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Dr Niman is posting about a new family cluster - Are these clusters connected?
Are we seeing the results of the uncle going back to his village and spreading the virus to his caregivers, friends, neighbors... who in turn scattered as he sickened and then died?
I am just throwing out possibilities based on human nature.
Dr Niman is posting about a new family cluster - Are these clusters connected?
Don't think so. The Big Cluster is in North Sumatra -- in the Karo district. The most recent cluster (the two individuals hospitalized have already died) is in West Java in Bandung. See map below. I've also added Surabaya which is where the 'Lily' cluster is from.
...when you have eliminated the impossible, whatever remains, however improbable, must be the truth. - Sherlock Holmes
<NYT_BYLINE type=" " version="1.0">By DONALD G. McNEIL Jr.
</NYT_BYLINE>Published: May 24, 2006
<NYT_TEXT>Reacting to the death on Monday of an Indonesian man, the World Health Organization said yesterday that the case appeared to be the first example of the avian flu jumping from human to human to human.
But the health agency quickly cautioned that this did not necessarily mean that the virus had mutated into a strain that could start a pandemic by jumping rapidly between people as ordinary flu does.
It is a "definite possibility" that the virus jumped more than once inside a family cluster, said Maria Cheng, a spokeswoman for the W.H.O. in Geneva. Although a second jump sounds alarming, "It doesn't look like the trend has changed," she said. "Each case was in very close contact with the previous one."
In the past there have been at least three cases of suspected human-to-human transmission of the A(H5N1) strain of bird flu; all were between family members who spent hours in close contact and would have breathed in large amounts of virus-contaminated droplets. The virus is known to attach itself to receptors deep in the lungs, not in the nose and throat as seasonal flu does.
The man who died was 32 and became sick on May 15. He is believed to have caught the flu while caring for his 10-year-old son, who died of the disease on May 13.
The boy attended a family pork roast in the village of Kubu Sembilang in northern Sumatra on April 29. The hostess, a 37-year-old woman, had become sick on April 27 and was coughing heavily, and several family members slept in her small room, the health agency said. She died May 4 and was buried without any tissue samples being taken; she is presumed to have spread the flu only because of her symptoms.
Six more family members who were at the barbecue fell sick in the first week of May. Five of them, including the 10-year-old, died in the second week of May; only one, the hostess's 25-year-old brother, recovered.
Thirty-three other people in Kubu Sembilang who had contact with the family have been quarantined or have been treated with Tamiflu, an antiviral drug, Ms. Cheng said.
The W.H.O. assumes that the incubation time for bird flu in humans is 7 to 10 days, longer than that of regular flu, she said.
Henry L. Niman, who runs recombinomics.com, a Web site tracking the genetics of flu cases, argues that the incubation period is closer to the two to four days of regular flu, so the boy may have been infected by another family member, meaning that the virus might have made three consecutive human-to-human jumps. But Ms. Cheng said the health agency's "working hypothesis" was still that it had jumped only twice.
An Indonesian health official, according to local news reports, said the boy's father had run away after falling ill and had been treated with Tamiflu. He was later found in the village again but refused treatment.
Ms. Cheng said the village had "not been as cooperative as we'd like."
Recalling outbreaks of Ebola in which African villagers had been terrified at the sight of foreign doctors arriving in hoods and white overalls, she said she thought that the W.H.O. team had worn civilian clothes, and put on masks only when talking to sick patients.
An outbreak of the H5N1 avian influenza virus in North Sumatra has taken the lives of six family members, and the World Health Organization says that human-to-human transmission cannot be ruled out.
Yesterday, the Ministry of Health in Indonesia confirmed the virus in a 32-year-old man who developed symptoms on May 15, and died on May 22. This man was the seventh member of an extended family in the Kubu Sembelang village to become infected with the H5N1 virus, and the sixth to die. The first member of the family to fall ill died on May 4, but because no specimens were taken, the cause of her death cannot be determined. However, as her clinical course was compatible with H5N1 infection, epidemiologists at the outbreak site include this woman as the initial case in the cluster.
The newly confirmed case is a brother of the initial case, and his 10-year-old son died of H5N1 infection on May 13. The father was closely involved in caring for his son, and this contact is considered a possible source of infection.
Although the investigation is continuing, preliminary findings indicate that three of the confirmed cases spent the night of April 29 in a small room together with the initial case at a time when she was symptomatic and coughing frequently. These cases include the woman's two sons and a second brother, age 25, who is the sole surviving case among infected members of this family. Other infected family members lived in adjacent homes.
All the confirmed cases in the cluster can be directly linked to close and prolonged exposure to a patient during a phase of severe illness. Although human-to-human transmission cannot be ruled out, the search for a possible alternative source of exposure is continuing.
Both the Ministry of Health and WHO are concerned about the situation in Kubu Sembelang and have intensified investigation and response activities. Priority is now being given to the search for additional cases of influenza-like illness in other family members, close contacts, and the general community. To date, the investigation has found no evidence of spread within the general community and no evidence that efficient human-to-human transmission has occurred.
Full genetic sequencing of two viruses isolated from cases in this cluster has been completed by WHO H5 reference laboratories in Hong Kong and the U.S. Sequencing of all eight gene segments found no evidence of genetic reassortment with human or pig influenza viruses and no evidence of significant mutations. The viruses showed no mutations associated with resistance to the neuraminidase inhibitors, including oseltamivir (Tamiflu).
