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Homeland Security

30 January 2006

Iraq Reports Bird Flu in Humans; Turkish Deaths Confirmed

Iraq is seventh nation in which disease confirmed; human infections now at 160

By Charlene Porter
Washington File Staff Writer

Washington – Iraq’s Ministry of Health has confirmed its first human death from avian influenza, and is working to confirm a possible second death.

The U.S. Naval Medical Research Unit provided a preliminary laboratory confirmation of the Iraqi conclusions, but further investigation is under way, according to a summary of the situation issued by the World Health Organization January 30.

A 15-year-old girl died of the disease January 17. She suffered from severe respiratory symptoms similar to those that have occurred in other patients who have succumbed to this strain of bird flu. The deadly H5N1 viral strain first appeared in poultry in East Asia and now has been detected in humans in seven nations, causing 85 deaths.

The Iraqi case occurred in the north, near Sulaimaniyah. The town is close to the border with Turkey, where human infections also have been confirmed over the last month. Twelve human cases have been verified in Turkey, WHO reports, and testing continues in nine other cases identified by Turkish health officials but not yet confirmed by an outside laboratory.

IRAQI CASES

The uncle of the 15-year-old girl who is a confirmed bird flu death also is dead.  He cared for his niece during her illness, and began showing similar symptoms after her death on January 24. He died three days later from severe respiratory illness and his tissue samples now are being analyzed for confirmation of the H5N1 diagnosis.

Identifying the possible source of the disease is also part of this analysis. The girl’s exposure to diseased birds has been documented, but the uncle’s source of infection remains under investigation.

Of the 160 human cases that have been confirmed by WHO, the vast majority have occurred because the patients had been exposed to sick birds. In one case in Asia, disease investigators believe that the illness did pass from one family member to a second who kept close contact with the sick relative while providing care.

International health officials do not think that H5N1 passes easily from birds to humans. Hundreds of millions of birds have been exposed to the disease with just as many opportunities for the virus to pass on to humans sharing their homes and yards with those birds.  In that context, 160 human cases is a small number of cases.

But if H5N1 does mutate to become transmissible between humans, international health officials fear that pandemic influenza could sweep the world because of the virulence of this flu strain. 

The case of the Iraqi girl and her uncle will be examined carefully to determine how the 39-year-old man became infected.

Even though poultry illness has been reported in the neighborhood of the deceased near Sulaimaniyah, H5N1 has not been confirmed in birds in the area.

The Iraqi Ministry of Health also is investigating a third human case of respiratory illness in a 54-year-old woman.

TURKISH CASES

A United Kingdom laboratory collaborating in the international effort to track the disease has verified 12 human cases of H5N1 reported by Turkish health officials. Nine other cases still are undergoing what a January 30 statement from WHO describes as a “technically challenging” process of confirmation.

The four people in Turkey who died from the severe respiratory illness that marks H5N1 infection are among those confirmed.

Epidemiologists have been investigating clusters of childhood cases in families from Turkey’s Dogubayazit district. They have found that exposure to diseased or dead poultry has been documented in just about all those cases.

“The investigation found no clear evidence of human-to-human transmission and no evidence that the virus is now spreading more easily from birds to humans,” according to the January 30 WHO statement.

The fact that almost all the Turkish cases are occurring in children and teens is puzzling to epidemiologists, especially because adults in some of these families had similar levels of exposure and chance for infection as those of the sick children.

“This observation further supports the possibility, raised previously during field investigations in Asia, that some as yet unidentified genetic or immunological factor may influence the likelihood of human infection,” the statement said.

The international health community has praised Turkish health officials for their rapid response when the flu appeared and their swift mobilization of a public information campaign that heightened awareness of disease and the risks for exposure. Those efforts were bolstered by surveillance for poultry outbreaks, poultry culling operations and infection control measures in hospitals.

No further human cases have emerged after those that appeared in the first weeks of January, but the WHO statement warns that human exposure is a distinct possibility if the virus continues to circulate in birds.

For additional information on the disease and international efforts to combat it, see Bird Flu (Avian Influenza).

(The Washington File is a product of the Bureau of International Information Programs, U.S. Department of State. Web site: http://usinfo.state.gov)



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