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Fatal H5N1 Bird Flu Transmission in Suburban Jakarta Family

Recombinomics Commentary

July 15, 2005

The victims, a 38-year-old man and his two girls, ages nine and one, would be the country's first human fatalities linked to the virus. They lived in a suburb of Jakarta and all died in the last week and a half, Health Minister Siti Fadilah Supari said.

The deaths of three family members from a Jakarta suburb are cause for concern.  The nine year old daughter was hospitalized last month, while her father and one year old sisted were hospitalized on July 7.  The gap between admission dates strongly suggests that the index case infected two of her family members.

The family lives in suburban Jakarta and the 37 year old father has a masters degree and audits government spending.  He has not traveled out of the country for several months and the index case is nine, strongly suggesting transmission in Indonesia.

In northern Vietnam, human-to-human transmission is becoming more efficient, but the infections have become milder.  In contrast, in the first reported cluster in Indonesia, all three family members have died.

The H5N1 in Indonesia is the
Z genotype, but is genetically distinguishable from the H5N1 in Vietnam and Thailand as well as other H5N1 isolates in Asia.  The human transmission signals the ability of yet another Z genotype version of H5N1 transmitting to humans.

As H5N1 infected migratory birds begin returning to southeast Asia, more human infections are expected.  The isolates from Qinghai Lake have acquired a human polymorphisms that is associated with a high fatality rate when it is recombined into the PB2 gene in H5N1, which was found in all eight Qinghai isolates.  The large number of different species from different regions of Asia will allow for a wider distribution of H5N1, which could lead to dramatic increases in human fatal cases.

Sequencing of H5N1 isolates from the latest victims as well as bird isolates in Indonesia would be useful.

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