14 February 2006

Over the course of one week from Feb 7-14 laboratory-proven H5N1 infection of animals was reported for the first time from five nations (Nigeria, Azerbaijan, Greece, Italy, and Bulgaria).  Initial results for H5N1, pending official confirmation in a second reference laboratory, were also reported from Slovenia, Austria, Germany, and Iran.  Fortunately, so far no human infections with H5N1 have been confirmed in any of these countries, although some persons are being tested for this H5N1 avian flu virus.

Nigeria is the first nation in Africa to have reported H5N1 outbreaks. Chickens were reported to be infected with this virus and a die-off of chickens in northern Nigeria began in mid-January, approximately one month previously. In a WHO update 13 February, posted on their website, it was stated that “Occurrence of the bird flu has so far been confirmed in poultry in the three northern states of Kaduna, Kano and Plateau. Unconfirmed cases, also in poultry, have however been reported in Yobe, Nassarawa and Jigwa states as well as in the Federal Capital Territory—all in the north of the country”. The WHO has sent a team of experts to Nigeria to work as partners with the Nigerian team already in place. 

Most of the other H5N1 outbreaks reported in the past week do not involve poultry at this time. Instead, birds and particularly swans have been found to be infected with the H5N1 avian flu virus. Predictably, there will likely be more nations, from Europe to the Middle East, Asia to Africa that will report additional H5N1 avian outbreaks in the weeks ahead.

Key lessons learned from the past 25 months of outbreaks of H5N1 must routinely be applied to these and future outbreaks. Such lessons include educating young persons and adults to avoid close contact with ill or dead poultry, and testing and rapidly treating patients with such exposure to poultry for H5N1 virus infection.

One can reasonably anticipate that when the next human pandemic of influenza occurs, whether directly related to the H5N1 virus or not, that the nation-by-nation spread of the pandemic human flu virus will at some point be as rapid as the avian outbreaks of H5N1 have been in the past week.  If we are not much better prepared for the next human pandemic of influenza than we are today, then eventually the survivors will have investigations and commissions that will try to examine why we did not use the time we have now to prepare better for the pandemic.

Daniel R. Lucey, MD, MPH

Director, Centre for Biologic Counterterrorism and Emerging Diseases

ER One Institutes, Washington Hospital Center

Co-Director, Master of Science Program in Biohazardous Threat Agents and

Emerging Infectious Diseases

Georgetown University School of Medicine, Washington, DC

Website: www.BePast.org; cell #: 202-299-4398