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Mild H5N1 Cases Near Ankara Turkey
January 11, 2006
Two young brothers, aged 4 and 5, are being closely watched at the gleaming new Kecioren Hospital here, a police car at the entrance guarding a potential scientific treasure. Though both boys have tested positive for the H5N1 virus after contact with sick birds, neither has any symptoms of the frequently deadly disease.
Doctors are unsure if - for the first time - they are seeing human bird flu in its earliest stages, or if they are discovering that infection with the H5N1 virus does not necessarily lead to illness.
The above description of two young boys near Ankara, Turkey is similar to two other young brothers who came into contact with gloves used by their father to carry two dead wild ducks that later tested positive for H5N1. The second set of brothers, aged 2 and 5, also had mild or no symptoms when tested, and they were also H5N1 positive.
Similar situations have been recorded in Indonesia for nephews of H5N1 positive relatives. The nephews were tested because they were contacts of H5N1 positive cases and the nephews were H5N1 positive and recovered after brief hospitalization.
Additional cases with mild symptoms who had visited a zoo in Jakarta were not tested and the lack of testing of mild cases leaves significant questions about the level of H5N1 in human populations and the transmissibility of H5N1 from mild cases unanswered.
The positive cases suggest that early testing can lead to the detection of mild cases. Most testing is done on advanced cases, which frequently are negative because the H5N1 has already been cleared of the nose and throat and is present in the lungs of the pneumonia cases when tested. The mild cases indicate that early testing can produce positive results because the H5N1 has not been cleared from the nose or throat.
The clinical course of the above cases may have been attenuated because of Tamiflu treatment, but the possibility that patients infected with low doses of H5N1 might recover without treatment is real and the number of mild cases that resolve without treatment may be significant.
More widespread testing of patients with bird exposures or their contacts would be useful. The early detection may increase the effectiveness of antiviral treatment. In addition mild cases that are more efficiently transmitted may recombine with more virulent versions of H5N1 to generate H5N1 that is more virulent and more efficiently transmitted.