By Charlene Porter
Washington File Staff Writer

Washington – Chinese and international health officials have verified another human case of avian influenza, and the mystery of how the 31-year-old truck driver was exposed to the disease is causing some concern in Guangdon province and Hong Kong.

Chinese health authorities confirmed the case June 16, saying the ailing man still is alive, although in critical condition. In investigating the possible route of his infection, it has been confirmed that prior to his infection, he had visited a local market where live poultry were being sold. Thus far, there is no confirmation that he had direct exposure to ailing birds.

Inability to make that direct link to an animal carrier of the H5N1 virus that has been plaguing East Asia for more than two years is causing some genuine concern in Hong Kong.

Health Secretary York Chow of the special administrative region of Hong Kong told Radio-TV Hong Kong that he is concerned about this case for several reasons. The sick man has no apparent history of contact with sick animals; rather, he comes from the city and not from the countryside where the virus has been more common.  Chow also is concerned that the case is occurring in the hot summer; most of China’s avian flu cases have occurred in winter.

“So we have a suspicion - and we cannot confirm it yet - that the virus might be more virulent and more widespread than we expected,” Chow said in the interview. “We need to monitor the situation closely to see if there is continuity of this pattern.”

This is only the third case of avian influenza detected in China in 2006. Since 2005, 11 cases of the disease have been reported, resulting in seven deaths.

Indonesia, in contrast, has verified more human cases of H5N1 infection than any other country in 2006; another was confirmed June 15. A 7-year-old girl succumbed to infection in the Tangerang district of the Banten province about a week after her symptoms first appeared.

Health authorities have detected a history of dying poultry in the child’s household and neighborhood. A 10-year-old brother of this deceased girl also developed the symptoms, and died several days before his sister. The cause of his death cannot be definitively identified, however, because no tissue samples to test for the presence of H5N1 were obtained from his body before burial.

The 7-year-old girl in Banten was Indonesia’s 50th case of H5N1 in a human since 2005, the 32nd case this year. Indonesia’s cumulative death toll from avian influenza is 37. The World Health Organization (WHO) has verified a total of 129 deaths from H5N1 in the 2.5-year emergence of the disease.

Authorities make no connection between these cases and a family cluster of cases that appeared in North Sumatra in May. Investigation revealed that there was no sustained human transmission of the virus among seven infected family members. (See related article.)

Humans never have been exposed widely to the H5N1 virus and thus have no immunity to it. Experts warn that if this viral strain develops the capability to pass easily from person to person, then a global flu pandemic could be unleashed with severe human, economic and social consequences.

ASSISTANCE EFFORTS

At an international meeting June 6 and June 7 in Vienna, Austria, senior officials from donor and affected nations met to refine the global strategy against the spread of avian influenza and the prevention of the development of a human pandemic.

Indonesian delegates appealed to the meeting for international assistance to build up disease surveillance and monitoring systems thought to provide the best defense against the emergence of disease and the best strategy for containing its spread. According to a summary of the meeting from the World Organisation for Animal Health, decentralization of veterinary services on the 6,000 occupied islands of the archipelago nation is a key issue to be overcome.

Leading the U.S. delegation to the meeting, Under Secretary of State for Democracy and Global Affairs Paula Dobriansky announced an additional $28 million in U.S. assistance to help developing nations contain avian influenza and prevent a pandemic. (See related article.)

U.S.-backed programs are operating in Indonesia, where the U.S. Agency for International Development (USAID) is supporting an international effort to establish an emergency team of experts at local disease control centers in likely areas of outbreak. These centers will offer up-to-date information and train animal health technicians and veterinarians in how to carry out rapid disease investigations and implement control measures, such as culling of birds, vaccination and biosecurity.

Additional information on the United States’ international engagement on avian influenza is available on the USAID Web site.

For ongoing coverage of the disease and efforts to combat it, see Bird Flu (Avian Influenza).