Pakistan: Human H5N1 Cluster December 2007

[HenryN]

Re: Pakistan: Bird Flu claims 2 lives

Re: Pakistan: Bird Flu claims 2 lives

I think there could be as many as 8 patients. My guess is that the 40 samples collected were from contacts with the farm (owner, workers, cullers). These samples were collected and tested in October. There were four positives. One was the vet and another was the culler. The other two could be cullers not named. After that first wave, the two brothers of the vet were developed symtoms (H2H2H). One tested positive the other wan't tested (but both died from H5N1). Next the daughter of the positive culler developed symptoms, as did a male (possibly a contact) and both are still hospitalized.

All of the above link back to the small October cull of 3000 birds. Since then there have been more outbreaks and probably more suspect cases who have not been reported / tested, which led to the hospital alert.

 

[Niko]

Re: Pakistan: Bird Flu claims 2 lives

Re: Pakistan: Bird Flu claims 2 lives

I think there could be as many as 8 patients. My guess is that the 40 samples collected were from contacts with the farm (owner, workers, cullers). These samples were collected and tested in October. There were four positives. One was the vet and another was the culler. The other two could be cullers not named. After that first wave, the two brothers of the vet were developed symtoms (H2H2H). One tested positive the other wan't tested (but both died from H5N1). Next the daughter of the positive culler developed symptoms, as did a male (possibly a contact) and both are still hospitalized.

All of the above link back to the small October cull of 3000 birds. Since then there have been more outbreaks and probably more suspect cases who have not been reported / tested, which led to the hospital alert.

See post #3

...Pakistan has reported 76 outbreaks of Bird Flu in 2007, the latest being on November 22 at Mansehra. Of these, 56 outbreaks involved commercial and backyard poultry and 20 outbreaks were reported in wild birds, mostly crows....

 

[Laidback Al]

Re: Pakistan: Bird Flu claims 2 lives

Re: Pakistan: Bird Flu claims 2 lives

Niman may be correct that there are more than 4 human cases from more than one outbreak in this area of Pakistan.

Thirty total poultry outbreaks are reported by OIE for 2007 in Pakistan. Post #1 notes that Dr Ishtiaq Durrani was tasked with culling the 3000 hens on the ?Ijaz Shah Poultry Farm in Abbotabad? from October 21 to 23. This outbreak, in Abbottabad District, has a start date of October 19, as posted by OIE.

The last reported poultry outbreak by OIE is on October 23, at Farm M/S Ahtasham, Batal, in Mansehra District, about 11 miles north of the outbreak in Abbottabad.

But as Niko points out above there has been at least one other poultry outbreak in Mansehra District on November 22 and many other outbreaks in Pakistan unreported to OIE.

The 40 human samples that have been processed in Pakistan were collected from individuals in ?Peshawar and Abbottabad? (Post #19). It seems that the four positive samples were from Abbottabad because there has been no reports of human cases from Peshawar District.

BUT, post #19 refers to positive results from a ?Mansehra-based poultry handler?, and post #4 states ?two brothers Muhammad Ilyas and Tariq working in a poultry farm in Mansera suffered flu?. This suggests that several of the infected individuals are from or worked in Mansehra District, where samples have yet to be processed or at least the results have not yet been made public.

As shown in the map below the two OIE reported outbreaks are in different districts. It may be that news reports are confusing cases between several separate areas from two separate Districts. Niman may be correct that there could be as many as 8 or more human cases of H5N1 in this area of Pakistan.

Official news releases from the Pakistan Ministry of Health would clear up a lot of this confusion.
View attachment 2113

 

[wetDirt]

Re: Pakistan: Bird Flu claims 2 lives

Re: Pakistan: Bird Flu claims 2 lives

I think there could be as many as 8 patients. My guess is that the 40 samples collected were from contacts with the farm (owner, workers, cullers). These samples were collected and tested in October. There were four positives. One was the vet and another was the culler. The other two could be cullers not named. After that first wave, the two brothers of the vet were developed symtoms (H2H2H). One tested positive the other wan't tested (but both died from H5N1). Next the daughter of the positive culler developed symptoms, as did a male (possibly a contact) and both are still hospitalized.

