Pakistan: Suspected Human Cases December 10 - December 17, 2007

[Treyfish]

Re: Pakistan: Bird Flu claims 2 lives; more suspects

<TABLE id=AutoNumber21 style="BORDER-COLLAPSE: collapse" borderColor=#111111 cellSpacing=0 cellPadding=0 width="98%" border=0><TBODY><TR><TD width="100%" colSpan=3>Avian influenza preventive measures adopted
ISLAMABAD: The Ministry of Health has adopted special preventive measures on the outbreak of influenza in NWFP, official sources said.
The viral transport medium required for the transport of suspected human samples along with related guidelines have been dispatched to the provinces and district health departments, sources added.
The directions have been issued in the wake of high transmission season and the global threat posed by H5N1 Influenza virus.
Meanwhile, the Ministry has advised the provincial and district Governments to adopt recommended measures for preventing and averting any outbreak of avian influenza.
According to sources, the government was also considering registration of poultry farms for having proper monitoring system to check any outbreak of bird flu in the country.
As many as 14 suspected patients were admitted last year in hospitals of Lahore and Islamabad however their blood samples were declared negative by the laboratories.
Total 136 blood samples were sent to laboratory for test and all were found negative.
Total 21 cases were reported in poultry farms last year while 76 in 2005 mainly in wild birds and commercial backyard poultry in the country.
Globally 206 deaths have been confirmed due to bird flu in 12 countries out of 335 suspected cases.
According to health experts the virus may expand from one farm to another and even to population by mechanical means like contaminated equipment, vehicles, feed, bird-cages etc.
They added the fatality rate of disease stands at 70% which is very high.
The symptoms of disease included high fever, cough, aches, running nose and sore throat while pneumonia or other complications may occur at a later stage. - APP
</TD></TR><TR><TD width="90%"> </TD></TR></TBODY></TABLE> http://statesman.com.pk/national/national2.htm

[Treyfish]

Re: Pakistan: Bird Flu claims 2 lives; more suspects

Steps being taken to control Avian Influenza

Islamabad?The National Institute of Health in collaboration with the Ministry of Food, Agriculture and Livestock, the Health Department of NWFP, WHO and UNICEF are taking necessary action to control Avian Influenza out break in NWFP.
The Ministry of Health will maintain this measure to ensure the health and well-being of the population and avert the threat from avian influenza in Pakistan, said a press release issued here on Saturday.
The National Institute of Health has tested patients and contacts suspected for Avian Influenza in late October, 2007. Six cases were found positive for H5N1 Avian Influenza virus, five of them from Abbottabad and one from Mansehra district.
Five of them have fully recovered, one of the confirmed cases died in hospital while his brother who could not be tested has also died.
To avert the potential spread of this infection to humans, the Ministry of Health has implemented the following control activities.
Investigation and sampling of cases and contacts and the organization of active surveillance for the early detection of infection; Ensuring standard treatment to all detected cases and contacts; Identification of isolation wards/rooms in all referral hospitals in the area and the nomination of focal persons to ensure proper case management and early notification of suspected cases; Ensuring an early stock piling of Personal Protective Equipment (PPE), to ensure necessary protection of health providers; Ensuring a preliminary stock of Osaltamivir for prophylaxis and treatment.?APP http://pakobserver.net/news/islamabad07.asp

[Niko]

Re: Pakistan: Bird Flu claims 2 lives; more suspects

Last Updated: December 15, 2007 21:11 EST

Pakistan Has Eight Suspected Human Cases of Bird Flu (Update4)
By Jason Gale


<!-- WARNING: #foreach: $wnstory.ATTS: null at /bb/data/web/templates/webmacro_en/20601080.wm:313.2 --><!-- WARNING: #foreach: $wnstory.ATTS: null at /bb/data/web/templates/webmacro_en/20601080.wm:327.19 --> Dec. 16 (Bloomberg) -- Five members of a family in Pakistan are among eight people who may be the country's first human cases of bird flu, the World Health Organization said. At least one brother died.

Pakistan's national laboratory found the lethal H5N1 avian flu strain caused the infections in three brothers and two cousins from the same family, according to information from a Dec. 15 WHO statement and Gregory Hartl, a WHO spokesman in Geneva. Another brother from the U.S., who attended a funeral for one of the victims, and his son tested negative for the virus at a hospital in Nassau County, New York, Hartl said.

Medical teams have been sent to Pakistan to assist local authorities in investigating the cases, in which two people had only mild symptoms, Hartl said. Doctors are monitoring for signs avian flu may be adapting to humans by killing fewer people, fostering its spread.

