The Three Possible Avian Flu Cases in Hunan Province (China)

There is apparently a hot debate over those three pneumonia cases of uncertain causes in Hunan province which may or may not be avian flu cases.  Why the uncertainty?  This post contains the translations from a couple of Chinese-language newspaper accounts.  They are in much greater detail than the summaries that you will find in the English-language media.  For example, the Associated Press reports:

China said Sunday it had asked for outside help to test three possible cases of bird flu in people, while scientists and government representatives prepared for a strategy session in Geneva amid fears of a possible worldwide flu pandemic among humans.

China said it asked the World Health Organization to help determine whether the virus caused the death of a 12-year-old girl and infected her 9-year-old brother and a 36-year-old middle school teacher in Wantang, a village in central Hunan province.

Chinese experts "cannot rule out the possibility of human transmission of H5N1 bird flu" in the cases of the three, who came down with pneumonia last month following a bird flu outbreak among poultry in their village, the official Xinhua News Agency reported.

The girl's brother and the teacher recovered. Chinese officials initially said the girl and her brother tested negative for the bird flu virus.

This is not fully filled out.  The Chinese-language media has more details than that.  As always, I cannot guarantee that this (or anything else) is accurate.  You will have to exercise your own judgment to see if the circumstances are credible.  But this exercise serves to show how western reports necessarily have to cut off many details due to restrictions on length, and thereby leaving a sense of incompleteness.

(Southern Weekend)  Eyewitness from the flu area in Xiangtan.  By Ju Jing and Shu Mei.  November 3, 2005.

['Loose' translation: this means that I have included the reporters' observations and the details of the cases as related by the principals; I have excluded interviews with some officials]

On October 7, a duck in the He family in Xiangtan County died.  He Tieguang turned the dead duck into a dried duck.

On October 11, the sick duck was served on the He family's dining table.

On October 12, the daughter He Yin developed a high fever and became drowsy.  He Tieguang took the child to the Shebu town hospital for treatment, and her condition seemed to improve.

On October 13, He Yin developed high fever again and her father took her to the hospital again.  Then she was sent to the Women & Children Health Clinic in Xiangtan City, before finally being sent to the Henan Provincial Pediatric Hospital.

The bed of the late He Yin

On the morning of October 17, He Yin died at the Henan Provincial Pediatric Hospital.  Her body was sent to the Changsha Yangminshan Funeral Home for cremation.  While He Yin was being treated in Changsha, He Tieguang's younger song He Junyao developed similar symptoms.

On the afternoon of October 18, He Junyao was sent to the infected disease ward on the fourth floor of the Hunan Province Pediatric Hospital.  After many requests from the family members, the parents were permitted to see He Junayo.  "The boy stuck his head out of the window while we spoke to him under below."  According to He Tieguang, the doctor told him that He Junyao had problems with his breathing tract very much like the SARS condition.

On the afternoon of October 28, the Ministry of Health's Emergency Office director Chen Yanyi announced the death of He Yin at a press conference.  Chen said that the Hunan Provincial Health Department reported those two cases to the Ministry of Health  Laboratory tests conducted by the Hunan Provincial Center for Disease Control and the Chinese Center for Disease Control on the samples collected from the two sufferers were both negative for the avian flu.  Thus, these two cases have been excluded for having been caused by the avian flu.

He Tieguang and the photograph of his two children

On the afternoon of November 1, the reporter went in Xiangtan County.  He came up to a station where two workers were holding high-pressure water guns.  Whenever vehicles came in and out, they would use the water guns to spray the wheels.  According to the regulations, they only have to worry about the parts underneath the windows.  There are a total of five such stations, four acting as the first line entering into the general area and the last one leading into the Heping Brigade, where the outbreak occurred. 

The Heping Brigade is the located where the suspected case occurred.  On the afternoon of October 18, the Xiangtan County Avian Flu Prevention Headquarters received information from the Shebu town Animal Epidemic Prevention Station.  Among 15 bird-rearing households of the Heping Brigade, 13 of them had sick birds with a total of 545 deaths.  The on-the-scene analysis shows a suspected outbreak of avian flu.  On October 25, the National Avian Flu Study Laboratory confirmed that this was an outbreak of H5N1 flu.  On that day, the Ministry of Agriculture announced the news and the experts initially suspected that the virus was brought in by migratory birds.

At Heping Brigade, anyone who comes and goes must be decontaminated.  Since the village entrance is on a narrow slope, cars must slow down anyway.  The workers therefore take the opportunity to wash down and spray the vehicles.  There is someone on duty from 8am to 7pm.

The villager Tan Weihong has 10 chickens, and he has slaughtered all of them.  He said that he reared the chickens for home consumption, so it is no big loss to him.  There are 24 households in the Heping Brigade, of which 15 reared a total of 687 chickens and ducks.  During this outbreak, 13 households were affected, losing 182 chickens and 363 ducks.  On October 19, 2487 birds belonging to 121 households within 3 kilometers of the Heping Brigade were culled and buried deep under the ground.  The village grounds were also covered with 35 tons of lime and 5,000 kilograms of antiseptic liquid.

At 8pm on November 1, the reporter entered into Heping Brigade.  Villager Hu's home was brightly lit, as a few young man were chatting in front of his door.  Hu did not feel terrified by the avian flu.  His dog was running around in his dog pound, yelping when a stranger comes by.  According to the rules, all dogs are kept inside pounds.

Near He Tieguang's house, a village house had its door open and four women were playing mahjong.  The owner told the reporter that these were all neighbors playing for recreation.  They were not worried about the avian flu.

(Wenxue City, consolidated from multiple news reports)

On November 6, the Ministry of Health spokesperson reported on the conditions of the three cases of  pneumonia of uncertain causes in Hunan province.

Case number one is He Yin, female, 12 years old.  She was a first-year secondary school student in Shebu Town, Xiangtan County.  On the morning of October 16, she was admitted into Xiangtan City Women's and Children's Health Clinic with a severe case of pneumonia and then transferred to the Hunan Province Pediatric Hospital.  On the morning of October 17, she died from "pneumonia in both lungs and ARDS."  From the samples collected He Yin, the tests were negative for the H5N1 avian flu as well as SARS.

Case number two is He Junyao, younger brother of He Yin, age 9, third year student in an elementary school in Shebu Town, Xiangtan County.  On October 18, he was admitted into the Hunan Province Pediatric Hospital and placed under quarantine.  As of October 22, his body temperature returned to normal and all other bodily functions are stable and normal.  The testing of the throat culture and blood serum showed that all H5N1 avian flu tests were negative except for one test might be positive..  All SARS-related tests were negative.

The epidemiologists found out that the He family lived in Wantang Village, where an avian flu outbreak had occurred among chickens and ducks.

Case number three, a man named Song, 36 years old, a secondary school teacher in Yihe town of Xiangtan City.  On October 24, he went to Xiangtan Chinese Medicine Hospital to seek treatment, and the X-rays showed a case of pneumonia in the lower part of his left lung.  On the same day, he went to seek treatment at the Xiangtan Hospital Central and was admitted to stay.  After treatment with anti-biotic, the patient's temperature returned to normal and his condition was stable.  The throat culture and blood serum samples were negative for both H5N1 avian flu and SARS.

Teacher Song

On October 28, the Ministry of Health reported the conditions of the He brethren to the World Health Organization.  On November 3, the Ministry of Health explained the details of the three Hunan cases of uncertain pneumonia and the related preventative measures.  The Ministry of Health has asked the WHO to send its experts to look for the explanation of the causes of those three cases.