"The virus first seen in wild swans in the area ... has been found among native ducks and geese around the northern village of Barzanghib in Iran's Mazandaran province."
The above comments describe confirmed H5N1 in wild birds in Iran along the coast of the Caspian sea. These results support the H5N1 confirmed in domestic poultry in the region. In the past, H5N1 from Iran was clade 2.2.3, which was also detected in Russia, Azerbaijan. Afghanistan, and India in 2006.
Recent outbreaks in Europe have been the Uva Lake strain, which is also clade 2.2.3. Therefore, it is likely that the H5N1 in Iran is also the Uva Lake strain, which is active in Europe and is also likely to be in the Middle East and south Asia, including Afghanistan, Pakistan, India, and Bangladesh.
Recombinomics Commentary 19:29 January 20, 2008 The Jharkhand government has sealed the borders of its nine districts and constituted a high-level committee to monitor the situation following the deadly Avian flu in West Bengal.
Official sources said the committee, headed by Chief Secretary P P Sharma, yesterday decided to seal borders of Ranchi, Singhbhum, Chaibasa, Dhanbad, Bokaro, Dumka, Jamtara, Pakur and Sahebganj with the neighbouring West Bengal.
The above comments indicate Jharkhand has sealed its border with West Bengal. Recently, H5N1 was confirmed in the Saltora block of Bankura, which shares a border with Jharkhand. Earlier, H5N1 was confirmed in multiple blocks in Birbhum, which also share borders with Jharkhand.
H5N1 has spread throughout West Bengal, but the rapid spread is likely linked to wild birds, which limit the effectiveness of sealed borders.
Medical and veterinary personnel are also being dispatched to Jharkhand to assess the bird flu situation in birds and patients.
Suspect H5N1 Patients in Isolation in Bolpur West Bengal India
Recombinomics Commentary 20:08 January 20, 2008
Talking to UNI after paying a surprise visit to the Bolpur Sub-Divisional Hospital and Primary Health Centre, she said, ''Despite the Centre extending all possible cooperation in tackling the situation as well as providing masks, ventilators and other necessary equipment to contain Avian Influenza, the state government has failed to handle the alarming crisis created by the outbreak of bird flu.'' Ms Lakshmi alleged that the condition of the isolated wards in which the affected patients were being treated and which she had personally overseen, was 'abject'.
''There are no proper beds and other essential equipment and they are also found wanting in hygiene and safety precautions,'' she said.
The above comments suggest suspect H5N1 patients are in isolation in Bolpur. Earlier reports had indicated that none of the 700 patients in Birbhum with respiratory problems were bird flu patients because they had no contact with birds and did not have lower respiratory tract infections.
However, the dramatic spread of H5N1 in Birbhum suggests many of the 700 patients had H5N1 exposure through wild or domestic birds. Moreover, H5N1 infections do not always lead to lower respiratory conditions.
There have very few reports of suspect cases in West Bengal, even though villagers were eating birds that had died, and were handling dead birds with PPEs.
Recombinomics Commentary 22:35 January 20, 2008 The death of a migratory bird at the Santragachi Jheel created panic among the locals on Sunday.
The bird has been identified as the Lesser Whistling Teal, popularly known as Sharal.
Tucked away in the peaceful interiors of Santragachi, the lake has become a safe haven for thousands of migratory birds.
About 5,000 migratory birds, both from within the country and Trans-Himalayan birds, congregate at the lake every year.
The above comments describe a dead teal at Santragachi Jheel in Calcutta. Although the H5N1 outbreak in West Bengal has led to the testing of wild birds found in areas of confirmed H5N1, India has never reported H5N1 in a wild bird, dead or alive.
As noted above, wild birds from Siberia and China winter in northern India, and H5N1 has been reported in long range migratory birds China, Russia, and Mongolia since the spring of 2005, yet India has yet to report a wild bird infection.
Wild bird investigations frequently involve the collection of a small number of samples, which invariably test negative.
However, the deaths of large number of resident wild birds in association with confirmed poultry deaths, leaves little doubt that the wild birds are also H5n1 infected.
The recent deaths of crows and hawks in and around Calcutta may lead to enhanced surveillance and H5N1 positives, although the number of dead poultry being tested remains low.
Watchful Waiting for Suspect H5N1 Patients in West Bengal India
Recombinomics Commentary 08:58 January 21, 2008
Today, he is searching for a particular house. Finally, he finds it. The house belongs to Kalu Sheikh, a daily-wage labourer. Roychowdhury begins a round of questions. “I heard your children are ill?” he says. “For how many days have they had fever? How many birds in your house are dead?”
