WHO Suspects H2H BF Tranmission

[moonstar]

http://news.yahoo.com/s/nm/20060524/wl_nm/birdflu_dc

[Guest Guest]

Updated... (It says 35 minutes ago... about 6:30 AM - 5/24/06)

 

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No sign of bird flu mutation in Indonesia case: WHO By Diyan Jari

35 minutes ago

 

Limited human-to-human transmission of bird flu might have occurred in an Indonesian family but there is no evidence the virus has mutated to allow it to pass easily among people, the World Health Organization said.

 

Fears of human-to-human transmission pushed down European shares and boosted demand for safe-haven bonds on Wednesday, lifting benchmark Bund futures to their highest in more than six weeks. The dollar rose against the yen.

 

Concern has been growing about the case in north Sumatra in which seven family members from a village died this month. The case is the largest family cluster known to date, the WHO has said.

 

The WHO and Indonesian health officials are baffled over the source of the infection but genetic sequencing has shown the H5N1 bird flu virus has not mutated, the UN agency said on its Web site (http://www.who.int) on Tuesday. Nor was there any sign of the virus spreading among other villagers.

 

"To date, the investigation has found no evidence of spread within the general community and no evidence that efficient human-to-human transmission has occurred, the WHO said.

 

"Sequencing of all eight gene segments found no evidence of genetic reassortment with human or pig influenza viruses and no evidence of significant mutations," the WHO statement read.

 

"The human viruses from this cluster are genetically similar to viruses isolated from poultry in North Sumatra during a previous outbreak."

 

Sick poultry have been the source of bird flu infections for the vast majority of human cases worldwide. The virus can also infect pigs.

 

Clusters are looked on with far more suspicion than isolated infections because they raise the possibility the virus might have mutated to transmit efficiently among humans.

 

That could spark a pandemic, killing millions of people.

 

Financial markets have become worried after the WHO said one of the family members, a 32-year-old father, died on Monday after caring for his ailing son, who also died.

 

The agency said such close contact was considered a possible source of infection.

 

WORRYING

 

"This is the most significant development so far in terms of public health," Peter Cordingley, spokesman for the West Pacific region of the WHO, told Reuters Television in the Philippine capital on Wednesday.

 

"We have never had a cluster as large as this. We have not had in the past what we have here, which is no explanation as to how these people became infected."

 

"We can't find sick animals in this community and that worries us," he added.

 

Bird flu has killed 124 people in ten countries since it re-emerged in Asia in 2003. It remains essentially a disease in birds and has spread to dozens of countries in wild birds and poultry.

 

Limited transmissions between people -- the result of very close and prolonged contact when the sick person is coughing and probably infectious -- are very likely to have occurred before in Hong Kong, Vietnam, Thailand and Indonesia.

 

Close contact also occurred in the Sumatran family, the WHO said, giving its first details of the case.

 

So far, investigators know that a woman, known as the initial case, appeared to have been the first to become ill at the end of April. She died in early May and was buried before samples could be taken from her body.

 

"Preliminary findings indicate that three of the confirmed cases spent the night of 29 April in a small room together with the initial case at a time when she was symptomatic and coughing frequently," the WHO Web statement on Tuesday reads.

 

"All confirmed cases in the cluster can be directly linked to close and prolonged exposure to a patient during a phase of severe illness. Although human-to-human transmission cannot be ruled out, the search for a possible alternative source of exposure is continuing," the WHO said.

 

Markets are also nervous about a suspected family cluster in Iran.

 

An Iranian medical official told Reuters on Monday that a 41-year-old man and his 26-year-old sister from the northwestern city of Kermanshah had tested positive for bird flu.

 

But Health Minister Kamran Lankarani denied this although international health officials are still investigating.

 

The two siblings were among five members of a family who became sick and the other three remain in the hospital.

 

http://news.yahoo.com/s/nm/20060524/wl_nm/birdflu_dc

 

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I'm sorry, but I hesitate to believe *anything* too quickly. They sure don't want to start a panic.

 

And the only reason I would imagine our government might send Tamiflu to Indonesia would be to try and *stop* something, and/or see if it *works* against it.

