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The death toll continues to rise in the recent outbreak of the mysterious disease in China’s Sichuan province, with 32 people dead and 152 showing signs of the illness, state-controlled media reported.
Sichuan health officials say that neither the feared H5N1 bird flu virus, nor Severe Acute Respiratory Syndrome (SARS), is causing the deaths. They say that the illness, which has spread to over 100 villages, 40 townships and seven cities, with one possible case as far away as Guangdong province, is caused by the pig bacterium Streptococcus suis.
However, conflicting assessments from experts have cast doubt on this claim, and have highlighted the need for transparency in China’s disease monitoring system.
"It could be another disease altogether, it need not be Streptococcus suis because the presentation is so atypical," Samson Wong, microbiology associate professor at the University of Hong Kong, told Reuters.
Both Promedmail.org and Recombinomics.com, websites that closely track infectious diseases, also suggest that a swine bacterium is an unlikely cause. They say the reported symptoms, the widespread geography of those affected, the speed the disease has spread, and the past sporadic (as opposed to “outbreak”) incidence of Streptococcus suis, all point to another cause, likely a virus.
Promedmail.org, hosted by the International Society for Infectious Diseases, states that the symptoms as described by Chinese officials do not appear to resemble bird flu.
However, the symptoms described do not appear to resemble the Streptococcus suis, either. Experts note that the bleeding under the skin seen in the Sichuan victims is extremely rare in Streptococcus suis, while deafness, a common symptom in the past, has not been documented here.
Verification is difficult because the Chinese authorities have not yet allowed any independent analysis of the Sichuan pathogen.
"We'd like to see more of that gold standard proof (laboratory tests)," Asia-Pacific WHO spokesman Bob Dietz told Reuters, adding that co-infection by other pathogens needs to be checked for as well.
The lack of information has some pondering the worst. Unconfirmed reports from China on Boxun.com (“Abundant News” in English) describe symptoms with remarkable similarities to some from the 1918 flu pandemic. Posts on the website also suggest the disease could be strain of Ebola.
According to Dr. Henry Niman, president of the Recombinomics predictive viral change research centre, a strain of Ebola has exchanged genetic material with H5N1 in the past. It is possible, however unlikely, that a new strain of either disease could emerge.
Boxun, while claiming no definitive information, hopes that its posts will inspire further inquiry.
Independent Verification Needed
Experience shows such investigation is necessary. The Chinese government’s cover-up of SARS in 2002-03 allowed the disease to grow out of control. SARS went on to kill at least 800 worldwide and made 8,000 others sick. News of SARS came to light only when first-hand accounts appeared on Boxun and the Epoch Times Chinese web site.
Experts are pushing for independent isolation and identification of the Sichuan pathogen(s), but so far have not been able to do either.
The same closed door has been encountered in investigating recent instances of H5N1 in wild bird populations at Qinghai Lake Nature Reserve, west of Sichuan, as well as in nearby Xinjiang.
Neither the raw data nor the samples required to do a credible genetic assessment have been made available, to the WHO or to any other independent institution. WHO investigators have also been denied access to the Xinjiang site altogether.
Patchy Information, State Clampdowns on Research and Reporting
Other reports suggest there could be more going on. In a visit to the H5N1 outbreak zone, Qinghai Reserve, in June, WHO researchers found 5000 dead migratory birds. Chinese state media had acknowledged the death of only 1000. Casualties were continuing at a rate of 20 per day.
Meanwhile, Boxun.com reported 121 human deaths in nearby Gangca County, as well as a corresponding military quarantine. These claims were denied by Chinese state media. Few further details emerged on Boxun, although a June 5 brief noted that the reporters who published the earlier news had been arrested.
Dr. Yi Guan, a H5N1 researcher at Hong Kong University, was permitted to analyze genetic samples from avian flu-stricken birds and published his findings in Nature on May 25. He and others describe strong similarities between the viral genes found in wild birds in western China, and the H5N1 in affected poultry farms found earlier in southern China. They also discovered that the Qinghai geese contained "virulence genes" that had a 100 percent mortality rates in both chickens and mice in the lab.
The study further concluded that there was a “…danger that H5N1 might be carried along the birds' winter migration routes to densely populated areas in the south Asia subcontinent, a region that seems free of this virus, and spread along migratory flyways linked to Europe.”
A day after the article was published, director general of the Chinese Ministry of Agriculture's Veterinary Bureau, Jia Youling, criticized the findings and denied the existence of any bird flu outbreak in southern China. Four days later, the Joint Influenza Research Center, where Yi conducted the bird flu study, was ordered to immediately cease H5N1 research. State-controlled media in China reported that this was because the lab lacked “the basic conditions for biological safety,” a claim vigorously denied by the center.
Risk of Bird Flu Pandemic
WHO places the risk assessment of a worldwide avian flu pandemic at three on a scale of six, indicating that human infections have occurred. Since the UN body must wait for official corroboration before any incident can be acknowledged, this rating could well understate the risk.
Dr. Niman says the WHO might also be wary of prematurely declaring a global pandemic after its experience with SARS.
"SARS has the potential to become a raging pandemic, but did not do so in 2003. Consequently there is concern about over-reacting as well as the difficulty of predicting precisely when a virus such as H5N1 will achieve efficient human-to-human transmission."
Niman, known for sometimes speculative commentary, has analyzed the apparent pattern of new outbreaks, which in his view are radiating outwards from Qinghai Reserve, presumably a result of bird migration. Within the range of the Qinghai birds are the other China H5N1 outbreak sites, as well as a location in Mongolia where 400 sheep reportedly died of a mystery illness in early June. If the culprit there was bird flu, then the array of H5N1 animal hosts now includes domestic and wild birds, pigs and sheep.
Bird Flu Documented in Russia, Japan, Southeast Asia
Also within range is Novosibirsk, Russia, where 1300 domestic fowl recently died due to a bird flu variant that Ministry of Agriculture officials say can infect humans. H5N1 has also surfaced last week on three poultry farms near Tokyo, Japan.
Recent human deaths are also part of the equation. According to AP, Avian Influenza has killed two more people this week in Vietnam, only days before mass poultry vaccinations were to be implemented. And, in Jakarta, Indonesia, the source of the H5N1 infections of three suburban family members that died in quick succession last month remains a mystery. Officials are concerned that human-to-human transmission may have occurred.
All this raises the question of whether the bird flu might already have turned pandemic in Asia.
On July 22, the WHO issued yet another warning that the coming avian influenza pandemic may be imminent. According to WHO figures, there have been 109 confirmed human cases of bird flu in Vietnam, Thailand, Cambodia and Indonesia resulting in 55 deaths. These figures put the death rate at a startling 50 percent.
Officially, China has reported no human cases of bird flu. With a lack of confirmed sources or verifiable scientific data from China, arguably the most significant and certainly the most disputed locality for H5N1 outbreak and mutation, outsiders can only guess at how far the disease has developed.
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