Pakistan: Human H5N1 Cluster December 2007

[AlaskaDenise]

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

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

<TABLE><TBODY><TR><TD>Hospitals on alert against bird flu

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</TD></TR><TR><TD>Laboratories, drugs and emergency units put in order | Doctors say cooked meat safe for human consumption

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</TD></TR><TR><TD>Manzoor Qadir

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</TD></TR><TR><TD>LAHORE: After the conformation of eight human cases of bird flu influenza, of which two real brothers reportedly died in NWFP, for the first time in the history of country, the Punjab government has put all public hospitals on high alert to cope with any emergency arising out of H5N1 strain of avian (birds) influenza.

According to World Health Organisation, the virus has killed more than two hundred people worldwide since it began ravaging Asian poultry stocks in late 2003. ​

The experts say that it is difficult for people to catch the disease as the flu does not infect humans but, they fear, the virus could mutate into a form that passes easily among people, potentially sparking an epidemic that could kill millions of people. That is why the government has started taking extra ordinary steps to stop it. ​

Special directions have been issued to principals, medical superintendents of teaching hospitals and executive health officers (Health) for keeping surveillance and adopt recommended measures for preventing any outbreak of avian influenza. Isolation units that were meant during the last year in various public hospitals to house the suspected bird flu victims have been reactivated while medicines and diagnostic kits have been provided to the hospitals in this regard. ​

Talking to The Post, WHO representative to Punjab, Dr Asmatullah Chaudhry said in the wake of threat posed by H5N1, special instructions had been issued to the EDOs to keep constant vigil on the situation.​

"The viral transport medium required for the transport of suspected human samples along with related guidelines has been dispatched to the district health departments", he added.​

Moreover, special arrangements for rapid response if any case is detected in the province have been ensured while special teams constituted to collect blood samples for laboratory tests of the affected persons and to send these through TCS courier service to National Institute of Health Laboratory, he said , adding that besides EDO (Health), Executive District Officers (Agriculture), District Officers Forests and District Officers Livestock had been asked to reactivate surveillance to identify and isolate the viruses causing bird flu. ​

They have been directed to monitor the situation in their respective districts and to report swiftly any suspected case of bird flu in Punjab. ​

More diagnostic tests would be conducted at the Veterinary Research Institute (VRI) Lahore and Poultry Research Institute (PRI) Rawalpindi in this regard, he notified. ​

Eastern Mediterranean Region of World Health Organization (EMRO-WHO) Advisor on Infectious Diseases Dr Akbar Chaudhry said that most human cases had so far been linked to contact made with sick birds while this was very early to determine if the virus could have been transmitted through human contact in the case of two brothers' death. ​

""I can not answer that yet, it is possible, if the man to man transmission of H5N1 will be confirmed in the cases of NWFP, it will be pandemic situation for the country," he worried. He said that mortality rate owing to H5NI strain is as high as 70 per cent among the humans. ​

Dr Akbar Chaudhry, who is also one of the eight members of WHO's Task Force on Bird Flu, said that only 272 cases of birds to human transmission of H5N1 virus and just 4 cases of human to human transmission all over the world were reported since 2003 while about 210 H5N1 affected patients had died to-date. ​

Indonesia, Malaysia, Philippine, China, Vietnam, Egypt and South Asian Estates are among the bird flu affected countries, he pointed out. ​

He observed that migratory birds from Russia, Siberia, Mongolia, China, Kazakhstan, etc., were major source of bird flu transmission among poultry products and other domestic birds in Pakistan, which needed to be protected through preventive measures and vaccination among poultry and domestic birds. He said that there was a need to adopt precautionary measures by vulnerable people like poultry handlers, transporters, butchers and the buyers to avoid transmission of H5N1 virus. However, he said that the cooked chicken was absolutely safe for consumption because anything cooked at 70 degrees, which usually was a practice in our households, destroyed H5N1 virus in the meat.​

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</TD></TR></TBODY></TABLE>​

http://thepost.com.pk/CityNews.aspx?dtlid=134605&catid=3

 

[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/12170705/H5N1_Pakistan_Cloudy.html

