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WHO, US Navy send teams to probe human bird flu clusters in Pakistan


The two most famous survivors of H5N1 since Jones Ginting are pictured at left. 

Pakistani brothers Mohammed Ishtiaq, right, and Mohammed Tariq, left, who were treated for suspected H5N1 bird flu, come out from 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)

The WHO has gotten their Boots on the Ground in Pakistan.  They are accompanied by top-flight staff from the world-famous US Navy research lab, headquartered in Cairo (NAMRU-3).  They are all charged with finding answers that may or may not ultimately invoke Phase Four on the Big Board. Specifically, the situation in Mansera and Peshawar, Pakistan, is growing more disconcerting, as some media reports are reporting that a third family cluster has arisen.  That third cluster of human cases would be the cousins of the many brothers infected (or suspected to have been infected) by H5N1.

To recap:  Pakistan has had anywhere from six to nine confirmed cases of human H5N1.  All indications -- from the onset of symptoms to the dates of death for the dead brothers -- point to classic human-to-human infection of Influenza A.  Two separate families are confirmed to be involved, and the third is awaiting confirmation.  Check my blog http://www.scottmcpherson.net/journal/2007/12/14/all-eyes-on-pakistan-as-h5n1-h2h-transmission-grows-more-pro.html

The two towns in question are very close together.  Flusite poster Hawkye has started a map pinpointing the locations of the clusters.  The site can be reached at: http://hawkeye00x00.awardspace.com/map/mapit.php?mapid=pakistan.xml . By the way, note the proximity of the two towns to the Tarbela Reservoir, a large body of water in the area.  

The topic now turns to determining just how many brothers are in this index family!  From what I can figure out, the brother at right in the photo above is the index case, Patient Zero if you will.  He is the veterinarian and helped in the culling of poultry in late October.  The brother (Jean Reno look-alike) at left also tested positive for H5N1.  Counting their two dead brothers, that would be four suspected cases and three confirmed cases in one single family.  No samples were taken of one of the two dead brothers, inexplicably.

Now to the day laborer/culler:  According to the Frontier Post (a Peshawar, Pakistan Newssite), the infected culler, his niece and another person are positive for H5N1, albeit less severe. That makes three more, which brings us to six comfirmed human cases of H5N1. 

The site also attempts to clear up the confusion surrounding patient Zero's US-resident brother, but adds some even more troubling news:

New York State health officials were informed Dec. 7 that a man from Nassau County who had returned from Pakistan told his doctor he might have been exposed to avian flu, said Claudia Hutton, director of public affairs for state department of health. The man went into voluntary quarantine at home, Hutton said. Then his son began developing flu-like symptoms. Samples from both man and his son were tested at state laboratories and at U.S. Centers for Disease Control and Prevention in Atlanta. CDC sent an airplane to Albany to pick up samples. The samples came back negative for H5N1 avian flu this week, and man and his son are no longer in quarantine, he said. He said there were erroneous reports on Internet that another brother of H5N1-infected family members in Pakistan returned to the U.S. and tested positive. The remaining suspected cases in Pakistan include a man and his niece, and a male who worked on a nearby farm. (bold mine)

Apparently, the reports of the CDC being Johnny-on-the-spot were wrong.  They were notified by the brother that he had traveled to Pakistan.  The CDC were not waiting for him on the tarmac, bunny suits at the ready.  The family doctor called the health department. Imagine for a moment if the two were asymptomatic carriers of H5N1.  Yeah, it scares the beejeesus outta me, too.  The newssite is at: http://www.thefrontierpost.com/News.aspx?ncat=hn&nid=640 with a big hat-tip to flusite poster Commonground.  The official New York State Department of Health press release regarding the sequence of events is available at: http://www.health.state.ny.us/press/releases/2007/2007-12-16_nassau_county_resident_tests_negative_for_bird_flu.htm with a hat-tip to flusite poster Dark Horse.

helen%20branswell.gifAnyway, the Canadian Press' Helen Branswell (photo) is also covering the situation, and one hopes the Canadians can cough up (no pun intended) the airfare to get her over there with an interpreter!  Ms. Branswell reports:

There was some confusion Saturday about how many people had tested positive for the virus, with Pakistan announcing six cases but an official of the World Health Organization suggesting as many as nine people may have tested positive for the virus in that country.

