- "Samples from 11 patients under
investigation in Azerbaijan for possible H5N1 infection have now been tested
at a WHO collaborating laboratory in the United Kingdom. Positive H5N1
results were obtained for seven of these patients. Five cases were fatal.
- Six of the cases occurred in Salyan Rayon
in the south-eastern part of the country. All six cases resided in the
small Daikyand settlement of around 800 homes.
- A 17-year-old girl died on 23 February.
Her first cousin, a 20-year-old woman, died on 3 March. The 16-year-old
brother of this woman died on 10 March. A 17-year-old girl, a close friend
of the family, died on 8 March. All four of these cases lived together
or near each other. The source of their infection is presently under investigation.
- The additional two cases in Salyan involve
a 10-year-old boy, who has recovered, and a 15-year-old girl, who is hospitalized
in critical condition.
- The seventh case occurred in a 21-year-old
woman from the western rayon of Tarter. She died on 9 March.
- Two additional patients, from Salyan
and the adjacent rayon of Neftchela, have been hospitalized with symptoms
of bilateral pneumonia. Testing of these patients is presently under way."
- The above comments from the WHO update
confirm media reports and commentaries on the relationship of the Azerbaijan
familial cluster. It is reassuring that such relationships are again
appearing in WHO updates. The initial familial clusters in Turkey
did not include the relationship between three familial clusters of cousins.
- Like Turkey, in addition to the familial
cluster there is a geographical cluster suggesting the transmission of
H5N1 to people has become more efficient. The proximity of the Azerbaijan
cases to the Dogubeyazit cluster in eastern Turkey raises the possibility
that S227N may be involved. Donor sequences were identified in H9N2
isolates that are endemic to the region, so new recombinants could be generated.
However, the S227N change only reduces affinity for avian receptors, so
S227N detected in the index case in Turkey could have also been transmitted
to the index case in Azerbaijan via infected birds.
- Alternatively, the close proximity of
Azerbaijan to Dogubeyazit may indicate more efficient human-to-human transmission
via less intimate contact. The dates of death of family members and
a close friend suggest human-to-human transmission may be more efficient.
- Isolation of the H5N1 and release of
the sequences from this cluster would be useful. Although one H5N1
sequences from the bird flu infection in western Turkey last October has
been released, none of the sequences from human cases in Turkey have been
made public. This delay appears to be linked directly to Weybridge,
since they have already released the turkey H5N1 sequence from Turkey.
Moreover, they have held a large number of H5N1 sequences from isolates
throughout Europe. Other countries, such as Russia, Italy, France,
Nigeria, Iraq, Iran, and Denmark have released sequences as soon as the
accuracy of the sequence has been verified.
- The growing cluster in Azerbaijan highlights
the need for immediate release of the sequestered sequences as well as
rapid release of the H5N1 in this new geographic and familial cluster.
- © 2006 Recombinomics. All