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10th Familial Bird Flu Cluster Bimodal for Disease Onset Date

Recombinomics Commentary
February 17, 2005

>>The routes of transmission in our patients are unclear. Epidemiologic investigations did not reveal exposure to ill poultry. In view of recent data suggesting that ducks infected with the current H5N1 strain shed large amounts of virus, the source of transmission may have been domestic ducks present in the canal near the children's house. Water from this canal was used for washing, and Patient 1 was reported to have swum regularly in this canal.<<

The familial case cluster in Vietnam last year is the 10th cluster reported for Vietnam, Thailand and Cambodia and all 10 had a bimodal distribution of onset dates.  The index case (9F) developed a fever on January 27, 2004, was admitted February 1 and died the next day.  Her brother developed symptoms on February 10, was admitted February 12 and died February 17.  H5N1 was isolated from the brother. This is the 10th familial cluster reported and the 10th with a bimodal distribution of disease onset dates, strongly implicating human to human transmission.  Since neither patient was diagnosed as bird flu initially, the possibility of a significant number of other misdiagnosed cases presenting with a broad spectrum of symptoms remains high.

In the 1918 flu pandemic, many patients were misdiagnosed as cholera, dengue fever, and typhoid.  Some also had neurological problems.

Clearly a broad H5N1 screening of clusters of serious and unusual cases is long overdue.

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