2006 Bird Flu Parallels With the 1918 Flu Pandemic

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2006 Bird Flu Parallels With The 1918 Flu Pandemic
Recombinomics Commentary
March 8, 2005

The seven people, all from southern Vietnam, didn't have clinical or epidemiological factors typical of previous bird-flu cases, the institute official said. One patient had tuberculosis.

Last month, the New England Journal of Medicine reported on one case dating back to February 2004 where the victim exhibited none of the classic respiratory symptoms associated with bird flu. Instead, Oxford University researchers said the four-year-old boy had suffered from encephalitis, or inflammation of the brain, before slipping into a coma. His case was only discovered months later after researchers found his samples among encephalitis victims.

Those findings suggested that avian influenza may be more widespread than originally believed because the total number of infections may have been underestimated.

In the 1918 flu pandemic many of the patients were misdiagnosed as having cholera, dengue fever, and typhoid. The recent false negatives on atypical patients in southern Vietnam raise significant monitoring issues. A repeat of the mistakes of 1918 is a definite concern.

Many of the index cases in familial clusters were not tested, and many other members initially tested negative, even though the suspicion level was high due to typical bird flu symptoms or prior poultry outbreaks in the region.

The suspicion level in the atypical cases is markedly lower. There has been a reluctance to H5N1 test unusual outbreaks of fatal disease, such as the meningococcemia cases in the Philippines.

Because pandemic vaccines have not been tested and anti-viral medicines such as Tamiflu are in short supply, WHO has announced a strategy of containment of bird flu through conventional contact tracing and quarantine, coupled with prophylactic treatment with Tamiflu.

However, the failure to monitor bird flu in Vietnam and Thailand, as well as neighboring countries, limits the effectiveness of such a strategy. The spread of H5N1 is poorly understood because of monitoring deficiencies, which are still scandalously poor

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