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Ominous Case Reports of Avian Flu

The avian influenza A (H5N1) virus has, to date, sickened millions of chickens and only a few dozen humans, but the mortality rate is high, and the epidemiologic patterns unfolding in Asia are increasingly alarming. Researchers now detail the first cases of likely human-human transmission and describe two pediatric cases with markedly atypical clinical features.

The cases of human-human transmission occurred in late summer 2004. An 11-year-old Thai girl living with her aunt in a village where avian flu was epidemic among poultry slept and played near a flock of sick chickens. Three days after the aunt buried the last sick chicken, the girl developed a flulike illness; the child died 6 days later. Her mother, who lived in Bangkok and traveled to care for her sick daughter, also developed a flulike illness and died shortly thereafter. The girl's aunt also subsequently became ill, but she recovered. Specimens from the mother and aunt confirmed influenza A (H5N1) infection that was similar to strains seen in poultry, with no reassortment with human influenza strains.

Researchers believe that both the aunt and mother acquired their infections from the girl: The mother had had no contact whatsoever with poultry and, although the aunt had handled sick chickens, her illness developed too long thereafter to be considered poultry-related.

In another report, researchers describe two Vietnamese siblings (ages, 4 and 9) who died several days after the acute onset of diarrhea and rapidly deepening coma. Neither had respiratory symptoms. Influenza A (H5N1) was cultured from stored serum, cerebrospinal fluid, and throat and rectal swab specimens taken from the 4-year-old. No other likely pathogens were found in either child. No other human or poultry flu cases were reported in the town, although healthy chickens did live with the family.

Comment: The great influenza epidemics of the twentieth century occurred when avian influenza strains acquired genetic components of human strains. To date, this event has not been reported in the present outbreak, but many experts suspect that it is only a matter of time before the virus reassorts. World health officials are poised to identify such a catastrophic event and hope, before then, to have accumulated the knowledge needed to thwart it.

— Abigail Zuger, MD

Published in Journal Watch General Medicine February 18, 2005

Citation(s):

Ungchusak K et al. Probable person-to-person transmission of avian influenza A (H5N1). N Engl J Med 2005 Jan 27; 352:333-40.

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de Jong MD et al. Fatal avian influenza A (H5N1) in a child presenting with diarrhea followed by coma. N Engl J Med 2005 Feb 17; 352:686-91.

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Stöhr K. Avian influenza and pandemics -- Research needs and opportunities. N Engl J Med 2005 Jan 27; 352:405-7.

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Monto AS. The threat of an avian influenza pandemic. N Engl J Med 2005 Jan 27; 352:323-5.

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