Tuesday, January 31, 2006

Nature's terrorist now in Iraq

We have gone from no cases of bird flu in Iraq to a probable three, overnight. Two were the Uncle and niece first reported last week and the week before but denied by the Iraqis as bird flu even though clinically this was the obvious diagnosis. Now we learn a 54 year old woman was hospitalized almost two weeks ago as well with severe respiratory problems and remains under treatment. She comes from the same area as the other two fatal cases. (Reuters Alertnet)

The death of the uncle ten days after his niece suggests human to human transmission, although other explanations are possible. We don't know the dates of onset of the illnesses, whether there was contact or whether the uncle was exposed to diseased poultry.

None of this is a surprise. The village where these cases occurred is near the Turkish border and even closer to the Iranian border. It is remote but near a known focus of H5N1 poultry infection. Spread of H5N1 to Iran, Iraq, Azerbaijan and surrounding areas is a given. Already Turkish Cyprus has reported the infection in birds. Next step is the Greek side and then Greece itself. But Iraq is a special case, politically and epidemiologically because of the presence of 160,000 foreign occupying troops and constant warfare:
Battered by rampant violence and political instability, a new threat in Iraq was confirmed Monday - the first case of the deadly bird flu virus in the Middle East.

A 15-year-old Kurdish girl who died this month had the deadly H5N1 strain, Iraq and U.N. health officials said. The discovery prompted a large-scale slaughter of domestic birds in the northern area where the teen died as the World Health Organization formed an emergency team to try to contain the disease's spread.

"We regretfully announce that the first case of bird flu has appeared in Iraq," Iraqi Health Minister Abdel Mutalib Mohammed told reporters. "The results show infection with the deadly H5N1."

World Health Organization officials confirmed the finding, though it was not immediately clear how the girl, Shangen Abdul Qader, who died Jan. 17 in the northern Kurdish town of Raniya, contracted the disease.

The prospect of a bird flu outbreak in Iraq is alarming because the country is gripped by armed insurgency and lacks the resources of other governments in the region. Government institutions, however, are most effective in the Kurdish-run area of the north where the girl lived. (AP)
While Turkey was able to take vigorous measures to contain the disease, Iraq may not be in such a favorable position. As in Turkey, the disease first appeared in humans, not birds, suggesting either a change in its behavior or (more likely) that widespread disease in birds has gone undetected for some time.
The confirmation of the cause of the girl's death also suggests, officials said, that the disease may be spreading widely — and undetected — among birds in the countries of central Asia, which are poorly equipped to identify and report infections. Avian flu has never been reported in birds in Iraq.

As happened in Turkey earlier this month, the spread of the H5N1 strain of bird flu to a new part of the world became evident only through a human death. That is notable, and alarming to health officials, because bird flu rarely infects humans, and usually does so late in the course of an animal outbreak, after close contact with sick birds.

"We shouldn't be seeing human cases first, and this points to serious gaps in surveillance," a spokeswoman for the World Health Organization, Maria Cheng, said in Geneva. "But given the situation in Turkey, I don't think we'd be surprised to see isolated humans cases in surrounding areas."


[Juan Lubroth of the UN Food and Agriculture Organization], who is studying the spread of avian influenza, said that monitoring to detect the disease in animals was weak in much of the region and that governments needed to be more transparent — both in acknowledging outbreaks and in admitting when they lacked the capacity or money to detect the disease, which requires complicated laboratory testing.

For example, Dr. Rod Kennard, who is managing a year-old United Nations project to rebuild veterinary services in Iraq, said that the local government in Sulaimaniyah was monitoring commercial poultry flocks, "but they don't really have the ability to monitor what's going on in village flocks."

He said that "it is a really big question" whether a country in the throes of armed conflict could coordinate a response to a complicated problem like bird flu, although he noted that northern provinces were generally "not as troubled" as some of the areas in Central Iraq.


In October, there were large-scale deaths on commercial farms in northern Iraq, Dr. Kennard said. Birds were tested and "we were told it was negative," he said, "but we're not entirely sure how reliable that is."

In most countries with serious bird flu outbreaks, including Turkey, the military has provided the manpower required to contain them, going door-to-door to find chickens to cull. That is not an option in Iraq. (Elizabeth Rosenthal, New York Times)
The preliminary diagnosis of H5N1 was made by the U.S. Navy Medical Research Unit laboratory in Cairo, Egypt. There seems to be little room for doubt here.

Today, the US made its first acknowledgement of the situation, "offering help."
The United States has offered assistance to Iraqi authorities to help deal with the outbreak, while a World Health Organization team of epidemiologists and clinicians was expected to arrive later in the week to start tests.

"We are working with the government of Iraq and the World Health Organization to ensure that the necessary support for diagnosis and treatment of avian influenza is available as needed," U.S. Embassy spokeswoman Sylvia Blackwood said. (Newsday)
The US is already stopping support for rstoration of water, electricity and other infrastructure destroyed in the invasion. Will occupation authorities, who have made so many other errors, understand support for controlling this disease is a top priority?

Or is the switch from killing people to killing chickens just too big a leap?