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

[HenryN]

Re: Possible Human H5N1 Infections in Pakistan Reported

We still have not received any response from that news organization.

Even Promed is on board

AVIAN INFLUENZA, HUMAN (163): PAKISTAN FIRST REPORT
************************************************** *
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Thu 13 Dec 2007
Source: onlinenews.com, Islamabad [edited]
<http://www.onlinenews.com.pk/details.php?id=121912>


Bird Flu claims 2 lives in Mansera
----------------------------------
For the first time in the history of Pakistan, Bird Flu influenza has
been confirmed among human beings after 2 brothers died at a local
hospital in Peshawar.

According to a spokesman of the Health Ministry, 2 brothers working in
a poultry farm in Mansera suffered flu a few days back that later
turned [out] to be critical in the form of Bird Flu influenza (H5N1).
They were admitted to a local hospital in Peshawar where on Monday [10
Dec 2007] they died.

After the blood samples of both the brothers were sent for formal
testing in a Laboratory, it was found that both brothers died due to
Bird Flu virus (H5N1).

It is [worth] mentioning that this is the first case of human loss in
the history of Pakistan where a person died due to Bird Flu. On the
other hand, the spokesman of the Health Ministry confirmed the death
due to Bird Flu adding both the brothers were working in a poultry
farm in Mansera and had direct links with the chickens that resulted
in the transformation [transmission?] of the virus (H5N1).

It may be recalled that 208 people lost their lives around the world
due to the virus (H5NI). Indonesia, Malaysia, Philippines, China, Vietnam,
Egypt & South Asian States are among the bird flu affected countries.

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[This is the first report of human cases of H5N1 avian influenza
virus infection in Pakistan, and indeed in the Indian Sub-continent.
Confirmation of the diagnosis by an independent laboratory is
awaited. No information is provided in this report on the presence of
disease in poultry or of the the occurrence of non-fatal cases of
human avian influenza.

An interactive HealthNet map of Pakistan can be accessed at
<http:// healthmap.org/promed?v=30,69.4,5>.
Mansera is close to Peshawar in the north of Pakistan. - Mod.CP]

[yielddude]

Re: Pakistan: Bird Flu claims 2 lives

Hospitals put on alert



By Muhammad Qasim
12/14/2007
Rawalpindi

The National Institute of Health (NIH), Islamabad, has advised health departments at both provincial and federal levels to be ready to deal with any untoward situation after confirmation of avian influenza virus in birds in various parts of the country.

The letter that Rawalpindi General Hospital has received from NIH says that during last two to three weeks, a number of avian influenza outbreaks have been reported from Islamabad, Murree, Abbottabad, Mansehra and adjoining areas. ?The environmental sampling shows high concentration of H5N1 influenza virus which posed a serious threat to human health as well,? stated the letter.

A top official, who wanted his name not to be mentioned, told ?The News? on Thursday that the NIH has advised hospitals to be ready for any untoward situation and ensure all necessary measures including facilities for effective management and care of expected bird flu victims. ?Adequate stock of Tami flu, ventilators, nursing and personal protective equipment should be ensured,? adds the letter. Tami flu can reduce severity and duration of illness caused by avian influenza.

Rawalpindi General Hospital (RGH) Chief Dr. Habib Ahmed Khan, when contacted by ?The News,? confirmed that the hospital had received directions from the NIH for clinical management of avian influenza and infection control. ?I am about to circulate among staff a protocol for handling and treatment of patients with strain of avian influenza. We would soon identify wards which would be isolated in case of bird flu outbreak in the city,? he said while responding to a query.

The greatest disaster involving the virus was the ?Spanish flu? outbreak in 1918 that claimed 20 million to 50 million lives around the world. The most effective way of fighting avian influenza at present available to man is destruction of infected birds or those at risk of infection.

http://www.thenews.com.pk/print1.asp?id=86157

[HenryN]

Re: Pakistan: Bird Flu claims 2 lives

Commentary at

http://www.recombinomics.com/News/12130704/H5N1_Pakistan_Alert.html

[HenryN]

Re: Pakistan: Bird Flu claims 2 lives

http://www.thenews.com.pk/print1.asp?id=86156

Education for poultry workers
By Shahina Maqbool

Islamabad

The deaths of two brothers of a veterinarian, who acquired the deadly H5N1 Avian Influenza virus after coming into contact with infected poultry at a farm in Abbottabad late-October, and the recent hospitalisation of a Mansehra-based poultry handler who has also tested positive for the disease, provide sufficient evidence for the government to institute concrete measures for interruption of human transmission of the disease from birds to poultry handlers and their close contacts.

Of the 40 suspected human samples collected from Peshawar and Abbottabad in the wake of the first-ever confirmed human transmission of H5N1 in Pakistan, 36 have tested negative, while four are positive, investigations conducted by ?The News? have revealed.

