33 suspected cases - infects 2nd generati

By Helen Branswell

(CP) - The large cluster of human cases of H5N1 avian flu being investigated in Indonesia may represent the first time the virus has been seen to ignite two successive waves of human-to-human spread, the World Health Organization said Tuesday,

A spokesperson said the agency has not yet started the process of reviewing whether the global pandemic alert level should be raised to Phase 4 from the current Phase 3.

But Maria Cheng said it is conceivable that WHO might convene a meeting of the panel of experts who would advise on that decision - depending on what further investigation in the affected area reveals.

"This is the first time we have seen cases that have gone beyond one generation of human-to-human spread," Cheng told The Canadian Press.
"It is an evolving situation and it is possible we would convene the task force if we saw evidence the virus was changing."

According to the WHO's six-level pandemic staging plan, Phase 3 is no human-to-human spread, or only on rare occasions after close contact with a sick individual. Phase 4 is a small cluster or clusters of limited and localized human-to-human spread, a pattern suggesting the virus had not yet become fully efficient at infecting people. Phase 6 is a pandemic.


Cheng noted the pattern of infections in this cluster seems to point away from a substantial change in the transmissibility of the virus. So do the genetic sequences of two viruses retrieved from this group of people. A statement from the WHO said analysis of those viruses showed "no evidence of significant mutations."


But a veteran U.S. infectious diseases expert said he's worried the world may be seeing something different with this group of cases.


"Certainly there've been more cases in this cluster than we've had before," said Dr. D.A. Henderson, of the Center for Biosecurity of University of Pittsburgh Medical Center.


Previous cases of human-to-human transmission of the H5N1 virus are believed to have happened, but it is thought that in those earlier instances the virus died out after one generation of person-to-person spread.


There has been a clear pattern in all these cases: A family member, closely tending someone severely ill with the virus, becomes infected, presumably through exposure to large amounts of virus. And that pattern appears to hold in the Indonesian family cluster, Cheng said.


Henderson, who wasn't so sure, suggested in this case it seems illness has spread beyond caregivers to others in the family. An 18-month-old girl and a 10-year-old boy are among the dead.


"They all had contact, but it was not the kind of contact we've had described before, where the caregiver would be really heavily exposed," he noted.


"And from that standpoint, I find this worrisome. And I think there is an awful lot of information we need about those cases and the circumstances."


Cheng said if new cases began to emerge where people with only passing contact with a case became infected "certainly our level of alarm would increase."


"We haven't seen any evidence that's the case," she added. "So far we haven't identified cases outside this family cluster."


Expert investigators from the WHO and the U.S. Centers for Disease Control believe a woman who died in early May infected some members of her extended family, including a 10-year-old nephew.

During his illness, the boy's father helped nurse the child. The boy died on May 13. Two days later his father started developing symptoms . On May 22, the father died.

Cheng said the current theory is that the index case infected her nephew, who infected his father.

The first case, who died on May 4, was not tested before her burial and is not factored into the WHO's official case count. Investigators in the village of Kubu Sembelang in the Karo district of North Sumatra are watching closely for any evidence the virus is continuing to spread among contacts of the family. Cheng said 33 people are under observation, though she had not heard whether any of them are showing signs of illness.

Some are being given the flu antiviral oseltamivir or Tamiflu. Others were not. Cheng wasn't clear why all the contacts were not taking the drug.

But there have been reports that the rapid and devastating decimation of this family - eight people have become ill, seven have died - has triggered a local crisis of confidence with surviving residents of the village demonstrating fear and hostility to authorities. It was reported, for instance, that the man who died on May 22 refused to take Tamiflu. He fled from the investigators and authorities and lived on the run, sheltered by friends, for the final four days of his life.

"We are still not getting the level of co-operation we would consider optimal," Cheng admitted. Additional WHO personnel are being sent to the village. Included in the group is an expert on social mobilization - the art of gaining local trust and co-operation in the high tension setting of an infectious disease outbreak.

yeah but its history like the holocaust....my love to all

 If that's how HE got the virus .....

