Pakistan - BF Suspected Human Cases December 18, 2007 to Feb 2, 2008

[Treyfish]

<TABLE class=ap-story-table style="veritcal-align: :top" border=0><TBODY><TR class=ap-story-tr><TD class=ap-story-td>WHO team begins investigating Pakistan bird flu outbreak

</TD></TR><TR><TD><!-- Story-MediaBoxPosition: 0 --><!-- MediaBox: 15065874 Created : 2007/12/18 08:44:11 Modified : 2007/12/18 08:44:11 Generated: 2007/12/18 08:44:12 --><TABLE class=ap-mediabox-table style="CLEAR: both; MARGIN-TOP: 10px; FLOAT: right; MARGIN-BOTTOM: 3px; MARGIN-LEFT: 3px" cellSpacing=0 cellPadding=0 border=0><TBODY><TR class=ap-mediabox-tr><TD class=ap-mediabox-td><!-- Package: 1465312: online Created: 2007/12/18 08:44:11 Modified: 2007/12/18 08:44:11 Generated: 2007/12/18 08:44:12 --><!-- SmallPhoto: 2981441 Created: 2007/12/18 08:18:55 Modified: 2007/12/18 08:18:57 Generated: 2007/12/18 08:44:12 --><TABLE class=ap-smallphoto-table cellSpacing=0 cellPadding=0 border=0><TBODY><TR class=ap-smallphoto-tr><TD class=ap-smallphoto-td-image>
AP Photo/Greg Baker</TD></TR></TBODY></TABLE><!-- /SmallPhoto: 2981441 --><!-- /Package: 1465312 --></TD></TR></TBODY></TABLE><!-- /MediaBox: 15065874 --><!-- /Story-MediuaBoxPosition: 0 -->ISLAMABAD, Pakistan (AP) -- A World Health Organization team began piecing together Pakistan's first human bird flu cases Tuesday to try to determine whether human-to-human transmission may have occurred.
The health experts visited a hospital in the northwestern city Peshawar that treated many of the eight patients suspected of being infected with the H5N1 bird flu virus. They were working with doctors and nurses on how to handle suspected cases and improve infection control measures.
"They want to go through the records in the hospital for the last month or two to see if there's been any upsurge in respiratory cases that weren't identified as H5N1 but which could actually be," said Gregory Hartl, a WHO spokesman in Geneva.
They were expected to visit the other affected areas Wednesday, he said. Pakistan has also requested additional supplies of the antiviral Tamiflu as a precaution.
Four brothers and two cousins fell ill last month in Abbotabad, north of Islamabad, while other people, who slaughtered poultry in the same area and a nearby town, tested positive for the H5N1 bird flu virus this month.
Two of the brothers died, but specimens were collected from only one.
The cases were positive for H5N1 in initial government testing, but WHO will conduct further analysis to confirm the results.
The WHO team will work to determine which patients could have been exposed to the virus by infected birds and were investigating whether human-to-human transmission could have occurred.
One of the brothers who survived said he was hospitalized with flu symptoms after slaughtering chickens suspected of carrying bird flu without wearing protective clothing last month.
The siblings who died were both studying at an agricultural college in the northwestern city of Peshawar, did not accompany him to the farm, but visited him in a hospital, Mohammed Ishtiaq said.
It was unclear if they had other contact with poultry or another potential sources of infection.
Hartl said no new cases have been discovered, but increased awareness has led to more people with flu-like symptoms being checked.
"What this is showing is that they're taking everything very, very seriously," Hartl said. "Surveillance has been enhanced, more people are reporting cases and more people have been sensitized on the heath care worker side of the need to notice."
At least 208 people have died from the virus, which began plaguing Asian poultry stocks in late 2003, according to the WHO. It remains hard for people to catch, but scientists worry it could mutate into a form that spreads easily among people, potentially sparking a pandemic. http://hosted.ap.org/dynamic/stories...12-18-08-44-11

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[HenryN]

