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Likely Human to Human H5N1 Transmission in Pakistan

Recombinomics Commentary
December 13, 2007

The deaths of two brothers of a veterinarian, who acquired the deadly H5N1 Avian Influenza virus after coming into contact with infected poultry at a farm in Abbottabad late-October, and the recent hospitalisation of a Mansehra-based poultry handler who has also tested positive for the disease, provide sufficient evidence for the government to institute concrete measures for interruption of human transmission of the disease from birds to poultry handlers and their close contacts.

Of the 40 suspected human samples collected from Peshawar and Abbottabad in the wake of the first-ever confirmed human transmission of H5N1 in Pakistan, 36 have tested negative, while four are positive, investigations conducted by ‘The News’ have revealed.

It is learnt that both the veterinarian, Dr. Ishtiaq Durrani, who is working as livestock production officer at the Department of Livestock and Dairy Development, NWFP, as well as the poultry handler from Mansehra, did not follow the recommended protective measures while handling infected birds.

Dr. Ishtiaq was involved in culling of 3,000 birds following the October 21 outbreak of bird flu at a poultry farm in Abbottabad. The other victim from Mansehra happens to be a daily wage labourer who was commissioned for culling without being advised on how he should protect himself. The labourer’s daughter, along with another male, is also under observation at a hospital in Abbottabad.

While Dr. Ishtiaq himself is on the path to recovery, his brothers Mohammad Ilyas Durrani and Mohammad Owais Durrani — both of who were attending him at the Khyber Teaching Hospital during his illness — died on November 19 and November 29, respectively.

The above details suggest H5N1 in Pakistan was transmitted  human-to-human in the three family members.  Although disease onset dates were not given, the 10 day gap between the date of death strongly suggests one brother infected one or two other brothers.  Moreover, the cluster of four positives in the same area, possibly involving five people since one of the dead brothers was not tested, highlight a relatively efficient transmission of H5N1, as do the two hospitalized contacts under observation

Hospitals in Pakistan have gone on alert.

Sequence data on the recent human and poultry cases, as well as earlier outbreaks would be useful.

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