 

 

Exactly..he would have been very ill during those 4 days..I read that he died 'on the WAY to hospital'.You would think the people sheltering him would have to have been at severe risk.

gettingready sounds about right by the time they cut through all the red tape.You would think they would realize that things need to be done in a timely manner.

It is celar that the media is covering things up. Bird flu is bad for the companies and governments. I think that  they don't get it and frankly never will get it.  It does not matter how or what the public does now. We don't have the real story and we won't ever know the real truth.  follow the money trail and  you will see the huge multinationals in charge of the bird flu efforts.

I wish instead of having meetings to decide where to put the alert level, they would have some to decidehow to distribute the tamiflu amoung the contacts of the clusters.  There aren't many yet, it wouldn't waste the drug. if this is the start of something (and it may not be), then immediate action couldavert disaster. Beth

It's not specific to that culture, I don't think.

There's a basic level of mistrust of the government and of authorities in general. Assume that; it's true in most developing countries.

So they don't trust the government to start with. He probably didn't have the education we do. All he knew was that the hospital -- run by "the authorities" took his family and THEN THEY DIED. That's an earth-shattering event for anyone. It utterly destroyed his world. Everyone he knew and loved, gone.

And he doesn't trust the authorities. Not a small step to go from not trusting the authorities to assuming they KILLED his family. He wants out before he's the next victim ... wants to be treated by the village healer (of whatever flavor, mordern or primitive) that his community has) who he DOES trust. So he flees home to "safety" -- to people he trusts.

Doesn't matter that the authorities told him he was carrying a plague that could destroy humanity. (If he was even told this.) He doesn't believe or trust them.

ReadyMom wrote: Since this is the case that is in discussion regarding the H2H2H (sick/dead woman - sick/dead child - sick/dead father) I think we can only ask:   '... The man, 32, is said to have nursed his son while the boy was dying, putting him in the path of blasts of virus-laced droplets....' http://www.avianflutalk.com/forum_posts.asp?TID=8533  If that's how HE got the virus .....   from above: '... It was reported, for instance, that the man who died on May 22 refused to take Tamiflu. He fled from the investigators and authorities and lived on the run, sheltered by friends, for the final four days of his life....'  Then who has he passed it on to????? And WHERE ARE THEY NOW???? -k

If it is still a "Deep Chest" infection, the likelyhood of him having passed it on to many others is small.

The question the WHO is wrestling with is about the type of infection that is being passed on.  If the virus has gained the capacity to readily replicate in nose and throat tissue, then we have us a potential pandemic strain. If it is still in the lungs, then the sick person has to be in very close proximity to the new victim to pass it on.

That is why we need the sequences available to the world.  The WHO and the US have been playing games and refusing scientists free access to the information.  We have to make them change their policy.

Recently I talked with a couple of RVers from Canada (we are snowbirders) at a local RV Park in Seattle area.  They commented on the fact that at the border between the  US and Canada, they were told to throw out everything that was an avian product....eggs, chicken meat, etc.  I have not heard this mentioned on the news but it appears that the gov is more nervous about this than they let on.

At the very least, it boost some food sales in the US as the Canadians are not allowed to bring "some certain"  food into the country.

I don't mean to be too cynical, but the fact of the matter is that there has been no reports of irregularities in the Canadian food system.  They appear to be far more proactive than we in the US are.  There were two fairly large outbreaks of Bird Flu (not Sichuan Sheet) in Canada last year and the Canadian officials did everything by the book.

Something funny hapened in Arkansas a month ago and it was covered up and nothing was released to the public.  Something funny happened in Iowa last month and again no report to the public.

oknut wrote: JoeNeubarth wrote: Something funny hapened in Arkansas a month ago and it was covered up and nothing was released to the public.      I caught that something funny in Arkansas too and since I live next door in OK, I stopped buying poultry products. What I would say to Tyson and other poultry companies is "Tell us the truth - if you level with us and tell us you have effectively dealt with the problem, we gain confidence in you". That hasn't happened. Instead it was another exercise of control and power over the press. No trust gained.

oknut wrote: Dang Jhetta - you are good at putting things together and posting them. I just want to tell you that I really appreciate all of the work you put into the forum. We all benefit from your hard work and digging. Deb (oknut)