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**Sharpe** · July 19, 2006, 11:35 PM

Re: Thailand - 10 bf suspects from Phichit province?

Between Nakhon Ratchasima and Phichit, there are at least 44 suspected cases in Thailand at present. Consider that the last four years have only witnessed 22 confirmed cases combined. Not the greatest sign.

**Theresa42** · July 19, 2006, 11:37 PM

Re: Thailand - 10 bf suspects from Phichit province?

I wonder what's going on in Nakhon Ratchasima -- haven't seen any word on those 40+ people who were put under observation/quarantined....

**Mellie** · July 20, 2006, 12:33 AM

Re: Thailand - 10 bf suspects from Phichit province?

Do any of the articles say what signs or symptoms make them suspected of having H5N1?

**Toaster2** · July 20, 2006, 02:38 AM

Re: Thailand - 10 bf suspects from Phichit province?

Last novermber or december there were a few hundred people under observation in Thailand and only a few of them tested positive. I think they are quite cautious in Thailand hence the high number of 'suspected' cases, few of which will turn out to be real.

**Sharpe** · July 20, 2006, 07:43 AM

Re: Thailand - 10 bf suspects from Phichit province?

The rule in these countries is simply that mildly symptomatic infections or ones that recover quickly are never tested or confirmed. H5N1 does not have the reported 60% lethality that the WHO says it does. In fact it may be a 10th of that much. There may be 20 or more times the number of infections than we know about. It's very informative to read the study on monkeys done with the Qinghai strain. Most of them only had a mild fever and recovered.

**Mellie** · July 20, 2006, 09:21 AM

Re: Thailand - 10 bf suspects from Phichit province?

If that's true, why did the study that tested people in the area of the intense birdflu outbreak in Indonesia reveal no one with antibodies against birdflu?

I would like to see some actual evidence for what you believe.

**Sharpe** · July 20, 2006, 09:38 AM

Re: Thailand - 10 bf suspects from Phichit province?

Originally posted by Mellie

Vaffie,

If that's true, why did the study that tested people in the area of the intense birdflu outbreak in Indonesia reveal no one with antibodies against birdflu?

I would like to see some actual evidence for what you believe.

If there was evidence, would you be asking me? Besides, H5N1 is not a very antigenic virus--that's why they're having so much trouble creating vaccines that produce a good antibody response. And is there anything about Indonesia's "testing" that gives you any certainty about what they find?

**Snowy Owl** · July 20, 2006, 09:41 AM

Re: Thailand - 10 bf suspects from Phichit province?

Thai dogs carry bird-flu virus, but will they spread it?

303 See Other

http://www.nature.com/news/2006/060213/full/439773a.html

**Laidback Al** · July 20, 2006, 12:36 PM

Re: Thailand - 10 bf suspects from Phichit province?

Mild cases of H5N1 were apparently not missed in Cambodia.

http://www.cidrap.umn.edu/cidrap/con...2706cases.html

Mild H5N1 cases weren't missed in Cambodian outbreak

Mar 27, 2006 (CIDRAP News) ? Researchers who looked for mild or asymptomatic human cases of H5N1 avian influenza following an outbreak in Cambodia last year didn't find any, challenging the view that human cases have gone undetected, according to findings presented last week.
The research described Mar 20 at the International Conference on Emerging Infectious Diseases in Atlanta implies that surveillance for human cases might be more effective than some experts assumed, according to a story by the Canadian Press (CP). However, the findings also imply that the case-fatality rate for avian flu is higher than some experts thought.
Dr. Philippe Buchy and his colleagues at the Institut Pasteur in Phnom Penh last spring tested blood samples from 351 residents of a Cambodian village where poultry and one person had died of avian flu, the CP reported. No signs of antibodies to H5N1 were found in the samples, indicating the residents had not suffered even mild cases of avian flu.
Some of the people tested had "significant" exposure to poultry or infected people, the story said. For example, a doctor who inserted a tube down an H5N1 patient's windpipe without wearing any protective gear did not show any antibodies indicating infection. The same was true for other healthcare workers, including two veterinarians who had autopsied H5N1-infected birds. The healthcare workers did not know at the time they were dealing with avian flu cases.
"We didn't find any cases of H5N1, so nobody seems to have been asymptomatic or with mild symptoms during this outbreak in Cambodia," Buchy told the CP.
On the bright side, Buchy was quoted as saying the data indicate the virus still finds it difficult to jump from poultry to humans.
Dr. Nancy Cox, head of the influenza branch at the US Centers for Disease Control and Prevention (CDC) in Atlanta, concurred with Buchy, but added: "On the other side of the coin, it means that the case-fatality rate is still very high. And that is a negative thing."
Experts have suggested that the current case fatality rate for avian flu, about 56%, could be inaccurate because milder or asymptomatic cases have not been identified.
"The work in Cambodia is extremely important because it shows that we really aren't missing that much," Cox told the CP. However, she added that it is important to conduct research on a larger scale to determine whether mild or asymptomatic cases are occurring, and said such studies are planned.

