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

[AlaskaDenise]

Re: Pakistan: December 18+, WHO Begins Investigations

The negative data does demonstrate that many factors can produce false negative, including sample degradation and suppression of RNA levels by Tamiflu treatment.....

Can tamiflu-supressed cases still produce antibodies? Will they show up in 21 days in sufficient quantity to test?

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[HenryN]

Re: Pakistan: December 18+, WHO Begins Investigations

Commentary at

http://www.recombinomics.com/News/12280702/H5N1_Pakistan_New_Concerns.html

[HenryN]

Re: Pakistan: December 18+, WHO Begins Investigations

Commentary at

http://www.recombinomics.com/News/12280703/H5N1_Pakistan_US_Antibodies.html

[AlaskaDenise]

Re: Pakistan: December 18+, WHO Begins Investigations

Commentary at

http://www.recombinomics.com/News/12..._Concerns.html

Commentary

New Suspect H5N1 Case in Pakistan Increases Concerns

Recombinomics Commentary 2:48
December 28, 2007

another suspected H5N1 case has been found in the same region of Pakistan as the recent cluster but with no known connection to it. The suspected case is in an 8-year-old who had contact with sick poultry before falling ill, he reported.

"The new case is in the same region, but there's no epidemiologic link to the other cases," Rainford said

The above comments describe a new suspect sporadic H5N1 case in Pakistan. The new specifics on the earlier clusters, including some disease onset dates, raise concerns of more efficient transmission of H5N1 in Pakistan. The disease onset dates of the large cluster which began in late October and extended at least through the end of November demonstrated multiple human to human transmissions.

The lack of transparency, delayed reporting, and abysmal collection and handling of samples, raise serious concerns over false negatives. The new case above suggests there are additional cases in the area, which has been thrown into turmoil because of the Benazir Buttoh assassination.

With the human sequencing in doubt, sequences from poultry collected throughout 2006 and 2007 in Pakistan should be released, along with sequences from 2007 isolates in Afghanistan and India.

The sequence hoarding and false negatives increase pandemic concerns and contunue to be hazardous to the world's health.


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[AlaskaDenise]

Re: Pakistan: December 18+, WHO Begins Investigations

Commentary at

http://www.recombinomics.com/News/12...ntibodies.html

Commentary

Antibody Testing for New York Brother in H5N1 Pakistan Cluster?

Recombinomics Commentary 3:59
December 28, 2007

Yet another brother, who lives on Long Island, N.Y., travelled to Pakistan with his son to attend at least one of the funerals. On their return to the United States they suffered mild respiratory symptoms and consulted their family doctor, who alerted New York State public health authorities.

In early December, the U.S. Centers for Disease Control sent a plane to Albany, N.Y., to collect samples taken from the two. Testing at the CDC's labs in Atlanta confirmed the man and his son were not infected with the virus.

The above comments on the son contradict the State of New York report that indicated the family of the brother from New York was not exposed to the cases in Pakistan. If both father and son flew to Pakistan for the funeral(s), there would have been exposure. The first brother died November 19 and the other fatally infected brother developed symptoms November 21, so if the father and son were in Pakistan for the first funeral, they would have been exposed to the second brother, as well as the source that infected the second brother. Moreover, if they then stayed for the second funeral, they would have been in Pakistan for more than 3 weeks, since they returned to New York on December 5.

Pakistan acknowledged that some relatives did not develop pneumonia because they were receiving Tamiflu prior to collection of samples. It seems likely that both father and son from the US would also be receiving Tamiflu. One or both developed respiratory symptoms, but testing of mild cases frequently generates false negatives.

As noted in the recent reports on the WHO updates, most of the confirmatory test on patients that had previously tested positive in Pakistani labs, tested negative in NAMRU-3?s mobile lab as well as the Mill Hill labs in London.

Thus, negative testing of the New York residents does not preclude infections in Pakistan, since their symptoms were mild, and they were likely taking prophylactic Tamiflu when tested in the US.