Kalu’s children—seven-year-old Anarul Sheikh and eight-year-old Tumpa Sheikh—have been running a fever for the past four days. Kalu tells Roychowdhury that they had seven hens. Four died last week and the rest fell ill. The family ate one of the birds a few days ago.
“When my four birds died, the children picked them up and threw them behind the house. The other three were ill, so we thought why not eat one. But why are you asking these questions?” Kalu says.
One of the health workers ventures to tell Kalu that there is a new disease in the area that could be fatal to humans. Roychowdhury interrupts him, asking him not to create panic. Don’t worry, he tells Kalu and his wife, putting his hand on the children’s foreheads. “Keep a watch on the family,” he tells his staff as he leaves.
The above description of two suspect cases in Birbhum, West Bengal suggests that those who have eaten dead chickens and develop fever are simply being watched. There is no indication of hospitalization or treatment.
Earlier reports described 700 patients with fevers who were given medicine and sent home. There has also been no suggestion that these patients are being tested or being given Tamiflu. Earlier reports indicated the patients had no chicken contact or lower respiratory disease.
However, H5N1 can produce mild symptoms as was seen in children in Egypt last year. Samples from those children yielded H5N1 sequences which were clearly the Qinghai strain of H5N1.
The number of suspect hospitalized patients remains unclear. There have been no confirmed cases, and one media report citing patients in an isolation ward have been followed with reports indicating the isolation ward did not meet standards, it had not yet received patients.
Many villagers in hard hit areas have engaged in risky behaviors, including cooking and eating dead birds, or collecting dead birds or feathers without PPE's.
The lack of hospitalized patients appears to be linked to the lack of testing.
According to district animal husbandry department, hundreds of chickens died of unknown disease in the villages under Taldaha-Majdiya gram panchayat in Krishnaganj block and Hatisala gram panchayat in Chapra block over the past few days.
Mr Gour Biswas, sabhapati of the Krishnaganj panchayat samity said: “I have reported the unnatural deaths of chickens in Taladaha area to authorities and urged them to take immediate action.” Chapra block administrative officer Mr Bhaba Sindhu Mondol said: “A stray dog was found dead after eating the carcasses of a few chickens which were dumped near Hatra village. I have brought the attention of the incident to the district administration.” Besides chickens, pigeons were also found dead in Muragacha near Bethuadahari Sanctuary. The district administration has sent the samples of the dead pigeons to the High Security Animal Disease Laboratory (HSADL) in Bhopal.
Meanwhile, the district administration received reports of the samples collected from the villages Jaggeswardihi, Bonkapasi, Baktona, Srikhanda, Napara in Durmut panbchayat area. The reports have confirmed the existance of flu. The villages under the panchayat witnessed death of more than 20,000 birds in four days.
New cases of avian flu were also reported from Jamuria and Raniganj under the Assansol sub division this evening. Almost 7,000 chickens from the Hijalgora and Pariharpur areas of Jamuria and Kunustoria, two kilometres from Raniganj and Raniganj have died over the past five days. When contacted, SDO (Assansol) Mr Alokesh Roy said that he had received information about chicken deaths from these areas.
The above comments describe multiple outbreaks in Nadia and Birdwan districts in West Bengal. Included are suspect death of wild birds and a dog. This spread is exacerbated by the testing protocols in India, which involve a minimal amount of testing in regions were bird deaths are high.
Initial reports of deaths in Nadia were blamed on New Castle Disease. However, villagers noted that the dead birds had not responded to treatment, indicating the deaths were not due to New Castle Disease, which is control through vaccinations. Rapid tests showed the tested birds were H5N1 negative, which also indicates the number of samples tested was a minimal number. Over the weekend more sensitive tests confirmed H5N1 in Nadia and Birdwan. However, while the government was denying H5N1 with mis-diagnosis and rapid tests, H5N1 was spreading throughout the blocks listed above.
The denials in India are not new. Although wild birds are now being tested, and the large number of dead crows and pigeons leaves little doubt that these birds are H5N1 positive, India has never reported H5N1 in migratory birds, even though the birds that summer in Siberia and Mongolia winter in India and birds at the locations in Siberia and Mongolia are H5N1 positive.
Moreover, the H5N1 sequences from the 2006 outbreak in India are clade 2.2.3, which were the precursor sequences for the Uva Lake outbreak in Mongolia in the summer of 2006. Thus, sequence data and migration support new introductions of H5N1 into India via migratory birds. A dead teal in Calcutta has created panic in the region, as have dead hawks and crows.
India’s testing continues to chase the virus, as it spreads throughout West Bengal and will likely spread further into adjacent regions.
