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CLUSTER PAGE

by: FloridaGirl

Sat Nov 18, 2006 at 13:22:15 PM EST


See also...
Graph of Cluster size and frequency over Time

Clusters of H5N1 infections are important because they may indicate human to human transmission of H5N1 influenza. Alternatively, they may simply indicate common exposure to the virus from an environmental source, presumably avian.

A cluster here is defined as two or more individuals:
1. who are in close physical contact,
2. who become very sick with a respiratory disease, and
3. at least one of whom is a confirmed H5N1 influenza case.

This is a relatively liberal definition of a cluster. It is left to the reader to evaluate the significance of the information presented here.

Information is derived from several sources including: WHO avian influenza situation updates, ProMED and a paper published in Emerging Infectious Diseases in November 2005 - Family Clustering of Avian Influenza A (H5N1)

China - 2003 February
A family of 5 from Hong Kong visited Fujian province in Mainland China early in 2003. A mother went with two daughters and one son on January 25 2003. The 7 year old girl developed respiratory symptoms...

FloridaGirl :: CLUSTER PAGE
and a high fever on January 27/28. She developed pneumonia on January 28 2003. The father joined his family in Fujian province on January 31. His 7 year old daughter died on February 4, 2003. She was not tested for H5N1 and was buried in Mainland China. Her 33 year old father became ill on February 7 with fever, cough and blood in sputum. The family returned to Hong Kong on February 9 2003. The father was admitted to a hospital in Hong Kong on February 11. He died on February 17. He was tested and was found to have been infected with H5N1. The 8 year old boy in the family became ill with a cough and fever on February 9, 2003. He was tested and was also found to be positive for H5N1, but recovered. Peiris et al 2004

Viet Nam - 2003 December
A 12 year old girl from Ha Nam became ill on December 25 2003 and was admitted to a Hanoi hospital on December 27 2004. She died on December 30 2003. This is first confirmed death from H5N1 in Viet Nam. Her 30 year old mother became ill on January 1 2004 and died of H5N1 influenza on Jan 9 2004. Corresponds to Olsen et al. cluster 1

A 7 year old girl Nam Dinh died on December 29 2003 of acute respiratory distress. No samples were tested from this girl. Her 5 year old brother was admitted to the hospital on December 29 2003. He died 17 days after becoming ill. H5N1 infection was confirmed. Corresponds to Olsen et al. cluster 2

Thailand - 2004 January
A 6 year old boy from Kanchanaburi province first became ill on January 6 (or 8) 2004. He died on January 25. His 33 year old mother also became ill with respiratory symptoms and died. She was not tested for H5N1 infection. Corresponds to Olsen et al. cluster 4

Viet Nam - 2004 January
A family cluster of H5N1 infections was observed in Thai Binh province in January 2004 (see also WHO update 15). A 31 year old man was hospitalized on January 7 2004 with severe respiratory illness. He died on January 12. No samples from this patient were tested for H5N1. His 28 year old wife became ill with a severe respiratory illness on January 10, but recovered. H5N1 infection was confirmed. The man’s two sisters, 23 and 30 years old, became ill on January 11 and January 10, respectively. Both died on January 23. H5N1 infection was confirmed in both sisters. Corresponds to Olsen et al. cluster 3

Viet Nam - 2004 January-February
A 9 year old girl in Dong Thap province became ill with diarrhea, but no respiratory symptoms on January 28 2004. She died of acute encephalitis on February 2 2004. She was not tested for H5N1 influenza. Her 4 year old brother became ill with diarrhea on February 10 2004, also with no respiratory symptoms. He developed encephalitis and died of respiratory failure on February 17 2004. This 4 year old boy was tested for H5N1 influenza and found to be positive.

Viet Nam - 2004 July
A 19 year old man in Hai Giang province became ill on July 23, 2004 with symptoms of fever, breathing difficulties and hemorrhage. His 22 year old female cousin exhibited the same symptoms. They both died on July 30. They were not tested for H5N1 infection. The man’s 25 year old sister became ill with the same symptoms on July 31 2004. She died on August 2 2004. H5N1 infection was confirmed. Corresponds to Olsen et al. cluster 5

