Suspected H5N1 Familial
Cluster In Najaf Iraq
By Dr. Henry L. Niman, PhD
2/7 "And in Najaf three individuals met from a single family in towards Al Abasia their death yesterday [Feb 06] the effect of doubts with their injury with influenza disease the birds and the Iraqi news agency correspondent in City of Najaf reported that three individuals, two men he exceeds their age the thirty and a woman an old they departed the life affected by a non discovered disease, after their taking before two days a food including the chickens.... [Deaths reported as pneumonia but] ...they will send samples of the deceased blood to Baghdad and hence they send to Egypt to be submitted to accurate analyses."
The above translation suggests another H5N1 familial cluster has been identified in Iraq. These three fatal cases were in the city of Najaf. The victims developed a fatal pneumonia after eating chicken. Samples have been sent out for testing, but testing in Iraq and elsewhere has been problematic at a number of levels for a number of reasons. Testing for H5N1 appears to be getting less reliable, and a diagnosis based on clinical descriptions may be more useful.
The index case in Iraq was "discounted" because of an initial lack of a connection with reported H5N1 infections in birds, although the clinical signs clearly indicated H5N1. In addition, like every index cluster for every country reporting human H5N1 cases since 2005, false negatives were reported. In Turkey, not only are false negatives common, but even positives have tested negative after shipment to Weybridge.
The reliance on lab confirmation has led to delays and a very distorted database of H5N1 infected people. Obvious H5N1 infections are excluded because of lack of samples or poorly collected samples. The current WHO is useful for identifying a full set of clusters, because more have one or more members excluded by lab tests (or lack of lab tests).
The above cluster adds to a growing list of clusters linked to the Qinghai strain of H5N1. The first cluster was reported in Turkey and is easily the longest and largest cluster recorded for H5N1. This first cluster was linked to HA S227N identified in the index case.
The index case was the first confirmed human H5N1 case caused by the Qinghai strain. It seems likely that this change, which increases the affinity of HA in H5N1 for human receptors would create more efficient transmission of H5N1 to humans. This increased efficiency would generate additional clusters, as has been seen in northern and southern Iraq.
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