Pakistan - BF Suspected Human Cases December 18, 2007 to Feb 2, 2008

[Treyfish]

Re: Pakistan: December 18+, WHO Begins Investigations

Re: Pakistan: December 18+, WHO Begins Investigations

<TABLE cellSpacing=0 cellPadding=0 width="100%" border=0><TBODY><TR><TD>Nothing on birds or human bf..

Warden Notice 27/2007

12/18/2007</TD></TR><TR><TD class=content vAlign=top>
This warden message is being issued to alert Americans to safety concerns during the upcoming holidays and elections scheduled for January 8th. Historically, the holiday season is a time when the number of terrorist incidents worldwide increases. This year, the confluence of holidays and the elections in Pakistan...
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:tiphat: http://peshawar.usconsulate.gov/peshawar/wn07121801.html

 

[Treyfish]

Re: Pakistan: December 18+, WHO Begins Investigations

Re: Pakistan: December 18+, WHO Begins Investigations

<TABLE cellSpacing=0 cellPadding=0 width="96%" align=center border=0><TBODY><TR bgColor=#f4faff><TD class=small_txt height=20>CDA takes precautionary measures to avert Bird Flu</TD></TR><TR><TD>

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</TD></TR><TR><TD class=small_txt>Wednesday, December 19, 2007
Islamabad

Following the threat of Bird Flu in the country especially in Islamabad, the Directorate of Health Services of the Capital Development Authority has taken strict immediate preventive precautionary measures against spread of the disease.

The Eidul Azha holidays for the concerned staff has been cancelled and the Authority has launched a special spray and fogging campaign in the different areas of the city usually being used for poultry business.

For this purpose, the federal capital has been divided into six zones and poultry shops of all the markets of the Capital City were properly sprayed and fogged with special anti-virus chemical.

A comprehensive awareness campaign has also been launched for the public, especially for the people attached with the poultry business and provided them proper guideline to avoid the spread and to combat the disease efficiently.

The shopkeepers and poultry businessmen have been advised to cover the eatable items properly and must be made their shops complete fly proofs and put the meat inside the shops.

The people concerning poultry, meat and hotels/motels have been advised for proper vaccination from Vaccination Section (DHS).:tiphat: </TD></TR></TBODY></TABLE>
http://thenews.jang.com.pk/daily_detail.asp?id=87089

 

[Theresa42]

Re: Pakistan: December 18+, WHO Begins Investigations

Re: Pakistan: December 18+, WHO Begins Investigations

Theresa42's comments about cousin marriage above are very important. English translation of the kinship term "cousin" does not distinguish between cross and parallel cousins. Right now there is no data available to link the family cases patrilaterally or matrilaterally.

Apart from trying to sort out the relationships of all these people (thanks Al and everyone who's been working on that!), the cousin-marriage thing is pretty important, I think, in relation to the some-families-seem-to-be-more-susceptible question.

Chances are very good that spouses are cousins in this area of Pakistan -- so when we see, for instance, only the brothers getting infected as seems to be the case here, one has to wonder why not their wives (if they're married) who would share (at least*) 1/8th of their genes with their husbands if they're 1st cousins, and (at least*) 1/32nd of their genes if they're 2nd cousins? If there are wives and they're not infected, that might debunk the some-families-seem-to-be-more-susceptible theory.

On the other hand, if we should happen to see husbands and wives infected in Pakistan or some other country where cousin-marriage is prevalent (it is actually rather common amongst the Kurds in eastern Turkey), that might support the some-families-seem-to-be- more-susceptible theory.

[*The relationships are actually closer in Pakistan because people there have been practicing cousin-marriage for many generations.]

 

[Shannon Bennett]

Re: Pakistan: December 18+, WHO Begins Investigations

Re: Pakistan: December 18+, WHO Begins Investigations

The genetics are probably even more closely linked than that Theresa. You have to assume they have inter-married for generations not just one. First cousins marrying first cousins for hundreds if not thousands of years. Which makes me wonder if they have done genetics studies on populations here? There would have to be some interesting diseases in this part of the world. Rather like the Amish in Pennsylvania.

 

[Theresa42]

Re: Pakistan: December 18+, WHO Begins Investigations

Re: Pakistan: December 18+, WHO Begins Investigations

The genetics are probably even more closely linked than that Theresa. You have to assume they have inter-married for generations not just one. First cousins marrying first cousins for hundreds if not thousands of years. Which makes me wonder if they have done genetics studies on populations here? There would have to be some interesting diseases in this part of the world. Rather like the Amish in Pennsylvania.