Thailand - 2004 September
A family cluster of H5N1 and severe respiratory illness was observed in September 2004 in Kamphaeng Phet province. A 11 year old girl from Kamphaeng Phet province became ill on September 2 2004 and died of pneumonia on September 8 2004. She was not tested for H5N1 infection, but was considered to be a probable H5N1 fatality. Her 26 year old mother lived in Bangkok but visited her daughter to take of her while she was ill. The mother became ill on September 11 2004 and died on September 20. H5N1 infection was confirmed. The girl lived with her 32 year old Aunt. The Aunt became ill on September 16 2004 but recovered. H5N1 infection was confirmed. The Aunt’s son became ill with a respiratory infection. This cluster is considered one of the most convincing cases of human-to-human transmission of H5N1 because the mother lived in an area which had no infected birds, Bangkok, and was exposed to H5N1 by her daughter (who did have exposure to sick chickens). Corresponds to Olsen et al. cluster 6

Viet Nam - 2005 January
A 45 year old man from Thai Binh became ill with a respiratory illness on December 26 2004 and died on January 9 2005. H5N1 influenza was confirmed. His 42 year old brother, from Hanoi, was hospitalized on January 10 but recovered. He was also confirmed to be infected with H5 influenza. A third 36 year old brother was reported to be positive for H5N1 infection, but did not exhibit any symptoms Corresponds to Olsen et al. cluster 7

A 17 year old boy from Bac Lieu was hospitalized on January 10 2005. He died of H5N1 influenza on January 14 2005. His 22 year old sister also had respiratory symptoms and was hospitalized. Her fate and H5N1 status were not reported.Corresponds to Olsen et al. cluster 8

A 35 year old woman from Dong Thap became ill on January 14 2005. She died of H5N1 influenza on January 21. Her 13 year old daughter became ill on January 20 2005. She later died. H5N1 infection was confirmed. Corresponds to Olsen et al. cluster 9

Cambodia - 2005 January
A 14 year old boy from Kampot province became ill with respiratory symptoms and died on January 20 2005. He was not tested for H5N1 infection. His 25 year old sister became ill on January 21 2005. She traveled to Vietnam to receive care but died on January 30. H5N1 infection was confirmed. Corresponds to Olsen et al. cluster 10

Viet Nam - 2005 February
A 21 year old man from Thai Binh province ate meat from a sick chicken on February 8 2005. He developed a high fever and cough on February 14 2005. On February 20, he was admitted to an hospital with severe pneumonia. He received oseltamivir (Tamiflu −75 mg twice a day for 7 days) on February 23. He was discharged from the hospital on May 13. H5N1 infection was confirmed. His 14 year old sister cared for him from February 14 to February 21. She became ill with a mild cough and mild fever on February 23 2005. H5N1 infection was confirmed. She received an initial treatment with oseltamivir (Tamiflu −75 mg once a day) from February 24 to February 27. She was admitted to a hospital for observation on February 24. At this time, she had no fever but did have a mild cough. On February 27, she developed a high fever and severe cough. On February 28, she received oseltamivir (Tamiflu −75 mg twice a day for 7 days). She was discharged from the hospital on March 14 2006. The girl had no contact with poultry prior to becoming ill. A 26 year old male nurse, who cared for 21 year old male patient mentioned above, was admitted to a hospital in early March. H5N1 infection was apparently detected. The 80 year old grandfather of the 21 year old and 14 year old brother and sister was reported to be infected with H5N1. He did not exhibit any symptoms. Corresponds to Olsen et al. cluster 11

A 69 year old man from Thai Binh province became ill on February 19 2005. He died of H5N1 influenza on February 23. His 61 year old wife was reported to be infected with H5N1 but was not ill. Corresponds to Olsen et al. cluster 12

Viet Nam - 2005 March
A 13 year old girl from Quang Binh died of a respiratory condition on March 9 2005. No test for H5N1 infection was done. Her 5 year old brother was hospitalized on March 12. H5N1 infection was confirmed. Corresponds to Olsen et al. cluster 13

Five members of a family in the city of Haiphong were all reported to be infected with H5N1 influenza and were hospitalized on March 22 2005. The 35 year old father, 33 year old mother, 13 year old daughter, 10 year old daughter and 4 month old daughter were all infected. Corresponds to Olsen et al. cluster 14

Indonesia - 2005 July
An 8 year old girl from Tangerang, Banten province, a suburb of Jakarta, became ill on June 24 2005 and died on July 14. She was reported to be H5N1 positive. Her 1 year old sister became ill on June 29 2005 and died on July 9. She was not tested for H5N1 infection. The father of the two girls, a 38 year old man, became ill on July 2 2005 and died on July 12 2005. H5N1 infection was confirmed. Corresponds to Olsen et al. cluster 15

Indonesia - 2005 September
On September 10 2005 a 37 year old woman from Jakarta died of confirmed H5N1. Her 9 year old nephew became sick with respiratory symptoms. Initially he tested postive with PCR. It was later reported that he was not infected with H5N1.