``It's too early to make any definitive conclusions'' about the outbreak, Hartl said in a Dec. 15 telephone interview. ``We are still in the middle of it.''

New York State health officials were informed Dec. 7 that a man from Nassau County who had returned from Pakistan told his doctor he might have been exposed to avian flu, said Claudia Hutton, director of public affairs for the state department of health in a telephone interview.


Voluntary Quarantine

The man went into voluntary quarantine at home, Hutton said. Then his son began developing flu-like symptoms. Samples from both the man and his son were tested at state laboratories and at the U.S. Centers for Disease Control and Prevention in Atlanta. The CDC sent an airplane to Albany to pick up the samples, Hutton said.

The samples came back negative for H5N1 avian flu earlier this week, and the man and his son are no longer in quarantine, Hutton said.

``The man did a courteous thing by seeing his physician and saying `I might have been exposed,''' Hutton said. ``In the end, no one in New York is sick.''

Hutton said she didn't know whether the man or his son received antiviral medications. Drugs such as Roche Holding AG's Tamiflu are believed to fight avian flu.

Hutton said that there were erroneous reports on the Internet that another brother of the H5N1-infected family members in Pakistan has returned to the U.S. and tested positive.


`No Risk'

``That's not true,'' she said. ``At this point there's no risk to the public or the individuals.''

CDC officials referred all questions to the New York State health department.

The remaining suspected cases in Pakistan include a man and his niece, and a male who worked on a nearby farm.

Doctors from the WHO in Geneva and Cairo, and from the U.S. Navy Medical Research Unit No. 3 in Cairo will arrive in Pakistan during the next two days to track and stem the disease's spread, and to analyze specimens for any genetic mutations in the virus.

Pakistan has reported 44 H5N1 outbreaks in poultry to the World Organization for Animal Health since early 2006. The most recent occurred on Nov. 27 and Nov. 28 in Punjab and North-West Frontier Province, killing almost 20,000 chickens.

The frequent outbreaks in Pakistan and high density of people meant that it was ``not surprising'' that human cases eventually occurred in that country, Hartl said.


Chickens, Quails

It is too early to determine whether the cases were caused by an animal source or through limited person-to-person spread, he said. Some of the infected people also kept chickens and quails and it is unclear what personal protective equipment was used during culling operations, Hartl said.

Pakistan authorities sent Tamiflu to the affected area to treat cases and prevent further infection, Hartl said.

``Pakistan has been doing everything right'' in terms of tracing people at risk of infection and preventing its spread, Hartl said.

The infections probably began late October in an agriculture ministry official involved in culling diseased poultry on a farm at Abbottabad in North-West Frontier Province, which borders Afghanistan, Hartl said.

The man fell ill and was cared for by two of his brothers, who also became unwell. One of the brothers died about a month ago and was buried before specimens could be taken for a diagnosis. The other died on Nov. 29 and was positive for H5N1 in preliminary tests, Hartl said. Antibody screening on the first man, who recovered, found he'd been infected with H5N1.


U.S. Brother

A third brother was hospitalized for H5N1 infection and also recovered. A fourth brother who lives in the U.S. tested negative for H5N1 after returning to Pakistan for his brother's funeral, Hartl said.

Two cousins, at least one of who is a woman, were positive for H5N1, although they developed only mild symptoms, he said. A man and his niece, who were also involved in culling poultry on either the same or a neighboring farm, have tested positive, Hartl said. The eighth case is a male farm-worker from Mansehra, about 20 kilometers (12 miles) from the other cases, he said.

The suspected Pakistan cases occurred in the Peshawar area of the country and were detected following a series of culling operations in response to outbreaks of H5N1 in poultry, according to the WHO statement. Samples from the cases are being sent to a WHO reference laboratory in Cairo for confirmation and further analysis.

Avian flu has infected at least one person a month in Asia and Africa during the past three years.

At least 340 people in 13 countries have contracted the virus since 2003, WHO said Dec. 14. Three of every five cases were fatal and most were caused by contact with infected poultry, such as children playing with them or adults butchering them or plucking feathers, according to the Geneva-based agency. It says millions could die if the virus becomes as contagious as seasonal flu and touches off a global pandemic.


To contact the reporter on this story: Jason Gale in Singapore at j.gale@bloomberg.net

http://www.bloomberg.com/apps/news?pid=20601087&sid=aVTc75sr5yCM&refer=home

[Laidback Al]

Re: Pakistan: Bird Flu claims 2 lives; more suspects

The National Institute of Health has tested patients and contacts suspected for Avian Influenza in late October, 2007. Six cases were found positive for H5N1 Avian Influenza virus, five of them from Abbottabad and one from Mansehra district.

