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H5N1 Familial Cluster in Amara Iraq Expands
February 11, 2006
The governor of Maysan province told Reuters the suspected bird flu victim was a 24-year-old pigeon seller from Amara who died on Sunday. WHO said earlier that Iraqi officials had identified the victim as a 13-year-old boy.
"He was suffering from constant flu. In hospital he turned worse and began bleeding from both his mouth and nose, and then he died," said Jabbar Zahuri, 38, the dead man's uncle.
The pigeon seller, whom officials identified as Muhaned Radhi, lived in a house with five brothers and eight sisters. Health officials have taken samples from them to test for the virus.
The brother and the sister of a stockbreeder of pigeons of Amara, in the south of Iraq, deceased Sunday after having expressed symptoms of the aviary influenza, were hospitalized Friday, according to the local authorities. "Ali Radi, 10 years, Douaa Radi, 7 years, were allowed today at the hospital because they presented the symptoms of the aviary influenza", affirmed the governor of the province of Missane, Mr. Adel Mohajar Al-Maliki, in a déclarationà the press.
The above media comments describe a growing familial cluster in Amara that has a bimodal disease onset date distribution and represents more efficient human to human transmission of H5N1.
The symptoms of the index case match those of fatal cases in Turkey and northern Iraq. In addition, his pigeons were H5N1 positive. The above indicate three cousins were hospitalized on Wednesday and two siblings were hospitalized on Friday. 11 other siblings are being monitored.
These data indicate H5N1 is efficiently transmitting among family members. The circumstances surrounding the infections of the relatives are not give, but a cluster of six is cause for concern, as is the large number of siblings under observation.
Comments by WHO concerning the inability to find the S227N polymorphisms in any of the Turkey isolates other than the index case are a cause for concern. Although the Qinghai strain of H5N1 has been killing wild and domestic birds since May, there were no confirmed H5N1 human cases associated with this strain until the outbreaks in Turkey. These outbreaks included extremely large familial clusters and signaled a more efficient transmission of H5N1 to humans.
The linkage of S227N, to increased affinity of H5N1 for human receptors is quite clear, and the loss of this linkage as indicated in comments by WHO is cause for concern. The selection away from mammalian receptor bind domain determinants via selection chicken eggs is well known. More details on the “loss” of S227N, as indicated by WHO comments would be useful.
The large size of clusters in Turkey and northern and southern Iraq suggests that the S227N in H5N1 is being transported by wild birds and is functioning efficiently.