Time to Know the Truth
Is the threat of bird flu in humans increasing or decreasing? How great is the threat anyway? It seems impossible to know.
Layers of uncertainty
First, there is the kind of uncertainty that is inherent in the molecular events of virus behavior -- how its many variants are sorted by their ability to survive and spread in different environments and hosts. Much of this uncertainty may not be reducible.
Then there is uncertainty due to the absence of an international public health system that can dependably spot-check for bird flu, recognize outbreaks early on, gather and analyze virus samples reliably, and correctly determine when and where a genetic change has occurred.
Add to that the utterly unnecessary uncertainty that is a result of information being withheld and slanted reporting, especially of information on the genetic sequences of H5N1 virus samples.
“To understand the genetics, and link this to the epidemiology and pathology of the virus, we need immediate sharing of all virus samples and data. None of this is happening adequately. National governments’ performance is half-hearted, incomplete and far too slow. International organizations are working with their hands tied behind their backs, for bureaucratic and diplomatic reasons. In short, the level of current efforts is not commensurate with the threat we face.”[1]
A recent example - H5N1 in Indonesia
Several stories in the press suggest that the World Health Organization (WHO) now acknowledges likely human-to-human transmission in the recent Sumatra cluster in which seven of eight H5N1-infected family members died.[2] Apparently these stories are based on a leaked report that was distributed at a closed-door meeting in Jakarta.[3]
So far, there is no good explanation of what caused the Sumatra cluster. A knowledgeable blogger cites rumors that the cases in this cluster had unusually high viral loads in the throat and nose.[4] If true, this would suggest that some H5N1 virus strains have become more transmissible among humans.
Confirming evidence?
Possible confirming research was mentioned in an interview with Dr. C. A. Nidom, a well-known virologist in Surabaya, Indonesia.[5],[6] He had succeeded in culturing H5N1 from 20 samples taken from poultry, swine, and humans, and found that 11 of the 20 virus isolates were able to attach to cell receptors in the upper respiratory tract of humans. This would enable the virus to spread much more easily than from the lower respiratory tract, which was thought to be the place where H5N1 infected humans.
Three of the 11 virus isolates also had a mutation in the PB2 gene that allows the virus to replicate at the lower temperatures prevailing in the upper human respiratory tract. These two characteristics would make the H5N1 virus far more dangerous than previously believed and help explain the Sumatra cluster.
A late admission
After statements that there was no mutation in the Sumatra H5N1 strain, other official statements that there was a mutation, but that it was “insignificant,” a WHO official is now quoted as saying, “We have seen a genetic change that confirms in a laboratory that the virus has moved from one human to another. . . . It doesn't mean it's more dangerous, that it transmits more easily or anything like that.”[7]
That judgment would make me more comfortable if it were the product of open scientific inquiry. Without knowledge of the complete sequence information for the viruses isolated from the cluster, we do not know how dangerous the virus may have become.
What needs to be done?
It is vitally important to all of us that the genetic sequence information of all H5N1 virus isolates become publicly available -- immediately![8] Right now, such information is “usually either restricted by governments or kept private within an old-boy network of researchers linked to the WHO, the U.S. Centers for Disease Control (CDC), and the FAO.”[9]
Dr. Ilaria Capua’s collaboration
“The Asian HPAI H5N1 virus is spreading very quickly. Real-time availability of genetic information is now possible and is essential for timely monitoring of viral evolution.” (Capua et al. 2006)[10]
Acting on the recognition that we need information on how the virus spreads across and within continents, a group of veterinary virologists, led by Dr. Capua, has established a collaboration for publishing genetic information on the highly pathogenic version of the H5N1 virus. Participating researchers will make samples of HP H5N1 available for genetic sequencing and for placing the full genetic sequences in GenBank.[11]
What you can do
Dr. Henry Niman has posted a petition, addressed to WHO, CDC, St. Jude's, Weybridge, Mt. Sinai, the U.S. Congress, and other national governments, asking all flu scientists who have not yet released H5N1 sequence data to deposit them immediately in GenBank. You can find the petition at: http://www.petitiononline.com/h5n12006/petition.html.
Please read it and, if you agree, sign the petition!
[4] Declan Butler at http://declanbutler.info/blog/?p=41
[6] Translations and various commentaries on the interview with Dr, Nidom can be found at http://www.fluwikie2.com/pmwiki.php?n=Forum.H5N1ReceptorBindingDomainDiscrepancy
[8] See Blog 7: Free the sequences! 7 April 2006
[10] Capua I, Brown I, Johnson M, Senne D, Swayne D.
Veterinary virologists share avian flu data.
Science. 2006 Jun 16;312(5780):1597.
[11] http://www.ncbi.nlm.nih.gov/Genbank/
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