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First North American H5N1 case passed through YVR: Dr. Perry Kendall

The first human case of H5N1 in North America was announced this afternoon by Health Minister Rona Ambrose in Ottawa. An Alberta resident, returning to Canada from Beijing on December 27, fell ill en route and died in Edmonton on January 3. Here in Vancouver, B.C.'s chief medical officer of health, Dr. Perry Kendall, said B.C. faces "minimal risk" of the disease spreading.

Dr. Kendall was speaking at a telephone news conference. He said B.C. was informed of the fatal case last night.

After arriving from China on Air Canada Flight 030, the person waited for two and a half hours at Vancouver International Airport before boarding AC 244 to Edmonton.

"The average incubation time is three to four days," Dr. Kendall told the news conference. "It's been 12 days since the person's return, and no symptoms have been observed in passengers or contacts." He noted that the case's symptoms did not include coughing. Since early last year, when H7N9 avian flu began to appear in China, he said, B.C. health authorities have been on alert for arrivals from China with respiratory problems. The B.C. Centre for Disease Control, he said, "has not been notified of any such cases." He added that BCCDC is equipped to detect novel flu strains. "There have been absolutely no cases of H5N1 detected in B.C. to date," he said.

Dr. Kendall said the Public Health Agency of Canada will find and notify passengers on the case's flights. Responding to a question about possible contacts the case may have had with persons in the waiting area, he said it would be impossible to trace such persons. "But I don't think it's a risk."

The first case of H5N1 took the world by surprise in 1997, when a 3-year-old in Hong Kong was found to have died from it. After several more cases and deaths, Dr. Margaret Chan, then the Hong Kong chief medical officer of health, ordered the slaughter of all poultry in the Hong Kong Special Administrative Region. That ended the immediate threat, and H5N1 was not detected again until 2003. Chan is now the Director General of the World Health Organization.

Until this case, the most recent WHO tally of confirmed H5N1 cases since 2003 has been just 648. But the disease has killed 384 of its victims, giving it a "case fatality rate" of 59 percent. Indonesia has seen a case fatality rate of over 80 percent. The lethality of the disease makes health experts pay attention to it despite the few cases. Knowing how rapidly influenza viruses can mutate, they worry that H5N1 could learn how to transmit from human to human as easily as H1N1 did in the 2009 pandemic. So far, however, only a few cases of human-to-human transmission have been reported -- usually a family member caring for someone who has contracted the disease by touching or eating an infected bird.

In the past year, however, other avian flu strains have crossed from birds to humans, notably H7N9 -- which first appeared in Shanghai last March, and which is currently reappearing from eastern China to Hong Kong.

Crawford Kilian is a contributing editor of The Tyee.

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