 

Humanitarian aid and scientific investigation.

 

 

[PlanoPa]

Extended Human to Human H5N1 Trasmission in North Sumatra

 

Recombinomics Commentary

May 23, 2006

 

The case occurred in a 32-year-old man. He developed symptoms on 15 May and died on 22 May.

 

The case is part of a family cluster in the Kubu Sembelang village, Karo District, of North Sumatra.

 

His 10-year-old son died of H5N1 infection on 13 May. The father was closely involved in caring for his son, and this contact is considered a possible source of infection.

 

Although the investigation is continuing, preliminary findings indicate that three of the confirmed cases spent the night of 29 April in a small room together with the initial case at a time when she was symptomatic and coughing frequently. These cases include the woman's two sons and a second brother, aged 25 years, who is the sole surviving case among infected members of this family. Other infected family members lived in adjacent homes.

 

The above WHO description of the North Sumatra familial cluster suggests that H5N1 bird flu was transmitted human-to-human (H2H) through three generations. Most H2H of H5N1 has a 2-4 day incubation period, which explains the 5-10 day gap between the index case and other family members in the vast majority of clusters since 2004. The incubation range would explain all of the transmissions in the above Indonesian cluster.

 

The index case developed symptoms on April 27 and was symptomatic and coughing on April 29 when she could have infected her two sons (19M and 18M) and one brother (25M) generating H2H.. Media reports indicated they developed symptoms at the beginning of May, consistent with a 2-4 day incubation period. Disease onset dates were not included in the earlier WHO update.

 

The index case died May 4 so additional family members could have been infected at that time by the members who developed symptoms at the beginning of May. The new infections would extend the chain to H2H2H. Included would have be the nephew of the index case (10M) who died May 13. The nephew could have then infected his father (32M) who developed symptoms on May 15. This last infection would extend the chain to H2H2H2H.

 

The above scenario requires no tortured logic or unusual incubation times. This is in marked contrast to WHO updates, which tried to explain clusters using common source and incubation times that fell outside of the 2-4 day period, which explains the extended chain above.

 

One earlier example was in late December of 2004. It also involved a family gathering and the cases were linked to duck blood pudding. However, the index case developed symptoms one day after the meal, which requires an unusually short incubation time. His brother developed symptoms 17 days after the meal, requiring an unusually long incubation. The brother-in-law who was the third person to eat the pudding developed no symptoms or detectable antibody. A third brother who did not eat the pudding did develop antibodies. The epidemiological data clearly pointed away from the duck blood pudding as a source, yet WHO subsequently used the 17 day incubation period as an outside value for incubation times.

 

The same logic was applied to another cluster that also involved duck blood pudding. The index case developed symptoms 5 days after the meal and his younger sister developed symptoms 10 days after the meal. The older sister who also had the pudding developed no symptoms or detectable antibody, but the grandfather who did not eat the pudding had antibodies and the nurse of the index case developed symptoms and was H5N1 positive. Another nurse also developed symptoms, but she tested negative.

 

These two clusters and almost all familial clusters from Vietnam, Thailand, Cambodia, Indonesia, China, Turkey, Iraq, and Azerbaijan have the same 5-10 day gap and are readily explained using a 2-4 day incubation period coupled with transmission 2-6 days after symptoms.

 

The H5N1 transmission chain of H2H2H2H is among the longest reported, and generates yet another signal indicating the H2H transmission within families is common and several recent clusters are uncommonly large and have uncommonly long H2H transmission chains.

 

The H2H transmission placed the pandemic phase at four or higher over a year ago and the "proof" of H2H has been in the disease onset dates in the WHO updates since early 2004.

 

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This is written by Dr. Niman at recombinomics...he is a leading professional in AI. I have to pay attention to him more that I do WHO and CDC. He is very straight forward and he tells it like it is over at Fluwiki where he is a regular poster.

There are so many conflicting reports coming out of that area and the natives are not at all trusting nor helpful to the WHO team. At this point, I am just holding my breath on this and like you Cat, I believe there has to be a good reason for us to let go so quickly of that Tamiflu stockpile....I don't think they are telling the entire story yet.

 

Q