Fatal H5N1 Bird Flu Cases in Azerbaijan Expand
Recombinomics Commentary March 14, 2006

Two of the cases were from the south-eastern rayon of Salyan, but resided in different settlements. The cases occurred in a 17-year-old girl, from Sarvan settlement, who died on 23 February, and a 20-year-old woman, from Daikyand settlement, who died on 3 March.

The third case occurred in a 21-year-old woman from the central-western province of Tarter. She died on 9 March.

The above comments from today's WHO update on Azerbaijan indicates the familial cluster is growing in size and length and is linked to a geographical cluster in Azerbaijan. Five deaths have been reported and media reports indicated the other two fatalities also tested positive for H5N1 bird flu. Media reports indicate all victims are from two families, suggesting human-to-human transmission.

This mode of transmission is further support because the index case, who died February 23 is the cousin of the case who died March 3. Although the WHO update again withholds disease onset dates and relationships between H5 positive patients, the spread between the dates of death support human-to-human transmission. This transmission chain appears to have extended to the third generation because the 16 year-old male who died on March 10 was the brother of the patient who died on March 3.

This cluster is similar to the cluster of clusters in Turkey. In that cluster HA S227N was isolated from the index case. This genetic change increases the affinity of HA for human receptors and may be responsible for the cluster in Azerbaijan based on location and size of the clusters.

A mobile lab has been set up in Azerbaijan and WHO is sending additional personnel. More details on onset dates, familial relationships, and H5N1 genetic changes, would be useful.