Friday, August 18, 2006

Human to Human Transmission

Fantastic. I’m going to address some questions (or implied questions) from readers right away. Michele, Al – you raise some really important topics.

Al asks how many cases of human to human transmission there have been here. The answer is seven – sort of. Samples from Jones and six of his family members revealed they’d contracted a mutated version of the virus, which they caught from each other rather than directly from the chicken. Samples were not taken from an eighth victim, Jones sister, who was buried before investigators arrived in the district. She is generally included in this “Karo cluster” of cases, but only those who were tested are officially counted.

They are the only confirmed cases of human to human transmission in the world, and the mutated strain is considered to have died out with its last victim.

And yes, scientists are saying passage from family member to family member is not surprising, and may indicate a genetic disposition that matched that particular mutation.

I should add that the sickness spread during a family feast where other family members and outsiders were present. Jones wife and two children, for example, had close contact with the virus, but remained healthy – not even carriers.

I was at a conference on bird flu in Indonesia this summer when those results (from the WHO labs) were released. There was a lot of information at the time, and I have to admit the epidemiologists played down the presence of the mutation to such a degree that I missed the biggest news lead of the day. I eventually changed my story – not the facts, but the angle - based on other media reports. The AP has a very good reporter who is assigned to cover bird flu all over the globe, and she led with the mutation story. As I only had one story to file, I decided “Indonesia’s Bird Flu Reporting Network Needs Help” wasn’t as pressing.

Here’s the story I filed for VOA that day. NOTE: some of the information is outdated. The bird flu death toll in Indonesia, for example, is now 45, not 39.

The Karo mutation is not considered to be significant by WHO scientists, and I’m sure they were disappointed to see it was the lead in most media reports (even mine) coming out of that conference.

I asked Dr. Keiji Fukuda, co-ordinator of the WHO's global influenza program, if H5N1 would continue to produce different, more potent versions of itself.

His answer: “It’s a virus. That’s what viruses do.”

The Game of Risk

I’m very glad to see so many comments from around the world. It’s clear to me that there’s a lot of anxiety about the potential for a pandemic bird flu strain, and that there’s a lot of conflicting information. Media reports about the risk are certainly running hot and cold.

I’m afraid those temperatures are subject to the hokus-meteorology of news markets. The answer to the question “what’s the risk for a pandemic?” truly depends on who you ask. I’ve talked to a lot of experts, and there just isn’t a lot of agreement. Today I talked with a H5N1 advisor for the Food and Agriculture Organization – he downplayed the risk and called himself an optimist. Others are trying to support Indonesia’s case for more funding from international donors, so you can hear them playing up the risk. The country is dancing with the World Bank right now about…well…money. It’s a complicated and clumsy dance – one is doing the Cha-Cha and one is counting T-A-N-G-O.

I think I can’t really comment on the risk level, but I can say that Indonesia does not have its prevention program together. Vaccination, public education, and culling are really the only tools for mitigating the risk. As far as I can tell, none of those are working here.

I should reiterate that bird flu is still extremely hard for humans to get, and still seems to require prolonged, high risk exposure. There is a pandemic in birds, however, so exposure will continue.

There is an investigation right now into another possible case of human to human transmission. Today epidemiologists clarified that it’s not a ‘cluster’ they’re looking at – because the infections come from five different district in Java.

In any case, I’d like to make an appeal for more questions. I may be in a position to ask the right person as I continue reporting on the disease. There are obviously some people out there following media chatter on this, and I say we work together to figure out where the information gaps are.