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Human cases of influenza A(H5N1) infection, in eastern Turkey, December 2005?January 2006
27 October 2006, Weekly Epidemiological Record (WER) vol. 81, 43 (p 410)
p.410 - Human cases of influenza A(H5N1) infection, in eastern Turkey, December 2005?January 2006
:: Download full text [pdf 581kb] WHO update 10-27-06.pdf
"In the beginning of change, the patriot is a scarce man (or womanhttps://flutrackers.com/forum/core/i...ilies/wink.png), and brave, and hated and scorned. When his cause succeeds, the timid join him, for it then costs nothing to be a patriot."- Mark TwainReason obeys itself; and ignorance submits to whatever is dictated to it. -Thomas Paine
Re: WHO release regarding Dec 2005 to January 2006
WHO: H5N1 cases in Turkey targeted children, youth
Oct 31, 2006 (CIDRAP News) ? A recent World Health Organization (WHO) report on 10 of the 12 confirmed H5N1 avian influenza cases that occurred in Turkey last winter adds to evidence that children and youth may be particularly susceptible to the infection.
The disease struck only children younger than 16, even though their parents had probably been exposed to the same probable source of infection, infected poultry, according to the Oct 27 issue of WHO's Weekly Epidemiological Record.
"To some extent, this reflects the same age distribution observed globally, where 50.5% of cases occurred among people aged <20 years, and it suggests that age-related factors may influence susceptibility to the disease," the report states.
Of the four case-patients described in the report who died, all were teenagers, while all the survivors were younger children, aged 3 to 9 years. "This reflects closely the global situation where the highest case-fatality rate (73%) has been observed in the 10-19-year age group," the article says.
Turkey was the first country outside Southeast Asia to have human cases. The WHO report discusses 10 cases that occurred in the eastern provinces of Van and Agri in late December 2005 and January 2006 and were investigated by WHO epidemiologists. The two other confirmed cases in Turkey were in other provinces, according to Mary K. Kindhauser, a WHO spokeswoman in Geneva.
A total of 21 human H5N1 cases had been reported in January on the basis of tests in a Turkish laboratory. But the WHO recognized only 12 cases that were confirmed by a reference laboratory in the United Kingdom.
At the time of the outbreak, a WHO official reported that two Turkish boys had asymptomatic H5N1 infections. But those two cases were among the nine that were never confirmed by the UK lab, Kindhauser told CIDRAP News by e-mail today.
The 10 cases covered in the report included three family clusters, one involving three cases and two involving two each. But investigators concluded that person-to-person transmission in the families was unlikely, because in each family the members fell ill within about a 2-day period, indicating they all contracted the virus from a common environmental source.
Although all three family clusters occurred near one another and within a 2-week period, "field investigations provided no evidence of human-to-human transmission between households," the report says. The families had had no interactions, and the children attended different schools. [?!]
Investigation indicated that close exposure to infected poultry was the primary risk factor for infection, the WHO says. All the patients had been exposed to backyard poultry, and at least five were known to have had contact with sick or dead poultry. The three families that had multiple cases had been sheltering their poultry indoors in late December because of severe cold.
Two patients had pet pigeons, but the birds' possible role could not be assessed because no samples were collected from pigeons in the area, the report says.
The article notes that 135 people in the two provinces had suspected cases of H5N1 and were hospitalized and treated with oseltamivir at the time, but testing ruled out all the cases.
See also:
Oct 27 WHO bulletin with report on H5N1 cases in Turkey
Human cases of influenza A(H5N1) infection in eastern Turkey, December 2005?January 2006
Background
On 3 January 2006, the National Influenza Centre at the Refik Saydam Hygiene Centre in Ankara, Turkey, informed WHO that 2 children with fulminant atypical pneumonia had been admitted to Y?z?nc? Yil University Hospital in the city of Van in eastern Turkey. Both were from a single family residing in Dogubeyazit District (Agri Province) and reported histories of recent contact with poultry. Nasal swabs, obtained from the patients 4?6 days after onset of llness, tested negative for influenza A(H5) infection by enzyme-linked immunosorbent assay rapid tests and realtime reverse-transcriptase polymerase chain reaction (rtRT-PCR) at the National Influenza Centre. Chickens had been dying in the Dogubeyazit District since the end of December 2005; influenza A(H5N1) virus activity in poultry was confirmed by laboratory testing in the neighbouring province of Igdir on 27 December 2005.
