The two best kept secrets in Pakistan
The first secret is, 'Where is Osama bin Laden?'. Secret number two is that there was confirmed Human-to-Human (H2H) spread of Avain flu in Pakistan more than 5 months ago. Here's the complete info release from the WHO:
3 April 2008
Two additional H5N1 cases were confirmed by serological testing, thus providing final H5N1 infection test results on a previously reported family cluster in Peshawar.
These tests were conducted by the WHO H5 Reference Laboratory in Cairo, Egypt and the WHO Collaborating Centre for Reference and Research on Influenza in Atlanta, USA. The table below summarises the testing results of the confirmed/probable cases in the family cluster.
- The preliminary risk assessment found no evidence of sustained or community human to human transmission.
- All identified close contacts including the other members of the affected family and involved health care workers remain asymptomatic and have been removed from close medical observation.
These laboratory test results support the epidemiological findings from the outbreak investigation in December 2007, and the final risk assessment that suggested limited human to human transmission likely occurred among some of the family members which is consistent with some human-to-human transmission events reported previously. This outbreak did not extend into the community, and appropriate steps were taken to reduce future risks of human infections.
Relationship Onset Date Outcome Exposure Status Case 1 (Index case) 29 Oct 07 Fully recovered Direct contact sick/dead poultry Confirmed (serology) Case 2 12 Nov 07 Dead (19 Nov 07) Close contact with Case 1, no known direct contact with sick/dead poultry Probable
(No sample available)
Case 3 21 Nov 07 Dead (28 Nov 07) Close contact with Case 1 and 2, no known direct contact with sick/dead poultry Confirmed (PCR)
Case 4 21 Nov 07 Fully recovered Close contact with Case 1 and 2, no known direct contact with sick/dead poultry Confirmed (serology)
It is great news that the H2H transmission burned out before it hit the wider community. But many aspects of this news are troubling. First and foremost is the credibility of the WHO reporting. It seems that we hear complete details if a single duck shows up with H5N1 in Eureka-stan; why such a delay for major news such as H2H?
Speaking of credibility, contrast today's news with this Reuters article on December 28, 2007:
No proof of human-to-human bird flu in Pakistan No evidence that bird flu passed between relatives, WHO says
Reutersupdated 1:10 p.m. ET, Fri., Dec. 28, 2007
GENEVA -The World Health Organization said on Thursday it had established a single case of human infection of the H5N1 bird flu virus in a sick family in Pakistan but there was no apparent risk of it spreading further.
A statement from the U.N. agency said tests in its special laboratories in Cairo and London had established the “human infection” through presence of the virus “collected from one case in an affected family.”
But it said a WHO team invited to Pakistan to look into an outbreak involving up to nine people from late October to December 6 had found no evidence of sustained or community human-to-human transmission.
No identified close contacts of the people infected, including health workers and other members of the affected family, had shown any symptoms and they had all been removed from medical observation, the WHO added.
The outbreak followed a culling of infected chickens in the Peshawar region, in which a veterinary doctor was involved. Subsequently he and three of his brothers developed proven or suspected pneumonia.
The brothers cared for one another and had close personal contact both at home and in hospital, a WHO spokesman in Geneva said. One of them, who was not involved in the culling, died on November 23, but the cause of death was not known.
On November 28 another brother who had not been involved in the culling died, and tests on him — in Pakistan as well as in Cairo and London — had established the presence of the H5N1 virus.
The WHO spokesman told Reuters on Thursday all the evidence ”suggests that the outbreak within this family does not pose a broader risk. He added: “But there is already heightened surveillance and there is a need for ongoing vigilance.”
Truth delayed, is none the less the truth. But going forward it is harder to accept what the WHO says is the truth.