Feb 13, 2006 (CIDRAP News) – As the H5N1 virus spreads, so does the toll of human illness cases and deaths known or suspected to be due to the deadly influenza.

The World Health Organization (WHO) today announced that two human deaths in Indonesia have been confirmed as H5N1 cases. The agency identified the victims as a 22-year-old woman who fell ill Jan 25 and died Feb 10, and a 27-year-old woman who fell ill Jan 31 and died Feb 10. The cases were first reported last week when tests in local laboratories were positive.

They hailed from different areas of West Java province. No direct contact with poultry was reported, although both women had poultry near their homes, and some poultry died in the 27-year-old"e;s neighborhood 4 days before she fell ill.

The Jakarta Post"e;s online edition also noted that a man from East Jakarta who died Feb 10 had tested positive for H5N1 in local tests. The WHO tally for Indonesia stands at 26 cases and 18 deaths, excluding that man.

Bloomberg news service reported today that an Indonesian couple and their 2-year-old daughter are being treated for possible avian flu. If confirmed, those cases could represent the country"e;s sixth cluster of human infections, a doctor at the Jakarta hospital that admitted them yesterday told Bloomberg.

In addition, the WHO has confirmed the 12th human case in China, first reported by Chinese officials last week. The case involved a 20-year-old woman in Hunan who became ill on Jan 27 and died Feb 4, following the culling of poultry in her household, WHO said.

Overall, the WHO said today, 169 people have fallen ill with H5N1 infections, and 91 of them have died.

Along with the rapid spread of the virus—which was confirmed in poultry in five new countries last week—people with suspected H5N1 infections are appearing around the globe.

In Nigeria, blood samples from two children living on a poultry farm are being tested for evidence of H5N1 infections, according to Agence France-Presse (AFP).

The 4-year-old boy and 4-month-old boy had high temperatures and coughed up blood 2 weeks ago, their father told Reuters news service. The signs and symptoms appeared at about the same time that 250 of the farmer"e;s geese, turkey, and chickens suddenly died.

"The two of them were coughing and if they sneezed, blood came from their nose and throat," father Isaac Achi said. "I took them to the hospital and they recovered." The family"e;s farm is near a farm where the virus was confirmed in poultry.

Officials are having a hard time changing Nigerian cultural norms to persuade people to follow safer poultry handling practices, Reuters reported.

"I have been in the field and they say, "e;What are you telling us? We eat dead chickens and we have been doing that for centuries,"e;" said Abdulsalam Nasidi, who is overseeing efforts to prevent the spread of the virus among people.

Ironically, the fact that polio is endemic in Nigeria may prove helpful in the fight against avian flu there, a Washington Post report said today. Thousands of vaccinators and surveillance officers are already in place in Nigeria to stem the spread of polio.

"The polio organization has offered to use all its network to deliver information, and also for surveillance and case detection," said Mohammed Belhocine, WHO representative in Nigeria. "We are going to support all kinds of activities to mitigate the impact of avian flu."

For example, field supervisors are teaching village leaders chicken-avoidance messages and allowing the leaders to decide how best to spread the word in villages, said David L. Heymann, director of the WHO polio eradication efforts.

In Greece, where avian flu was confirmed in some wild swans last week, two people who had contact with dead or wounded birds are now being tested for avian flu, Bloomberg reported today. A 19-year-old hunter developed a high fever and collapsed after handling two ducks, and a 29-year-old man rescued an injured swan and later developed flulike symptoms. Both are hospitalized, Bloomberg reported.

In southern Iraq, investigators were looking into six suspected human H5N1 infections, the New York Times reported yesterday. One of the cases involves a 25-year-old fisherman who died after having contact with his backyard poultry. He had been ill for more than 2 weeks. Five of his cousins, who lived with him in Amara and also had contact with the household poultry, were also being tested.