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Timeline on H5N1 Clusters in Pakistan
December 14, 2007
There have been a number of media reports on the H5N1 clusters in Pakistan, and although these reports lack an official confirmation by WHO (or the CDC), the reports are quite detailed and appear to be describing three familial clusters linked to two culling operations in October and November in northern Pakistan. Media reports indicate these are lab confirmed cases, and begin with a culling operations from October 21-23 at the Ijaz Shah poultry farm in Abbotabad.
The culling at the above farm, and possibly some additional farms, led to laboratory testing of 40 individuals on October 30. Four of the forty individuals were positive.
One of the positives was a veterinarian, Ishtiaq Durrani, who organized the cull of 3,000 birds. He was hospitalized and is recovering. However his two brothers, who cared for their brother at Khyber Teaching Hospital, and who were not involved in the cull, developed symptoms and died. One brother, Mohammad Ilyas Durrani died on November 19, while a second brother, Mohammad Owais Durrani died on November 29. One of the brothers tested positive for H5N1, while the other was not tested. These three brothers, who are linked directly or indirectly to the October cull, represent the first familial cluster.
Another positive was a laborer from Manshera. He was hospitalized and his daughter was subsequently hospitalized. Although the reports did not indicate the daughter had tested positive, her hospitalization suggests she is part of a second cluster. A third person was also hospitalized, but his relationship to the five mentioned above is unclear. Similarly, the identity of the other two people who tested positive in the October testing are not known.
Most media reports have ignored these two cluster, and instead have focused on two additional deaths. Media reports indicate these two brothers died this month. They are linked to another culling. This more recent culling was at a Manshera chicken farm. The most detailed report describes four brothers. The index case is also said to be H5N1 positive. Two of his brothers were admitted with bird flu symptoms and pneumonia and died shortly after admission. Some reports indicate they were buried and not tested. A fourth brother was said to have recovered and returned to the United States. Media reports indicate the brothers were in their 20’s or 30’s and one report indicates their names are Muhammad Ilyas and Tariq. The similarity in names with one of the brothers who died last month raises questions about the accuracy of these names.
Thus, the media reports would appear to be describing three clusters linked to culling in October and November, although it is possible that the dates in the reports are in error and the two larger clusters represent two descriptions of the same cluster.
The media reports leave many questions unanswered and raise significant transparency issues, especially if there were four lab confirmed cases in October.
The recent H5N1 alert to hospitals in Pakistan raises concerns that the number of unreported patients linked to the poultry outbreaks and culls this month is significant.
More information on testing and reporting on this alarming number of patients would be useful.
Recombinomics Paper at Nature Precedings