Note that these confirmed samples were collected from individuals in late October. There seems to be quite a delay in reporting positive/negative test results. It would be beneficial if test results on any suspected cases between November and today were more quickly announced.

[HenryN]

Re: Pakistan: Bird Flu claims 2 lives; more suspects

Yes, it appears that teh more deatiled story presented several days ago, which mentioned the second familial cluster, the samples collected in October, and the November dates for the deaths of the two brothers had the most accurate early information.

[HenryN]

Re: Pakistan: Bird Flu claims 2 lives; more suspects

Sunday, December 16, 2007
ISLAMABAD, Pakistan: International health experts have been dispatched to Pakistan to help investigate the cause of South Asia's first human bird flu cases and determine if the virus was transmitted from person to person, an official and local media said Sunday.
Pakistan's Health Ministry said Saturday six people last month had tested positive for the H5N1 virus and one man had died, but officials have yet to comment on how the disease was transmitted.
The brother of the dead bird flu victim also died, but he had not been tested.
The H5N1 virus has killed at least 208 people worldwide, mostly in Southeast Asia and China, since it began ravaging Asian poultry stocks in late 2003.
So far, most human cases have been linked to contact with sick birds. There have only been a few reported cases of it spreading from human to human, all among blood relatives.
Experts fear the virus could mutate into a form that passes easily among people, potentially sparking a pandemic.
The World Health Organization reported on its Web site that it had been informed of eight cases, not six, in Pakistan. Poultry outbreaks had earlier been reported in the area and slaughtering operations took place, WHO said.
The cases involved several family members. The Health Ministry confirmed two brothers died, but specimens were only collected from one. Another case has fully recovered, the WHO statement said. The condition of the other patients and their relationship to each other were not immediately available Sunday.
A WHO team was scheduled to arrive in Pakistan on Sunday and was expected to visit the affected areas to try to determine how the infections occurred and whether human-to-human transmission could have occurred, Khalif Bile, the WHO representative in Pakistan was quoted as saying in the Dawn newspaper.
A man who had been in contact with the Pakistan cases and then traveled to the United States tested negative for the virus in New York and at the U.S. Centers for Disease Control and Prevention in Atlanta, said CDC spokesman Dave Daigle.
"There was a tie to the suspected human-to-human cases in Pakistan," he said.
A team from the U.S. Naval Medical Research Unit in Cairo was being dispatched to Pakistan to help with the investigation, Daigle said.
People who came into contact with those infected in Pakistan are being monitored, the WHO said.
Bile told The Associated Press on Saturday that preliminary tests had been carried out. He said the WHO was encouraging the government to carry out confirmation tests in the same government laboratory and the results should be available by Tuesday.
A brother of the two men who died in Pakistan said Saturday he had been hospitalized with flu-like symptoms. Mohammed Ishtiaq said he fell ill last month after slaughtering chickens suspected of carrying bird flu at a farm near Abbottabad.
"I was not aware that this was such a dangerous disease," said Ishtiaq, a veterinary doctor who works for a government-funded livestock program. He said he wore no protective clothing.
His two brothers did not accompany him to the farm, but visited him in hospital, Ishtiaq told Associated Press Television News in the village of Sukur.
He identified his brothers as Mohammed Ilyas and Mohammed Idrees and said they were both studying at an agriculture college in the northwestern city of Peshawar.
It was unclear if they had other contact with poultry or another potential sources of infection.
Ishtiaq said a fourth brother, a primary school teacher, also fell ill after visiting him but recovered. He said doctors had taken blood samples from him and other relatives but gave them no results.
The Health Ministry said Saturday it was treating people who had been in contact with those infected, setting up isolation wards in hospitals and procuring drugs for treatment and protective clothing for health workers.
Pakistan has grappled with outbreaks of bird flu in poultry for the past two years, but had previously not confirmed cases in humans.
___
Associated Press medical writer Margie Mason in Hanoi, Vietnam, Zarar Khan in Islamabad and APTN cameraman Inam ur-Rahman in Sukur contributed to this report.

http://www.iht.com/bin/printfriendly.php?id=8762434

[HenryN]

Re: Pakistan: Bird Flu claims 2 lives; more suspects

Commentary at

http://www.recombinomics.com/News/12160701/H5N1_Pakistan_Clusters_3.html

[Sally Furniss]

Re: Pakistan: Bird Flu claims 2 lives; more suspects

<big><big>Commentary</big></big>

Three H5N1 Familial Clusters in Pakistan

Recombinomics Commentary
December 16, 2007

A third brother was hospitalized for H5N1 infection and also recovered. A fourth brother who lives in the U.S. tested negative for H5N1 after returning to Pakistan for his brother's funeral, Hartl said.

