Pakistan : H5N1 Virus Spreads Through Family

Pakistan Officials Waited 13 Days After Bird Flu Positive Test Results To Alert World Health Organisation
The Pakistan human transmissions reports grows only more confused and contradictory, but this story appears to lay out a few firm facts :

Authorities in Pakistan announced the country's first reported human cases of H5N1 avian flu Saturday in a cluster of family members which may have involved person-to-person transmission.

There was some confusion Saturday about how many people had tested positive for the virus, with Pakistan announcing six cases but the World Health Organization saying eight suspected cases had been identified.

The WHO said confirmatory testing must still be done. And a spokesperson for the agency said investigations are underway to try to determine how the various people became infected, but noted some human-to-human spread may have occurred.

"We can't rule it out," Gregory Hartl said from Geneva.

"There are other plausible explanations.... We don't know enough at this point. And in some of these cases, one never will know enough."

The cluster of cases involved four brothers and two cousins living in the country's North-West Frontier Province. Two of the brothers died, one without having been tested.

While the brothers who died are believed to have had at least some exposure to infected poultry, they were also known to have nursed the first case in the family, a brother who worked as a livestock official.

A doctor who treated members of the family also has tested positive for H5N1, but with a non-standard diagnostic test, Hartl said. He cautioned that further testing is needed to determine if she is indeed a case, noting she hadn't shown signs of infection.

Three people who are unrelated to the family but who were involved in culling H5N1-infected poultry in the same area have also tested positive; all are still alive. At least one of the cullers worked on the same farm as the livestock official.

The initial infection in this family dates back to late October, when the livestock official became sick. It appears that it was only after two of the man's brothers fell ill and died that testing was done looking for H5N1 infection. It is believed the first positive test was received in late November.

The WHO was officially alerted Dec. 12, Hartl said.

"We feel that the Pakistanis have done everything right in terms of their response," he said, noting the country has done a "huge" amount of work to strengthen infection control and increase surveillance.

"(But) yes, they could have alerted us earlier."

There was also a mild scare in the United States relating to the Pakistan outbreak. It's remarkable to see how fast the CDC can move when it needs to :

Meanwhile, U.S. public health authorities have confirmed they conducted H5N1 testing on a man who had recently visited Pakistan and was complaining of mild respiratory symptoms. The man, who officials will only identify as having a link to the cluster, is said to have been concerned he might have been infected.

"The individual went to his private physician after returning from Pakistan, and discussed this with his physician," said Claire Pospisil, a spokesperson for the New York State department of health.

Pospisil said the doctor contacted the local health department in Nassau County, where the man lives, and they collected samples for testing. The tests came back negative.

David Daigle, a spokesperson for the U.S. Centers for Disease Control, said the CDC sent its plane to Albany on Dec. 8 to collect specimens for confirmatory testing. Within hours a CDC lab verified the state lab's findings.

"He was negative. There was no doubt about it," Daigle said from Atlanta on Saturday.

And more on other recent human infections :

On Friday, the WHO announced that Myanmar had reported its first human case in a seven-year-old girl who fell ill in late November. She has since recovered.

Earlier this month, China reported infections in a son and father from Jiangsu province; the son died. And in recent weeks Indonesia, the country hardest hit by H5N1, has reported several human cases.

China and Indonesia are warning there may be more human infections in the weeks ahead.