Q & A: Bird Flu Emerges in Turkey
The Kocyigit family mourns at a cemetery in the eastern Turkish town of Dogubayazit after the loss of two of their children to bird flu.
Six provinces in Turkey, highlighted here have confirmed or suspected human cases of bird flu.
Six provinces in Turkey, highlighted here have confirmed or suspected human cases of bird flu.
Bird Flu Q & As
More than 50 people in Turkey are being tested for the H5N1 strain of bird flu. Already the outbreak there is the largest seen since 1997, with almost as many cases as Indonesia reported in the last half of 2005. NPR science correspondent Richard Knox answers questions about this troubling outbreak:
Q: How many cases of bird flu in humans are there in Turkey?
A: Turkey has confirmed 15 human cases this month, with at least two fatalities. A teen-aged brother and sister living near the country's Iranian border died in early January. (Tests are pending on a third child in that family who has died.) Some 40 others at a hospital in the eastern Turk city of Van, where the siblings died, are being tested and monitored for possible bird flu. The World Health Organization (WHO) is awaiting independent testing at a U.K. laboratory before backing Turkey's results.
The outbreak in Turkey is the largest since the first human cases of H5N1 appeared eight years ago in Hong Kong. In that outbreak, 18 infections and six deaths were reported.
Q: How is the virus being spread?
A: The pattern of infection in Turkey so far fits the pattern of disease in other countries -- that is, through human contact with infected birds. Turkey's fatalities have occurred in a rural, eastern region where people live in close contact with poultry. The siblings who died were reportedly playing with the carcass of an infected chicken.
Investigators are also comparing strains of the Turkish virus with H5N1 samples from elsewhere. According to WHO, initial analysis suggests virus samples from human cases in Turkey are a genetic match for samples from poultry there, which suggests the virus has passed from animals to humans rather than person-to-person.
Q: What about this outbreak has investigators most worried?
A: The relatively high number of suspected human infections in Turkey in such a short period might mean that the virus there has mutated to become more easily spread from poultry to people. This may not be apparent through genetic analysis, though, since scientists do not know what gene sequences are associated with transmissibility. Analysis of transmission patterns might reveal if the Turkish virus is more contagious.
Q: Most of the cases in Turkey are in children. Are they more susceptible to H5N1 than adults?
Not necessarily, according to Guenael Rodier, a lead investigator with the WHO. Chickens tend to be treated as pets in rural Turkey, and children may be more likely to come into contact with sick chickens, which are easier for children to chase and catch.
One new feature of the Turkish outbreak is that at least two children have tested positive for the H5N1 virus without showing symptoms. This could reflect a high degree of awareness --- parents are bringing children in for testing if they've been exposed to sick chickens, before infected children have had time to develop symptoms. It could also mean that some H5N1 infections are mild or asymptomatic, as a recent study in Vietnam suggested. In the past those milder infections may not have been picked up.
Q: What measures are being taken to protect people in Turkey?
A: In the 10 provinces where there are outbreaks of H5N1 in birds, extensive slaughtering is under way in an attempt to prevent the spread of the disease. Vehicles are being sprayed with disinfectant at the entrance to the city of Van, where most of the suspected cases are. A phone hotline has been set up for people to report loose or sick poultry. And several thousand doses of Tamiflu, which can shorten the duration of the illness and perhaps prevent fatal infections, are being sent to hospitals treating suspected cases.
Q: How have countries around Turkey responded?
A: Bird flu is clearly moving westward from Asia -- and possibly faster than predicted, according to the WHO. That has the European Union worried. When outbreaks in poultry were first reported in Turkey last October, the EU banned imports of whole birds from Turkey and its neighbors, such as Iran, Iraq and Azerbaijan. The EU has responded to this latest outbreak by adding a ban on imports of untreated bird feathers from the same countries.
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