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Re: Pakistan: December 18+, WHO Begins Investigations
Sorry Laidback Al. No, he's not part of the family.
Sorry Laidback Al. No, he's not part of the family.
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Re: Pakistan: December 18+, WHO Begins Investigations
AVIAN INFLUENZA, HUMAN (169): PAKISTAN
************************************************** *********
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Mon 17 Dec 2007
Source: Nature News [edited]
<http://www.nature.com/news/2007/071217/full/news.2007.383.html>
Human cases in Pakistan could hint of person-to-person spread.
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A team of experts from the World Heath Organization (WHO) is making
its way north in Pakistan to investigate a cluster of at least 8
cases of avian flu in people living near the Afghan border. They will
be seeking to establish whether the disease is spreading, and whether
the cases were caused by human-to-human transmission. Cases of bird
flu continue to occur worldwide, mostly in Indonesia, and this is the
colder time of year when flu is expected to hit hardest in the
northern hemisphere. But this latest outbreak is worrying in that it
involves the biggest batch of closely related cases since a cluster
of 8 infected people was reported in Indonesia in May 2006. "So far,
we are not seeing anything different than in previous instances of
H5N1 outbreaks," says Gregory Hartl, a spokesman for WHO, whose
current information comes from Pakistani authorities.
The Pakistan cases started in mid-November [2007], or possibly
earlier, when 5 family members fell ill in Abbottabad, north of
Islamabad. There, 2 of the brothers have died, one of whom was buried
before he could be tested for H5N1. In December [2007], a man and his
niece in the same town were found to have H5N1. They are thought to
have worked on the same farm as the 1st family affected. Another man
was found to have H5N1 in a nearby town some distance from there.
Another case is suspected but not yet confirmed, which would bring
the cluster to 9.
Pakistan has had repeated outbreaks of avian flu in poultry over the
past 2 years. The WHO team will be tracking down, treating and
testing people who came into contact with the infected cases.
Monitoring for cases in the area will be key to establishing whether
the virus has become more virulent or shows signs of spreading.
Meanwhile, Pakistani health authorities are poring over hospital
records from the past few months to see, retrospectively, whether
there has been any upsurge in the incidence of respiratory illnesses.
Human-to-human transmission cannot be ruled out, says Hartl, as it
has occurred on a limited basis on several occasions in the past.
Tests of 40 people who have had contact with the patients have so far
all turned up negative. Genetic sequencing will help to pin down the
mode of transmission and whether any important genetic changes have
occurred in the virus.
The Pakistan cluster highlights the obstacles faced by the WHO in
containing the spread should a pandemic strain of H5N1 appear. The
strategy calls for early diagnosis of cases, in the hope that blanket
treatment with antivirals will stamp out an emerging pandemic before
it spirals out of control. Computer models suggest that for this to
have any chance of succeeding, WHO would have a window of 3 weeks for
this diagnosis at most. But although the 1st cases occurred in
mid-November [2007] at the latest, Pakistan only officially informed
WHO on 12 Dec 2007, a day after the first media reports. WHO made the
cases public on 15 Dec 20007.
Last Friday [14 Dec 2007], the WHO also confirmed the 1st case in
Myanmar: a 7-year-old girl from Kyaing Tone Township, Shan State, who
was hospitalized in late November [2007], and has since recovered. A
WHO team has so far found no evidence of infections in any of the
case's contacts or in the area.
[Byline: Declan Butler]
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[Another version of events with the added information that the 2
deceased brothers and an H5N1-positive man and his H5N1-positive
niece all lived in the same town (Abbottabad), and all worked on the
same farm (previously located in Mansera). Circumstances consistent
with infection from a common source rather than by person-to-person
transmission of virus. - Mod.CP]
[see also:
Avian influenza, human (168): Pakistan 20071217.4059
Avian influenza, human (167): Pakistan 20071216.4049
Avian influenza, human (166): Pakistan, WHO 20071215.4038
Avian influenza, human (165): Pakistan 20071214.4023
Avian influenza, human (163): Pakistan 1st report 20071213.4008]
....................cp/ejp/lmComment
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Re: Pakistan: December 18+, WHO Begins Investigations
PIMS on the lookout for bird flu cases
Staff Report
ISLAMABAD: Pakistan Institute of Medical Sciences (PIMS) has directed its staff to record bird flu cases and reserved two isolation rooms for suspected patients.
