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A strain of the influenza virus that previously was known to infect only birds has now been associated with human infection and illness in Hong Kong. The first known human case of influenza type A (H5N1) occurred in a three-year-old child who died from respiratory failure in May 1997. The virus was initially identified as influenza type A, but it took until August for the Centers for Disease Control and Prevention (CDC), Atlanta, Georgia; the National Influenza Center, Rotterdam, The Netherlands; and the National Institute for Medical Research, London, United Kingdom to identify independently the virus as influenza A (H5N1). An investigation that included the CDC excluded laboratory contamination as a source of the infection.
Since this initial case was identified and as this article goes to press, four people have died from the virus, 12 people are confirmed to have contracted the virus and five others are suspected of having been infected. As part of the exercise to control the spread of the virus, Hong Kong has ordered the slaughter of 1.4 million chickens and other poultry. In addition to a less than optimal extermination of the fowl, the failure to pick-up carcasses promptly has been connected to additional public health risk. Moreover, tens of thousands of poultry workers are without work.
Tracking the story of this outbreak is almost as fascinating as the speculation on the risk of this virus to humans. A web site has been dedicated to the virus on YAHOO! <http://search.yahoo.com/bin/search?a=m3&p=H5Nl>. This site provides comprehensive listings of news stories on the subject, ranging from health implications to the political consequences of the decision to kill over one million chickens in Hong Kong. The articles are from the International Wire Service as well as local newspapers in the affected area.
More health-related information, including suggestions for travel to Hong Kong, can be found on the Health Canada’s Laboratory Centre for Disease Control (LCDC) web site <http://www.hc-sc.gc.ca/hpb/lcdc/hp_eng.html>. In addition to information on the virus, a handy information page on questions and answers about avian flu in Hong Kong is provided. It deals with issues ranging from cases in Canada to human-to-human spread. These pages are of interest to physicians counselling people travelling to the Hong Kong region as well as those answering concerns raised by the public on the topic of influenza. While visiting the site, one can take the opportunity to download the Statement on Influenza Vaccination for the 1997/98 season produced by the National Advisory on Immunization. This nine-page publication is of value to any practising pediatrician who is serving a high risk population. As well, the LCDC site provides a hot link to the Hong Kong Health Department web site.
Those wanting the official position of the American public health system can access similar information at the CDC web site <http://www.cdc.gov/ncidod/diseases/flu/in-fol27.htm>. Europe has been tracking this virus and a Norwegian web site on the virus <http://www.uib.no/virus/Flu/H5Nle.html> is quite interesting.
For those interested in upgrading their understanding of influenza, the University of Florida offers an Update on Influenza <http:/www.medinfo.ufl.edu/cme/flu/flu.html>, which was revised in November 1997. The information and accompanying exercise are recognized as a continuing medical education activity for 1 h in category 1 of the American Medical Association’s Physician’s Recognition Award. The site, written by Parker A Small Jr and Bradley S Bender, provides a timely update on both influenza A and B. The credit is earned after completing a module on four case studies.
The emerging issues surrounding this pathogen and efforts to eradicate it have often appeared on the internet before being covered by local media and newspapers. The interest in this threat to human health underscores the phenomenon that, at least electronically, we are moving towards a global village. Had this virus been highly infectious and readily spread from human to human, it is unlikely that the spread of the virus would have equalled the rapidity of transmission of the electronic information about its existence.