- [A woman's teenage daughter] lay sprawled
on a hospital bed, under observation for avian influenza. In an adjacent
room, her haggard husband was sitting wrapped in a gray blanket, also
under treatment for the virus. 2 of her other children had already died
from it. "I don't know exactly why I'm healthy," she admitted
from a cot where she was keeping vigil late last month for her family.
"I don't have a fever, a cough or other symptoms. I really don't
know why not."
- In the weeks before the family became
sick, the virus raced through their small flock of chickens. When the
last 6 birds developed symptoms, the woman's husband helped his brother
slit their throats beside a large palm in the front yard. The chickens
were plucked and cooked in coconut milk for a family feast.
- With 4 cases confirmed or suspected,
her family represents one of the largest clusters of bird flu among humans
in the world. It is also notable in sharing a characteristic with nearly
all the other family clusters: Those infected by the virus were related
to each other by blood and not by marriage. This raises the possibility
that genetics play a role in determining who among those exposed contracts
the often-lethal disease.
- "It's intriguing," said Sonja
J. Olsen of the Centers for Disease Control and Prevention in Bangkok,
who has studied family clusters of avian influenza. If a biological explanation
were ultimately proved, she added, "perhaps we could identify people
at genetic risk."
- Since H5N1 avian influenza began spreading
across Asia in 2003, there have been 25 recorded family clusters involving
confirmed or suspected cases. In the overwhelming majority, these have
involved blood relations such as siblings, parent and child, children and
grandfather, or niece and aunt. In only 3 instances did both husband and
wife test positive.
- Worldwide, bird flu has infected at least
165 people and killed 91, according to the World Health Organization.
Health experts warn that the notoriously changeable influenza virus could
develop into a form more easily transmitted among people and spark a global
- Outside the isolation ward in Hasan Sadikin
hospital, a facility designated to treat bird flu in Bandung, the capital
of West Java province, the young woman's relatives were camped on the lobby
floor, spending nights on thin woven mats, wondering, like the experts,
why she was spared while the rest of the family fell sick.
- "It's a mystery. It's really incomprehensible
to us," said the father's cousin. "Everyone in the family had
the same contact with chickens." There is no evidence that properly
cooked poultry or eggs can be a source of infection, according to the
CDC. Most cases of bird flu in humans have resulted from direct or close
contact with infected live or uncooked poultry or surfaces contaminated
with secretions and excretions from infected birds.
- The family lives about 100 miles east
of Jakarta in the village of Cipedung, in the modest dwelling of a meatball
peddler, with dirt floors, flimsy bamboo walls and a ramshackle roof that
leaks in the rain. Chickens often wandered inside, sleeping beneath the
platform beds. Health investigators have attributed the outbreak to infected
poultry, reporting that avian influenza has been identified in chickens
across much of the village.
- 2 days after the family killed and ate
the infected birds, the 13-year-old daughter, the 1st to fall sick, began
coughing and developed a high fever. By the time she was taken to a district
hospital 6 days later, she was gravely ill. The medical staff recommended
she be moved to a better hospital, but she died as the ambulance was coming
to transport her. The day she died, the young woman brought their son,
4, to the district hospital after he came down with the same symptoms.
The boy was urgently transferred to the provincial hospital, but he survived
for only 2 days. Another daughter, 14, was next to become ill, with a
slight fever, not enough to keep her out of school. But health workers
urged that she too be admitted to the hospital. Her father joined her
3 days later after he began complaining of trouble breathing while overseeing
the funeral for another of the children.
- Tests confirmed that the 13-year-old
girl and the 4-year-old boy died of bird flu. Initial results were inconclusive
for the father and older daughter. But international health experts said
they expected that further testing would show all 4 had contracted the
disease. The father and daughter recovered and left the hospital 2 weeks
- The question of how the mother eluded
the virus is part of a puzzle now stumping global influenza experts. Researchers
acknowledge that they know little about why some people become ill while
others, with even greater exposure to the infection, remain healthy.
- For instance, thousands of agricultural
workers, officials and soldiers have been culling poultry across Asia
in an effort to contain the spread of bird flu, at times lacking even
basic protection such as gloves, masks and goggles. Yet according to WHO
records, not one has fallen sick. This finding has reinforced the suspicion
that some people are more susceptible than others.
- "We've discussed how it's always
likely there's some genetic component going on," Keiji Fukuda, WHO's
influenza chief, said in a telephone interview from Geneva. He cautioned
that it was too soon to conclude that there is genetic susceptibility.
Although the family pattern is suggestive, Fukuda said the size and number
of clusters remain small. Moreover, even if research proves that some
people are more susceptible, he said this information may have little
practical benefit if the virus mutates into a form that spreads faster
than people can be tested for genetic risk.
- Olsen and other researchers have noted
that behavior and not genetics might be the determining factor in who
in a family gets sick. Could the rest of the family have had more contact
with sick chickens than the mother did? That's doubtful, relatives and
local agriculture officials said, reporting that as a rural homemaker,
she was in daily contact with livestock.
- Perhaps the 3 children contracted the
virus by playing with chickens. Could they have then passed it to their
father but not their mother? Relatives said the mother was the parent
who usually looked after the children and who carried her ailing son in
a sling across her chest for days.
- When pressed by a reporter, the mother
suggested she was spared because she did not eat chicken when the rest
of the family feasted on the sick birds. She said she had high blood pressure
and avoided meat. But back in the village, next door to the family's home,
her mother-in-law dismissed that explanation. "Many people ate that
chicken. I ate the chicken," recalled [the mother-in-law], 70, sitting
cross-legged on the porch. Beside her in the rain- soaked yard were the
abruptly abandoned reminders of her family: her son's rickety meatball
pushcart and her grandson's plastic tricycle. "The rest of us didn't
get sick," she continued, eyes reddening. "So that can't be the
- [Byline: Alan Sipress]
- Mary Marshall
- [On the basis of the predominance of
blood relatives (siblings, parent and child, children and grandfather,
or niece and aunt -- rather than husband and wife -- among those infected
in so-called "clusters" of avian influenza virus infection,
it is reasonable to suggest that genetic constitution may play a role
in the susceptibility and resistance of individuals to infection. However,
the numbers are small and other factors such as age, nature of exposure,
and behavior cannot be discounted. A compounding factor is that there
is little published information on the immune status of the population
in the affected communities. The observation that none of those employed
in commercial poultry operations and in the culling of diseased fowl have
been victims of H5N1 avian influenza may indicate that asymptomatic infection
and development of immunity is widespread. Also the predominance of children
and younger people among the victims of infection could indicate protection
of older people by development of immune responses. Comprehensive data
on seroprevalence are still lacking. - Mod.CP]
- Patricia A. Doyle, DVM, PhD- Bus Admin,
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