Six Members of Indonesian Family Die of Bird Flu

JAKARTA, Indonesia, May 23, 2006 (ENS) - Six members of a family on the Indonesian island of Sumatra have now died from the highly pathogenic form of avian influenza, H5N1, that has killed 124 people in nine countries, the World Health Organization (WHO) confirmed today.

Although early tests have been negative, the cluster of H5N1 infections in the same family indicates that the virus may have mutated to become contagious among humans.

“All confirmed cases in the cluster can be directly linked to close and prolonged exposure to a patient during a phase of severe illness,” WHO said in a statement. “Although human-to-human transmission cannot be ruled out, the search for a possible alternative source of exposure is continuing.”

The most recent death was a 32 year old man. He developed symptoms on May 15 and died on Monday. The man is the seventh member of the extended family to become infected with the H5N1 virus and the sixth to die.

Investigation of illness in this family in the Kubu Sembelang village in the Karo District of North Sumatra indicates that three of the sick relatives spent a night in a small room with the female family member who is considered the initial case.

She was displaying symptoms of illness that night, and coughing frequently, according to the inquiry by WHO and the Indonesian Ministry of Health.

Indonesian chickens like these from Bandar Lampung, Sumatra, Indonesia, are implicated in the spread of avian influenza. (Photo courtesy FAO)

Most of the Kubu Sembelang family members died in the first two weeks of May, and no other cases have appeared in the broader area, providing “no further evidence that efficient human-to-human transmission has occurred,” WHO reports.

The H5N1 strain would have to undergo a genetic mutation to become a microbe efficiently transmitted among humans.

WHO says full genetic sequencing of two viruses isolated from cases in this cluster has been completed by WHO reference laboratories in Hong Kong and the USA that specialize in H5 influenza viruses.

Sequencing of all eight gene segments found no evidence of genetic reassortment with human or pig influenza viruses and no evidence of significant mutations. The viruses showed no mutations associated with resistance to the neuraminidase inhibitors, including oseltamivir, known as Tamiflu.

The human viruses from this cluster are genetically similar to viruses isolated from poultry in North Sumatra during a previous outbreak.

The H5N1 strain has appeared in animals in more than 50 countries since it first began spreading in Southeast Asia in late 2003. Human cases have appeared in 10 countries, with a total of more than 220 infections.

Humans have little immunity to this strain of influenza, so health officials warn that H5N1 could set off a global human pandemic if it were to mutate to become contagious among people.

Several earlier human cases have been transmitted from one person to another, but only with the close personal contact that comes with caring for a sick relative.

Transmission through such contact is not considered "efficient transmission," as when a cough or sneeze can infect a planeload of people.

Epidemiologists from the U.S. Centers for Disease Control and Prevention are in Sumatra helping WHO and Indonesian health officials as part of a broad U.S. plan to provide assistance in world regions where the virus is considered most widespread.

U.S. Secretary of Health and Human Services Michael Leavitt announced Monday that the United States is sending a shipment of the antiviral medication Tamilflu to Asia to be available in case of a widespread disease outbreak.

The United States has earmarked $334 million to an international campaign to control avian influenza and prevent the emergence of human pandemic influenza, and Indonesia is one of the vulnerable nations receiving assistance in that campaign.

Live chickens for sale at a traditional market on the Indonesian island of Sumatra (Photo courtesy FAO)

The prospect of a human pandemic aside, the damage the disease will cause to bird populations, and domestic poultry in particular, is tremendous, Domenech warns. The effect on the poultry sector is enormous and it could deal a significant blow to local, national and regional economies.

The rapid spread of the disease means that FAO now needs US$308 million for its contribution to the global programme for the progressive control of avian influenza over the next three years – more than twice the sum required a few months ago. To date, FAO has only received US$71 million.

Of that total, the organization has spent over $20 million supplying goods and services to 87 countries - almost $10 million in laboratory and veterinary supplies and equipment; more than $6 million in human resources, including veterinarians and other experts; almost $1.5 million for training in laboratory, epidemiology and wildlife activities; over $500,000 for diagnostic reference and training, and epidemiological studies in the field; and $2 million for general operating expenses.

FAO and the World Organization for Animal Health are organizing an international scientific conference on avian influenza and wild birds from May 30 and 31 in Rome to try to understand better the role of wild birds in the transmission of avian flu.