Count of human cases in Pakistan rises to eight

[Guest guest]

According to WHO, the number of suspected cases of avian flu in

Pakistan has increased to eight. This is a significant escalation.

Has anyone heard any reports of this on the nightly news? The major

media 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 cases

17 minutes ago

Authorities in Pakistan announced the country's first reported human

cases of H5N1 avian flu Saturday in a cluster of family members which

may have involved person-to-person transmission.

There was some confusion Saturday about how many people had tested

positive for the virus, with Pakistan announcing six cases but the

World Health Organization saying eight suspected cases had been

identified.

The WHO said confirmatory testing must still be done. And a

spokesperson for the agency said investigations are underway to try to

determine how the various people became infected, but noted some

human-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 at

this point. And in some of these cases, one never will know enough. "

The cluster of cases involved four brothers and two cousins living in

the 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 some

exposure to infected poultry, they were also known to have nursed the

first case in the family, a brother who worked as a livestock official.

A doctor who treated members of the family also has tested positive

for H5N1, but with a non-standard diagnostic test, Hartl said. He

cautioned that further testing is needed to determine if she is indeed

a case, noting she hadn't shown signs of infection.

Three people who are unrelated to the family but who were involved in

culling H5N1-infected poultry in the same area have also tested

positive; all are still alive. At least one of the cullers worked on

the same farm as the livestock official.

Meanwhile, U.S. public health authorities have confirmed they

conducted H5N1 testing on a man who had recently visited Pakistan and

was complaining of mild respiratory symptoms. The man, who officials

will only identify as having a link to the cluster, is said to have

been concerned he might have been infected.

" The individual went to his private physician after returning from

Pakistan, 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 in

Nassau County, where the man lives, and they collected samples for

testing. 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 specimens

for confirmatory testing. Within hours a CDC lab verified the state

lab's findings.

" He was negative. There was no doubt about it, " Daigle said from

Atlanta on Saturday.

The initial infection in this family dates back to late October, when

the livestock official became sick. It appears that it was only after

two of the man's brothers fell ill and died that testing was done

looking for H5N1 infection. It is believed the first positive test was

received in late November.

The WHO was officially alerted Dec. 12, Hartl said.

" We feel that the Pakistanis have done everything right in terms of

their response, " he said, noting the country has done a " huge " amount

of 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. Naval

Medical Research Unit in Cairo - a laboratory known as NAMRU-3 - for

confirmatory testing. Those specimens are expected to be shipped

Monday, he said.

In addition, people who have had contact with the cases are being

traced and monitored, with close contacts being issued the antiviral

drug oseltamivir (Tamiflu).

Experts from the NAMRU-3 lab are travelling to Pakistan this weekend

and WHO is sending a team of two doctors with experience treating H5N1

patients as well as an epidemiologist to help with the investigation

of cases.

Hartl said there don't appear to be any new infections within the

family group. But he warned it is too soon to say whether this

outbreak is similar to other small clusters of cases among family

members or represents something larger.

" We're on our toes still, because we're still in the middle of it. We

don't have enough information yet. It's not over. "

Dr. Uyeki, a H5N1 expert with the CDC, cautioned against

drawing premature conclusions.

" Anywhere highly pathogen influenza A/H5N1 viruses are circulating

among poultry and people have direct and close contact with sick or

dead poultry or poultry that are infected or wild birds that are

infected, there is the potential for human cases, " Uyeki said.

Small, self-limiting clusters of cases - virtually always among family

members with blood ties - have occurred in many of the countries which

have 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 whether

related cases were infected because they shared exposure to an

environmental source of the virus - infected chickens, for example -

in a number of cases the time gap between the onset of illness among

relatives has been suggestive of human-to-human spread.

The statement from Pakistan's Health Ministry announced six

infections, with five people having recovered. It was unclear who the

country was counting as cases in that report.

But that figure would not include the brother who died without being

tested. While his symptoms and his exposure history make H5N1

infection seem probable, without test results he cannot be added to

the official case count.

Pakistan is the 14th country to announce human infections with the

H5N1 virus. If these cases are confirmed, they will bring the global

case count since late 2003 to nearly 350 human cases and 209 deaths.

The Pakistan outbreak is part of a flurry of recent H5N1-related human

cases.

On Friday, the WHO announced that Myanmar had reported its first human

case in a seven-year-old girl who fell ill in late November. She has

since recovered.

Earlier this month, China reported infections in a son and father from

Jiangsu province; the son died. And in recent weeks Indonesia, the

country hardest hit by H5N1, has reported several human cases.

Experts who study H5N1 have come to expect this kind of upswing in

viral 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 have

seen increases in human H5N1 cases that are reported towards the end

of the year and the early part of the new year, " Uyeki said.

" And therefore it would not be surprising to begin to see an increase

in human cases over the next several months. "

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