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

[sharon sanders]

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

From Resident Dark Horse at PFI this morning:

"Sorry, Cactus, I had lots of work to do yesterday and didn't have time to watch the boards. Woke up to all this news this morning.<o:p></o:p>
<o:p> </o:p>
I just contacted Tom Skinner, CDC spokesman, and asked him about this New York City event last weekend. He said that the NY State Health Dept. has chapter and verse on the whole thing. Skinner said that the man was tested and did not have H5N1 even though his siblings reportedly did. At this point, he showed no antibodies.<o:p></o:p>
<o:p> </o:p>
I have to run now and don't have time to call the NY State Health Dept, but I'll try later this afternoon.<o:p></o:p>
<o:p> </o:p>
Why don't you folks here put together a list of questions for me to ask?"



Further corroboration.

http://www.singtomeohmuse.com/viewtopic.php?t=1988&postdays=0&postorder=asc&start=285

[Farmer]

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

to Oremus at Flu Wiki. More details from WHO and CDC, Helen Braswell reporting:

http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20071215/avian_flu_071215/20071215?hub=TopStories

Pakistan H5N1 cases may involve human transmission
Updated Sat. Dec. 15 2007 10:12 AM ET

Helen Branswell, medical reporter, The Canadian Press

Authorities in Pakistan have announced that country's first reported cases of H5N1 avian flu in a cluster of family members which may have involved human-to-human transmission.

There was some confusion Saturday about how many people had tested positive for the virus, with Pakistan announcing six cases but an official of the World Health Organization suggesting as many as nine people may have tested positive for the virus in that country.
The WHO spokesperson said investigations are still underway to try to determine how the various people became infected, but some human-to-human spread is possible.

"We can't rule it out,'' WHO spokesperson Gregory Hartl said from Geneva.

"There are other plausible explanations.... We don't know enough at this point. And in some of these cases, one never will know enough.''

The cluster of cases involved four brothers and two cousins living in the country's North West Frontier Province. Two of the brothers died, one without having been tested.

A doctor who treated members of the family also has tested positive for H5N1, Hartl said. But she was not tested with the standard diagnostic assay used to detect H5N1 infection and further testing is needed to determine if she is indeed a case.

Three people who are unrelated to the family but who were involved in culling H5N1-infected poultry in the same area have also tested positive.

Meanwhile, U.S. health officials have confirmed they conducted H5N1 testing on a man who had recently visited Pakistan and was complaining of mild respiratory symptoms. The man is believed to be another brother from the affected family.

A spokesperson for the U.S. Centers for Disease Control confirmed Saturday that the CDC sent its plane to Albany last Saturday to collect specimens taken from the man, who lives in Nassau County.

Tests done in the state lab and confirmed at the CDC in Atlanta showed the man was not infected with the virus.

The initial infection dates back to Oct. 25, when a livestock official -- a brother in the family -- fell ill. It appears that it was only after two of the man's brothers fell ill and died that testing was done looking for H5N1 infection. It is believed the first positive test was received in late November.

The WHO was officially alerted on Dec. 12, Hartl said.

"We feel that the Pakistanis have done everything right in terms of their response,'' he said, noting the country has done a "huge'' amount of work to strengthen infection control and increase surveillance.

"(But) yes, they could have alerted us earlier.''

The statement from Pakistan's health ministry announced six infections, with five people having recovered. It was unclear who the country was counting as cases in that report.

But that figure would not include the brother who died without being tested. While his symptoms and his exposure history are highly suggestive of H5N1 infection, he cannot be added to the official case count.

A lab team from the U.S. Naval Medical Research Unit in Cairo is travelling to Pakistan to conduct confirmatory testing. And WHO is sending a team of two doctors with experience treating H5N1 patients as well as an epidemiologist to help with the investigation of cases.

Pakistan is the 14th country to announce human infections with the H5N1 virus. If these cases are confirmed, they will bring the global case count since late 2003 to nearly 350 human cases and 209 deaths.

On Friday, the WHO announced that Myanmar had reported its first human case in a seven-year-old girl who fell ill in late November. She has since recovered.

[sharon sanders]

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

"..Meanwhile, U.S. health officials have confirmed they conducted H5N1 testing on a man who had recently visited Pakistan and was complaining of mild respiratory symptoms. The man is believed to be another brother from the affected family.