Re: Pakistan: Bird Flu claims 2 lives; more suspects

Commentary at

http://www.recombinomics.com/News/12180702/H5N1_Onset_Murky.html

[HenryN]

Re: Pakistan: Bird Flu claims 2 lives; more suspects

Possible H5N1 family cluster probed in Pakistan

Dec 17, 2007 (CIDRAP News) ? The World Health Organization (WHO) has sent a team to Pakistan to investigate at least eight suspected human cases of H5N1 avian influenza in the same general area, including cases in four brothers and two of their cousins, according to news services.
WHO spokesman Gregory Hartl said limited human-to-human transmission in the cases is possible, according to an Associated Press (AP) report published yesterday. However, he told Nature that 40 contacts of the suspected case-patients have tested negative.
If confirmed, the cases will mark the first human H5N1 infections in Pakistan. They also appear to constitute the largest cluster of related infections since eight cases (seven confirmed, one probable) occurred among relatives in North Sumatra in May 2006. Transmission of the disease from a 10-year-old boy to his father was confirmed by laboratory testing in that episode.
In a Dec 15 statement, the WHO said Pakistan's ministry of health had reported eight suspected cases in the Peshawar area, in the wake of culling operations to control poultry outbreaks there. Peshawar is in the country's North-West Frontier province, near the Afghan border, where most of the country's poultry outbreaks have occurred.
Samples from the patients tested positive in Pakistan's national laboratory and were being sent to a WHO reference lab for confirmation and further analysis, the WHO said.
Doctors from the WHO in Geneva and Cairo and others from US Navy Medical Research Unit 3 in Cairo were on their way to Pakistan yesterday to help investigate the cases and combat the disease, according to a Dec 16 Bloomberg news report. The team planned to track down, treat, and test contacts of the suspected case-patients, according to the Nature report.
Details of the suspected cases remained somewhat hazy today, as news reports varied in some respects.
According to the AP, Hartl said the illnesses involved four brothers, two of whom died, and two cousins, all from Abbotabad, a city about 30 miles north of Islamabad. Specimens were never collected from one of the deceased brothers. Two of the deceased men were students at an agricultural college in Peshawar; they were not involved in culling poultry, but they visited another brother when he was hospitalized, the story said.
Also among the suspected cases were a man and his niece from the Abbotabad area and a person who slaughtered poultry in Mansehra, 15 miles away, Hartl told the AP. He said some of the patients had had only mild symptoms and were never hospitalized.
The Bloomberg News report, also based on information from Hartl, concurred that the suspected case-patients included four brothers. The first case was in an agriculture official who fell ill after culling poultry in the Abbotabad area in late October. He was cared for by two of his brothers, both of whom subsequently died, one about a month ago and the other on Nov 29. A third brother of the first man also got sick, was hospitalized, and recovered, the story said.
The suspected cases also included two of the four brothers' cousins, who had only mild symptoms, plus a man and his niece who were involved in culling poultry in the area, Bloomberg reported. (It was not clear if the cousins were involved in culling.) Another case was in a male farm worker from Mansehra.
Still another brother of the first man to fall ill lives in New York state but flew to Pakistan to attend the funeral of one of his deceased brothers, according to Bloomberg. On his return, he told his physician that he might have been exposed to avian flu and quarantined himself at home, after which his son experienced flu-like symptoms. Samples from both father and son tested negative in state and federal laboratories last week, the story said.
Hartl told Bloomberg it was too early to tell whether the cases all spread from birds or involved limited person-to-person spread. He said some of the patients kept chickens and quail, and it was unclear what kind of protective equipment they used during culling.
The Nature report said Pakistan was slow to inform the WHO of the possible cases, boding ill for the agency's hope of detecting any person-to-person transmission early and quickly providing antiviral treatment to stop a potential pandemic. The story said the first cases occurred in mid-November at the latest, but Pakistan didn't officially inform the WHO until Dec 12.
See also:
Dec 15 WHO statement
http://www.who.int/csr/don/2007_12_15/en/index.html
Jun 23, 2006, CIDRAP News story on human-to-human transmission in North Sumatra cases
http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/jun2306cluster.html

http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/dec1707pakistan.html

[Treyfish]

