Where bird flu began is a Chinese puzzle

A surprising revelation by a group of Chinese researchers has led to a formal request from the World Health Organization (WHO) for a meeting with officials of the Chinese Ministry of Health.

In a letter to the New England Journal of Medicine eight researchers have claimed that a 24-year-old man who died from pneumonia and respiratory distress in 2003 and was at first classified as a SARS victim, might have in fact died of avian influenza.

The case occurred when sporadic cases of SARS were cropping up in southern China, but it seems serum and lung tissue from the patient, as well as fluid aspirated from his chest, were examined for the SARS virus, and the researchers say that all the tests were negative.

The letter says the samples genetically resembled those of viruses taken from Chinese chickens in various provinces in 2004, and also resembled Japanese samples.

They believe that evidence is important for developing an eventual bird flu vaccine.

SARS first broke out in China's southern Guangdong province in 2002 and then spread as far as Canada before it was brought under control in 2003, by which time it had killed almost 800 people out of the 8,000 known to have been infected.

The admission has shocked the international influenza community because the death occurred two years before China began reporting H5N1 cases to WHO, and predates by a month the first confirmed human infections since the virus re-emerged in Asia in late 2003.

The first human victims were in Hong Kong in 1997.

The eight reputable researchers from prestigious institutions, submitted a letter to the journal describing the molecular characteristics of H5N1 viruses taken from the lung tissue of the man who died in November 2003, in Beijing.

Included in the group of eight were Dr. Wu-Chun Cao of the State Key Laboratory of Pathogens and Biosecurity, Dr. Qing-Yu Zhu of the State Key Laboratory of the Beijing Institute of Microbiology and Epidemiology, and Dr. Wei Wang of the 309th Hospital of the People's Liberation Army.

Had that information been made available at the time, countries in the region may have been able to respond when the virus appeared within their borders and lives may have been saved.

China only began reporting cases in November 2005, and has only admitted to 19 H5N1 cases with 12 deaths.

Officials say lives certainly would have been saved in Vietnam and Thailand and the incident has all manner of implications.

International influenza experts have always suspected China has not always been totally transparent when it comes to such cases and has thought there were hidden or missed human cases of H5N1, but none expected those suspicions to be confirmed in one of the world's most respected medical journals.

The Chinese researchers apparently attempted to withdraw the letter but the journal had already been printed.

The New England Journal of Medicine is trying to clarify with the authors why they wanted to withdraw the letter and if justifiable will then offer them the opportunity to retract it.

Strict protocol has to be followed when the WHO is seeking information from a country, and the process is time-consuming process and demands that any correspondence must be directed to the ministry of health in the country concerned; direct contact with the researchers themselves is not possible.

Since 2003 the H5N1 avian flu virus has spread across most of Asia, into Europe and Africa; it has infected at least 228 people in 10 countries, and has killed 130.

Millions of birds have died or been culled as a result and the livelihood of many poor people have been jeopardised.