WHO Probes Bird Flu Cluster

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WHO Probes Bird Flu Cluster

Signs of Human Transmission Sought in Indonesian Deaths

By Alan Sipress, Washington Post Foreign Service

Friday, May 19, 2006; Page A17

JAKARTA, Indonesia, May 18 -- An international team of health

investigators arrived on the Indonesian island of Sumatra on Thursday

to determine whether an unusually large cluster of human bird flu

cases indicates that the highly lethal virus has mutated into a form

easily spread among people.

Laboratory tests conducted for the World Health Organization

confirmed this week that five members of one extended family in Kubu

Sembilang village had died of bird flu during the first two weeks of

May and a sixth had been infected but was recovering. A seventh

family member, a 37-year-old woman who had been the first to fall

ill, is also suspected of succumbing to the disease but was buried

before samples could be taken.

The Sumatran cluster is the world's largest since the disease emerged

in East Asia in 2003, although several dozen others have been

reported. Any cluster raises the prospect that the virus has

undergone genetic change allowing it to spread more readily among

people, increasing the likelihood of a global pandemic.

WHO dispatched two investigators from its Jakarta office to northern

Sumatra last week, but their initial efforts were stymied by

distraught relatives' reluctance to discuss the cases. A second team,

which arrived Thursday, included a senior epidemiologist from WHO's

headquarters in Geneva and investigators from the Centers for Disease

Control and Prevention in Atlanta and WHO's regional office in New

Delhi.

" We are taking this very seriously, " said Sari Setiogi, spokeswoman

for WHO's Indonesia office. " The good news is that from our

investigation to date, there's no evidence of further spread of the

virus beyond the family. "

Setiogi said that relatives, neighbors and health-care workers who

treated the patients were being monitored and that none had shown

influenza-like symptoms.

Influenza specialists have said they suspect human transmission

played a role in several other clusters of infection, including

instances in Thailand, Vietnam and elsewhere in Indonesia. But the

disease has yet to demonstrate it can pass beyond the confines of a

family, which would be necessary for bird flu to spark a global

epidemic.

The source of the Sumatra outbreak remains unclear. Health officials

said that they had heard a report of sick chickens near one of the

victims' homes but that tests of poultry and other livestock in the

village had failed to identify any infected animals. Agriculture

Minister Anton Apriyantono said Thursday, however, that samples taken

from chickens, ducks and pigs from the surrounding district had

tested positive for exposure to bird flu.

Some Indonesian health officials have speculated that the afflicted

family members, who lived near each other in four houses, had

contracted the virus either by sharing a feast of infected chicken

and pork or from contaminated manure. Health Minister Siti Fadilah

Supari minimized the possibility that the virus had spread from one

family member to another.

If they had all caught bird flu from the same contaminated source,

the victims would have been expected to become sick within the normal

incubation period for the disease, which at most is slightly more

than one week. But the final victim, a toddler, became ill after

that, raising the possibility that the virus was passed between

relatives.

Nur Rasyid Lubis, who heads the bird flu prevention team at Adam

Malik Hospital in North Sumatra, said five members of the family,

including at least two children, were admitted at the same time on

May 8 with fever and respiratory problems. X-rays showed symptoms of

pneumonia. They all died over the following week.

Lubis reported that all seven victims from the family were related to

one another by blood rather than through marriage, reinforcing the

suspicions of some influenza specialists that genetic susceptibility

could play a role in determining who catches bird flu.

The Sumatra cases and a separate fatal infection confirmed this week

in Surabaya, Indonesia's second-largest city, increased the country's

death toll from the disease to at least 30. Bird flu has infected

more than 216 people worldwide, killing more than half.

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