LONDON, Sept. 27 (UPI) -- Indonesia, the country hardest hit by avian influenza, has seen a number of human infections and at least one fatality in recent days, causing concern among health and veterinary officials that an infection cluster may have emerged.
While there has as yet been no confirmation that the dreaded human-to-human transmission of avian influenza has occurred anywhere in the world, officials are concerned that three members of the same family in Bandung, West Java, who are believed to have been infected with bird flu may have infected each other.
The first member of the family to succumb to the disease was the 23-year-old elder brother, who died Sunday afternoon. He died before being admitted to hospital and before any samples were taken, but as his younger brother, 20, and his 15-year-old sister have since been admitted to Hasan Sadikin General Hospital, in Bandung, with confirmed avian-influenza infection. Health authorities believe his cause of death to have been avian influenza.
According to Hadi Jusuf, who heads up the avian-influenza team at the hospital, the 20-year-old's condition has not improved since treatment began.
He told the Jakarta Post: "He's still on a ventilator and we are watching him closely. The pneumonia which was previously only found on the lower side of his left lung has now spread to both sides."
Officials investigating the elder brother's death have determined that a likely initial source of infection was the dead birds the family was feeding to their dogs.
In related news, a 9-year-old boy died of avian influenza in Jakarta Friday. He was admitted to hospital nine days prior to his death, displaying avian-flu-like symptoms including high fever and respiratory difficulties. It has since been confirmed that he had been in contact with sick chickens prior to falling ill.
Indonesia has suffered 51 official deaths from avian influenza; 40 of those have occurred this year. Already the world's worst-hit country, its figures look set to climb as the World Health Organization announces other cases currently awaiting confirmation.
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The Thai Health Ministry this week announced the country's 17th death from avian influenza, a man who died in August.
The unnamed man, who lived in Nong Bua Lamphu province in northeastern Thailand, bred and reared fighting cocks. Once his birds became ill, rather than report them to the authorities, the man attempted to treat them using herbal medicines. It is believed this contact with the birds -- valuable animals the man did not wish to see culled -- led to his death.
On July 14 the man first reported suffering aches and a fever, but although he sought treatment he neglected to tell his doctor about the sick birds or his contact with them. Two weeks after he first became ill, his wife told the local health authorities about the birds and their possible involvement in his infection, and the birds were then culled.
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Officials from Egypt's Ministry of Health and the WHO Wednesday confirmed that there had been an outbreak of avian influenza in poultry in the north of the country.
The infected birds were reared in a garden in the village of Edfu, near Aswan, in Upper Egypt.
According to WHO spokesman Hassan el-Bushra, the infected birds have since been culled, and local health officials "instigated the WHO-approved control measures, and no human infection has been reported."
Egypt was badly hit by avian influenza in the early part of this year, and authorities instituted a ban on urban poultry breeding in an attempt to stem the spread of infection. The ban was not extended to rural areas, however, as it was feared that the economic impact of such a move would be so great as to inspire people to become furtive about their domestic flocks, thereby increasing the likelihood of the disease's spread.
"A ban (in rural areas) would lead many to conceal their birds, heightening the danger rather than quelling it," Health Ministry press spokesman Abdel Rahman Shahine said in March. "Instead, we're working to help them increase awareness to prevent the emergence of new cases."
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Australian authorities were on high alert Wednesday after reports emerged that a passenger on a plane to Sydney was unwell and was possibly infected with avian influenza.
The passenger, who was flying to Australia from Vietnam, "was assessed as being unwell," according to a statement from the New South Wales Health Ministry. As he had previously suffered an influenza-like infection and had been staying in an area where he had been in prolonged contact with chickens, Australian authorities acted quickly to assess the incoming traveler.
It has since emerged, however, that the man was probably a drug courier who became ill after a condom containing heroin burst in his stomach.
Australian authorities have yet to confirm reports that the man was treated with Narcan, a medicine used to treat heroin overdoses, in the ambulance on the way to the hospital.
However, Australia's The Age newspaper cites NSW Health Communicable Diseases Director Jeremy McAnulty as saying: "It turns out that (bird flu) is a very unlikely diagnosis. But the person's still being assessed in hospital.
"Our concern is whether a person has a quarantinable disease or avian influenza, and at this stage it seems very unlikely that that's the case."
The Age also quotes an Australian Federal Police spokesman as saying: "This man is now a person of interest to the AFP and investigations are continuing."
