Mar 10, 2006 (CIDRAP News) – The human toll of H5N1 avian influenza mounted again today with reports of the deaths of two young Indonesian patients, while authorities in Azerbaijan were investigating a cluster of 10 suspected human cases in one village.

The World Health Organization (WHO) listed one of the Indonesian victims as a 4-year-old boy from Semarang in central Java who fell ill on Feb 10 and died Feb 28.

The other victim was a 12-year-old girl who died Mar 1 in Solo, also in central Java, according to an Associated Press (AP) report citing Health Minister Siti Fadilah Supari as the source. The report said the WHO reference laboratory in Hong Kong had confirmed the case.

The AP also reported on the boy from Semarang but described him as a 3-year-old. Indonesian Health Ministry official Hariadi Wibisono said his case was confirmed by a local lab and later by a lab in Atlanta, according to the story.

The WHO said an investigation showed that the boy lived in a neighborhood where chickens had died shortly before he became ill. The AP report said both patients "appeared to have come into contact with infected birds."

The two cases apparently raise Indonesia"e;s count of human cases to 29 with 22 deaths and the global tally to 177 cases with 98 deaths, though the WHO has not yet noted the 12-year-old girl"e;s case at this writing.

Agricultural authorities have reported a recent increase in poultry deaths in central and eastern Java, the WHO said, adding, "These reports have led to a heightened awareness of the risk of human cases and a higher level of clinical suspicion when patients present with respiratory symptoms."

Many Indonesian patients initially suspected of having avian flu have been cleared by lab tests, the WHO added.

In Azerbaijan, authorities are investigating suspicious illnesses in 10 people, all from the same town, of whom three have died, the WHO reported in a separate statement today. Azerbaijan, a former Soviet republic on the west side of the Caspian Sea, reported its first H5N1 outbreak in wild birds on Feb 9 and found an outbreak in poultry 2 weeks ago.

The patients in the cluster are all from the settlement of Daikyand in the Salyan area in southeastern Azerbaijan, the WHO said. Their homes are near wetlands used by migratory birds, and poultry deaths have been reported in their town, but the cause was not yet known.

The surviving patients include a 16-year-old boy who is hospitalized in critical condition and six people who were hospitalized with mild symptoms but have recovered and been discharged, the WHO said.

Among the three patients who died was a 17-year-old girl who succumbed on Feb 23 after suffering for more than a year from respiratory symptoms associated with a "neoplastic condition" (tumor), the agency said. The preexisting illness is now believed to have caused her death, but samples from her will be tested in England.

The second victim was a 20-year-old woman and a neighbor of the first victim. She had rapidly progressive acute pneumonia—typical of H5N1 cases—and died Mar 3, the WHO said. The third victim, a 17-year-old girl, died Mar 8; officials gave no details on her illness.

The agency did not say whether any of the patients or victims are related. But an Agence France-Presse report published yesterday quoted WHO spokeswoman Maria Cheng as saying the cluster includes eight members of one family.

If any of the cases are determined to be H5N1, Azerbaijan will be the eighth country to face human cases. The list now includes Vietnam, Thailand, Cambodia, Indonesia, China, Turkey, and Iraq.

The WHO said the Azerbaijani health authorities have responded well to the situation but have been hampered by a lack of some essential equipment and inadequate diagnostic capacity. A WHO team is in the country to assess needs and provide technical support, and more personnel and supplies are due to arrive Mar 13, the agency said.

The patients in the cluster have been treated with oseltamivir (Tamiflu), a limited supply of which is available in the country, the WHO said.