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The news from China is not good, not good at all. And I cannot help but feel uncomfortable about what is going on there.

First, some appreciation needs to be senttoward the Chinese government for being transparent on this topic. If our scientists and researchers can get their hands on some samples, it will be even better news.

In case you have not paid attention: Since the first of the year, four Chinese residents have been struck down with H5N1 avian influenza. Of the four, apparently only one remains alive -- a 2-year-old girl. the other three cases have all perished, the latest being a 16-year-old male student.

According to the CIDRAP news release,

China reports 3 H5N1 cases, 1 death

Lisa Schnirring, Staff Writer

Jan 19, 2009 (CIDRAP News) – China's health ministry today reported three new human H5N1 avian influenza cases, one of them fatal and the other patients hospitalized in critical condition, according to a statement from the World Health Organization (WHO).

In the first case, a 27-year-old woman from Jinan City in Shandong province got sick on Jan 5, was hospitalized, and died on Jan 17, the WHO reported.

Public health officials are investigating the source of the woman's H5N1 infection, the WHO said. Shandong province is in northeastern China.(bold mine)

In the second case, a 2-year-old girl from Luliang City in Shanxi province began having symptoms on Jan 7, was hospitalized, and is in critical condition, the WHO reported.

Authorities are also exploring how the girl became infected, the WHO said. Shanxi province is in the north central part of the country.(bold mine)

The third patient, a 16-year-old boy from Huaihua City in Hunan province, became ill on Jan 8 and was hospitalized on Jan 16, where he is in critical condition, the WHO said.

An investigation into the source of the boy's illness found that he was exposed to sick and dead poultry, the WHO said. Hunan province is in south central China. (bold mine)

China's national laboratory confirmed all three of the cases, according to the WHO, which added that close contacts of the three cases are under medical observation, and all remain healthy so far.

The illnesses and death raise China's H5N1 case count to 34 and fatality total to 22, and these cases bring to four the number of cases in the country in as many weeks. On Jan 7 China's health ministry announced that a 19-year-old Beijing woman who got sick on Dec 24 and died from an H5N1 infection on Jan 5. (bold mine)

The WHO said in a press release today that it anticipates China will keep it updated on the new H5N1 cases and that the organization stands ready to provide China with technical assistance, if needed.

As more people eat chicken as part of Chinese New Year celebrations, the WHO in its statement urged people to observe routine safety precautions such as ensuring that poultry is well cooked and washing hands after contact with raw meat.

This year's Chinese New Year celebration, which lasts for 15 days, starts on Jan 26.

These latest H5N1 cases and fatality raise the world's WHO-confirmed H5N1 total to 397 cases and 249 deaths.

In related developments, China's agriculture ministry is intensifying its efforts to reduce the spread of H5N1 in poultry, according to a Bloomberg News report today. The country will strengthen poultry immunization against the virus, increase vaccine production, boost monitoring of poultry markets and other high-risk areas, and improve surveillance of poultry movements across country borders, the report said.

Meanwhile, York Chow, Hong Kong's secretary for food and health, called on China to release more epidemiological information about the recent human infections, Reuters reported today. He said that an apparent lack of information about recent poultry outbreaks in light of the recent human cases raises questions about a possible change in the virus. (bold mine)

However, about a week after the 19-year-old Beijing woman died, Chinese health officials said they had found no evidence that the virus has mutated to allow easier human-to-human transmission, according to previous media reports.

Chow also expressed concern about the possible role that asymptomatic H5N1-infected chickens might be playing in the spread of the virus, Reuters reported. (bold mine)

As mentioned above, earlier this month, 19-year-old Beijing woman Huang Yanqing died of H5N1, ostensibly acquired from a wet market just outside of Beijing.

You have four infections -- and three deaths -- occurring all over the Chinese mainland. Not confined to one singular province, and not necesarily accompanied by any known die-off of poultry. And to top it all off, the mother of the 2-year-old just died of "pneumonia." Sounds like the authorities need to go back and test for H5N1 on the dead mother, if they can.

And not to say "I told you so," but even York Chow, Hong Kong'sSecretary for Food and Health, is saying he is deeply concerned about a possible change in the virus that is making detection in poultry extremely difficult. As you know, I speculated in such a change in my recent blog In Like a Lion. York's call for investigation into possible viral mutation is echoed by Chinese viral researcher and hero Guan Yi and by the Jiangsu Department of Agriculture and Forestry. So you have two Chinese provinces officially declaring there may be something to this viral mutation stuff.

Context is important here. Note that the Chinese New Year officially begins January 26th. This event causes travel for hundreds of millions of Chinese, as they migrate back home or to relatives. The highlight is the Reunion Dinner, held on New Year's Eve. From Wikipedia:

A reunion dinner is held on New Year's Eve where members of the family, near and far away, get together for the celebration. The venue will usually be in or near the home of the most senior member of the family. The New Year's Eve dinner is very sumptuous and traditionally includes chicken and fish.

OK, let's put it all together.  We ahve at least four H5N1 human cases across China, all orccurring within the past month.  Three of the cases have been fatal, meaning this strain of H5N1 packs the same degree of lethality as before.  These cases are scattered all over mainland China, especially in the central and north/northeast regions.  People are going home, usually to the home of the most senior person, and my guess is that most senior person is in rural China.  And they eat chicken, of course, meaning rural chicken, recently slaughtered in a backyard or a wet market.

While we watch this situation closely, let us also hope we get our hands on some viral samples soon.