Re: Pakistan: Bird Flu claims 2 lives; more suspects

The news agencies have posted reports of a mild earthquake in southern Punjab in the middle of the morning, rated just over 5 on the Richter scale. No damage has been reported.
The Americans have issued a press release about help they're giving in Pakistan's battle against H5N1 bird flu. They're giving more than 70,000 US dollars worth of protective equipment, to safeguard frontline workers.
<!-- S IIMA --><TABLE cellSpacing=0 cellPadding=0 width=203 align=right border=0><TBODY><TR><TD> There has been an outbreak of the deadly H5N1 strain of bird flu

</TD></TR></TBODY></TABLE><!-- E IIMA -->This is the latest in a stream of stories in the last few days about some recent deaths, just confirmed as the often fatal H5N1 strain of avian flu. More investigations are underway about whether there's any sign of human-to-human transmission. If there were, that would be a huge story with implications worldwide - but it seems alarmist to file on this at this early stage. http://news.bbc.co.uk/2/hi/south_asia/7148767.stm

[HenryN]

Re: Pakistan: Bird Flu claims 2 lives; more suspects

The news agencies have posted reports of a mild earthquake in southern Punjab in the middle of the morning, rated just over 5 on the Richter scale. No damage has been reported.
The Americans have issued a press release about help they're giving in Pakistan's battle against H5N1 bird flu. They're giving more than 70,000 US dollars worth of protective equipment, to safeguard frontline workers.
<!-- S IIMA --><TABLE cellSpacing=0 cellPadding=0 width=203 align=right border=0><TBODY><TR><TD> There has been an outbreak of the deadly H5N1 strain of bird flu


</TD></TR></TBODY></TABLE><!-- E IIMA -->This is the latest in a stream of stories in the last few days about some recent deaths, just confirmed as the often fatal H5N1 strain of avian flu. More investigations are underway about whether there's any sign of human-to-human transmission. If there were, that would be a huge story with implications worldwide - but it seems alarmist to file on this at this early stage. http://news.bbc.co.uk/2/hi/south_asia/7148767.stm

The popular press doesn't grasp what OBVIOUS H2H looks like.

[sharon sanders]

Re: Pakistan: December 18+, WHO Begins Investigations

Previous Pakistan thread:

http://www.flutrackers.com/forum/showthread.php?t=44767

[Shannon Bennett]

Re: Pakistan: December 18+, WHO Begins Investigations

http://www.presstv.ir/detail.aspx?id=35518&sectionid=3510210

<TABLE cellPadding=10 width="98&#37;" border=0><TBODY><TR><TD>Pakistan reports human bird flu cases
Tue, 18 Dec 2007 20:23:47
</TD></TR><TR><TD><TABLE cellSpacing=0 cellPadding=0 width=200 align=right border=0><TBODY><TR><TD>
</TD></TR></TBODY></TABLE>The Pakistani Health Ministry has reported the first six human cases of H5N1 avian influenza in the North West Frontier Province.

According to health officials, the first known H5N1 case in Pakistan was a poultry culler who died as a result of the virus.

The statement says that two of the man's brothers also fell sick, one of whom died subsequently.

It has not been confirmed whether the second death occurred as a result of the man caring for his brother or from exposure to the infected birds kept in their home.

The Federal Health Secretary has claimed no more poultry or human cases have been detected over the last two weeks, but a World Health Organization (WHO) team will arrive in Pakistan in the next few days.

The Geneva-based WHO said it was aware of eight suspected human cases of H5N1 bird flu in Pakistan's Peshawar region.

PKH/HGH
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[Laidback Al]

Re: Pakistan: December 18+, WHO Begins Investigations

Here is my guess at the genealogy of family cluster in Pakistan.

Red names are postive or suspected human H5N1 cases. The brother from NY has tested negative. Information on the testing of his son is lacking, but the son is not a suspected case.

