Genetic Clue Pursued in Families Struck by Bird Flu

Health investigators have attributed the outbreak to infected poultry, reporting that bird flu has been identified in chickens across much of the village.

Two days after the family killed and ate the infected birds, Nurochmah, 13, the first to fall sick, began coughing and developed a high fever. By the time she was taken to a district hospital six days later, she was gravely ill. The medical staff recommended she be moved to a better hospital, but she died as the ambulance was coming to transport her.

The day she died, Buenah brought their son, Indrawan, 4, to the district hospital after he came down with the same symptoms. The boy was urgently transferred to the provincial hospital, but he survived for only two days.

Another daughter, Indrawati, 14, was next to become ill, with a slight fever, not enough to keep her out of school. But health workers urged that she too be admitted to the hospital.

Her father, Kadis, joined her three days later after he began complaining of trouble breathing while overseeing the funeral for Nurochmah.

Tests confirmed that Nurochmah and Indrawan died of bird flu. Initial results were inconclusive for the father and older daughter. But international health experts said they expected that further testing would show all four had contracted the disease.

The father and daughter recovered and left the hospital two weeks ago.

The question of how Buenah eluded the virus is part of a puzzle now stumping global influenza experts. Researchers acknowledge that they know little about why some people become ill while others, with even greater exposure to the infection, remain healthy.

For instance, thousands of agricultural workers, officials and soldiers have been culling poultry across Asia in an effort to contain the spread of bird flu, at times lacking even basic protection such as gloves, masks and goggles. Yet according to WHO records, not one has fallen sick. This finding has reinforced the suspicion that some people are more susceptible than others.

"We've discussed how it's always likely there's some genetic component going on," Keiji Fukuda, WHO's influenza chief, said in a telephone interview from Geneva.

He cautioned that it was too soon to conclude that there is genetic susceptibility. Although the family pattern is suggestive, Fukuda said the size and number of clusters remain small. Moreover, even if research proves that some people are more susceptible, he said this information may have little practical benefit if the virus mutates into a form that spreads faster than people can be tested for genetic risk.

Olsen and other researchers have noted that behavior and not genetics might be the determining factor in who in a family gets sick.

Could the rest of Buenah's family have had more contact with sick chickens than she did? That's doubtful, relatives and local agriculture officials said, reporting that as a rural homemaker, she was in daily contact with livestock.

Perhaps the three children contracted the virus by playing with chickens. Could they have then passed it to their father but not their mother? Relatives said Buenah was the parent who usually looked after the children and who carried her ailing son in a sling across her chest for days.

When pressed by a reporter, Buenah suggested she was spared because she did not eat chicken when the rest of the family feasted on the sick birds. She said she had high blood pressure and avoided meat.

But back in the village, next door to Buenah's home, her mother-in-law, Jaonah, dismissed that explanation.

"Many people ate that chicken. I ate the chicken," recalled Jaonah, 70, sitting cross-legged on the porch. Beside her in the rain-soaked yard were the abruptly abandoned reminders of her family: her son's rickety meatball pushcart and her grandson's plastic tricycle. "The rest of us didn't get sick," she continued, eyes reddening. "So that can't be the reason."