WHO issues Azerbaijan update

It has been almost a week since first reports of a cluster of cases in Azerbaijan started circulating. WHO has now issued an update.

The first infected birds were discovered near Baku on February 9. Two other outbreaks announced on February 24, one near Salyan district 80 miles south of Baku. Salyan is near a wetlands that are also home for migratory birds and an outbreak in poultry was reported in nearby Dakyand settlement.

The first human case, a 17 year old girl, was reported on February 23, but her death was thought to be related to an underlying medical condition. Samples were sent to WHO for analysis as a precaution. On March 3 a 20 year old died from a virulent respiratory infection that looked like avian influenza. At that point the Azerbaijan Ministory of Health began a household survey for respiratory disease and fever in her neighborhood. Eight people were hospitalized for observation as a result, but six had mild symptoms and have recovered. WHO reported that one of the two remaining patients, another 17 year old girl, died on March 8, and now Xinhuanet reports that the other case, a 16 year old boy, died yesterday (March 10).

Laboratory confirmation of these ten cases is still not available:

Of the Azerbaijan cases, World Health Organisation spokeswoman Maria Cheng said: "There have been three deaths [now four], with symptoms somewhat similar to H5N1 infection.

"The samples are from a cluster of 10 or 11 people in a region where H5N1 has apparently led to a die-off in birds."

Azerbaijan's Deputy Health Minister Abbas Velibeyev said a family of six may have contracted the disease.

The preliminary diagnosis was severe pneumonia, but suspicions were raised after two children died and it was discovered the family kept chickens, he said. (Sky News)

The size of this cluster is unusual and if confirmed as H5N1 would be a worrisome sign there might be a change in the transmissibility of the virus, either in bird to human, or worse, bird to human to human, depending on the facts. At the moment these are still diagnoses of "rule out H5N1 infection," but we are wondering what the delay is. It may just be difficult logistical arrangements in getting the samples to the WHO reference laboratory. Or it may indicate that further tests on isolates, possibly including sequencing, is being done. WHO's statements seem unusually cautious.

We'll have to wait and see.