Confirmed H5N1 Clusters in Pakistan Raise Pandemic Concerns
Recombinomics Commentary
December 15, 2007
Three of the patients are in a hospital in Mansehra and the other two cases have been reported from Peshawar. One of the patients had been discharged from the hospital after recovery, health authorities said.
The last confirmed case had been reported on Dec 5 and there had been no fresh case, a senior health official said.
The two brothers, who were reported to have died of bird flu, were poultry workers and related to two other patients.
The above information can be used to clear up confusion in the multiple media reports and reduce the number of H5N1 cases to seven.
Four of the seven would be the four brothers. The index case is the veterinarian, Ishtiaq Durrani, who is recovering at the Kyber Teaching Hospital in Peshawar. His two brothers, Mohammad Ilyas Durrani and Mohammad Owais Durrani died and were not tested, although one media report indicated one had been tested and was H5N1 positive. They were also treated at the Kyber Teaching Hospital. The fourth brother, who was not named, was discharged and flew back to the United States. These four brothers would be the first familial cluster.
The three patients at the hospital in Mansehra would be another culler, who was a laborer, his daughter, and an unnamed male. The culler and daughter would represent the second familial cluster.
These two familial clusters among the seven confirmed or dead patients raise pandemic concerns. Transmission of H5N1 from birds to cullers is difficult, and media reports indicated the three brothers of the veterinarian were not exposed to poultry. Similarly, there is no indication that the daughter of the culler from Manshera was exposed to poultry.
More detail would be useful, but these two familial clusters have strong potential to represent human-to-human transmission. In any event, seven infected patients in two familial clusters is an unusually high number of H5N1 patients in one area, and the apparent recovery of five of the patients raises concerns that there are additional unreported cases, due in part to the large number of poultry outbreaks detailed in the H5N1 hospital alert.
Reliable disease onset dates for the seven patients would be useful as would sequence data from isolates from poultry and patients.
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