All of the above link back to the small October cull of 3000 birds. Since then there have been more outbreaks and probably more suspect cases who have not been reported / tested, which led to the hospital alert.

And perhaps the vet was on tamiflu, but the cullers weren't

 

[Gert van der Hoek]

Re: Pakistan: Bird Flu claims 2 lives

Re: Pakistan: Bird Flu claims 2 lives

Pakistani men suspected of being country's first bird flu victims

Fri, 14 Dec 2007


Islamabad - Two brothers who suddenly died after becoming ill at a chicken farm in north-west Pakistan are suspected of being the country's first bird-flu victims, health officials said Friday. The men died at least 10 days ago, but the Pakistani government did not disclose their deaths and has refused to confirm test results of whether they succumbed to the H5N1 avian influenza virus.

The victims, whose names were not released, were in the 20s and 30s and worked together on a chicken farm in Manshera, North-West Frontier Province, and had direct contact with birds, said Dr. Siddiqur Rahman, chief medical officer at the Khyber Teaching Hospital in Peshawar, the provincial capital.

He said the men were brought into the hospital in critical condition "about 10 days ago" suffering from pneumonia and died soon after.

"After having suspicions that the deaths were caused by bird flu, we informed the Health Ministry, which took blood samples and sent them to the (government) laboratory in Islamabad," Rahman told Deutsche Presse-Agentur dpa.

Dr. Mazhar Barjis, chief public health officer at the National Institute of Health in Islamabad, which houses the laboratory, said testing of the samples was underway.

"We will inform the public of the results in a couple of days," he said.

Health officials declined to say why the Islamabad government did not disclose the men's deaths, or why it was taking so long to analyze the blood samples for bird flu, a process that should only take a few days.

Pakistan does not have any recorded human cases of bird flu, according to the World Health Organization. However, there were two significant outbreaks among poultry populations on chicken farms in 2006 and in June of this year, prompting health officials to cull some 50,000 birds.

http://www.earthtimes.org/articles/show/158589.html

 

[Giuseppe]

Re: Pakistan: Bird Flu claims 2 lives

Re: Pakistan: Bird Flu claims 2 lives

First launch of Associated Press
---
Pakistan tests for bird flu after 2 poultry farm workers die

Friday, December 14, 2007 04:36 PM
PESHAWAR, Pakistan (AP) - Pakistani authorities were testing the country's first suspected fatalities from H5N1 bird flu after two poultry farm workers died this week, a hospital official today said.

The workers, from northwestern Mansehra district, were hospitalized in Peshawar over the weekend with fever and flu-like symptoms. They died in the isolation ward of the Khyber Teaching Hospital on Monday, said Khushdil Khan, the hospital's medical superintendent.

Blood samples were sent to the Health Ministry in Islamabad for clinical analysis and were being tested for H5N1, but there was as yet no confirmation of the cause of the deaths, Khan said.

He said the U.N. World Health Organization had been informed.

WHO in Islamabad referred inquiries about the case to the Health Ministry where officials declined comment Friday.

H5N1 and other forms of bird flu have hit Pakistan poultry farms in the past two years but there have been no confirmed cases of humans contracting the disease.

WHO has recorded more than 200 deaths from H5N1 since 2003, mostly in Southeast Asia and China.

-
http://www.philstar.com/index.php?Global News&p=54&type=2&sec=3&aid=2007121426
------

 

[Gert van der Hoek]

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

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

This is from Avian Flu Diary, there seem to be at least 6 (suspect) patients:

For the past 12 hours or so, newshounds on the flu forums have been going through and dissecting the wire reports, trying to piece them together into some coherent timeline. Much of my understanding comes from the hard work of people like Theresa42, Niman, Niko, Laidback Al, Frenchiegirl, and yielddude on Flutrackers and Okieman, DennisC and pugmom on the Wiki.

