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Pakistan: Human H5N1 Cluster December 2007

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

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

H5N1 virus among chickens scares buyers

Nazia Hameed

ISLAMABAD: After the conformation by the Health Ministry of the presence of H5N1 virus among chickens, residents of twin cities have avoided buying chickens.

The National Institute of Health under the auspices of the Ministry of Health had tested patients and suspects for Avian Influenza in late October, 2007. Six cases were found positive for H5N1 Avian Influenza virus, five of them from Abbottabad and one from Mansehra district. Five of them have fully recovered. One of the confirmed cases died in hospital, while his brother who could not be tested has also died.

Prices of chicken have deflated and heath conscious people are avoiding buying chicken and prefer meat or vegetable. Workers of poultry farms can be affected by H5N1. Chicken prices have been reduced to Rs 80 per kg.

Dr Mansoor Ahmed told The Post Sunday that H5N1 was more dangerous than HIV Aids because it has no vaccine for human beings. He added this virus existed in the environment of butchers, workers of poultry farms and housewives, who have long nails. They can easily be affected by this virus but if the chicken is cooked on high centigrade, there are no chances of H5N1 virus.Dr Hameedullah Shah, executive district officer, Rawalpindi, told The Post that Rawalpindi had 250 poultry farms and their team daily checked the sample but no one case positive of bird flu had been found. He added if any case existed then all the farm chickens had to be destroyed.
 
Re: Pakistan: Bird Flu claims 2 lives; more suspects

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

Asymptomatic H5N1 in Pakistan

Recombinomics Commentary
December 17, 2007

Pakistan's Health Ministry issuing a statement Saturday saying six people had initially tested positive for the virus last month, while the WHO said eight had been reported. Hartl said the discrepancy was likely linked to a technicality since six patients had tested positive using an internationally recommended method while a less reliable test was used on the others.

Specimens were never collected from one of the brothers who died, and many of those who tested positive experienced only mild symptoms and were not hospitalized, Hartl said.

A doctor who treated members of the family also has tested positive for H5N1, but with a non-standard diagnostic test, Hartl said. He cautioned that further testing is needed to determine if she is indeed a case, noting she hadn't shown signs of infection.

The above comments from WHO suggest that several patients were H5N1 antibody positive and were asymptomatic. These assays don?t address the time of the infection, because antibodies can represent a prior exposure. Therefore, official confirmed cases are limited to those who have tested positive twice for antibodies and the two tests show a rising antibody level, either via sero-conversion from negative to positive, or an increase in titer of at least four fold.

These tests are most accurate when the initial sample is collected early, and the second samples is collected three to four weeks post symptoms or exposure.

The testing of asymptomatic cases is important to determine if H5N1 is silently spreading, and also important to determine if transmission chains are growing. Thus, a positive in the health care worker could signal a chain as long as H2H2H2H involving the index case, the brother who died November 19, the brother who died November 29, and the health care worker who was a contact of teh brotehrs. These transmission chains are most accurately defined when disease onset dates as well as contact dates are known.

The asymptomatic positives are also important for identifying additional cases which may not have been reported, If the contact is repeatedly positive, but the level doesn?t increase, the antibodies would signal an earlier exposure, indicating earlier transmissions.

Thus, antibody tests on contacts, including samples collected recently, would be useful.


Media Links

Recombinomics Presentations

Recombinomics Publications

Recombinomics Paper at Nature Precedings

http://www.recombinomics.com/News/12...mptomatic.html
 
Re: Pakistan: Bird Flu claims 2 lives; more suspects

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

Pakistani brothers Mohammed Ishtiaq, left, and Mohammed Tariq, right, who were treated for suspected H5N1 bird flu, during an interview with The Associated Press at their house in Sukur village near Peshawar, Pakistan on Saturday, Dec. 15, 2007. Six people caught H5N1 bird flu in northern Pakistan last month and at least one person with the disease has died, the government said Saturday. The U.N. World Health Organization confirmed the deadly H5N1 strain was found in the six cases, but said a second round of tests were being carried out to make sure. (AP Photo/Mohammad Zubair)

http://www.boston.com/news/world/asia/articles/2007/12/16/who_to_investigate_pakistan_bird_flu/
 
Re: Pakistan: Bird Flu claims 2 lives; more suspects

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

Pakistan reports first cases of bird flu

Last Updated: Monday, December 17, 2007 | 9:45 AM ET

The Canadian Press


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 six cases but a World Health Organization official suggesting as many as nine people may have tested positive for the virus in that country.
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.… We don't know enough at this point. And in some of these cases, one never will know enough."
The cluster of cases involved four brothers and two cousins living in the country's North West Frontier Province. Two 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.

