Monday, January 02, 2006

China's sharing problem and puzzling new case

To no one's surprise (at least not to mine), China is still behaving badly. WHO has complained again it is not sharing virus samples from their poultry outbreaks. These samples provide important information about the evolution of the virus. At the same time WHO is taking pains to say it sees no evidence of a SARS-style cover-up. But cover-ups are invisible if they are truly cover-ups. And China's behavior gives reason for continued suspicion.

WHO has also voiced concern that small, undetected outbreaks may be occurring. "May" be occurring? I think it is obvious they are. This took on new significance with the death of 41 year old factory worker in southeast Fujian province. No outbreaks were reported in the area and the patient had no history of contact with any poultry, and according to her family, had no visitors prior to becoming ill, and rarely ate meat. The area's poultry had all been vaccinated, according to the Chinese, and no infected birds have been found in the vicinity. It is reported that people who had close contact with the victim have "tested negative" but what tests were conducted isn't stated. The patient became ill enough to seek medical attention on December 6 and was hospitalized on December 8. She was tested for H5N1 on December 13 by the Fujian Provincial Center for Disease Control and Prevention (CDC) and the test was negative. But further tests were done (no details as to what tests or how long after) that revealed she was infected with H5N1. This raises the question of the nature and accuracy of the tests done on this patient's contacts.

The first human cases in the current Asian outbreak of H5N1, which began in 2003, were a family of three, two of whom had just returned to Hong Kong from a visit in Fujian province. A young daughter died during the Fujian visit and diagnosis could not be confirmed. The father and son took ill upon return to Hong Kong. The father died, the son survived (summary here). The current case is the first reported case from Fujian since that time, but there is strong suspicion the disease has been endemic in the province at least since 2003 and probably before.

Which brings us back to the problem of China not sharing virus samples. As Moderator CP noted on ProMed, it would be of great interest to compare the Hong Kong samples and the latest Fujian samples, both for sequence information and biology (virulence, host range, transmissibility, etc.). For the latter, only the samples will suffice.

WHO has yet to decide if it will send a mission to Fujian. If it does do so, the extent of Chinese cooperation will be an important test. But WHO will have to push harder and if it fails to get what it wants, it will have to say so publicly. That they are doing so with respect to virus samples is a hopeful sign. We wonder what other difficulties it has faced with Chinese authorities it has not disclosed.