Kudos to all doing this exhausting, but vital, work.



Here is the tentative timeline.

On or about October 21st, Dr. Ishtiaq Durrani (a veterinarian) was involved in a culling operation of H5N1 infected chickens. He reportedly did not take proper precautions, and became infected with the virus.


A second victim from that culling, a day laborer working without protective gear, also became infected.


The day laborer's daughter, along with long with `another male', are also under observation at a hospital in Abbottabad. (Note: Given the onset dates, it is unclear if they are still under observation).


Dr Durrani's two brothers- both of who were attending him at the Khyber Teaching Hospital during his illness - died in mid to late November from the disease.

http://afludiary.blogspot.com/

 

[Giuseppe]

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

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

From NGO PeaceReporter News Agency:
--
Pakistan - 14.12.2007 09:50:00
Due morti sospette nel nord-ovest, si pensa all'influenza aviaria





Il Pakistan potrebbe aver registrato i primi suoi due morti di influenza aviaria. Due fratelli di 20 e 30 anni, che lavoravano in un allevamento di polli nella Provincia della frontiera nord-occidentale, sono deceduti almeno una decina di giorni fa, ma il governo non ha mai parlato della scomparsa dei due e non ha ancora confermato che la morte ? stata provocata dal virus H5N1. "Dopo aver sospettato che la causa delle morti fosse l'influenza aviaria abbiamo informato il ministero della Sanit?, che ha prelevato campioni di sangue e li ha inviati a un laboratorio statale di Islamabad", ha detto a un'agenzia di stampa tedesca una fonte del Khyber Teaching Hospital di Peshawar. Gli esami sono ancora in corso.
-
http://www.peacereporter.net/default_news.php?idn=45975
-----
Pakistan may have detected its first two human fatal cases of bird flu. Two brothers (around 20 and 30 year-old respectively), who worked in a poultry farm in North West Frontier Province, died around ten days ago, although central government didn't release any information about the case and final diagnosis. ''After suspicious of H5N1-related infections, we informed ministry of health and sent samples for testing at Islamabad'', an official at Khyber Teaching Hospital, Peshawar reportedly said to a german news agency. Further analysis are ongoing.
(My translation.)

 

[AlaskaDenise]

Re: Pakistan: Bird Flu claims 2 lives

Re: Pakistan: Bird Flu claims 2 lives

Commentary at

http://www.recombinomics.com/News/12130702/H5N1_Pakistan_Cluster.html

Commentary

Fatal H5N1 Cluster in Pakistan

Recombinomics Commentary
December 13, 2007

two brothers Muhammad Ilyas and Tariq working in a poultry farm in Mansera suffered flu, few days back that later turned to be critical in the form of Bird Flu influenza (H5N1).

They were admitted to a local hospital in Peshawar where on Monday they died.

The above comments describe two fatal H5N1 infections in Pakistan, which appear to be related to a poultry outbreak last month. More details on disease onset dates would be useful.

Pakistan has not previously reported human cases and H5N1 sequences from bird infections have not been released, although it seems likely that the sequences in Pakistan will be similar to sequences from Afghanistan, which has had outbreaks in close proximity to the Northwest Frontier in Pakistan (see satellite map).

Recent sequences from Afghanistan have also not been published, but it seems likely that sequences will be closely related to the recent H5N1 cases in Krasnodar, which were related to sequences in Europe this summer as well as Kuwait.

Thus, these two confirmed fatalities raise concerns for health risks associated with the wildly circulating H5N1 that links back to Uva Lake in Mongolia in 2006.

Sequence data on bird and human isolates from Pakistan would be useful.


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[AlaskaDenise]

Re: Pakistan: Bird Flu claims 2 lives

Re: Pakistan: Bird Flu claims 2 lives

Commentary at

http://www.recombinomics.com/News/12130703/H5N1_Pakistan_Cluster_Grows.html

H5N1 Cluster in Pakistan Grows?

