Re: Pakistan: Bird Flu claims 2 lives; more suspects
Re: Pakistan: Bird Flu claims 2 lives; more suspects
AVIAN INFLUENZA, HUMAN (166): PAKISTAN, WORLD HEALTH ORGANIZATION
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A ProMED-mail post
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International Society for Infectious Diseases
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[1]
Date: Fri 14 Dec 2007
Source: Earthtimes.org, Deutsche Presse-Agentur report [edited]
<
http://www.earthtimes.org/articles/show/158727.html>
Health officials on Friday [14 Dec 2007] were investigating a possible
human-to-human transmission of bird flu among 4 brothers in northwest
Pakistan, 2 of whom later died. Khushnood Akhtar, secretary in
Pakistan's Ministry of Health, said the bird flu cases occurred last
month [November 2007] in Manshera, North-West Frontier Province, when
a man contracted the H5N1 virus while working on a poultry farm and
helping to cull sick birds. Human-to-human transmissions are extremely
rare, with only 3 previous cases in Indonesia, Cambodia, and Viet Nam.
The Pakistani man, who has not been identified, survived the virus
[infection], but may have infected 3 of his brothers, none of whom
had ever been to the farm or were believed to have been in contact
with sick birds, Akhtar told Deutsche Presse-Agentur (DPA). 2 of the
brothers died from pneumonia-like symptoms but were buried by family
members before health officials could take blood samples to test for
the virus. A 3rd brother who lives in the United States but was
visiting at the time also tested positive for bird flu, but survived
and has since returned to the US, Akhtar told the DPA. "The 2 brothers
died and we suspect that they might have died because of the human
transmission of the H5N1 virus," he said. "We have requested the World
Health Organization (WHO) send a team to the area so we can find out
exactly what happened there."
The 2 Pakistani brothers who survived are the 1st confirmed people in
Pakistan to have contracted the virus, while health officials are not
sure whether they will be able to confirm that the 2 who died
succumbed to bird flu.
There have been outbreaks of bird flu within the country's commercial
poultry population, prompting culls of around 50 000 birds.
The latest reports contradict earlier claims by a health official at
a hospital in Peshawar, the capital of North-West Frontier Province,
who erroneously said the 2 victims had worked on a poultry farm and
died earlier this month [December 2007]. He also did not have any
information about the 2 brothers who survived.
--
Communicated by:
ProMED-mail Rapporteur Mary Marshall
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[2]
Date: Sat 15 Dec 2007
Source: Reuters Foundation AlertNet [edited]
<
http://www.alertnet.org/thenews/newsdesk/L15305867.htm>
Pakistan has recorded its 1st human death from bird flu and 6 other
people have been infected with the deadly H5N1 virus over the last 2
months, a senior Health Ministry official said on Saturday [15 Dec
2006]. "7 in total. One died and 6 other people were infected with the
H5N1 virus," Federal Health secretary Khushnood Akhtar Lashari told
Reuters. "It was confirmed by blood tests." The cases were reported in
the North West Frontier Province, Lashari said; 2 people have
recovered and 4 are in quarantine.
[Byline: Alistair Scrutton; editing: Robert Birsel and Robert Woodward]
--
Communicated by:
David Price
<
dprice_1171@earthlink.net>
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[3]
Date: 15 Dec 2007
Source: WHO Disease Outbreak News
<
http://www.who.int/csr/don/2007_12_15/en/index.html>
Avian influenza ? situation in Pakistan
15 December 2007
The Ministry of Health in Pakistan has informed WHO of 8 suspected
human cases of H5N1 avian influenza infection in the Peshawar area of
the country. These cases were detected following a series of culling
operations in response to outbreaks of H5N1 in poultry. One of the
cases has now recovered and a further 2 suspected cases have since died.
Samples taken from the suspected cases have tested positive for H5N1
in the national laboratory and are being forwarded to a WHO H5
Reference Laboratory for confirmation and further analysis. The MoH is
taking steps to investigate and contain this event, including case
isolation and contact tracing and monitoring, detailed epidemiological
investigations, providing oseltamivir [an anti-viral drug] for case
management and prophylaxis, reviewing hospital infection control
measures and enhancing health care-based and community-based
surveillance for acute respiratory infections.
WHO is providing technical support to the MoH in epidemiological
investigations, reviewing the surveillance, prevention and control
measures that have been implemented and carrying out sequencing of
avian and human virus isolates.
Multiple poultry outbreaks of H5N1 influenza have been occurring in
Pakistan since 2006. In 2007, there have also been outbreaks in wild
birds. A majority of the outbreaks discovered have been in the
?poultry belt? of North-West Frontier Province, particularly in the
Abbottabad and Mansehra area, and cases of infection in wild birds
have been identified in the Islamabad Capital Territory.
