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H5N1 Human Transmission in Karo Cluster in North Sumatra?

Recombinomics Commentary

August 2, 2006

"Sedangkan Evi only normal fevers then. Because his parents felt the difficulty of his two children was sick, yes at the same time was shifted to RS HAM," beber him sembari mentioned a week beforehand Dedek experienced the cough. "Dan just overnight, on Monday (31/7) fevers tinggi," he exclaimed.

The three patients suspect bird flu that was reconciled to RSUP Adam the Owner was Moses (1,5), Evi boru Sitepu (10), Dedek Sitepu (10) was reconciled to Medan struck 14.00.

Now, still had three other patients who had the sign was the same as three patients suspect. Only, the patient was named Julham Sitepu (15), Reni boru Tarigan (32), Alvian Ginting (10) -- the mother and the child, still was in in the Kabanjahe Public Hospital, Karo. Their condition was not yet as serious as three patients who were stated suspect.

The above translation gives more detail on the six hospitalized patients in Karo.  Media reports indicate the 18 month old child is a neighbor, but some local reports indocate the toddler's name is Moses Valentine Septu while others use Moses Perangin-angin.  Thus, the genetic relationship between the three most serious cases remains unclear.  The index case is Dedak Sitepu who developed symptoms about a week before sibling Evi boru Sitepu (aka Elvi Febrianti Sitepu).  These three patients have lung involvement and have been transferred tp Adam Malik, the hospital that treated most of the cases in the earlier Karo cluster.

Alvian Ginting is the child of Reni boru Tarigan.  They are in a nearby village and their chickens died.  It is unclear if the is a genetic relationship to the Sitepu's or to the Ginting's who were in the earlier cluster.  There had been speculation on a genetic predisposition for the earlier cluster because all confirmed cases were blood relatives.  The genetic relationship between the current cases with each other or the earlier cluster remains unclear.

However, transmission in other clusters in Vietnam and Azerbaijan involved a nurse or neighbor, which diminishes a genetic predisposition explanation for the human-to-human transmissions.

Although H5N1 has not been confirmed in the patients, there have been bird outbreaks in the area and birds owned by two of the patients have died.  However, recent sequences from birds in the area are lacking and sequences from the patients who died in the earlier Karo cluster have been withheld.  On Java, the sequences from H5N1 bird flu in the patients do not match the sequences from the poultry.

More detail on the genetic relationship between the six hospitalized patients as well as the H5N1 from birds in the area as well as the earlier cluster would be useful.

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