Pakistan: Suspected Human Cases December 10 - December 17, 2007

[AlaskaDenise]

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

Commentary at

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

Commentary

Tamiflu Blanket and H5N1 False Negatives in Pakistan

Recombinomics Commentary
December 17, 2007

Four brothers and a cousin from a family in Peshawar, near the border with Afghanistan, were among those who tested positive for the virus during the past three weeks, WHO spokesman Gregory Hartl said.

While almost all human H5N1 cases confirmed by WHO have shown severe symptoms, such as pneumonia, in Pakistan at least two people had only mild disease. Anwar said this was probably because the patients had begun taking Roche Holding AG's Tamiflu one to two days before being tested, and the medicine reduced the severity of symptoms.

The above comments describe the use of a Tamiflu blanket in the recent H5N1 outbreak in Pakistan. Although this approach certainly has the potential for suppressing the spread of H5N1, collection of samples 1-2 after the start of treatment can generate false negatives.

This is a possibility for the sixth brother (38M), who lives in Nassau County, New York. As noted above, four of the brothers tested positive, and the fifth brother died with bird flu symptoms, so all five brothers of the New York resident were H5N1 infected. If the New York resident was in Pakistan for both funerals, and funerals followed the November 19 and 29 deaths, then the exposure period was extensive. Moreover, it is likely that he had received prophylactic Tamiflu treatment in Pakistan, which may have generated false negatives in tests in the United States conducted by New York and the CDC.

Similarly, the spread of H5N1 in Pakistan may have been masked by the Tamiflu blanket. Testing of contacts, including the brother in New York would be useful, to determine how efficiently the H5N1 in Pakistan infects contacts. Clearly, the infection of five brothers in the same family is an H5N1 cluster high, and strongly supports human-to-human transmission. This transmission may have also extended to the health care worker, who was also said to be positive, and who also was a likely recipient of prophylactic Tamiflu prior to collection of samples.

Media reports have indicated the brother from New York was H5N1 positive in Pakistan, was negative in the US but symptomatic, and was negative in the US and asymptomatic. Similar mutually exclusive descriptions for the health care worker have also been published in media reports.

Accurate information on disease onset dates and disease symptoms would be useful.


.

[Theresa42]

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

Hat-tip, Rickk!

Tests Negative on L.I. Man Whose Relatives Had Avian Flu
By DONALD G. McNEIL Jr.
Published: December 18, 2007

Avian flu in Pakistan nearly touched the United States this month when a 38-year-old Nassau County resident returned from visiting family members who were later confirmed to be part of Pakistan?s first cluster of human infections.

But the resident, who landed at Kennedy International Airport on Dec. 5 and visited his family doctor the next day, tested negative for flu, both at a state laboratory and at the Centers for Disease Control and Prevention, the New York State Health Department and the C.D.C. said.

The cluster of human cases in Pakistan ? which apparently began in November ? was described last week in Pakistani press reports, which were picked up by flu-watcher Web sites.

But only on Saturday did the World Health Organization say that Pakistan had detected H5N1 virus in eight people, two of whom had died. The H5N1 virus is the strain of avian flu that has international health officials most worried about the threat of a pandemic.

All the cases occurred in the remote North-West Frontier Province, near the Afghan border, where outbreaks of H5N1 in poultry have been reported for months.

Exactly how the Long Island resident was connected to the cluster was vague.

Pakistani media reports said a man who had attended the funerals of his two brothers in late November had returned to the United States. State and federal officials could not confirm that on Monday.

While some reports said he visited his doctor because he felt ill, a State Health Department spokeswoman said he had not.

Another family member on Long Island had flu symptoms even before his relative returned from Pakistan, but both tested negative, the spokeswoman said.

Early local reports of avian flu clusters have routinely been confusing.

The Pakistani cluster appears to be the largest to be detected since May 2006, when seven confirmed cases in one family were found in Karo, a village in Indonesia. Others have occurred in Egypt, Turkey and Azerbaijan. In some cases, limited human-to-human transmission has appeared likely because relatives fell sick well after others had contact with birds.

