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Six Hospitalized Suspected H5N1 Cases In Turkey
Recombinomics Commentary
January 1, 2006
Symptoms of pneumonia are very similar to symptoms of viral infections, he said, speaking on condition of anonymity because he is not permitted to comment to the media.
The four children -- two brothers and two sisters between 6 and 15 years old -- were admitted to the hospital on Saturday after they developed high fevers, coughing, and bleeding in their throats.
"One of them, a 14-year-old boy, is in the most serious situation, others are in stable condition,'' Dr. Huseyin Avni Sahin, the hospital's head physician told private CNN-Turk television. "I hope they are not diagnosed with bird flu. But they are suspected cases of bird flu since they ate a sick chicken and they were in close contact with fowl.''
Two other patients, aged 35 and 5, were sent to the same hospital on Sunday, the Anatolia news agency reported, as Turkish health and security authorities gathered to coordinate a response.
The above comments indicate the number of hospitalized suspected bird flu victims has increased to six. The four family members, if confirmed, would represent increased efficiency in transmission to humans. In the past H5N1 was not efficiently transmitted to humans, so most family clusters involved two or three family members. Four siblings would be unusual, even if the H5N1 infections were due to exposure to a common source.
The two additional cases would signal a serious outbreak. H5 has been confirmed in the outbreak in Igdir Province. The four children are from Agri Province and dead birds are being tested in Erzurum and Kars Provinces.
H5N1 has shown signs of rapidly evolving in the Volga Delta and Crimea Peninsula to the north of the current outbreaks in Turkey. However, birds are now migrating to the south through the Middle East and into Africa, so more spread of H5N1 into new regions is a virtual certainty.
If the H5N1 infected migrating birds can readily transmit H5N1 to humans, as suggested by the six hospitalized case, then a dramatic up-tick in human cases would be expected.
H5N1 in wild birds can recombine with H9N2 which is endemic in the Middle East to acquire the HA S227N polymorphism, which has increased affinity for human receptors which would increase transmission efficiencies to humans. Moreover, all H5N1 wild bird sequences published since the May, 2005 Qinghai Lake outbreak have had the human PB2 E627K which is linked to increased virulence in mammals and the change allows H5N1 to grow more efficiently at lower body temperatures of mammals, which is lower than cold blooded avian species.
These molecular changes could dramatically increase the efficiency of human-to-human H5N1 transmission and are cause for considerable concern.
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