# 2722
When someone presents with a high fever, respiratory symptoms, or pneumonia in Indonesia, or China, or anywhere else in the world where the H5N1 virus exists, one of the first questions most doctors ask is about recent exposure to poultry.
Since H5N1 is primarily a disease of birds, that makes sense.
And early on, almost all of the known human bird flu infections could be traced directly to some sort of contact with fowl.
Increasingly, however, we are seeing occasional cases where there are no known contacts with poultry, leaving us with an unanswered question.
Where did the victim contract the virus?
Another animal vector, like a dog or a cat, or even possibly an asymptomatic human? Or perhaps the virus was in the environment; bird droppings brought in on someone's shoes, or in house plant fertilizer, in store-bought produce, or . . .
Well, you get the picture. There are a lot of possibilities.
The latest case out of Indonesia, that of a 21 year-old housemaid, is another example of an unknown vector for the virus.
This from the Jakarta Post.
Thursday, January 29, 2009 7:34 PM
Dead housemaid tests positive for bird flu
Indra Harsaputra , THE JAKARTA POST , SURABAYA | Thu, 01/29/2009 1:46 PM | The Archipelago
A housemaid who died from a lung infection at Dr. Soetomo General Hospital in Surabaya over the weekend was infected with Avian flu, the hospital revealed Wednesday.
Chairman of the Press Forum at state-run hospital Urip Murtedjo said Sunday that a blood sample taken before the victim's death and sent to the Health Ministry had tested positive for Avian Flu.
The victim, identified only as S, and who is believed to have worked as a housemaid for a family in the city, was transferred from to the hosptical from a private hospital last Friday after suspicions were raised that she was suffering from the fatal disease.
"Initially, we did not know but remained suspicious of the patient's symptoms. After her death, the hospital's medical team sent a sample of her blood to the Health Ministry and the laboratory test result *confirmed* she was infected with the H5N1 virus," he told The Jakarta Post.
Urip said the hospital's medical team had doubted she was infected with the disease after learning the patient was not exposed to poultry at her work place or in her home village in Lumajang.
"This case has received a serious level of attention from the medical team because it is a new phenomenon," Urip said.
Chairul Anwar Nidom, a bird flu specialist at Airlangga University in Surabaya, said it would be foolish to rule out the possibility of an endemic in the city, citing recent outbreaks in Jakarta, West Java, North Sumatra and Banten.
He said his team would continue to research the path the virus was taking across the archipelago to determine which areas were vulnerable.


1 comments:
CUT THE CHAIN OF INFECTIONS ! Spread of avian flu by drinking water:
Proved awareness to ecology and transmission is necessary to understand the spread of avian flu. For this it is insufficient exclusive to test samples from wild birds, poultry and humans for avian flu viruses. Samples from the known abiotic vehicles as water also have to be analysed. Proving viruses in water is difficult because of dilution. If you find no viruses you can not be sure that there are not any. On the other hand in water viruses remain viable for a long time. Water has to be tested for influenza viruses by cell culture and in particular by the more sensitive molecular biology method PCR.
Transmission of avian flu by direct contact to infected poultry is an unproved assumption from the WHO. There is no evidence that influenza primarily is transmitted by saliva droplets: “Transmission of influenza A in human beings” http://www.thelancet.com/journals/laninf/article/PIIS1473309907700294/abstract?iseop=true.
There are clear links between the cold, rainy seasons as well as floods and the spread of influenza. There are clear links between avian flu and water, e.g. in Egypt to the Nile delta or in Indonesia to residential districts of less prosperous humans with backyard flocks of birds and without a central water supply as in Vietnam: http://www.cdc.gov/ncidod/EID/vol12no12/06-0829.htm. See also the WHO web side: http://www.who.int/water_sanitation_health/emerging/h5n1background.pdf. That is just why abiotic vehicles as water have to be analysed. The direct biotic transmission from birds, poultry or humans to humans can not depend on the cold, rainy seasons or floods. Water is a very efficient abiotic vehicle for the spread of viruses - in particular of fecal as well as by mouth, nose and eyes excreted viruses. Infected humans, mammals, birds and poultry can contaminate drinking water everywhere. All humans have very intensive contact to drinking water. Spread of avian flu by drinking water can explain small clusters in households too.
