Tuesday, March 29, 2005

Haiphong and North Korea

We have made a conscious decision not to chase every case report or bird flu event on this site but instead to summarize every few days, with any appropriate observations (other than "Holy Shit!"). We do this now with the Haiphong cases and the North Korean poultry outbreak.


Simultaneous infection with H5N1 influenza of five members of one family in northern Haiphong has now been confirmed by health officials there:
Initial tests showed the H5N1 virus was present in samples taken from a 35-year-old man, his 32-year-old wife and their three daughters, aged 10 years, 4 years, and 4 months, said Nguyen Van Vy, director of Haiphong Health Department.
The five family members were admitted to the hospital on March 22 (one week ago) with fever and shortness of breath. The family raised about 400 chickens. A month ago the birds began to die and the family ate some of them. Today XinhuaNet reported a 41 year old woman who lives "near" the family was admitted to the hospital with suspicion of H5N1 infection. Niman at Recombinomics reports two other "neighbors," a 41 year old male and a child (or perhaps a 35 year old woman, a 41 year old male and a child). There is no information if there was any actual contact in any of these instances.

Exactly how many people are involved in addition to the family, whether they all have H5N1, and their condition is unclear at this point, as is what all this means. Niman's interpreation is that it is evidence of suddenly increased transmission efficiency (from birds to humans). He may very well be right and this is an obvious interpretation. Others might be some unusual host factor among the family, an unusually heavy exposure of some sort, or (less likely) a common exposure other than the family's chickens. The significance of the "neighbors" is also unclear at this time.

What is clear is that H5N1 infection is entrenched in local poultry, has not been eliminated and continues to be transmitted to humans. Whether this witch's brew is simmering or starting to boil over is not obvious. One could defensibly see it either way. But it is indefensible to act as if it is not boiling over. The costs of an error are too great. But that is what we continue to do.

North Korea

As long as two weeks ago there were rumors that North Korea had an avian influenza outbreak (emphatically denied at the time), but not until Sunday did North Korea admit it had avian influenza virus at "two or three poultry farms" in Pyongyang and had destroyed hundreds of thousands of chickens. The nature and scope are still unclear, however. In particular, WHO's Delhi office still is unsure if this is an H5, H7 or H9 (or some other?) strain and how widespread the outbreak is. Scattered reports say the infection has spread to rural areas and poultry was not being sold in the markets, a blow to North Korea's poorly fed population. (AFP via Turkish Press and New Zealand TV)

We now learn that WHO was in touch with Pyongyang well before the rumors surfaced to offer assistance in preparing for human cases of avian flu. At this point, however, the lead UN agency is FAO. No human cases have been reported but no one trusts the North Koreans. An Editorial in South Korea's Joong Ang Daily believes the public admission is evidence that the damage "must be colossal." North Korea's lack of credibility and the perilous nutritional state of the population is spawning rumors that "North Korean citizens are digging up dead poultry and selling it on the market." These rumors have not been verified. However it has been known that the country has been trying to expand its poultry industry since 2001 in an effort to increase sources of protein to the population and this has resulted in "scores" of "poultry factories" in the country.

Now South Korean intelligence sources are being cited as believing that the cancellation of the regular session of the Supreme People's Assembly, that had been scheduled for March 9, was postponed because of fears of an avian flu epidemic (Joong Ang Daily):
"With more than 600 delegates from all over the country supposed to gather in Pyongyang for the legislative meeting, there was concern the disease would spread uncontrollably," the [South Korean] Unification Ministry source said. In connection with the Supreme People's Assembly session, North Korean officials usually tour poultry farms, other cooperatives and power plants in and around Pyongyang.
Even more interesting was the report in the same paper that South Korea was aware of the outbreak sometime before rumors surfaced and had imposed secret quarantine measures.
Following the indications that North Korea was facing a bird flu outbreak, Seoul quietly began quarantine measures. The 400,000 tons of chicken meat, scheduled to be imported from the North on March 11, was stopped, and incoming travelers from the Kaesong industrial complex and the Mount Kumgang resort were given thorough health checks at the border.

"Because the North would possibly get upset, we had to carry out the measures secretly," Rhee Bong-jo, vice minister of unification, said.
This is just one more example of the complex interaction between politics, social conditions and the natural environment. Fortunately most of the time the stars don't line up just right. But sometimes they do.