The World Health Organization (WHO) urged citizens to stay away from dying birds to prevent bird flu from spreading to humans and multiplying the risk of a new pandemic. The analysis of the first case of this animal disease in a person in Latin America, however, revealed a worrying lack of control and surveillance. In December, a family in a town in Ecuador bought chickens that died in a few days, just 100 kilometers from the farm where the first outbreak of avian flu in the country had just been detected. A 9-year-old girl from the house began to show flu symptoms on December 25 and had to be admitted five days later, but samples were not sent to analyze until January 5 and the positive was not communicated to WHO until January 9 of January. Scientists who studied the girl warn of the “high risk” that cases like this cause the appearance of new variants that represent “a pandemic threat” to humanity.

The avian influenza A(H5N1) virus has been circulating around the world for over two decades. Since 2003 it has jumped nearly 900 times to humans and killed more than half, but it has never been effectively transmitted from person to person. Over the past three years, a highly contagious subtype of the virus called 2.3.4.4b has caused an unprecedented spread of the disease in birds. Europe is suffering from the worst avian flu epidemic in its history and many American countries are on high alert.

In this context, the Ecuadorian girl, from a town near the municipality of Guaranda, was transferred to a local health center on December 27, with flu symptoms, after living with the chickens that had died a week earlier. On December 30, she was admitted to a general hospital and treated for meningitis. On January 3, she was finally admitted in critical condition to the Intensive Care Unit of the Pediatric Hospital Baca Ortiz in Quito, with very serious pneumonia. The girl was about to die, as confirmed by pediatrician Greta Muñoz, medical director of the center. After weeks with mechanical ventilation and antivirals, the girl, already recovered, was discharged on February 17th.

The intensity of surveillance at the animal level in Ecuador is low and at the human level it is non-existent.

Miguel Ángel García Bereguiain, biologist

Spanish biologist Miguel Ángel García Bereguiain was another specialist who analyzed the girl’s case. “Unfortunately, the intensity of surveillance at the animal level in Ecuador is low and at the human level it is non-existent,” he says. The scientist regrets the chain of errors surrounding the case. “It took almost two weeks to send a sample to the National Institute for Research in Public Health in Ecuador, despite the girl’s town being very close to the farm where the initial outbreak occurred,” says the biologist, from the University of the Americas, in Quito.

Epidemiologist Richard Pebody, head of the World Health Organization’s high-threat pathogen monitoring team, made an appeal to the population in an interview with EL PAÍS last week. “Citizens should be reminded that if they see dead or dying birds or other animals, they should not take them, due to the potential risk they pose,” he warned via video link from his office in Copenhagen.

García Bereguiain highlights the impossibility of complying with this recommendation in many parts of the world. “Interacting with birds in Copenhagen is limited to going to the supermarket to buy chicken and eggs. Here you have them on your patio. Nothing is further from reality than pretending that people in a village in Ecuador are wearing gloves and a mask, interacting with the chickens they have at home,” says the biologist. “That’s why we believe that the emergence of this 2.3.4.4b outbreak is particularly worrying in the context of South America, where there are no good control strategies”, she emphasizes.

García Bereguiain’s team published this Monday the analysis of the girl’s case in the journal of the International Society of Travel Medicine. The authors point out that local technicians from the Ministry of Health in Ecuador took “several days” to send the girl’s samples, “due to logistical problems”, despite the fact that the country was already on alert for highly pathogenic avian flu. The patient had been on antiviral treatment for days, so the genetic material of the virus was highly degraded, which made the diagnosis difficult. The US Centers for Disease Control and Prevention confirmed this week that the virus is an A(H5N1) 2.3.4.4b subtype.

The authors of the study also criticize that “due to budget constraints, there has been no active surveillance of people exposed to infected birds in Ecuador”. One of the signatories is microbiologist Alfredo Bruno, general technical coordinator of the National Institute of Public Health Research, the reference laboratory for avian flu in Ecuador. Bruno details that, since the first outbreaks in November, his team has received only five samples of birds to sequence the virus genome, essential information to follow the evolution of the pathogen and prepare vaccines. His laboratory did not receive suspicious samples from humans, except those associated with the case of the 9-year-old girl. “We need to improve surveillance at the human-animal interface and strengthen coordination between institutions”, acknowledges Bruno.

Ecuador started a vaccination campaign on March 3 in poultry farms close to avian flu outbreaks. The Ministry of Agriculture and Livestock announced the administration of four million doses of this vaccine, which reduces the mortality rate from 80% to 40%, but does not prevent contagion to other farms. The biggest concern is that the virus will jump from birds to mammals. In Peru, the mass death of sea lions from bird flu suggests the virus may already be spreading among mammals in the wild. In Spain, analysis of a fatal outbreak at a mink farm in October also pointed to likely carnivore-to-carnivore transmission of the avian virus. The 52,000 mink were slaughtered.

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