H5N1 H2H Transmission in Tangerang Raises Concerns
Recombinomics Commentary 16:25
February 12, 2008
The confirmed H5N1 familial cluster in the Tangerang area raises pandemic concerns. Prior to this familial cluster, there was a geographic cluster in the Tangerang area. This type of cluster signals more efficient H5N1 transmission to humans.
Now the geographic cluster has been overlaid with a familial cluster, which has been confirmed and is almost certainly human to human transmission based on disease onset dates and acknowledged association between the mother and daughter.
H5N1 data out of Indonesia has been difficult. Sequences have been withheld for over a year, and the liberal use of Tamiflu blankets limits the number of lab confirmed H5N1 cases.
However, in spite of these limitations, a confirmed human cluster has emerged on the heals of clustering in the Jakarta area. The withholding of the sequence data is hazardous to the world’s health, and the denial of human to human transmission increases the likelihood of familial transmissions.
In the current cluster, the exposure of the daughter to her mother appears to be after the mother was hospitalized, raising concerns about H5N1 containment in hospital settings. In the past, familial exposures were linked to the misdiagnosis of patients, which may be the case here because the index case was transferred on January 29, which was after the daughter's exposure when her mother was hospitalized in Tangerang on January 26.
More information on the exposure, as well as sequence data from the mother and daughter, would be useful.
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