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Four Suspected H5N1 Fatalities in Iraq
February 7, 2006
"There is one confirmed case, the girl, and three suspect cases under investigation who have died. They include her uncle, the boy in the south and another case," WHO spokeswoman Maria Cheng said in Geneva.
Seven patients suspected of having bird flu are being treated in hospital in the north, the WHO said.
The above comments identify 11 confirmed or suspect bird flu cases, including 4 fatalities. The "other case" mentioned above may the cousin of the index case who has also died, according to media reports. If so, WHO's referral to a cousin as "another case" would again be misleading. Situation updates on the confirmed cases in Turkey omitted disease onset dates and relationships between confirmed and hospitalized cases. These relationships, as well as the cluster described above, support for efficient human-to-human transmission of H5N1.
The fatality in southern Iraq indicates H5N1 has spread throughout Iraq via wild birds and the number of cases in Iraq as well as Iran, Kuwait, and Saudi Arabia should increase, although none have reported H5N1 in birds. Iraq has filed an OIE report on two outbreaks in the, although the pigeons in the south appear to be H5N1 positive. Similarly, media reports describe and H5N1 positive bird in Kuwait as well as H5N1 falcons in Saudi Arabia, adding addition support for widespread infections of H5N1 in poultry and wild birds in the Middle East.
All countries have reported large wild bird die-offs, but H5N1 has been denied. These denials lack credibility due to H5N1 infections in birds and people in Turkey and Iraq.
The four deaths indicate the H5N1 in Iraq is quite lethal and transmissible human-to-human since three of the four fatalities appear to belong to the same family.. Reports for Turkey described a mixture of H5N1 in the index case. Sequences with and without S227N were identified. Since S227N can be acquired via dual infections of H5N1 and H9N2, more versions of H5N1 with S227N could have been generated. H9N2 is endemic in the Middle East and many birds with H5N1 migrated through the area in the past few months.
Sequence information on H5N1 in northern and southern Iraq would be useful, as would information on the reported fatlity of the cousin of the index case.