Bird flu in West Bengal spread to a seventh district Malda while authorities on Monday raised the target to cull 20 lakh birds in the next one week in a desperate bid to curb the reach of the dreaded avian disease.
The above comments describe the confirmation of H5N1 in another West Bengal district. The location of Malda, just north of the massive outbreak in Birbhum and adjacent to Bangladesh, suggested the bird deaths there would test positive eventually, and media reports indicated culling had begun last week, again signaling that the situation on the ground is worse than the delayed confirmations.
The number of reports of dead poultry continues to pour in and includes multiple outbreaks at the northern and southern borders of West Bengal, suggesting that soon the entire region will have confirmed H5N1.
The increased cull target of 2 million birds reflects the announced and suspected H5N1 positives in West Bengal. Moreover, observers are now being dispatched to adjacent regions in India to the west of West Bengal, and neighboring countries are banning imports or sealing their borders.
However, the spread of H5N1 is likely to be linked to resident and migratory wild birds, so attempts to halt the spread on the ground are not likely to succeed.
Several dead chickens tested positive for the bird flu virus in a northern Turkish village, Agriculture authorities said Monday, adding that further tests were underway to determine the virus strain.
The chickens were found dead in Saz, a village in Zonguldak province
The above comments describe likely H5N1 in Turkey. The location on the shores of the Black Sea increase the likelihood of H5N1 related to the outbreak described earlier in Romania. In the fall of 2005, both Romania and western Turkey reported H5N1 outbreaks.
The sequences from the recent Romanian outbreak have been published and are the Uva Lake strain.
Likely H5N1 in Five Cullers in Murshidabad West Bengal
Recombinomics Commentary 19:29 January 21, 2008
All five are residents of Murshidabad, one of seven West Bengal districts to have been hit by the deadly H5N1 virus in its latest outbreak in India, and have been quarantined and administered Tamiflu - the most effective antibiotic against avian influenza.
Investigations revealed that the men had handled backyard poultry soon after the disease infected and killed birds. The outbreak has been traced to small pens maintained by individuals rather than large farms. The men reported influenza-like symptoms including fever, cough, sore throat and muscle ache.
Some of them are also suspected to be suffering from respiratory illness like pneumonia. A special team from the National Institute of Virology (NIV), Pune, collected blood and throat samples of the patients on Sunday.
The above comments describe five likely H5N1 infections in cullers in Murshidabad, West Bengal, India. Human cases are not a surprise. The H5N1 in India is likely to be similar to the H5N1 in Pakistan (clade 2.2.3).
In Pakistan, 10 people were laboratory confirmed, although WHO labs could only confirm one, due to sample degradation from multiple freeze thaws. In Pakistan there were at least two clusters, one of which represented the most sustained H5N1 human to human transmission recorded to date. The infections in Pakistan were linked to culling operations. At least four of the cullers or contacts developed pneumonia.
The development of pneumonia in some of the cullers is a strong indicator of H5N1 infections.
Selim Malick Sheikh (9), a class III student of Mira Sahid Swaran Primary School of Kadamtalapara in Plassey in Kaliganj block of Nadia died on the night of 19 January within 48 hours after consuming sick chickens cooked at home. He died on his way to Beliaghata ID Hospital.
State health minister Dr Surjya Kanta Mishra said: “This is not a case of a human death caused by avian flu. No such case has been reported in the state so far.”
The above comments describe a suspect H5N1 fatality in India. Although it is unlikely that consuming H5N1 infected chicken would cause death within 48 hours, exposure prior to the meal is likely. H5N1 has been widespread in Nadia for some time, although initial government characterizations were New Castle Disease. Although initial rapid tests were negative, H5N1 was subsequently confirmed for Nadia, and poultry deaths as well as the death of wild birds and a dog have been reported.
The H5N1 in India is likely to be related to the H5N1 in Pakistan, which was linked to two deaths late last year. Therefore, the statements by the state health minister on the child’s diagnosis and death have no medical or scientific basis. Moreover, the location in Nadia is only 20 mile from the five suspect H5N1 infected cullers.
In Bhangar alone more than 700 chickens have died over the past few days generating bird flu scare. In Diamond Harbour almost 400 chickens have died, while in Baruipur and Sonarpur the number of deaths stands at 400 and 200. Almost 60 chicken deaths have been reported from Sarisha. These deaths have prompted the district administration to issue an alert. A ban on chicken trade has already been issued in the affected areas, district health officials said.
The above comments describe poultry deaths in South-24 Parganas. Although H5N1 has not been confirmed in this district, the steady increase in poultry deaths in multiple locations leaves little doubt that H5N1 has spread to the southern coast of West Bengal.
