H5N1 hit Indonesian mother, son, but not father

Jan 16, 2007 (CIDRAP News) – Reports from Indonesia say officials have confirmed that H5N1 avian influenza infected the 18-year-old son of a woman who died of the infection last week, but the woman's husband escaped the virus.

The report, coming amid a spate of Indonesian cases and suspected cases, indicates the latest family case cluster resembles most previous ones in that cases have been limited to blood relatives, suggesting that some people have a genetic susceptibility to the virus.

The World Health Organization said yesterday that the 18-year-old man had a confirmed case and was hospitalized in critical condition. His mother, a 37-year-old from Tangerang City, Banten Province, died of the disease Jan 11.

The teenager's father, husband of the deceased woman, who also has been ill, has tested negative for the virus, according to news services. However, it was not clear whether the three all lived together, as a Reuters report said the father lives in Serpong in west Java.

I Nyoman Kandun, director of communicable disease and environmental health, said three sets of tests on the 46-year-old father were negative, Canadian Press reported in a Jan 14 story. Kandun said the man was recovering and would soon be discharged from the hospital.

Kandun reported Indonesia has had 10 H5N1 case clusters, all involving blood relatives, according to a Reuters story today. The latest cluster reinforces the suspicion that genetic factors play a role in such clusters, he said.

But there was no suggestion that the son caught the illness from his mother. The WHO said investigation has indicated that both family members had similar environmental exposures to the virus—though the agency didn't specify what that exposure was.

Besides the 18-year-old's case, the WHO yesterday reported a confirmed case in a 22-year-old woman from South Jakarta. Indonesian health officials said the woman had become ill Jan 6 and died Jan 12. "Investigations into the source of her exposure found reports of bird deaths near her home in the days prior to symptom onset," the agency said.

In addition, the WHO said Indonesia had reported the death of another 22-year-old woman, whose H5N1 infection had been announced Jan 12. The patient, from Tangerang City, died the same day her case was reported.

Five human cases have been confirmed in Indonesia so far this month, after about 6 weeks with no cases. Those affected have included a 14-year-old boy who died Jan 10, in addition to the 18-year-old, his mother, and the two 22-year-old women.

Indonesia has had 79 confirmed human cases, 61 of them fatal, according to the WHO's count. The global count is 267 cases with 161 deaths.

Hospitals in Jakarta have also been dealing with a number of suspected H5N1 cases, prompting worries about hospital capacity, according to reports. Reuters reported today that Perahabatan Hospital, one of two Jakarta facilities designated for avian flu patients, said it was overwhelmed by suspected cases.

Kandun told Reuters, "In the event of an escalation, more hospitals must be prepared. We are taking an inventory of what they need."

Muchtar Ikhsan, head of the hospital's avian flu ward, said 6 children had been discharged after they tested negative for the virus, but 3 remained and 3 more were admitted, according to Reuters.

David Heymann, the WHO's senior official for communicable diseases, said the apparent strain on Indonesian hospitals was largely due to Muslim pilgrims presenting with various illnesses after returning from Mecca, according to an Agence France-Presse report today.

Meanwhile, a government-run newspaper in Egypt reported a suspected human H5N1 case yesterday in a 20-year-old woman living in Fayoum province, southwest of Cairo, according to Bloomberg News.

The newspaper, Al-Ghomhuria in Cairo, also reported the death of a 23-year-old woman from avian flu in the same province, Bloomberg reported. But the WHO office in Cairo and the Egyptian health ministry would not confirm the reports.

The latest human cases come amid reports of new outbreaks in poultry in Japan and Thailand and a growing number of poultry outbreaks in Vietnam.

Peter Cordingley, spokesman for the WHO's Asia-Pacific regional office in Manila, found some positives in the current situation, according to the Reuters story.

"Obviously we are very concerned if this virus should develop the ability to transmit between humans. We have not seen any clear sign of that yet," Cordingley said.

"A lot of countries have done very well," he added. "Their defenses are better, their reactions are better, the surveillance is better. But if we want to describe this as a soccer game, I would say we are still in the first half and the virus is winning 5-2."

See also:

Jan 15 WHO statement
http://www.who.int/csr/don/2007_01_15/en/index.html

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