This is the first time that human cases have been reported in Pakistan, placing an onerous responsibility on the government and its partners to eradicate some of the dangerous trends in the poultry industry that could spell disaster for the country.

It is learnt that both the veterinarian, Dr. Ishtiaq Durrani, who is working as livestock production officer at the Department of Livestock and Dairy Development, NWFP, as well as the poultry handler from Mansehra, did not follow the recommended protective measures while handling infected birds. They may either have come into contact with the saliva, nasal excretions and faeces of the infected birds, or the feed and water that are given to them.

Dr. Ishtiaq was involved in culling of 3,000 birds following the October 21 outbreak of bird flu at a poultry farm in Abbottabad. The other victim from Mansehra happens to be a daily wage labourer who was commissioned for culling without being advised on how he should protect himself. The labourer?s daughter, along with another male, is also under observation at a hospital in Abbottabad.

While Dr. Ishtiaq himself is on the path to recovery, his brothers Mohammad Ilyas Durrani and Mohammad Owais Durrani ? both of who were attending him at the Khyber Teaching Hospital during his illness ? died on November 19 and November 29, respectively. The symptoms of avian flu infection in humans include muscle aches, fatigue, fever, coughing, sneezing, sore throat and eye infections. In severe cases, infection may lead to fatal pneumonia, blood disorders and multiple organ failure.

Ilyas has been confirmed as being the first casualty of H5N1 in Pakistan. Even though his brother?s blood sample could not be collected, health experts talking to ?The News? said clinical evidence suggests that he too succumbed to the deadly virus. The blood samples of two of the three brothers were received by the National Institute of Health on October 28.

The engagement of daily wage labourers for culling ? a task that should not be performed without observing strictest possible protective measures ? is criminal, to say the least. It is na?ve to expect a labourer to be aware of the health risks involved in the activity.

The government needs to appoint trained workers for swift and complete culling of infected poultry in the event of an outbreak. It must also make arrangements for prompt payment of dues to such workers so that they perform their job with diligence.

Since testing of human samples is a costly affair, it is better to adopt protective measures rather than expecting all persons engaged in culling and handling of birds to be tested. Measures to restrict the movement of infected birds should also be enforced, along with licensing and regular inspections of poultry farms. At present, anyone can open a poultry farm by obtaining a certificate from the relevant ministry.

Avian Infleunza is primarily a disease of birds and under normal circumstances, does not affect humans. However, people who are exposed to infected poultry are at a risk of contracting the virus because the infected birds shed large amounts of virus in their droppings. It is, therefore, essential to ensure that poultry farm workers, particularly those handling birds or engaged in their culling, take due precautions. Before retuning home, they should change their clothes and properly disinfect their bodies so that they do not carry the infection with them.

Poultry workers also need to be educated on prompt identification of infected birds. Some of the key symptoms of sick birds are difficulty in respiration; decrease in weight; loss of hunger; falling of wings; decrease in number of eggs; tremors; diarrhoea; head tilt and paralysis; and, staggering. Given the role of sick chicken in the transmission of the disease from birds to humans, the government must direct all its energies and resources towards stopping the spread of the disease in poultry through improved surveillance and biosecurity measures.

Meanwhile, the NIH is reported to have sought the assistance of the World Health Organisation for confirmation of results and establishment of epidemiological links between the recent episodes. The Centres for Disease Control-Atlanta has also offered its services for provision of necessary tests and investigations, ?The News? has learnt on good authority.

The NIH has also instructed the provincial and districts governments to follow the recommended preventive measures in view of the high transmission season of Avian Influenza, as previously reported in the media. The viral transport medium required for the transport of suspected human samples, as well as protective gears and medicines, have also been dispatched to over 22 identified high-risk districts. </TD></TR></TBODY></TABLE>

[yielddude]

Re: Pakistan: Bird Flu claims 2 lives

So the doctor (vet) contracts AI. His two brothers that are caring for him then contract AI, and both die, though ten days apart (I'm assuming one of them was able to fight off the disease longer than the other). And then in addition to those three brothers, there are 4 others (out of 40) that also tested positive for AI.
Does this sound right?
Sounds like enough news is starting to come out of Pakistan, that they won't be able to keep much of a lid on it now?

[HenryN]

Re: Pakistan: Bird Flu claims 2 lives

Commentary at

http://www.recombinomics.com/News/12130705/H5N1_Pakistan_H2H.html

[Theresa42]

Re: Pakistan: Bird Flu claims 2 lives

So the doctor (vet) contracts AI. His two brothers that are caring for him then contract AI, and both die, though ten days apart (I'm assuming one of them was able to fight off the disease longer than the other). And then in addition to those three brothers, there are 4 others (out of 40) that also tested positive for AI.
Does this sound right?
Sounds like enough news is starting to come out of Pakistan, that they won't be able to keep much of a lid on it now?

I think it's 4 totally: the vet, his two brothers and the poultry worker from Mansehra.