**colormyquilt** · July 20, 2006, 01:10 PM

Re: Thailand - 10 bf suspects from Phichit province?

You may have a better sense of the number of people who have been suspected of having bird flu but no additional info has been made available with those numbers. Several times during the spring, reports stated there were suspected cases that were to be followed- but no additional info following. If there are numbers of people who are asympomatic and/ or experience a lighter case of and recover, then indeed it would seem that would be very userful and helpful info. It would have to be reflected in the CFR. It seems like all the pieces are not fitting. Having a high CFR pushed through the media would/ could directly effect the public in general's reaction to this issue- both in positive and negatvie ways.

**Sharpe** · July 20, 2006, 02:38 PM

Re: Thailand - 10 bf suspects from Phichit province?

You make some good points, Color my quilt. Apparently, no country wants to EVER admit bird flu patients. When they do, it is usually because of an overzealous doctor or because a local newsman somehow gets hold of the information. If a case tests positive, no one is ever told. It remains just an internet article that I or someone else have copied, with never any follow-up. (And let me tell you--it's worse with poultry and bird deaths--you have no idea how many thousands of mass deaths that were never followed up.) Only for very short periods of time do governments become open about suspected or confirmed bird flu patients--for a short period of time Vietnam and Thailand did, and for a short time, Turkey and Egypt did. Indonesia reports, but it has a weak central government and a handful of vocal doctors in a handful of major cities like Jakarta and Semarang who like to report to the press everything, and the press happily publishes it so that they can get readers in those areas where people can and have time to read. Outside of those four or five cities, bird flu infections of humans are never reported anywhere else in the country or the world, unless by mistake, they send the sample to a WHO testing body like Azerbaijan and Iraq did. Those were accidents made by people who didn't actually think that the results would be positive and did it just to pacify their own populations. China will still have us believe that it's only had a handful of infections after ten years. Personally, I have no idea why they report anything in the first place, but I've realized that it may be a means of reminding the public to obey their instructions about culling poultry.

**Theresa42** · July 20, 2006, 11:30 PM

11 bf suspects from Phichit province as of 3:00 p.m., 07/20/06

The Nakhon Sawan Office of Disease Prevention & Control (DPC) covers the following provinces:

Nakhon Sawan
Uthani Thani
Kamphaeng Phet
Phichit

http://dpc8.ddc.moph.go.th/

According to their latest suspected bf cases spreadsheet, there are currently 11 suspected bf cases (people presenting with pneumonia symptoms, I think) in Phichit (พิจิตร).

http://dpc8.ddc.moph.go.th/db8/disease/04_bird_day/up/group4_tw1mtE720072006.pdf

Table 1 on this page enumerates all suspected bf cases (suspicious pneumonia cases) from the 4 provinces between Jan 1, 2005 - July 20, 2006. Note the 11 "on investigation" cases from Phichit province.

Table 2 enumerates all suspected bf cases (suspicious pneumonia cases) this year.

It's not clear if these 11 cases "on investigation" include/are the same as the 10 reported bf suspects we have seen in news reports.

**Sharpe** · July 21, 2006, 12:35 AM

Re: Thailand - 10 bf suspects from Phichit province?

Now, before anyone goes nuts, remember that these are just random comments by a poorly informed outside observer--me.

Do you guys realize what the problem with these reports really is? Thailand has the freest press in the region. They report more than any other press in that part of Asia. What that means is that if more than 2/3 of Thailand is reporting poultry dying and people becoming sick, the odds are very high that all their more secretive neighbors--whose borders are pretty meaningless and created by the colonial powers of old to divide up the place for control purposes, are experiencing the same thing. Extrapolation of this then to the region means the following.

If we assume that half of suspected cases are true and that rates of human infection are the same outside the two provinces getting a lot of coverage for some reason--which I can't see any reason why they should be all that different--although it looks like these two provinces might have been hit the hardest first, that means that there would be 75 bird flu patients per day in Thailand alone. In a week, this region (Thailand, Laos, Cambodia, Myanmar, and Vietnam), based on population sizes, would be approaching a rate of 1600 patients/week!

**Sally Furniss** · July 21, 2006, 12:41 AM

Re: Thailand - 10 bf suspects from Phichit province?

Correct me if I am wrong .
Thailand has the freest press but they are also the most cautious. Treating many people with unusual pneumonia as suspected bird flu until results show it was not bird flu.

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