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Sixth Suspect H5N1 Case in Jakarta Causes Concerns

Recombinomics Commentary

September 16, 2005

In the fifth suspected case, a person who had been in contact with the patient who died probably contracted the same disease, the minister said. A 37-year-old woman died in Jakarta on Sept. 10 after suffering from pneumonia and flu-like respiratory problems for several days, Supari told reporters in Jakarta. A laboratory in Hong Kong confirmed that the woman tested positive for the H5N1 virus, a deadly strain of the avian flu virus, Supari said.

``Further tests are being done to confirm if the other person was also infected,'' Supari said. ``There is no evidence that this was a human-to-human transmission case,'' she said.

The above comments further increase concerns.  Comments on no evidence of human-to-human transmission remain highly suspect.  The first cluster of human H5N1 fatalities certainly had evidence of of human-to-human transmission.  The main piece of evidence is a gap in onset dates, which has been present in almost all familial clusters from Vietnam, Thailand, and Cambodia.  Little additional evidence is expected because both common source and human-to-human transmission would involve very similar H5N1 in affected individuals, and even differences are not conclusive because one person could be infected with multiple strains.  Thus, the best evidence in most clusters is the gap in disease onset dates, which was clearly present in the three earlier fatalities in Tangerang.

In the contact mentioned above, the comments indicated the contact "probably contracted the same disease", which suggests a positive initial test has already been obtained and confirmation from Hong Kong is anticipated.  The details on the contact have not been provided, but since the contact has not been described as deceased, there is probably a significant divergence in disease onset dates, again supporting human-to-human transmission.

In addition to the contact being tested, there is another case under investigation.  This case was fatal and contacts are being tested.  It does not sound like samples were collected from the fatal case of a 2 month old male, but the family lived above a chicken slaughterhouse which may have been the slaughterhouse located 100 meters from the fourth fatality.

Testing of birds and pigs following the familial clusters indicated H5N1 was in domestic waterfowl, a pet birdcage, and swine in several sub-districts of Tangerang, even though the testing was minmal.  The confirmation of H5N1 in fatal cases of office workers suggest that patients who are in regular contact with H5N1 infect birds and swine are at risk and this group may include many unreported H5N1 infections.

More details on the contact who is likely to be infected would be useful.

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