WHO Investigating Possible H5N1 Human Cluster

http://www.cnn.com/2006/HEALTH/conditions/05/13/indonesia.birdflu/index.html?section=cnn_latest

Indonesia probes possible bird flu Four of eight cases investigated were fatal (snipped)

All eight cases were from the same family. Four members of the family have died from what health officials suspect could be bird flu, said WHO spokeswoman Sari Setiogi. . .

Health officials closely study such groups of cases, know as "clusters," to see whether the virus, which currently is almost always transmitted from birds to humans, has mutated into one that can easily pass between humans -- a scenario that many fear could turn into a global human pandemic.

I hope this thread (and any others on this topic) dies a quick death due to the story being overblown, but the fact that four are dead in a single family cluster would be a new milestone. Unfortunately, if this story "has legs", I'll bet a good number of the posts on this and related threads will be openly derisive.

I was in Houston during the hurricane and the evacuation. In the morning I was driving around with a friend visiting from out of town and he asked me "what's the smell". I had bought an extra can of gas and put it in the back. I told him "watch the light bulbs all come on at the same time in everyone's head". Sure enough, right around lunch, the gas lines started to form. Everyone decided they needed to top off their tanks - - all at the same time. By 3pm, all the freeways were in gridlock and the gas stations were running out from the panic buying and hoarding.

I doubt this is the start of an efficient human-to-human transmission, but it might be the strongest example to date of an "inefficient" human-to-human transmission (there have been some other possible family clusters, but not like this I don't think). If people wait to take this seriously, then when they finally realize or accept what is happening, it may be too late. And then they will have to make do with what they have on hand until the panic buying/hoarding runs its course and supply begins to catch up with demand. And there is no telling when the virus would make its way here after the start of the outbreak. So by the time the hoarding has run its course, and all the procrastinators have "topped off" their pantries, the virus may already be here. And going out into public once it is in full swing may be literally "taking your life into your hands".

After 9/11, the largest terror attack in our history, and after Katrina, the largest natural disaster in our history, there is no excuse for the complacent unwillingness to prepare that is now so prevalent.

Unfortunately people poo-poo these sort of stories. After being barraged by all the scare stories in the media most just become jaded and think that it's all nothing more than a "chicken little" story. H5N1 is a ticking time bomb that may or may not go off. If it does we're all in a world of hurt. It could be repeat of the Black Plague in which a significant portion of the human race is wiped off the planet. Then it might be nothing more than a few isolated cases (with lots of hysteria fed by the media). But the facts should get everyone pause:

1.) H5N1 currently kills +50% of those it infects. The young and healthy seem to be the most at risk because the virus sends the immune system into overdrive and turns the body against itself. This was also the case in the 1918-19 pandemic.
2.) Computer models suggest that all a pandemic would need to race around the world is to infect 40 people. Given the population densities and availablity of global travel it is likely that the computer models are correct. In 1918 the pandemic reach every single corner of the planet, with the one exception of an island off the coast of Brazil. And that was in era before jet travel.
3.) The US government predicts that should a H5N1 pandemic
break out half of the US population will get infected. It is likely that once the virus achieves h2h it won't be as lethal are it currently is. A successful virus is one that doesn't kill off its hosts and is thus able to spread. But even at a 10% lethality rate 15 million Americans could die (300 million x 50% infected x 10% dead). Imagine the consquences of that, especially if most of the dead are the young of the nation. [It will be all Bush's fault don't you know]
4.) The virus is mutating so rapidly that the chance of having a vaccine in time to meet the threat are almost nil.
5.) Tamiflu and the other antiviral agents are not cures. They could help spread the disease by allowing those infected to carry on with their normal routines.
6.) Because any country in which the pandemic began to take shape would quickly be sealed off from the rest of the world and would face economic ruin you can bet your bottom dollar that the government in that country would downplay/hide the facts for as long as possible. China last summer is a prefect example. A mysterious illness broke out in the interior provinces in which 400 people died. The official line is that it was a pig-borne illness, but given that the China government didn't allow WHO or reporters into the areas affected until after the disease died down makes you wonder. Especially given the fact that the provinces affect were near to Qinghai Lake where the currently H5N1 strain causing the most concern started to spead last May. H5N1 capable of human-to-human transmission could rage in rural China for weeks before news would filter out. And there it would be too late.