On 4 January 2006, the National Influenza Centre informed WHO that additional samples from the lower respiratory tracts of the 2 patients had tested positive for influenza A(H5N1) infection by rtRT-PCR. That same day, the Ministry of Health in Turkey publicly confirmed influenza A(H5N1) infection in 2 individuals, both of whom had died. On 5 January, at the request of the Ministry of Health, a 3-person international expert team led by WHO was deployed to assist national and local health authorities in investigation and control activities. National Intersectoral Crisis Committees, which included representatives from the Ministry of Health, the Ministry of Agriculture and Rural Affairs, academia and other concerned parties, were established in Ankara and in Van Province to coordinate outbreak response activities. On the same day, the culling of domestic birds in both Van Province and Agri Province commenced.
On 6 January 2006, the Ministry of Health circulated to health authorities in all provinces revised guidelines for the detection, investigation and treatment of patients suspected of having influenza A(H5N1) infection. On 7 January 2006, tests performed at the WHO Collaborating Centre for Reference and Research on Influenza at the National Institute for Medical Research in London, England, confirmed the positive test results obtained at the National Influenza Centre. On the same day, the WHO-coordinated Global Outbreak Alert and Response Network (GOARN) disseminated a request to partner institutions to mobilize additional international experts.
Between 5 January and 30 January 2006, WHO, through GOARN, the United Nations Food and Agriculture Organization, and the United Nations Children?s Fund (UNICEF) sent to Ankara and to Van Province more than 25 experts in infection control, clinical management, epidemiology, laboratory diagnosis, communication, social mobilization and animal health. Altogether, 10 institutions and organizations were represented in the WHO-led multidisciplinary international outbreak response team.1
This report describes the results of the epidemiological investigations conducted in Agri and Van provinces from where more than 80% of the laboratory-confirmed cases were reported.
Epidemiological description
A total of 10 cases of influenza A(H5N1) infection, including 4 fatal cases, with dates of onset from 25 December 2005 to 8 January 2006, were identified at health-care facilities in Agri Province (9 cases) and Van Province (1 case) (Fig. 1 and Table 1). In 9 cases, influenza A(H5N1) infection was confirmed by rtRT-PCR at the National Influenza Centre and the collaborating centre. In 1 case, influenza A(H5N1) virus infection was confirmed by rtRTPCR at the National Influenza Centre and by serology at the collaborating centre.
The median interval between the date of onset of illness and death was 8 days (mean, 8 days; range, 7?10 days). All cases occurred among children aged 3?15 years (median, 8.5 years; mean, 8.9 years). The median age among the 4 fatalities was 14 years (mean, 13.7 years; range, 12?15 years). Five of the cases occurred among females aged 8?15 years, 3 of whom died. The remaining cases occurred among males aged 4?14 years.
Altogether, 7 cases occurred in 3 different households in the Dogubeyazit District, representing 1 family cluster of 3 cases, and 2 family clusters of 2 cases each.
In addition to the 10 confirmed cases in Agri and Van provinces, between 1 January 2006 and 26 January 2006 more than 600 people from Van Province were investigated for influenza A(H5N1) infection. Altogether, 135 probable cases2 were hospitalized and received oseltamivir treatment in the Y?z?nc? Yil University Hospital. Influenza A(H5N1) infection was ruled out in all of them on the basis of rtRT-PCR analysis of nasopharyngeal swabs.
During the field investigation, information was collected from a variety of sources including surviving family members, local medical officers and epidemiologists.
