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Supected H5N1 Fatality in Iraq

Recombinomics Commentary

January 18, 2006

Health officials in northern Iraq have sent samples to Jordan for testing for the bird flu virus H5N1 after a 14-year-old girl died in the Kurdish city of Sulaimaniya, officials said on Wednesday.

Tijan Abdel-Qader died on arrival at the main hospital on Tuesday after falling ill 15 days earlier in her home town of Raniya, in Kurdistan close to the Turkish and Iranian borders, Kurdish regional health minister Mohammed Khashnow said.

"The doctors in Sulaimaniya suspected this might be a case (of bird flu)," he told Reuters. "They have sent samples to Amman and we will know the results next week."

Raniya is close to Lake Dukan, which draws many migratory birds to the region and where Iraqi officials had been taking measures to try to prevent domestic fowl from being infected.

"The rest of the family is in good health," Khashnow added, saying the family was not in the poultry business.

The above comments suggest H5N1 has migrated across Turkey’s southern border and has cause a human fatality in Iraq.  The lack of contact with poultry and the proximity to migratory birds signals a movement of H5N1 throughout the Middle East.  The recent OIE report on H5N1 in Turkey identified H5 in wild birds and the confirmed or suspected wild bird and domestic poultry outbreaks blanketed Turkey.  These data left little doubt that H5N1 had spread into neighboring countries.

However, none of the countries in the Middle East have filed OIE reports for H5N1 and if this case is positive, it would be the first reported human case outside of Turkey.

These data are of concern because they suggest that polymorphisms  such as HA S227N and PB2 E627K have increased the transmission of H5N1 to humans. In Turkey there are many large clusters, demonstrating extensive human-to-human transmission and this case in Iraq suggests similar transmissions will soon be reported throught the Middle East.

More information on testing of this suspect case would be of use.  Since symptoms began 15 days earlier, it is probably too early for antibody tests and too late from nose or throat swabs.  However testing on lung samples would more likely identify an H5N1 infection.

In Turkey, all four fatal cases initially tested negative for H5N1, but were subsequently positive, especially when lung material was tested.  Similar testing in Iraq would be useful.


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