Recombinomics Commentary
December 13, 2007

Three suspected cases of human-to-human transmission of bird flu virus have been detected in North West Frontier Province (NWFP), sources told The Post on Monday.

Of these three cases, two people died and the Ministry of Health has collected samples to determine the cause of their deaths.

Sources said about three weeks ago the Ministry of Health obtained blood samples of people suspected of being infected with bird flu virus, but their results have yet to be announced.

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 above report provides some additional detail on the circumstances around the two fatal H5N1 cases. However, it is unclear if there is a third patient and if the third patient is related to the brothers won died.

In any event, the two reports indicate there is an H5N1 cluster, which is common for the index cases for a country. Almost all initial reports of H5N1 in humans are linked to clusters.

These cases represent the first Qinghai fatalities of the season. Last season reported fatalities were limited to Egypt and Nigeria. However, the large number of outbreaks early in the season suggests more cases will be reported this season.

More information on the patients, as well as sequence data from bird and human H5N1 isolates from Pakistan would be useful.


.

 

[AlaskaDenise]

Re: Pakistan: Bird Flu claims 2 lives

Re: Pakistan: Bird Flu claims 2 lives

Commentary at


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

Commentary

Pakistan Hospitals on H5N1 Alert

Recombinomics Commentary
December 13, 2007

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.

The above comments indicate hospitals in Pakistan are on H5N1 alert. The regions mentioned above match earlier outbreaks (see satellite map) and suggest H5N1 is either endemic in these areas, or subject to new introductions via recent wild bird migrations.

In the past, the H5N1 sequences from adjacent Afghanistan and India were related to the Uva Lake strain from the wild bird outbreak in Mongolia, which has been recently reported in Europe and the Middle East. The sub-clade in Pakistan may have acquired new polymorphisms because of new introductions, and the confirmed human cluster is cause for concern.

Sequence data on H5N1 circulating in poultry earlier this year, as well as the new infections in poultry and patients, would be useful.


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[AlaskaDenise]

Re: Pakistan: Bird Flu claims 2 lives

Re: Pakistan: Bird Flu claims 2 lives

Commentary at

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

Commentary

Likely Human to Human H5N1 Transmission in Pakistan

Recombinomics Commentary
December 13, 2007

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.

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.

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 above details suggest H5N1 in Pakistan was transmitted human-to-human in the three family members. Although disease onset dates were not given, the 10 day gap between the date of death strongly suggests one brother infected one or two other brothers. Moreover, the cluster of four positives in the same area, possibly involving five people since one of the dead brothers was not tested, highlight a relatively efficient transmission of H5N1, as do the two hospitalized contacts under observation

Hospitals in Pakistan have gone on alert.

Sequence data on the recent human and poultry cases, as well as earlier outbreaks would be useful.


.

 

[HenryN]

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

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

Commentary at

http://www.recombinomics.com/News/12140701/H5N1_Pakistan_C2C.html

 

[AlaskaDenise]

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

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

Commentary at

http://www.recombinomics.com/News/12140701/H5N1_Pakistan_C2C.html

Commentary

Clusters of H5N1 Clusters in Pakistan

Recombinomics Commentary
December 14, 2007

Pakistani authorities were testing the country's first suspected fatalities from H5N1 bird flu after two poultry farm workers died this week, a hospital official said Friday.

The workers, from northwestern Mansehra district, were hospitalized in Peshawar over the weekend with fever and flu-like symptoms. They died in the isolation ward of the Khyber Teaching Hospital on Monday, said Khushdil Khan, the hospital's medical superintendent.

The above comments describe an H5N1 cluster involving two brothers who died on Monday and were described in early media reports. However, more recent reports describe at least six other patients linked to an outbreak reported in October in Abbottaba. Although there may be overlap and errors in reported locations and dates, there are clearly clusters of clusters, and more information would be useful.

The first cluster involves a veterinarian and his two brothers linked to the October outbreak. For that outbreak samples were collected from 40 individuals from Peshawar and Abbottabad and 4 were said to be H5N1 positive. One of those positives was the vet, while a second was a culler. The identity of the other two positives remains unclear.