The lack of confirmation is due to slow testing in Bhopal. The number of samples tested per day is low, and the delays in confirmation are creating an artificial picture of the spread of H5N1. Bird deaths indicate H5N1 has spread across West Bengal, and now suspect human cases are being reported in two districts with confirmed H5N1 in poultry, Murshidabad, with five suspect cullers and Nadia with one suspect fatality.
The number of birds to be culled has been raised to 2 million, which will increase more when additional tests are completed.
The suspect H5N1 cases raise serious pandemic concerns.
The HSADL, Bhopal has confirmed a positive result for Avian Influenza (H5) in respect of samples from Chachal-I block of Malda district, Nakashipara block of Nadia district and Mejia block of Bankura district of West Bengal on the basis of rapid tests.
A total of 22 samples have been sent to the HSADL, Bhopal from North 24 Parganas, South 24 Parganas, Hooghly, Nadia, West Midnapur and Birbhum districts on 20.01.2008.
The above official numbers for yesterday demonstrate that the spread of confirmed H5N1 poultry outbreaks in West Bengal is limited by sample collection and testing.
The reported 107,881 poultry deaths represents an increase of 9627 over the prior day. However, of the almost 10,000 bird deaths, 22 samples were sent to Bhopal for testing. Consequently, only 7 of the 18 districts in West Bengal have confirmed positives, while virtually all have reported excess poultry deaths. The lag in testing leads to lags in culling, while H5N1 continues to extend its reach at an alarming rate.
If adequate testing was being done, H5N1 would be found in virtually all districts and in multiple blocks per district, as seen in the satellite map of confirmed and suspect outbreaks.
The explosion of cases is now just beginning to show suspect cases. Five cullers are in isolation and on Tamiflu, as samples are being tested for H5N1. Similarly one fatal case is highly suspect, based on circumstances and proximity to positive poultry and the five suspect cullers.
The failure to find addition suspect cases among villagers who ate H5N1 infected birds or had exposures through collection of playing with infected birds, raises additional questions about the testing in general. Interviews with parents of children exposed to H5N1 suggest that those with fever are not being tested or hospitalized. The government appears to have a watchful waiting program fro such cases. Tamiflu is largely limited to cullers and health care workers, although this approach does not appear to have been successful for the five suspect cullers.
Clearly the spread of confirmed cases of H5N1 in birds and patients is limited by testing, which should be dramatically increased.
H5N1 Culler Cluster in West Bengal Raises Pandemic Concerns
Recombinomics Commentary 04:22 January 22, 2008
The men reported influenza-like symptoms including fever, cough, sore throat and muscle ache.
Some of them are also suspected to be suffering from respiratory illness like pneumonia. A special team from the National Institute of Virology (NIV), Pune, collected blood and throat samples of the patients on Sunday.
They are being tested by scientists at the National Institute of Cholera and Enteric Diseases (NICED), Kolkata, and Delhi's National Institute of Virology and National Institute of Communicable Diseases - the only three bio safety level (BSL)-III labs in India equipped to test human samples for avian influenza.
The next 24 hours will be a nervous wait for officials monitoring the outbreak as final reports are expected on Tuesday.
The above comments on five likely H5N1 infections in cullers in West Bengal, India are cause for concern. If confirmed, the cluster would have striking similarities to the recent clusters in Pakistan. The H5N1 in India is likely to be similar to the H5N1 in Pakistan. Although Pakistan has not released any H5N1 sequences, and the last sequences from India or Pakistan’s neighbor, Afghanistan, were from outbreaks two years ago, those sequences were clade 2.2.3 and it is likely that the recent sequences in both countries will be the Uva Lake strain, which evolved from clade 2.2.3.
In Pakistan the index case for the outbreak was a culler and all initial cases seemed to be linked to culling operations. Brothers of the index cullers also developed symptoms, and two died. The two fatal cases and two others developed pneumonia, a common complication of H5N1 infections.
In India, H5N1 symptoms in five cullers from the same region, who apparently developed symptoms at the same time, suggests the H5N1 is efficiently transmitted to humans. The rapid spread of H5N1 in West Bengal (see satellite map) puts a large number of people at risk, in the region, which is densely populated with humans and domestic poultry, which also has wetlands frequented by migratory birds. The large number of dead resident crows, pigeons, owls, and hawks also suggests that the H5N1 infections are widespread and have reached a critical mass. ] Culling plans, based on limited confirmations due to limited testing, have targeted 2,000,000 birds, but will likely grow larger as more suspect poultry samples are tested. The excessive poultry deaths suggest H5N1 has spread across the entire West Bengal region.
