Experts Doubt Bird Flu Tallies From China and Elsewhere

By ELISABETH ROSENTHAL

ROME, Nov. 30 - With China reporting its first two human deaths from bird flu, international health specialists are warning that current tallies may greatly underestimate the problem, there and elsewhere.

Scientists have long been mystified by the low number of cases in humans reported in China, which has such a severe bird flu problem that it recently announced plans to vaccinate 14.2 billion chickens, geese and ducks. Far smaller countries, with less severe bird flu outbreaks, have reported many more human cases.

Ryan Pyle for The New York Times

Teams vaccinating birds in China against avian flu walked door to door recently in a county in Anhui Province. Some teams fail to wear protective masks or gloves, raising the risk of bird flu transmission to humans.

A team from the World Health Organization has gone to China to help investigate the deaths of two women in eastern Anhui Province, a 24-year-old poultry worker on Nov. 10 and a 35-year-old farmer on Nov. 22.

Dick Thompson, a W.H.O. spokesman in Geneva, said last week that the health agency did not believe that China was hiding human bird flu cases the way it covered up the number of patients with severe acute respiratory syndrome, or SARS, in 2003. But he said systems to diagnose a viruslike bird ailment were often poorly developed and underfinanced in the rural areas with the most cases.

"In some cases the surveillance system may not be there," he said.

"We're not nosing around," he added, "but we may be able to provide some technical expertise."

Vietnam has reported 91 cases of bird flu in humans, with 41 deaths, said Cao Duc Phat, the minister of agriculture, who presented new data last week to the United Nations Food and Agriculture Organization. China, which has reported 24 outbreaks this year, has reported only three cases of infection in humans.

While bird flu is now an animal disease, one form of it, H5N1 influenza, can, in rare cases, infect humans who have had contact with sick birds, and it is often deadly. In rural areas with little expertise or capacity to diagnose the disease, cases may go unreported. The virus may cause a mild disease in some people that would not be detected because they would not go to a hospital, Mr. Thompson said.

On Wednesday at a news conference, China's health minister, Gao Qiang, defended the government against accusations of a cover-up of bird flu infections, saying official figures were "transparent, comprehensive and accurate," Reuters reported. But he said doctors in rural areas might be too ill equipped and ill trained to detect cases in people.

Creating further concern about China's bird flu data, news on outbreaks has sometimes been slow to emerge from provinces and to the state media. Vietnam, in contrast, posts a daily 4 p.m. update on the Internet, detailing human and animal infections.

China's lack of openness about SARS helped it spread throughout the nation and beyond in 2003, because most people did not know they were at risk. While the government has become more open about health statistics, the specialists said, the penchant for secrecy remains.

In a recent editorial, Hu Shuli, the outspoken editor of Caijing, China's most prestigious investigative magazine, complained that local officials had stymied her journalists' attempts to investigate the death, possibly from bird flu, of a 12-year-old girl in Hunan.

"The situation has improved immensely over what we witnessed in the early days of the SARS epidemic in 2003, when the question of the virus's very existence was deemed a state secret," she said. "But if we want to further improve the situation, we must also acknowledge that officials still are not open and efficient enough in disclosing virus information to the public."

Scientists studying the international spread of bird flu have complained that China has not shared information about its experiences with the disease, although they say the situation has improved lately.

Still, while Vietnam, Indonesia and Thailand have provided international specialists with samples of viruses from each bird flu outbreak, China has not shared such material.

It has provided only one sample, in April, said Juan Lubroth, chief of infectious diseases at the Veterinary Service of the Food and Agriculture Organization of the United Nations.

China usually publishes only the genetic sequence of the viruses from its outbreaks, which gives only partial insight into how each virus spreads and how deadly it is.

By analyzing virus samples, health researchers can better track how the virus is changing, and perhaps even use such changes as an early warning system, should the virus become more virulent, or mutate to spread more easily to humans.