<TABLE style="WIDTH: 775px; COLOR: rgb(190,5,1); FONT-FAMILY: helvetica,arial,sans-serif; TEXT-ALIGN: left" cellSpacing=0 cellPadding=0 border=0><TBODY><TR><TD style="VERTICAL-ALIGN: top; WIDTH: 40px">
</TD><TD style="VERTICAL-ALIGN: top; WIDTH: 515px" colSpan=5><BIG><BIG>Commentary</BIG></BIG>

Details on H5N1 Transmission in Pakistan Remain Cloudy

Recombinomics Commentary
December 17, 2007

The Pakistan cases started in mid-November, or possibly earlier, when five family members fell ill in Abbottabad, north of Islamabad. Two of the brothers have died, one of whom was buried before he could be tested for H5N1.

In December, a man and his niece in the same town were found to have H5N1. They are thought to have worked on the same farm as the first family affected. Another man was found to have H5N1 in a nearby town some distance from there. Another case is suspected but not yet confirmed, which would bring the cluster to nine.

The above comments from a Nature story by Declan Butler provide additional detail to the H5N1 cluster(s) in Pakistan, but don?t clear up the many contradictions. Some of the media reports are quite precise on dates, indicating the outbreak links back to a poultry cull on October 21-23. A veterinarian was the index case, who developed symptoms on October 25. Forty samples were collected on or about October 30, and at least four were said to be positive. Two brothers of the index case were students, and they died November 19 and 29. A third brother, a student, also tested positive, but recovered. Two more relatives (originally described as two cousins, but updated to a cousin and another brother), also tested positive, but had mild symptoms.

A sixth brother, residing in Nassau County, New York, was in Pakistan for the funerals. He returned to New York December 5 and tested negative, but WHO media quotes indicated he had mild respiratory disease symptoms, while the report from New York indicated he was asymptomatic. Since he did not return until December 5, it seems likely he was receiving Tamiflu prior to testing, which may have generated a false negative.

Similarly, there is contradictory data on a health care worker. Media reports indicated she tested positive, but was asymptomatic. A subsequent media report indicated she had mild symptoms, but test results were pending.

Thus, key data on disease onset symptoms as well as disease onset dates, remain confused, at best.

Clarification of these issues would be useful. Human-to-human transmission appears to be likely, but the length of the transmission chain and contacts in the chain, remain very much confused.

</TD></TR></TBODY></TABLE>
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[Vibrant62]

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

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

<TABLE><TBODY><TR><TD>Hospitals on alert against bird flu

snip

Eastern Mediterranean Region of World Health Organization (EMRO-WHO) Advisor on Infectious Diseases Dr Akbar Chaudhry said that most human cases had so far been linked to contact made with sick birds while this was very early to determine if the virus could have been transmitted through human contact in the case of two brothers' death.

""I can not answer that yet, it is possible, if the man to man transmission of H5N1 will be confirmed in the cases of NWFP, it will be pandemic situation for the country," he worried. He said that mortality rate owing to H5NI strain is as high as 70 per cent among the humans.

Dr Akbar Chaudhry, who is also one of the eight members of WHO's Task Force on Bird Flu

snip</TD></TR></TBODY></TABLE>​

http://thepost.com.pk/CityNews.aspx?dtlid=134605&catid=3

He is clearly concerned at the possibility of h2h, to be placed on record in an interview as saying this. Has a similar statement been made within WHO official communications as yet, or is this merely an expression of his personal concern?

 

[AlaskaDenise]

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

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

Sorry for the disappearing story. I moved a copy to the India thread, but restored the post here.

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[Sally Furniss]

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

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

Today I received this statement in my email from the CDC and I have permission to quote:

"From CDC,​

There are no reports of animal or human avian influenza A (H5N1) infections in the United States.​

• On December 7, 2007, the Centers for Disease Control and Prevention (CDC) was notified by the New York State Department of Health about a man in Nassau County, New York who had recently returned from Pakistan and who had contact with a person suspected of having been infected with avian influenza.

• The contact has since tested negative for influenza, H5 at the New York State Department of Health. This negative test result was confirmed at CDC by real-time reverse-transcriptase polymerase chain reaction (rtRT-PCR test).

• Upon returning from Pakistan to the United States, the contact was hospitalized for observation on December 6 and discharged on December 7. Voluntary home quarantine was in place until all specimens collected tested negative for avian influenza, H5 by real-time PCR on December 9."