Dogubeyazit District and Agri Province
Family A [Kocyigit family]
Family A, residing in the district capital, consisted of 6 members (4 children [Muhammed Ali, Fatima, Hulya & Ali Hasan] and their parents Zeki & Marifet]). Influenza A(H5N1) virus infection was confirmed in 3 of the children, all of whom died. The first case, a 14-year-old boy (Case 1) [Muhammed Ali] developed symptoms on 26 December 2005. His 2 sisters, aged 15 years (Case 2) [Fatima] and 12 years (Case 3) [Hulya] became ill 2 days later. Case 1 attended the outpatient department of Dogubeyazit District Hospital on 27 December 2005 where he was provided with antibiotic treatment and discharged home. Owing to a worsening of his condition, he returned to Dogubeyazit District Hospital on 30 December 2005 together with his 2 sisters. Because the attending physician suspected avian influenza infection, all 3 children were transferred on the following day to Y?z?nc? Yil University Hospital, where they died.
Family A kept 8 chickens and 1 turkey. On 20 December 2005, 1 of the household?s chickens fell ill. On 25 December 2005, Case 1 and Case 2 slaughtered 1 of the chickens. Case 3 was reportedly not directly involved in the process but was present in the house.
The fourth child, a 6-year-old boy, presented with mild symptoms on 29 December 2005. He was admitted to Y?z?nc? Yil University Hospital for evaluation and treatment at the same time as his 3 siblings. Samples obtained from the 6-year-old tested negative for influenza A(H5N1) infection at both the National Influenza Centre and the collaborating centre. The children?s parents did not present with any clinical signs or symptoms.
Family B [Ozcan 1]
Family B, residing in a small village located on the outskirts of the district capital, consisted of 10 members (8 children [Aysegul, Yusuf, Hakan, Hatice, Mehmet, Ahmet, Mustafa & Rumeysa] and their parents [Samil & Refika]). The family kept 25 chickens and 2 domesticated pigeons that were being raised as pets. On 26 December 2005, the chickens became ill and were slaughtered over the next 3 days. Case 4, a 9-year-old girl [Aysegul], helped her mother slaughter the sick chickens; she developed symptoms on 29 December 2005. On 30 December 2005, 1 of her brothers (Case 5), aged 3 years, [Yusuf] became ill. The boy had not been present when the chickens were slaughtered but had played with the pet pigeons. Both children were administered a full course of oseltamivir treatment starting on the day of admission to hospital. Both children recovered.
On 4 January 2006, the mother and the remaining 6 siblings were admitted to Y?z?nc? Yil University Hospital, partly on clinical grounds (the mother had mild respiratory symptoms and 2 siblings had headache and malaise) and partly for social reasons. They each received a full course of oseltamivir treatment. Nasopharyngeal swabs obtained from them tested negative for influenza A(H5N1) infection by rtRT-PCR at both the National Influenza Centre and the collaborating centre.
Family C [Ozcan 2]
Family C, residing in the district capital, consisted of 8 members (6 children [Fatma, Muhammet, ?] and their parents [Mehmet Emin & ?]). The family kept 4 ducks and 4 pet pigeons. One duck became ill on 4 January 2006. On this date, Case 6, a 14-year-old girl, [Fatma] helped her mother [she is actually Fatma's step-mother] slaughter and prepare ducks for consumption. She and her younger brother (Case 7), aged 5 years, [Muhammet] had onset of illness on 8 January 2006. Case 7 did not contribute to the preparation of the ducks but he had played with the family pigeons. Both children were transferred to Y?z?nc? Yil University Hospital 2 days later and were administered a full course of oseltamivir treatment. Case 6 died at the hospital on 15 January 2006; her brother recovered. The 6 remaining family members continued to be healthy.
The heads of family B and family C are brothers, but the 2 households are located about 2 kilometres apart. The 2 families had reportedly had no interactions during the period preceding the presentation of illness in the families. Therefore, these 2 family clusters should be regarded as epidemiologically unrelated. [Note, also that family A and family C are related -- Fatma Ozcan was reported as a cousin of the Kocyigits (see next post).]