The WHO spokesperson said investigations are still under way 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.” (bold mine)


My point exactly.  We may never know conclusively if this virus attained efficient H2H transmissibility in Pakistan.  But if medical authorities suspect it strongly, is that not evidence enough to press the button and move to Phase Four?  That is where the US Navy's NAMRU-3 unit comes in.  If anyone can find the answer quickly, they can.  They are remarkable.  To learn a quick tidbit about NAMRU-3, read my blog http://www.scottmcpherson.net/journal/2007/7/22/new-bird-flu-case-in-egypt.html .

Almost on que with my earlier post on the simultaneous threat of H2H H5N1, the WHO issued this statement:

WHO warns countries to be vigilant as bird flu flares in Asia

Monday, December 17, 2007

HANOI, Vietnam: The World Health Organization warned Monday 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.

"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 antivirals early on, the health outcome is a lot better."

WHO experts arrived in Pakistan to try to sort out cases reported there, South Asia's first human infections. They were expected to visit a hospital and affected areas Tuesday, said WHO country representative Khalif Bile in Islamabad.

"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.

Four brothers and two cousins fell ill last month in Abbotabad, a small city north of Islamabad, while three others who slaughtered poultry in the same area and a nearby town tested positive for the H5N1 bird flu virus earlier this month.

Two of the brothers died, but specimens were collected from only one.

The cases were positive for H5N1 in initial government testing, but WHO will conduct further analysis to confirm the results.

WHO spokesman Gregory Hartl in Geneva said Sunday human-to-human transmission had not been ruled out, but added that poultry outbreaks had earlier been reported in the area and it was unclear if all patients had links to sick birds or infected surroundings.

A doctor who cared for the brothers also experienced mild flu-like symptoms, but more testing needs to be carried out to determine if she was infected, Hartl said.

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.

"We are on high alert, though we still await any confirmation of human-to-human transmission," he said.

At least 208 people have died from the virus, which began plaguing Asian poultry stocks in late 2003. It remains hard for people to catch, but scientists worry it could mutate into a form that spreads easily among people, potentially sparking a pandemic.

With fresh poultry outbreaks reported in a number of countries, including Germany over the weekend, WHO urged nations to be vigilant in identifying and reporting cases in both birds and humans.

Myanmar's first human case was reported Friday in a 7-year-old girl who fell ill last month and survived, while Indonesia, the country hardest hit by the virus, has announced its 93rd death from the virus.

Two human cases were also recently confirmed in China, one of whom died.

The H5N1 virus often flares during the winter months. In some countries, like Indonesia, poultry outbreaks and human cases are reported year round, but many countries experience a flurry of activity when temperatures drop.

"It starts to pop at this time of the year, not just in this region where it's endemic, but it starts to appear in the West," Cordingley said. "Between now and April is a very dangerous time of the year."

Most human bird flu cases have been linked to sick birds, but experts suspect limited person-to-person transmission may have occurred in a few cases involving blood relatives. (bold mine)

Interesting that the WHO is now picking up the H2H mantra.  When dealing with risk communications, it is critically important to stay "on message" and not give mixed signals.  How many times have we watched with incredulity as a government, while trying to prepare its people for a flu pandemic, downplays the seriousness of a poultry outbreak of H5N1?

You cannot try to raise awareness and concern about an influenza pandemic, and then tell people a poultry outbreak is not a cause for alarm.  My God, two weeks ago the Polish were selling H5N1-tainted raw chicken and EGGS in their supermarkets!  Patting people on the back and reminding them that cooking poultry thoroughly will kill virus is of no consolation to some hapless sod who orders his eggs over easy and gets them runny in a Polish restaurant, or gets an accidentally undercooked chicken there.   

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February 13, 2009 | Unregistered CommenterBuireeaccuddy

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