China had bird flu two years before it told the world

From CBC:

"(CP) - In an extraordinary turn of events, Chinese researchers have contradicted Beijing's official version of the country's H5N1 human infection timeline, revealing a Chinese man died of H5N1 avian flu fully two years before China reported its first human case to the World Health Organization in November 2005.

The eight researchers reported in a letter in Thursday's New England Journal of Medicine - a letter they attempted to withdraw Wednesday - on the genetic blueprint of H5N1 virus isolated from the man, who died in November 2003.

That case predates any of the 228 confirmed cases that have been reported to WHO since the current outbreak of H5N1 virus began in late 2003. Officially, the first human cases in this outbreak occurred in Vietnam in December of 2003.

Influenza experts outside China have long believed the country has hidden or missed human cases of H5N1. To date the country has reported 19 cases to the WHO; 12 of those people have died.

"They were just so noticeable by their absence," influenza virologist Earl Brown of the University of Ottawa said of China's contention through 2004 and most of 2005 that it had found no human cases of the often fatal disease.

A spokesperson for the WHO's China office said officials will be seeking answers from the Chinese Ministry of Health about the discrepancy.

"I think it's safe to say that we will be asking for more information on this in the wake of the publication of this letter by the eight scientists," Roy Wadia said from Beijing.

"We would certainly want much more information as to exactly what happened, who this case was, what the possible source of infection was, where he was infected, the treatment - all the standard questions.

"There is information that needs to be shed on this by the Ministry of Health and we will be asking for that."

Meanwhile editors of the New England Journal, one of the most prestigious scientific publications in the world, have questions of their own. They were caught totally off guard Wednesday when they received word the authors wished to withdraw their letter. No explanation was given.

Spokesperson Karen Pedersen said the journal was trying to reach the authors to ask for their rationale and explain that the request came too late. Though the journal's official release day is Thursday, it has been in the hands of first-class subscribers for days.

"The only option for them is to retract. But they have to do that. We can't do it for them," Pedersen said.

The worrisome H5N1 virus was first isolated from a goose in the southern Chinese province of Guangdong in 1996 and is believed to have spread widely throughout the country's vast expanses.

When country after country in Asia reported outbreaks in domestic poultry in late 2003 and early 2004, China maintained an official silence, insisting it was free of the virus.

"I think they were probably part of it (the outbreak) and they didn't look hard or they didn't tell us when they found stuff," Brown said.

The letter is signed by Dr. Qing-Yu Zhu, Dr. E-De Qin, Dr. Wei Wang, Jun Yu, Bo-Hua Liu, Yi Hu, Jian-Fei Hu and Dr. Wu-Chun Cao. The researchers are from a variety of well known Beijing-based scientific institutions, including 309th Hospital of the People's Liberation Army and the State Key Laboratory of Pathogens and Biosecurity.

Cao, the corresponding author, did not respond to an e-mail from The Canadian Press seeking an interview or additional information.

The eight wrote of the case of a 24-year-old man, apparently from Beijing, who had pneumonia and respiratory distress in November 2003. In that period, when the entire world was anxiously waiting to see if severe acute respiratory syndrome would re-emerge with the arrival of cold and flu season, doctors thought he was suffering from SARS.

The man tested negative for the SARS coronavirus. But H5N1 was found in tissue from his lungs. The letter does not state when the testing was done or how long it has been known that the man died from H5N1.

Nor does it make any reference to the fact that this case predates by two years the official version of when H5N1 cases first started occurring in China. Instead, it describes the molecular characteristics of the virus and compares them to earlier and later viruses.

Flu watchers aren't surprised that China had cases as early as 2003. In fact, outside China it has been widely assumed, given that three people from Hong Kong became infected with the virus during a visit to Fujian province in February 2003.

But those cases - only two were confirmed as one died without being tested - were shoved off the world's radar screens within days. That's because SARS exploded in the intensive care wards of hospitals across Asia and in Toronto.

"It's clear that (H5N1) cases were occurring in China before they were reported and likely have occurred since - and were not reported," infectious disease expert Dr. Michael Osterholm said when told of the letter.

"So I think it says that the idea that we have an understanding of the true magnitude of the current ongoing endemic disease in Asia is not correct."

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How would this actually effect our view of what's going on in China? If there was an H5N1 pandemic it could not be hidden, even in remote regions of rural China. SARS and H5N1 seemed to be competing in China in 2003, is that perhaps part of why SARS largely subsided quickly, competition amongst pathogens?