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Bird Flu Case Clusters in Vietnam - Report 1

Recombinomics Commentary
January 28, 2005

>> "We think as we go deeper into the cooler weeks, we'll hear about more cases, more dying poultry, more human cases and even possibly these little clusters, one associated with the other," said Peter Cordingley, spokesman for WHO's Western Pacific Regional Office in Manila.

The latest victim'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 above warning of clusters of cases suggests that they will be little.  However, media reports are confusing, initial testing is frequently falsely negative, and stated sources of infection vary widely, even for a single index case. Therefore, I will list potential clusters based on family links or geographical links and will update the clusters as more information becomes available.  The key measure for defining human to human transmission as a cause of a cluster is the time differential between onset of symptoms.  Since the number of clusters is large, and there are age/gender duplications, I will include names cited in various media reports.

Three Brother Cluster in Hanoi area:
Index case, Nguyen Huu Viet, 47M, is a confirmed fatality, died Jan 9 - onset date Dec 26.  Brother, Nguyen, Thanh Hung, 42M, confirmed recovering case.  Onset date Jan 10, possible discharge Jan 28.  Younger brother from Thai Bihn has no symptoms.  Reported H5N1 positive by media. WHO has not confirmed. 2 year old child of index case died before Dec 25, 2004.  No information on gender or cause of death. Dec 25 raw duck, blood pudding meal not within 2-10 days of onset of symptoms for any members in cluster.

Dong Thap Cluster
Index case, Mai Thi Truc Li, 35F, admitted to local Dong Thap hospital Jan 13.  Transferred to HCM City Jan 21 and died within hours of transfer.  Confirmed, with multiple possible sources of infection (bath, swim, chicken slaughter).  Daughter, 13F, confirmed and in critical condition at Children's hospital in HCM City (reported help with chicken slaughter).  No reported relationships to confirmed death (6M) on Dec 30, 2004 of boy from Dong Thap.

Bac Lieu Cluster
Index case Bui Tan Tai, 17M confirmed fatality admitted Jan 10, died Jan 15.  Sister (22F) in critical condition.  From Phuoc Long district.

Long An Cluster
Index case  Vo Thi Ngoan, 10F.  Confirmed case in critical condition in HCM City.  Relationship to suspect fatality (39F) who died Jan 22 in Long An is unknown.

Tien Giang Cluster
Index case, 18F, confirmed fatality admitted Jan 3 and died Jan 18.  Sister, 15F, initially reported as hospitalized in stable condition.  Subsequent media reports indicated sister had no symptoms.  Relationship to 65M suspect case from Tien Giang is unknown.

Tra Vinh Cluster
Index case, 35F, died Jan 18 after being hired to dispose of dead poultry.  Relationship to other Tra Vinh cases including confirmed Jan 4 fatality (9M) following swim, or suspect case (14M) admitted Jan 16 in critical condition, is unknown.

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