Background During 2004, a highly pathogenic avian influenzaA (H5N1) virus caused poultry disease in eight Asian countriesand infected at least 44 persons, killing 32; most of thesepersons had had close contact with poultry. No evidence of efficientperson-to-person transmission has yet been reported. We investigatedpossible person-to-person transmission in a family cluster ofthe disease in Thailand.
Methods For each of the three involved patients, we reviewedthe circumstances and timing of exposures to poultry and toother ill persons. Field teams isolated and treated the survivingpatient, instituted active surveillance for disease and prophylaxisamong exposed contacts, and culled the remaining poultry surroundingthe affected village. Specimens from family members were testedby viral culture, microneutralization serologic analysis, immunohistochemicalassay, reverse-transcriptase–polymerase-chain-reaction(RT-PCR) analysis, and genetic sequencing.
Results The index patient became ill three to four days afterher last exposure to dying household chickens. Her mother camefrom a distant city to care for her in the hospital, had norecognized exposure to poultry, and died from pneumonia afterproviding 16 to 18 hours of unprotected nursing care. The auntalso provided unprotected nursing care; she had fever five daysafter the mother first had fever, followed by pneumonia sevendays later. Autopsy tissue from the mother and nasopharyngealand throat swabs from the aunt were positive for influenza A(H5N1) by RT-PCR. No additional chains of transmission wereidentified, and sequencing of the viral genes identified nochange in the receptor-binding site of hemagglutinin or otherkey features of the virus. The sequences of all eight viralgene segments clustered closely with other H5N1 sequences fromrecent avian isolates in Thailand.
Conclusions Disease in the mother and aunt probably resultedfrom person-to-person transmission of this lethal avian influenzavirusduring unprotected exposure to the critically ill index patient.
Source Information
From the Bureau of Epidemiology (K.U., C.P.), the Departments of Medical Sciences (R. Kitphati, W.A., P.T., M.C.) and Disease Control (S.C.), and the Kamphang Phet Hospital (R. Khontong), Thai Ministry of Public Health, Nonthaburi, Thailand; the Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand (P.A., P.P., M.U., K.B.); the International Emerging Infections Program, Thai Ministry of Public Health and U.S. Centers for Disease Control and Prevention, Nonthaburi, Thailand (S.F.D., J.M.S.); and the Centers for Disease Control and Prevention, Atlanta (N.J.C., S.R.Z.).
Address reprint requests to Dr. Ungchusak at the Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health, Tivanon Rd., Nonthaburi 11000, Thailand, or at kum{at}health.moph.go.th.
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