​

This is the release we have been waiting for?

 

[sharon sanders]

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

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

They informed me that they are not issuing a press release.

This is their statement on that event.

 

[Laidback Al]

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

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

They informed me that they are not issuing a press release.

This is their statement on that event.

Will we receive any more information about whether or not the individual was treated with an antiviral while he was in Pakistan?

And will they be doing any follow up tests for antibodies at a later date?

 

[sharon sanders]

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

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

Will we receive any more information about whether or not the individual was treated with an antiviral while he was in Pakistan?

And will they be doing any follow up tests for antibodies at a later date?

They are referring all inquiries to WHO for any questions on Pakistan and for specific information on "the New York case" contact the New York state health department.

So the above statement is it, apparently.

 

[AlaskaDenise]

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

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

There are interesting photos of Pakistan's poultry farms, hospital disinfection of isolation rooms, & comments relative to each, in photos here.

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[HenryN]

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

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

<TABLE cellSpacing=0 cellPadding=0 width="96%" align=center border=0><TBODY><TR bgColor=#f4faff><TD class=small_txt height=20>Bird business</TD></TR><TR><TD>

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</TD></TR><TR><TD class=small_txt>Tuesday, December 18, 2007
The confirmation that at least eight people and possibly more have been hit by bird 'flu, and the fears expressed by the NWFP health department that a pandemic could hit the whole province, have immediately stirred panic. The deaths of two victims, and the decision by the WHO to send in a team to help Pakistan tackle the crisis, indicates the gravity of the threat. Indeed one of the aspects the WHO experts will be examining is the possibility of human to human transmission of the virus -- which could lead to a far more rapid spread of the often deadly sickness. During the last two years, the bird 'flu epidemic has taken a big toll on the country's poultry industry -- which employs thousands of people, and indeed is one of the largest job-provision and income generation sectors. The mass culling of birds at farms where the virus had been found and the sudden drop in the sales of poultry with fears of infection running high among consumers were both factors in this.

The government, in situations such as the present one, has a dual responsibility. It must ensure that people at large are safe, while also protecting the poultry industry from unnecessary losses. This can be most effectively achieved by telling the truth, acknowledging the problems that exist and informing people about necessary safety measures, especially for those who are in close contact with hens or other birds. The perception that the government is involved in any way in covering up facts is an immensely damaging one, and in recent years has had an impact on the degree of public panic generated by the surfacing of the virus within the country. The authorities then need to learn from this experience and ensure that the information they convey is reliable and that untruths are not told. At the same time, they need to try and curb the spread of the disease by carrying out organized testing at farms, particularly in NWFP, and by advising farmers on means of prevention. It is necessary, in other words, to build public trust and work along with citizens, to control the disease and the damage caused by it -- some as a consequence of the very real risks it presents, and some due to rumours that circulate swiftly and gain ground all the more quickly when, as has happened in the past, there are questions over the credibility of official voices.
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http://www.thenews.com.pk/daily_detail.asp?id=86778

 

[HenryN]

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

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

<TABLE class=RedTableBorder style="HEIGHT: 483px" cellSpacing=0 cellPadding=0 width="100%" border=0><TBODY><TR style="PADDING-LEFT: 10px" vAlign=top><TD class=articalTitle align=middle>WHO team arrives to probe bird flu cases

