New Bird Flu Cases in Turkey Put Europe on 'High Alert'
By ELISABETH ROSENTHAL
Published: January 7, 2006
ROME, Jan. 6 - Health officials in Europe said Friday that they were on "high alert" as a third child in eastern Turkey was confirmed to have bird flu and more than two dozen people there were under observation at a local hospital, an unusual cluster of human cases that raised the possibility that the virus had become more contagious to humans.
The officials have watched with concern over the last four months as the strain of bird flu known as H5N1 has moved steadily from East Asia to the edge of Europe, first in birds and now probably in humans. A laboratory in England confirmed for the first time on Friday that the three children in Turkey, two of whom died, had had the H5N1 virus. The tests pointed to the most serious N1 strain, health officials said. Further testing on samples from them and other patients was under way.
"I'm not sure we've seen a cluster like this in terms of numbers, and certainly it's a concern," said Maria Cheng, spokeswoman for the Division of Epidemic Preparedness at the World Health Organization. "Is the virus being transmitted more easily from birds to humans, or even from humans to humans? We need to put all the pieces together before we can come to conclusions."
International health authorities say the Turkish victims - the first outside of East Asia - probably became ill after close contact with sick or dead chickens infected with the virus. Reports in the Turkish press said that two siblings who died, Mehmet Ali Kocyigit, 14, and his sister, Fatma, 15, had been playing catch with the heads of dead chickens.
While the H5N1 virus does not now readily infect humans or pass between them, scientists worry that it may acquire that ability through naturally occurring processes, a development that could ultimately set off a worldwide flu epidemic.
Scientists point out that the cluster of cases in Turkey does not indicate that such a mutation has occurred. Even if additional cases of bird flu are confirmed there, some scientists say, they probably stemmed from people handling the same sick birds - not from a mutated virus that passed between humans.
Still, the W.H.O. and the European Commission were alarmed enough to dispatch a joint team of scientists to eastern Turkey this week. Both entities also said they did not believe that people in Europe were at risk, unless they had had contact with poultry in disease zones.
"Europe is on high alert," said Christine McNab, a spokeswoman in the Director General's office of the W.H.O. "But unless there is new information, the risk still lies with people who are in contact with sick birds." In Europe, Romania and Croatia have reported outbreaks.
The full extent of the cluster is unclear because tests for H5N1, which are difficult to perform, are still under way in England. Beyond the Kocyigit siblings, another unrelated boy was also found to be infected. He is severely ill in the same hospital where the siblings were treated, in the city of Van.
Two other children in the Kocyigit family were also recently hospitalized with severe respiratory disease. One died Friday, and the other is recovering, although tests have not yet confirmed their diagnoses.
An additional 26 people are in the Van hospital under observation for possible bird flu, the Turkish Anatolia news agency reported, though many will presumably turn out to have lesser ailments.
"There is naturally panic among locals who believed for many years that there was no harm in eating dead poultry," Prof. Ahmet Faik Oner, head of the Van University Hospital child care unit, said in a telephone interview. "Now is the time to change their habits without any delay in light of these casualties."
Until now, all known 142 cases of human bird flu have been in East Asia. Most have been lone cases in families, and about half of those infected have died.
Scientists in Cambridge, England, are examining virus samples from Turkey for genetic changes from the Asian variant that could make the virus more capable of jumping from birds to humans. The European Commission, which banned poultry imports from Turkey in October, after the first outbreak in chickens there, said that it was "closely monitoring the situation."
Dr. Jeremy Farrar, director of the Oxford University Research Unit in Ho Chi Minh City, Vietnam, who has treated more than a dozen people with bird flu, said the Turkish cluster was "worrying" but in no way meant that a flu pandemic was imminent or inevitable.
Dr. Farrar said that he, too, had seen a few tiny clusters of people with H5N1 in Vietnam and had concluded that they were probably caused by "common exposure" to the same infected birds.
"In rural communities, whether in Vietnam or Turkey, people live very close to poultry," Dr. Farrar said. "When a bird is prepared for a meal, the whole family is involved."
He also said that many patients now in Turkish hospitals would ultimately test negative for the disease.
"It's a horrible virus, but in the early stages it's like any pneumonia," he said. "When people are scared they have a lower threshold for going to the hospital. It's a natural reaction."
At the very least, the outbreak underscored serious gaps in the world's strategy for addressing this emerging disease. For one thing, even though chickens were dying, there were no reports of H5N1 in the remote village of Dogubayazit when the Kocyigit children fell ill.
"Especially in rural areas, we need to do more to get the message out," said Ms. Cheng, the W.H.O. spokeswoman.
Sebnem Arsu contributed reporting from Istanbul for this article.
The New York Times
New Bird Flu Case in Turkey
Linear Mode
