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Possible Human-to-Human Transmission of Avian Flu in Indonesia

According to Bloomberg, seven cases of Indonesian bird flu are connected to patients:

May 23 (Bloomberg) -- All seven people infected with bird flu in a cluster of Indonesian cases can be linked to other patients, according to disease trackers investigating possible human-to-human transmission of the H5N1 virus.


A team of international experts has been unable to find animals that might have infected the people, the World Health Organization said in a statement today. In one case, a 10-year- old boy who caught the virus from his aunt may have passed it to his father, the first time officials have seen evidence of a three-person chain of infection, an agency spokeswoman said. Six of the seven people have died.

Almost all of the 218 cases of H5N1 infections confirmed by the WHO since late 2003 can be traced to direct contact with sick or dead birds. Strong evidence of human-to-human transmission may prompt the global health agency to convene a panel of experts and consider raising the pandemic alert level, said Maria Cheng, an agency spokeswoman.

``Considering the evidence and the size of the cluster, it's a possibility,'' Cheng said in a telephone interview. ``It depends on what we're dealing with in Indonesia. It's an evolving situation.''

The 32-year-old father in the cluster of cases on the island of Sumatra was ``closely involved in caring for his son, and this contact is considered a possible source of infection,'' The WHO said in its statement. Three others, including the sole survivor in the group, spent a night in a ``small'' room with the boy's aunt, who later died and was buried before health officials could conduct tests for the H5N1 virus.

MSNBC has more:

The WHO says there was probably an eighth case, a woman who died, but no tests were carried out.


Epidemiological evidence suggests that the woman was in fact the first case and that three family members spent at least one night in a small room with her at a time when she would have been coughing frequently, the WHO said.

H5N1 has picked up speed this year, moving into parts of Africa, the Middle East and Europe. Bird flu remains primarily an avian disease.

However, the bird flu isn't expected to come to the US for quite a while.


Comments (19)

Another good reason to secu... (Below threshold)
Lee:

Another good reason to secure our borders, and know who is coming into this country, and where they've been.

However, the bird flu i... (Below threshold)
Mrs. Davis:

However, the bird flu isn't expected to come to the US for quite a while.

That was before H2H transmission. Bill Frist suggests updating your will.

This is a little off topic,... (Below threshold)
Sam the Man:

This is a little off topic, but I wanted to post it. If Democrats controled congress, gas would be $3.75 per gallon:

RNC's Mehlman Warns of $3.75 Gas with Democrats

A Democratic-controlled Congress would boost gasoline prices even more though over-regulation and cost the average American family nearly $1,000 more a year, the Republican National Committee warns.


The Democrats favor an increase in the taxes imposed on gasoline purchases, and the average price of regular gas would rise to $3.751 a gallon, according to an e-mail from RNC Chairman Ken Mehlman.


The Web site GOP.com offers a "gas calculator" to show how much more each driver would pay in a year. The figures are based on year, make and model information about the vehicle, along with the average gasoline price in the state in which it is driven and the weekly distance traveled. This information is calculated against a template of proposed taxes and environmental regulations/restictions in accordance with the Kyoto Treaty, which is favored by many Democrats.

Bottom line: The average family would pay $955 more a year if Democrats take control of Congress, according to the RNC.

"Democrats have consistently stood in the way of lower energy prices for American families," the e-mail states.

"Whether it's higher taxes, more regulation, blocking new exploration, or opposing the conservation measures in last year's energy bill, Democrats in control of Congress would mean higher prices at the pump.

"President Bush is focused on providing practical solutions to energy prices: fair prices at the pump, increased supplies of gasoline, greater fuel efficiency, and new alternative fuels . . . All Democrats offer is hot air designed to conceal their long record of supporting higher energy costs for America's families.

"When it comes to gas prices, Americans have a choice between President Bush's four-point plan for lowering prices at the pump, or liberal Democrats who consistently choose higher taxes, more regulations, and more dependence on foreign oil over safe exploration within our borders."