[Shannon Bennett]

Re: Pakistan: Bird Flu claims 2 lives

H2H does look likely here. Not the first time we have seen this happen. The veterinarian culls chickens in late October, his brothers care for him and die 10 days apart with the last one dying a few days ago.

[HenryN]

Re: Pakistan: Bird Flu claims 2 lives

I think it's 4 totally: the vet, his two brothers and the poultry worker from Mansehra.

I think there are at least five (four positives and one who died without testing), but there are six hospitalized (Vet and two dead brothers plus another culler, his daughter, and another male). Thus, there are six or seven who are positive, or dead with symptoms, or hospitalized - presumably with symptoms.

[Theresa42]

Re: Pakistan: Bird Flu claims 2 lives

I think there are at least five (four positives and one who died without testing), but there are six hospitalized (Vet and two dead brothers plus another culler, his daughter, and another male). Thus, there are six or seven who are positive, or dead with symptoms, or hospitalized - presumably with symptoms.

I'm so confused. Lemme look at the article again!

[HenryN]

Re: Pakistan: Bird Flu claims 2 lives

I'm so confused. Lemme look at the article again!

I think the timeline is something like this

Oct 21-23 - 3000 birds culled
Oct 27 - 40 samples colected for testing
early November 4 of 40 are positive
culler hospitalized one positive
vet hospitalized - another positive
vet brother dies Nov 19 - no sample collected
vet brother dies - Nov 29 maybe one poistive
culler's duaghter hospitalized no result
male hospitalized - maybe the fourth positive

[Niko]

Re: Pakistan: Bird Flu claims 2 lives

I think there are at least five (four positives and one who died without testing), but there are six hospitalized (Vet and two dead brothers plus another culler, his daughter, and another male). Thus, there are six or seven who are positive, or dead with symptoms, or hospitalized - presumably with symptoms.

I still think it is four - 3 confirmed with samples; 1 presumed confirmation based upon clinical and exposure. No mention of test results for daughter and "other male" in cluster with poultry culler.

Ilyas has been confirmed as being the first casualty of H5N1 in Pakistan. Even though his brother?s blood sample could not be collected, health experts talking to ?The News? said clinical evidence suggests that he too succumbed to the deadly virus. The blood samples of two of the three brothers were received by the National Institute of Health on October 28.

[Theresa42]

Re: Pakistan: Bird Flu claims 2 lives

Yeah -- you guys are right -- I count 6, too (missed the daughter & the other male in my first, panic read...):

Dr. Ishtiaq Durrani - Abbottabad vet - positive - Oct 21 culling
Mohammad Ilyas Durrani - brother 1 - d. Nov 19 - positive
Mohammad Owais Durrani - brother 2 - d. Nov 29 - not tested

Manshera poultry handler - positive
Manshera poultry handler daughter - observation
Another male - observation

Who's the fourth pos, then?

[Theresa42]

Re: Pakistan: Bird Flu claims 2 lives

I think the timeline is something like this

Oct 21-23 - 3000 birds culled
Oct 27 - 40 samples colected for testing
early November 4 of 40 are positive
culler hospitalized one positive
vet hospitalized - another positive
vet brother dies Nov 19 - no sample collected
vet brother dies - Nov 29 maybe one poistive
culler's duaghter hospitalized no result
male hospitalized - maybe the fourth positive

Weirdly, it sounds like it was the first brother that died that was tested and not the second.... ??

While Dr. Ishtiaq himself is on the path to recovery, his brothers Mohammad Ilyas Durrani and Mohammad Owais Durrani ? both of who were attending him at the Khyber Teaching Hospital during his illness ? died on November 19 and November 29, respectively. The symptoms of avian flu infection in humans include muscle aches, fatigue, fever, coughing, sneezing, sore throat and eye infections. In severe cases, infection may lead to fatal pneumonia, blood disorders and multiple organ failure.

Ilyas has been confirmed as being the first casualty of H5N1 in Pakistan. Even though his brother?s blood sample could not be collected, health experts talking to ?The News? said clinical evidence suggests that he too succumbed to the deadly virus.

[Niko]

Re: Pakistan: Bird Flu claims 2 lives

Okay, now I'm confused

I think my confusion stems from the names of towns/farms.

Are Abbotabad andMansera/Mansehra interchangable?

Ministry officials said on October 21, 2007, bird flu virus H5-N1 was confirmed at Ijaz Shah Poultry Farm in Abbotabad and a veterinarian, Dr Ishtiaq Durrani, from the NWFP Livestock Department was tasked with culling as many as 3,000 hens in Abbotabad from October 21 to 23.

The deaths of two brothers of a veterinarian, who acquired the deadly H5N1 Avian Influenza virus after coming into contact with infected poultry at a farm in Abbottabad late-October

According to a spokesman of the Health Ministry, 2 brothers working in
a poultry farm in Mansera

the poultry handler from Mansehra