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Kocyigit and Ozcan H5N1 Transmission Chains in Dogubeyazit

Recombinomics Commentary

January 15, 2006

twelve year old Fatma Ozcan. She lived near the family which lost already three children to the bird influenza, and probable she had been also contaminated

Of this probable fourth bird flu death, a brother and six nephews and nieches are remaining in the same hospital.

We lost a member of the Ozcan family .. after the losses of the Kocyigit family. What is similar for all cases is that they came too late. Kocyigit family cases were sick for 10 days and the Ozcan family cases for 5 days when they first went to clinics

The above comments on the death of Fatma Ozcan provide evidence for possible extended transmission chains of H5N1 between and through members of the Ozman and Kocyigit families.

WHO updates of H5N1 positive patients do not give disease onset dates nor do they give relationships of H5N1 patients with hospitalized patients.

The first four H5N1 cases of human H5N1 in Turkey were the four Kocyigit family members.  Initial WHO quotes in media reports mentioned two large extended families that were infected.  The other large family was the Ozcan family.  Some or all of the Ozcan family lived near the Kocyigit family.  Media reports name at least 18 hospitalized members of the two families.  These include four fatalities, of which three were H5N1 confirmed, as well as three additional members who are still hospitalized and H5N1 positive.

Media accounts provide admission dates, and the above comments indicate fatal cases in the two families showed symptoms 5-10 days prior to admission to the hospital in Van.  These dates allow for extended human to human transmission chains.

The Kocyigit siblings were admitted to Van on December 31. The above comments indicate the began showing symptoms 10 days earlier, but additional report suggest the oldest boy Muhammet, showed symptoms first and his siblings showed symptoms after he visited the doctor complaining of flu symptoms.  Media reports suggest his symptoms may have been as early as mid-December, when poultry began to die in Dogubayazit.  Thus, the first transmission could have been from the Muhammed Kocyigit to his three siblings.  Mohammed died January 1 and his two sisters died January 5 and January 6.

The first Ozcans were admitted to Van on January 4.  Two of the siblings, and , were the most advanced and were placed into the ICU suggesting symptoms may have begun in late December. The other members of their family were admitted on January 5 and 6 suggesting their symptoms began closer to their admission dates.  Thus, there could have been transmission from the Kocyigit siblings to the most advanced Ozcans, who they infected their mother and other siblings.  The cases would have provided an opportunity for two more transmission links along the chain.

Recently, four more Ozcans were admitted.  These Ozcans were cousins of the patients admitted earlier, and two of the recent admissions, Fatma and Muhammed were advanced cases that had developed symptoms five days earlier.  Also admitted were two younger family members raising the possibility that H5N1 was transmitted from the Ozman cousins admitted earlier to the advanced cases who then infected the later cases.  Thus, each cluster of admissions could have had index cases infected by members of the earlier clusters, and the index case(s) could have infected other members of the cluster, creating five transmissions over a period of approximately one month.

Since many chickens were dying in the area any or all of the cluster members could have ben infected by poultry, but since all cluster members were members of two families that were neighbors, an extended human transmission chain cannot be excluded.


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