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 six cases but a World Health Organization official suggesting as many as nine people may have tested positive for the virus in that country.
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.… We don't know enough at this point. And in some of these cases, one never will know enough."
The cluster of cases involved four brothers and two cousins living in the country's North West Frontier Province. Two 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.

Three people who are unrelated to the family but who were involved in culling H5N1-infected poultry in the same area have also tested positive, Hartl said.
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 last Saturday to collect specimens taken from the man, who lives in Nassau County. Tests done in the state lab and confirmed at the CDC in Atlanta showed the man was not infected with the virus.

Pakistan slow to report cases

The initial infection dates back to Oct. 25, when a livestock official — a brother in the family — fell ill. It appears that it was only after two of the man's brothers fell ill and died that testing was done looking for H5N1 infection. It is believed the first positive test was received in late November.
The WHO was officially alerted on Dec. 12, 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."
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 of two 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.
On Friday, the WHO announced that Myanmar had reported its first human case in a seven-year-old girl who fell ill in late November. She has since recovered.

http://www.cbc.ca/health/story/2007/12/17/bird-flu.html
 
Re: Pakistan: Bird Flu claims 2 lives; more suspects

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

hat-tip Rickk

Three more bird flu victims detected in NWFP

NIH confirms two patients suffering from H5N1; Federal Health Ministry taking steps to control virus

Monday, December 17, 2007,

PESHAWAR:" The NWFP Health Department on Saturday feared that the bird-flu pandemic could engulf the whole province as three more victims of the virus were admitted to hospitals in Peshawar and Abbottabad.?The virus can spread to the whole province if precautionary measures are not taken on war-footing by the federal government and the concerned international donors,? remarked NWFP Caretaker Health Minister Syed Kamal Shah.

Also, heirs of two young students and Pakistan?s first-ever bird flu victims held the authorities concerned responsible for their loss. Official sources told ?The News? that three more patients suffering from bird-flu virus were brought to hospitals in the NWFP.

Two patients ? a 10-year-old girl and a man ? living in the vicinity of a poultry farm in Abbottabad were admitted to hospitals in Abbottabad district on Saturday.

Health Minister Kamal Shah said one of the patients was admitted to the Ayub Medical Complex (HMC) and another to a private health facility, Shahina Jamil Hospital.

Sources told this scribe that blood samples of both the patients were sent to the National Institute of Health (NIH), which confirmed the two patients were suffering from H5N1 virus, which is considered the most severe bird-flu virus. Also, blood samples of the third patient who was admitted to Peshawar?s Khyber Teaching Hospital (KTH) were sent to NIH, which is supposed to release report within 24 hours.

Two young brothers ? Muhammad Idrees and Muhammad Ilyas ? had lost their lives in the KTH, mainly because of the negligence of the hospital administration as well as lack of coordination between the provincial and federal health departments. Health Minister Kamal Shah said he did not want to hide the facts from the people and felt the situation could become critical if necessary measures were not taken in time by the federal government as well as by the international donor agencies.

?This is a totally new challenge, which we are completely ill-equipped and ill-planned to tackle,? explained the minister." - excerpt

http://www.thenews.com.pk/top_story_detail.asp?Id=11764
 
Re: Pakistan: Bird Flu claims 2 lives; more suspects

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

Commonground said:
hat-tip Rickk

Three more bird flu victims detected in NWFP

NIH confirms two patients suffering from H5N1; Federal Health Ministry taking steps to control virus

Monday, December 17, 2007,

PESHAWAR:" The NWFP Health Department on Saturday feared that the bird-flu pandemic could engulf the whole province as three more victims of the virus were admitted to hospitals in Peshawar and Abbottabad.?The virus can spread to the whole province if precautionary measures are not taken on war-footing by the federal government and the concerned international donors,? remarked NWFP Caretaker Health Minister Syed Kamal Shah.

