Human-to-human bird flu transmission probed   (AP)  Updated: 2006-05-24 14:01  
JAKARTA, Indonesia - The U.N. health agency is investigating whether 
bird flu was passed from human-to-human among members of an Indonesian family, 
but said Wednesday there is no evidence the virus has mutated or spread beyond 
the family. 
  "We're not surprised that there is possible human-to-human 
transmission," said Steven Bjorge, a World Health Organization epidemiologist 
based in Jakarta. "The thing we're looking for is whether it's sustained beyond 
the immediate cluster." 
  Six of the seven people in the family in 
northern Sumatra who caught the disease have died, the most recent on Monday. It 
is one of the largest human clusters ever reported. 
  Person-to-person 
transmission of bird flu is rare, but it is one of the biggest concerns about 
the disease. Scientists say that if the virus mutates into a form easily passed 
between people, it could cause a pandemic that could kill millions. 
  Bjorge, the WHO team leader at the village in Kubu Sembelang, said none 
of the poultry in the area had tested positive for the H5N1 virus, leading 
international experts to explore whether the virus spread among the family 
members. 
  Isolated cases of very limited human-to-human transmission have 
been documented - including one in Thailand involving a mother and child - but 
such cases do not mean a pandemic flu strain has emerged. 
  Bjorge said 
the virus found in Kubu Sembelang is genetically the same as the one found 
circulating in the area earlier. 
  "That, for me, is the most significant 
piece of evidence," he said. "Despite some weeks now in following up, we cannot 
find any evidence of any other cases beyond this cluster. If either of those two 
things changed, then I would be talking very differently." 
  Indonesia and 
other countries like Vietnam have experienced similar family clusters in the 
past, but none as large as the Indonesian one. 
  "We are worried for two 
reasons," said Peter Cordingley, spokesman for the WHO regional office for the 
Western Pacific in Manila. "One is we've never seen a cluster this size before. 
And the second reason is that we have a team down there, they are examining what 
is going on and they can't find an animal source of this infection, and that 
worries us." 
  Bjorge said the woman first believed to be infected by the 
virus worked as a vegetable vendor in a market where live poultry was sold. 
Experts are trying to determine if that's where she became infected. The woman, 
who died May 4, was never tested for the H5N1 virus, but WHO considers her part 
of the family cluster. The woman's 25-year-old brother is the only family member 
still living after being infected. 
  "All confirmed cases in the cluster 
can be directly linked to close and prolonged exposure to a patient during a 
phase of severe illness," the WHO said in a statement on its Web site. 
  Bjorge said some samples have been taken from villagers, but that local 
authorities have resisted working with outside health experts. WHO has enlisted 
local villagers to help monitor the village for anyone experiencing flu-like 
symptoms. 
  If anyone is found to have even mild symptoms, they will be 
quarantined and given the anti-bird flu drug Tamiflu, he said. 
  Bird flu 
has killed 124 people worldwide, more than a quarter of them in Indonesia. So 
far, most human cases have been traced to contact with infected poultry. 
  "Indonesia at the moment has very, very serious problems with this 
virus," Cordingley said. "(It's had) lots of cases this year and it doesn't seem 
to be any closer to control." 
    
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