[Commonground]

Re: Pakistan: December 18+, WHO Begins Investigations

Great Job Laidback Al.

I have:
Riaz Hussain - Adm: 12/15 From: Palosai (town). Hospital: Peshawar Khyber Teaching Hospital.

[Theresa42]

Re: Pakistan: December 18+, WHO Begins Investigations

Awesome! Thanks, Al!

Keep in mind that Pakistan has one of the highest rates of consanguineous marriages (i.e. mostly cousin marriages) in the world -- 50&#37;+ of marriages in Pakistan are between (mostly) 1st or 2nd cousins:

http://www.consang.net/index.php/Global_prevalence

I'd expect the rates to be particularly high in the more remote, "tribal" areas of Pakistan such as the NWF Province.

So, in your genealogical charts there, the husbands and wives are likely to also be cousins (and probably paternal cousins -- I believe that FBD or Father's Brother's Daughter is the most common type of cousin marriage in Pakistan).

[hawkeye]

Re: Pakistan: December 18+, WHO Begins Investigations

awesome chart! thnx!

[hawkeye]

Re: Pakistan: December 18+, WHO Begins Investigations

Nassau man tests negative for bird flu

BY STEVE RITEA | steve.ritea@newsday.com; This story
December 17, 2007

A 38-year-old Nassau County man tested negative for bird flu after being quarantined for three days following his return from Pakistan, where health officials are investigating the cause of South Asia's first outbreak of the deadly virus.

The unidentified man landed at Kennedy Airport on Dec. 5 and the next day visited his doctor, who referred him to an unnamed local hospital for observation, according to the state health department.

Investigators with the Centers for Disease Control and Prevention flew to Albany Dec. 8 to collect a portion of a sample the Nassau County Health Department sent to the state health department for testing. All agencies confirmed the results were negative by Dec. 9 and the man's home quarantine was lifted. State officials said the man exhibited no symptoms.

CDC spokesman Dave Daigle said the man may have ties to people in Pakistan who have been infected with bird flu, but he was unable to elaborate.

He said the CDC's involvement is not uncommon, recalling some 50 instances where they have tested for bird flu around the nation since last year.

Bird flu has never been detected in the United States.

Daigle said there are no travel restrictions to Pakistan or South Asia and passengers returning from those countries are not subject to any special scrutiny.

In Pakistan, four brothers - two of whom died - and two cousins from Abbotabad, a small city about 30 miles north of Islamabad, were suspected of being infected by the virus, said World Health Organization spokesman Gregory Hartl in Geneva. A man and his niece from the same area who had slaughtered chickens were also suspected of having the virus.

Another person in a separate case who slaughtered poultry in Mansehra, 15 miles away, also tested positive for the disease, he said.

Details surrounding the cases remained confusing, with Pakistan's Health Ministry issuing a statement Saturday saying six people had initially tested positive for the virus last month, while the WHO said eight had been reported.

Hartl said a team of WHO experts have been sent to Pakistan to help determine the cause. He said all four brothers were believed to have worked on a farm and poultry outbreaks had earlier been reported in the area.

Hartl said WHO has not ruled out limited human-to-human transmission.

The H5N1 virus, also known as bird flu, has killed at least 208 people worldwide, mostly in Southeast Asia and China, since it began ravaging Asian poultry stocks in late 2003. So far, most human cases have been linked to contact with sick birds.

Pakistan has grappled with outbreaks of bird flu in poultry for the past two years, but had previously not confirmed cases in humans.

This story was supplemented with an Associated Press report.

[HenryN]

Re: Pakistan: December 18+, WHO Begins Investigations

Here is my guess at the genealogy of family cluster in Pakistan.

Red names are postive or suspected human H5N1 cases.

[ATTACH]2130[/ATTACH]

Bloomberg indicates there are five brothers (four positive and one dead but not tested), which I assume does not include the NY resident.

