Web Exclusive: Worlds apart on H5N1

Just 48 hours after confirmation of H5N1, the sub-type of highly pathogenic avian influenza (HPAI) in United Kingdom (UK) poultry on 13 November 2007, more than one thousand related items had appeared on the worldwide web. Indonesia simultaneously announced its 113th human case and 91st fatality – a 31-year-old man from Riau province on Sumatra – from the same virus sub-type. The disease had been ‘picking off’ people with increasing regularity in Indonesia. The victim’s wife looks like the 114th case.

H5N1 is endemic right across Indonesia and the government has virtually ceased to notice, let alone identify, record and report H5N1 in poultry. Most human cases there are announced with the same fatalistic phrase, ‘The patient/victim had no previous contact with sick or dead fowl’.

Indonesia has not reported a single outbreak in poultry since September 2006. Its last report logged with World Organisation for Animal Health (OIE) was for July to September 2006 and covered outbreaks in Sulawesi and Irian Jaya. There was no mention of infected poultry in Java or Sumatra where almost all human cases and fatalities have occurred. Since the start of 2007, there have been 38 human cases in Indonesia, of which 33 have been fatal.

Virologists, veterinarians and doctors around the world remain concerned about mutation and genetic re-assortment that could spark a human H5N1 pandemic. The poultry industry is clearly worried about loss of stock, but the public at large – especially in the West – are more concerned about the human dimension. This is why an isolated outbreak in eastern England generates so much media interest.

Given the extent of modern international travel any potential effect of isolated European outbreaks in poultry on a potential human pandemic is largely academic. There is a ‘time bomb’ is ticking away in Indonesia where the H5N1 is endemic and the authorities appear to have been defeated by the virus in poultry is concerned.