One can only hope that the heighten awareness about the threat will catch any possible H5H1 h2h outbreak before it has a chance to spead. We can only cross our fingers.

"Either China or Indonesia could be "Ground Zero"

Five Fatal H5N1 Cases in Sumatra Raise Pandemic Concerns

Recombinomics Commentary
May 13, 2006

The fatal H5N1 bird flu infections of five family members in Karo in North Sumatra has raised pandemic concerns. 2-3 additional family members are hospitalized, but 12 other suspect patients are of even greater concern.

Media reports have provided no detail on these other 12 patients. The hospital is 170 km from the family residence, so it is unclear why there are 12 more suspect patients at the hospital in Medan. Least worrisome would be hospital quarantine due to exposure to the family. However, transporting these patients 170 km as a precaution suggests the local level; of concern is high. Media reports had described panic in the region, but the panic is more likely to be in Karo than Medan.

If the 12 are casual contacts or hospital contacts, than the cause for concern would be increased. The five fatalities have already set a record for H5N1 clusters and so far none of the family members have been discharged. Two fled from the hospital, but they have been returned to a private hospital and their current medical condition is not clear.

The family members most severely affected have died, and the spread in the dates of death suggests human-to-human transmission from the index case to the other family members. Although fertilizer may have contributed to the infection of the index case, infection of the other family members from the fertilizer seems unlikely, unless the other 12 suspect cases also are linked to the fertilizer, which originated in areas that are H5N1 positive.

In any event, more information on the 12 Indonesian suspect cases would be useful.

and then there is this:

H5N1
News and Resources about Avian Flu
May 12, 2006

Indonesia: Not only H5N1 but also a volcano
You could get kicked out of the Disaster Novelists' Guild for complicating your plot like this: Red alert for Indonesia volcano.

Indonesian authorities have ordered the compulsory evacuation of thousands of residents living on the slopes of the volcano Mount Merapi.

The alert status has been raised to the highest level, warning of an imminent eruption of the volcano which has been rumbling ominously for weeks.

The 3,000m (9,700ft) peak, in densely populated Central Java province, is in a state of "constant lava flow".

So if (or when) Mount Merapi erupts, chickens will be the last thing on everyone's mind. Thousands of people will seek shelter elsewhere on the overcrowded island of Java, and maybe mingle with the people who try to escape the ominous flu cluster in North Sumatra.

This does not look good.

" . . . There is no immediate evidence the H5N1 flu virus passed easily among at least seven members of the family in North Sumatra province. But experts said nothing could be ruled out and more testing was crucial. In a day of fast-moving events, the WHO also said a caterer from Surabaya city in East Java had died of bird flu, while Indonesia's health ministry said local tests had confirmed a 12-year-old boy from Jakarta who died four days ago was infected with H5N1. Both cases are separate from the Sumatra case. . .

"Any time we have a cluster, it raises the suspicion that human-to-human transmission may have occurred. We don't rule out either way ... it is too early to make any conclusion because investigations are still going on," Setiogi said. . .

Asked about the possibility of a change in the virus and whether there had been human-to-human infection in Sumatra, a WHO spokeswoman in Geneva said, "It is too early to draw any conclusions. . .

Hong Kong virologist Guan Yi said the long time lag of nine days between the first and last victims showing symptoms of the disease was unusual. "If they were all infected by the same source, their onset time (of illness) would have been closer, but that is not the case ... The later cases may involve the possibility of human-to-human transmission," Guan told Reuters. . ."

http://www.alertnet.org/thenews/newsdesk/SP285120.htm

WHO confirms bird flu in Indonesian family
17 May 2006 15:58:08 GMT
Source: Reuters

(Adds Djibouti halt to chicken slaughter, paragraphs 6-7)

By Achmad Sukarsono and Diyan Jari

JAKARTA, May 17 (Reuters) - At least five members of an Indonesian family have been infected with bird flu, the World Health Organisation confirmed on Wednesday, after the case triggered widespread fears of human-to-human transmission.