[HenryN]

Re: Pakistan: December 18+, WHO Begins Investigations

Bird Flu May Spread, Driven by Cooler Weather, Researcher Says

By Jason Gale
<!-- WARNING: #foreach: $wnstory.ATTS: null at /bb/data/web/templates/webmacro_en/newsarchive.wm:265.2 --><!-- WARNING: #foreach: $wnstory.ATTS: null at /bb/data/web/templates/webmacro_en/newsarchive.wm:279.19 -->Dec. 18 (Bloomberg) -- Bird flu outbreaks may spread in the Northern Hemisphere this winter, putting more people at risk, as cooler weather spurs infections in poultry, a researcher said.
World Health Organization doctors are investigating eight suspected human cases of the H5N1 avian influenza strain in Pakistan. If confirmed, the infections would bring to 13 the number reported worldwide this month, the most since March. Russia had its biggest H5N1 outbreak, while the virus infected poultry in Benin, Germany, and Saudi Arabia the past month.
``This virus is endemic among poultry species and it is continuing to expand its range,'' said Lance Jennings, a clinical virologist with the Canterbury District Health Board in Christchurch, New Zealand. ``I'm sure we will see more human cases'' in developing countries, where people and poultry often live close together amid poorer sanitation, he said.
At least one person has caught the disease every month during the past three years, mostly through contact with infected poultry, such as children playing with them or adults butchering them or plucking feathers. New cases provide opportunities for H5N1 ``to evolve into a virus that decides that it likes humans'' and potentially touch off a lethal pandemic, Jennings said in an interview today.
At least 340 people in 13 countries have contracted the virus since 2003, the Geneva-based WHO said on Dec. 14. Three of every five cases have been fatal. Millions could die if the virus adapts to humans and is spread by sneezing and coughing.
Myanmar, China
The other cases reported this month were in a 7-year-old girl from eastern Myanmar, a father and son in China and two people in Indonesia.
`Public health and veterinary authorities are being kept on their toes,'' Jennings said. ``The real concern if the epidemic goes on is the sustainability of the capacity that has been established in a number of countries.''
H5N1 infected a flock of 11 chickens in Germany's Brandenburg state, the European Commission said yesterday. In Saudi Arabia, agriculture officials ordered a further 22,500 ostriches to be culled to contain a new outbreak in the desert kingdom, Agence France-Presse reported yesterday.
Diseased fowl were reported in the U.K., Romania and Poland in November. More than 1,210 hens, ducks, geese, turkeys and wild birds were infected by the virus in central and northern Poland between Nov. 30 and Dec. 12, Chief Veterinary Officer Ewa Lech said in a Dec. 13 report to the World Organization for Animal Health.
Russian Outbreak
In western Russia, 42,959 hens died in an outbreak on a farm in Rostovskaya Oblast, Evgueny A. Nepoklonov, deputy head of the country's veterinary department in Moscow, told the Paris-based veterinary organization last week. He said 17 outbreaks are recorded as unresolved.
Ukraine reported its first H5N1 outbreaks in poultry in December 2005, about two months after the disease emerged in Romania, Croatia and Turkey, signaling its establishment in Eastern and Central Europe.
``Most of the activity in central Europe was associated with the winter months in poultry,'' Jennings said. ``What we might be seeing is the increased activity associated with the seasonality of this virus in poultry populations.''
To contact the reporter on this story: Jason Gale in Singapore at j.gale@bloomberg.net .
Last Updated: December 18, 2007 03:07 EST

http://www.bloomberg.com/apps/news?pid=newsarchive&sid=ar92IWO_wbxc

[Laidback Al]

Re: Pakistan: December 18+, WHO Begins Investigations

Great Job Laidback Al.

I have:
Riaz Hussain - Adm: 12/15 From: Palosai (town). Hospital: Peshawar Khyber Teaching Hospital.

With the chart above, I am trying to delineate the family members associated with the main cluster. Do you think that Riaz Hussain is a part of that cluster, or possible a related family member.

I would invite anyone from the Pakistan NIH, WHO, or the CDC to add any additional facts to this thread to help clarify the situation.