Background Since 2003, the widespread ongoing epizootic of avianinfluenza A (H5N1) among poultry and birds has resulted in humanH5N1 cases in 10 countries. The first case of H5N1 virus infectionin Indonesia was identified in July 2005.
Methods We investigated three clusters of Indonesian cases withat least two ill persons hospitalized with laboratory evidenceof H5N1 virus infection from June through October 2005. Epidemiologic,clinical, and virologic data on these patients were collectedand analyzed.
Results Severe disease occurred among all three clusters, includingdeaths in two clusters. Mild illness in children was documentedin two clusters. The median age of the eight patients was 8.5years (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 samefamily, and most lived in the same home. In two clusters, thesource of H5N1 virus infection in the index patient was notdetermined. Virus isolates were available for one patient ineach of two clusters, and molecular sequence analyses determinedthat the isolates were clade 2 H5N1 viruses of avian origin.
Conclusions In 2005 in Indonesia, clusters of human infectionwith clade 2 H5N1 viruses included mild, severe, and fatal casesamong 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.
Govorkova, E. A., Ilyushina, N. A., McClaren, J. L., Naipospos, T. S. P., Douangngeun, B., Webster, R. G.
(2009). Susceptibility of Highly Pathogenic H5N1 Influenza Viruses to the Neuraminidase Inhibitor Oseltamivir Differs In Vitro and in a Mouse Model. Antimicrob. Agents Chemother.
53: 3088-3096
[Abstract][Full Text]
Fazekas, G., Martosne-Mendi, R., Jankovics, I., Szilvasy, I., Vajo, Z.
(2009). Cross-Reactive Immunity to Clade 2 Strains of Influenza Virus A Subtype H5N1 Induced in Adults and Elderly Patients by Fluval, a Prototype Pandemic Influenza Virus Vaccine Derived by Reverse Genetics, Formulated with a Phosphate Adjuvant, and Directed to Clade 1 Strains. CVI
16: 437-443
[Abstract][Full Text]
Van Hoeven, N., Belser, J. A., Szretter, K. J., Zeng, H., Staeheli, P., Swayne, D. E., Katz, J. M., Tumpey, T. M.
(2009). Pathogenesis of 1918 Pandemic and H5N1 Influenza Virus Infections in a Guinea Pig Model: Antiviral Potential of Exogenous Alpha Interferon To Reduce Virus Shedding. J. Virol.
83: 2851-2861
[Abstract][Full Text]
Katz, J. M., Veguilla, V., Belser, J. A., Maines, T. R., Van Hoeven, N., Pappas, C., Hancock, K., Tumpey, T. M.
(2009). The public health impact of avian influenza viruses. Poult. Sci.
88: 872-879
[Abstract][Full Text]
Gray, G. C., Kayali, G.
(2009). Facing pandemic influenza threats: The importance of including poultry and swine workers in preparedness plans. Poult. Sci.
88: 880-884
[Abstract][Full Text]
Van Hoeven, N., Pappas, C., Belser, J. A., Maines, T. R., Zeng, H., Garcia-Sastre, A., Sasisekharan, R., Katz, J. M., Tumpey, T. M.
(2009). Human HA and polymerase subunit PB2 proteins confer transmission of an avian influenza virus through the air. Proc. Natl. Acad. Sci. USA
106: 3366-3371
[Abstract][Full Text]
Cameron, C. M., Cameron, M. J., Bermejo-Martin, J. F., Ran, L., Xu, L., Turner, P. V., Ran, R., Danesh, A., Fang, Y., Chan, P.-K. M., Mytle, N., Sullivan, T. J., Collins, T. L., Johnson, M. G., Medina, J. C., Rowe, T., Kelvin, D. J.
(2008). Gene Expression Analysis of Host Innate Immune Responses during Lethal H5N1 Infection in Ferrets. J. Virol.
82: 11308-11317
[Abstract][Full Text]
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]
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]
A correction has been published: N Engl J Med 2007;356(13):1375.
Previous
