Two latest H5N1 cases push WHO count to 251

Sep 27, 2006 (CIDRAP News) – The World Health Organization (WHO) today confirmed reports of two more human H5N1 avian influenza cases, one in Indonesia and one in Thailand, raising the official global tally to 251 cases with 147 deaths.

The two cases involve a 20-year-old Indonesian man who is part of a suspected case cluster in Bandung, West Java, and a 59-year-old farmer from northeastern Thailand. Both cases were reported by news services yesterday.

The Indonesian man became ill with a fever and cough on Sep 17 and has been hospitalized since Sep 24, the WHO said. The man's 23-year-old brother fell ill on Sep 16 and died 2 hours after he was admitted to a hospital on the 24th. H5N1 infection is suspected in his case, but it can't be confirmed because no samples were taken, the agency said. Both men had fed dead chickens to their dogs, and there was evidence of H5 infection in household birds.

In addition, a 15-year-old sister of the two men was hospitalized Sep 25 with a fever and cough and remains hospitalized in stable condition, the WHO said. Initial tests were negative for H5 viruses and positive for H1 virus, indicating that she has normal seasonal flu rather than avian flu, the statement said.

Dr. Hudi Yusuf, a physician involved in caring for the two siblings, said the girl would be tested twice more in the next 2 days, according to an Agence France-Presse report published today. He reported that the girl was doing well but described her brother's condition as bad. Yusuf told the Jakarta Post that the brother has pneumonia in both lungs and is on a ventilator.

The latest case raises Indonesia's H5N1 toll to 68 cases with 51 deaths.

In confirming the Thai farmer's case, the WHO said he was ill for nearly a month and repeatedly tested negative for H5N1. The farmer, a 59-year-old from Nong Bua Lam Phu province, got sick with a fever Jul 14, was hospitalized Jul 21, and died Aug 10, the WHO said. Thailand has had 25 human H5N1 cases, 17 of them fatal.

Repeated polymerase chain reaction (PCR) tests on samples from the man's upper respiratory tract were negative for influenza A viruses, including H5N1, the WHO said. The virus's presence was not confirmed until after his death, when lung samples were tested. Several fighting cocks belonging to the farmer had died in the days before he fell ill, the agency said.

A report today in the Thai newspaper The Nation filled in more details about the man's case. Thawat Suntrajarn, director of the government's disease control department, said doctors initially suspected the man had leptospirosis, the story said. It wasn't until he had been sick for 2 weeks that his wife told doctors the patient had nursed sick chickens. Doctors then started treating him with oseltamivir.

An autopsy showed that the farmer's death was actually caused by drug-resistant Acinetobacter bacteria, rather than by the viral infection itself, the newspaper reported. News reports yesterday said the man had died of a bacterial infection.

The story said nine PCR tests failed to detect the H5N1 virus in the man. One doctor, Tawee Chotpitayasundond of the Queen Sirikit National Institute of Child Health, speculated that the oseltamivir treatment might have eliminated the virus from the part of the respiratory tract where swabs were taken for testing, according to the story.

See also:

WHO confirmation of H5N1 case in Indonesia
http://www.who.int/csr/don/2006_09_27a/en/index.html

WHO confirmation of case in Thailand
http://www.who.int/csr/don/2006_09_27/en/index.html

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