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H5N1 Cluster in Pakistan Grows

Recombinomics Commentary
December 15, 2007

an official of the World Health Organization suggesting as many as nine people may have tested positive for the virus in that country.

The cluster of cases involved four brothers and two cousins living in the country's North West Frontier Province. Two of the brothers died, one without having been tested.

A doctor who treated members of the family also has tested positive for H5N1, Hartl said. But she was not tested with the standard diagnostic assay used to detect H5N1 infection and further testing is needed to determine if she is indeed a case.

Three people who are unrelated to the family but who were involved in culling H5N1-infected poultry in the same area have also tested positive.

Meanwhile, U.S. health officials have confirmed they conducted H5N1 testing on a man who had recently visited Pakistan and was complaining of mild respiratory symptoms. The man is believed to be another brother from the affected family.

A spokesperson for the U.S. Centers for Disease Control confirmed Saturday that the CDC sent its plane to Albany last Saturday to collect specimens taken from the man, who lives in Nassau County.

The above comments provide more detail to the alarming situation n Pakistan.  The recent report from the Health Minister acknowledged six confirmed cases as well as an fatal infection in an untested family members.  However, in addition to these four brothers, two cousins as well as a health care worker have tested positive. 

Earlier reports indicated the index case for this cluster was a veterinarian who organized a 3000 bird cull between October 21-23.  Samples from forty people were collected on October 30 and four tested positive.  However, six weeks later, the details remain murky.  Earlier reports indicated the two fatally infected brothers died on November 19 and 29, strongly suggesting human-to-human transmission because of the spread between the date of the cull as well as days between dates of death.  Moreover, media reports indicated the brothers were not involved in the culling.

Human-to-human transmission would be further supported if the positive H5N1 tests for the cousins and health care worker are confirmed.

The situation in Pakistan is more alarming because of the multiple H5N1 outbreaks in poultry farms in adjacent regions, as well as wild birds in Islamabad as described in the WHO update.

Although Pakistan has had H5N1 outbreaks in 2006 and 2007, so sequence data has been made public.

The lack of detail on a large laboratory confirmed cases with exposures that date back to October remain a cause for concern.

The involvement of NAMRU-3 in the investigation should help remedy the situation.

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