However, the two brothers of the vet developed symptoms and died in November (19 and 29). One of the two was tested and was also H5N1 positive. The other wasn?t tested, but died with bird flu symptoms, indicating all three brothers were H5N1 infected. In addition, the daughter of the culler and another male are hospitalized, presumably with symptoms and representing another familial cluster..

Thus, there appear to be at least six individuals forming at least two clusters linked to the October outbreak in Abbottaba.

However, there have been multiple recent outbreaks in Pakistan (see satellite map), and an alert has been issued to hospitals. The alert describes multiple H5N1 poultry outbreaks in northwest Pakistan.

The two brothers described above appear to have died this month, and therefore appear to be distinct from the three brothers linked to the outbreak in October. These two brothers were linked to culling in Mansera. If true, they would represent the third familial cluster and increase the concern about clusters of cluster in Pakistan.

More information on these and other H5N1 clusters in the area would be useful.


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[Blue]

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

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

"A third brother who lives in the United States but was visiting Manshera at the time also tested positive for bird flu, but survived and has since returned to the US, Akhtar told dpa."

Could we expect the CDC to be all over this brother and getting his
antibodies?????

 

[Blue]

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

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

Do they even know about this man? Maybe not...

 

[HenryN]

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

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

Brothers may be Pakistan's first bird flu victims
Islamabad, Dec 14: Two brothers who died after being taken ill at a chicken farm in northwest Pakistan are suspected of being the country's first bird-flu victims, health officials said Friday.

The men died at least 10 days ago, but the Pakistani government did not disclose their deaths and has refused to confirm test results of whether they succumbed to the H5N1 avian influenza virus.
The victims, whose names were not released, were in the 20s and 30s and worked together on a chicken farm in Manshera, North-West Frontier Province, and had direct contact with birds, said Siddiqur Rahman, chief medical officer at the Khyber Teaching Hospital in Peshawar, the provincial capital.
He said the men were brought into the hospital in critical condition "about 10 days ago" suffering from pneumonia and died soon after.
"After having suspicions that the deaths were caused by bird flu, we informed the Health Ministry, which took blood samples and sent them to the government laboratory in Islamabad," Rahman told DPA.
Mazhar Barjis, chief public health officer at the National Institute of Health in Islamabad, which houses the laboratory, said testing of the samples was underway.
"We will inform the public of the results in a couple of days," he said.
Pakistan does not have any recorded human cases of bird flu, according to the World Health Organization. However, there were two significant outbreaks among poultry populations on chicken farms in 2006 and in June of this year, prompting health officials to cull some 50,000 birds.
Globally, the virus has killed at least 208 people worldwide from 339 cases since 2003.
Most human cases of H5N1 are linked to contact with infected birds, but experts fear the virus will mutate into a form that spreads easily among humans, potentially sparking a pandemic that could kill millions of people.
--- IANS

http://www.newkerala.com/one.php?action=fullnews&id=3334

 

[HenryN]

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

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

Commentary at

http://www.recombinomics.com/News/12140703/H5N1_Pakistan_Pandemic.html

 

[yielddude]

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

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

"A third brother who lives in the United States but was visiting Manshera at the time also tested positive for bird flu, but survived and has since returned to the US, Akhtar told dpa."

Could we expect the CDC to be all over this brother and getting his
antibodies?????

Blue, I think this is a scary example of how a pandemic could have started. This man was already back in the US before any of these stories started coming out. Fortunately, he was already treated. But goes to show that if an easily transmitted virus does commence, it will be almost impossible to prevent spreading, particularly without open reporting from all countries.

 

[sharon sanders]

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

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

I just talked to my contact at the CDC and he told me that the brother who returned to the US was tested last weekend and he tested negative for H5N1.

He flew into Nassau County, Long Island. He was met at the airplane and quarantined immediately. Evidently, the local health department did an excellent job of managing this risk.