http://www.recombinomics.com/News/05170601/H5N1_Indonesia_WHO.html Commentary WHO Confirms H5N1 Cluster In Indonesia Recombinomics Commentary May 17, 2006 "There are six confirmations. One from Surabaya and five from Medan. One from Medan is still alive," said Sari Setiogi, the WHO's Indonesia spokeswoman. An outbreak of H5N1 bird flu involving up to eight members of a family at Medan in North Sumatra province has worried health agencies around the world but a Health Ministry official said on Wednesday it was not a case of human-to-human transmission. The WHO confirmation of 5 Medan cases is not a surprise. Virtually all cases that test positive in Indonesia are confirmed by the WHO associated lab in Hong Kong. There are eight members in the cluster and six have died. In local testing, it appears that only one of the eight has tested negative, although false negatives are common. Since one of the surviving members of the clusters has tested positive, the size of the cluster is at least seven members, including six fatalities. The disease onset date of the index case is April 27, indicating that this cluster, like the majority of H5N1 clusters is another example of human-to-human transmission. Local media has mentioned a family gathering, but this is yet another mechanism for the creation of familial clusters. This is similar to the large cluster in Turkey, which was precede by a family gathering between cousins. The index case had developed symptoms prior to the gathering, and many family members developed symptoms after the gathering. Although these large clusters have not generated a pandemic thus far, the large clusters have demonstrated a more efficient transmission to humans, and the presence of an index case with symptoms strongly implicates human-to-human transmission. The first H5N1 confirmed case in Indonesia was also a cluster. The sequence of the HA from the father in that cluster has been made public, and it has a novel cleavage site (RESRRKKR). Although these have now been many sequences from bird isolates released, none have had this cleavage site, nor have any other HA sequences at GenBank. The failure to release additional human sequences raises concerns that these sequences do not support a poultry origin, but such data is being withheld. WHO maintains a large private database and those sequences should be released immediately.
http://www.consumeraffairs.com/news04/2006/05/bird_flu_mutate.html Scientists Fear Bird Flu Virus May Have Mutated May 18, 2006 World Health Organization officials are increasingly concerned that a thus far unexplained outbreak of the bird flu virus could mean that a long-feared scenario has been borne out -- that the virus may have mutated so that it can be passed from one human to another. The concern began with reports that seven members of one family in a remote Indonesian village had come down with the disease. Doctors were immediately troubled by the fact that there had been no outbreaks of the disease among birds in the region. To date, all of the more than 200 people infected with the virus have gotten it from contact with a diseased bird. Health authorities hoped that their investigation would disclose a common contact among the seven infected people. So far, that contact has not been found. At this point, health officials say they cannot rule out that the seven infected family members passed the virus to each other. Scientists from the Centers for Disease Control and Prevention have joined their WHO colleagues on the scene to continue the probe. Unless they can find a connection among all seven family members with one or more diseased birds, they say they may be forced to conclude that a mutation has occurred. Some scientists have said that if the disease can be transmitted easily among humans, the resulting pandemic could be catastrophic, resulting in millions of fatalities worldwide. At least 115 of the 208 people known to be infected with the bird flu have died in the last three years, mainly in Asia.
