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10th Confirmed Fatal Bird Flu Case in Vietnam

Recombinomics Commentary
January 28, 2005

>> Doctors also said two additional people were sickened with the virus, bringing to 15 the number of people stricken with the avian flu in the current wave of infections.

The latest victim was a 32-year-old man from northern Phu Tho province who died Thursday after spending five days in Bach Mai Hospital in Hanoi, a doctor there said on condition of anonymity.

The man had developed a high fever, coughing and breathing difficulties on Jan. 12, said Nguyen Dinh Trong, director of Phu Tho provincial Preventive Medicine Center.

Doctors were still trying to determine how he caught the disease, which is usually traced to direct contact with sick birds.

The World Health Organization has warned that if the virus alters and becomes easily spread from person-to-person, it could spark a global pandemic. However, there is no evidence that the virus has undergone such a mutation yet.

The man's family raised poultry, but none of them have shown signs of illness, Trong said, adding that there were no bird flu outbreaks reported among poultry in his village. <<

The latest fatality (32M) extends the number of confirmed cases to at least 15.  Other than the 10 who have died there are two cases (10F and 13F) in the south and two (66M and 30M) who are hospitalized in the north.  The two in the south are in critical condition and those in the north are reported as stable.

There are a number of additional unconfirmed cases, including at least two who have died and one case reported as confirmed by the media, but not by WHO.  That case (38M) had no symptoms and is one of the three brothers from Hanoi.  However, there have been many conflicting reports regarding the number of people with or without symptoms as well as dead or alive in the family from Hanoi.  The most recent UN report referred to two deceased brothers, in addition to the brother (42M) who is recovering.  Media reports mention the death of a 2 year old child of the index case, but give no detail concerning the circumstances other than a date which is before the meal of raw duck.  Although initial reports suggested the meal was the source of infection for one or more brothers, the latest date reported for the meal (Dec 26, 2004) is not 2-10 days prior to onset of symptoms for any real or reported family members.

Similarly, there is confusion about the source of infection for the 9th fatal case (35M) from Dong Thap.  Various media reports list the possible source of her confirmed fatal H5N1 infection as a canal that she bathed in, a body of water that she swam in, a pond near her work, a duck that she slaughtered that did not produce illness in any family member who ate it, and a duck that she slaughtered with her daughter (13F) who is the confirmed critical case mentioned above.  The only consistent fact related to transmission is death on January 21 within hours of being transferred (she had been hospitalized for almost a week in Dong Thap).  The date of onset of symptoms for her and her daughter remain unclear, although clearly the time differential between her death and a potential date of death for her daughter is significant.

The latest confirmed fatality in the north (32M) is the first in the north this season that does not have a reported link to dead or dying poultry and strengthens the demographic differential.  In the north the confirmed avian influenza cases are older and male, versus the confirmed cases in the south, which are younger and female.

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