AR-News: (US-NY)Westchester Man Has Avian Flu, Federal Officials Confirm

[Ronda Roaring]

Westchester Man Has Avian Flu, Federal Officials Confirm

April 20, 2004
By RICHARD PÉREZ-PEÑA and LAWRENCE K. ALTMAN 

The case of a Westchester County man who survived an
extremely rare case of avian flu last fall has local, state
and federal health officials grappling with a troubling
mystery. 

Five months after the patient checked into Westchester
Medical Center complaining of fever and cough, no one can
say how he was infected with avian influenza. The man
recovered and went home after a few weeks, but it was not
until a month ago that the federal Centers for Disease
Control and Prevention suspected an avian virus had caused
his illness, and only last Friday that the centers
confirmed that diagnosis. 

As health officials continue to interview the man, his
family and people he has contacted, they have found no
evidence that he had contact with contaminated birds, the
only proven way avian flu can be contracted, forcing them
to consider another means of transmission. 

Health officials say that any new case of avian flu must be
taken seriously because it can spread rapidly among birds
and it can be quite serious in humans on the rare occasions
when they are infected. In recent years, cases of avian flu
in Asia, Europe and North America have prompted the
slaughter of millions of chickens and ducks. The World
Health Organization has sounded an alarm because some
strains of the virus - not the one found in Westchester -
have killed people, including at least 16 victims in
Vietnam and Thailand early this year. 

Invariably, the human victims have turned out to be people
who had close contact with birds. In the only previous case
in the United States, in 2002, the patient was a poultry
worker in Virginia. 

Human cases that do not fit that pattern are particularly
worrisome because scientists theorize that inside a human
host, the viruses for avian and human influenzas could swap
some genetic material, creating an avian flu that transmits
readily from person to person. They fear that such a
development could lead to a flu pandemic like the one that
killed tens of millions of people in 1918 and 1919. 

Local and federal health officials say they have found no
evidence that the Westchester County patient had direct
contact with birds or had traveled to any region affected
by avian flu. 

"We can't figure out how he was exposed and why he's an
isolated case," said Nancy J. Cox, an influenza expert at
C.D.C. "We need to understand how he got infected." 

Dr. Joshua Lipsman, the Westchester County health
commissioner, said, "While we can't rule out it being
person-to-person transmission, the likelihood is still very
small." He added that the patient "had some potential
exposures that we're looking into," but declined to
elaborate. 

Officials said the man was infected with Type A influenza,
Strain H7N2, the same one that hit chicken farms in New
Jersey, Maryland and Delaware this year. The H7 viruses are
thought to be less virulent in humans than the H5 strain
that appeared in Southeast Asia in recent months. Other H7
strains were responsible for outbreaks in Canada this year,
and in the Netherlands last year. 

The Westchester patient, a Caribbean immigrant, lives in
Yonkers with his wife and children, officials said.
(Hospitals and health officials do not reveal the names of
patients in cases involving public health issues.) He
entered the hospital in November suffering from other
serious ailments that weakened his immune system and that
might have masked the symptoms of avian flu. One official
said the patient had symptoms of a respiratory illness,
including coughing and an abnormal chest X-ray. Doctors at
first suspected tuberculosis. 

"We knew it was something weird, but we didn't know what it
was," said Claire Palermo Flower, spokeswoman for the
hospital. "They did an elaborate culture and asked the lab
to do more than the usual tests." 

The county's laboratory tentatively identified the virus as
a human flu strain, H1N1, and sent sputum samples to C.D.C.
in Atlanta, said Ms. Flower and Dr. Cox. The specimen was
set aside because few H1N1 cases were reported last winter,
and the centers routinely concentrate on testing the most
prevalent strains. 

It was not until February that C.D.C. tested the sample,
when scientists there found that the virus was not from the
H1 group, Dr. Cox said. A subsequent test ruled out another
family of flu viruses, Type B. Further testing showed that
it was Type A, but not the H1, H3 or H5 subtypes. 

Finally, on March 17, scientists using other tests
identified the virus as H7N2. The next day, Dr. Cox said,
C.D.C. notified health officials in New York that they had
a suspect human case of avian flu. To be certain that the
sample had not been contaminated in a laboratory, they did
further tests. 

Doctors asked the patient for another blood sample, to
compare antibody levels in it with another sample kept from
the initial phase of his illness. Last week, the tests
confirmed a recent infection with H7N2, and the C.D.C.
alerted state and local officials in a conference call on
Friday. 

Westchester officials and the state Department of Health
have also tested the man's family, co-workers and close
contacts - none of whom were sick - without finding
evidence that any had also been infected. 

C.D.C. officials said the federal agency did not believe
that the case represented an imminent threat to public
health. 

Dr. Cox said C.D.C. reported the case Monday to the World
Health Organization, which has repeatedly warned about the
threat of avian flu. But a W.H.O. spokesman said that as of
5 p.m. in Geneva, where the agency is based, no such report
had been received. 


Copyright 2004 The New York Times Company


		
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