Not sure about Pakistan, but I know there are lots of genetic studies done on Saudis who have similarly high levels of cousin marriage -- lots of birth defects and genetic illnesses there.

http://query.nytimes.com/gst/fullpage.html?sec=health&res=980DE0DF1F3DF932A35756C0A9659C8B63

 

[Laidback Al]

Re: Pakistan: December 18+, WHO Begins Investigations

Re: Pakistan: December 18+, WHO Begins Investigations

There may be other issues beside genetics at work here. Of the 310 WHO confirmed cases, it is about equally divided between male (49%) and female (50%). Of the eight case in Pakistan so far, only one is a female. A small sample, but 90% of the human cases in Pakistan are male.

 

[AlaskaDenise]

Re: Pakistan: December 18+, WHO Begins Investigations

Re: Pakistan: December 18+, WHO Begins Investigations

Regarding cousin marriages, see http://www.cousincouples.com/info/facts.shtml

They say the US is the only western country with cousin marriage restrictions.

The high rate of male infections may be due to something as simple as these cullers were working away from home. Since the culling was not a regular day-to-day job, they may have recruited workers from distance communities.

.

 

[AlaskaDenise]

Re: Pakistan: December 18+, WHO Begins Investigations

Re: Pakistan: December 18+, WHO Begins Investigations

<TABLE cellSpacing=0 cellPadding=0 width=600 align=center border=0><TBODY><TR bgColor=#f4faff><TD class=heading_txt height=20>WHO team visits families of bird flu victims</TD></TR><TR><TD>

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</TD></TR><TR><TD class=small_txt height=20>By By Mushtaq Yusufzai
12/19/2007</TD></TR><TR><TD class=small_txt>PESHAWAR: A team of the World Health Organisation experts on Tuesday visited the NWFP where they visited the Khyber Teaching Hospital and also met the ill-fated family of two young students who died of bird flu virus in October.

Also, a WHO technical team is also arriving Pakistan today (Wednesday) which, according to sources, would verify the results of bird flu victims diagnosed by the NIH Islamabad.

After their arrival, the WHO officials held talks with senior officials of the NWFP health department who told them of the situation in the province created after the bird flu virus.They went to the Khyber Teaching Hospital (KTH) where the two young brothers, Muhammad Idrees and Muhammad Ilyas, died on October 19 and 29 respectively mainly because of sheer negligence of the hospital administration, the NWFP health department as well as of the National Institute of Health (NIH), Islamabad.

In KTH, the WHO team arranged an informative workshop for doctors and nurses of the hospital, especially those dealing with bird flu patients.

Officials in the KTH told 'The News' the WHO team had brought Personal Protection Equipment (PPE) for the staff of the hospital.

The team also visited isolation rooms in the hospital where patients suffering from bird flu virus were admitted and advised the hospital administration to select some safe place at a distance from the rest of the hospital for keeping the bird flu victims, so that the virus could not spread in the hospital. It is very painful to mention here that in the entire province, there is not even a single isolation room for infectious diseases.

With the consultation of the WHO team, the KTH administration selected a separate portion in the hospital for keeping bird flu patients. There are 11 isolation rooms in the portion, which would accommodate 22 patients.

Acting Chief Executive KTH, Prof Dr Siddiqur Rahman, nominated Dr Mukhtiar Zaman Afridi as the head of a team that would handle bird flu related cases.

The WHO officials praised doctors and health workers of the KTH for their efforts, which the officials felt saved many lives. The team members said in the world so far 60 per cent of the bird flu patients died while the ratio in Pakistan, 35 per cent, was quite encouraging.

The team members later went to Tajabad town in Peshawar and met the family members of two young brothers died of the disease.

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[Laidback Al]

Re: Pakistan: December 18+, WHO Begins Investigations

Re: Pakistan: December 18+, WHO Begins Investigations

. . .
The high rate of male infections may be due to something as simple as these cullers were working away from home. Since the culling was not a regular day-to-day job, they may have recruited workers from distance communities.

Yes, that could be true, but how many other cullers were there. At least 40 human samples were processed yet, it seems that the only positive individuals are people that have some kind of familial, genetic relationship with each other.

In Egypt we saw a lot of children and young people infected. In Indonesia we see cases that have only tenuous links to poultry and a high CFR. In Pakistan, we have more males and less severity.

Something different is happening in Pakistan. We need more information and transparency. And we need the sequences.

 

[HenryN]

Re: Pakistan: December 18+, WHO Begins Investigations

Re: Pakistan: December 18+, WHO Begins Investigations

NWFP govt sets up task force to contain bird flu
Staff Report

PESHAWAR: The NWFP government has set up a task force to monitor and contain bird flu or avian influenza in the province, officials said on Saturday.

A Health Department official, requesting anonymity, told Daily Times that a task force had been established at the Chief Minister’s Secretariat to monitor the spread of the diseases.

“At present there are no people in quarantine in the province,” he said and added that two people belonging to Manshera died recently at the Khyber Teaching Hospital (KTH) and three others were also believed to be infected.