WHO had indicated that follow-up antibody testing was planned for the relatives in Pakistan. The same testing should be applied to the relatives who returned to the United States.


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[Laidback Al]

Re: Pakistan: December 18+, WHO Begins Investigations

Here is a list of current suspected and possibly positive human cases associated with outbreaks in Pakistan. This information is based primarily on posts 157 and 160 above, commentaries by Niman, and earlier news posts in this thread.

It summarizes two potential clusters and two isolated cases including one young 8 year old child reported yesterday in post 160. The list also identifies the individuals that I think were the initial nine cases that tested positive in Pakistan. Originally 40 human samples were tested at the end of October/early November. Four were positive and Niman has suggested that all four of these samples were from cullers. If so, the four would mostly likely be Ishtiaq, the veteranarian; one of his brothers who was a culler; the poultry culler from Mansehra (index case for the second cluster); and another culler from Mansehra identified below as Isolated Case #1.

The number of brothers (and the names) in the Durrani cluster is confusing.The index case is fairly well established as Ishtiaq, the verteranarian. Mohammad Ilyas Durrani is almost certainly one of the brothers that died. The names of the remaining brothers, their occupation, and testing results are unclear. Names reported in media, include Tariq, Owais, Farooq, Idrees, and Omar. One of these might be the brother who travelled to Pakistan with his son to attend a funeral of one or both of his brothers.

Further epidemiological information on these individuals would clarify important information about potential human-to-human transmission in Pakistan.

Case listing

Cluster 1

Index Case
Ishtiaq Durrani (Age ?, M)
Occupation: Veterinarian overseeing culling at Ijaz Shah Poultry Farm, Abbottabad District from October 21-23, 2007.
Location of infection: Abbottabad District, Pakistan
Residence: Sukur village near Peshawar, Pakistan (?)
Onset: Oct 29, 2007 (October 25, 2007?)
Status: Recovered
Initial Test Results: Positive (positive 1)
Later Test Results: Positive WHO?
<!--[if !supportLineBreakNewLine]--><!--[endif]-->
Mohammad Ilyas Durrani ? (Age: 20-30, M, Brother 1)
Occupation: Student at agricultural college
Location of Infection: Peshawar?s Khyber Teaching Hospital (KTH)
Residence: Unknown, possibly Sukur village near Peshawar, Pakistan
Onset: Unknown (Prior to November 21, 2007, estimated early November)
Status: Died November 19.
Initial Test Results: Not tested

Mohammad Owais (or Idrees) Durrani (Age: 25, M, Brother 2)
Occupation: Student at agricultural college
Location of Infection: Peshawar?s Khyber Teaching Hospital (KTH)
Residence: Unknown, possibly Sukur village near Peshawar, Pakistan
Onset: November 21, 2007
Hospitalized: November 23, 2007
Status: Died November 28.
Initial Test Results: Positive (positive 2)
Later Test Results: Positive WHO

Mohammed Tariq Durrani (Age ?, M, Brother 3)
Occupation: School teacher ?
Location of Infection: Unknown, most likely Peshawar?s Khyber Teaching Hospital (KTH)
Residence: Sukur village near Peshawar, Pakistan (?)
Onset: Unknown
Status: Recovered
Initial Test Results: Positive? (positive 3)

(Omar or Idrees or Owais or Farooq)? Durrani (Age 38?, M, Brother 4)
Occupation: Culler
Location of Infection: Abbottabad District?
Residence: Unknown
Onset: Unknown
Status: Recovered
Initial Test Results: Positive? (positive 4)

(Omar or Idrees or Owais or Farooq)? Durrani (Age ?, M, Brother 5)
Occupation: Unknown
Location of Infection: Peshawar, Pakistan ?
Residence: Sukur village near Peshawar, Pakistan (?)
Onset: Unknown
Status: Recovered
Initial Test Results: Positive? (positive 5)

(Omar or Idrees or Owais or Farooq)? Durrani (Age 38?, M, Brother 6)
Location of Infection: Peshawar, Pakistan? (assuming infection)
Residence: Nassau County, NY
Status: Healthy (recovered?)
Initial Test Results: Unknown
Later Test Results: Negative
Comments: Reported as 38 years old at http://www.care-mates.com/blog/?p=42

