Human transmission possible in Sumatra bird flu – WHO
By Diyan Jari and Telly Nathalia
The Star, 24 May 2006

JAKARTA (Reuters) - An Indonesian who died of bird flu after nursing his sick son may have caught the virus in a case of direct human-to-human transmission, the World Health Organization said on Tuesday. 

WHO gave its first details of the case of a family cluster of H5N1 avian influenza infections in which six people have now died, and said it was still looking for the source of the outbreak. If it was a case of human-to-human transmission, the virus has not spread very far, it emphasized. 

It would not be the first case of human-to-human transmission. WHO believes some limited human-to-human transmission has occurred before in other countries, but as in the Indonesian case, it did not last for long. 

And on Tuesday officials in Tehran denied a suspected outbreak in Iran, although international health officials said they were still investigating. 

The 32-year-old Indonesian man is the latest to die and WHO said Indonesian health officials had confirmed he was infected with the virus. 

"The father was closely involved in caring for his son, and this contact is considered a possible source of infection," WHO said in a statement posted on its Web site at http://www.who.int. 

"The case is part of a family cluster in the Kubu Sembelang village, Karo District, of North Sumatra," it added. 

Investigators have had trouble finding out just what happened in the village, where a woman appears to have been the first to become ill at the end of April. Villagers have been suspicious of

Indonesian authorities. 

"Although the investigation is continuing, preliminary findings indicate that three of the confirmed cases spent the night of 29 April in a small room together with the initial case at a time when she was symptomatic and coughing frequently," the WHO statement reads. 

"All confirmed cases in the 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." 

NOT SPREADING EASILY  But WHO stressed that the virus was not yet spreading easily among people -- a necessary first step toward a feared pandemic. 

"Priority is now being given to the search for additional cases of influenza-like illness in other family members, close contacts, and the general community. 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," the WHO said. 

Scientists say millions of people could become ill and if the virus acquires this ability, either through mutations or by swapping genetic material with a common human flu strain. 

But the WHO said samples from the victims have not shown any big genetic changes. 

"Sequencing ... found no evidence of genetic reassortment  ... and no evidence of significant mutations," the United Nations health agency said in its statement. 

Several health experts have expressed concern about how long it has taken to get information about the outbreak in Sumatra and said it shows that if H5N1 did evolve into a pandemic form, there would be little chance of stopping it. 

"It does shake your confidence in the fire blanket approach," Dr. Eric Toner of the Center for Biosecurity at the University of Pittsburgh Medical Center said in an interview. 

A 'fire blanket' approach would involve using drugs, isolation and quarantine to stop an early outbreak of human-to-human spread of the virus. 

HARD TO STOP  "I doubt greatly the likelihood of any control mechanism being able to be activated quickly and effectively enough to be able to snuff out the person-to-person H5N1 variant," agreed Dr. D. A. Henderson of the same center, who helped lead the vaccination drive that eradicated smallpox in the 1970s. 

WHO is trying to encourage countries to report suspected bird flu cases quickly so that teams can move in immediately to help control any outbreaks. 

But there are fears that some countries may try to cover up cases, in order to deal with them quietly. 

WHO and other agencies have been on alert after an Iranian medical official told Reuters on Monday that a 41-year-old man and his 26-year-old sister from the northwestern city of Kermanshah had tested positive for bird flu. 

On Tuesday, Health Minister Kamran Lankarani denied this. 

"Fortunately, these two cases were negative for avian flu. There is no confirmed case until now," Lankarani told Reuters on the sidelines of the WHO annual meeting in Geneva. 

The two siblings were among five members of a family who became sick. Surviving relatives were in hospital and one was dangerously ill.