The three deaths in Turkey, all children from the same family, mark the virus’ first occurrence in people outside Southeast Asia and China.
According to the World Health Organization, Turkish health authorities said that since Jan. 1, a total of 11 patients have been hospitalized with symptoms suggesting infection with avian influenza.
Doctors said some of the victims — most between the ages of 6 and 15 — had been playing with the severed heads of infected birds. All the patients live in the Dogubayazit district near the Armenia and Iranian borders, a district that has not officially reported an outbreak of H5N1 in birds but where people live in close contact with poultry. Turkish authorities informed the WHO that the district has been placed under quarantine.
The WHO has sent investigators to the region to look for signs that the virus has spread from person to person. Most human cases have occurred after close contact with sick birds. Health experts fear that if preventive measures are not taken, the disease could mutate to spread easily between humans and spark a worldwide pandemic.
Turkey lies on the path of migratory birds believed to be responsible for spreading the virus from Asia. It reported the first outbreak of H5N1 avian influenza in poultry in mid-October of 2005. According to the WHO, that outbreak was attributed to contact between domestic poultry and migratory waterfowl. Most of Europe imposed a ban on imports of Turkish live birds at the first sign of avian outbreaks but have since eased the measures.
In China, where three of the seven human cases have proved fatal, authorities are still not sharing virus samples from animals infected with the H5N1 strain of the bird flu despite requests from the WHO and other international health bodies.
“It means that there is a question mark that hangs over the progress of the virus in China,” WHO’s Beijing-based spokesman Roy Wadia said late last week. “It’s perhaps more significant to get animal viruses because this virus is something that is primarily in the animal sector.”
The WHO said it was unclear why China was not sharing the samples but also said there was no evidence of a SARS-style cover-up. In early December, China did agree to share virus samples isolated from human bird flu cases.
On Dec. 29, China confirmed its third human death from the H5N1 strain of bird flu. The 41-year-old woman had apparently contracted the disease in the southeastern province of Fujian, an area that had not officially reported previous outbreaks among birds. China has confirmed seven human cases of bird flu and new outbreaks in birds despite its nationwide effort to vaccinate all 14 million farm birds.
According to the WHO, investigators have not been able to confirm any direct contact between the woman and poultry prior to her illness.
To help alert countries at risk along migration flyways, United Nations experts are developing a bird flu warning system that maps the routes of migratory birds. Officials said a pilot project is expected to be operational within six months and the final plan should be running in two years.
But health officials worry a widespread flu outbreak could occur before then. WHO experts have said the threat of another influenza pandemic is at its highest since 1968 when the last pandemic occurred. On its global pandemic alert scale, the world is currently at Phase 3 of 6, meaning a new influenza virus is causing disease in humans but has no or very little human-to-human transmission. Phase 6 signifies a pandemic where efficient and sustained human-to-human transmission occurs.