Tuesday, May 23, 2006

Bird Flu : 1st Human to Human cases reported

There is now growing concern over several cases of the H5N1 flu in Indonesia (Sumatra)in which it appears that the virus may have adapted to human to human transmission (reported in Bloomberg.com) .
"In one case, a 10-year- old boy who caught the virus from his aunt may have passed it to his father, the first time officials have seen evidence of a three-person chain of infection, an agency spokeswoman said. Six of the seven people have died."
At this point no one knows if any mutations have occured.

"So far, studies of the Sumatran outbreak and genetic analyses of the virus don't indicate the virus has undergone major changes, Cheng said. Scientists at WHO-affiliated labs in the U.S. and Hong Kong found no evidence that the Indonesian strain of H5N1 has gained genes from pigs or humans that might change its power or spreading ability, WHO said."

"Almost all of the 218 cases of H5N1 infections confirmed by the WHO since late 2003 can be traced to direct contact with sick or dead birds. Strong evidence of human-to-human transmission may prompt the global health agency to convene a panel of experts and consider raising the pandemic alert level, said Maria Cheng, an agency spokeswoman.

``Considering the evidence and the size of the cluster, it's a possibility,'' Cheng said in a telephone interview. ``It depends on what we're dealing with in Indonesia. It's an evolving situation.''

"Health officials earlier found strong evidence of direct human-to-human spread of H5N1 in Thailand in 2004. Scientists reported in the Jan. 27, 2005, issue of the New England Journal of Medicine that the H5N1 virus probably spread from an 11-year- old girl in Thailand to her aunt and mother, killing the mother and daughter. People who had more casual contact with the girl didn't become infected.

In the Sumatran cluster, close, direct contact with a severely ill person was also needed for spread, Cheng said. Preliminary findings from the investigation indicate that the woman who died, considered to be the initial case, was coughing frequently while the three others spent the night in the same room. One of the three, a second brother, is the sole survivor. The other two, her sons, died."

``It looks like the same behavior pattern'' of close contact and caretaking during illness with the bird flu virus, Cheng said. To raise the level of pandemic alert ``i

t would have to be transmissible from more casual contact.''

Indonesia is the worlds 2nd largest country and like China, the worlds largest, there is an abundant bird population in close association with people. If this is the start of human to human transmission then look for cases to turn up in it's neighbors ( Australia and Asia). I would guess that those countries with more 3rd world medical facilities would show up first, since ICU protocols would isolate prolonged close human contact. Something that at least for now, seems necessary.

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