PIMS Deputy Executive Director Dr Raja Amjid, has issued a circular directing the staff to adopt proper measures and protocols for handling bird flu suspects.
Officials told Daily Times that no bird flu case had been brought to the hospital so far. A polyclinic doctor said no bird flu case had been registered.
The Health Ministry, last week, confirmed six H5N1 Avian Influenza patients, five of them were in Abbotabad and one was in Mansehra. Five patients have recovered and one died, reportedly.
The National Institute of Health (NIH) tested suspects in late October.
Situation under control: A Health Ministry meeting has reviewed the situation and expressed its satisfaction.
Representatives of the Ministry of Food, Agriculture and Livestock, World Health Organisation, Food and Agriculture Organisation and UNICEF attended the meeting.
Health Ministry officials said the situation was completely under control. They called for better cooperation between the Health Ministry, Ministry of Food, Agriculture and Livestock (MINFAL) and the provinces.
An official said a three-member team of World Health Organisation experts was in Pakistan to assist federal and provincial health departments to contain the spread of avian influenza.
He said MINFAL had ensured that personal protective equipment had been provided to control teams. Early this year, 24 birds began dying and the dead tested positive for flu.
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Re: Pakistan: December 18+, WHO Begins Investigations
High-level meeting reviews situation
Tuesday, December 18, 2007
Our correspondent
Islamabad
Officials of the Ministry of Health, World Health Organization, Food and Agriculture Organization, Unicef, and the Ministry of Food, Agriculture and Livestock (MINFAL) met here Monday to take stock of the situation arising in the wake of the confirmed cases of human transmission of H5N1 Avian Influenza.
The daily coordination meeting, which was chaired by Secretary Health Khushnood Lashari, will be convened again today (Tuesday) and will have a representative of the WHO sharing latest findings of the three-member WHO team currently visiting Abbottabad, Mansehra and Peshawar, wherefrom confirmed cases of the disease among humans have been reported. ?The WHO teams will stay in those areas till need be,? an official of the Ministry of Health told this correspondent. The team is here to assist the federal and provincial health departments in formulating guidelines to contain the spread of Avian Influenza.
The health secretary is said to have expressed satisfaction over the response to the situation. He stressed on the need for better coordination between the ministries of health and MINFAL and the provincial government.
The meeting expressed satisfaction over the compensation being given to poultry farmers for culling of infected birds. The participants were informed that the last outbreak of Bird Flu occurred on November 30 in NWFP and culling of the infected chicken was done within 48 hours. Since then, the situation is under control. The MINFAL representative informed that personal protective equipment have been provided to the culling teams. Meanwhile, Lashari said, a media campaign is being launched to create awareness about preventive measures.
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Re: Pakistan: December 18+, WHO Begins Investigations
The above commentary is the first time I have ever seen clustering (especially when most of the cluster members are related and the clustering is of clusters) used to argue against H2H transmission.Originally posted by niman View Post
This commentary, coupled with the earlier remarks out of Pakistan arguing that sequencing would prove a common source, are among the most alarming comments to date, which is remarkable because the H2H question has been on the front burner since the first human H5n1 cases were reported in 1997.Comment
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Re: Pakistan: December 18+, WHO Begins Investigations
INTERVIEW-Mixed scenario seen behind Pakistan birdflu spread
18 Dec 2007 18:52:43 GMT
<!-- 18 Dec 2007 18:52:43 GMT ## for search indexer, do not remove -->Source: Reuters
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</SPAN><INPUT id=CurrentSize type=hidden value=13 name=CurrentSize> <!-- INTERVIEW-Mixed scenario seen behind Pakistan birdflu spread --><!-- Reuters -->By Stephanie Nebehay
GENEVA, Dec 18 (Reuters) - The eight suspect human bird cases in Pakistan are likely a combination of infections from poultry and limited person to person transmission due to close contact, a top World Health Organisation expert said on Tuesday. Keiji Fukuda, coordinator of WHO's global influenza programme, said while unconfirmed, any human to human spread seemed similar to previous outbreaks in Thailand and Indonesia -- affecting close family members caring for sick loved ones.