The human viruses from this cluster are genetically similar to viruses isolated from poultry in North Sumatra during a previous outbreak. The newly confirmed case brings the total in Indonesia to 41. Of these cases, 32 have been fatal.
<!-- 24 May 2006 10:31:56 GMT ## for search indexer, do not remove--> 24 May 2006 10:31:56 GMT Source: Reuters
By Tan Ee Lyn JAKARTA, May 24 (Reuters) - Health experts are tracing anyone who might have had contact with an Indonesian family struck down by bird flu and is putting them on anti-viral drugs as a precaution, a senior WHO official said. Seven of the family members died this month but so far there is no evidence of anyone else being infected, the World Health Organisation has said.
"We are going wide, contacting the various contacts, putting on (anti-viral) Tamiflu whoever has had close contact, basically putting family members who have not been affected on Tamiflu as a precaution," Firdosi Mehta, acting representative of the WHO in Indonesia told Reuters. "There is active surveillance in the village, fever surveillance to look for any more cases that are occurring outside this immediate family cluster," he said.
The H5N1 bird flu virus infected as many as eight members of the family in the remote village of Kubu Sembilang in north Sumatra. It is the largest bird flu family cluster known to date and has drawn an enormous amount of attention from medical experts. Clusters are looked on with far more suspicion than isolated infections because they raise the possibility that the virus might have mutated to transmit more efficiently among humans.
That could spark a pandemic that can kill millions.
But Mehta urged against any over-reaction, saying this was not the first cluster that the world has known. He added it was little different from other family clusters that have been documented in the past in Hong Kong, Thailand and Vietnam.
Such limited human-to-human transmissions of the virus are invariably, up till now, the result of very close and prolonged contact when a person takes care of a sick relative who is coughing and probably infectious. HUMAN TRANSMISSION VERY HARD TO PROVE "This is not the first time, and we cannot conclusively discard or prove this to be human-to-human transmission," Mehta said, echoing a statement made by the WHO.
On Tuesday, the WHO said limited human-to-human transmission of bird flu might have occurred in the family, but there was no scientific evidence that the virus had mutated to allow it to spread easily among people.
"What is reassuring is two of the human samples from Kubu Sembilang have shown no evidence of reassortment or significant mutations. The lineage of these viruses are very similar to H5N1 viruses from avian specimens from north Sumatra," Mehta said. Human-to-human transmission is very difficult to prove because epidemiologists will have to eliminate all other possible causes, such as the presence of a non-human source or any other infecting agent in the environment.
But in the case of this rural family, they had slaughtered and cooked a pig and chickens for a feast on April 29, animals which are known to be highly susceptible to the virus. Efforts to test chickens and pigs for the virus have failed because residents there have refused to cooperate.
Tensions are high as they blame the government for not helping enough.
This large cluster meanwhile has re-ignited interest in a theory expounded by a growing number of scientists that genetics might predispose certain people to being infected by H5N1, which remains essentially a disease of birds. Some people who survived H5N1 have been found to have more of a type of receptor cells along their respiratory tracts that avian flu viruses like to bind to -- which in theory would explain why some humans might be more susceptible to H5N1. Such a genetic trait would also explain why cluster cases have invariably involved blood relations, and never husbands and wives. "It appears that familial susceptibility amongst certain races, certain cultures and certain groups of people appear to be having a play in the pathogenesis and behaviour of this virus when it jumps from one species, like poultry, to humans," Mehta said, but added that evidence for this was still sketchy.
Format... I know it's evolving. I'm curious about genetics thoughts...
To some degree I agree that discussion or comments should be separate from newspaper-type copy and paste. But often or almost always this community knows more about what's going on than the reporters writing the articles. Where does their info get "peer reviewed" and clarified by our knowledgeable people in a civil way?
Where do maps go with info about outbreaks? Where do comments go about waterways that might be associated with the outbreak. Down here in venting?
Where do we have a logical discussion or make comments or ask relevant questions associated with a post?
I will not post any questions or comments again in the venting room unless I'm venting. Why should I? Venting is not how I feel. Outer Limits is not how I feel. I just want to tap our experts and logical thinkers.
Anyone else have some suggestions? How we set this up now will help when the pandemic fire goes gunnysack.
the who said that they would up the level if human to human transmission has jumped three or more times? am i right at reading that? if so then shouldnt they have up'd the level already?
the who said that they would up the level if human to human transmission has jumped three or more times? am i right at reading that? if so then shouldnt they have up'd the level already?
* Phase 4: Small cluster(s), meaning less than 25 people, lasting less than two weeks, with limited human to human transmission occur, but spread is still highly localized, suggesting that the virus is not well adapted to humans.
Alright...since this is the venting room:
WHAT IS THE WHO DOING? Are they going to convene a meeting about raising the pandemic status or not?! Who (no punintended) is running the show?
i still feel the level should be up'd to level 4 already. the W.H.O does not seem to be informing people of the reality of the situation, meaning how bad it can really get.
Frm Post 23 ''We have to closely monitor the situation in Indonesia for at least 10 days. If it gets worse, we are ready to implement preventive measures under WHO's recommendations,'' he said.
Does anyone know what those preventive measures will be?
A thing long expected takes the form of the unexpected when at last it comes. Mark Twain
Frm Post 23 ''We have to closely monitor the situation in Indonesia for at least 10 days. If it gets worse, we are ready to implement preventive measures under WHO's recommendations,'' he said.
Does anyone know what those preventive measures will be?
They are administering Tamiflu to a number of contacts.
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