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First bird flu death in the country exposes passive surveillance and poor preparedness

  • The 21-year-old’s case is the first H5N1 human infection in the world since February 2017
- ARJUN POUDEL & ARPAN SHRESTHA, Kathmandu

May 2, 2019-

The H5N1 bird flu virus that has been confirmed as the first cause of death in Nepal, 10 years after it was first detected in birds in 2009, is the world’s first H5N1 human infection since February 2017 and has raised issues of public health emergency of international concern as government and WHO officials refuse further information on the case.

“We are taking the help of the UN body to contain the disease,” Ministry of Health and Population spokesperson Mahendra Prasad Shrestha told the Post.

As experts from the World Health Organization headquarters and its Delhi office gather in the Capital to take stock of the situation, Shrestha says the government is taking the incident seriously and adhering to the standard protocols of international health regulations that Nepal is obligated to.

The deceased, a 21-year-old from Kavrepalanchok district, who had been residing in Bhaktapur and whose identity has not been revealed by the government, was first admitted to Nepal Medical College on March 24 after showing signs of fever and cough.

Doctors, who had then suspected influenza infection sent throat swab specimens to the National Public Health Laboratory on March 25. The same day, before the laboratory results were out, the patient was administered with Oseltamivir, an influenza antiviral medication taken from the Epidemiology and Disease Control Division. But the laboratory failed to identify the strain of the virus, the ministry said in a statement on Thursday.

The patient, who worked as a driver, was then transferred to Om Hospital as his condition became critical, according to one official who wanted to remain anonymous. Four days later, on March 29, the patient died due to respiratory complications while undergoing treatment.

Throat swab specimens were then sent to the WHO Collaborating Center for Influenza in Japan, according to the ministry and laboratory results received on April 30 tested positive for Influenza A (H5N1).

H5N1 is a lethal bird flu virus strain that is highly pathogenic. The first infection in humans was reported in 1997 in Hong Kong and the virus has since spread to Asia, Africa, Middle East and Europe and other parts of the world causing millions of poultry infections.

Although rare, confirmed human cases for bird flu as reported by the WHO from 2003 to April 9 this year stands at 860 human cases and 454 deaths. According to the UN body, almost all cases of H5N1 infection have been associated with close contact with infected live or dead fowls or contaminated environment.

While the virus does not seem to spread from human to human, a major concern among scientists is that the virus could mutate or combine with other influenza virus into something more infectious and result in a pandemic.

But least measures were taken since the 21-year-old boy first got admitted to a hospital with influenza-like symptoms and little was done to isolate mourning family members and relatives or anyone the patient had come in close contact with after his death.

Additionally, there was nothing done to contain the two hospitals in which the patient was admitted to. But five weeks since the boy’s death, EDCD director Dr Bibek Kumar Lal says epidemiological investigations have now started and that his office has stepped up surveillance to contain the disease.

“The good thing is no one has come in contact with the virus. The incubation period of the virus is one week but we do not have any cases of infection, five weeks on,” Lal told the Post. “No other patients in the area or elsewhere have been diagnosed with the disease as our laboratory records show.”

Nepal declared itself free from H5N1 in 2012 but this strain of the deadly bird flu virus continues to be found in poultry in Nepal and more recently even in some 350 crows in the Capital.

According to Dr Bansi Sharma, director general at the Department of Livestock Services, this year alone, 52 samples collected from poultry farms examined by the central veterinary laboratory tested positive for the deadly H5N1 virus.

Following the confirmations, rapid response teams of veterinary technicians were deployed to poultry farms in Kathmandu, Bhaktapur, Lalitpur, Makwanpur, Morang, Sunsari and Kaski district and over 100,000 infected chickens were culled.

“The outbreaks of H5N1 have serious public health, economic and social implications, therefore its prevention is a priority across the globe and the human infection is evident of zoonotic disease spillover from animals to humans,” said Manisha Bista, a disease surveillance officer at the Center for Molecular Dynamics Nepal.

“This is an opportunity to identify flaws in our passive surveillance programmes and invest in technical and human capacities to detect diseases and investigate outbreaks and inform the general public without creating public outcry."

Published: 02-05-2019 22:01

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