NYTimes.com Article: Thai Officials Investigate Possible Person-to-Person Bird Flu

[David Farber <dave () farber net>]

\
Thai Officials Investigate Possible Person-to-Person Bird Flu

September 27, 2004
 By KEITH BRADSHER





HONG KONG, Sept. 27 - Officials in Thailand announced today
that a 32-year-old woman had been hospitalized with avian
influenza and that two of her family members had already
died of a flu-like illness, raising the possibility that
these might be among the first case of human-to-human
transmission.

Thai health officials cautioned that they had no laboratory
confirmation that the two deaths were caused by avian
influenza, popularly known as bird flu, or that the virus
had developed the ability to spread from person to person.

But a team of experts from Thailand's Ministry of Public
Health, the World Health Organization in Geneva and the
Centers for Disease Control in Atlanta has been assembled
in Bangkok to investigate what happened to the family, and
especially whether human-to-human transmission had
occurred.

The health ministry put hospitals across Thailand on alert
for possible further cases. In the area where the family
fell sick, the government asked volunteers to report anyone
who fell sick with a cold or flu.

The United Nations Food and Agriculture Organization and
the World Organization for Animal Health said in a joint
statement late today that avian influenza is ``a crisis of
global importance.''

The 32-year-old woman is the second confirmed human case of
A(H5N1) avian influenza in Thailand since the resurgence of
the disease in July. The woman is the aunt of an
11-year-old girl who died recently.

A Thai official said in a telephone interview that the aunt
and niece lived in a village where many poultry had been
dying of bird flu. Five chickens living in the home of the
aunt and niece had died shortly before the girl fell ill,
the official added.

The case has attracted particular attention because of the
death of the girl's mother. The mother, whose exact age has
not been confirmed, lived in Bangkok and came back to visit
her daughter in the hospital and attend her funeral, but is
not known to have had contact with sick chickens.

Dick Thompson, a spokesman for the World Health
Organization in Geneva, said that even if the mother had
contracted the disease from her daughter, there was no sign
of avian influenza spreading among people in northwest
Thailand.

``If there was an outbreak of avian influenza in this area,
it seems to have been contained,'' he said. ``It's our
understanding at this moment there's no continuing public
health threat.''

The Thai official said viral samples had only been taken
from the mother after she died, and it had not proven
possible to obtain a genetic sequence of them by
conventional means. More sophisticated tests are now being
performed, and the results should become available later
this week, he said.

The girl's body was cremated before the importance of her
illness was understood. But some samples were taken before
the cremation and tests are also being conducted on these.

Identifying whether human-to-human transmission of a virus
took place is especially difficult among family members.
Even if the genetic sequence of their viruses is
practically identical, it is possible that they contracted
the virus from the same chicken or other source and not
from each other. It would be harder to rule out
human-to-human transmission if the mother is confirmed to
have the same virus.

Human-to-human transmission of a new strain of influenza
has long ranked at or near the top of nightmares for public
health experts, who warn that it could in theory cause a
pandemic, killing millions of people worldwide, and
possibly hundreds of millions. But little is known about
how quickly an avian virus can develop the ability to pass
easily from person to person.

A handful of cases of human-to-human transmission may have
occurred during bird flu outbreaks in Hong Kong in 1997 and
in Europe a year ago. Neither outbreak resulted in a
pandemic.

But many scientists think that an avian influenza strain
that jumped to people was responsible for the Spanish
influenza of 1918-19, which is believed to have killed
anywhere from 20 million to 100 million people at a time
when the world had a quarter of its current population,

Thailand has identified 146 possible human cases of bird
flu since July, of whom two have turned out to have the
disease, 16 cases are under investigation and 128 have
turned out to be false alarms. World Health Organization
officials have encouraged countries to err on the side of
caution in isolating anyone who has been in close contact
with dead or dying birds and subsequently runs a high fever
and has such symptoms as muscle pain, cough or difficulty
in breathing.

Thailand's first human case since a cluster of nine of them
last winter was an 18-year-old man who died on Sept. 8
after handling diseased poultry.

When Thailand's health ministry first said on Saturday that
it was investigating the possibility of human-to-human
transmission, W.H.O. officials were initially skeptical.
Dr. Kumara Rai, the acting head of the W.H.O. office in
Bangkok, said in a telephone interview on Sunday that the
odds of such transmission were ``remote'' and pointed out
that most suspected bird flu cases in Thailand had proven
to be other illnesses.

Dr. Rai declined to comment today. There have been 40
confirmed human infections with the A(H5N1) avian influenza
so far this year and they have killed 28 people.

Malaysia has also isolated at least 25 people suspected of
bird flu since late summer, but not one of them has turned
out to have the disease yet.

Speculation about bird flu cases has reached such a frenzy
in southeast Asia that considerable attention was paid in
the Southeast Asian news media over the weekend to five
Malaysian sailors who fell ill after visiting an island
between the southern Philippines and peninsular Malaysia,
where they saw some dead swallows. The sailors, who were
isolated but quickly recovered, tested negative for bird
flu.

Dr. Hawari Hussein, the director general of Malaysia's
veterinary department, said that a few dead swallows from
the island had already tested negative for bird flu, but
that a team of veterinary workers were on their way to the
island to retrieve fresher samples.



http://www.nytimes.com/2004/09/27/international/asia/27CND-FLU.html? 
ex=1097320954&ei=1&en=64b7c7a3b51002cc


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