Case 8
Case 8, a 5-year-old boy, [Yusuf Tunc] residing in the same neighbourhood as family A and family C, presented with mild respiratory symptoms on 25 December 2005 and was admitted to Y?z?nc? Yil University Hospital on 1 January 2006. The boy?s family had a small flock of poultry; since December 2005, widespread death among free-ranging poultry had been reported in the immediate surroundings. Case 8 was administered a full course of oseltamivir treatment starting on the day of admission and he recovered.
Case 9
Case 9, a boy aged 4 years, [Ferhat Tilaver] became ill on 6 January 2006. He was hospitalized in Erzincan Hospital on 9 January 2006 and, due to worsening of his condition, was transferred to Atat?rk University Aziziye Research Hospital in Erzurum on 13 January 2006. He resided in the village of ?etenli, near the district capital. The boy?s family did not raise poultry but widespread death among free-ranging poultry had been reported in the village, including among his neighbour?s poultry flock, since December 2005. Case 9 had no known contact with other cases. Case 9 was administered a full course of oseltamivir treatment starting on the day of admission and he recovered.
Van City, Van Province
Case 10
Case 10 was an 8-year-old girl [Summeye Mamuk] from a suburb of the city of Van. Her family kept 22 hens; these had started dying around 26 December 2005 and were slaughtered by family members. The girl cared for a sick pet chicken and also helped her mother prepare the slaughtered poultry for consumption. She presented with conjunctivitis on 2 January 2006 and was admitted on the following day to Y?z?nc? Yil University Hospital, where she received a full course of treatment with oseltamivir. Because her respiratory symptoms were mild, she was discharged. The next day she was readmitted when local health workers noticed dead birds in the household. Case 10 recovered.
Discussion
The human cases of influenza A(H5N1) infection described here are the first cases documented in Turkey and the first to be diagnosed outside of south-east Asia. The investigations carried out by Turkey?s Ministry of Health, with the assistance of the international multidisciplinary team, supported the hypothesis that close exposure to infected poultry was the principal risk factor for human infections with this virus. This is corroborated by the fact that no new cases were detected after the Ministry of Agriculture and Rural Affairs implemented extensive culling of poultry in areas where suspected or confirmed outbreaks in poultry had been identified. Exposure to backyard poultry was common among all cases and, for at least 5 of them, close contact with sick or dead poultry could be documented. At least 2 cases also had direct contact with pet pigeons. However, the part played by pigeons in transmitting the virus could not be established because no samples were collected from pigeons in the area. Consequently, it is not known whether the pigeons could have been infected or perhaps had surface contamination of infectious excreta and transferred the virus to the children in this way.
Environmental factors might have contributed to the occurrence of human cases in Agri Province, which is located in the mountainous Anatolian Region. Poultry is usually kept and fed outside, but during the winter poultry is brought indoors at night to protect it from the cold. During the second half of December 2005, the average daily temperatures recorded in the area were unusually low, reaching ?30? C.3 Because of the severe cold spell, many families, among them families A, B and C, sheltered their poultry indoors. This, combined with the cramped living conditions of the rural population, considerably increased the opportunity for contact between humans and poultry.
Despite the fact that 8 cases, including 3 family clusters, were observed in a limited geographical area of approximately 2 km? and during a period of 2 weeks, field investigations provided no evidence of human-to-human transmission between households. The affected families had had no interactions with one another during the period preceding the onset of illness; the children from the different families did not attend the same schools; and there were no reported community gatherings. Although the possibility of limited transmission within households cannot be excluded, the timing of the onset of illness (intervals of 0?2 days) within each of the 3 households, occurring in clusters, indicates that a common environmental source of exposure is the most likely explanation for infection. No additional cases were identified through the active followup of contacts of cases, including health-care personnel.
