Indonesia Family of Seven Infected with Avian Influenza
Six of the seven family members are now dead. WHO may heighten pandemic alert level.
Compiled by staff
Published: May 24, 2006
A total of six family members have died from avian influenza over the last month in an Indonesia village in North Sumatra and another one is sick. All confirmed cases in the family cluster can be directly linked to close and prolonged exposure to a patient during a phase of severe illness. Although human-to-human transmission cannot be ruled out, the search for a possible alternative source of exposure is continuing, the World Health Organization says.
WHO officials are monitoring the situation closely since the virus spread from a woman, to her nephew and then to his dad - the first three-person chain transmission of the virus. To date, the investigation has found no evidence of spread within the general community and no evidence that "efficient" human-to-human transmission has occurred.
Health experts plan to meet next week to further discuss the cluster of illnesses.
There is some talk about potentially raising the risk of a human-influenza pandemic scale, although several WHO officials indicate it has not triggered that kind of response yet.
Currently the alert level is at stage three. According to WHO's guidelines this indicates human infections have occurred "but no human-to-human spread, or at most rare instances of spread to a close contact." The stage four level describes a small cluster or clusters "with limited human-to-human transmission but spread is highly localized, suggesting that the virus is not well adapted to humans."
A 37-year-old woman developed symptoms on April 27 and died of respiratory disease on May 4. No specimens were obtained before her burial, and the cause of her death cannot be confirmed. WHO says she is, however, considered the initial case in this family cluster.
The six confirmed cases in the Sumatra include the woman's two sons, aged 15 and 17 years, who died respectively on May 9 and May 12. The 28-year-old sister of the initial case died on May 10. This sister had an 18-month-old girl, who died on May 14. The fifth confirmed case, who is still alive, is the 25-year-old brother of the initial case. The sixth confirmed case is the 10-year-old nephew of the initial case. He died on May 13. The latest case occurred in a 32-year-old man and is a brother of the initial case and father of the 10-year-old boy. He developed symptoms on May 15 and died on May 22.
Although the investigation is continuing, preliminary findings indicate that three of the confirmed cases spent the night of April 29 in a small room together with the initial case at a time when she was symptomatic and coughing frequently. These cases include the woman's two sons and her 25-year-old second brother, who is the sole surviving case among infected members of this family. Other infected family members lived in adjacent homes.
The human viruses from this cluster are genetically similar to viruses isolated from poultry in North Sumatra during a previous outbreak.
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