[Kabar-indonesia] NYT: Mystery Deepens on Possible Avian Flu Case in China in 2003

[Joyo at aol.com]

also: NYT: Human-to-Human Infection by Bird Flu Virus
Is Confirmed

The New York Times 
June 24, 2006

Mystery Deepens on Possible Avian Flu Case in China in
2003

By DONALD G. McNEIL Jr.

Did China have a death from avian flu two years before
it admitted having any human cases?

The mystery deepened yesterday, and the possibility
was raised that someone had tried to block publication
of that event from a prestigious American medical
journal.

The New England Journal of Medicine reversed an
announcement it had made two days before, saying the
eight Chinese authors of a letter describing a man's
death in 2003 from avian flu had insisted that they
really did want it printed.

The timing of the death is important because
scientists believe that the A(H5N1) avian flu virus
had percolated in China's chickens for many years, but
it was not until last November that the government
admitted to having a human case; it has officially
reported 19 cases and 12 deaths. In 2003, China
covered up dozens of SARS deaths for months after the
epidemic began there.

The journal had gone to press on Wednesday when the
editors received several e-mail messages asking that
the letter describing the 2003 death not be printed.
One appeared to come from the e-mail address of the
letter's chief author, Dr. Wu-Chun Cao, of the State
Key Laboratory of Pathogens and Biosecurity.

Yesterday, the journal's editors said that they had
reached Dr. Cao, and that he had denied sending that
e-mail message. At their request, they said, he faxed
a signed statement saying he stood by what he and his
co-authors had written. However, Sandra Jacobs, a
journal spokeswoman, said it had no earlier examples
of his signature for comparison.

The editor who spoke to Dr. Cao, she said, did not
want to disclose whether he knew why or how an e-mail
message had been forged. Dr. Cao did not respond to
e-mail messages from The New York Times.

The letter said that doctors initially thought the
24-year-old man had SARS, but tests on his lung tissue
proved negative. It did not say when the flu tests
were done, and it did not note the discrepancy between
the date of his death and China's tally.

It did detail the genetics of the virus found, saying
different portions resembled A(H5N1) viruses found in
2004 in three regions of China and one region in
Japan, and concluding that the virus that killed him
was a mixed virus, and different from others found in
humans. This could complicate efforts to make a
vaccine, it noted. The World Health Organization's
China office has asked the government to explain the
discrepancy.

Liu Pengyu, a consul in the press office of the
Chinese Consulate in New York, said yesterday that he
knew nothing about the study, but did not believe his
government would try to cover up an earlier death from
avian flu. Pointing out that it had been widely
criticized for concealing its SARS epidemic, he said:
"Our prime minister takes a very serious stance on
these issues. We don't think there is anything to
hide."

-----------------------------------------------------------

The New York Times 
June 24, 2006

Human-to-Human Infection by Bird Flu Virus Is
Confirmed

By ELISABETH ROSENTHAL

ROME, June 23 — An Indonesian who died after catching
the A(H5N1) bird flu virus from his 10-year-old son
represents the first confirmed case of human-to-human
transmission of the disease, a World Health
Organization investigation of an unusual family
cluster has concluded, the agency said Friday.

The W.H.O. investigators also discovered that the
virus had mutated slightly when the son had the
disease, although not in any way that would allow the
virus to pass more readily among people.

"Yes, it is slightly altered, but in a way that
viruses commonly mutate," said Dick Thompson, a
spokesman for the agency in Geneva. "But that didn't
make it more transmissible or cause more severe
disease."

The greater importance of the slightly modified virus
is that it allowed researchers from the W.H.O. and the
Centers for Disease Control and Prevention in the
United States to document that the virus almost
certainly was passed from person to person.

In previous cases where human-to-human transmission
was suspected, researchers could not test samples from
the patients, or the virus in the patients was the
same as that in poultry in the area.

The genetics work vindicates some Internet flu
watchers who had disputed statements by a W.H.O.
official and the Indonesian Health Ministry soon after
the cluster was reported, saying it was possible the
whole family had been infected by a barbecued pig,
poultry or chicken manure.

The independent flu watchers, relying on local
Indonesian news media, had argued that the pattern of
dates on which different family members fell ill
suggested that the virus had jumped from human to
human to human.

Scientists have long said the A(H5N1) virus, which has
killed or led to the culling of hundreds of millions
of birds worldwide, does not spread easily to humans
or among them. But they have worried that it might
mutate to acquire that ability, setting off a
devastating pandemic.

More than 200 people have contracted bird flu
worldwide, almost all of them after very close contact
with infected birds.

International health officials have been in Indonesia
for much of the past month, investigating a family
outbreak that affected seven relatives in Kubu
Sembilang, a remote village in the mountainous Karo
district of Sumatra. Six of the seven died, and one is
still hospitalized.

Although Indonesia has been struggling all year to
control bird flu outbreaks among poultry, the family
on Sumatra had no known direct contact with sick
birds, although the first to die was a woman who sold
vegetables in a market that also sold birds.

But scientists have long suspected that A(H5N1),
though an avian virus, could also spread between
people in rare cases, if there was prolonged close
contact.

The family members in the cluster had a banquet in
late April when the vegetable merchant was already ill
and coughing heavily. Some spent the night in the same
room with her, and some nursed sick relatives.

The first five family members to fall ill had
identical strains of A(H5N1), one found in animals in
Indonesia. But that virus had mutated slightly in the
sixth victim, a child, and he apparently passed the
mutated virus to his father, who cared for him in a
hospital without proper protection, said Dr. Tim
Uyeki, an American epidemiologist on the W.H.O. team.

Still, Mr. Thompson said there was no evidence that
the mutated virus was better adapted to human
infection. To the contrary, the agency has been
following 54 relatives and neighbors for a month and
none have caught it.

"So we know it is not more easily transmitted," he
said.

Donald G. McNeil Jr. contributed reporting from New
York for this article.

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Joyo Indonesia News Service
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