Two cousins, at least one of who is a woman, were positive for H5N1, although they developed only mild symptoms, he said. A man and his niece, who were also involved in culling poultry on either the same or a neighboring farm, have tested positive, Hartl said. The eighth case is a male farm-worker from Mansehra, about 20 kilometers (12 miles) from the other cases, he said.

The above detail on the additional cases who were H5N1 laboratory confirmed and described in the WHO update, define two more familial clusters, in addition to the larger cluster of four brothers were lab confirmed or died with bird flu symptoms. All nine of these patients are linked to culling in October. Seven of these patients match earlier reports which described a culler and his daughter, in addition to a hospitalized male.

The presence of three familial clusters linked to the October culling, provides additional support for a more efficient transmission of H5N1, as well as human to human transmission. This analysis would be more precise if disease onset dates were available, but the deaths of the two brothers on November 19 and 29 strongly support a human-to-human mechanism because of the time gaps, and the two brothers were not involved in the cull and a third positive brother was a school teacher.

In addition, media reports describe an initial positive result in a health care worker linked to the cluster, and there is a media report of symptoms in a hospital visitor, who was linked to a patient hospitalized near the two brothers in isolation. In addition, a fifth brother, who flew to Pakistan for the funerals developed flu-like symptoms as did his son. Although they both tested negative for H5N1, follow-up on convalescent antibody levels on these two primary and secondary contacts would be useful.

The large number of cases described above, as well as familial clusters within the clusters highlights a more efficient transmission of H5N1. Two cases said to have been admitted Saturday have also been described, although the lab confirmation has raised questions about when these two patients were admitted. They are geographically linked to the outbreaks in October and may just be another description of the patients admitted earlier.

However, there are at least nine patients who have died or been lab confirmed, raising concerns of a more efficiently transmitted H5N1 in Pakistan.

http://www.recombinomics.com/News/12160701/H5N1_Pakistan_Clusters_3.html

[HenryN]

Re: Pakistan: Bird Flu claims 2 lives; more suspects

WHO praises swift bird flu reporting
<!-- BEGIN STORY BODY -->by Guy Newey 7 minutes ago


<!-- end storyhdr -->HONG KONG (AFP) - The World Health Organisation (WHO) on Sunday praised Asian countries for swiftly reporting the latest bird flu cases after Pakistan and Myanmar were hit by a resurgence of the disease.
Asia-Pacific spokesman Peter Cordingley said prompt notification was helping keep the virus in check after Pakistan announced its first human death and Myanmar revealed its first human case.
"People have learned that hiding cases just makes things worse," Cordingley told AFP.
This month China, which has previously been accused of withholding information, reported its 27th bird flu death and Indonesia, the worst hit country, reached 93.
Outbreaks have also been reported among poultry in Germany and Russia as bird flu, which has killed more than 200 people worldwide since late 2003, re-emerges.
Cordingley warned bird flu was likely to become more prevalent with the onset of the northern hemisphere winter.
"At this time of year, we do expect the virus to be more active in poultry and humans," said Cordingley, who is based in Manila.
"In the same way that you and I are picking up flus, so will birds."
Pakistan on Saturday said a man who culled infected birds had died become the country's first human fatality. The man's brother also died but was not tested for bird flu, officials said without explanation.
Meanwhile a seven-year-old girl became Myanmar's first confirmed human case, although she has since been discharged from hospital after showing signs of recovery.
"This virus is no respecter of borders, so there nothing startling about the latest outbreak," Cordingley said.
"We have always seen more cases in the cooler months, so there is nothing surprising in the developments in Pakistan and Myanmar," he added.
The two cases follow the deaths of a 47-year-old Indonesian and a 24-year-old Chinese man earlier this month.
The Chinese victim's father was also diagnosed with the disease, raising fears over human-to-human infection.
The H5N1 strain has passed from human to human only in very rare cases and scientists fear that such a transmission could become more efficient and widespread through mutation, causing a global pandemic.
Cordingley said the spread of the virus was assisted by migratory patterns of birds, but also illegal trade in poultry, which is a staple food for much of Southeast Asia.
"This virus will continue. We cannot fight it on a public health front, it depends on how farmyards and chickens are raised and that is a long-term fight," he said.