West Bengal testing has been lagging, and rapid tests have generated false negatives. India has yet to confirm a human case, in part because of minimal testing.
Dr. Paul A. Offit, a vaccine specialist at Children’s Hospital in Philadelphia, was one of those who, he jokes, “dared to be stupid” by bucking the alarmist trend in 2005.
“H5 viruses have been around for 100 years and never caused a pandemic and probably never will,” he said.
The above comments ignore the well documented evolution of the H5N1 with pandemic potential which is clearly at odds with the above statements. Although everyone has a right to “be stupid”, the comments on pandemic potential are at odds with the facts.
H5N1 evolution is clear in the sequence changes of various H5 isolates collected over the years. The first H5N1 was found about 50 years ago, in a chicken in Scotland in 1959. However, that H5N1 was really a “European” sequence, and quite distinct from the H5N1 which was first reported in Asia in 1996. Low path H5 has been circulating worldwide, but those strains tend to cause problems in poultry when they acquire a polybasic cleavage site through non-homologous recombination. However, such high path variants have caused problems for poultry, but have not have been isolated from humans or other mammals.
The H5N1 of concern was not reported prior to 1996, when it was found in a goose in Guangdong province in China. The following year, it caused a human outbreak in Hong Kong, which led to infections of 16 people, including 6 fatal infections. The WHO official count of fatal human infections by bird flu is 220. 219 of the 220 were due to H5N1. Thus, H5N1 has a lethality and pandemic potential not seen in other bird flu serotypes.
Although the first recorded fatalities were in 1997/1998, there were no further reported fatalities until 2003. Thus, of the 219 H5N1 reported fatalities, 213 of them have been since 2003.
The pandemic potential of H5N1 can also be seen in the recent spread and evolution of H5N1. In 2004, H5N1 exploded out of China, resulting in the first human cases in Vietnam and Thailand, as well as poultry outbreaks in most countries to the east of China. Human cases were reported in 2005 in Indonesia, multiple provinces in mainland China, and Cambodia.
In 2005 H5N1 was also detected in long range migratory birds at Qingahi Lake, China, which led to an expansion into 50 countries west of China. None of these countries had reported “Asian” H5N1 prior to 2005 and all subsequent human, mammal, and bird infections were the Qinghai strain of H5N1. The Qinghai strain led to human fatalities in Turkey, Iraq, Azerbaijan, and Egypt in 2006 and Nigeria and Pakistan in 2007. The Qinghai strain is distinct from the Fujian strain, which has caused the deaths in China and more recently in southeast Asia. Both strains are distinct from the strain causing the fatal infections in Indonesia.
In 2007 the Qinghai strain in Europe was replaced by the Uva Lake strain, a Qinghai Lake variant. It is likely responsible for the confirmed cases in Pakistan, and the current outbreak in India (as well as poultry infections in Europe since the summer of 2007).
Thus, the evolution of H5N1 into a human killer with a markedly expanded geographic reach has developed in the past few years, not the 100 years cited above. Moreover, the recent trend has been quite clear and although there was somewhat of a lull in 2007 when the Qinghai strain was being replaced by the Uva Lake strain, this strain caused the longest H5N1 sustained transmission chain reported to date (in Pakistan).
The recent activity, especially in West Bengal, India, signals more significant evolution and pandemic potential in the upcoming weeks.
Recombinomics Commentary 13:38 January 22, 2008 "Bird flu is now everywhere. Every day we have reports of birds dying in farms," said leading poultry expert and the treasurer of Bangladesh Poultry Association M M Khan.
"Things are now very serious and public health is under danger. The government is trying to suppress the whole scenario," Khan said, adding that farmers were also holding back from reporting cases.
The comments came after the government reported a series of outbreaks of the deadly H5N1 strain of bird flu last week in several southern and northern districts of the country.
"The situation is far worse than before. There were huge outbreaks in the past weeks and the disease is now more widespread than before," an expert at an international agency said, speaking on condition of anonymity.
The above comments suggest that the dramatic spread of H5N1 in West Bengal has been accompanied by spread in Bangladesh also. Last week several outbreaks were reported, but reported H5N1 in West Bengal has been much higher (see satellite map), even though much of the recent spread has not been confirmed because of limited testing.
Similarly, earlier reports of H5N1 in cullers in India have been denied, with comments suggesting that the patients tested did not have the reported pneumonia and did not have clinical criteria for bird flu.
In West Bengal, projected culling has been increased to 2,000,000, but the lag in testing suggests the numbers will continue to rise.