This is a little off top... (Below threshold)
Lee:

This is a little off topic, but I wanted to post it. If Democrats controled congress, gas would be $3.75 per gallon

According to the RNC -- LOL.

I remember the sneering cov... (Below threshold)
drjohn:

I remember the sneering coverage when Bush wanted to allocate a significant sum to guad against this possibility.

Let's recall a couple of im... (Below threshold)

Let's recall a couple of important facts. Indonesia does not lead the planet in quality of medical care. And, all of the cases have occurred in a region with three billion plus people.

Were H5N1 at all contaigious H2H, the population desnity and number of people in the region would ensure an epidemic of biblical proportions. It has not happened in the 9 years that the disease has been known to infect humans. It has not happened since H5N1 was first discovered, in Scotland, in 1958.

The death rate for this disease is almost exclusively due to the level of health care available to its victims. Simple treatments such as fluid replacement and oxygen are not normally available in many of these countries until the patient is in extremis.

H5N1 is a disease of poor hygiene. Until you can rule out exposure to diseased birds in any manner, including droppings, you cannot presume H2H transmission.

Frist is a moron. Your best protection against H5N1 is an annual influenza shot and the pneumonia vaccination. Pneumonia is the killer when it comes to deaths from any variety of influenza.

What? are we going to put u... (Below threshold)
CurlyLarryMoe:

What? are we going to put up a huge net and make our country an aviarie now?

Sam the Man : In a democratically controlled congress gas would be at least $5.00 a gallon! just like it is in Europe..

Oh my god!!! This is IT! Th... (Below threshold)
johnny o:

Oh my god!!! This is IT! This is the end!!

And just as I was about to ugrade to HiDef television.

Damnit..life is so cruel

Each strain of H5N1 is in a... (Below threshold)
Mac Lorry:

Each strain of H5N1 is in a race with the other strains of H5N1. The strain that spreads quickest is the strain that wins the race and survives. This is because the quickest spreading strain leaves immune hosts in its wake driving other strains to extinction. High lethality is a poor strategy in this race as it limits the number of contacts each host encounters. Also, humans are not naive hosts, so human behavior further reduces the number of contacts a highly lethal virus will have.

There may in fact be an H5N1 strain capable of H2H transmission, but it's high lethality indicates it's not the strain of some future pandemic. When we see a strain of H5N1 that behaves much like the currently circulating influenza viruses, then we will finally know the enemy.

Chuck,Glad you hav... (Below threshold)
Dave in W-S:

Chuck,

Glad you have such a definitive opinion. Next time try getting some facts to support it.

The reason H5N1 has not hit the explosive pandemic stage is because critical recombinations or mutations in the virus have not yet occurred. The Indonesian / Sumatran H2H cases are being watched for signs that recombination between the avian and other strains of influenza have occurred.

If you are interested, check the Recombinomics site for cutting edge news on the recombination side and this clearinghouse of government info.

OK, let me see if we get th... (Below threshold)
Jay Tea:

OK, let me see if we get this right: Bush is WRONG to take pre-emptive measures against H5N1, because it really doesn't pose an imminent threat to the United States? In fact, Bush's whole move to crush bird flu is part of some neocon plot to bring the whole medico-pharmaceutical industry untold riches? It's all a plot of Big Drugs? What we really ought to do is focus on other issues, and just worry about containing bird flu until it either rejoins the community of organisms, or it gets so dangerous that we have no choice but to take firm, decisive action and crush it? But what about all the innocent civilians who it now treats as hostages?

This has me so confused. I knew I should have studied pre-med instead of political science.

J.

Hmmm.H5N1... (Below threshold)
ed:

Hmmm.

H5N1 is a disease of poor hygiene. Until you can rule out exposure to diseased birds in any manner, including droppings, you cannot presume H2H transmission.

RTFA.

