Recombinomics Commentary 21:22
April 16, 2009

WHO authorities are working with Russian authorities to track the case and ensure it did not represent an international public health threat, Setiogi said.

The above comments on the train passengers quarantined in Russia raise concerns that the atypical bilateral pneumonia in the fatal case was caused by H5N1. China had issued an alert in January for atypical pneumonia cases because of the spate of H5N1 infections. These infections were not linked to H5N1 confirmed poultry outbreaks and the reported cases ceased in February. Prior to the outbreaks in patients, there were poultry outbreaks in Jiangsu which were cause by clade 7 H5N1,

The first reported case was in Beijing, A/Beijing/01/2009, which was likely also caused by clade 7. The first confirmed H5N1 cases in China was a patient with atypical pneumonia who was diagnosed as SARS, but was subsequently found to be infected with H5N1, A/Beijing/01/2003.

The victim on the train was a Chinese citizen who boarded the train in at the Russian border with northeastern China (see map). The patient was symptomatic for four days on the train before dying, raising concerns of spread to the relatives on the train, who have a temperature.

Passengers in other cars, who were releases were given Ribavarin, signaling a suspect viral etiology, and the involvement of WHO in the investigation increases concerns that the virus is H5N1.

More information of the symptoms of the relatives / contacts, who were initially sad to have high fever and were subsequently said to have low fever, would be useful