A spokesperson for the U.S. Centers for Disease Control confirmed Saturday that the CDC sent its plane to Albany last Saturday to collect specimens taken from the man, who lives in Nassau County.

Tests done in the state lab and confirmed at the CDC in Atlanta showed the man was not infected with the virus..."


A 2nd corroboration. Thank you.

[Giuseppe]

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

-=From World Health Organization:=-

Avian influenza ? situation in Pakistan
15 December 2007

The Ministry of Health in Pakistan has informed WHO of 8 suspected human cases of H5N1 avian influenza infection in the Peshawar area of the country. These cases were detected following a series of culling operations in response to outbreaks of H5N1 in poultry. One of the cases has now recovered and a further two suspected cases have since died.

Samples taken from the suspected cases have tested positive for H5N1 in the national laboratory and are being forwarded to a WHO H5 Reference Laboratory for confirmation and further analysis. The MoH is taking steps to investigate and contain this event, including case isolation and contact tracing and monitoring, detailed epidemiological investigations, providing oseltamivir for case management and prophylaxis, reviewing hospital infection control measures and enhancing health care-based and community-based surveillance for acute respiratory infections.

WHO is providing technical support to the MoH in epidemiological investigations, reviewing the surveillance, prevention and control measures that have been implemented and carrying out viral sequencing of avian and human isolates.

Multiple poultry outbreaks of H5N1 influenza have been occurring in Pakistan since 2006. In 2007, there have also been outbreaks in wild birds. A majority of the outbreaks discovered have been in the ?poultry belt? of North-West Frontier Province, particularly in the Abbottabad and Mansehra area and cases of infection in wild birds have been identified in the Islamabad Capital Territory.
-

http://www.who.int/csr/don/2007_12_15/en/index.html

------

[sharon sanders]

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

I am now adjusting our ticker tape to reflect this latest corroboration.

Thank you to everyone who supported FluTrackers.

[Commonground]

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

The Ministry of Health in Pakistan has informed WHO of 8 suspected human cases of H5N1 avian influenza infection in the Peshawar area of the country. These cases were detected following a series of culling operations in response to outbreaks of H5N1 in poultry. One of the cases has now recovered and a further two suspected cases have since died.

O.K., now what about the confirmed?

[Theresa42]

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

A doctor who treated members of the family also has tested positive for H5N1, Hartl said.

Another indication of possible (probable?) H2H infection.

(THANK YOU, HELEN BRANSWELL!!!)

[Theresa42]

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

CDC notice:

Avian influenza - Situation in Pakistan

December 15, 2007

The Ministry of Health in Pakistan has informed the World Health Organization (WHO) of 8 suspected human cases of H5N1 avian influenza infection in the Peshawar area of the country. If confirmed, these would be the first reported human cases in Pakistan. For more information, see the WHO update from December, 15, 2007. There are no reports of animal or human avian influenza A (H5N1) infections in the United States.

http://www.cdc.gov/flu/avian/updates/pakistan15dec07.htm

[HenryN]

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

Commentary at

http://www.recombinomics.com/News/12150703/H5N1_Pakistan_Cluster_HCW.html

[HenryN]

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

<table id="ss" cellspacing="0"><tbody><tr id="ss-navigation"><td id="ss-zoom-single" colspan="3"></td></tr><tr><td colspan="3">



</td></tr><tr><td id="ss-caption" colspan="3">Pakistani brothers Mohammed Ishtiaq, right, and Mohammed Tariq, left, who were treated for suspected H5N1 bird flu, come out from their house in Sukur village near Peshawar, Pakistan on Saturday, Dec. 15, 2007. Six people caught H5N1 bird flu in northern Pakistan last month and at least one person with the disease has died, the government said Saturday. The U.N. World Health Organization confirmed the deadly H5N1 strain was found in the six cases, but said a second round of tests were being carried out to make sure. (AP Photo/Mohammad Zubair)

