Risk factors for cluster outbreaks of avian influenza A H5N1 infection, Indonesia.
BACKGROUND
By 30 July 2009, Indonesia had reported 139 outbreaks of avian influenza (AI) H5N1 infection in humans. Risk factors for case clustering remain largely unknown. This study assesses risk factors for cluster outbreaks and for secondary case infection.


METHODS
The 113 sporadic and 26 cluster outbreaks were compared on household and individual level variables. Variables assessed include those never reported previously, including household size and genealogical relationships between cases and their contacts.


RESULTS
Cluster outbreaks had larger households and more blood-related contacts, especially first-degree relatives, compared with sporadic case outbreaks. Risk factors for cluster outbreaks were the number of first-degree blood-relatives to the index case (adjusted odds ratio [aOR], 1.50; 95% confidence interval [CI]: 1.20-1.86) and index cases having direct exposure to sources of AI H5N1 virus (aOR, 3.20; 95% CI: 1.15-8.90). Risk factors for secondary case infection were being aged between 5 and 17 years (aOR, 8.32; 95% CI: 1.72-40.25), or 18 and 30 years (aOR, 6.04; 95% CI: 1.21-30.08), having direct exposure to sources of AI H5N1 virus (aOR, 3.48; 95% CI: 1.28-9.46), and being a first-degree relative to an index case (aOR, 11.0; 95% CI: 1.43-84.66). Siblings to index cases were 5 times more likely to become secondary cases (OR, 4.72; 95% CI: 1.67-13.35).


CONCLUSIONS
The type of exposure and the genealogical relationship between index cases and their contacts impacts the risk of clustering. The study adds evidence that AI H5N1 infection is influenced by, and may even depend on, host genetic susceptibility.
Directorate-General Disease Control and Environmental Health, Ministry of Health, Jakarta, Indonesia.
Tjandra Y
TY
Aditama
Gina
G
Samaan
Rita
R
Kusriastuti
Wilfried H
WH
Purba
Misriyah
Hari
H
Santoso
Arie
A
Bratasena
Anas
A
Maruf
Elvieda
E
Sariwati
Vivi
V
Setiawaty
Alex R
AR
Cook
Mark S
MS
Clements
Kamalini
K
Lokuge
Paul M
PM
Kelly
I Nyoman
IN
Kandun
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D005191:Family Characteristics; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D007223:Infant; D053124:Influenza A Virus, H5N1 Subtype / Q000302:isolation & purification*; D007251:Influenza, Human / Q000453:epidemiology* / Q000635:transmission* / Q000821:virology; D008297:Male; D012307:Risk Factors; D055815:Young Adult