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More Human to Human Transmission in Hanoi?

Recombinomics Commentary
January 26, 2005

>> An investigation into the brothers' illness is still going on and the mode of transmission has not been firmly established, said Peter Horby, a WHO epidemiologist in Hanoi.

Hung said the family gathered for a meal on Dec. 25 after the death of his older brother's 2-year-old child. The brothers ate raw duck blood pudding, a delicacy, and drank rice wine as they always did during family reunions.

A third brother who also ate the blood pudding reportedly tested positive for the virus, but WHO has not confirmed that case and Horby said the test results are still being analyzed. The third brother is healthy and has not developed bird flu symptoms. <<

The latest report contains additional details that make the raw duck and blood pudding less likely to have been the source of any of the infections in the brothers.  Bird flu symptoms typically develop 2-10 days after exposure.  If the date of the meal is correct, then none of the brothers developed symptoms within the 2-10 day time frame of the meal.

The oldest brother developed symptoms 1 day after the meal.  The middle brother developed symptoms 17 or 18 days after the meal.  The youngest brother didn't develop any symptoms but tested positive, if the initial reported results are confirmed.  Moreover, since the food was consumed at a family reunion, it seems likely that one or more family members ate the meal but didn't develop symptoms and tested negative for H5N1.

The only piece of information that fits the other H5N1 clusters in Vietnam and Thailand is the older brother's development of fatal bird flu symptoms after his child died.  More information on the circumstances surrounding the death of the 2 year old would be useful.

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