On September 20 2005 a 21-year-old man from Lampung province developed symptoms. On September 24 2005 he was hospitalized; H5N1 infection was confirmed. On October 4, the 4 year old nephew of this man became ill. H5N1 infection was confirmed.

China - 2005 October
On October 8 2005, a 12 year old girl from Hunan province became ill with respiratory symptoms. She died on October 16. Her 9 year old brother became ill with respiratory symptoms on October 10 2005. He was confirmed to be infected with H5N1. He was released from the hospital on November 12 2005.

Thailand - 2005 October
A 48-year old man from Kanchanaburi province became ill on October 13 2005 and died on October 19. His 7 year old son became ill on October 16, but recovered. H5N1 infection was confirmed in both cases.

Indonesia - 2005 October
On October 19 2005, a 19 year old woman from Tangerang became ill. She died on October 28. Her 8 year old brother became ill on October 25. H5N1 infection was confirmed in both cases.

Indonesia - 2005 November
On November 3, two brothers, ages 7 and 20, from West Java province developed fever and respiratory symptoms. They died on November 11. On November 6, their 16 year old brother also developed fever and respiratory symptoms. He was hospitalized on November 16. H5N1 infection was confirmed in the 16 year old. The 7 year old and 20 year old were not tested for H5N1.

Turkey - 2006 January
The first reported case of H5N1 influenza in Turkey occurred in a 14 year old boy from Dogubayazit, in the province of Agri. He died on January 1 2006. His 15 year old sister died of H5N1 influenza on January 5 2006. The 12 year old sister of these children died on January 6 2006. The 6 year old brother of these children was hospitalized.

Two brothers, 5 and 2 years old, from Ankara province were reported infected with H5N1 on January 8 2006.

A 9 year old girl and her 3 year old brother, from the Dogubeyazit district in Agri Province, were reported infected on January 9 2006.

A 14 year old girl from the Dogubayazit district of Agri province became ill on January 4 2006. She died of H5N1 influenza on January 15. Her 5 year old brother also became ill on January 4 2006. He was confirmed to be infected with H5N1 influenza.

Information from the WHO on the symptom onset dates and the relationships between patients in this outbreak is limited. Bloggers have attempted to compile this information from Turkish media sites. One such compilation is provided by the Armchair Epidemiologist at his blogsite, H5N1 Avian Flu. The graph he presents is based on information obtained from the Recombinomics website. This information has not be verified by any official source. Caveat lector.

Indonesia - 2006 January
On January 6 2006, a 13 year old girl became ill. She died of H5N1 influenza on January 14. On January 8 2006, her 4 year old brother became ill. He died of H5N1 influenza on January 17. Their 14 year old sister was hospitalized with respiratory symptoms on January 14 2006. Their 43 year old father was hospitalized on January 17 with respiratory symptoms. On January 19 2006, a 9 year old girl from a neighboring village was hospitalized, but later recovered. H5N1 infection was confirmed.

Iraq - 2006 January
The first person reported to contract H5N1 influenza in Iraq was a 15 year old girl from the town of Raniya. She became ill on January 2 2006 and died on January 17. A US naval Medical Research Unit located in Cairo, Egypt confirmed infection with H5N1. Her 39 year old uncle, who cared for her while she was sick, became ill on January 24 2006. He died of a respiratory illness on January 27. H5N1 infection was confirmed in the uncle.

Indonesia - 2006 February
A 12 year old girl from Boyolali, Central Java became ill on February 19 2006. She died on March 1. H5N1 infection was confirmed. Her 10 year old brother also became ill on February 19 and died February 28. He was not tested for H5N1.

Azerbaijan - 2006 March
A 17 year old girl from Salyan Rayon died on February 23 2006. H5N1 infection was confirmed. Her first cousin, a 20 year old woman from Salyan Rayon died on March 3. H5N1 infection was confirmed. This woman’s 16 year old brother died on March 10. H5N1 infection was confirmed. A 17 year old girl, who was a close friend of this family, died on March 8. H5N1 infection was confirmed. A 10 year old boy from Salyan Rayon became ill. H5N1 infection was confirmed. A 15 year old girl from Salyan Rayon became ill on March 11 2006. H5N1 infection was confirmed. She recovered. Her 17 year old cousin also became ill on March 11 2006. She also recovered.

