- Today WHO disclosed that another person
(17F) related to several H5N1 positive patients in Azerbaijan, has also
tested positive for H5N1 bird flu. The latest disclosure raises the
number of relatives or close friend who were H5N1 positive to 7, representing
- The index case (17F) died on February
23. Initially she was thought to have died from respiratory complications
associated with lung cancer. However, the initial WHO report failed
to indicate that she was a first cousin of the second confirmed H5N1 fatality
(20F) who died March 3. Her close friend (17F) died March 8 and her
brother (16M) died March 10. Thus, the first 4 H5N1 positive cases
in the community died, and all were related or neighbors.
- The latest report indicates that two
more relatives developed symptoms on March 11, after the first four had
died. In addition, a sister (16F) of one of the discharged patients
(15F) also was H5N1 positive in local tests.
- Thus, there were 7 patients who were
H5N1 positive and closely linked, although the disease onset dates were
spread over a period of more than a month. The extended time frame
makes a common source unlikely, although WHO initially speculated that
the cases were linked to feather plucking of dead wild birds.
- These cases are similar to the large
and extended clusters in nearby eastern Turkey and raise questions about
genetic alterations such as S227N in the receptor binding domain.
S227N was detected in the index case in Turkey, and some reports suggest
that H5N1 from the sister also had S227N.
- Although the latest WHO update indicated
additional cases in Azerbaijan were not found, H5N1 migrating back north
from Africa could bring or create more H5N1 with S227N, resulting in more
large clusters and more efficient human-to-human transmissions,
- © 2006 Recombinomics. All