Also, heirs of two young students and Pakistan?s first-ever bird flu victims held the authorities concerned responsible for their loss. Official sources told ?The News? that three more patients suffering from bird-flu virus were brought to hospitals in the NWFP.

Two patients ? a 10-year-old girl and a man ? living in the vicinity of a poultry farm in Abbottabad were admitted to hospitals in Abbottabad district on Saturday.

Health Minister Kamal Shah said one of the patients was admitted to the Ayub Medical Complex (HMC) and another to a private health facility, Shahina Jamil Hospital.

Sources told this scribe that blood samples of both the patients were sent to the National Institute of Health (NIH), which confirmed the two patients were suffering from H5N1 virus, which is considered the most severe bird-flu virus. Also, blood samples of the third patient who was admitted to Peshawar?s Khyber Teaching Hospital (KTH) were sent to NIH, which is supposed to release report within 24 hours.

Two young brothers ? Muhammad Idrees and Muhammad Ilyas ? had lost their lives in the KTH, mainly because of the negligence of the hospital administration as well as lack of coordination between the provincial and federal health departments. Health Minister Kamal Shah said he did not want to hide the facts from the people and felt the situation could become critical if necessary measures were not taken in time by the federal government as well as by the international donor agencies.

?This is a totally new challenge, which we are completely ill-equipped and ill-planned to tackle,? explained the minister." - excerpt

http://www.thenews.com.pk/top_story_detail.asp?Id=11764
Click to expand...

http://www.recombinomics.com/News/12150704/H5N1_Pakistan_New.html
 
Re: Pakistan: Bird Flu claims 2 lives; more suspects

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

WHO team arrives in Pakistan to investigate bird flu outbreak

Dec 17, 2007, 11:56 GMT


Islamabad - A medical team from the World Health Organization (WHO) arrived in Pakistan on Monday to investigate a possible human-to-human transmission of the bird flu virus in the country's north-west region.

The team, which arrived from Geneva, was due to travel to the North-West Frontier Province to join other WHO staff in the towns of Manshera and Abbotabad, site of the country's first-ever human cases of the H5N1 avian influenza virus, according to WHO officials in Islamabad.

At least two people have died and a total of eight were infected, including a number of blood relatives, prompting Pakistan's Ministry of Health to request the WHO investigate a possible human-to-human transmission, which are extremely rare but have occurred among family members in Indonesia, Cambodia and Vietnam.

Globally, bird flu has killed at least 210 people worldwide since 2003. Most human cases of H5N1 are linked to contact with infected birds, but experts fear the virus might mutate into a form that spreads easily among humans, potentially sparking a pandemic that could kill millions of people.

http://news.monstersandcritics.com/..._in_Pakistan_to_investigate_bird_flu_outbreak
 
Re: Pakistan: Bird Flu claims 2 lives; more suspects

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

Recently posted on the NY State Dept of Health web site:

Nassau County Resident With Travel History to Pakistan Tests Negative for Bird Flu
ALBANY, N.Y. (Dec. 16, 2007) ? Today the New York State Health Department provided the following information concerning a 38-year-old male Nassau County resident who recently returned from Pakistan, where he was exposed to suspected avian influenza or H5N1, also known as bird flu. After consulting with the Centers for Disease Control and Prevention (CDC) and taking appropriate measures, the state and Nassau County Health Departments determined that there was no risk to the public or to individuals that this person came into contact with.

Upon returning from Pakistan, the man landed at JFK International Airport on December 5. He visited his private physician the next day and was referred to a local hospital for observation. The hospital reported the patient to the Nassau County Health Department on December 7. While this individual showed no symptoms, as a precaution the Nassau County Health Department notified the State Health Department on December 7 and had patient specimens sent to the state Wadsworth Laboratories in Albany to test for H5N1. The results of the tests were negative. This negative test result was confirmed by the CDC, which had dispatched its plane to Albany on December 8 to collect the patient's specimens and conduct testing in parallel. Upon confirmation of the negative test results on December 9, the man's quarantine period ended.

As an additional precaution, the Nassau County Health Department arranged for this individual to be voluntarily quarantined in his home and monitored his condition via videophone. Post-exposure prophylaxis (Tamiflu) was prescribed. Because this individual's family was not exposed to avian influenza, they were not prescribed post- exposure prophylaxis. However, one family member who was symptomatic both before and after the man's return was also tested for H5N1 by the state laboratory and CDC and also found negative.

