Feb 20, 2006 (CIDRAP News) – Two human cases of H5N1 avian flu have been confirmed by the World Health Organization (WHO) in recent days—one each in Iraq and Indonesia—and dozens of sick people in several countries are being tested.

In addition, the WHO said today that studies of the human H5N1 cases in Turkey have produced no clear evidence that the virus has changed its behavior in humans or improved its ability to spread from person to person.

The newly confirmed cases in Iraq and Indonesia had been reported earlier when initial testing indicated H5N1. Their confirmation brings the global total of avian flu cases to 171 cases with 93 deaths, although the WHO"e;s case count hadn"e;t been updated to reflect the Iraqi case at this writing.

Indonesia"e;s 19th fatal human case involved a 23-year-old man from East Jakarta who sold eggs at a wet market, WHO said today. He became ill on Feb 5 and died Feb 10. His was the 26th human infection in Indonesia. None of his contacts appear to have contracted the illness, WHO said.

Indonesian Health Minister Siti Fadilah Supari told Agence France-Presse (AFP) on Feb 18 that the government was boosting its stockpile of the antiviral drug oseltamivir, which has been used to treat people suffering from the H5N1 infection.

In addition, authorities are urging Indonesians to close down backyard farms to lessen the risk of infection from birds, AFP reported. The suggestion pales in comparison with measures in Hong Kong, where governmental orders led to the culling of all backyard flocks, despite homeowners"e; objections.

In Iraq, a 39-year-old man who died Jan 27 in Sulaimaniyah was confirmed as an avian flu victim by the WHO on Feb 17. His 15-year-old niece had died of H5N1 illness on Jan 17. She had the first confirmed human case in that country.

Those two cases may be the harbinger of many more, authorities fear. The Iraqi Ministry of Health yesterday said that tests were under way in 13 new suspected human infections in the southern governorate of Missan, and an additional 12 suspected cases were being investigated in Sulaimaniyah, according to a story by the United Nations Integrated Regional Information Networks (IRIN).

"They"e;ve been showing symptoms very similar to those of bird flu," said Ibtissam Azize, spokesman for the avian flu program at the health ministry.

Tests were negative in another 14 suspected cases, said WHO spokeswoman Maria Cheng, speaking to IRIN from Geneva.

No human cases have been found in India, where poultry outbreaks have been confirmed. However, concern is high and at least one farmer has been tested for H5N1 infection, Reuters news service reported yesterday.

The Indian government said that as of Feb 18, six people from Navapur were known to have "upper respiratory tract infection with mild fever" along with a history of poultry deaths in their backyard farms, Reuters reported. Two of them were under hospital isolation.

Reuters reported today that another three children from Nanandurbar district in Maharashtra state were quarantined.

The government said about 100 samples had been sent to two laboratories in India, and results were expected within 4 days, according to a Feb 18 Reuters report. Despite the concern about the possible spread of H5N1 to people in India, the report said poultry workers were burying culled chickens with their bare hands.

In a separate statement today, the WHO said that recent evidence of mutations in some H5N1 viruses isolated from humans has not been accompanied by a change in the epidemiology of the disease in humans.

In January the agency reported that hemagglutinin mutations had been found in some human viruses isolated in 2005 and from one of the four fatal cases that occurred that month in Turkey. Officials expressed concern that the mutations might make it easier for the virus to jump from birds to humans. Turkey has had 12 confirmed human cases, which emerged rapidly in January, raising fear that the virus had changed.

Today the WHO said, "The effect of these changes on transmissibility of the virus, either from birds to humans or from one person to another, is not fully understood. Moreover, recent studies show that these mutations were transient and did not become fixed in the circulating viruses."

The statement went on to say that scientists don"e;t know which specific mutations it would take to enable the virus to spread easily from person to person.

"Assessments of the outbreak in Turkey, conducted by WHO investigative teams, have produced no convincing evidence that mutations have altered the epidemiology of the disease in humans, which [in Turkey] was similar to the pattern consistently seen in affected parts of Asia," the WHO said. "There is no evidence, at present, from any outbreak site that the virus has increased its ability to spread easily from one person to another.