There have been 340 confirmed cases of H5N1 flu in the world since 2003, 208 of which have been fatal, according to the World Health Organization. There have been fewer cases this year than in 2006, but the flu season has just begun.

The Pakistan press reported that the first case was in a veterinarian in Abbottabad who culled sick birds. He recovered but was reported to have infected two of his brothers, who died. However, the Pakistan government denied that human-to-human transmission had occurred.

http://www.nytimes.com/2007/12/18/nyregion/18flu.html

[Giuseppe]

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

Pakistanis, WHO check if bird flu passed by people 18 Dec 2007 07:32:37 GMT
Source: Reuters
By Augustine Anthony

ISLAMABAD, Dec 18 (Reuters) - Pakistani authorities and World Health Organisation (WHO) experts were trying to determine on Tuesday whether bird flu had passed from human to human after the country reported its first human death from the virus.

Pakistani health officials confirmed at the weekend that eight people had tested positive for the H5N1 bird flu virus in North West Frontier Province since late October, of which one person, who worked on a poultry farm, died.

A brother of the dead person, who had not been tested, also died. It was not yet clear if he was a victim of bird flu.

One hundred people with symptoms of flu living in the vicinity had been checked but all tested negative, said a Ministry of Health spokesman.


"No linkage has been developed about human-to-human transmission. We are safe but we have to be very cautious," said the spokesman, Orya Maqbool Jan Abbasi.

The last human case was reported on Nov. 23, he said.

Health Secretary Khushnood Akhtar Lashari said on Monday some of the seven affected people had not worked with poultry and authorities were tracing who they had been in contact with.

Six had recovered while one was being treated, a provincial health official said.

Humans rarely contract H5N1, which is mainly an animal disease. But experts fear the strain could spark a global pandemic and kill millions of it mutates to a form that spreads more easily.

The area of the outbreak, near the towns of Mansehra and Abbottabad, about 60 km (40 miles) north of the capital, Islamabad, is in the foothills of the Himalayas.

Partly forested slopes are dotted with villages and small chicken farms.

A three-member WHO team, joined by officials from the Pakistan National Institute of Health, travelled on Monday to Peshawar, the province's capital where the patients were treated.

They were due to travel to Mansehra on Tuesday and were also expected to visit Abbottabad, where authorities reported the last H5N1 virus case in wild birds on Nov. 30.

The team would carry out epidemiological tests, Abbasi said.

Bird flu first appeared in Pakistan in early 2006, and several outbreaks of H5N1 were reported this year.

The Pakistani cases bring to nearly 350 the number of people worldwide who are known to have contracted the H5N1 virus, which has killed more than 200 people since 2003. (Editing by Robert Birsel and Sanjeev Miglani)

AlertNet news
-

http://www.alertnet.org/thenews/newsdesk/ISL151237.htm

-----

[AlaskaDenise]

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

The last human case was reported on Nov. 23, he said

Unless there are undiscovered cases, 24 days since the last case might mean any possible human-to-human transmissions have stopped.

.

[sharon sanders]

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

Hat-tip, Rickk!

Tests Negative on L.I. Man Whose Relatives Had Avian Flu
By DONALD G. McNEIL Jr.
Published: December 18, 2007

Avian flu in Pakistan nearly touched the United States this month when a 38-year-old Nassau County resident returned from visiting family members who were later confirmed to be part of Pakistan?s first cluster of human infections.

But the resident, who landed at Kennedy International Airport on Dec. 5 and visited his family doctor the next day, tested negative for flu, both at a state laboratory and at the Centers for Disease Control and Prevention, the New York State Health Department and the C.D.C. said.

The cluster of human cases in Pakistan ? which apparently began in November ? was described last week in Pakistani press reports, which were picked up by flu-watcher Web sites.

But only on Saturday did the World Health Organization say that Pakistan had detected H5N1 virus in eight people, two of whom had died. The H5N1 virus is the strain of avian flu that has international health officials most worried about the threat of a pandemic.

All the cases occurred in the remote North-West Frontier Province, near the Afghan border, where outbreaks of H5N1 in poultry have been reported for months.