According to the CDC, no human infections with avian influenza H5N1 have been detected in the United States. The state Health Department thanks Nassau County Health Department officials for their teamwork during this process. Preparedness exercises in the past had helped train medical staff to respond to this type of incident. CDC is working with the World Health Organization (WHO) and other international partners closely to monitor the avian influenza situation in humans.

http://www.health.state.ny.us/press...unty_resident_tests_negative_for_bird_flu.htm
 
Re: Pakistan: Bird Flu claims 2 lives; more suspects

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

Good find Darkhorse!

So he was quarantined and put on tamiflu.
 
Re: Pakistan: Bird Flu claims 2 lives; more suspects

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

Let's hope he was on Tamiflu in Pakistan, especially if he was flying home in a commercial jet liner. Another thought, it seems like this whole notion of "no harm, no foul" is a really dangerous game, especially when the virus could be tucked away in his luggage.

niman said:
Which order? Tamiflu was in use in Pkaistan.
Click to expand...
 
Re: Pakistan: Bird Flu claims 2 lives; more suspects

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

hawkeye said:
Let's hope he was on Tamiflu in Pakistan, especially if he was flying home in a commercial jet liner. Another thought, it seems like this whole notion of "no harm, no foul" is a really dangerous game, especially when the virus could be tucked away in his luggage.
Click to expand...
Testing after Tamiflu treatment produces false negatives.
 
Re: Pakistan: Bird Flu claims 2 lives; more suspects

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

Monday, December 17, 2007
WHO to investigate bird flu concerns in Pakistan
* People who were in contact with infected persons being monitored
ISLAMABAD: International health experts have been dispatched to Pakistan to help investigate the cause of South Asia?s first human bird flu cases and determine if the virus could have been transmitted from person to person, a World Health Organisation official said on Sunday. Four brothers ? two of who died ? and two cousins from Abbotabad were suspected of being infected by the H5N1 virus along with a man and his niece from the same area who had slaughtered chickens, said WHO spokesman Gregory Hartl. Another person who slaughtered poultry in Mansehra also tested positive for the disease, Hartl said. Details surrounding the cases remained confusing, with the Health Ministry issuing a statement on Saturday saying six people had initially tested positive for the virus last month, while WHO said eight cases had been reported. Hartl said the discrepancy was likely because six patients had tested positive using an internationally recommended method while a less reliable test was used on the others. Specimens were never collected from one of the brothers who died, and several of those who tested positive were not hospitalised, Hartl said. Hartl said WHO had not ruled out limited human-to-human transmission. ?We can?t answer that yet,? he said. A US medical research team is being dispatched to Pakistan to help with the investigation, US Centre for Disease Control and Prevention spokesman Dave Daigle said. Monitoring: People who came into contact with those infected in Pakistan are being monitored, WHO said. Khalif Bile, WHO representative in Pakistan, said that preliminary tests had been carried out. He said WHO was encouraging the government to carry out confirmation tests in the government laboratory and the results should be available by Tuesday. The WHO team sent to Abbotabad to help investigate the causes of the outbreak have visited the affected area and collected samples for laboratory tests, Daily Times Monitoring reported. The team who visited Abbotabad would visit the affected areas of Mansehra tomorrow, Aaj TV reported. The Health Ministry said it was treating people who had been in contact with those infected, setting up isolation wards and procuring drugs for treatment and protective clothing for health workers. Muqarab Khan, director general livestock and animal husbandry in the province, said animal surveillance was under way across the province. Vaccination campaigns have also been started, he said. ap
Courtesy DailyTimes.com.pk

http://www.pakistanlink.com/Headlines/Dec07/17/09.htm
 
Re: Pakistan: Bird Flu claims 2 lives; more suspects

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

I'm just going to look the other way now...Lets just all be glad that he wasn't infected with H5N1 ;)

niman said:
Testing after Tamiflu treatment produces false negatives.
Click to expand...
 
Re: Pakistan: Bird Flu claims 2 lives; more suspects

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

The Nassau county man is well beyond any known gestation period for H5N1.
 
Re: Pakistan: Bird Flu claims 2 lives; more suspects

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

Florida1 said:
The Nassau county man is well beyond any known gestation period for H5N1.
Click to expand...
Actually, WHO claims 17 days (but that was linked to the duck blood pudding clusters).
 
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