Earlier this month, international donors committed more than 400-million US dollars to fight the disease at a conference in New Delhi.
But the figure fell far short of World Bank projections that said 1.2 billion dollars was needed over the next two to three years to help countries fight the disease.
Cambodia, Laos, Thailand and Vietnam are the other countries that have reported human infections of bird flu in Asia, which has borne the brunt of the disease. So far this year, 51 people have died from the disease, down from 71 in 2006, according to WHO figures.

http://news.yahoo.com/s/afp/20071216/hl_afp/healthfluasia_071216094303;_ylt=A0WTcUXp82RHZVAAUA2TvyIi

[HenryN]

Re: Pakistan: Bird Flu claims 2 lives; more suspects

<TABLE id=topTools cellSpacing=0 cellPadding=0 border=0><TBODY><TR><TD>WHO experts to investigate bird flu concerns in Pakistan</TD></TR></TBODY></TABLE>

ISLAMABAD, Pakistan (AP) ? International health experts have been dispatched to Pakistan to help investigate the cause of South Asia's first human bird flu cases and determine if the virus could have been transmitted from person to person, a World Health Organization official said Sunday.
Four brothers ? two of whom died ? and two cousins from Abbotabad, a small city about 50 kilometers (30 miles) north of Islamabad, were suspected of being infected by the H5N1 virus along with a man and his niece from the same area who had slaughtered chickens, said WHO spokesman Gregory Hartl in Geneva.
Another person in a separate case who slaughtered poultry in nearby Mansehra, 20 kilometers (15 miles) away, also tested positive for the disease, he said.
Details surrounding the cases remained confusing, with Pakistan's Health Ministry issuing a statement Saturday saying six people had initially tested positive for the virus last month, while the WHO said eight had been reported. Hartl said the discrepancy was likely linked to a technicality since six patients had tested positive using an internationally recommended method while a less reliable test was used on the others.
Specimens were never collected from one of the brothers who died, and many of those who tested positive experienced only mild symptoms and were not hospitalized, Hartl said.

He added a team of WHO experts have been sent to Pakistan to help determine the cause. He said all four brothers were believed to have worked on a farm and poultry outbreaks had earlier been reported in the area. He said WHO has not ruled out limited human-to-human transmission.
"It's possible," Hartl said. "We don't know if brothers two and three were cullers or not, and we do know that brothers two and three cared for brother one."
The H5N1 virus has killed at least 208 people worldwide, mostly in Southeast Asia and China, since it began ravaging Asian poultry stocks in late 2003. So far, most human cases have been linked to contact with sick birds.
Another brother who flew to Pakistan to attend one of the funerals then traveled to the United States and tested negative for the virus in New York and at the U.S. Centers for Disease Control and Prevention in Atlanta, said CDC spokesman Dave Daigle.
"There was a tie to the suspected human-to-human cases in Pakistan," he said.
A team from the U.S. Naval Medical Research Unit in Cairo was being dispatched to Pakistan to help with the investigation, Daigle said.
People who came into contact with those infected in Pakistan are being monitored, the WHO said.
Khalif Bile, WHO representative in Pakistan, told The Associated Press on Saturday that preliminary tests had been carried out. He said the WHO was encouraging the government to carry out confirmation tests in the same government laboratory and the results should be available by Tuesday.
A brother of the two men who died in Pakistan said Saturday he had been hospitalized with flu-like symptoms. Mohammed Ishtiaq said he fell ill last month after slaughtering chickens suspected of carrying bird flu at a farm near Abbottabad.
"I was not aware that this was such a dangerous disease," said Ishtiaq, a veterinary doctor who works for a government-funded livestock program. He said he wore no protective clothing.
His two brothers did not accompany him to the farm, but visited him in a hospital, Ishtiaq told Associated Press Television News in the village of Sukur.
He identified his brothers as Mohammed Ilyas and Mohammed Idrees and said they were both studying at an agriculture college in the northwestern city of Peshawar.
It was unclear if they had other contact with poultry or another potential sources of infection.
Ishtiaq said a fourth brother, a primary school teacher, also fell ill after visiting him but recovered. He said doctors had taken blood samples from him and other relatives but gave them no results.
The Health Ministry said Saturday it was treating people who had been in contact with those infected, setting up isolation wards in hospitals and procuring drugs for treatment and protective clothing for health workers.
Pakistan has grappled with outbreaks of bird flu in poultry for the past two years, but had previously not confirmed cases in humans.
__
Associated Press medical writer Margie Mason in Hanoi, Vietnam, Zarar Khan in Islamabad and APTN cameraman Inam ur-Rahman in Sukur contributed to this report.
Copyright 2007 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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<!--Bibliography End--><TABLE cellSpacing=0 cellPadding=0 width="100%" border=0><TBODY><TR><TD class=font-cn> </TD></TR><TR><TD class=font-cn>Find this article at:

http://www.usatoday.com/news/health/2007-12-16-pakistan-birdflu_N.htm

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[Treyfish]