<TABLE cellSpacing=0 cellPadding=0 width=430 border=0><TBODY><TR><TD class=dates id=hDate height=27>Published: Tuesday, 18 December, 2007, 03:27 AM Doha Time</TD></TR></TBODY></TABLE></TD></TR><TR style="PADDING-RIGHT: 12px; PADDING-LEFT: 10px"><TD class=articalBody id=artical1 vAlign=top height=345>ISLAMABAD: A World Health Organisation (WHO) team headed for Pakistan?s North West Frontier Province (NWFP) yesterday to investigate how eight people were infected with bird flu, after the country reported its first human death from the virus.
Health officials confirmed at the weekend that eight people had tested positive for H5N1 in the province since late October, of which one person, who worked in a poultry farm, died.
A brother of the dead person, who had not been tested, also died. It was not yet clear if he was a victim of bird flu.
?The team will investigate whom the affected people were in contact with, whether they visited poultry farms or affected persons,? Health Secretary Khushnood Akhtar Lashari told Reuters.
?The other people tested positive were not from the poultry farm. Five of them have recovered while two were still being treated.?
No more new cases have been reported in the last two weeks.
Humans rarely contract H5N1, which is mainly an animal
disease. But experts fear the strain could spark a global pandemic and kill millions of it mutates to a form that spreads more easily.
The three-member WHO team, joined by officials from the Pakistan National Institute of Health, will visit Peshawar, where patients were treated, and Abbottabad, where authorities reported the last H5N1 virus case in wild birds on November 30.
Bird flu first appeared in Pakistan in early 2006, and several outbreaks of H5N1 were reported this year.
The Pakistani cases bring to nearly 350 the number of people worldwide who are known to have contracted the H5N1 virus, which has killed more than 200 people since 2003. - Reuters </TD></TR></TBODY></TABLE>

http://www.gulf-times.com/site/topi...=190578&version=1&template_id=41&parent_id=23

 

[KBD]

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

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

Pakistan Is Monitoring 40 People for Bird Flu, Official Says

By Jason Gale
Dec. 17 (Bloomberg) -- Doctors in Pakistan are monitoring
about 40 people for signs of bird flu after preliminary tests
indicated at least eight cases, including five in one family.
A team from the World Health Organization is investigating
the outbreak and will help local authorities confirm the cases
and determine whether the H5N1 strain of avian influenza was
spread from person to person, said Masood Anwar, executive
director of Pakistan's National Institute of Health in Islamabad.
Four brothers and a cousin from a family in Peshawar, near
the border with Afghanistan, were among those who tested
positive for the virus during the past three weeks, WHO
spokesman Gregory Hartl said. Disease trackers monitor clusters
of two or more linked cases to gauge whether the virus is
becoming adept at infecting humans, not just birds. Millions
could die if H5N1 develops the characteristics of seasonal flu
and spreads through coughing and sneezing.
``Luckily, no one else has come up'' positive in tests for the
virus, Anwar said in a telephone interview today.
Specimens from the patients will be studied by a team from
the U.S. Naval Medical Research Unit No.3 in Cairo, Anwar said.
Detailed analysis of the genetic makeup of the virus samples
will help doctors trace its spread and identify any mutations
that may make it more contagious to humans.
At least 340 people in 13 countries have contracted the
virus since 2003, according to the Geneva-based WHO. Three of
every five cases were fatal and most were caused by contact with
infected poultry, such as children playing with them or adults
butchering them or plucking feathers.
While almost all human H5N1 cases confirmed by WHO have
shown severe symptoms, such as pneumonia, in Pakistan at least
two people had only mild disease. Anwar said this was probably
because the patients had begun taking Roche Holding AG's Tamiflu
one to two days before being tested, and the medicine reduced
the severity of symptoms.
Pakistan's ministry of health is slated to brief reporters
on the situation after meeting with WHO doctors tomorrow, he
said.
--Editor: Naween A. Mangi

To contact the reporter on this story:
Jason Gale in Singapore at +65-6212-1579 or
j.gale@bloomberg.net

 

[HenryN]

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

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

Threat to poultry

DISTURBING news of the breakout of bird flu in some parts of the country have been heard during the past few days. And equally distressing is the reported frustration of the NWFP?s Health Minister at what has been called the National Institute of Health?s apathetic response to the blood samples of the victims sent to it for testing. This has prompted the provincial authorities to take the serious step of closing its poultry business, which is catering for, according to the Minister, 70 percent of the entire country?s demand. Acute fears are being expressed about the virus having crossed the species barrier, and the six positive cases reported so far would be investigated from the angle of whether there was human-to-human transmission of the disease. The WHO has sent experts to find out the facts and help Pakistan fight the disease. This is a serious situation that should demand wholehearted coordination between the WHO and local concerned authorities.

http://www.nation.com.pk/daily/dec-2007/18/editorials4.php

 

[AlaskaDenise]

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

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

from Bloomberg article in post 292...

.....in Pakistan at least two people had only mild disease. Anwar said this was probably because the patients had begun taking Roche Holding AG's Tamiflu one to two days before being tested, and the medicine reduced the severity of symptoms.

