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Likely Bird Flu Case in Thailand Tests Negative

Recombinomics Commentary
February 9, 2005

>> A seven-year-old boy suspected of having bird flu has been cleared by health authorities, Deputy Public Health Minister Suchai Charoenrattanakul said yesterday.

The boy, who was kept under close watch at Phra Buddha Chinarat Hospital in Phitsanulok province, tested negative for avian influenza, said Dr Suchai.

The boy was suspected of having bird flu when he fell ill after touching dead chickens in his village in the northern province's Phrom Phiram district. <<

The negative test result for bird flu raises serious questions about the validity of the testing.  The circumstances and clinical presentation strongly indicate the boy had been infected with H5N1.  Within a few days of touching a dead bird the patient developed symptoms of avian influenza including a high temperature and lung involvement.  He then tested positive for influenza A.

The report update does not mention the condition of the patient.  Test results for avian influenza frequently generate false negatives.  The frequency of false negatives was highlighted in a number of familial case clusters.  The clustering created a high level of suspicion, so the patients were retested and eventually tested positive for H5N1. 

These clusters included the two sisters of the index case in Thai Bin.  Their initial tests were inconclusive and they subsequently tested positive. 

The most publicized case was the cluster in Thailand, which was recently published in the New England Journal of Medicine.  The index case was misdiagnosed as dengue fever and was never tested for avian flu.  Her mother was also not tested initially.  After her death H5N1 sequences were detected in fixed tissues.  The aunt was tested while alive, and was initially negative.  She subsequently tested positive. 

The most recent example was the Hanoi cluster.  The index case tested negative twice.  He was not positive until tested at autopsy.  His brother also tested negative initially. 

The two most recent patients who eventually tested positive did recover.  Thus, further testing on the patient in Thailand is warranted.

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