Exactly how the Long Island resident was connected to the cluster was vague.

Pakistani media reports said a man who had attended the funerals of his two brothers in late November had returned to the United States. State and federal officials could not confirm that on Monday.

While some reports said he visited his doctor because he felt ill, a State Health Department spokeswoman said he had not.

Another family member on Long Island had flu symptoms even before his relative returned from Pakistan, but both tested negative, the spokeswoman said.

Early local reports of avian flu clusters have routinely been confusing.

The Pakistani cluster appears to be the largest to be detected since May 2006, when seven confirmed cases in one family were found in Karo, a village in Indonesia. Others have occurred in Egypt, Turkey and Azerbaijan. In some cases, limited human-to-human transmission has appeared likely because relatives fell sick well after others had contact with birds.

There have been 340 confirmed cases of H5N1 flu in the world since 2003, 208 of which have been fatal, according to the World Health Organization. There have been fewer cases this year than in 2006, but the flu season has just begun.

The Pakistan press reported that the first case was in a veterinarian in Abbottabad who culled sick birds. He recovered but was reported to have infected two of his brothers, who died. However, the Pakistan government denied that human-to-human transmission had occurred.

http://www.nytimes.com/2007/12/18/nyregion/18flu.html

Donald McNeil uses FluTrackers as a source. From an article he wrote in August 2006:

"...reports by local news services and radio stations, translated and posted on Web sites like flutrackers.com, suggest that up to eight villagers..."

http://www.flutrackers.com/forum/showthread.php?t=9628

[HenryN]

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

Unless there are undiscovered cases, 24 days since the last case might mean any possible human-to-human transmissions have stopped.

.

On December 10 there were ZERO reported cases in Pakistan.

[AlaskaDenise]

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

On December 10 there were ZERO reported cases in Pakistan.

So it's taking 16 days after onset to get reported?

Hopefully that situation will improve shortly.

.

[Snicklefritz]

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

Lack of evidence is not evidence of lack.

[tropical]

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

If I'm not maked a reading (from previous thread pages) page mixmatching,
the statement:
"his brother’s blood sample could not be collected"
is obviously a way to put on secret the results.
If it isn't, why it could be collected from his brother?

[HenryN]

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

So it's taking 16 days after onset to get reported?

Hopefully that situation will improve shortly.

.

No, the onset date for the first case was OCTOBER 25.

16 days would be FAST for Pakistan.

[HenryN]

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

Pakistanis, WHO check if bird flu passed by people

Tue Dec 18, 2007 1:06pm IST
By Augustine Anthony
ISLAMABAD (Reuters) - Pakistani authorities and World Health Organisation (WHO) experts were trying to determine on Tuesday whether bird flu had passed from human to human after the country reported its first human death from the virus.
Pakistani health officials confirmed at the weekend that eight people had tested positive for the H5N1 bird flu virus in North West Frontier Province since late October, of which one person, who worked on a poultry farm, died.
A brother of the dead person, who had not been tested, also died. It was not yet clear if he was a victim of bird flu.
One hundred people with symptoms of flu living in the vicinity had been checked but all tested negative, said a Ministry of Health spokesman.
"No linkage has been developed about human-to-human transmission. We are safe but we have to be very cautious," said the spokesman, Orya Maqbool Jan Abbasi.
The last human case was reported on Nov. 23, he said.
Health Secretary Khushnood Akhtar Lashari said on Monday some of the seven affected people had not worked with poultry and authorities were tracing who they had been in contact with.
Six had recovered while one was being treated, a provincial health official said.
Humans rarely contract H5N1, which is mainly an animal disease. But experts fear the strain could spark a global pandemic and kill millions of it mutates to a form that spreads more easily.
The area of the outbreak, near the towns of Mansehra and Abbottabad, about 60 km (40 miles) north of the capital, Islamabad, is in the foothills of the Himalayas.
Partly forested slopes are dotted with villages and small chicken farms.
A three-member WHO team, joined by officials from the Pakistan National Institute of Health, travelled on Monday to Peshawar, the province's capital where the patients were treated.
They were due to travel to Mansehra on Tuesday and were also expected to visit Abbottabad, where authorities reported the last H5N1 virus case in wild birds on Nov. 30.
The team would carry out epidemiological tests, Abbasi said.
Bird flu first appeared in Pakistan in early 2006, and several outbreaks of H5N1 were reported this year.
The Pakistani cases bring to nearly 350 the number of people worldwide who are known to have contracted the H5N1 virus, which has killed more than 200 people since 2003.

