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Suspect H5N1 Bird Flu Cluster in Djibouti

Recombinomics Commentary

May 12, 2006

A 2-year-old girl in Djibouti, the first confirmed human bird flu case in sub-Saharan Africa, was in stable condition on Friday while three siblings had tests for possible infection, the World Health Organisation said.

"Three of her siblings are undergoing investigation for possible infection. Their samples have been sent to the same laboratory," Cheng told Reuters in Geneva.

"They have flu-like symptoms," she said.

The family lives in a poor, rural area of the tiny country near the border with Somalia and kept chickens, Cheng said.

The above comments indicate the index case for Djibouti may be part of a familial cluster.  The index case is the youngest index case for a familial cluster or for a country.  Since 2005, all index cases for a country (Cambodia, Indonesia, China, Turkey, Iraq, Azerbaijan) with the exception of Egypt, have been part of a familial cluster.  Egypt is the only country without a H5N1 bird flu familial cluster.

The location of the family near the border of Somalia and its proximity to southwestern Yemen again highlight the fact that many countries in Africa and the Middle East continue to deny H5N1 infections in people of animals.

The denials are supported by media reports of the absence of H5N1 in thousands or tens of thousands of wild birds.  However, there reports of negative data are supplied by wildlife or wetlands conservation groups who have yet to disclose any data on the detection of low pathogenic avian influenza (LPAI) in the tested birds.  Low pathogenic avian influenza is common in wild waterfowl, and negative H5N1 data in the absence of positive data on LPAI says little about the presence of H5N1, but speaks volumes about the groups collecting the samples and the media report the data, which includes conclusions that wild birds play a minor role in the spread of H5N1.

However, 12 months ago, prior to the outbreak of H5N1 in long range waterfowl at Qinghai Lake, there were no reported cases of H5N1 in Russia, Kazakhstan, Mongolia, Europe, the Middle East, or Africa.  H5N1 was first reported in each of these areas in the past 12 months, and these reports have firmly linked the H5N1 infections to wild waterfowl.  In Europe, where the surveillance is more effective, the initial reports of H5N1 have been from waterfowl infections, and many European countries have yet to report H5N1 in domestic poultry.

In Djibouti, where surveillance is less than ideal, H5N1 was first reported in the index case and domestic poultry.  However, there have been persistent reports of large die-offs of waterfowl since the fall, although H5N1 infections have been denied, usually without an explanation for the bird deaths and without evidence of detection of LPAI in wild birds being tested.

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