Re: Pakistan: Bird Flu claims 2 lives; more suspects

Human transmission feared in Pakistan bird flu case

Updated Sun. Dec. 16 2007 8:34 AM ET
The Associated Press
<!-- dateline -->ISLAMABAD<!-- /dateline --> -- International health experts have been dispatched to Pakistan to help investigate the cause of South Asia's first outbreak of bird flu in people and determine if the virus could have been transmitted through human contact, officials said Sunday.
Four brothers -- two of whom died -- and two cousins from Abbotabad, a small city about 50 kilometres north of Islamabad, were suspected of being infected by the H5N1 virus, said WHO spokesman Gregory Hartl in Geneva. A man and his niece from the same area who had slaughtered chickens were also suspected of having the virus.
Another person in a separate case who slaughtered poultry in nearby Mansehra, 24 kilometres away, also tested positive for the disease, he said.
Details surrounding the cases remained confusing, with Pakistan's Health Ministry issuing a statement Saturday saying six people had initially tested positive for the virus last month, while the WHO said eight had been reported. Hartl said the discrepancy was likely linked to a technicality since six patients had tested positive using an internationally recommended method while a less reliable test was used on the others.
Specimens were never collected from one of the brothers who died, and many of those who tested positive experienced only mild symptoms and were not hospitalized, Hartl said.
He added a team of WHO experts have been sent to Pakistan to help determine the cause. He said all four brothers were believed to have worked on a farm and poultry outbreaks had earlier been reported in the area. But one brothers, Mohammed Tariq, said only one sibling worked on the farm.
Hartl said WHO has not ruled out limited human-to-human transmission.
"We can't answer that yet," he said. "It's possible."
The H5N1 virus has killed at least 208 people worldwide, mostly in Southeast Asia and China, since it began ravaging Asian poultry stocks in late 2003. So far, most human cases have been linked to contact with sick birds.
A team from the U.S. Naval Medical Research Unit in Cairo was being dispatched to Pakistan to help with the investigation, said Dave Daigle, a spokesman for the U.S. Centers for Disease Control and Prevention in Atlanta.
Khalif Bile, WHO representative in Pakistan, told The Associated Press on Saturday that preliminary tests had been carried out. He said the WHO was encouraging the government to carry out confirmation tests in the same government laboratory and the results should be available by Tuesday.
People who came into contact with those infected in Pakistan are being monitored, the WHO said.
A brother of the two men who died in Pakistan said Saturday he had been hospitalized with flu-like symptoms. Mohammed Ishtiaq said he fell ill last month after slaughtering chickens suspected of carrying bird flu at a farm near Abbottabad.
"I was not aware that this was such a dangerous disease," said Ishtiaq, a veterinary doctor who works for a government-funded livestock program. He said he wore no protective clothing.
His two brothers did not accompany him to the farm, but visited him in a hospital, Ishtiaq told Associated Press Television News in the village of Sukur.
He identified his brothers as Mohammed Ilyas and Mohammed Idrees and said they were both studying at an agriculture college in the northwestern city of Peshawar.
It was unclear if they had other contact with poultry or another potential sources of infection.
Muqarab Khan, director general of livestock and animal husbandry in the province, said animal surveillance was under way across the province.
Poultry vaccine campaigns also have been started and all farms in the surrounding area have been closed.
Pakistan has grappled with outbreaks of bird flu in poultry for the past two years, but had previously not confirmed cases in humans. http://www.ctv.ca/servlet/ArticleNew...1216?hub=World

[Treyfish]