There was no immediate cause for alarm and the United Nations agency was not raising its level of pandemic alert for the time being, he said, adding it was very reassuring that "we are not seeing large increases in the number of cases".
"Right now it doesn't look like pure human to human transmission. It looks like the veterinarian, who was the index case, and a number of other suspect cases had poultry exposure," Fukuda told Reuters in an interview.
"It is definitely possible that we have a mixed scenario where we have poultry to human infection and possible human to human transmission within a family, which is not yet verified."
But human to human transmission "would not be particularly surprising or unprecedented," he added.
Eight people have tested positive for the H5N1 bird flu virus in North West Frontier Province since late October, and one of the confirmed cases has died. A brother of the dead man also died, but was never tested, so is not counted among them.
H5N1 is mainly an animal disease, but experts fear it could mutate into a form that could spread easily between people, causing a pandemic which could kill millions of people. In Thailand, a mother was killed by the virus in 2004 after cradling her dying infected daughter all night. The largest known cluster of human bird flu cases worldwide occurred in May 2006 in Indonesia's North Sumatra province, where as many as seven people in an extended family died.
Three WHO experts, led by Hassan El-Bushra of its regional Cairo office, is in Pakistan helping investigate the outbreak.
The "index" case, who recovered, is a veterinarian who helped with culling operations and it is his two brothers who died after taking care of the ill man, according to Fukuda.
"This type of close contact we know can result in human to human transmission sometimes," he said.
"Right now, based on the information we have, the investigation going on and the feedback from the field team, we don't have anything pointing to push the alarm bells or increase the (pandemic alert) phase," he added.
The WHO uses a series of six phases of pandemic alert to gauge the level of threat. The world is currently in phase 3, a new influenza virus subtype is causing disease in humans, but is not yet spreading efficiently and sustainably among humans.
"In terms of public health implications, we are looking for human to human transmission where casual contact can lead to infections and allow big outbreaks in communities," Fukuda said.
A team from the U.S. Naval Medical Research Unit NAMRU-3 laboratory in Cairo was expected in Pakistan on Wednesday to carry out further tests on the samples from the suspect cases. (Editing by Sami Aboudi)
<!-- news ## for search indexer, do not remove -->Comment
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Re: Pakistan: December 18+, WHO Begins Investigations
The chart may be wrong and there could be six brothers total. Omar may be the other brother rather than a cousin. The young girl may be a daughter or niece of another positive culler not related to this cluster.Originally posted by niman View Post
Theresa42's comments about cousin marriage above are very important. English translation of the kinship term "cousin" does not distinguish between cross and parallel cousins. Right now there is no data available to link the family cases patrilaterally or matrilaterally.Comment
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Re: Pakistan: December 18+, WHO Begins Investigations
Commentary at
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Re: Pakistan: December 18+, WHO Begins Investigations
<TABLE><TBODY><TR><TD>CDA takes steps against bird flu</TD></TR><TR><TD>
</TD></TR><TR><TD>Associated Press of Pakistan
</TD></TR><TR><TD>ISLAMABAD: Following the threat of Bird Flu in the country especially in Islamabad, the Directorate of Health Services of the CDA has taken strict immediate preventive precautionary measures against spread of the disease.
The Eid holidays for the concerned staff has been cancelled and the authority has launched a special spray and fogging campaign in the different areas of the city usually being used for poultry business.
For this purpose, the federal capital has been divided into six zones and poultry shops of all the markets of the Capital City were properly sprayed and fogged with special anti-virus chemical.
A comprehensive awareness campaign has also been launched for the public, especially for the people attached with the poultry business and provided them proper guideline to avoid the spread and to combat the disease efficiently.
The shopkeepers and poultry businessmen have been advised to cover the eatable items properly and must be made their shops complete fly proofs and put the meat inside the shops.
The people concerning poultry, meat and hotels/motels have been advised for proper vaccination from Vaccination Section (DHS).
During the campaign, DHS has issued 58 notices to the poultry shopkeepers in the city markets due to poor hygienic conditions of their premises.
