Human-to-human spread suspected in latest Indonesian bird-flu death
Mon May 22, 06:16 PM EST
By Helen Branswell
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(CP) - The World Health Organization appears to be edging closer to suggesting that an Indonesian man who died from H5N1 avian flu Monday may have been infected by his 10-year-old son, not through exposure to sick poultry or some other environmental source.
WHO officials had earlier expressed the theory that a thorough investigation might reveal a potential source of contagion in the community, such as use of contaminated chicken feces as manure. But expert disease investigators seem to be ruling out that possibility, a spokesperson for the WHO said from Geneva.
"There's no supporting evidence to suggest that this is a continuing environmental source that we've uncovered yet in the investigation," said WHO spokesperson Dick Thompson.
"The investigation is still ongoing. We wouldn't discount the possibility that it is human-to-human transmission."
Limited spread of the virus among people is believed to have happened on several previous occasions. But in each of these suspected cases, transmission of the virus petered out. Sustained human-to-human spread of the virus would be needed to trigger a pandemic.
Meanwhile, an Indonesian official revealed that the man who died Monday refused treatment and fled from authorities after falling ill - behaviour that highlights the difficulties of disease containment in settings where an unfamiliar disease is extracting a high death toll.
"This is precisely what we see, time and time again," medical anthropologist Barry Hewlett, a veteran of a number of WHO missions to contain outbreaks of Ebola virus in Africa, said of the panicked reactions Indonesian media have reported.
Reports have suggested fear and distrust have been running high in the affected community, which has watched in horror as multiple members of an extended family fell gravely ill in recent weeks, with most dying.
Dr. Heinz Feldmann of the Public Health Agency of Canada's National Microbiology Laboratory said in his experience fighting outbreaks of diseases like Ebola and Marburg fever, panic and distrust of authorities and medical outsiders is exacerbated when the death toll starts to rise.
"There are these white doctors who come in. Everyone thinks they're getting help, and then they're realizing they're not getting help. And everyone who goes into isolation (in hospital) is basically dying or a lot of them are dying," said Feldmann, a leading expert on hemorraghic fevers who heads the Winnipeg lab's special pathogens division.
"Then the community turns against you."
In cases dating back to late April, three of the man's siblings, two nephews, and two of his children became infected with the H5N1 virus. Only one family member who fell ill, a brother, has recovered from the infection.
The man's older sister, believed to be the first case in this cluster, died without being tested and is not on the WHO's official case count. With this latest case, the number of confirmed H5N1 cases in this family rises to seven, with six deaths.
The man, 32, is said to have nursed his son while the boy was dying, putting him in the path of blasts of virus-laced droplets.
When he himself became ill, he evaded authorities, the director-general of communicable disease control for the Indonesian health ministry told a news conference Monday.
"He ran away after he received Tamiflu," said I. Nyoman Kandun. "He was found in the village later but refused treatment."
Both Hewlett and Feldmann said getting people in such settings to co-operate with public health officials is a significant challenge that requires lots of communication with the community, sensitivity and a willingness to try to figure out what is motivating the behaviour.
Hewlett, a professor at Washington State University in Vancouver, Wash., recalls seeing Ugandans fleeing ambulances during a major Ebola outbreak in that country in 2000.
It turned out that there were rampant rumours that the team wasn't fighting disease, but was kidnapping Ugandans for body parts. The urban myth was fuelled by the fact that family members weren't allowed to visit their loved ones during their illnesses or after their deaths because of the fear of further spread of disease.
"My point is simply that you need to work with local people if you're going to make these things successful. Otherwise there's going to be resistance and the outbreaks will get worse rather than get better," said Hewlett, adding the WHO often now includes medical anthropologists or psychologists on outbreak teams as "social mobilizers" who can bridge the divide between the people affected and medical experts.
Feldmann said he can see another possible source of conflict with the Indonesian villagers - the fact that H5N1 control requires the culling of affected poultry. Demanding people give up animals they need, and which they often don't believe are a source of infection, can create tension, he suggested.
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Minister calls for calm as bird flu spreads in Romania 1 hour, 55 minutes ago
BUCHAREST (AFP) - Romania's agriculture minister urged Bucharest residents not to panic after the bird flu virus surfaced in 44 locations, including two in the capital, since reappearing here 10 days ago.
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Possible contamination in around 30 other locations, including one in Bucharest, has been identified over the last 24 hours.
Before this wave of new cases, bird flu had been confirmed in over 60 villages in Romania since October.
Agriculture Minister Gheorghe Flutur told residents in the capital "not to give in to panic," and called on district mayors to "deal with this crisis responsibly".
A quarantine in the capital's southern fourth district, one of the 44 sites affected, was reduced Tuesday, following criticism by Bucharest general administrator Mioara Mantale.
"We decided to isolate only five streets, or less than 500 people, so as not to distress the population," said Adrian Inimaroiu, the district's mayor.
"In the end, we only killed 230 birds in high-risk streets," he said.
Late Monday, Inimaroiu had said that around 13,000 residents would be placed under quarantine for 21 days and 2,500 birds culled, which led Mantale to accuse him on television of being irresponsible.
"There is no logical reason for putting 13,000 people under quarantine when only two farm yards have been contaminated," Mantale said, adding for Inimaroiu's benefit: "if you had been a civil servant and not elected, you would have been fired".
On Tuesday afternoon, a quarantine in the northern part of the capital affecting over 1,000 people since early Monday was also lifted.
Romanian authorities were still unable to explain how the virus had reached Bucharest.
The intelligence service (SRI) claimed contaminated birds imported from Hungary and Slovakia were the source of this latest spread of the disease but Prime Minister Calin Tariceanu said there was no evidence to support this.
"An investigation has been launched by the National Veterinary Health Agency, which should determine the source of the virus. The SRI did its job but we must allow specialists to establish the causes of this disease," Tariceanu said.
The highly virulent H5N1 strain of bird flu can be transmitted to humans and is potentially fatal. So far no humans have been infected in Romania.
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Bird Flu Deaths Climb as Scientists Probe Human Link (Update3)
Bloomberg.com - May 23 8:19 AM
May 23 (Bloomberg) -- The number of bird flu deaths reported this month climbed to 13, the most since February 2004, as scientists investigate whether the virus is able to spread more easily between people.
Fears of human-to-human bird flu spread
Sydney Morning Herald - 31 minutes ago
The World Health Organisation says it cannot rule out human-to-human transmission of bird flu in the deaths of six Indonesians. -
WHO probes possible human-to-human bird flu spread
Reuters via Yahoo! UK & Ireland News - 1 hour, 20 minutes ago
The World Health Organisation (WHO) said on Tuesday human-to-human transmission of bird flu could not be ruled out in the deaths of six Indonesians. |
