H5 and H9 not the only bugs that could bring the next pandemic, health body warns The World Health Organisation yesterday warned countries to be alert to the possibility that many different viruses could spark the next flu pandemic, after a baby girl in Hong Kong was confirmed to be suffering from H9N2 bird flu. Keiji Fukuda, the co-ordinator of the world body's global influenza programme, said cases of H9N2 human infections have been reported only in Hong Kong, though the virus has been known to be circulating in poultry in Asia since the 1990s. 'Detection of the current H9 case serves to point out that surveillance for avian influenza has been excellent in Hong Kong for many years, and serves as a reminder that there are many potential viruses that could result in the next influenza pandemic,' he said from the global body's Geneva headquarters last night. Efforts to develop a prototype H9 vaccine were continuing, he said, as the H9N2 virus was considered a potential 'candidate' to spark the next flu pandemic. Gregory Hartl, the organisation's project leader on pandemic response and alert, agreed the 'culprit', if a pandemic occurred, may not necessarily be the deadly H5N1 strain. He urged countries to remain vigilant. 'All countries [should be] ready to detect and respond to any type of unusual disease event, whether it be H5N1, H9N2 or another disease altogether. Pandemic preparedness and response come as a package.' In Hong Kong, Centre for Health Protection controller Thomas Tsang Ho-fai said yesterday he had notified the Ministry of Health, the WHO and the Macau authorities about the infection found in the two-month-old girl, who is in stable condition in Tuen Mun Hospital. He said H9N2 was a bird virus that had been found in ducks and chickens for many years but infection in humans was rare and usually mild. In previous cases, three girls and a boy were confirmed to have suffered from H9N2 infection in 1999, 2003 and 2007. All recovered. Dr Tsang said the H9N2 strain should not be confused with H5N1. Unlike H5 or H7 bird flu, H9 is not a notifiable disease in Hong Kong. Infectious diseases specialist Lo Wing-lok said H9N2 had been 'with us even before 1997 when H5N1 jumped to humans'. 'The baby most likely contracted it at wet markets,' Dr Lo, chairman of People's Health Action, said. 'The lesson to be learned for parents is not to take their children to the wet markets, near bird droppings or areas where there are poultry.' He said the city's health authorities had not made H9 bird flu notifiable because it did not cause serious disease. Dr Tsang said further genetic sequencing was being conducted on the H9N2 virus to determine whether it originated completely with birds. 'As the girl was staying in Shenzhen for the whole incubation period, we have informed the Guangdong health department,' he said.