******
[4]
Date: Sat, 15 Dec 2007 16:47:30 -0000
From: "Mary Marshall" <
tropical.forestry@btinternet.com>
Source: Canadian Press
<
http://canadianpress.google.com/article/ALeqM5gl49j9v2NcnPwVlOrbtNIG1xrkLw>
Family cluster infected in Pakistan's first reported bird flu cases
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Authorities in Pakistan have announced that country's first reported
cases of H5N1 avian flu in a cluster of family members which may have
involved human-to-human transmission.
There was some confusion Saturday about how many people had tested
positive for the virus, with Pakistan announcing 6 cases but an
official of the World Health Organization suggesting as many as 9
people may have tested positive for the virus in that country [pending
confirmation by an international lab. ? Mod.JW]
The WHO spokesperson said investigations are still underway to try to
determine how the various people became infected, but some
human-to-human spread is possible. "We can't rule it out," WHO
spokesperson Gregory Hartl said from Geneva. "There are other
plausible explanations....?
The cluster of cases involved 4 brothers and 2 cousins living in the
country's North West Frontier Province; 2 of the brothers died, one
without having been tested.
A doctor who treated members of the family also has tested positive
for H5N1, Hartl said. But she was not tested with the standard
diagnostic assay used to detect H5N1 infection and further testing is
needed to determine if she is indeed a case; 3 people who are
unrelated to the family but who were involved in culling H5N1-infected
poultry in the same area have also tested positive.
Meanwhile, U.S. health officials have confirmed they conducted H5N1
testing on a man who had recently visited Pakistan and was complaining
of mild respiratory symptoms. The man is believed to be another
brother from the affected family. A spokesperson for the U.S. Centers
for Disease Control confirmed Saturday
that the CDC sent its plane to Albany [NY] last Saturday to collect
specimens taken from the man, who lives in Nassau County [Long Island,
NY state]. Tests done in the [NY] state lab and confirmed at the CDC
in Atlanta showed the man was not infected with the virus. [Another
report says that this man?s son in the USA has also been tested there
& found to be negative. ? Mod.JW]
The initial infection dates back to 25 Oct [2007], when a livestock
official -- a brother in the family -- fell ill. It appears that it
was only after 2 of the man's brothers fell ill and died that testing
was done looking for H5N1 infection. It is believed the 1st positive
test [from the national lab] was received in late November [2007].
The WHO was officially alerted on 12 Dec [2007], Hartl said. "We feel
that the Pakistanis have done everything right in terms of their
response," he said, noting the country has done a "huge" amount of
work to strengthen infection control and increase surveillance. "(But)
yes, they could have alerted us earlier."
The statement from Pakistan's health ministry announced 6 infections,
with 5 people having recovered. It was unclear who the country was
counting as cases in that report. But that figure would not include
the brother who died without being tested. While his symptoms and his
exposure history are highly suggestive of H5N1 infection, he cannot be
added to the official case count.
A lab team from the U.S. Naval Medical Research Unit in Cairo is
travelling to Pakistan to conduct confirmatory testing. And WHO is
sending a team oftwo doctors with experience treating H5N1 patients as
well as an epidemiologist to help with the investigation of cases.
Pakistan is the 14th country to announce human infections with the
H5N1 virus. If these cases are confirmed, they will bring the global
case count since late 2003 to nearly 350 human cases and 209 deaths.
--
Communicated by:
ProMED-mail Rapporteur Mary Marshall
******
[These reports provide additional information about recent human
cases and suspected human cases of H5N1 avian influenza in Pakistan.
They are, however, confusing and contradictory. Clarification is
urgently required.
The 1st report of the outbreak (see ProMED-mail Avian influenza,
human (163): Pakistan 1st report 20071213.4008) stated that the
deaths of 2 brothers had been attributed to H5N1 virus infection. The
next report (see: ProMED-mail Avian influenza, human (165): Pakistan
20071214.4023) stated that a 3rd person had been diagnosed
H5N1-positive.
In the 1st of the 2 reports above the 2 brothers have become 4
brothers, and it was believed now that the 2 dead brothers had
contracted H5N1 virus infection from another of their brothers. This
brother was a poultry worker whereas the 2 deceased brothers were not
farm workers. The 4th brother was a visitor now returned to the USA.
It is now revealed that the H5N1 status of the 2 deceased brothers is
uncertain and cannot be verified because they were buried before
samples could be taken for diagnosis. Other reports above raise the
number of cases to 8 or 9, but
record only a single death.
Assuming the correctness of the diagnoses, it seems likely that the
outbreak occurred several weeks ago since no new cases have appeared
in the past 2 weeks. Confirmation of the diagnoses of H5N1 virus
infection from an independent source is urgently required. - Mod.CP]
[see also:
Avian influenza, human (165): Pakistan 20071214.4023
Avian influenza, human (163): Pakistan 1st report 20071213.4008]
........................................cp/mj/jw