The Senior Director Health Services Dr Saeed Ahmed has constituted a special team to launch a special spray and fogging campaign during Eid holidays especially in the cattle markets to maintain hygienic conditions.
</TD></TR></TBODY></TABLE>
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Re: Pakistan: December 18+, WHO Begins Investigations
Thanks to all for the timely posts of reports as they become available.
Separate the wheat from the chaffComment
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Re: Pakistan: December 18+, WHO Begins Investigations
Some of the confusion over the family relationship of cases could be attributed to the translation of kin terms. The English term 'cousin' does not have an equivalent Pukhto term rather, as noted in the quote below, male and female cousins are generically called ror or khor; "brother" and "sister" respectively.Originally posted by Laidback Al View Post
. . . Choice of marriage for girls is commonly determined by preference for parallel and cross-cousin marriage, as among other groups of Pakistani such as Punjabis (Shaw 2001). These alliances aim to consolidate patrimonial lands and strengthen political and social ties. Political leadership is thus reinforced through marriage alliances. While referring to first cousins by sibling names (?sister? {khor}, ?brother? {ror} rather than ?cousin? which lacks a Pukhto equivalent), Bibiane say that many of their relationships are ?six times? (shpag wara), that is multiply connected by marriage. . . .
<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" /><o:p></o:p>
From page 34, Sorrow and Joy Among Muslim Women: The Pukhtuns of Northern Pakistan, by Amineh Ahmed, 2006, <?xml:namespace prefix = st1 ns = "urn:schemas-microsoft-com:office:smarttags" /><st1:place w:st="on"><st1:PlaceName w:st="on">Cambridge</st1:PlaceName> <st1:PlaceType w:st="on">University</st1:PlaceType></st1:place> Press.
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Re: Pakistan: December 18+, WHO Begins Investigations
I believe the Bloomberg article specifically said four brothers and two cousins should be five brothers and one cousin (and this doen't include the brother in the US).Originally posted by Laidback Al View PostComment
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Re: Pakistan: December 18+, WHO Begins Investigations
Commentary at
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Re: Pakistan: December 18+, WHO Begins Investigations
<TABLE id=table4 cellSpacing=0 cellPadding=0 border=0><TBODY><TR><TD class=Heading>Investigation launched into possible transfer of bird flu among humans
</TD></TR><TR><TD>AP</TD></TR><TR><TD class=ArticleBody>
Last updated: December 19, 2007, 00:32Islamabad: A World Health Organisation team began piecing together Pakistan's first human bird flu cases on Tuesday to try and 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 on 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.
Potential sources
One of the brothers who survived said he was hospitalised 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, Mohammad 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 being checked.
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Re: Pakistan: December 18+, WHO Begins Investigations
<TABLE><TBODY><TR><TD>People urged to take steps against H5N1</TD></TR><TR><TD>
</TD></TR><TR><TD>Staff Reporter
</TD></TR><TR><TD>PESHAWAR: The Khyber Medical University, Directorate of Research and Development, has informed the general public that bird flu virus, in the absence of its arrest, becomes highly infectious and spreads easily from one person to another.
The directorate said efforts were made in their awareness drive to educate the NWFP people regarding the simple precautionary measures to contain bird flu influenza, adding the transmission of the H5N1 was from poultry to human beings and direct contact with infected poultry, their nasal secretions, or surfaces and the objects contaminated by their faces was presently considered the main cause of human infection.
"If this mode of transmission is not contained, there is a risk of the virus mutating to a form that is highly infectious for humans and spreads easily from one person to another which will lead to a worldwide epidemic, adding that products from the areas experiencing outbreaks could be safely consumed provided these items were properly handled during food preparation and thoroughly cooked.
The directorate added that H5N1 was sensitive to heat and thorough cooking of poultry at high temperatures would kill the virus and persons handling the poultry either in the poultry farm or in the kitchen needed to wash their hands thoroughly with soap and hot water.
It further said in the event of any person suffering from flu like symptoms (runny nose, nasal congestion, chest congestion, fever etc), especially poultry farm workers, should immediately contact physicians, saying "If it is avian influenza, early detection and management through treatment with oseltamivir and Zanamivir may reduce the severity of the illness and improve prospects of survival if administered early."
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