Mixed scenario seen behind Pakistan birdflu spread

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Mixed scenario seen behind Pakistan birdflu spread

By Nebehay Tue Dec 18, 5:29 PM ET

The eight individuals in Pakistan who are suspected to have bird flu

probably have a combination of infections from poultry and limited

person-to-person transmission from close contact, a top World Health

Organization expert said on Tuesday. Keiji Fukuda, coordinator of

WHO's global influenza program, said while unconfirmed, any

human-to-human spread seemed similar to previous outbreaks in Thailand

and Indonesia -- affecting close family members caring for sick loved

ones.

There was no immediate cause for alarm and the United Nations agency

was not raising its level of pandemic alert for the time being, he

said, adding it was very reassuring that " we are not seeing large

increases in the number of cases. "

" Right now it doesn't look like pure human to human transmission. It

looks like the veterinarian, who was the index case, and a number of

other suspect cases had poultry exposure, " Fukuda told Reuters in an

interview.

" It is definitely possible that we have a mixed scenario where we have

poultry to human infection and possible human to human transmission

within a family, which is not yet verified. "

But human to human transmission " would not be particularly surprising

or unprecedented, " he added.

Eight people have tested positive for the H5N1 bird flu virus in North

West Frontier Province since late October, and one of the confirmed

cases has died. A brother of the dead man also died, but was never

tested, so is not counted among them.

H5N1 is mainly an animal disease, but experts fear it could mutate

into a form that could spread easily between people, causing a

pandemic which could kill millions of people. In Thailand, a mother

was killed by the virus in 2004 after cradling her dying infected

daughter all night. The largest known cluster of human bird flu cases

worldwide occurred in May 2006 in Indonesia's North Sumatra province,

where as many as seven people in an extended family died.

Three WHO experts, led by Hassan El-Bushra of its regional Cairo

office, is in Pakistan helping to investigate the outbreak.

The " index " case, who recovered, is a veterinarian who helped with

culling operations and it is his two brothers who died after taking

care of the ill man, according to Fukuda.

" This type of close contact we know can result in human to human

transmission sometimes, " he said.

" Right now, based on the information we have, the investigation going

on and the feedback from the field team, we don't have anything

pointing to push the alarm bells or increase the (pandemic alert)

phase, " he added.

The WHO uses a series of six phases of pandemic alert to gauge the

level of threat. The world is currently in phase 3, a new influenza

virus subtype is causing disease in humans, but is not yet spreading

efficiently or sustainable among humans.

" In terms of public health implications, we are looking for human to

human transmission where casual contact can lead to infections and

allow big outbreaks in communities, " Fukuda said.

A team from the U.S. Naval Medical Research Unit NAMRU-3 laboratory in

Cairo was expected in Pakistan on Wednesday to carry out further tests

on the samples from the suspect cases.