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Scientists led by virologist Peter Palese of Mount Sinai School of Medicine in New York altercate in an assay appear in the online copy of the annual Science that the WHO, a U.N. agency, is artful the afterlife amount application an appraisal of animal bird flu cases that is artlessly too low.
C. But based on abstracts cited in their analysis, the amount appears to be beneath 1 percent.
The WHO stood by its calculations and some experts criticized the Palese team's findings, adage they were based on ambiguous data. As of Thursday, the WHO counts 586 cases of bodies adulterated by bird flu. Of those, 346 died, for a accident amount of 59 percent.
Palese beneath requests for an interview, and asked his co-authors not to allege to reporters, according to the Mount Sinai columnist office.
The important accurate journals Science and Nature are captivation off on publishing affidavit on two abstracts that created mutant, added catching forms of the H5N1 bird flu virus. The adjournment comes at the appeal of a U.S. biosecurity console for abhorrence the assay could abatement into the amiss easily and be acclimated to actualize a communicable that ability annihilate tens of millions of people.
Researchers in the United States and the Netherlands accept agreed to a acting arrest to their work. Scientists and accessible bloom admiral affair at the WHO aftermost anniversary agreed that the adjournment should abide in abode until they can absolutely appraise the risks airish by the research.
Science and Nature accept appear their ambition to eventually broadcast the affidavit in full. The new abstraction could abutment arguments that fears about the assay are overblown.
"There has been a abundant alarm amid the accessible aerated up amid the columnist in the aftermost few months. That needs to be dealt with," Science editor-in-chief Bruce Alberts said aftermost week.
A backer for the annual said the altercation over bird flu assay did not comedy a role in the accommodation to broadcast the new paper. "All Science affidavit are evaluated on their own merits," backer Kathleen Wren said. "The catechism that this cardboard addresses, namely the prevalence and accident amount of the virus, is an important one in itself for accessible health."
Some scientists said there was little accompaniment in the timing of the study's publication. They acclaimed that Palese appear agnate allegation aftermost anniversary in the annual Proceedings of the National Academy of Sciences and that it is abnormal for Science to broadcast a cardboard back key abstracts accept appeared elsewhere.
"The editors of Science and Nature are the best able bodies in science," said an affliction epidemiologist who asked not to be called for abhorrence of retribution. "This is the editors of Science adage H5N1's accident amount isn't 50 percent, so we don't charge to anguish about a (possible) lab release."
The new allegation appear in Science additionally belie beginning assessments by Michael Osterholm of the University of Minnesota, a affiliate of the National Science Advisory Board for Biosecurity (NSABB). Osterholm cites affirmation that the afterlife amount from bird flu is at atomic as aerial as the WHO reports.
According to the WHO, the bird flu animal afterlife amount ranges from about 30 percent in Egypt to added than 80 percent in Indonesia and Cambodia, WHO agent Gregory Hartl said. Hartl said the WHO "is still adequate ciphering a accident amount amid 30 percent and 60 percent" admitting the Palese analysis.
"CASE FATALITY RATE"
In the new paper, Palese's aggregation revisited the adding of the "case accident rate" of H5N1, which equals the cardinal of H5N1 deaths disconnected by the cardinal of accepted animal infections.
Palese's aggregation says the WHO's appraisal of cases is too low. To calculation as an H5N1 infection, the WHO requires that a accommodating accept a agitation aloft 100.3 degrees Fahrenheit and that an accustomed lab affirm the attendance of H5N1 by atomic diagnosis.
That does not annual for rural patients clumsy to get to a hospital, adulterated bodies who do not appearance affection and added factors, the advisers said. As a result, abounding added than 586 bodies may accept been adulterated with H5N1 and survived, they said.
To abutment that idea, they cited beforehand studies assessing the prevalence of H5N1 infection. Based on claret samples from 14,000 people, these studies estimated infection ante of 0.2 percent to 5.6 percent, the advisers reported.
Palese's aggregation acclimatized on 1 percent to 2 percent. If alike 1 percent of bodies in rural areas area H5N1 is abounding accept been infected, again "millions of bodies ... accept been adulterated worldwide," he and his colleagues wrote in Science.
In that case, the accident amount of H5N1 is at atomic 10 times beneath than the appraisal by the WHO, the advisers said. Added precisely, if millions of bodies accept been adulterated but alone 346 died, the afterlife amount would far beneath than 1 percent, based on abstracts presented by Palese's team.
A case accident amount of a few percent would still accomplish H5N1 far deadlier than the best pandemics. Seasonal flu kills beneath than 1 percent of those it infects. The 1918-19 Spanish affliction communicable that claimed 20 actor to 40 actor lives dead about 2 percent of those infected.
Dr. Andrew Hayward, a flu able at University College London, calls the new assay an "important study."
The bodies "most acceptable to be activated for H5N1 are astringent cases that end up in hospital," Hayward said. "People who are ill abundant to get activated for H5N1 accept a actual aerial accident of dying, but this assignment suggests that abounding added bodies in the association become infected" and do not die.
"SIGNIFICANT PROBLEMS"
Other experts bidding doubts about the new study.
"There are cogent problems with the analysis," said Arturo Casadevall, administrator of the administration of microbiology and immunology at the Albert Einstein College of Medicine in New York and a affiliate of the NSABB. Particularly worrisome, he said by email, is "the admittance of several studies in the meta-analysis that may not accept been appropriate."
One of those studies counted infections from the 1997 Hong Kong bird flu outbreak. That ache of H5N1 is genetically altered from after forms and should not accept been included in an assay of accident rates, Osterholm said.
"The admittance of the Hong Kong study, which was on a altered virus, makes this cardboard actively awry methodologically," Osterholm said in an interview.
In a far altered assay to be appear Friday in mBio, the annual of the American Society for Microbiology, Osterholm and a aide achieve that H5N1 kills up to 80 percent of bodies it infects.
"The adverse of what Palese suggests absolutely occurs," Osterholm said. That is, balmy and asymptomatic H5N1 infections are counted through accurate surveys of claret samples, but some deaths are absent "because H5N1 infection was not considered, testing was not done, or no testing was available," he said.
If the WHO is amiss on the afterlife amount by a agency of, say, 20? "Even if H5N1 had a 20-fold lower mortality," said Osterholm, "it would still annihilate added bodies than the 1918 pandemic.
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