15th Turk Is Found to Have Bird Flu

A Turkish veterinary official in protective gear runs after chickens in the snow-covered city of Van, in far eastern Turkey.
A Turkish veterinary official in protective gear runs after chickens in the snow-covered city of Van, in far eastern Turkey. (Anatolian News Agency Via Reuters)

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By Daniel Williams and Alan Sipress
Wednesday, January 11, 2006

ISTANBUL, Jan. 10 -- Authorities confirmed a new human case of bird flu Tuesday as Turkey and its neighbors rushed to defend themselves against the disease, which international health officials said had spread more quickly and broadly across the country than originally believed.

Preliminary tests showed that 15 people have been stricken with the sometimes deadly H5N1 strain of the disease, Turkish officials said. A 14-year-old boy and his sister, 15, died of the disease last week in far eastern Turkey. A third sibling, an 11-year-old girl, also died, but tests have yet to confirm that she had bird flu.

Since the first outbreaks in late 2003, those infected with avian flu have had close contact with poultry. The virus does not readily jump from person to person, but health researchers are concerned that it could change into a form that would ease such contagion, signaling the start of a pandemic. The World Health Organization reports a total of 143 infections in Indonesia, Thailand, Cambodia, Vietnam and China, with 76 fatalities.

"The more humans infected with the avian virus, the more chance it has to adapt. We may be playing with fire," said Guenael Rodier, a senior WHO communicable disease specialist who has spent two days in Turkey investigating the outbreak.

Rodier said in an interview that cases of infected birds are being reported in areas of Turkey that animal health officials had considered free of the virus. "It seems like it has spread much more widely in animals and in more districts that was initially thought," he said.

The number of cases could reflect an increase in public awareness and anxiety about the disease, prompting scores of Turks who have come into contact with sick birds to get medical attention, Rodier added. This could mean that hospitals are now catching human cases they might have otherwise missed.

WHO investigators and medical experts spent two days visiting the rural village of Dogubayazit, where the brother and sister caught the disease, and a hospital in the nearby city of Van before returning to the capital, Ankara.

"The picture is quite clear. We have a situation similar to what we've seen in Asia so far," Rodier said. "There are a number of small-size family clusters of disease, including many children that had contact with infected birds, in particular backyard poultry, particularly backyard chickens."

It is not surprising that children contracted bird flu because, in villages, they often play with domestic fowls and keep them as pets, Rodier said. "With sick chickens, it is easier to catch them than healthy ones," he said.

The Istanbul newspaper Sabah published an account of a child and her attachment to chickens as pets. It reported that in Van a 9-year-old, identified as Sumeyye, became ill after mourning dead poultry. Her brother, Enes, said, "Only Sumeyye got sick because, despite all our warning, she kept on touching the dead chickens and crying for them."

In a hospital in the north-central city of Sivas, a patient, Gulsen Yesilirmak, told CNN-Turk television that she fell ill after removing dead chickens from a coop. "I threw out one, and another died and I threw out that, too. Then I got sick," she said. "I sat down exhausted and I had a headache." She appeared to be short of breath and wore a surgical mask.

Health officials have been dispensing leaflets warning against handling birds, television stations broadcast hand-washing instructions, and preachers at mosques used the occasion of the Muslim festival of Eid al-Adha to warn against the disease.

Flu cases in Istanbul, although they have yet to be confirmed as originating with birds, prompted health officials to quarantine three city districts on the European side of the city, in order to disinfect vehicles leaving the area and cull birds within it. So far, Turkey has killed more than 300,000 domestic birds in hopes of squelching the spread of H5N1.

Addressing criticism that national health authorities ignored the deaths and illness of poultry in the far east until the children from Dogubayazit died, Prime Minister Recep Tayyip Erdogan said, "Everything is under control. Unfortunately, a mood of panic has emerged which gives an impression Turkey is under invasion." The number of people hospitalized with symptoms climbed to about 70, Turkish officials said.

Turkey's neighbors took precautions to keep the disease from jumping borders. Greece intensified border checks by veterinary officials. Bulgaria was testing the remains of a dozen dead hens from a village near the Turkish border to check if they had died of the disease. It also has banned poultry imports from its neighbors, forbidden hunting of wild birds and told farmers to keep domestic fowls indoors. Ukraine reported a new outbreak of bird flu in Crimea, but officials said they were unsure whether the poultry was struck by the H5N1 strain. Chicken deaths in Crimea during December prompted officials to kill about 90,000 birds in an effort to curb the outbreak.

Michael L. Perdue, who is running the WHO's response to the Turkish outbreaks from the agency's headquarters in Geneva, said initial genetic sequencing of human and animal samples from Turkey indicate there have been "interesting changes" in the makeup of H5N1. He said that the agency received this information Tuesday and that it would take several weeks for experts to determine whether these genetic changes were significant for the behavior of the virus.

But he said researchers had already been able to determine from this sequencing information that the virus infecting people in Turkey was almost identical to that in poultry. "They are very similar to each other, so it verifies that the animal seems to be the source for the human infection, which we assumed," Perdue told journalists in a teleconference.

Sipress reported from Jakarta, Indonesia.

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