? Durrani child (Age ?, M, Son of Brother 6 and nephew to index case and the other 4 brothers)
Location of Infection: Peshawar, Pakistan? (assuming infection)
Residence: Nassau County, NY
Status: Healthy (recovered?)
Initial Test Results: Unknown
Later Test Results: Negative

Omar? (Age ?, M, cousin of Durrani brothers?, husband of female doctor?)
Occupation: unknown, husband of wife who worked at KTH?
Location of Infection: KTH, Peshawar
Residence: Palosai town, Peshawar, Pakistan
Onset: Unknown
Status: Healthy, recovered?
Initial Test Results: Positive (positive 6)
Unknown (may be the 9th case as reported by WHO on Dec 15, 2007)
Comments: May have been infected through wife at KTH. Wife may be the case reported as female doctor.

Female Doctor (Age:?, F)
Occupation: Doctor at KTH
Location of Infection: Peshawar?s (KTH)?
Residence: Unknown
Onset: Unknown
Status: Healthy, recovered?
Initial Test Results: Positive, but with a non standard test.
Later Test Results: Negative?
Comments: May have been the spouse of the infected individual above who is identified as a possible cousin of the Durrani brothers

Cluster 2

Index Case
Unnamed Individual (Age:? M)
Occupation: Poultry Culler
Location of Infection: Manserha District?
Residence: Unknown
Onset: Unknown (October ?)
Status: Unknown
Initial Test Results: Positive (positive 7)

Unnamed girl (Age:10, F, niece of culler above)
Occupation: Child
Location of Infection: Abbottabad District?
Residence: Unknown
Onset: Unknown
Status: Unknown
Initial Test Results: Positive (positive 8)
Later Test Results: Unknown

Isolated Case #1

Identified as ?another man? (Age:?, M)
Occupation: Poultry culler?
Location of Infection: Manserha District ?
Residence: Unknown
Onset: Unknown (October ?)
Status: Unknown
Initial Test Results: Positive (positive 9?)
Later Test Results: Unknown ?
<!--[if !supportLineBreakNewLine]--><!--[endif]-->
Isolated Case #2

Identified as a Child (Age: 8, M)
Occupation: Poultry culler?
Location of Infection: Unknown
Residence: Unknown
Onset: Unknown (December ?)
Status: Unknown
Initial Test Results: Positive?
Later Test Results: Unknown<o:p></o:p>
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[AlaskaDenise]

Re: Pakistan: December 18+, WHO Begins Investigations

Can tamiflu-supressed cases still produce antibodies? Will they show up in 21 days in sufficient quantity to test?

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from: http://www.rxlist.com/cgi/generic/oseltamiv_cp.htm

Immune Response

..... In studies of naturally acquired and experimental influenza, treatment with TAMIFLU did not impair normal humoral antibody response to infection.

[mixin]

Re: Pakistan: December 18+, WHO Begins Investigations

from: http://www.rxlist.com/cgi/generic/oseltamiv_cp.htm

Thanks for that link; it's a good one

So does that mean Tamiflu does not create false negatives?

[HenryN]

Re: Pakistan: December 18+, WHO Begins Investigations

Thanks for that link; it's a good one

So does that mean Tamiflu does not create false negatives?

Tamiflu creates false negatives in PCR tests and limits isolation of the virus for sequencing and otehr studies.

[AlaskaDenise]

Re: Pakistan: December 18+, WHO Begins Investigations

Thanks for that link; it's a good one

So does that mean Tamiflu does not create false negatives?

It takes 3 to 4 weeks to get an antibody response from the humoral system. The referenced tests were done far earlier.

Good graph is at http://www2.umdnj.edu/mimmweb/Instruction/week40/flu%20ifn.gif

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[Farmer]

Re: Pakistan: December 18+, WHO Begins Investigations

Thank you for the informative case summary Laidback Al!