Dave, the good doctor who w... (Below threshold)

Dave, the good doctor who write Recombinomics is trying sell sell a computer program to public health agencies that will predict the course of an epidemic. He spent an inordinate amount of time trying to convince the gullible that SARS was the next pandemic. He was wrong.

Jay, it's entirely appropriate to prepare for a pandemic, from whatever source. The current data suggests that it probably will not be H5N1. We should be prepared but preparing specificly for H5N1 will most likely be money wasted.

There is zero evidence that a vaccine developed for H5N1 as it now exists will provide any protection against an H2H variant.

Tamilfu is a preventative, but it is only effective as a daily dose. Pandemics take years to burn out. In order to use Tamiflu as a preventative, you need a dose per day per person. We cannot produce that quantity at this time.

If you're over the age of 49 or so, you've lived through two influenza pandemics. There is zero scientific evidence to indicate that the next influenza pandemic will resemble the Spanish Flu and not the two pandemics that followed.

Influenza, and the pneumonia that results, kill about 30,000 Americans every single year. World-wide, the death toll must be in the millions. Worrying about a disease that has killed 120 people in nine years is foolish.

This is a scare perpetuated by the media for sales, and by certain experts to increase their funding opportunities. They were wrong about Swine Flu. They were wrong about anthrax. They were wrong about SARS. In fact, you would be hard pressed to find an illness, including AIDS, where these experts have been correct in their predictions.

http://blog.simmins.org/index.php/category/medicine/avian-flu/

Chuck,it's called ... (Below threshold)
jpm100:

Chuck,

it's called mutation and evolution. It's a demonstraitable force among lower life forms observed in nature all over the world. Get over it.

Mac,

There is no "balance" in nature. There never has been. Nature is cruel and changing. After much turmoil things may reach a new equilibrium through feedback for a time.

To be more specific, once a virus can spread from host to host quicker than it kills its original host, it doesn't get that feedback anymore. Not until the viable hosts are gone.

Europe survived the black plague (whatever disease it was) because everyone suseptible to it died. 1/3 of the population died. As far as I know, there are very few carriers if any human carriers of the original Black Death. Basically while killing a whole lot of people, it obliviously killed most of it prospective hosts.

The entire bird flu flap ha... (Below threshold)
Kamatu:

The entire bird flu flap has been more interesting as a study in hype than anything else. Yes, it might become the next big pandemic, even one of Biblical (well, maybe Spanish) proportions, but....

1) Hygenie vastly improved.
2) The only OTC drugs available now that were available during the Spanish flu were PeptoBismol and Bayer aspirin (brand new) and with the fighting of the dirty Boche, German companies like Bayer might just be trying to poison Americans...
3) Medical facilities are a bit more widespread than the local doc in town with a few extra guest beds for patients.
4) Arguably, half or more of the deaths from Spanish flu could be considered "exposure" deaths as entire families fell ill and without OTC meds to keep fever, congestion, intestinal problems in check, nobody could manage to nurse people past the crisis days.

As for the entire wild migratory bird spreading theory, it fails on several points:
1) No trails of dead H5N1 birds on migratory paths
2) Outbreaks off migratory paths (Nigeria) but near poultry factory farms
3) Outbreaks related to questionable poultry farm practices (selling sick chickens to villagers for cheap on Turkish villages)
4) Outbreaks not happening in places where migratory birds cross between two outbreak countries (Laos - Thailand/Vietnam)
5) Laos banning poultry industry imports after initial outbreak in and around factory farms and staying free of outbreaks
6) Biggest "smoking gun" in China for the wild bird theory, where a "pristine" lake full of wild birds dying of H5N1 actually is surrounded by poultry factories which dump their floor wastes into aquafarms in the lake.

Hmmm.Infl... (Below threshold)
ed:

Hmmm.

Influenza, and the pneumonia that results, kill about 30,000 Americans every single year. World-wide, the death toll must be in the millions. Worrying about a disease that has killed 120 people in nine years is foolish.