Factors influencing human susceptibility to influenza A(H5N1) infection and those associated with severe disease are poorly understood. Some behaviours are likely to increase the risk of becoming infected (for example, the slaughtering and defeathering of infected birds). However, among the families investigated in eastern Turkey, even though both children and parents had most likely been exposed to the same source, infection was documented only among children aged <16 years. To some extent, this reflects the same age distribution observed globally, where 50.5% of cases occurred among people aged <20 years, and it suggests that age-related factors may influence susceptibility to the disease. The 4 fatalities occurred in children aged 12?15 years, while the 4 children who recovered were aged 3?9 years. This reflects closely the global situation where the highest case?fatality rate (73%) has been observed in the 10?19-year age group.4
Footnotes:
1) 1 The international response team included members from the Swedish Central Field Epidemiology Group; the Israeli Medical Association; Institut de Veille Sanitaire, France; the United States Centers for Disease Control and Prevention; the European Centre for Disease Prevention and Control, Stockholm, Sweden; the European Union; the National Institute for Medical Research in London, England; the United Nations Food and Agriculture Organization; UNICEF; and WHO.
2) A probable case was defined as an individual presenting with fever and contact with birds or a with an individual with an illness compatible with influenza A(H5N1) infection.
3) 3 Giesecke J. Human cases of avian influenza in eastern Turkey: the weather factor. Eurosurveillance, 2006, 11: E060119 (available from http://www.eurosurveillance. org/ew/2006/060119.asp).
The heads of family B and family C are brothers, but the 2 households are located about 2 kilometres apart. The 2 families had reportedly had no interactions during the period preceding the presentation of illness in the families. Therefore, these 2 family clusters should be regarded as epidemiologically unrelated. [Note, also that family A and family C are related -- Fatma Ozcan was reported as a cousin of the Kocyigits....]
Hat-tip, robync!
Children on bird flu frontline in Turkey
Friday, January 20, 2006
Hande Culpan
VAN - AFP
The doctor overseeing children stricken with bird flu in eastern Turkey said on Wednesday that the risk of more human infections was diminishing as people became more aware of the lethal virus sweeping across the country.
The lethal H5N1 strain of bird flu has so far claimed at least four lives, infected 17 others and rapidly spread to nearly a third of the country's 81 provinces since it emerged in a remote eastern town late last month.
"We did not expect the disease to reach such a dimension in Turkey," admitted Ahmet Faik ?ner, the head of the pediatrics department in Van hospital.
"But human infections will decrease because people have now learnt that they need to stay away from poultry," he told AFP.
The deaths in Turkey, the first human casualties outside Southeast Asia and China, were all the result of infection after coming into contact with sick poultry.
Since then, the government has mounted a nationwide campaign to increase public awareness, distributing leaflets explaining how the disease spreads and broadcasting spot warnings on national television networks.
"There was nothing we could have medically done for those patients," ?ner lamented, recalling that all the patients were brought into his hospital late, after their disease had advanced.
The first deaths were three children from the Ko?yiğit family [family A], aged 11, 14 and 15, hailing from the impoverished eastern town of Dogubayazit. They were followed on Monday by Fatma ?zcan, their 16-year-old cousin[family C].
There are currently four children diagnosed as H5N1 carriers in Van hospital.
One is Fatma's five-year-old brother Muhammed [family C]; the others are his cousins, 11-year-old Ayşeg?l and three-year-old Yusuf [family B]; and the last is Yusuf Tun?, a five-year-old boy.
No outsiders are allowed into the ward where the children are kept. A glimpse through the door of their ward, guarded by hospital staff, reveals little children playing with a ball in the corridor, accompanied by chaperones wearing protective masks and gloves.
?ner said the children were not in a critical condition, including little Muhammed, who has been described as one of the most serious cases.
"Since yesterday, his condition has stabilized. We are hopeful that he will recover," he added.
But the news was little comfort for the ?zcan family.
