May 15, 2006 (CIDRAP News) – Indonesian authorities have attributed the deaths of five members of one extended family to H5N1 avian influenza, and three surviving relatives are also suspected of having the virus, according to news services.

The five people who died all tested positive in local laboratories, according to an Agence France-Presse (AFP) report yesterday. Four had died early last week, and the fifth died yesterday, the Associated Press (AP) reported. AFP said the victims included two women, two men, and an 8-year-old girl.

Reports on the status of the three surviving relatives conflicted. Nyoman Kandun, director general of disease control for Indonesia"e;s Ministry of Health, said the three had also tested positive, according to AFP. But a Reuters report described them as suspected cases only, while some other news services did not mention them at all.

The family members, from Tanah Karo village in northern Sumatra, had all been in contact with sick poultry and pigs near their homes, Kandun told AFP.

However, agricultural minister Anton Apriyantono said that H5N1 had not been found in local poultry, according to Reuters. Officials continue to check poultry in and around Tanah Karo, the report said.

Samples from the family members have been sent to a World Health Organization (WHO)-accredited laboratory in Hong Kong for confirmatory testing. If the WHO confirmed all eight cases, the Indonesian death toll would rise to 30, and its case total would reach 41. Indonesia"e;s 33 confirmed cases and 25 deaths are second only to Vietnam, which hasn"e;t logged a human case since November 2005, according to the AP.

In addition to the five fatalities that have tested positive, a sixth family member died of suspected avian flu but was buried without being tested, the AP reported. Kandun said all nine were members of the "same family tree," according to AFP.

The WHO is paying close attention to this cluster of cases, because it may indicate human-to-human infection, according to a Reuters story. But even if human-to-human transmission occurred, it is not necessarily evidence of viral mutation, WHO spokesperson Maria Cheng told Reuters. It could be caused, as in some cases in Vietnam and Thailand, by the close contact normal in families, she said.

This family cluster, however, could also come from a common animal exposure, Cheng said. Another possible factor in family clusters of H5N1 cases, flu experts have said, is a common genetic susceptibility (see link below).

In other avian flu news, poultry outbreaks of H5N1 have been confirmed in three counties in central Romania, according to an AFP article. Romanian Agriculture Minister Gheorghe Flutur said, "Almost 1 million birds will be culled in total in central Romanian regions that have been hit or could be hit by bird flu."

Authorities have traced the outbreak to a single farmer who sold infected chickens to farms in three counties. Romanian authorities first reported H5N1 in poultry in October 2005, but the country has had no human cases.