May 18 (Bloomberg) -- The World Health Organization sent two officials to Indonesia's North Sumatra province to investigate the largest cluster of human bird flu cases, as a government official said sick animals may have been involved.
Medical epidemiologists Thomas Grein and Timothy Uyeki joined the team in the province today, said Sari Setiogi, a WHO spokeswoman in Jakarta. The H5N1 avian influenza strain infected as many as eight members of a family in the past month. It may also have been in farm animals near their homes, Agriculture Minister Anton Apriantono said today.
``Hopefully the two people heading to North Sumatra today can contribute and identify the source,'' Setiogi said.
Infected animals increase the risk of human infection and create opportunities for the virus to mutate into a pandemic form. Fatalities from H5N1 this year have surpassed 2005 levels as the virus spread to more than 30 countries on three continents.
At least 115 of the 208 people known to be infected with bird flu have died, the WHO said on its Web site May 12. The tally doesn't include six cases, five of which were fatal, in North Sumatra and an unrelated fatality in East Java confirmed by the WHO yesterday.
The virus infected a 75-year-old woman in Egypt, marking the county's 14th human case, China's Xinhua news agency reported yesterday. The woman, from the governorate of Minya, about 220 kilometers (137 miles) south of Cairo, contracted the H5N1 strain through direct contact with backyard poultry, Xinhua said.
Almost all human H5N1 cases have been linked to close contact with sick or dead birds, such as children playing with them or adults butchering them or taking off feathers, according to the WHO. Cooking meat and eggs properly kills the virus.
Pigs, Poultry
Pigs, chickens and ducks are raised by about half the 400 households in the North Sumatran village of Kubu Sembilang, where some of the infected people lived.
Most of Kubu Sembilang's residents are Christian and many of them are distantly related, Umbat, who runs a food stall in the village, said in an interview yesterday. Indonesia has the world's highest population of Muslims.
Waterfowl are the natural hosts of avian influenza. Pigs are susceptible to both human and avian strains and are considered a potential ``mixing bowl'' of flu viruses.
Ten of 11 pigs in the district where the infected people lived were found to have avian flu antibodies in their blood, Apriantono told reporters in Jakarta today.
Previous Infection
The presence of antibodies is an indication of an existing or previous infection. Antibodies were also found in chickens and ducks by a national laboratory in Bogor, and confirmatory tests on the animal samples are under way, Apriantono said.
``As soon as we know it's positive, these animals should be culled,'' he said.
``If the virus is in pigs, that would be a major concern,'' Ton Schat, a professor of virology and immunology at Cornell University, said in an interview today.
Previous testing on farm animals surrounding the patients' homes had shown no evidence of avian flu, raising concern that the virus may have been passed from one person to another.
The possibility of human-to-human transmission cannot be ruled out, the WHO's Setiogi said.
Genetic Changes
Human-to-human transmission would suggest the virus had undergone genetic changes making it more contagious to people. Avian flu has the potential of sparking a pandemic if it spreads easily among people.
``It is certainly alarming,'' said Dick Thompson, a WHO spokesman in Geneva. ``This is the largest H5N1 cluster we have seen. There are obviously important questions that we need answered. But right now it is too early in the investigation to say anything definitive.''
Yesterday, three members of the family said they were feeling sick, with symptoms including headache and cough.
``At this point there is no evidence that infectivity, transmissibility or virulence has changed dramatically, but we're investigating the Indonesian cases very carefully,'' Shigeru Omi, the WHO's regional director for the western Pacific region, told reporters in Hong Kong today.
To contact the reporters on this story: Jason Gale in Singapore at j.gale at bloomberg.net; Karima Anjani in Jakarta at kanjani at bloomberg.net. Last Updated: May 18, 2006 01:10 EDT
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