H5N1 Spread to Siliguri India Raises Pandemic Concerns
Recombinomics Commentary 14:24
January 5, 2009
Culling of domesticated fowls in the bird flu hit Matigara and Phansidewa blocks in Siliguri subdivision and the adjacent Rajganj block in Jalpaguri district is progressing in a sluggish rate with mere 388 birds been culled until 5 pm today out of the total 18,000 target. The drive was initiated from 8 pm yesterday.
Culling operations have also begun in Takdah block in the Darjeeling Hills with a target of slaughtering 700 birds. All these four blocks were confirmed of bird flu infection late on Friday but the official notification for culling reached the district administration on Saturday morning.
After unusual mortality of poultry birds was also reported from Dasberia village in Takada block, it was decided that the department would cull all birds in the hill village without waiting for bird flu confirmation reports.”
“If bird flu spreads to the hills rapidly, it would be tough for the department to keep a lid on it as the hills are already boiling over the Gorkhaland agitation. Culling of poultry birds in a large area of the hills would certainly be a problem in a situation like this,” the official added.
The above comments from local media reports describe widespread H5N1 in and around the city of Siliguri (see zoomed map) which has portions in Darjeeling and Jalpaiguri districts of West Bengal, India. 34 of 47 wards in the city are affected, raising concerns of exposure of the more than 500,000 inhabitants. In addition to outbreaks in the city and its suburbs, there are outbreaks as far south as the Phansidewa block, which borders Bangladesh, as well as the north in Darjeeling Hills, about 30 km from the city of Darjeeling.
Culling is going slowly and more “surveys” of inhabitants in the cull zones is anticipated. The reliability of these surveys is highly questionable. In Assam there were hundreds of residents within the 0-3 km cull zone who had URI symptoms, but none were said to have contact with dead poultry, so there has been no reported testing. Similarly, surveys of residents in the 0-3 km zone of the Malda outbreak at Englishbazaar identified over 40 such cases, while over 800 were identified in hospitals, yet none were said to have had exposure to dead poultry, so once again there was no test results.
The widespread outbreaks in Siliguri will put an even higher number of residents within the 0-3 km zone of outbreaks and similar survey results are expected.
The absence of reports on testing remains a cause for concern. Even if there is no relationship between dead poultry and bird flu symptoms, some patients should fall into both groups, but the number of such cases remains at zero. The failure to find a single case that has exposure to dead poultry as well as symptoms remains highly suspect. Many confirmed H5N1 cases in other countries have no history of direct contact with dead poultry. Frequently, poultry deaths in the area are reported, or the victim lives near a poultry slaughterhouse, but the direct linkage to dead poultry is lacking.
Testing of patients with bird flu symptoms remains unclear. Last season test results from children in Birbhum who had bird flu symptoms and who had eaten dead poultry was not reported. H5N1 was confirmed in one child in Bangladesh, but the H5N1 was discovered long after the child was discharged, raising surveillance concerns for Bangladesh also. The child also had no reported contact with dead poultry.
Mild cases of H5N1 infections have been reported previously in Egypt and Vietnam, and more recently in Cambodia, raising additional concerns that such cases are not being tested in Bangladesh because the patients are not being tested.
The apparent lack of testing of symptomatic residents within the 0-3 km cull zone is a growing concern.
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