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H5N1 Kocyigit Ozcan Cluster Continues to Grow
January 23, 2006
Dr. Onbaþý, Agri Doðubayazýt district former evening hour kuþ gribi (bf) suspect brought to 16 year old Murat Özcan, hospital hayatýný kaybeden(?) Fatma Özcan relative happened, sick child department put under treatment registered.
The above translation suggests another Ozcan (16 year-old Murat) has been admitted to Van. The latest patient, like the six transferred to Igdir State Hospital, are also related to Fatma Ozman, the latest confirmed H5N1 fatality in Turkey.
As listed in the Kocyigit / Ozcan timeline, the list of family members admitted and/or confirmed H5N1 cases continues to arise. Although media reports cite exposure to chickens of some sort, the size and reach of the familial clusters indicate the transmission involves more than exposure to sick chickens.
Since Murat Ozkan is not listed among prior Ozcan family members admitted, and the latest six to be admitted are to another hospital, it seems likely that the case above is a member of a sixth family. At least five of these six families are related to Fatma Ozcan.. Three other family members have died and three others also remained hospitalized after testing positive for H5N1. Nine other family members have been admitted and released and an additional seven have just been admitted. Thus, the total number of hospitalized patients related to Fatma Ozcan is 23, in addition to two hospitalized Ozcans that may be related.
The disease onset dates suggest that considerable human-to-human transmission could have happened within the various clusters. However,. it is also possible that further transmission occurred between clusters. The Kocyigit family had the Ozcan family over for dinner on December 24, which created opportunities for H5N1 transmission between the families.
Similarly, the burial of Fatma Ozcan on January 16, 2006 could have created additional H5N1 exposures. Hatice Ozman attended the burial and she had just been released from Van hospital. The criteria for releases are unclear. The test for H5N has been repeatedly shown to be unreliable. All four fatal cases initially tested negative for H5N1. Others who had been hospitalized with symptoms, including Ali Hasan Kocyigit and Hatice Ozman have yet to be added to the confirmed list of H5N1 infected patients.
It is unclear how many, if any of the seven Ozcan’s recently admitted attended the burial of their cousin Fatma Ozcan, but the burial would appear to offer the opportunity of direct or indirect transmission of H5N1 to these newly admitted patients.
As the Kocyigit / Ozcan cluster continues to grow and involve more relatives in more families, the role of dead or frozen chickens in the transmission of H5N1 between these family members becomes less obvious.