"The family is just devastated," said Samil ?zcan, father to Ayşeg?l and Yusuf and uncle to Fatma and Muhammed, as he walked out of the hospital onto the snow-covered street with a Koran in his hand.
"Fatma's death was a surprise to us. We did not expect it in the least. We are praying for Allah's intervention for Muhammed," he said, looking weary and confused.
?ner said Van hospital was capable of dealing with the influx of patients rushing into the hospital since the outbreak. Nearly 500 people have come in suspecting of having caught the virus; most have tested negative.
But he underlined that what was most needed was a laboratory in Van that could identify cases of the deadly virus.
Currently, there are only two labs in Turkey, one in the capital Ankara and the other in the country's biggest city Istanbul, which can run the tests. It takes three days to get the final result on samples sent over.
"It is essential that we carry out the tests here so that we can quickly make a diagnosis and begin treatment," he underlined.
?ner said the outbreak in Turkey was giving scientists useful insight into the virus that has claimed some 80 lives, most of them in Southeast Asia and China, since 2003.
"There are some cases where the patients are identified as carriers but show little symptoms. We are learning new things about the virus in the outbreak here," he noted.
All but two of the 21 human cases in Turkey are children, aged two to 18, including also three other siblings who have perished since Jan. 1.
As the outbreak in Turkey, on the doorstep of Europe, spurred global fears, donor countries and organizations pledged more than $1.9 billion for international efforts to combat the disease at a conference in Beijing.
Doctors in Turkey, meanwhile, described the death on Wednesday of an 11-year-old as a possible bird flu case.
The child, initially thought to be suffering from pneumonia, perished while being transferred between hospitals in the eastern city of Erzurum after suspicions mounted that it might be bird flu.
Samples from the child -- reports did not indicate whether it was a boy or girl -- were to be analyzed at a lab in Ankara to determine the cause of death, the chief physician of the Erzurum hospital, Akın Aktaş, told the Anatolia news agency.
Turkish Daily News: Explore the latest Turkish news, including Turkey news, politics, political updates, and current affairs. Conflict in the Judiciary - Criminal Complaint Against Members of the Constitutional Court by the Court of Cassation - 21:15
...when you have eliminated the impossible, whatever remains, however improbable, must be the truth. - Sherlock Holmes
Re: WHO release regarding Dec 2005 to January 2006
Here is a discussion of the information presented by WHO in the recent summary of cases from Turkey earlier this year. See: http://www.who.int/wer/2006/wer8143.pdf
According to WHO cumulative tables there have been 12 H5N1 confirmed cases with four deaths in Turkey. Ostensibly 10 of the 12 cases are discussed in detail in the WER report of 10/27/2006. I have matched up the information in the WER with case information from earlier this year for each of the 10 reported cases. The correlation is presented below. ----------------------------------------------------------------
Case Listing Wednesday, November 01, 2006 __________________________________________________ _____________________________________ caseid:191 Country:Turkey City and Region:Dogubayazit, Agri Name:Mehmet Ali Koycyigit - Family A, Case 1 Sex:M Age:14 Symptom onset:12/16/2005 Hospital Admission:1/1/2006 Death:1/1/2006 Outcome:D WHO confirmed:Yes Relation:self Hyperlink 1/5/2006 http://www.who.int/csr/don/2006_01_05/en/index.html
1/18/2006 http://www.saglik.gov.tr/eng/
