Fatal Bird Flu Familial Cluster
In Azerbaijan Grows Again
By Dr. Henry L. Niman, PhD
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 5 families.
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,
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