Suspect H2H2H H5N1 Transmission in Bali Indonesia
Recombinomics Commentary
August 12, 2007
the Patient Ni right Putu Sriwidiantari (29), the resident of the Dangin Tukad Aya Village, the Country's Subdistrict, of the Jembrana Regency, finally had died, on Sunday (12/8, around struck 16,20 Wita in Space Nusa Beautiful, the room of the bird flu isolation in RSUP, Denpasar.
Not long after the Putu Sriwidiantari death, around struck 18,00 Wita, Kadek Putri N (2 years 9 months) came and entered one of the space of the bird flu isolation of Nusa Indah RSUP Sanglah. According to the grandmother the daughter, Nurni, his grandchild was hot since the last three days. The daughter was one of casualties's neighbours died Putu Sriwidiantari, in the Dangin Tukad Aya Village, Negara.
Beforehand, the Lamp (5), Putra Putu Sriwidiantari died first last August 3.
The lamp could not be run off with to RSUP Sanglah. However he showed the sign was sick as signs were attacked by the bird flu virus.
The above translation describes a suspect H5N1 familial cluster representing human to human to human (H2H2H) transmission in Denpasar on the island of Bali in Indonesia.
The index case (5F) dies on August 3. Her mother (29F) died today and a neighbor (3F) was admitted today, after developing symptoms three days ago. This cluster is cause for concern.
The recent evolution of H5N1 in Indonesia is largely unknown. Samples have been withheld since the beginning of the year, but reports of H5N1 in patients and birds have been frequent. Initial sequences of H5N1 from birds did not match the human cases, but more recent sequences have matched the human isolates, which usually have a novel HA cleavage site of RESRRKKR. The more frequent matches may be due to increased testing of wild waterfowl. The first bird isolate on Java with the novel cleavage site was a duck from Indramayu. Moreover, a more recent isolate from a muscovy duck in Jakarta was identical to H5N1 from a patient in Jakarta. A second duck, was virtually identical, and both sequences had another Qinghai polymorphism.
However, sequences from Bali have been limited. One duck isolate, A/duck/Badung-Bali/05/2005, had the Qinghai HA cleavage site, and another isolate, A/chicken/Denpasar/01/2004 had a Qinghai polymorphism, but there are no public human sequences from Bali, so little is known about the above cluster, including the H5N1 of the fatally infected family members.
The sequential dates of death however, strongly suggest that the transmission is H2H2H, which is one of the longest H5N1 human transmission chains.
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