http://ap.google.com/article/ALeqM5ilbnTDTey5W_baRqkBnsmWGHIiDwD8TI1NE00

6 Pakistanis Infected With H5N1 Bird Flu

19 minutes ago
ISLAMABAD, Pakistan (AP) — Six people caught the deadly strain of bird flu in northern Pakistan last month and at least one person with the disease has died, the government said Saturday.
The World Health Organization confirmed that all six cases were positive for the H5N1 strain of the virus in preliminary testing, but said a second round of analysis was being conducted to make sure.
If confirmed, the infections would be the first in humans in South Asia.
Pakistan's Health Ministry said it had tested several patients and others with whom they had come into contact in late October. The results for six people from the Abbottabad and Mansehra districts of North West Frontier Province were positive, it said in a statement.
The ministry said five people had fully recovered, one died in a hospital and his brother, who could not be tested, also died. It did not explain why the brother could not be tested.
The virus has killed more than 200 people worldwide since it began ravaging Asian poultry stocks in late 2003, according to the WHO.
Most of the human cases of H5N1 bird flu have been reported in Indonesia and Vietnam. On Friday, the WHO confirmed the first case in Myanmar, where a 7-year-old girl was infected but recovered.


</td></tr></tbody></table>

[Niko]

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

Commentary at

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

<big><big>Commentary</big></big>

H5N1 Cluster in Pakistan Grows

Recombinomics Commentary
December 15, 2007

an official of the World Health Organization suggesting as many as nine people may have tested positive for the virus in that country.

The cluster of cases involved four brothers and two cousins living in the country's North West Frontier Province. Two of the brothers died, one without having been tested.

A doctor who treated members of the family also has tested positive for H5N1, Hartl said. But she was not tested with the standard diagnostic assay used to detect H5N1 infection and further testing is needed to determine if she is indeed a case.

Three people who are unrelated to the family but who were involved in culling H5N1-infected poultry in the same area have also tested positive.

Meanwhile, U.S. health officials have confirmed they conducted H5N1 testing on a man who had recently visited Pakistan and was complaining of mild respiratory symptoms. The man is believed to be another brother from the affected family.

A spokesperson for the U.S. Centers for Disease Control confirmed Saturday that the CDC sent its plane to Albany last Saturday to collect specimens taken from the man, who lives in Nassau County.

The above comments provide more detail to the alarming situation n Pakistan. The recent report from the Health Minister acknowledged six confirmed cases as well as an fatal infection in an untested family members. However, in addition to these four brothers, two cousins as well as a health care worker have tested positive.

Earlier reports indicated the index case for this cluster was a veterinarian who organized a 3000 bird cull between October 21-23. Samples from forty people were collected on October 30 and four tested positive. However, six weeks later, the details remain murky. Earlier reports indicated the two fatally infected brothers died on November 19 and 29, strongly suggesting human-to-human transmission because of the spread between the date of the cull as well as days between dates of death. Moreover, media reports indicated the brothers were not involved in the culling.

Human-to-human transmission would be further supported if the positive H5N1 tests for the cousins and health care worker are confirmed.

The situation in Pakistan is more alarming because of the multiple H5N1 outbreaks in poultry farms in adjacent regions, as well as wild birds in Islamabad as described in the WHO update.

Although Pakistan has had H5N1 outbreaks in 2006 and 2007, so sequence data has been made public.

The lack of detail on a large laboratory confirmed cases with exposures that date back to October remain a cause for concern.

The involvement of NAMRU-3 in the investigation should help remedy the situation.

[Niko]

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

several additional details

http://www.bloomberg.com/apps/news?pid=20601202&sid=aYP_YfthdMiA&refer=healthcare

Pakistan Has Eight Suspected Human Cases of Bird Flu (Update1)
By Jason Gale

<!-- WARNING: #foreach: $wnstory.ATTS: null at /bb/data/web/templates/webmacro_en/20601202.wm:289.2 --><!-- WARNING: #foreach: $wnstory.ATTS: null at /bb/data/web/templates/webmacro_en/20601202.wm:303.19 --> Dec. 16 (Bloomberg) -- Five members of a family in Pakistan are among eight people who may be the country's first human cases of bird flu, the World Health Organization said. At least one brother died.

Pakistan's national laboratory found the lethal H5N1 avian flu strain caused the infections in three brothers and two cousins from the same family, according to information from a WHO statement today and Gregory Hartl, a WHO spokesman in Geneva. Another brother and his son from the U.S., who attended a funeral for one of the victims, tested negative for the virus at a hospital in Nassau County, New York, Hartl said.