There is no immediate evidence the H5N1 flu virus passed easily among at least seven members of the family in North Sumatra province. But experts said nothing could be ruled out and more testing was crucial.

In a day of fast-moving events, the WHO also said a caterer from Surabaya city in East Java had died of bird flu, while Indonesia's health ministry said local tests had confirmed a 12-year-old boy from Jakarta who died four days ago was infected with H5N1. Both cases are separate from the Sumatra case.

Clusters of human infections are worrying because they indicate that the virus might be mutating into a form that is easily transmissible among humans. That, experts say, could spark a pandemic in which millions might die.

For the moment, the virus is mainly a disease in birds and is hard for humans to catch.

In Djibouti, which has confirmed the first human case in sub-Saharan Africa after a two-year-old girl tested positive for H5N1, slaughtering of poultry was halted after angry villagers refused to cooperate unless they received immediate compensation.

Officials hoped to re-start culling domestic chickens to contain the virus as soon as possible. The impoverished nation in the Horn of Africa has appealed for international help to fight the disease.

The WHO and other health experts are puzzled over the source of infection in the Sumatran family, six of whom have died.

"The possibility that they may have been infected by the same source is still there," said Sari Setiogi, the WHO spokeswoman in Indonesia. More animal samples would be collected for testing.

"Any time we have a cluster, it raises the suspicion that human-to-human transmission may have occurred. We don't rule out either way ... it is too early to make any conclusion because investigations are still going on," Setiogi said.

The WHO has sent a team to Kubu Simbelang village in Karo regency, about 50 km (30 miles) south of Medan.

Samples taken from six members of the family were sent to a WHO-affiliated laboratory in Hong Kong and five tested positive for H5N1. Results of the sixth were still pending.

Samples from the first person to fall ill, a 37-year-old woman, were not sent to Hong Kong but she is considered to have been infected with H5N1. She fell ill on April 27 and later died.

NO SUGGESTION OF MUTATION

Asked about the possibility of a change in the virus and whether there had been human-to-human infection in Sumatra, a WHO spokeswoman in Geneva said, "It is too early to draw any conclusions.

"I have not heard any suggestion that the virus is any different," Maria Cheng said, referring to the laboratory tests in Hong Kong.

Indonesia's Health Ministry said the Sumatra cluster was not a case of human-to-human transmission.

"The spread was through risk factors from poultry or other animals. There is no proof of human-to-human," Nyoman Kandun, director-general of disease control, told Reuters.

But an Indonesian agriculture official who declined to be identified said animal tests have not shed any light.

"There is a big question mark. Blood samples from all kinds of animals from chickens, ducks, geese, birds, pigs, cats and dogs turned out negative so far. Manure has also been checked. The result is negative," the Jakarta-based official said.

Hong Kong virologist Guan Yi said the long time lag of nine days between the first and last victims showing symptoms of the disease was unusual.

"If they were all infected by the same source, their onset time (of illness) would have been closer, but that is not the case ... The later cases may involve the possibility of human-to-human transmission," Guan told Reuters.

"They may have infected one another ... but we have no evidence. This needs to be investigated by the locals."

The latest deaths bring to at least 30 the number of people killed by bird flu in Indonesia.

Among the confirmed deaths on Wednesday was a 38-year-old catering businesswoman from Surabaya who had dealt with live pigs and pork meat before she died last week.

Not including the latest cases, bird flu has killed 115 people worldwide, the majority in east Asia, since reappearing in 2003. Virtually all victims caught the disease from poultry.

The U.N. Food and Agriculture Organization said on Wednesday that H5N1 had been found in a duck in Laos, but there was no sign the virus was spreading. (Additional reporting by Tan Ee Lyn in Hong Kong, Richard Waddington in Geneva and Darren Schuettler in Bangkok)

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