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April 7, 2008 -- A Chinese father, 52, barely survived bird flu he caught from his son, 24, who died.
The December 2007 cases are only the second time scientists have demonstrated 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 two or more "epidemiologically linked" clusters of people -- usually other family members.
Of course, family members may share exposure to sick poultry. This is by far the 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 it from humans. Family members, are genetically similar. This means people may be at higher risk of catching the deadly virus from a relative than from someone to whom they are not related, suggest Nguyen Tran Hien, MD, MPH, PhD, of Vietnam's National Institute of Hygiene and Epidemiology, and colleagues in an editorial in the April 8 online issue of The Lancet.
"All family contacts of a patient with probable or confirmed H5N1 should be given [preventive treatment with flu drugs] and placed under surveillance," Nguyen and colleagues write. "Personal protection and advice must be extended to the family members and health workers visiting and looking after patients in the hospital."
The World Health Organization is currently following a cluster of human cases of H5N1 bird flu in Peshawar, Pakistan. Four members of this family fell ill -- 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 that suggested limited human-to-human transmission likely occurred among some of the family members," the WHO report states. "This outbreak did not extend into the community, and appropriate steps were taken to reduce future risks of human infections."
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, and colleagues, also in the April issue of Lancet.
The son, a salesman, lived in an urban area with his mother. He had not been feeling well since August 2007, but on Nov. 24 he came down with a fever. He was given antibiotics and 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 with antibiotics. Five days after entering the hospital, he died -- the same day a sample of lung fluid detected infection with H5N1 bird flu.
Meanwhile, the young man's father had been helping to care for him in the hospital. Even though he performed intimate care -- changing the son's diarrhea-soiled clothing and bed sheets, feeding him, and cleaning out a spittoon used for sputum -- the father was not given protective gear until the son's H5N1 infection was detected.