“Two people have been discharged while the third one, a KTH doctor, is suspected to be infected and officials are awaiting his test reports from the National Institute of Health (NIH) Islamabad,” he added.

He said there were around 14 centres for the treatment of bird flu in NWFP, with one centre in Mansehra, one in Abbottabad and two in Peshawar.

“We are taking extreme care while treating ordinary flu patients till it is made clear that they are not suffering from the bird flu” he said, and added that World Health Organisation (WHO) experts were also cooperating with them.

NWFP caretaker Health Minister Syed Kamal Shah told Daily Times that so far around six to seven cases of the disease had been reported in the province. He added two of the patients had died in November and that officials were awaiting results of the samples that they had dispatched to the NIH.

“If the results come out to be positive then the samples would be sent to the Centre for Disease Control and Prevention in Atlanta for further confirmation,” he said. “I am trying to get the results but poultry is a big industry with many stakeholders, some of whom may want to hush up the issue.”

“The strain detected in the Bird Flu-infected people is called H5N1, which is the most dangerous of all other strains,” he added.

Shah also said that currently there were three people in the hospitals of Peshawar and Abbottabad. However, he declined to say something about the infected doctor.

He said over 70 percent of the poultry industry was based in NWFP and added that “closure of the industry is under-consideration, as human lives are more precious and important than any industry.”

http://www.dailytimes.com.pk/default.asp?page=2007%5C12%5C18%5Cstory_18-12-2007_pg7_28

 

[HenryN]

Re: Pakistan: December 18+, WHO Begins Investigations

Re: Pakistan: December 18+, WHO Begins Investigations

Yes, that could be true, but how many other cullers were there. At least 40 human samples were processed yet, it seems that the only positive individuals are people that have some kind of familial, genetic relationship with each other.

In Egypt we saw a lot of children and young people infected. In Indonesia we see cases that have only tenuous links to poultry and a high CFR. In Pakistan, we have more males and less severity.

Something different is happening in Pakistan. We need more information and transparency. And we need the sequences.

Familial clusters are linked by CONTACT, not genetics.

The genetics are a red herring.

The latest report suggests a MALE HCW is hospitalized. Earlier reports indicated a FEMALE HCW tested positive. It is VERY unlikly that the HCW(s) who were at KTH were related.

They were contacts because of contact, which is how H5N1 is transmitted.

 

[Laidback Al]

Re: Pakistan: December 18+, WHO Begins Investigations

Re: Pakistan: December 18+, WHO Begins Investigations

Familial clusters are linked by CONTACT, not genetics. . . .

Yes, I would agree in regards to the source of infection in these cases. But don't you think that suspectibility among individuals varies and may possibly be related to genetics?

 

[HenryN]

Re: Pakistan: December 18+, WHO Begins Investigations

Re: Pakistan: December 18+, WHO Begins Investigations

Yes, I would agree in regards to the source of infection in these cases. But don't you think that suspectibility among individuals varies and may possibly be related to genetics?

No. Not at this level. This is an AVIAN virus and the genetic composition of infected humans is VERY diverse (as is the dogs, cats, tigers, leopards, pigs, minks, foxes, stone martins, civet cats infected).

 

[HenryN]

Re: Pakistan: December 18+, WHO Begins Investigations

Re: Pakistan: December 18+, WHO Begins Investigations

Commentary at

http://www.recombinomics.com/News/12190702/H5N1_Pakistan_HCW_2.html

 

[AlaskaDenise]

Re: Pakistan: December 18+, WHO Begins Investigations

Re: Pakistan: December 18+, WHO Begins Investigations

Commentary at

http://www.recombinomics.com/News/12190702/H5N1_Pakistan_HCW_2.html

Commentary

Hospitalized Doctor Raises Pandemic Concerns in Pakistan

Recombinomics Commentary
December 19, 2007

?Two people have been discharged while the third one, a KTH doctor, is suspected to be infected and officials are awaiting his test reports from the National Institute of Health (NIH) Islamabad,? he added.

The above comments describe a male health care worker hospitalized at Khyber Teaching Hospital (KTH). Earlier media reports described a female health care worker who had tested positive for H5N1. It is not clear if these two reports refer to the same health care worker, or if there are two who are either lab confirmed or hospitalized. Earlier media reports indicated the lab positive health care worker was not hospitalized.

A hospitalized health care work at this time is cause for concern. Although no official onset dates have been released, the consensus in media reports indicates the index case for the larger familial cluster was a veterinarian who organized a cull October 21-23. He developed symptoms on October 25 and was hospitalized at KTH. Two of his brothers, who were students and were not involved in the cull, visited him at the hospital and were subsequently hospitalized there. These two brothers died November 19 and 29. One was tested and was H5N1 positive as were two other brothers and a cousin. The above comments suggest at least one of the surviving relatives was also hospitalized at KTH.

