# 2710
While we follow individual cases of H5N1 infection around the world with interest, and clusters of cases with even greater concern, it takes more than a handful of cases to indicate that an epidemic (or worse, a pandemic) has started.
This month, we've seen a major increase in reported cases out of China. Perhaps this indicates an upsurge in bird flu activity in that country, or perhaps this just reflects better surveillance and reporting.
In either event, even if you count the rumored and suspected (but never tested) cases, the number of reported victims in China this month is less than 10.
Worthy of our attention,certainly - and a tragedy for those affected - but hardly sign of an epidemic.
There may even be more victims, misdiagnosed, or not yet hospitalized. It wouldn't surprise me at all. And we may yet hear of some of them over the coming days and weeks.
What then would it take to raise my level of concern?
Quite simply, signs of sustained human-to-human transmission. The word `sustained' being key.
In other words, clusters. Big clusters.
Clusters of twenty or more people, all epidemiologically connected, with varying onset dates suggestive of human-to-human (H2H) transmission.
That I would find worrisome. But even then, I wouldn't automatically assume that a pandemic had started.
But it would certainly have my undivided attention.
We watch places like China and Indonesia, and Egypt and carefully track individual cases because, someday, they may herald the beginning of a pandemic.
But it is important, as we do, to keep sporadic cases in perspective.
In light of recent media attention, the WHO today felt compelled to state the obvious; that there is no sign of a bird flu epidemic in China.
This report from AFP.
WHO says no evidence of China bird flu epidemic
Agence France-Presse | 01/27/2009 12:19 PM
BEIJING - The World Health Organization said Tuesday there was no evidence of a bird flu epidemic in China after a fifth person died of the disease this month, but urged caution in the Lunar New Year holiday.
An 18-year-old man succumbed to the deadly H5N1 strain of the virus Monday, bringing to five the number of fatalities from the disease so far this year in China, compared to just three in the whole of 2008.
The number of cases has sparked fears of an epidemic, particularly during this week's Lunar New Year, as hundreds of millions of families across China reunite around huge feasts that include poultry.
Peter Cordingley, WHO spokesman for the Western Pacific Region, said there was no need for undue alarm.
"What we are seeing is so far within our expectations and broadly matches previous years," he told AFP. "There is no evidence of an epidemic.
"Also, the China cases are geographically scattered and sporadic, with no sign of any connection between them."
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