Saturday, January 07, 2006

Turkey at this point

After initially denying the illnesses of five children and one adult were bird flu, the Turkish government is now eager for international assistance. The area in eastern Turkey where the cases occurred is Kurdish, complicating matters, and many in the area don't speak Turkish, making educational efforts about poultry hygiene more difficult. AP reports that 5000 "boxes" of Tamiflu have been sent to the area along with five ventilators for the hospital there (via The Star).

WHO and the European Commission have both sent teams of experts, and WHO's spokesperson, who usually downplays flu issues expresses more concern than usual:
"I'm not sure we've seen a cluster like this in terms of numbers, and certainly it's a concern," said Maria Cheng, spokeswoman for the Division of Epidemic Preparedness at the World Health Organization. "Is the virus being transmitted more easily from birds to humans, or even from humans to humans? We need to put all the pieces together before we can come to conclusions." (New York Times)
As usual, some of the best reporting comes from Canadian Press's Helen Branswell, whose contacts are among the best and most reliable and who has the journalistic judgment to match:
Three cases — a 14-year-old Turkish boy who died Sunday, a sister, 15, who died Thursday, and another sister, 11, who died Friday — have been added to the WHO’s list of confirmed H5N1 cases [NB correction: third sib not yet confirmed by WHO (1/7/06); 3rd confirmed case is unrelated child]. At least eight other children from the same and nearby families have been hospitalized and are under investigation.
Some relatives of the dead children are in serious condition, on mechanical ventilators. And a doctor from the hospital where the suspect cases are being treated called in a local television interview for more ventilators to be sent to the region.

Dr. Scott Dowell finds the suggestion that several suspected cases may require mechanical help to breathe a worrisome sign.

Dowell, director of global disease detection and preparedness at the U.S. Centers for Disease Control, studied family clusters of H5N1 human flu cases last year, reporting on 15 such groupings from December 2003 through July 2005.

"There have certainly been clusters, there’ve been family clusters before," he said from Atlanta.

"But to have a number of people on ventilators at the same time from a similar exposure, that would say ‘That looks like something is a little bit different from what’s happened before.’"

The largest of the clusters Dowell and his co-authors reported on contained five members of one Vietnamese family. Most were groups of two or three family members.


As of Thursday, the WHO has confirmed 144 human cases of H5N1 avian flu in six countries: Thailand, Vietnam, Cambodia, Indonesia, China and Turkey. Of those, 76 have died. (Branswell via The Chronicle Herald, Canada)
The big question is whether the Turkish cases signal a significant change in the epidemiologic behavior of the virus, specifically, whether mutations have occurred that make bird to human transmission easier or, the worst case, human to human transmission. The urgent dispatch of international expertise to the area is an appropriate first step.

We hope that WHO and the EC recognize the importance of an open and transparent dissemination of the most accurate information they have at any moment. Despite the plausible fear that the release of incomplete information that may later change could lead to an increase in public anxiety, on the other side is the necessity for building public trust and credibility (eliminating the suspicion that important information is being withheld), the importance of having as much advance lead time for preparation in other localities as possible (preparation which would not be wasted if concern were ratcheted down, facts warranting), and the obvious but often ignored point that an information vacuum is quickly filled with non-facts which can be more harmful still.