Avian flu infections may increase in consequence to increase of virus circulation. Human to human and contact transmission of influenza occur - but are overvalued immense. In the course of influenza epidemics in Germany, recognized clusters are rare, accounting for just 9 percent of cases e.g. in the 2005 season. In temperate climates the lethal H5N1 virus will be transferred to humans via cold drinking water, as with the birds in February and March 2006, strong seasonal at the time when (drinking) water has its temperature minimum.
The performance to eliminate viruses from the drinking water processing plants regularly does not meet the requirements of the WHO and the USA/USEPA. Conventional disinfection procedures are poor, because microorganisms in the water are not in suspension, but embedded in particles. Even ground water used for drinking water is not free from viruses.
In temperate regions influenza epidemics recur with marked seasonality around the end of winter, in the northern as well as in the southern hemisphere. Although seasonality is one of the most familiar features of influenza, it is also one of the least understood. Indoor crowding during cold weather, seasonal fluctuations in host immune responses, and environmental factors, including relative humidity, temperature, and UV radiation have all been suggested to account for this phenomenon, but none of these hypotheses has been tested directly. Influenza causes significant morbidity in tropical regions; however, in contrast to the situation in temperate zones, influenza in the tropics is not strongly associated with a certain season.
In the tropics, flood-related influenza is typical after extreme weather. The virulence of influenza viruses depends on temperature and time. Especially in cases of local water supplies with “young” and fresh influenza-contaminated water from low local wells, cisterns, tanks, rain barrels, ponds, rivers or rice paddies, this pathway can explain H5N1 infections. At 24°C, for example, in the tropics the virulence of influenza viruses in water exists for 2 days. In temperate climates with “older” water from central water supplies, the temperature of the water is decisive for the virulence of viruses. At 7°C the virulence of influenza viruses in water extends to 14 days.
Ducks and rice (paddies = flooded by water) are major factors in outbreaks of avian flu, claims a UN agency: Ducks and rice fields may be a critical factor in spreading H5N1. Ducks, rice (fields, paddies = flooded by water; farmers at work drink the water from rice paddies) and people – not chickens – have emerged as the most significant factors in the spread of avian influenza in Thailand and Vietnam, according to a study carried out by a group of experts from the United Nations Food and Agriculture Organization (FAO) and associated research centres. See http://www.un.org/apps/news/story.asp?NewsID=26096&Cr=&Cr1
The study “Mapping H5N1 highly pathogenic avian influenza risk in Southeast Asia: ducks, rice and people” also concludes that these factors are probably behind persistent outbreaks in other countries such as Cambodia and Laos. This study examined a series of waves of H5N1, a highly pathogenic avian influenza, in Thailand and Vietnam between early 2004 and late 2005. Through the use of satellite mapping, researchers looked at several different factors, including the numbers of ducks, geese and chickens, human population size, rice cultivation and geography, and found a strong link between duck grazing patterns and rice cropping intensity.
In Thailand, for example, the proportion of young ducks in flocks was found to peak in September-October; these rapidly growing young ducks can therefore benefit from the peak of the rice harvest in November-December, at the beginning of the cold: Thailand, Vietnam, Cambodia, Laos – as opposed to Indonesia – are located in the northern hemisphere.
These peaks in the congregation of ducks indicate periods in which there is an increase in the chances for virus release and exposure, and rice paddies often become a temporary habitat for wild bird species. In addition, with virus persistence becoming increasingly confined to areas with intensive rice-duck agriculture in eastern and south-eastern Asia, the evolution of the H5N1 virus may become easier to predict.
Dipl.-Ing. Wilfried Soddemann - Epidemiologist - Free Science Journalist soddemann-aachen@t-online.de http://www.dugi-ev.de/information.html
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