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Avian Flu Clusters Found in Turkey and Indonesia

Studies raise question about viral evolution toward consistent human-to-human transmission

WEDNESDAY, Nov. 22 (HealthDay News) -- Clusters of human H5N1 virus infection have been identified in Turkey and Indonesia, although the diagnoses in Turkey were at first difficult to make, according to two studies published in the Nov. 23 issue of the New England Journal of Medicine.

Ahmet Faik Oner, M.D., of Yuzuncu Yil University in Van, Turkey, and colleagues diagnosed eight patients aged 5 to 15 years with H5N1 virus infection who had a history of close contact with diseased or dead chickens. All had fever and seven had evidence of pneumonia, though initial influenza tests were negative, leading researchers to conclude that H5N1 can be difficult to diagnose. Four patients died.

I. Nyoman Kandun, M.D., M.P.H., of the Directorate General of Disease Control and Environmental Health in Jakarta, Indonesia, and colleagues investigated three clusters of H5N1 virus infection that affected eight patients (median age 8.5 years) and resulted in four deaths. In each cluster, the researchers found that infected patients were members of the same family, and most lived in the same home.

"The continuing evolution of H5N1 viruses and the clusters of human infections in Indonesia and Turkey raise important questions," state the authors of an accompanying editorial. "First, can the source of H5N1 be eliminated? And second, is the increasing number of clusters of human infection an indicator of evolution toward consistent human-to-human transmission?"

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