WHO cites possible family cluster of H5N1 cases in Indonesia

Nov 29, 2005 (CIDRAP News) – The World Health Organization (WHO) today raised the possibility that Indonesia's latest confirmed case of H5N1 avian influenza was part of a family cluster of three cases.

In noting Indonesia's confirmation of the case in a 16-year-old boy from West Java province, the WHO said he had two brothers who both died recently of an illness that included fever and breathing difficulty. The 16-year-old fell ill with a fever and cough on Nov 6, was hospitalized 10 days later, and is in stable condition, the WHO said.

The two brothers, aged 7 and 20, both became ill Nov 3 and died Nov 11, the agency said. Their illness was presumed to be typhoid fever, but no samples were taken before burial, which precluded definitive diagnosis of their cases.

The WHO didn't assess the likelihood that the two deceased brothers had H5N1 or that the virus spread from person to person in the family. The statement said investigators found that chickens in the household had died in the 2 weeks before the deceased brothers got sick, and samples from the birds are being tested.

Most human cases of H5N1 have been attributed to exposure to sick poultry. Family clusters of cases raise the possibility of person-to-person transmission of the virus, which could signal an increase in the risk of a pandemic. Researchers reported recently that 15 family clusters occurred in Southeast Asia between January 2004 and July 2005. But only one family cluster, which occurred in Thailand in September 2004, has been classified as a probable result of person-to-person spread.

WHO to investigate Chinese cases
In other news, the WHO today confirmed previous reports that it would help investigate two recent human H5N1 cases in China's Anhui province. WHO experts are part of a team investigating the fatal cases in two women, both farmers, aged 24 and 35.

The team is gathering information about how the two women were exposed to the virus. They lived some distance apart, and there is no known link between the cases, the WHO said. China has had three human cases so far.

Meanwhile, two new poultry outbreaks of avian flu were reported in China today, one in the northwestern region of Xingiang and one in the central province of Hunan, according to a Reuters report.

The WHO statement said China has had 25 poultry outbreaks in nine provinces since mid-October.

Outbreaks wane in Thailand and Russia
In Thailand, the government said only one area is still under an avian flu watch, according to an Agence France-Presse (AFP) report today. The country has had a number of poultry outbreaks and four human cases in recent months.

An official named Surapong Suebwonglee told AFP that a site in Nonthaburi province remained under 21-day surveillance for avian flu, "but if nothing goes wrong tomorrow, that will be lifted."

In Russia, the health ministry said only two areas are still affected by avian flu, down from 10 a month ago, according to another AFP report today. The sites are in the Kurgan region, about 1,300 miles southeast of Moscow, and in the Astrakhan region, about 930 miles south of Moscow, on the Caspian Sea.

US eases restriction on Canadian poultry
The United States lifted a week-old ban on poultry from British Columbia after concluding that the strain of avian flu found in two ducks on farms east of Vancouver posed no threat to human health, Bloomberg News reported yesterday.

The ban will remain in effect for poultry on farms within 3 miles of where the two infected ducks were found, the story said. Dr. Con Kiley of the Canadian Food Inspection Service said the virus found at the first farm was identified as an H5N2 strain, and the same result was expected at the second farm, according to the story. The farms are near Chilliwack.

The United States had banned all live poultry and raw poultry products from British Columbia on Nov 21. About 58,000 ducks on the two affected farms were killed as a precaution.

See also:

Nov 29 WHO statement
http://www.who.int/csr/don/2005_11_29/en/index.html

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