One more piece of this confusing puzzle. Wonder who they were?
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[Treyfish]

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

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

WHO team in Pakistan for probe

ISLAMABAD (Agencies) - International health officials on Monday arrived in Pakistan to probe the country?s first bird flu death and see if the virus was passed on by human contact, the World Health Organisation said on Monday, warning that countries should be on alert for bird flu because it is again on the move, with Pakistan reporting new infections and Myanmar logging its first human case.
?We have a three-member WHO team in Pakistan to look into the data and other details about the cases,? said the WHO?s chief in Pakistan, Khalif Bile. ?They are here to get more information and to provide more support in the case of any potential risk,? he said, adding that the Health Ministry, Agriculture Ministry and WHO are now working closely together following a ?communication gap? when the government did not immediately report suspected cases to the WHO. ?The key to the public health response is surveillance,? said Peter Cordingley, spokesman for the WHO Western Pacific region in Manila. ?If we do actually get to the cases with anti-virals early on, the health outcome is a lot better.?
Two poultry farms near Abbotabad have been closed and health workers are taking temperatures of those living in the affected area twice a day, but no new suspected cases have been reported, said Minhajul Haq, a district health officer.
Meanwhile, a high level meeting in Islamabad reviewed latest situation of avian influenza and decided to launch media campaign to create awareness about preventive measures.
Secretary Health Khushnood Akhtar Lashari chairing the meeting stressed the need for better coordination among the Ministries of Health and Ministry of Food, Agriculture and Livestock and the provincial government. He showed satisfaction over the response to the situation. The meeting was informed that the last outbreak of the Bird Flu occurred on November 30 in NWFP and culling of the infected chicken was done within 48 hours.
Since then the situation is under complete control and all the standing operating procedures are followed. The meeting was apprised that a three-member team of experts of WHO is in Pakistan to assist the federal and provincial health departments in providing guidelines to contain the spread of avian influenza. The participants showed satisfaction over the compensation process given to poultry farmers for culling the infected birds. :tiphat: http://www.nation.com.pk/daily/dec-2007/18/index9.php

 

[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/12170706/H5N1_Pakistan_Tamiflu_Blanket.html

 

[Farmer]

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

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

In December, a man and his niece in the same town were found to have H5N1. They are thought to have worked on the same farm as the first family affected.

Is it plausible in this cultural context that a 10 year old girl (see post 224) would be a commercial farm worker?

 

[Treyfish]

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

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

<TABLE><TBODY><TR><TD>

Govt to launch media campaign against bird flu​

</TD></TR><TR><TD>
</TD></TR><TR><TD>Nazia Hameed
</TD></TR><TR><TD>ISLAMABAD: The government is launching a media campaign to create awareness about preventive measures against avian influenza, says Health Secretary Khushnood Akhtar Lashari.

Chairing a high-level meeting at the Health Ministry Monday, he expressed satisfaction over the measures being taken by the ministry to contain the outbreak of the disease.

He said a media campaign was being launched to create awareness about preventive measures. He underscored the need for better coordination among all the departments concerned.

The meeting was informed that a three-member team of experts from the World Health Organisation (WHO) had arrived to assist the government in curtailing the spread of avian influenza in Pakistan.

Officials and representatives of the Ministry of Food, Agriculture and Livestock, WHO, Unicef attended the meeting. :tiphat:
</TD></TR></TBODY></TABLE>
http://www.thepost.com.pk/IsbNews.aspx?dtlid=134650&catid=17

 

[HenryN]

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

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

from Bloomberg article in post 292...



One more piece of this confusing puzzle. Wonder who they were?
.

I was under the impression that the two cousins (who are now one cousin and one brother) were mild cases.

However, what is clear from the Bloomberg article is that FIVE brothers of the the NY resident were H5N1 positive or died with H5N1 symptoms.

Moreover, if Tamiflu produced mild disease in some, it likely made others asymtomatic, which may have help halt transmission, but maksed the length of the transmission chain in samples were collected after the start of treatment.

 

[Theresa42]

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

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

So, did anyone actually have truly mild symptoms or were the mild cases all Tamiflu-created? I know there may not be an answer to this question just now -- just thought I'd throw it out there....