Most forms of influenza don't have a mortality rate in excess of 80%. And most forms of influenza don't leave a previously healthy young person dependent on a ventilator.

The reason why I'm worried about H5N1 is that it can be spread by wild birds, which means that quarrantine measures may or may not work. Another reason is that H5N1 uses the body's immune system against itself, which means it's devilishly difficult to treat.

The issue isn't that the experts were wrong in the past and the danger was less than expected. The issue is that experts might be wrong now and the danger is greater than expected.

Unless and until the various nations in Asia reform their native agriculture to eliminate the danger from cross-species contamination by influenza, we're going to be vulnerable.

Frankly I'd rather have a prepared nation that didn't need it, than an unprepared nation thrust head-first into chaos.

Nothing wrong with having a... (Below threshold)

Nothing wrong with having a plan to react to whatever virus becomes the next pandemic.

Chuck Simmins and the other skeptics are quite correct, however: there is no particular reason to expect that the H5N1 virus will mutate into a H2H virus, or that if it does, that the virus would be as deadly in its new form OR that it would transmit pandemically.

Frankly, the risk is always there, and there is absolutely no way, with current science, to determine which of the avian or porcine viruses will become the next H2H pandemic flu. The main difference with H5N1 is that people are paying more attention to the whole issue now. Part of it is reaction to the potential of bio-terrorism, part of it is just the reach of the internet, part of it is media hype.

jpm100,Th... (Below threshold)
Mac Lorry:

jpm100,

There is no "balance" in nature. There never has been. Nature is cruel and changing. After much turmoil things may reach a new equilibrium through feedback for a time.

The spread of a virus has nothing to do with balance or equilibrium.

To be more specific, once a virus can spread from host to host quicker than it kills its original host, it doesn't get that feedback anymore. Not until the viable hosts are gone.

A high lethality virus incapacitates its hosts, thus limiting opportunities to infect new hosts. This is particularly true when modern humans are the host. It's pure evolution at work with these RNA viruses, which mutate very fast. When a strain of H5N1 emerges that spreads faster then other strains of H5N1, it immunizes hosts against those other strains, which then go extinct. This natural process has been at work for a long time and results in the influenza viruses we see in current circulation, which are highly contagious, but not particularly lethal to healthy individuals. The fate of H5N1 will be the same.

Viruses that retain their lethality over time, like smallpox, are DNA viruses that mutate much slower. This slow mutation makes them easy to deal with by modern humans in the form of vaccinations that impart long lasting immunity.

The Spanish flu wasn't particularly lethal to healthy individuals except for soldiers fighting in the trenches in WWI. We now know that high stress, like combat, suppresses the immune system and living outdoors in cold and wet conditions greatly increases the risk of secondary infections like pneumonia, which before antibiotics were developed, was highly lethal. It was the environment of trench warfare that made the Spanish flu the killer of young men. BTW, the Spanish flu didn't just disappear, it's descendent is one of the strains included in this year's flu shot.

Another point is that once a strain of H5N1 emerges that is fast spreading among humans, it likely won't readily infect birds any more.

We all gotta die sometime, ... (Below threshold)
Peter F.:

We all gotta die sometime, I might as well die eating some tequila lime chicken.

Or chicken cordon blue.
Chicken Kiev (for those who really like to take their chances...)
Lemon chicken
Chicken la Orange
Italian-breaded chicken
Chicken parmesan
Almond chicken
Breaded and stuff chicken
BBQ chicken
Deep-fried chicken
Roasted chicken
Kung Pao Chicken
Chicken pot pie
Chicken enchiladas
Chicken tacos
Chicken in a pot
Chicken in spicy coconut sauce
Chicken with black-pepper maple sauce
Chicken cacciatore
Chicken a la king
Chicken a la liberal
Chicken bouilliabaisse
Jerk chicken
Chicken marsala
Chicken stir fry with peaniut sauce
Chicken curry
Chicken satay bites

"I believe that's all the kind of chicken there is...."

Did I mention duck?




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