[sharon sanders]

Re: Pakistan: December 18+, WHO Begins Investigations

Thank you for the informative case summary Laidback Al!

I agree!

[Blue]

Re: Pakistan: December 18+, WHO Begins Investigations

I think I asked about antibody testing when we first heard about the US
brother. I wonder if the public will be informed about antibody testing on him
or will privacy laws be cited as to the reason why we won't be?
Transparency about this case is important. Does he have antibodies
or not? Simple question...

[HenryN]

Re: Pakistan: December 18+, WHO Begins Investigations

I think I asked about antibody testing when we first heard about the US
brother. I wonder if the public will be informed about antibody testing on him
or will privacy laws be cited as to the reason why we won't be?
Transparency about this case is important. Does he have antibodies
or not? Simple question...

There has been no indication that he will be tested for convelescent antibodies.

[Commonground]

Re: Pakistan: December 18+, WHO Begins Investigations

WHO: Flu Burung To Spread Infection Between Humans Occurred in Pakistan

The expert from the Kesehatan Body of the World (WHO) confirmed the first case of bird flu that spread between humans in Pakistan.
However, according to them, this spread was very limited so as to be not risky spread.

The special test that was carried out in the Cairo laboratory and London showed that the person who was infected fatally by the virus H5N1 this did not have the story of contact with the poultry that was infected.

According to WHO, indeed contamination of humankind had to humankind been reported in Cambodia, Indonesia, and Vietnam in several months that. Although, that did not yet spread to more than one person.
Now the case a person suspect bird flu was in China denied by the local government.
In the last case in Pakistan, an official WHO said that the beginning cheque found did not have proof that showed the case spread between humans that continued or gathered.

The experts worried that strain the virus H5N1 has had the mutation became the very cruel form and spread, that could cause the pandemic as that happened the case of the flu pandemic in Spain in 1918,yang was claimed sacrificed 10 million souls.
The WHO team sent results of the research after the Health Minister local announced the death of a man who was one from six people who were infected H5N1 in the North West Frontier Province territory, the Afghanistan border.
Relatives from casualties also died on November 23 before being carried out by the test for the bird flu virus.
Both of them indeed worked in the place that was separated far from the poultry that was infected.
Till at this time, bird flu killed 211 people from 343 people who were infected.
Where the first case was to humankind reported since 2003 that was worried by this virus could mutate headed the form that really was easy to spread among humans.

Because, if this happened, could cause the plague of the world that could kill millions of humankind only in time singkat. Not was different from the annihilator's mass biological weapons.

In the meantime, the Bird Flu Researcher from the Health Faculty of the Airlangga University Animal, CA Nidom, said that indeed had the indication of the virus H5N1 began to change the form resembled was similar to the available virus in humans. Admitted/confessed him, there was the sign- the sign that the virus now no longer spreads through the poultry.

Results of this conclusion were based on his research in many cases of available bird flu in Indonesia.
In the meeting in Bandung around the last two months, the team's findings of this researcher have been sent to the government.

That is that the bird flu virus now has the new identity "humanized virus".
"Now the time for the government to increasingly encourage the control of this virus", he said to SINDO. Nevertheless, he not deny that the source of the spread of bird flu, the poultry still continue to be playing role. Certainly him, in Indonesia indeed a great number were found the poultry in the settlement.
So as rather was difficult to distinguish which virus that really from the poultry, and whatever that not.
"I recommended to the government to more serious open up the virus mystery this. The mechanism of the sending of the sample to WHO indeed stayed important.
However, more important again open up mystery in order to prevent the occurrence of the pandemic or the plague that could kill millions of humankind in time in an instant", he explained.

Responded to the WHO statement about the spread of bird flu between humans that was limited that, according to Nidom, could not be regarded as something that not serious. That was a warning that the bird flu virus currently becomes increasingly strong and vicious. So that the anticipation action and vigilance must be increased.

http://www.seputar-indonesia.com/edisicetak/berita-utama-sore/who-flu-burung-menular-antarmanusia-terjadi-di-pak.html