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Human To Human Transmission Cluster: Pakistan Might Be at High Risk of Bird Flu (H5 N1) Epidemic

Muhammad Khurram Shahzad, Muhammad Athar Khan, Tayyaba Ijaz,Sadia Ijaz.

Abstract
Continuing outbreaks of highly pathogenic avian influenza (HPAI) in a number of Asian countries, caused by an influenza type A virus of H5N1 subtype represent a serious risk for animal and public health worldwide (Ilaria and Stefano, 2004). New serotypes go on emerging between epidemics as a result of either through antigenic shift or through the recombination process between Human and Animal Influenza viruses. The later school of thought is more supportive since human Antigens have been found in cells infected with different strains of Animal influenza virus. The disease in animal and humans occurs in all the possible epidemiological farms I, E., sporadic endemic (enzootic) epidemic (epizootic) and pandemic (pan-zootic) in different parts of the globe. (Pilaipan et al., 2005, Capua et al., 2004, Murphy et al., 1996 and Webster et al., 1982)
Pakistan recorded first epizootic of Avian Influenza (H7N1) during 1994 fallowed by the second in 2003 killing more than 3.5 million poultry. The country experienced 48 outbreaks in 2006, 59 in 2007, and Eight during the first four month of years 2008. The bird flu (H5 N1) is zoonoses and about 128 people suspected of carrying the virus were tested for H5N1 in 2006, 146 in 2007, and 11 in 2008 (Anonymous, 2008). The alarming situation created panic when two brothers in a family died due to Bird flu (H5N1) during direct contact with the Index case in a hospital. The Index case and another direct contact person survive during this person to person contact epidemic. The Index case, and one dead contact person and other survived contact were confirmed H5 N1 cases through PCR and Serology. The sample of the other contact with the Index cases could not be obtained possibly because of socio-cultural constraints. The index case, a veterinarian, who had a job in an infected poultry farm with H5N1, probably contracted the disease which was later on confirmed through PCR and serology (WHO, 2008, 2007).The avian influenza A (H5N1) epizootic has resulted in sporadic human cases and case clusters. Previously, H5N1 case clustering was observed in cousins in 1997 (Anonymous, 1997) and in a father and son in 2003 in Hong Kong (Peiris et al., 2004). H5N1 clustering was described in 2004–2005 but without sufficient information to assess whether human-to-human transmission had occurred (Olsen et al., 2005). Although only one likely instance of limited human-to-human transmission of H5N1 virus was detailed in Thailand in 2004,( Ungchusak, 2005) the investigation of case clusters is critically important, since an increase in clusters could suggest greater transmissibility of H5N1 viruses, In Pakistan Human to human transmission in a family cluster was confirmed by the WHO. Although vaccination programs have been recommended, there is field evidence that vaccination alone will not achieve eradication, and if not used appropriately it may result in the infection becoming endemic (Ilaria and Stefano, 2004). Attempts at contro



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