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Suspected H5N1 Familial Cluster in Southern Iraq
February 9, 2006
Three brothers of the Salam family, Karim (three years), Karar (six years) and Mehdi (seven years), who lived in the same house that Mohanad Radi 30 years, were allowed Wednesday in a hospital of Amara, to 365 km in the south of Baghdad, affirmed Mohammad Rikab, director of the department of the infectious disease.
For its part, Sabah Mehdi, which forms part of a delegation of five doctors from Baghdad, to inform itself on the spot of the medical situation, confirmed that the three brothers had the same symptoms as those having preceded death by their cousin.
The above comments describe another familial cluster in Iraq. Mohanad Radi died on Sunday and was a pigeon trader. He appears to be the same person as described in the WHO update as a 13M who died on Sunday. Media reports indicated he was 14 and his name was Mohannad Radhi Zaouri, so there seems to be one fatality in the south, but there is a discrepancy in the age.
The three brothers appear to have developed symptoms after the cousin, suggesting human-to-human transmission. This bimodal distribution of onset dates was also seen in the H5N1 cluster in northern Iraq, as well as the larger clusters in Turkey.
Prior to the cases in Turkey, the Qinghai version of H5N1 had not been confirmed to have infected people. The polymorphism HA S227N was detected in the index case in Turkey. This polymorphism had previously been shown to increase the affinity for human receptors in the respiratory tract and increased efficiency in humans was expected.
The clusters in Turkey as well as northern and southern Iraq indicate that the S227N is being transmitted and transported by wild birds, suggesting that more cases in Iraq and neighboring countries are likely.