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Four Member H5N1 Cluster in Pakistan

Recombinomics Commentary
December 14, 2007

Two of the brothers died from pneumonia-like symptoms but were buried by family members before health officials could take blood samples to test for the virus.

A third brother who lives in the United States but was visiting Manshera at the time also tested positive for bird flu, but survived and has since returned to the US, Akhtar told dpa.

The updated media report above adds additional detail and supports multiple H5N1 clusters in Pakistan.  The initial familial cluster has now expanded to four, with two recovered patients, who are H5N1 positive, and two brothers who have died with avian influenza symptoms.  Earlier reports indicated these brothers died last month and were linked to an outbreak that was culled in October.  The large size of the cluster, coupled with lack of poultry exposure by three of the brothers, increases the likelihood of human-to-human transmission.

That outbreak was linked to another cluster, involving a culler, who tested positive, a hospitalized daughter, and a third hospitalized patient.  Early testing generated four H5N1 positives, suggesting at least one more positive associated with the earlier outbreak.

Additional media reports describe two brothers who died this month, who were said to be involved in more recent culling.

These reports are still somewhat contradictory and lack an official confirmation by an outside party.  However, the size of the first cluster, couple with media reports of additional clusters and confirmed positive patients, as well as the hospital alert for H5N1 patients in Pakistan, remain causes for concern, which is increased by the lack of timely information on human clusters linked to an October outbreak.  These delays raise concerns that the number of current human cases is markedly higher than the number being reported.

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