Egypt - 2006 March-April
A 6 year old girl from the Kafr El-Sheikh governorate became ill. H5N1 infection was confirmed. Her 1.5 year old sister became also became ill. H5N1 infection was confirmed.

Indonesia - 2006 April-May - Karo Cluster
A 37 year old woman from Kubu Sembelang (Karo district) became ill with respiratory symptoms on April 27 2006. She died on May 4. She was not tested for H5N1. Her 15 year old son died of H5N1 influenza on May 9. Her 17 year old son died of H5N1 influenza on May 12. Her 28 year old sister died on May 10 of H5N1 influenza. This sister’s 1.5 year old daughter died of H5N1 influenza on May 14. The 37 year old woman’s 10 year old nephew died of H5N1 on May 13. The 37 year old woman’s 32 year old brother, father of the 10 year old boy, became ill on May 15 2006 and died of H5N1 infection on May 22. Her 25 year old brother was also infected with H5N1. He is still alive. This is the largest cluster of H5N1 patients documented by the WHO. This cluster likely represents the first documented instance of human to human to human spread of H5N1.

Indonesia - 2006 May - West Sumatra
A 15 year old girl from West Sumatra province became ill on May 17 2006. Her 27 year old brother became ill with mild symptoms on May 28 2006. He recovered. H5N1 infection was confirmed.

Indonesia - 2006 May - Banten
A 10 year old boy from Banten Province died of respiratory disease on May 29 2006. No test for H5N1 was done. His 7 year old sister became ill on May 26 2006. She died on June 1. H5N1 infection was confirmed.

Indonesia - 2006 August
A 17 year old man from West Java, Garut district became ill on July 26 2006. H5N1 infection was confirmed. He recovered. His 20 year old neighbor, a cousin, died on August 5. No samples were taken, but H5N1 infection is suspected. A 9 year old girl from the same region became ill on August 1 2006. She died on August 15. H5N1 infection was confirmed. A 35 year old woman from West Java, Garut district became ill on August 8 2006. She died on August 17. H5N1 infection was confirmed. There are media reports of additional cases in this cluster.

Indonesia - 2006 September
A 11 year old boy from East Java Province became ill on September 16 2006. He died on September 18. H5N1 infection was confirmed. His 21 year old sister became ill on September 19 2006. H5N1 infection was confirmed.

A 24 year old man from West Java, Bandung became ill on September 16 2006. He died on September 24. He was not tested for H5N1 infection. His 20 year old bother became ill on September 17 2006. He died on September 28. H5N1 infection was confirmed.

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CLUSTER PAGE | 7 comments
OK... Time to Break
I think I am hurting my brain!!!!.

I will figure out how to extract from my excel and insert here later. Good day to play on the computer though... it is getting cold outside.

(Yes.... even in Florida it gets cold!)

I think I like all the cool stuff you can do here...  It will take some playing for me to build pages.  Learning keeps your brain active, right?  That's what I keep telling myself.... :)

Never believe that a few caring people can't change the world. For, indeed, that's all who ever have. ~ Margaret Mead


you can put a paragraph's worth
in the main text so that as people scan the Diaries page, they see what you are up to.

Right now, all the text is in the extended box.

The HTML markup for pics is

< img src="url" > with no spaces


[ Parent ]
Pics are a bonus
Great! and Thanks... After I finish laundry, I will try the cluster graphs... (I straightened out some of those crooked lines. :)

It might be a nice idea, also. for someone to start the humor thread and put some of those flu comics that are in the power points on the FTP, into the top of the thread... That might be an additional feature that people will appreciate, and enjoy...
Just a thought...

Never believe that a few caring people can't change the world. For, indeed, that's all who ever have. ~ Margaret Mead


[ Parent ]
now, i can do it but...
all someone has to do is start a Humor Diary, and I will promote it to the front page.

[ Parent ]
advantage to compiler people?
I think the diary format offers an advantage to people compiling information like this.  Instead of reposting something in its entirety, you can edit the existing list and put: Added on (date) to denote the new material.  Maybe.  It just seems it would be easier.

medical information provided is for discussion purposes only and should not be construed as medical advice. if you believe you have a medical problem, consult your practitioner.

thanks for the medical disclaimer reminder n/t


[ Parent ]
Thanks Lisa the GP
I am trying to figure out the differnt ways to present material... all suggestions are welcome.

Never believe that a few caring people can't change the world. For, indeed, that's all who ever have. ~ Margaret Mead

[ Parent ]
CLUSTER PAGE | 7 comments
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