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Bird Flu Case from Kampot Cambodia Confirmed

Recombinomics Commentary
February 1, 2005

>>The 25-year-old woman who died Saturday in a Vietnamese hospital tested positive for the deadly H5N1 strain of the virus, said Phan Van Tu, a doctor at the Pasteur Institute in Ho Chi Minh City, where the test was conducted. Relatives had reported dead poultry in her village and her brother died four days earlier with similar symptoms, but no tests were done on him, he said.<<

As noted above, the Kampot index case was the first confirmed death from Cambodia.  Her younger brother was almost certainly another H5N1 avian influenza fatality, but he was not tested.

This scenario of not testing or getting a negative result on initial tests is commonly reported.  In the Vietnam cluster last summer, the first 3 cases were not tested.  The caregiver developed symptoms after the index case died, and she tested positive.  Similarly, the Thailand cluster published in the New England Journal of Medicine also did not include test data for the index case.  She was initially diagnosed with dengue fever and the initial test on her aunt was negative.

Even when samples are collected, there are frequent false negatives.  For the cluster in Hanoi the index case was negative twice and was only positive at autopsy.  His caregiver brother also tested negative on the initial test.

The positive result for the Cambodia cases raises concerns about the many Cambodians who crossed the border recently with flu symptoms.  Apparently these cases in Ha Tien were not tested for bird flu and officials were waiting for an official confirmation.

Now that they have it, a serious effort should be made to determine the extent of H5N1 infections in Cambodia and the number of human to human transmissions.

Cluster Update

Kampot Cluster

Index case, brother (14M) of Soc Khol.  Conflicting data on date of death.  Reported as prior to Jan 21 and four days ago.  He had developed high fever, bad cough, and breathing problems.  Sister, Soc Khol, (25F) admitted to hospital in Vietnam on Jan 28, died Jan 30. Confirmed positive on Feb 1  Reports of dying chickens and ducks in Dec in area.  Additional reports of many patients in Kampot traveling to Ha Tien town for treatment.

Suspect cases will be added to tallies and be considered "still unconfirmed" until two laboratory results suggest that the cases are NOT H5N1 positive.  Thus, both cases from Kampot are considered positive for H5N1.

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