FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 355:2186-2194 November 23, 2006 Number 21 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Supplementary Material Perspective by Webster, R. G. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear Related Article by Goicoechea, M. PubMed Citation

ABSTRACT

Background Since 2003, the widespread ongoing epizootic of avian influenza A (H5N1) among poultry and birds has resulted in human H5N1 cases in 10 countries. The first case of H5N1 virus infection in Indonesia was identified in July 2005.

Methods We investigated three clusters of Indonesian cases with at least two ill persons hospitalized with laboratory evidence of H5N1 virus infection from June through October 2005. Epidemiologic, clinical, and virologic data on these patients were collected and analyzed.

Results Severe disease occurred among all three clusters, including deaths in two clusters. Mild illness in children was documented in two clusters. The median age of the eight patients was 8.5 years (range, 1 to 38). Four patients required mechanical ventilation, and four of the eight patients (50%) died. In each cluster, patients with H5N1 virus infection were members of the same family, and most lived in the same home. In two clusters, the source of H5N1 virus infection in the index patient was not determined. Virus isolates were available for one patient in each of two clusters, and molecular sequence analyses determined that the isolates were clade 2 H5N1 viruses of avian origin.

Conclusions In 2005 in Indonesia, clusters of human infection with clade 2 H5N1 viruses included mild, severe, and fatal cases among family members.

Source Information

From the Directorate General of Disease Control and Environmental Health (I.N.K., H.W., Y., W.H., W.P., H.S., C.S.) and the National Institute of Health Research and Development (E.R.S., E.T., B.H., D.Y., S.H.), Ministry of Health, Jakarta; the Infectious Disease Hospital Rumah Sakit Penyakit Infeksi Sulianti Saroso, North Jakarta (S.S., S.G.); the U.S. Naval Medical Research Unit 2, Jakarta (P.J.B., A.J., H.K., S.D.P.); and the World Health Organization, Jakarta (G.S., M.S.) — all in Indonesia; the University of Hong Kong (K.H.C., L.L.M.P., Y.G., M.P.) and the Department of Health (W.L.) — both in Hong Kong; and the Centers for Disease Control and Prevention, Atlanta (A.K., S.L., R.D., J.K., N.C., T.M.U.).

Address reprint requests to Dr. Uyeki at the Influenza Division, Mail Stop A-32, Centers for Disease Control and Prevention, Atlanta, GA 30333, or at tuyeki{at}cdc.gov.

Full Text of this Article

This article has been cited by other articles:

• Li, F C K, Choi, B C K, Sly, T, Pak, A W P (2008). Finding the real case-fatality rate of H5N1 avian influenza. J. Epidemiol. Community Health 62: 555-559 [Abstract] [Full Text]  
• Belser, J. A., Blixt, O., Chen, L.-M., Pappas, C., Maines, T. R., Van Hoeven, N., Donis, R., Busch, J., McBride, R., Paulson, J. C., Katz, J. M., Tumpey, T. M. (2008). Contemporary North American influenza H7 viruses possess human receptor specificity: Implications for virus transmissibility. Proc. Natl. Acad. Sci. USA 105: 7558-7563 [Abstract] [Full Text]  
• Korteweg, C., Gu, J. (2008). Pathology, Molecular Biology, and Pathogenesis of Avian Influenza A (H5N1) Infection in Humans. Am. J. Pathol. 172: 1155-1170 [Abstract] [Full Text]  
• Gottfredsson, M., Halldorsson, B. V., Jonsson, S., Kristjansson, M., Kristjansson, K., Kristinsson, K. G., Love, A., Blondal, T., Viboud, C., Thorvaldsson, S., Helgason, A., Gulcher, J. R., Stefansson, K., Jonsdottir, I. (2008). From the Cover: Lessons from the past: Familial aggregation analysis of fatal pandemic influenza (Spanish flu) in Iceland in 1918. Proc. Natl. Acad. Sci. USA 105: 1303-1308 [Abstract] [Full Text]  
• Writing Committee of the Second World Health Organ, (2008). Update on Avian Influenza A (H5N1) Virus Infection in Humans. NEJM 358: 261-273 [Full Text]  
• Zeng, H., Goldsmith, C., Thawatsupha, P., Chittaganpitch, M., Waicharoen, S., Zaki, S., Tumpey, T. M., Katz, J. M. (2007). Highly Pathogenic Avian Influenza H5N1 Viruses Elicit an Attenuated Type I Interferon Response in Polarized Human Bronchial Epithelial Cells. J. Virol. 81: 12439-12449 [Abstract] [Full Text]  
• Wan, X.-F., Chen, G., Luo, F., Emch, M., Donis, R. (2007). A quantitative genotype algorithm reflecting H5N1 Avian influenza niches. Bioinformatics 23: 2368-2375 [Abstract] [Full Text]  
• Carter, M. J. (2007). A rationale for using steroids in the treatment of severe cases of H5N1 avian influenza. J Med Microbiol 56: 875-883 [Abstract] [Full Text]  
• Yen, H.-L., Lipatov, A. S., Ilyushina, N. A., Govorkova, E. A., Franks, J., Yilmaz, N., Douglas, A., Hay, A., Krauss, S., Rehg, J. E., Hoffmann, E., Webster, R. G. (2007). Inefficient Transmission of H5N1 Influenza Viruses in a Ferret Contact Model. J. Virol. 81: 6890-6898 [Abstract] [Full Text]  
• Sellwood, C., Asgari-Jirhandeh, N., Salimee, S. (2007). Bird flu: if or when? Planning for the next pandemic. Postgrad. Med. J. 83: 445-450 [Abstract] [Full Text]  
• Peiris, J. S. M., de Jong, M. D., Guan, Y. (2007). Avian Influenza Virus (H5N1): a Threat to Human Health. Clin. Microbiol. Rev. 20: 243-267 [Abstract] [Full Text]  
• Mehlmann, M., Bonner, A. B., Williams, J. V., Dankbar, D. M., Moore, C. L., Kuchta, R. D., Podsiad, A. B., Tamerius, J. D., Dawson, E. D., Rowlen, K. L. (2007). Comparison of the MChip to Viral Culture, Reverse Transcription-PCR, and the QuickVue Influenza A+B Test for Rapid Diagnosis of Influenza. J. Clin. Microbiol. 45: 1234-1237 [Abstract] [Full Text]  
• Goicoechea, M., Pawitan, J. A., Dudley, J. P., Oner, A. F., Ceyhan, M., Akdeniz, H., Kandun, I. N., Sedyaningsih, E. R., Uyeki, T. M., Webster, R. G., Govorkova, E. A. (2007). Human H5N1 Influenza. NEJM 356: 1375-1377 [Full Text]  
• (2006). Updates on H5N1. JWatch Infect. Diseases 2006: 1-1 [Full Text]  
• Oner, A. F., Bay, A., Arslan, S., Akdeniz, H., Sahin, H. A., Cesur, Y., Epcacan, S., Yilmaz, N., Deger, I., Kizilyildiz, B., Karsen, H., Ceyhan, M. (2006). Avian Influenza A (H5N1) Infection in Eastern Turkey in 2006.. NEJM 355: 2179-2185 [Abstract] [Full Text]  
• (2006). Avian Flu: Deadly, and Difficult to Diagnose. JWatch General 2006: 1-1 [Full Text]