Avian Flu Commentary/Analysis

Azerbaijahn has received their own flu testing labs from the UN. This follows on a request by the Azeri Health Minister that the UN send this equipment because he suspects that four people have died there from the Avian flu. ...

As far as I know, the only other countries with labs are western nations. This is suspicious because other nations that have avian flu have not received such labs. The European labs are so overwhelmed with suspected avian samples and requests for analysis, that many cases of suspected flu have to wait up to weeks to get results.

Based on previous reports, I suspect that the reason why Azerbaijan is getting this equipment is because there are fears that human-to-human transmission is happening there. A badly garbled article from an Azeri newspaper says that perhaps up to 100 patients are being treated for avian-flu-like symptoms.

All of this follows on reports that Azerbaijan is experiencing what are known as "cluster cases" among families. This is an ominous development because it could mean that these families are passing it to each other, not by way of exposure to fowl.

Update 3/14/06 According to Medindia.com:

Eleven suspected human cases of the highly pathogenic H5N1 bird flu virus was found in Azerbaijan.

The World Health Organization (WHO) is investigating the scenario. Out of the 11 cases 3 people have already died. Maria Cheng, spokeswoman for the UN health agency, told that all 11 cases came from the same village near the Azerbaijani capital Baku.

Apart from the 3 fatal victims the rest of the 8 cases are from a single family. They have been hospitalized and their state is critical.

It is possible that they have been infected with the H5N1 virus because it was a known fact that poultry were already hit by the virus in neighboring areas. ... Azerbaijani authorities said they were investigating whether the deaths of two young children in the republic were caused by bird flu.

Update II 3/14/06 According to Recombinomics:

...[T]oday's WHO update on Azerbaijan indicates the familial cluster is growing in size and length and is linked to a geographical cluster in Azerbaijan. Five deaths have been reported and media reports indicated the other two fatalities also tested positive for H5N1 bird flu. Media reports indicate all victims are from two families, suggesting human-to-human transmission.

This mode of transmission is further support because the index case, who died February 23 is the cousin of the case who died March 3. Although the WHO update again withholds disease onset dates and relationships between H5 positive patients, the spread between the dates of death support human-to-human transmission. This transmission chain appears to have extended to the third generation because the 16 year-old male who died on March 10 was the brother of the patient who died on March 3.

This cluster is similar to the cluster of clusters in Turkey. In that cluster HA S227N was isolated from the index case. This genetic change increases the affinity of HA for human receptors and may be responsible for the cluster in Azerbaijan based on location and size of the clusters.

Update III 3/15/06According to Azeri news sources:

Two members of Musayev’s family, residents of the village Baim Sarikh of Terteri region died presumably of the bird flu on the same day.

Azerbaijani TV Channel ANS informs that according to physicians, the bird flu diagnosis is preliminary and can be confirmed after results of laboratory examinations are known.

It became known that the main part of peasants doesn’t slaughter poultry [my empahsis] ...

Update IV 3/15/06 This can't be good. The virus has now jumped species. While we knew that cats could contract the disease after eating dead infected birds (as found in Germany, as well as marten, it's now being reported that a dog died of the disease in Azerbaijan. From what I have read, the fact that the virus jumps to new species is a sign that it is now making itself comfortable in mammals--one step away from becoming humanly tansmissible, person to person.

According to Reuters:

A dog has died of bird flu in Azerbaijan, a country where the virus is believed to have caused the death of three young women, officials said on Wednesday.

"A dead stray dog has been found, and after analysis type A bird flu was discovered. The medical investigation is continuing," said a statement from the state commission tasked with fighting the spread of bird flu. It said the dog died on March 9 in the capital Baku.

Okay, so this was a stray dog. It makes you wonder how many other dogs have it that weren't found or that aren't stray.

Update V 3/15/06 Clarifying the idea that the virus has "jumped species," there's this article. The US virus expert says that species jumping has not yet occurred, but she is worried that the virus is aggressively seeking to do so.

According to Xinhua news:

Generally, the H5N1 virus transfers from wild birds to poultry, and then goes from poultry to wild birds or other species, including human, according to Cardona.

But in recent cases, domestic cats were infected after eating dead wild birds or contacting with them.

"That means, the virus may have acquired the ability of directly transferring from wild birds to other species, such as domestic cats or urban dogs," she said. "It may be able to do this without the poultry."

If the virus can infect domestic cats and urban dogs, which closely contact with people in everyday life, it will pose more threat to humans, she said.

There is no evidence that the virus has accomplished the so-called "species jumping," which means it can circulate among animals other than the birds.

"But there is the possibility, so we can never underestimate the virus," she said.

Update VI 3/15/06 According to Reuters, the main federal oversight department for banks issued the following statement. I hate to add to a feeling of panic, but you know something's serious when the moneychangers start trying to protect their assets.

U.S. bank regulators on Wednesday advised financial institutions to have contingency plans in place in case avian flu becomes pandemic.

"Financial institutions and their service providers supply essential financial services and, as such, should consider their preparedness and response strategy for a potential pandemic," the Federal Reserve, the Federal Deposit Insurance Corp., the Office of the Comptroller of the Currency and the Office of Thrift Supervision said in a statement.

Update VII 3/15/06Another piece of the Azerbaijan puzzle. The lab that was sent there is a Navy Lab:

The World Health Organization has yet to confirm bird flu caused the human deaths, but said the US Navy lab that carried out the tests was reliable.

Update VII 3/17/06 According to DigitalJournal.com:

Dr. Jeffrey Taubenberger, of the Armed Forces Institute of Pathology, says there is a frightening historic precedent from 1918. "The risk of the current bird flu is that this virus might be actually going down the same path as the 1918 virus."

Update VIII 3/17/06According to ABC News:

Three Serb children from a bird flu-affected area were taken to hospital after developing fever and flu-like symptoms, Serbia's chief epidemiologist said on Friday.

A teenager put into isolation on Thursday after developing fever was also moved to hospital. All four come from a southwestern area close to the Bosnian border, where there was a suspected case of the deadly H5N1 strain in a cockerel.

"Three children were admitted to hospital today displaying symptoms of respiratory infection," Predrag Kon told Reuters.

"Two of them have signs of a viral infection. All three are coming from the outbreak zone and came into contact with infected poultry."

Update IX 3/18/06Tests Show Egyptian Woman Dies of Bird Flu:

Initial tests have shown that a woman who died this week had bird flu, making her likely the first human death from the disease in Egypt, a spokesman for the World Health Organization said Saturday.

A U.S. Navy lab in Cairo found that the woman, who died on Friday, had the H5N1 virus, but further tests will be conducted by the WHO to give final confirmation, WHO spokesman Hassan el-Bushra told The Associated Press.

A number of people who came in contact with the woman are also being tested, said el-Bushra, who is the WHO regional adviser for emerging diseases. He would not say how many people were being tested or whether they had shown any symptoms of bird flu.

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