Re: Pakistan: Bird Flu claims 2 lives; more suspects

First bird-flu death confirmed
ISLAMABAD: Pakistan on Saturday confirmed that a man who worked on a poultry farm with infected birds has become the country's first death from the bird flu virus.
One of the man's brothers also died but he was not tested for the virus, the health ministry said in a statement. It did not say why the second man was not tested.
Six people were confirmed to have been infected with the H5N1 strain of avian influenza, all of them in North West Frontier Province, the ministry said.
"Five of them have fully recovered. One of the confirmed cases died in hospital while his brother, who could not be tested, has also died," the statement said.
A spokesman told AFP that the confirmed victim, Muhammad Tariq, had been involved in a cull of birds at an infected poultry farm in late October.
Three of his brothers were also admitted to hospital and one, named Mohammad Ilyas, also died.
"We are not certain how Ilyas died because we could not conduct his testing," the spokesman said.
Hospital officials in Peshawar told AFP that Tariq died late last month, a few days before his brother, who was admitted with similar symptoms but was not tested for the virus. - AFP http://statesman.com.pk/topnews/topnews9.htm

[Treyfish]

Re: Pakistan: Bird Flu claims 2 lives; more suspects

<CENTER>Editorial-Bird flu in humans now
</CENTER>

LAST year, when the H5N1 virus was first detected among poultry at two farms in the NWFP, it was feared that the emergence of avian flu in people in contact with diseased birds was not far off. With the confirmation of seven human cases of bird flu in recent days, that nightmare has come to pass. It has also been confirmed that bird flu was responsible for at least one of two recent deaths linked to it. More ominously, it is being investigated whether the deaths were cases of human-to-human transmission, especially as the dead men were related to two others suffering from bird flu. It is rare for the infection to spread in this way and so far there have been only three such cases worldwide. However, it is not impossible, and if this mode of transmission is confirmed, there would be good reason to fear that the virus is mutating to a point where people could catch the infection from one another quite easily. Such a situation would have horrendous implications for the spread of a disease which medicine cannot cure and that has caused more than 200 human fatalities globally since 2003.

Extreme precaution in handling birds at poultry farms, where most outbreaks of bird flu occur, coupled with an effective infection control strategy devised by the health authorities in consultation with international experts, is needed if the threat is to be warded off. Such a strategy should include easy and quick access (especially where vulnerable populations such as poultry workers are concerned) to antiviral drugs like Tamiflu which can reduce the severity of the symptoms and limit complications. Moreover, nothing should be left to chance, and even the detection of a single case among poultry at a farm should result in the culling of the entire stock. Obviously, commercial poultry farmers would feel the financial pinch of such a step and may not always report the infection. It is essential, therefore, for inspections and monitoring of poultry farms to be stepped up, and also to regulate their numbers. More attempts to create general awareness, without spreading undue alarm, remains a priority, and regular information on the subject will help people realise that bird flu may go beyond being merely an occupational hazard.

http://www.dawn.com/2007/12/16/ed.htm#2

[Theresa42]

Re: Pakistan: Bird Flu claims 2 lives; more suspects

He identified his brothers as Mohammed Ilyas and Mohammed Idrees and said they were both studying at an agriculture college in the northwestern city of Peshawar.

Well, this doesn't help to make anything clearer. This raises the possibility that the two brothers were infected at college. By way of example, there was an outbreak of bf in poultry in an agriculture college in Egypt a while back (I'll try to find the reference).

Edit: Well, I can't find anywhere that an H5N1 outbreak was confirmed at the agricultural college in Egypt that I was thinking of, but there were suspicions back in Feb '06:

"Testing of birds in Cairo University, Agriculture College farm, following the report of 134 dead birds."

http://www.emro.who.int/PDF/AI_SituationReport_21Feb05.pdf

[HenryN]

Re: Pakistan: Bird Flu claims 2 lives; more suspects

Family in Pakistan infected with bird flu

Provided by: Canadian Press
Written by: Helen Branswell, Medical Reporter , THE CANADIAN PRESS
Dec. 15, 2007

http://chealth.canoe.ca/channel_health_news_details.asp?news_id=23782&news_channel_id=1020&channel_id=1020

Authorities in Pakistan announced the country's first reported human cases of H5N1 avian flu Saturday in a cluster of family members which may have involved person-to-person transmission.
There was some confusion Saturday about how many people had tested positive for the virus, with Pakistan announcing six cases but the World Health Organization saying eight suspected cases had been identified.
The WHO said confirmatory testing must still be done. And a spokesperson for the agency said investigations are underway to try to determine how the various people became infected, but noted some human-to-human spread may have occurred.

"We can't rule it out," Gregory Hartl said from Geneva.

