By Cheryl Pellerin
USINFO Staff Writer

Washington - Investigations are under way in Laos, China and Egypt into new human cases of avian influenza, and the World Health Organization (WHO) is preparing to meet with representatives of developing countries to discuss equitable distribution of pandemic vaccine and the sharing of avian flu virus samples.

The latest human cases of H5N1 highly pathogenic avian flu, confirmed by WHO, bring the number of cases worldwide to 277, with 167 deaths, since the current outbreak in 2003.

“Something like 300 million birds have died directly from being infected or because they were exposed [to the avian virus] and were culled,” WHO spokesman Dick Thompson said during a March 2 USINFO interview. “In all that time – in three years – we’ve had fewer than 300 human cases. It’s a very rare event that any human becomes infected, but it’s not unexpected where the virus is widespread in animals and people are in close contact.”

HUMAN AVIAN FLU IN CHINA, EGYPT

The Ministry of Health in China reported one case of human infection with the H5N1 avian influenza virus March 1, according to WHO. The 44-year-old woman from Jian'ou County in Fujian province became ill with fever and pneumonia February 18 and was hospitalized February 22.

The woman is a farmer who keeps birds in her backyard and might have been exposed to sick birds, WHO reported. An investigation is under way to determine if that exposure is the source of her infection. Of 23 cases confirmed in China, 14 have been fatal.

Also March 1, the Egyptian Ministry of Health and Population reported a new human case of H5N1 infection, confirmed by the Egyptian Central Public Health Laboratory and U.S. Naval Medical Research Unit-3 in Cairo. (See related article.)

The 4-year-old girl, from the Dakahlia governorate in the Delta region, developed symptoms February 25 after being exposed to domestic backyard birds. She was admitted to Mansoura Chest Hospital February 26 and began receiving the anti-viral drug oseltamivir (Tamiflu^®). On February 27, she was transferred to El Bakry Hospital, where she was in stable condition at that time. Of 23 cases confirmed in Egypt, 13 have been fatal.

FIRST HUMAN CASE IN LAOS

The Ministry of Health in Laos, officially the Lao People's Democratic Republic, reported February 27 the first human case in Laos of infection with the H5N1 avian influenza virus.

The 15-year-old girl is from Vientiane, the capital of Laos, in the Mekong Valley. She developed flu-like symptoms February 10 and was hospitalized in Vientiane February 15. She sought medical care in neighboring Thailand February 17 and is now in a public hospital in Nong Khai province.

According to press reports, she was transferred to the hospital in Thailand in accordance with a Thai-Lao memorandum of understanding on bird flu cooperation.

A team from the Thai and Lao ministries of health and WHO officials investigated the situation February 24 and February 25 in the girl's village and in districts where poultry deaths had occurred. People with whom the girl had close contacts are being monitored and some are receiving Tamiflu^®.

The National Institute of Health in Thailand tested samples taken by Lao epidemiologists and Thai clinicians and found them positive for H5N1 infection. The Lao government also is providing samples to a WHO collaborating center for examination.

VIRUS SHARING AND VACCINE EQUITY

It is important for countries to share virus samples with WHO, Thompson said, so “scientists can tell very quickly whether or not H5N1 has reassorted, or mixed, with a human influenza strain. If that happened, we believe it would have greater likelihood of being able to move easily from person to person and then becoming a fully pandemic strain.”

In February, Indonesian officials said they would stop sharing virus samples with WHO collaborating centers unless an agreement could be reached guaranteeing the country access to affordable vaccines against avian influenza. (See related article.)

On February 16, Indonesia and WHO officials released a statement saying Indonesia again would share samples of avian flu viruses with WHO. However, sharing has not yet resumed, and WHO has not received virus samples since January.

“What’s going on in Indonesia is very important,” Thompson said. “It raises the issue of fairness and equity, especially about access to pandemic vaccine.”

Pandemic vaccines are based on viruses that come from Asia, where few countries can afford such vaccines and few have vaccine-production capability.

The next step will be a letter, now in development, from WHO Director-General Margaret Chan to the Indonesian minister of health. At the end of March, the government of Indonesia will host a meeting in Jakarta for representatives from WHO and interested countries to discuss the issue.

“We’d like to develop a system whereby we can get these samples,” Thompson added, “and yet somehow ensure that these countries have access to what will be a very limited supply of pandemic vaccine.”

For more information on U.S. and international efforts to combat avian influenza, see Bird Flu (Avian Influenza).