WHO update: likely H2H transmission in North Sumatra

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The WHO is announcing the latest case as likely to be h2h, and

acknowledging a possible chain h2h2h Avian influenza – situation in

Indonesia – update 14

http://www.who.int/csr/don/2006_05_23/en/index.html

" The Ministry of Health in Indonesia has confirmed an additional case

of human infection with the H5N1 avian influenza virus. The case

occurred in a 32-year-old man. He developed symptoms on 15 May and

died on 22 May.

The case is part of a family cluster in the Kubu Sembelang village,

Karo District, of North Sumatra. The man is the seventh member of an

extended family to become infected with the H5N1 virus and the sixth

to die. An additional person, who was the first member of the family

to fall ill, died of respiratory disease on 4 May. No specimens were

taken prior to her burial and the cause of her death cannot be

determined. However, as her clinical course was compatible with H5N1

infection, epidemiologists at the outbreak site include this woman as

the initial case in the cluster.

The newly confirmed case is a brother of the initial case. Specimens

were taken on 21 May and flown the same day to Jakarta. Tests run

overnight confirmed his infection. His 10-year-old son died of H5N1

infection on 13 May. The father was closely involved in caring for

his son, and this contact is considered a possible source of

infection.

Although the investigation is continuing, preliminary findings

indicate that three of the confirmed cases spent the night of 29

April in a small room together with the initial case at a time when

she was symptomatic and coughing frequently. These cases include the

woman's two sons and a second brother, aged 25 years, who is the sole

surviving case among infected members of this family. Other infected

family members lived in adjacent homes.

All confirmed cases in the cluster can be directly linked to close

and prolonged exposure to a patient during a phase of severe illness.

Although human-to-human transmission cannot be ruled out, the search

for a possible alternative source of exposure is continuing.

Both the Ministry of Health and WHO are concerned about the situation

in Kubu Sembelang and have intensified investigation and response

activities. Priority is now being given to the search for additional

cases of influenza-like illness in other family members, close

contacts, and the general community. To date, the investigation has

found no evidence of spread within the general community and no

evidence that efficient human-to-human transmission has occurred.