NEJM -- Probable Person-to-Person Transmission of = Avian Influenza A (H5N1)

From: Subject: NEJM -- Probable Person-to-Person Transmission of Avian Influenza A (H5N1) Date: Mon, 24 Jan 2005 17:56:45 +0200 MIME-Version: 1.0 Content-Type: multipart/related; boundary="----=_NextPart_000_0000_01C5023E.11BF6130"; type="text/html" X-MimeOLE: Produced By Microsoft MimeOLE V6.00.2800.1441 This is a multi-part message in MIME format. ------=_NextPart_000_0000_01C5023E.11BF6130 Content-Type: text/html; charset="Windows-1252" Content-Transfer-Encoding: quoted-printable Content-Location: http://content.nejm.org/cgi/content/abstract/NEJMoa044021 NEJM -- Probable Person-to-Person Transmission of = Avian Influenza A (H5N1)

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Published at www.nejm.org January 24, 2005=20 (10.1056/NEJMoa044021) =

Probable=20 Person-to-Person Transmission of Avian Influenza A = (H5N1)

Kumnuan Ungchusak, M.D., M.P.H., Prasert = Auewarakul,=20 M.D., Scott F. Dowell, M.D., M.P.H., Rungrueng Kitphati, M.D., Wattana = Auwanit,=20 Ph.D., Pilaipan Puthavathana, Ph.D., Mongkol Uiprasertkul, M.D., Kobporn = Boonnak, M.Sc., Chakrarat Pittayawonganon, M.D., Nancy J. Cox, Ph.D., = Sherif R.=20 Zaki, M.D., Ph.D., Pranee Thawatsupha, M.S., Malinee Chittaganpitch, = B.Sc.,=20 Rotjana Khontong, M.D., James M. Simmerman, R.N., M.S., and Supamit=20 Chunsutthiwat, M.D., M.P.H.

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ABSTRACT=20

Background During 2004, a highly pathogenic avian = influenza⁼²⁰A (H5N1) virus caused poultry disease in eight Asian = countries⁼²⁰and infected at least 44 persons, killing 32; most of these⁼²⁰persons had had close contact with poultry. No evidence of = efficient⁼²⁰person-to-person transmission has yet been reported. We = investigated⁼²⁰possible person-to-person transmission in a family cluster of⁼the disease in Thailand.

Methods For each of the three involvedpatients, we = reviewed the circumstances and timing of exposuresto poultry = and to=20 other ill persons. Field teams isolated andtreated the = surviving=20 patient, instituted active surveillancefor disease and = prophylaxis=20 among exposed contacts, and culledthe remaining poultry = surrounding=20 the affected village. Specimensfrom family members were = tested by=20 viral culture, microneutralizationserologic analysis,=20 immunohistochemical assay, = reverse-transcriptase-polymerase-chain-reaction⁼²⁰(RT-PCR) analysis, and genetic sequencing.

Results The indexpatient became ill three to four = days=20 after her last exposureto dying household chickens. Her = mother came=20 from a distantcity to care for her in the hospital, had no=20 recognized exposureto poultry, and died from pneumonia after = providing 16 to 18hours of unprotected nursing care. The = aunt also=20 provided unprotectednursing care; she had fever five days = after the=20 mother firsthad fever, followed by pneumonia seven days = later.=20 Autopsy tissuefrom the mother and nasopharyngeal and throat = swabs=20 from theaunt were positive for influenza A (H5N1) by RT-PCR. = No=20 additionalchains of transmission were identified, and = sequencing of=20 theviral genes identified no change in the receptor-binding=20 siteof hemagglutinin or other key features of the virus. The = sequencesof all eight viral gene segments clustered closely = with=20 otherH5N1 sequences from recent avian isolates in = Thailand.

ConclusionsDisease in the mother and aunt probably = resulted from person-to-persontransmission of this lethal = avian=20 influenzavirus during unprotectedexposure to the critically = ill=20 index patient.

Notice: To coincidewith a symposium on pandemic = influenza,=20 this article was publishedat www.nejm.org on January 24, = 2005. It=20 will appear in the January27 issue of the = Journal.

Click on "PDF" for the full text.

Comments and = questions?=20 Please contact=20 us.

The New=20 England Journal of Medicine is owned, published, and copyrighted =A9 = 2005=20 Massachusetts Medical = Society. All=20 rights reserved.

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