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Bird Flu Jumped From Son to Father

Family Members of Bird Flu Cases May Be at Risk

Medically Reviewed by Louise Chang, MD on April 07, 2008
From the WebMD Archives

April 7, 2008 -- A Chinese father, 52, barely survived birdflu he caught from his son, 24, who died.

The December 2007 cases are only the second time scientists havedemonstrated probable human-to-human transmission of the H5N1 bird flu virus.But a fourth of the 378 known human cases of H5N1 bird flu have occurred in twoor more "epidemiologically linked" clusters of people -- usually otherfamily members.

Of course, family members may share exposure to sick poultry. This is by farthe main way people get the virus. That's because H5N1 is still a bird virus,and has not adapted to human hosts.

However, the virus may well adapt to individuals unlucky enough to catch itfrom humans. Family members, are genetically similar. This means people may beat higher risk of catching the deadly virus from a relative than from someoneto whom they are not related, suggest Nguyen Tran Hien, MD, MPH, PhD, ofVietnam's National Institute of Hygiene and Epidemiology, and colleagues in aneditorial in the April 8 online issue of The Lancet.

"All family contacts of a patient with probable or confirmed H5N1 shouldbe given [preventive treatment with flu drugs] and placed undersurveillance," Nguyen and colleagues write. "Personal protection andadvice must be extended to the family members and health workers visiting andlooking after patients in the hospital."

The World Health Organization is currently following a cluster of humancases of H5N1 bird flu in Peshawar, Pakistan. Four members of this family fellill -- three with confirmed bird flu and one with "probable" bird flu.Two died and two recovered fully.

"Laboratory tests results support ... the final risk assessment thatsuggested limited human-to-human transmission likely occurred among some of thefamily members," the WHO report states. "This outbreak did not extendinto the community, and appropriate steps were taken to reduce future risks ofhuman infections."

Father Gets Bird Flu from Son

Details on the sad case of the Chinese father and son come from Hua Wang,MD, of the Jiangsu Provincial Center for Disease Control and Prevention, andcolleagues, also in the April issue of Lancet.

The son, a salesman, lived in an urban area with his mother. He had not beenfeeling well since August 2007, but on Nov. 24 he came down with a fever. He was given antibioticsand sent home. Three days later he was hospitalized with pneumonia.

Blood cultures on Nov. 28 detected a Salmonella infection(probably the cause of his earlier illness) and he was treated withantibiotics. Five days after entering the hospital, he died -- the same day asample of lung fluid detected infection with H5N1 bird flu.

Meanwhile, the young man's father had been helping to care for him in thehospital. Even though he performed intimate care -- changing the son's diarrhea-soiled clothing and bedsheets, feeding him, and cleaning out a spittoon used for sputum -- the fatherwas not given protective gear until the son's H5N1 infection was detected.

Two days after his son died, the father developed a fever, chills, and cough. He took a dose ofTamiflu that had been provided. The next morning, he was hospitalized. Despitetreatment with flu drugs, he got worse, requiring positive-pressureventilation.

Four days later, he received two transfusions of plasma from a woman who hadreceived two doses of an experimental H5N1 vaccine in an early-stage clinicaltrial. That night, the father's fever resolved. He left the hospital 22 daysafter admission.

Both the father and son were infected with virtually identical H5N1 strains.Six days before his illness, the son visited a market where poultry wereslaughtered. Even though he did not visit the poultry booths, the marketappears to be his only possible contact with infected poultry -- althoughnobody else appears to have been infected and there was no known H5N1 outbreakamong poultry in the region.

The father, too, had been to a market that slaughtered poultry as recentlyas eight days before his illness, but given the incubation period for bird flu-- three to six days -- Hua and colleagues feel the father's exposure to theson was a much more likely source of infection.

One hundred other people were exposed to the son, including his girlfriendand a doctor who came down with a cough and fever. But tests showed none ofthese people had become infected.

"H5N1 clusters require urgent investigation because of the possibilitythat a change in the epidemiology of H5N1 cases could indicate that H5N1viruses have acquired the ability to spread more easily among people," Huaand colleagues warn.

The World Health Organization has officially confirmed 378 human cases ofbird flu, with 238 deaths, in 14 countries.

Show Sources

SOURCES:

Hua Wang, The Lancet, published online, April 8, 2008.

Nguyen Tran Hien, The Lancet, published online, April 8, 2008.

World Health Organization: "Cumulative Number of Confirmed Cases of Avian Influenza A/(H5N1) Reported to WHO," April 3, 2008.

World Health Organization: "Avian Influenza -- Situation in Pakistan -- Update 2, April 3, 2008.

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