Medical teams have been sent to Pakistan to assist local authorities in investigating the cases, in which two people had only mild symptoms, Hartl said. Avian flu has infected at least one person a month in Asia and Africa during the past three years and doctors are monitoring for signs it may be adapting to humans by killing fewer people, fostering its spread.

``It's too early to make any definitive conclusions'' about the outbreak, Hartl said in a telephone interview today. ``We are still in the middle of it.''
The remaining suspected cases include a man and his niece, and a male who worked on a farm about 12 miles (20 kilometers) away.

Doctors from WHO in Geneva and Cairo, and from the U.S. Navy Medical Research Unit No. 3 in Cairo will arrive in Pakistan over the next two days to track and stem the disease's spread, and to analyze specimens for any genetic mutations in the virus.

Pakistan has reported 44 H5N1 outbreaks in poultry to the World Organization for Animal Health since early 2006. The most recent occurred on Nov. 27 and Nov. 28 in the states of Punjab and North-West Frontier Province, killing almost 20,000 chickens.

Poultry Culling
The suspected cases occurred in the Peshawar area of the country and were detected following a series of culling operations in response to outbreaks of H5N1 in poultry, according to the WHO statement. Samples from the cases are being sent to a WHO reference laboratory in Cairo for confirmation and further analysis.

At least 340 people in 13 countries have contracted the virus since 2003, WHO said yesterday. Three of every five cases were fatal and most were caused by contact with infected poultry, such as children playing with them or adults butchering them or plucking feathers, according to the Geneva-based agency. It says millions could die if the virus becomes as contagious as seasonal flu and touches off a global pandemic.

To contact the reporter on this story: Jason Gale in Singapore at j.gale@bloomberg.net
Last Updated: December 15, 2007 13:43 EST

[Theresa42]

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

Link to above story:

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

[Niko]

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

<table id="ss" cellspacing="0"><tbody><tr id="ss-navigation"><td id="ss-zoom-single" colspan="3"></td></tr><tr><td colspan="3">



</td></tr><tr><td id="ss-caption" colspan="3">Pakistani brothers Mohammed Ishtiaq, right, and Mohammed Tariq, left, who were treated for suspected H5N1 bird flu, come out from their house in Sukur village near Peshawar, Pakistan on Saturday, Dec. 15, 2007. Six people caught H5N1 bird flu in northern Pakistan last month and at least one person with the disease has died, the government said Saturday. The U.N. World Health Organization confirmed the deadly H5N1 strain was found in the six cases, but said a second round of tests were being carried out to make sure. (AP Photo/Mohammad Zubair)

http://ap.google.com/article/ALeqM5ilbnTDTey5W_baRqkBnsmWGHIiDwD8TI1NE00

6 Pakistanis Infected With H5N1 Bird Flu

19 minutes ago
ISLAMABAD, Pakistan (AP) ? Six people caught the deadly strain of bird flu in northern Pakistan last month and at least one person with the disease has died, the government said Saturday.
The World Health Organization confirmed that all six cases were positive for the H5N1 strain of the virus in preliminary testing, but said a second round of analysis was being conducted to make sure.
If confirmed, the infections would be the first in humans in South Asia.
Pakistan's Health Ministry said it had tested several patients and others with whom they had come into contact in late October. The results for six people from the Abbottabad and Mansehra districts of North West Frontier Province were positive, it said in a statement.
The ministry said five people had fully recovered, one died in a hospital and his brother, who could not be tested, also died. It did not explain why the brother could not be tested.
The virus has killed more than 200 people worldwide since it began ravaging Asian poultry stocks in late 2003, according to the WHO.
Most of the human cases of H5N1 bird flu have been reported in Indonesia and Vietnam. On Friday, the WHO confirmed the first case in Myanmar, where a 7-year-old girl was infected but recovered.


</td></tr></tbody></table>

Hospital officials in the provincial capital of Peshawar told AFP that Tariq died late last month


Is Tariq a zombie, a vampire or are one of the above reports wrong? I choose option 3.

[Theresa42]

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

Are (were) there two Tariqs, perhaps? They all seem to have the same/similar names. ??