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Clusters of H5N1 Clusters in Pakistan

Recombinomics Commentary
December 14, 2007

Pakistani authorities were testing the country's first suspected fatalities from H5N1 bird flu after two poultry farm workers died this week, a hospital official said Friday.

The workers, from northwestern Mansehra district, were hospitalized in Peshawar over the weekend with fever and flu-like symptoms. They died in the isolation ward of the Khyber Teaching Hospital on Monday, said Khushdil Khan, the hospital's medical superintendent.

The above comments describe an H5N1 cluster involving two brothers who died on Monday and were described in early media reports.  However, more recent reports describe at least six other patients linked to an outbreak reported in October in Abbottaba.  Although there may be overlap and errors in reported locations and dates, there are clearly clusters of clusters, and more information would be useful.

The first cluster involves a veterinarian and his two brothers linked to the October outbreak.  For that outbreak samples were collected from 40 individuals from Peshawar and Abbottabad and 4 were said to be H5N1 positive.  One of those positives was the vet, while a second was a culler.  The identity of the other two positives remains unclear. 

However, the two brothers of the vet developed symptoms and died in November (19 and 29). One of the two was tested and was also H5N1 positive.  The other wasn’t tested, but died with bird flu symptoms, indicating all three brothers were H5N1 infected.  In addition, the daughter of the culler and another male are hospitalized, presumably with symptoms and representing another familial cluster..

Thus, there appear to be at least six individuals forming at least two clusters linked to the October outbreak in Abbottaba.

However, there have been multiple recent outbreaks in Pakistan (see satellite map), and an alert has been issued to hospitals.  The alert describes multiple H5N1 poultry outbreaks in northwest Pakistan.

The two brothers described above appear to have died this month, and therefore appear to be distinct from the three brothers linked to the outbreak in October.  These two brothers were linked to culling in Mansera.  If true, they would represent the third familial cluster and increase the concern about clusters of cluster in Pakistan.

More information on these and other H5N1 clusters in the area would be useful.

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