Re: Count of human cases in Pakistan rises to eight

[Guest guest]

Haven't heard a peep about this in any of the media.Don <DCFrench@...> wrote: According to WHO, the number of suspected cases of avian flu inPakistan has increased to eight. This is a significant escalation. Has anyone heard any reports of this on the nightly news? The majormedia networks pretty much ignore all bird flu stories, it seems. This article has the most information that I have see:Family cluster infected in Pakistan's 1st reported bird flu cases17 minutes agoAuthorities in Pakistan announced

the country's first reported humancases of H5N1 avian flu Saturday in a cluster of family members whichmay have involved person-to-person transmission.There was some confusion Saturday about how many people had testedpositive for the virus, with Pakistan announcing six cases but theWorld Health Organization saying eight suspected cases had beenidentified.The WHO said confirmatory testing must still be done. And aspokesperson for the agency said investigations are underway to try todetermine how the various people became infected, but noted somehuman-to-human spread may have occurred."We can't rule it out," Hartl said from Geneva."There are other plausible explanations.... We don't know enough atthis point. And in some of these cases, one never will know enough."The cluster of cases involved four brothers and two cousins living inthe country's North-West Frontier Province. Two of

the brothers died,one without having been tested.While the brothers who died are believed to have had at least someexposure to infected poultry, they were also known to have nursed thefirst case in the family, a brother who worked as a livestock official.A doctor who treated members of the family also has tested positivefor H5N1, but with a non-standard diagnostic test, Hartl said. Hecautioned that further testing is needed to determine if she is indeeda case, noting she hadn't shown signs of infection.Three people who are unrelated to the family but who were involved inculling H5N1-infected poultry in the same area have also testedpositive; all are still alive. At least one of the cullers worked onthe same farm as the livestock official.Meanwhile, U.S. public health authorities have confirmed theyconducted H5N1 testing on a man who had recently visited Pakistan andwas complaining of mild

respiratory symptoms. The man, who officialswill only identify as having a link to the cluster, is said to havebeen concerned he might have been infected."The individual went to his private physician after returning fromPakistan, and discussed this with his physician," said Pospisil, a spokesperson for the New York State department of health.Pospisil said the doctor contacted the local health department inNassau County, where the man lives, and they collected samples fortesting. The tests came back negative. Daigle, a spokesperson for the U.S. Centers for Disease Control,said the CDC sent its plane to Albany on Dec. 8 to collect specimensfor confirmatory testing. Within hours a CDC lab verified the statelab's findings."He was negative. There was no doubt about it," Daigle said fromAtlanta on Saturday.The initial infection in this family dates back to late October, whenthe

livestock official became sick. It appears that it was only aftertwo of the man's brothers fell ill and died that testing was donelooking for H5N1 infection. It is believed the first positive test wasreceived in late November.The WHO was officially alerted Dec. 12, Hartl said."We feel that the Pakistanis have done everything right in terms oftheir response," he said, noting the country has done a "huge" amountof work to strengthen infection control and increase surveillance."(But) yes, they could have alerted us earlier."Hartl said Pakistan has agreed to send specimens to the U.S. NavalMedical Research Unit in Cairo - a laboratory known as NAMRU-3 - forconfirmatory testing. Those specimens are expected to be shippedMonday, he said.In addition, people who have had contact with the cases are beingtraced and monitored, with close contacts being issued the antiviraldrug oseltamivir

(Tamiflu).Experts from the NAMRU-3 lab are travelling to Pakistan this weekendand WHO is sending a team of two doctors with experience treating H5N1patients as well as an epidemiologist to help with the investigationof cases.Hartl said there don't appear to be any new infections within thefamily group. But he warned it is too soon to say whether thisoutbreak is similar to other small clusters of cases among familymembers or represents something larger."We're on our toes still, because we're still in the middle of it. Wedon't have enough information yet. It's not over."Dr. Uyeki, a H5N1 expert with the CDC, cautioned againstdrawing premature conclusions."Anywhere highly pathogen influenza A/H5N1 viruses are circulatingamong poultry and people have direct and close contact with sick ordead poultry or poultry that are infected or wild birds that areinfected, there is the potential for

human cases," Uyeki said.Small, self-limiting clusters of cases - virtually always among familymembers with blood ties - have occurred in many of the countries whichhave had human H5N1 infections, including Thailand, Vietnam,Indonesia, China, Turkey, Azerbaijan and Egypt.While in most cases it can be almost impossible to tease out whetherrelated cases were infected because they shared exposure to anenvironmental source of the virus - infected chickens, for example -in a number of cases the time gap between the onset of illness amongrelatives has been suggestive of human-to-human spread.The statement from Pakistan's Health Ministry announced sixinfections, with five people having recovered. It was unclear who thecountry was counting as cases in that report.But that figure would not include the brother who died without beingtested. While his symptoms and his exposure history make H5N1infection seem

probable, without test results he cannot be added tothe official case count.Pakistan is the 14th country to announce human infections with theH5N1 virus. If these cases are confirmed, they will bring the globalcase count since late 2003 to nearly 350 human cases and 209 deaths.The Pakistan outbreak is part of a flurry of recent H5N1-related humancases.On Friday, the WHO announced that Myanmar had reported its first humancase in a seven-year-old girl who fell ill in late November. She hassince recovered.Earlier this month, China reported infections in a son and father fromJiangsu province; the son died. And in recent weeks Indonesia, thecountry hardest hit by H5N1, has reported several human cases.Experts who study H5N1 have come to expect this kind of upswing inviral activity at this time of year, both in poultry and in people."If you look at the period since November 2003 to the present we

haveseen increases in human H5N1 cases that are reported towards the endof the year and the early part of the new year," Uyeki said."And therefore it would not be surprising to begin to see an increasein human cases over the next several months."http://tinyurl.com/2kjb6j . Do one thing every day that scares you. Eleanor Roosevelt