By Karl Vick
Washington Post Foreign Service
Saturday, January 7, 2006
ISTANBUL, Jan. 6 -- An international health team began Friday to investigate the first known fatal cases of bird flu outside East Asia, as government officials reported that a third child from a rural eastern village had died of the virus.
Specialists from the United Nations and the European Union were en route to the village of Dogubayazit, near Mount Ararat and Turkey's borders with Armenia and Iran. The disease was diagnosed last month among chickens in the village in Agri province, about 800 miles east of Istanbul.
The three victims were members of a family that had extended contact with chickens. Officials said that they were still testing to see whether the victims had contracted the most virulent strain of bird flu -- H5N1, known to be highly fatal -- but that there was no indication the virus had altered to become communicable among humans.
According to the World Health Organization, 142 people have been diagnosed with bird flu in Southeast Asia and China and 74 have died in that region since January 2004. Scientists have said that in most cases, those who contracted the disease had direct contact with infected poultry. Influenza specialists fear that the virus could develop into a form easily transmitted among humans, which they say would spark a pandemic.
A WHO official said Friday that specialists were awaiting the results of tests on virus samples sent to a laboratory in Britain. "It is very important to get the results on the genetic and virulent characteristics of this virus," said Caroline Brown, head of the WHO mission in Turkey. "I think that's crucial."
Turkish officials said they had placed Dogubayazit under quarantine after the deaths of the children: Muhammet Ali Kocyigit, 14, who died Sunday, and his sisters, Fatma, 15, who died Thursday, and Hulya, 11, who died Friday.
"This is taking us by surprise. We thought the chance to have a human case was very small," said Joseph Domenech, chief of animal health at the U.N. Food and Agriculture Office in Rome.
Officials said 20 patients were hospitalized with suspected cases of bird flu, mostly children from the same eastern border zone. Domenech said officials still needed to determine the level of contagion and whether there were suspected cases that had gone unreported.
International health officials were reluctant to criticize the Ankara government about late reporting of the human cases. After initially denying that bird flu had caused any deaths, the government has now welcomed foreign assistance in analyzing the outbreak.
The virus first appeared in northwestern Turkey in mid-October, transmitted by migratory waterfowl that flew westward across Asia. At that time, the Health Ministry announced that it was ordering 500,000 boxes of Tamiflu, an antiviral medication effective in treating the disease. But officials said physicians treating the Kocyigit children did not have a supply of the medicine.
Hospital officials launched a search of pharmacies at the hospital, located in Van province, and finally obtained a supply from a woman who said she had purchased two boxes in October. But officials said they were too late to save the infected children. To be effective, Tamiflu must be administered soon after the appearance of symptoms, officials said. The Kocyigit children had been ill for a week.
Health Ministry officials said Friday that 5,120 boxes of the antiviral drug were dispatched to eastern Turkey on Dec. 31. Serdar Etcacan, a physician at the Van hospital, said the facility now has "enough supplies in every way. We have also Tamiflu supplies now."
There has been a global shortage of the drug, manufactured by the Swiss pharmaceutical firm Roche.
Roche officials said the Turkish Health Ministry had a stock of 15,000 boxes of Tamiflu on hand. After the deaths this week, the company assembled a rush order of 100,000 more boxes, which were due to arrive Friday night, according to a Roche spokeswoman in Geneva. Each box contains 10 capsules, or one treatment course.
Prime Minister Recep Tayyip Erdogan defended the government's response to the bird flu outbreak. But his justice minister, Cemil Cicek, who also serves as spokesman for the governing Justice and Development Party, apologized Friday for having ruled out avian influenza as the source of the illnesses in eastern Turkey. "If my statement was not satisfactory, I apologize," Cicek said. "If there was any imprudence, I apologize. I apologize to my nation."
Researcher Yesim Borg contributed to this report.