flu in Asia and Egypt was partly because poultry farms were not using the right vaccines and that the virus is mutating, experts said on Tuesday.

Guan Yi, of the University of Hong Kong and an expert on H5N1 virus, warned that poultry farms in some parts of the world were using vaccines that did not provide full protection against the H5N1 and can't keep up with its mutation process.

"The vaccine (used in Hong Kong) was made to fight an American strain of the H5N2, and it is very different from the Guangdong strain of the H5N1 virus here," he said.

"When there were no outbreaks, we just assumed it was protective. Now that there is an outbreak (on a Hong Kong farm), we assume it is useless," he said.

Since late November, the virus has infected two children in Indonesia, killing one of them. Earlier this week, it killed a 16-year-old girl in Egypt, too. And a youth in Cambodia tested positive for the virus after eating chicken.

"The virus is definitely mutating," Guan said, warning that authorities in some areas were using batches of vaccine that may no longer be effective.

Since 1997, when H5N1 was identified in Hong Kong, scientists have discovered 10 strains of the virus, which shows the speed and extent at which it is mutating, though it has not mutated to pass from human to human.

The strain found in Indonesia, for example, is very different from the H5N1 strain in Europe, the Middle East and Africa.

"There is a theoretical possibility that the strain being used in the vaccine is too different from the one circulating," said Albert Osterhaus, a leading virologist with Erasmus Medical Center in Rotterdam, the Netherlands.

China Daily - Agencies

Now let's take a confirming look at the report coming from Jiangsu province, China:

Jiangsu suspects bird flu virus mutation

Shanghai. December 17. INTERFAX-CHINA - The H5N1 bird flu virus recently discovered in eastern China's Jiangsu Province may have mutated, local authorities announced on Dec. 17.

According to the Jiangsu Department of Agriculture and Forestry, bird flu-infected chickens in Jiangsu's Dongtai City and Hai'an county had been vaccinated against the virus although a new H5N1 virus strain has emerged and is unlike other strains previously discovered in southern China.

Jiangsu authorities reported the detection of the deadly H5N1 virus in poultry on Dec. 15 and have since ordered the culling of 377,000 poultry across the province. The Ministry of Agriculture announced on Dec. 15 that the outbreak in the two major poultry-rearing regions in Jiangsu may be attributed to migratory birds.

In the meantime, the National Bird Flu Reference Laboratory in Heilongjiang Province is running further tests on the virus, according to the Jiangsu Department of Agriculture and Forestry.

The MoA has also ordered chickens in the province to be vaccinated with a new vaccine in a bid to contain the outbreak.

Just last week, Hong Kong culled nearly 80,000 chickens after health authorities confirmed three chickens tested positive for the H5N1 virus. On Dec. 15, a 16-year-old girl died of bird flu in Egypt following contact with poultry.

To review:  A new, previously undiscovered strain of H5N1 has simultaneously appeared in both China and Egypt.  It may or may not have appeared in Cambodia.  It is once again lethal to humans, especially young humans.  It is believed to have mutated beyond the ability of a crude poultry vaccine to defeat it (so why should we believe an experimental human H5N1 vaccine should cause the virus to behave any different?). 

This poultry vaccine has produced a vaccine-resistant, mutant strain of bird flu.  Perhaps a new "clade" has been launched.  Just remember that each and every time this virus has a significant drift, it potentially places that virus one step closer in its evolutionary march toward pandemic status.  The death of the Egyptian teenager and the infection of the Cambodian young man clearly show that this virus has lost none of its lethality nor its proclivity toward infecting the young. 

So if we do, indeed, have a new strain of H5N1 emerging in two different continents simultaneously, we have a major cause for concern. 

As I mentioned in a blog a few weeks ago, Nature likes to kick Humanity when it is down.  With all the economic uncertainty, wars and upheaval, we need to be more on guard than ever against this viral foe.  As Michael Osterholm says:  Each day brings us closer toi the next pandemic, not further away from it.  I cannot help but feel that we are closer than ever.