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Three Additional Family Members in Karo With Bird Flu Symptoms

Recombinomics Commentary

May 18, 2006

"It is certainly alarming,'' said Dick Thompson, a WHO spokesman in Geneva. ``This is the largest H5N1 cluster we have seen. There are obviously important questions that we need answered. But right now it is too early in the investigation to say anything definitive.''

Yesterday, three members of the family said they were feeling sick, with symptoms including headache and cough.

H5N1 bird flu symptoms in three additional family members are cause for concern.  As of yesterday these symptoms were mild, but should these relatives deteriorate, their illness would be alarming.  Six family members have already died and the index case developed symptoms about a week prior to symptoms in family members.  The symptoms in the index case were April 27 and all infected family members were at an April 29 barbeque strongly implicating human-to-human transmission.  H5N1 infection in three more family members would implicate human-to-human-to- human transmission in multiple family members.

Human-to-human transmission in Indonesia is also suggested by the many clusters with 5-10 day gaps between the disease onset date of the index case in additional family members.  In addition, the only human sequence that has been made public has a novel cleavage site.  One report has suggested that this novel sequence is found in additional human sequences, as well as a cat,
and the swine in the Karo area have H5 antibodies. Since the sequence has not been reported in any poultry isolates, a non-poultry source is implicated  However, testing of patients in Indonesia is predicated on exposure to dead or dying poultry, which would underestimate H5N1 from sources other than poultry.

Since there are over 30 confirmed H5N1 cases in Indonesia, it is likely that sequences from many or most of these cases is at a private WHO database. Those sequences should be released immediately.

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