http://in.reuters.com/article/southAsiaNews/idINIndia-31030920071218?pageNumber=2&virtualBrandChannel=0

[tropical]

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

Now I'm got the answer dr. Niman (thanks).

"A brother of the dead person, who had not been tested, also died. It was not yet clear if he was a victim of bird flu."

[HenryN]

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

WHO probes Pakistan's first bird flu death
18 Dec 2007 13:10:05 GMT
<!-- 18 Dec 2007 13:10:05 GMT ## for search indexer, do not remove -->Source: Reuters

<!-- AN5.0 article title end -->
<SCRIPT language=JavaScript src="/bin/js/article.js"></SCRIPT>
</SPAN><INPUT id=CurrentSize type=hidden value=13 name=CurrentSize> <!-- WHO probes Pakistan's first bird flu death --><!-- Reuters -->(Repeats to additional subscribers)
(Adds comment from health official)
By Augustine Anthony
ISLAMABAD, Dec 18 (Reuters) - Pakistani authorities and World Health Organisation experts were trying to determine on Tuesday whether bird flu had passed from human to human after the country reported its first human death from the virus.
Pakistani health officials confirmed at the weekend that eight people had tested positive for the H5N1 bird flu virus in North West Frontier Province since late October, and one of the confirmed cases had died.
A brother of the dead man, who had not been tested, also died. It was not yet clear if he was a victim of bird flu.
Ministry of Health spokesman Orya Maqbool Jan Abbasi said the first man to catch avian influenza had been working culling poultry. He recovered but the two men who died were his brothers.
But Abbasi and other health officials said there was no suggestion of human to human transmission.
"Absolutely not," said Health Secretary Khushnood Akhtar Lashari. "The WHO is looking into all the things but whatever we have at the moment there's nothing to suggest that, remotely."
Humans rarely contract H5N1, which is mainly an animal disease. Experts fear the strain could spark a global pandemic and kill millions of it mutates to a form that spreads more easily.
Lashari said the man who had been culling poultry might have inadvertently brought the virus back to his home, where his brothers fell sick.
"He took his equipment along and the suspicion is the virus was in the equipment he was carrying," Lashari said."These are conjectures. It will be established when they do the sequencing test of the virus."
SECOND WHO TEAM
The area of the outbreak, near the towns of Mansehra and Abbottabad, about 60 km (40 miles) north of the capital, Islamabad, is in the foothills of the Himalayas.
Partly forested slopes are dotted with villages and small chicken farms.
Abasi said 100 people with symptoms of flu living in the vicinity had been checked but all tested negative.
The last human case was reported on Nov. 23, he said.
Of the seven people confirmed to be sick with avian influenza, six had recovered while one was being treated, a provincial health official said.
A three-member WHO team, joined by officials from the Pakistan National Institute of Health, travelled on Monday to Peshawar, the province's capital where the patients were treated. A second WHO team was due to arrive on Wednesday.
Authorities reported the last H5N1 virus case in wild birds in the area on Nov. 30.
Bird flu first appeared in Pakistan in early 2006, and several outbreaks of H5N1 were reported this year.
The Pakistani cases bring to nearly 350 the number of people worldwide who are known to have contracted the H5N1 virus, which has killed more than 200 people since 2003. (Additional reporting by Robert Birsel; Editing by Grant McCool)

http://www.alertnet.org/thenews/newsdesk/ISL137043.htm

<!-- news ## for search indexer, do not remove -->

[sharon sanders]

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

Please post to new Pakistan thread:

http://www.flutrackers.com/forum/showthread.php?t=45631

Our many dial-up viewers in remote areas/countries have trouble with long threads.

Thank you.