10/27/2006 http://www.who.int/wer/2006/wer8143.pdf
__________________________________________________ _____________________________________ caseid:192 Country:Turkey City and Region:Dogubayazit, Agri Name:Fatma Koycyigit - Family A, Case 2 Sex:F Age:15 Symptom onset:12/26/2005 Hospital Admission:1/1/2006 Death:1/5/2006 Outcome:D WHO confirmed:Yes Relation:sister Hyperlink 1/5/2006 http://www.who.int/csr/don/2006_01_05/en/index.html
10/27/2006 http://www.who.int/wer/2006/wer8143.pdf
__________________________________________________ _____________________________________ caseid:193 Country:Turkey City and Region:Dogubayazit, Agri Name:Hulya Koycyigit - Family A, Case 3 Sex:F Age:12 Symptom onset:12/26/2005 Hospital Admission:1/1/2006 Death:1/7/2006 Outcome:D WHO confirmed:Yes Relation:sister Hyperlink 1/7/2006 http://www.who.int/csr/don/2006_01_07/en/index.html
1/12/2006 http://www.who.int/csr/don/2006_01_12/en/index.html
1/18/2006 http://www.saglik.gov.tr/eng/
10/27/2006 http://www.who.int/wer/2006/wer8143.pdf
__________________________________________________ _____________________________________ caseid:199 Country:Turkey City and Region:Dogubayazit, Agri Name:Yusuf Ozcan - Family B, Case 5 Sex:M Age:3 Symptom onset:12/29/2005 Hospital Admission:1/4/2006 Death:
Outcome:R WHO confirmed:Yes Relation:brother Hyperlink 1/9/2006 http://www.who.int/csr/don/2006_01_09/en/index.html
10/27/2006 http://www.who.int/wer/2006/wer8143.pdf
__________________________________________________ _____________________________________ caseid:198 Country:Turkey City and Region:Dogubayazit, Agri Name:Asyegul Ozcan - Family B , Case 4 Sex:F Age:9 Symptom onset:12/29/2005 Hospital Admission:1/4/2006 Death:
Outcome:R WHO confirmed:Yes Relation:self Hyperlink 1/9/2006 http://www.who.int/csr/don/2006_01_09/en/index.html
10/27/2006 http://www.who.int/wer/2006/wer8143.pdf
__________________________________________________ _____________________________________ caseid:209 Country:Turkey City and Region:Dogubayazit, Agri Name:Fatma Ozcan - Family C, Case 6 Sex:F Age:14 Symptom onset:1/4/2006 Hospital Admission:1/11/2006 Death:1/15/2006 Outcome:D WHO confirmed:Yes Relation:sister Hyperlink 1/16/2006 http://www.who.int/csr/don/2006_01_16/en/index.html
7/10/2006 http://online.wsj.com/public/resources/documents/retro06-avfludeaths-country.html
10/27/2006 http://www.who.int/wer/2006/wer8143.pdf
__________________________________________________ _____________________________________ caseid:208 Country:Turkey City and Region:Dogubayazit, Agri Name:Mehmet Ozcan - Family C, Case 7 Sex:M Age:5 Symptom onset:1/4/2006 Hospital Admission:1/11/2006 Death:
Outcome:R WHO confirmed:Yes Relation:self Hyperlink 1/16/2006 http://www.who.int/csr/don/2006_01_16/en/index.html
10/27/2006 http://www.who.int/wer/2006/wer8143.pdf
__________________________________________________ _____________________________________ caseid:210 Country:Turkey City and Region:Cetenli, Dogubayazit, Agri Name:Ferhat Tilaver - Case 9 Sex:M Age:4 Symptom onset:1/6/2006 Hospital Admission:1/9/2006 Death:
Outcome:R WHO confirmed:No Relation: Hyperlink 1/16/2006 http://www.who.int/csr/don/2006_01_18/en/index.html
10/27/2006 http://www.who.int/wer/2006/wer8143.pdf
__________________________________________________ _____________________________________ caseid:331 Country:Turkey City and Region:Van, Van Province Name:Summeyye Mamuk - Case 10 Sex:F Age:8 Symptom onset:1/2/2006 Hospital Admission:1/3/2006 Death:
Outcome:R WHO confirmed:No Relation:self Hyperlink 1/7/2006 http://www.who.int/csr/don/2006_01_07/en/index.html
1/13/2006 http://crofsblogs.typepad.com/h5n1/2006/week2/index.html
1/18/2006 http://www.saglik.gov.tr/eng/
10/27/2006 http://www.who.int/wer/2006/wer8143.pdf
