China has confirmed a man died from bird flu in 2003, two years before Beijing reported its first human case.  The revelation has again raised concerns about China's ability to detect and report bird flu outbreaks. 

China's Ministry of Health Tuesday confirmed tests showed a 24-year-old soldier hospitalized in November 2003 was the country's first known human case of bird flu infection.

The man suffered from pneumonia-like symptoms and was suspected of having the respiratory disease SARS, but tested negative for it.  He died a few days later at a military hospital. 

The possibility he died from the bird flu virus, known as H5N1, came to light in June when eight scientists at the hospital published a letter in the New England Journal of Medicine.

Roy Wadia, the spokesman for the World Health Organization in China, says it is not clear why the scientists failed to follow regulations and immediately report the finding of bird flu virus to the Ministry of Health.

"Obviously the military scientists involved found out that this was H5N1 quite some time ago.  We don't know exactly when but it was certainly more than a few months ago," Wadia says.  "They apparently did not convey this to the Ministry of Health.  So, there seems to have been an internal communications problem."

China's military hospitals have a history of covering up disease.  During the 2003 SARS outbreak they deliberately undercounted SARS patients.

The cover-up embarrassed China and contributed to the spread of the sometimes-fatal disease, which eventually killed nearly 800 people worldwide.

Wadia says China's surveillance and cooperation in fighting infectious diseases have improved since then.  But, he says it is possible that for every bird flu case correctly diagnosed, there could be other cases that go unfound and undetected because of gaps in the country's overloaded health care system. 

"That would not be surprising in a place like China where the health systems are inconsistent," Wadia said.  "They're strong in some areas, weak in others.  In some areas they don't even exist."

Wadia says it is possible that other cases of bird flu infections prior to 2005 would be discovered in China if more samples were tested. 

The WHO says that two members of a family were found to have bird flu in Hong Kong in February 2003, and one of them died.  They had recently returned from mainland China, where a third relative died of an unidentified respiratory disease.  There have been no other human bird flu cases in Hong Kong since the disease first appeared in 1997. 

Thursday's confirmation brings the total number of reported bird flu cases in China to 20, more than half of which proved fatal.

The disease primarily affects birds, but more than 200 people have contracted it worldwide - almost all of them from sick birds.  Scientists fear that the virus will mutate so that it can be spread easily among humans, leading to millions of deaths.  Bird flu experts have said it is essential to identify all human cases to help track the disease and possible changes to the virus.