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H5N1 Bird Flu Cluster in Iran Grows to Five

Recombinomics Commentary

May 22, 2006

The two -- a 41-year-old man and 26-year-old woman -- were among five members of the same family who became sick after returning from a trip to the town of Marivan, close to their home in the northwestern city of Kermanshah.

The three surviving relatives were in hospital and one of them remained dangerously ill, the official, who spoke on condition of anonymity, told Reuters. It was not clear when the brother and sister died.

The above comments indicate the familial cluster of H5N1 bird flu has a least five family members.  The two fatal cases have already tested positive for H5N1.  The disease onset dates will be important for determining human-to-human transmission (H2H).  However, H2H was indicated for the very large clusters in Turkey as well as Azerbailan.  The cluster in northern Iraq also had a 5-10 gap between the disease onset date of the index case and the other family members.

The location of the cluster in Iran is close to the Iraqi border,  Officially there is only one cluster in Iraq, but other cluster remain suspect, including the pigeon breeder whose pigeons were H5N1 positive.  Thus, the lack of additional reports out of Iraq remain highly suspect.  These countries denied H5N1 in wild and domestic birds prior to the human infections.  Thus, the number of human cases in the area may be markedly higher than the reported clusters.

The cluster in Turkey was linked to S227N.  Similar changes by be linked to the cluster in the adjacent regions, including the current cluster in Iraq.

More information on disease inset dates and sequences would be useful.  The H5N1 swan sequence from Iran was generated by the Capua lab in Italy and was promptly made public.  Iraqi sequences were promptly made public by NAMRU-3.  However, the human Turkey and Azerbaijan sequences have been withheld,  The Iraqi and Turkey sequences had changes in or near the receptor binding domain.  The H5N1 sequences from the area should be published immediately.

The number of large clusters continues to increase.  Infections from three sets of cousins were linked in Turkey.  The Azerbaijan cluster was large, but a recent media report out of Indonesia indicated that 9 people had died in the Azerbaijan cluster.  The cluster in Indonesia is 8 and possibly growing.

The five members in the cluster in Iran increases the level of concern.

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