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HEALTH

6 more bird flu cases in Indonesia

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Mayo Clinic
• Infectious Disease

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Bird Flu
Indonesia
World Health Organization (WHO)

(CNN) -- Six more human cases of the H5N1 strain of avian flu have occurred in Indonesia, the World Health Organization has said, citing Indonesia's Ministry of Health.

Three of the cases were fatal.

That means 48 of the 224 human cases confirmed worldwide by the organization have occurred in Indonesia. Thirty-six of the Indonesian cases have proven fatal.

Only Vietnam, with 93 cases, 42 of them fatal, has tallied more.

Four of the infected people had been exposed to chickens or pigeon feces.

Investigators are still looking into how the other two contracted the virus.

WHO spokesman Dick Thompson told CNN it was highly unlikely that human-to-human transmission was responsible for any of the six cases, given that all but two they were separated by great distances.

And those two -- a brother and sister who have since died -- both got sick on the same day, making it unlikely one could have infected the other, Thompson said.

The six new cases are not related to a cluster of at least seven cases -- all of them blood relatives -- reported last week in Kubu Sembelang village, Karo District, of North Sumatra, Thompson said.

WHO has said the virus in that cluster may have been spread by human-to-human contact. The overwhelming majority of human cases to date have been linked to exposure to poultry.

Seven of eight family members died in the outbreak. The first case was not confirmed to be H5N1 since the body was buried without tissue samples being taken.

Health officials have long been concerned that a mutation in the virus would make it spread easily among humans. But laboratory tests show that has not happened, Thompson said.

Researchers are working on the hypothesis that the family members involved in the cluster were genetically more susceptible to H5N1, since spouses did not get sick, Thompson said.

-- CNN's Miriam Falco contributed to this report

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