If the above health care work is H5N1 confirmed, a long transmission chain is likely, based on the disease onset date of the index cases on October 25 and the dates of the deaths of the two brothers, November 19 and 29.

Disease onset dates and contact dates are required to detail the chain, but a chain for almost two months would be an H5N1 record and increase pandemic concerns.

Details, including disease onset dates and confirming lab tests, as well as sequence data, would be useful.


.

 

[hawkeye]

Re: Pakistan: December 18+, WHO Begins Investigations

Re: Pakistan: December 18+, WHO Begins Investigations

I've updated the map to include the location of the KTH doctor.

 

[Shannon Bennett]

Re: Pakistan: December 18+, WHO Begins Investigations

Re: Pakistan: December 18+, WHO Begins Investigations

Are there cultural differences in who cares for the sick in Pakistan? Are males the only/primary persons who visit hospitals? Mens and womans quarters are separate in most Pakistani households, especially in wealthier homes. Since this man was a professional I think we can assume the home was split into gender separation. If that was the case then perhaps the brothers cared for the ill man and not the females in the house.

 

[Laidback Al]

Re: Pakistan: December 18+, WHO Begins Investigations

Re: Pakistan: December 18+, WHO Begins Investigations

Are there cultural differences in who cares for the sick in Pakistan? Are males the only/primary persons who visit hospitals? Mens and womans quarters are separate in most Pakistani households, especially in wealthier homes. Since this man was a professional I think we can assume the home was split into gender separation. If that was the case then perhaps the brothers cared for the ill man and not the females in the house.

The news report indicate that it was the two student brothers who attended to the veterinarian, Ishtiaq, while he was being treated in the hospital. Why did the veterinarian, the index case, survive while the other two brothers who must have exhibited symptoms (in or near the hospital) did not?

Speculation -

Is it possible that the veterinarian had some previous exposure and had some limited immunity? Or did he just receive better care or antivirals earlier?

 

[Shannon Bennett]

Re: Pakistan: December 18+, WHO Begins Investigations

Re: Pakistan: December 18+, WHO Begins Investigations

But who treated him at home before going to the hospital? The brothers or, his presumed wife/mother/sister?

Good question why did he survive?

 

[HenryN]

Re: Pakistan: December 18+, WHO Begins Investigations

Re: Pakistan: December 18+, WHO Begins Investigations

No bird flu threat in Pakistan
'Pakistan Times' Wire Service
ISLAMABAD: Pakistan said on Wednesday there was no threat of a pandemic from bird flu, as World Health Organisation experts visited the country's northwest which reported the first human death from the virus.
Pakistani authorities confirmed at the weekend eight human bird flu cases, including the one death, that the WHO said were likely a combination of infections from poultry and limited person to person transmission due to close contact.
"There is no threat of epidemic or pandemic and there are no fresh cases being reported," Ministry of Health spokesman Orya Maqbool Jan Abbasi was quoted as saying. The last human case was reported on November 23.
"I think we are safe, but we are very cautions and have taken all the precautionary measures." A WHO report is due in the coming days, Abbasi said.
A report from Beijing quoting World Health Organization (WHO) said Tuesday the cases of H5N1 avian influenza among people in Pakistan have risen to eight.
WHO spokesman Greg Hartl gave the confirmation about the first such cases in Pakistan's remote North-West Frontier province through a telephone interview.
He detailed that one patient died, six recovered and one remained under medical supervision in the cities of Abbotabad and Mansehra.
The eight cases have a combination of infections from poultry and limited person-to-person transmission from close contact, according to Keiji Fukuda, coordinator of WHO's global influenza program.
"Right now it doesn't look like pure human to human transmission. It looks like the veterinarian, who was the index case, and a number of other suspect cases had poultry exposure," Fukuda said in an interview.
"It is definitely possible that we have a mixed scenario where we have poultry to human infection and possible human to human transmission within a family, which is not yet verified."
But human-to-human transmission "would not be particularly surprising or unprecedented," he added.
Pakistani and WHO officials said there was no immediate cause for alarm and the United Nations agency was not raising its level of pandemic alert for the time being.
Fukuda said it was very reassuring that "we are not seeing large increases in the number of cases."
But some public health officials worry that should the virus gain the ability to transmit easily among humans, a pandemic could occur.
Hartl said, "Our concern is that once this virus remains in the animal population, it mutates into a more transmissible form.
And the more they (the viruses) stay in the animal population, then we have a panic situation."
The WHO Tuesday noted the death of Indonesia's latest avian flu patient, a 47-year-old man from Tangerang who died Dec 13.
The country's overall H5N1 count has reached 115 cases with 93 deaths. Since 2003, the health agency has tallied 341 cases among people in 14 countries and regions, 210 of them fatal.

http://www.pakistantimes.net/2007/12/19/top12.htm