"There are other plausible explanations.... We don't know enough at this point. And in some of these cases, one never will know enough."
The cluster of cases involved four brothers and two cousins living in the country's North-West Frontier Province. Two of the brothers died, one without having been tested.
While the brothers who died are believed to have had at least some exposure to infected poultry, they were also known to have nursed the first case in the family, a brother who worked as a livestock official.
A doctor who treated members of the family also has tested positive for H5N1, but with a non-standard diagnostic test, Hartl said. He cautioned that further testing is needed to determine if she is indeed a case, noting she hadn't shown signs of infection.
Three people who are unrelated to the family but who were involved in culling H5N1-infected poultry in the same area have also tested positive; all are still alive. At least one of the cullers worked on the same farm as the livestock official.
Meanwhile, U.S. public health authorities have confirmed they conducted H5N1 testing on a man who had recently visited Pakistan and was complaining of mild respiratory symptoms. The man, who officials will only identify as having a link to the cluster, is said to have been concerned he might have been infected.
"The individual went to his private physician after returning from Pakistan, and discussed this with his physician," said Claire Pospisil, a spokesperson for the New York State department of health.
Pospisil said the doctor contacted the local health department in Nassau County, where the man lives, and they collected samples for testing. The tests came back negative.
David Daigle, a spokesperson for the U.S. Centers for Disease Control, said the CDC sent its plane to Albany on Dec. 8 to collect specimens for confirmatory testing. Within hours a CDC lab verified the state lab's findings.
"He was negative. There was no doubt about it," Daigle said from Atlanta on Saturday.
The initial infection in this family dates back to late October, when the livestock official became sick. It appears that it was only after two of the man's brothers fell ill and died that testing was done looking for H5N1 infection. It is believed the first positive test was received in late November.
The WHO was officially alerted Dec. 12, Hartl said.
"We feel that the Pakistanis have done everything right in terms of their response," he said, noting the country has done a "huge" amount of work to strengthen infection control and increase surveillance.
"(But) yes, they could have alerted us earlier."
Hartl said Pakistan has agreed to send specimens to the U.S. Naval Medical Research Unit in Cairo - a laboratory known as NAMRU-3 - for confirmatory testing. Those specimens are expected to be shipped Monday, he said.
In addition, people who have had contact with the cases are being traced and monitored, with close contacts being issued the antiviral drug oseltamivir (Tamiflu).
Experts from the NAMRU-3 lab are travelling to Pakistan this weekend and WHO is sending a team of two doctors with experience treating H5N1 patients as well as an epidemiologist to help with the investigation of cases.
Hartl said there don't appear to be any new infections within the family group. But he warned it is too soon to say whether this outbreak is similar to other small clusters of cases among family members or represents something larger.
"We're on our toes still, because we're still in the middle of it. We don't have enough information yet. It's not over."
Dr. Timothy Uyeki, a H5N1 expert with the CDC, cautioned against drawing premature conclusions.
"Anywhere highly pathogen influenza A/H5N1 viruses are circulating among poultry and people have direct and close contact with sick or dead poultry or poultry that are infected or wild birds that are infected, there is the potential for human cases," Uyeki said.
Small, self-limiting clusters of cases - virtually always among family members with blood ties - have occurred in many of the countries which have had human H5N1 infections, including Thailand, Vietnam, Indonesia, China, Turkey, Azerbaijan and Egypt.
While in most cases it can be almost impossible to tease out whether related cases were infected because they shared exposure to an environmental source of the virus - infected chickens, for example - in a number of cases the time gap between the onset of illness among relatives has been suggestive of human-to-human spread.
The statement from Pakistan's Health Ministry announced six infections, with five people having recovered. It was unclear who the country was counting as cases in that report.
But that figure would not include the brother who died without being tested. While his symptoms and his exposure history make H5N1 infection seem probable, without test results he cannot be added to the official case count.
Pakistan is the 14th country to announce human infections with the H5N1 virus. If these cases are confirmed, they will bring the global case count since late 2003 to nearly 350 human cases and 209 deaths.
The Pakistan outbreak is part of a flurry of recent H5N1-related human cases.
On Friday, the WHO announced that Myanmar had reported its first human case in a seven-year-old girl who fell ill in late November. She has since recovered.
Earlier this month, China reported infections in a son and father from Jiangsu province; the son died. And in recent weeks Indonesia, the country hardest hit by H5N1, has reported several human cases.
Experts who study H5N1 have come to expect this kind of upswing in viral activity at this time of year, both in poultry and in people.
"If you look at the period since November 2003 to the present we have seen increases in human H5N1 cases that are reported towards the end of the year and the early part of the new year," Uyeki said.
"And therefore it would not be surprising to begin to see an increase in human cases over the next several months."