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The concern within China regarding the origin of four recent human H5N1 cases is palpable. Within the past three weeks, there have been four cases of H5N1, and three of those cases have resulted in death. There are suspicions that in two of the cases, possible human-to-human transmission may have occurred, although proving this theory (or disproving it) is now almost impossible.

For example, in the case of the 2-year-old girl (to this point the lone survivor), "her mother had contact with live poultry around December 21 and she had a little fever on December 28," said an official with the public health office of Hunan Province. "Then it developed into pneumonia and she died on January 6." Hat-tip to Crof on that one.

In the case of 19-year-old Huang Yanging, the first Chinese death in almost a year: A nurse treating her was herself overcome with fever, and some 116 contacts were actively monitored by Chinese health authorities. My blog on that case can be found at: http://www.scottmcpherson.net/journal/2009/1/6/was-huang-yanqing-a-carrier-of-h2h-h5n1.html

These four cases occurred all overthe Chinese nation. To date, aside from that lone comment from the Hunan government, there is nothing linking the cases to diseased poultry -- a fact that has sent shivers down the spines of Chinese influenza and infectious disease researchers. And now, normally tight-lipped Chinese scientists are openly discussing the possibility that the virus may have mutated again (at least in China) to produce a virus that is less lethal to chickens, while retaining its lethality toward humans.

The latest article on this comes from today's Epoch Times. The article reads:

Hong Kong Expert Worries About Recent Bird Flu Cases

Four persons infected in China this year

By Lin Yi
Epoch Times Staff Jan 21, 2009

HONG KONG—In two weeks, four people in China have been confirmed infected with H5N1 bird flu virus. An expert in Hong Kong worries about the possibility of an inapparent infection,* and the risk of human-to-human transmission becoming more likely.

Currently, three of the four persons have died from the virus. Professor Paul K. S. Chan from the Department of Microbiology of the Chinese University of Hong Kong believes the situation is really worrisome because the source of the virus is still not identified. There is no apparent outbreak among the birds at the locations where the people were infected. It means the possibility of an inapparent infection. (bold mine)

“If we cannot identify which chicken or duck carries the virus, we would normally take precautions especially during close contact. It is really worrisome. Many experts want to identify whether the infection was caused by an inapparent infection (between humans) or transmission from infected poultry without symptoms, which could be the result of ongoing vaccinations (bold mine). If that is the case, the vaccine should be improved or the method of applying the vaccine should be improved.” said Professor Chan in an Epoch Times interview.

Chan pointed out that the virus has never stopped mutating. Because its human-to-human transmission efficiency is still low, there has not been a large scale outbreak among humans. However, many experts are concerned that the efficiency is gradually increasing. “The mutation from difficult human-to-human transmission to rapid human-to-human transmission could take a very short time, but could be a slow process as well.” said Chan adding that it could happen within a few months in the worst-case scenario, but it is difficult to predict. (bold mine)

Chan emphasized that the virus could spread to very distant locations by birds, so isolated human infection cases are possible. “If an outbreak happened in one province, the virus could also be carried to other provinces by the birds. I believe such things could happen.”

*not apparent clinically

Read the Original Chinese Article

OK, so we have two Chinese government agencies and several noted Chinese scientists openly speculating on the same thing: H5N1 has produced human deaths without any clue as to the vector. Of course, we have seen this in Indonesia time and time again. In fact, just today, the Indonesian government has revealed two more deaths from H5N1 in the past month. From Reuters:

Indonesia confirms two more bird flu deaths

Wed Jan 21, 2009 5:54am EST

JAKARTA, Jan 21 (Reuters) - Two Indonesians living close to the capital Jakarta have died of bird flu, the health ministry said on Wednesday, bringing the country's death toll from the disease to 115.

A 5-year-old girl from Bekasi east of Jakarta died in January, while a 29-year-old woman from Tangerang, west of Jakarta, died in December last year, the health ministry said on its website.

The girl from Bekasi got sick after her parents had bought a chicken in a market.

"The cat died after it ate the chicken they bought," the statement said.

The 29-year-old fell ill after visiting a market close to her house, the statement said, without elaborating.

Samples from the two women tested positive in two local laboratories, it said.

Indonesia, which has stopped updating bird flu deaths immediately after they occur, has the highest toll from the disease of any nation.

Including the latest two deaths, Indonesia has had 115 deaths confirmed from the deadly H5N1 virus, according to data compiled since 2003 by the World Health Organisation.

Although bird flu remains an animal disease, experts fear that the virus might mutate into a form easily passed from human to human, sparking a pandemic in which case millions could die.

(Reporting by Olivia Rondonuwu; Writing by Ed Davies; Editing by Sugita Katyal)

Note that the Tangerang province produces yet another human death from H5N1.

The year 2009, only 21 days old, has already met 2003's statistics for bird flu cases and deaths as reported to the WHO. It will undoubtedly surpass 2003's case and case fatality numbers by the end of this month.

But it this sudden, jarring appearance of H5N1 in Chinese victims that is so troubling. It may only be four cases; small change in the myriad ways Chinese citizens may meet their maker. But it is the large geographic dispersal of these cases, coupled with their lack of a vector, that makes this such a troubling problem.

One thing all the dead have in common: All the victims were under the age of 40. So it has gone since Day One of the 2003 resurgence of H5N1. So it continues:The elderly are spared while the young suffer and die.

Finally: I don't know a Replikin Count from a Palm Beach County recount, but the organization claims that we are entering a "third cycle" of H5N1 infection. And according to them, this one will surpass anything we have seen to date. Medical News Today has the press release, and I invite you to read it and tell me if this company has any standing or any track record when it comes to these matters. From the release:

The data suggests that additional increases in both Replikin Counts and consequent H9N2-H5N1 infections are anticipated in a coming third cycle. Suggesting that a third cycle has begun, after a 5 year absence, H5N1 reappeared in Hong Kong chickens in early December 2008. and an H9N2 infection in a child in Hong Kong was reported on 12/30/2008.

Since there is no mention of the four Chinese cases, one can assume this release was written prior to the Chinese cases of H5N1.   Still, in light of the past three weeks, I'd say they got it absolutely dead right.  Or a broken clock is right twice a day.  I'll defer to more seasoned analysis on this organization.