__________________________________________________ _____________________________________ caseid:333 Country:Turkey City and Region:Dogubayazit, Agri Name:Yusef Tunc - Case 8 Sex:M Age:5 Symptom onset:12/25/2005 Hospital Admission:1/1/2006 Death:
Outcome:R WHO confirmed:No Relation: Hyperlink 1/7/2006 http://www.who.int/csr/don/2006_01_07/en/index.html
10/27/2006 http://www.who.int/wer/2006/wer8143.pdf
-----------------------------------------------------------------------
----------------------------------------------------------------------- What is interesting is that, as noted in the field "WHO confirmed", three of these cases were never reported in the WHO Disease Outbreak Updates. These three cases are Ferhat Tilaver (210), Summeyye Mamuk (331) and Yusef Tunc (333). What was reported in the Disease Outbreak News for Turkey (assumed to be confirmed) were the 5 cases listed below from other areas. Also, note that Summeyye Mamuk's 18 year old female cousin was treated for H5N1 but is not mentioned. Also, in the list below note that there are two cousins (Kurts) who may represent another familial cluster in Turkey but are not discussed in the most recent WER. ----------------------------------------------------------------------------------- Case Listing Wednesday, November 01, 2006 __________________________________________________ _____________________________________ caseid:202 Country:Turkey City and Region:Yurekveren Village, Kastamonu Name:Uluf Can Kurt Sex:M Age:4 Symptom onset: Hospital Admission: Death: Outcome:UNK WHO confirmed:Yes Relation:self Hyperlink 1/9/2006 http://www.who.int/csr/don/2006_01_09/en/index.html 1/18/2006 http://www.saglik.gov.tr/eng/
__________________________________________________ _____________________________________ caseid:330 Country:Turkey City and Region:Yurekveren Village, Kastamonu Name:Ugur Can Kurt Sex:M Age:5 Symptom onset: Hospital Admission: Death: Outcome:UNK WHO confirmed:Yes Relation:cousin Hyperlink 1/9/2006 http://www.who.int/csr/don/2006_01_09/en/index.html 1/18/2006 http://www.saglik.gov.tr/eng/
__________________________________________________ _____________________________________ caseid:204 Country:Turkey City and Region:Samsun Name:Osman Senmenis Sex:M Age:12 Symptom onset: Hospital Admission: Death: Outcome:UNK WHO confirmed:Yes Relation: Hyperlink 1/9/2006 http://www.who.int/csr/don/2006_01_09/en/index.html 1/18/2006 http://www.saglik.gov.tr/eng/
__________________________________________________ _____________________________________ caseid:203 Country:Turkey City and Region:Cayyaka Village, Corum Name:Mursit Uyecider Sex:M Age:5 Symptom onset: Hospital Admission: Death: Outcome:UNK WHO confirmed:Yes Relation: Hyperlink 1/9/2006 http://www.who.int/csr/don/2006_01_09/en/index.html 1/18/2006 http://www.saglik.gov.tr/eng/
__________________________________________________ _____________________________________ caseid:205 Country:Turkey City and Region:Yellice Village, Kangal, Sivas Name:Gulten Yesilirmak Sex:F Age:37 Symptom onset: Hospital Admission: Death: Outcome:UNK WHO confirmed:Yes Relation: Hyperlink 1/10/2006 http://www.who.int/csr/don/2006_01_10a/en/index.html 1/18/2006 http://www.saglik.gov.tr/eng/
The bottom line on this post is that the WHO count and information on H5N1 cases from Turkey earlier this year (based on this most recent analysis presented in WER) does not match up with WHO's own cumulative count, the information published in the Disease Outbreak News Updates, nor does it correlate with information on H5N1 cases discussed by the Turkish Government in "Turkey in the Struggle" ( http://www.saglik.gov.tr/eng/ ).
This does not inspire confidence that WHO is being forthcoming with information about H2H clusters for H5N1 infected individuals.
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