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Another Bird Flu Cluster in Thai Binh Vietnam

Recombinomics Commentary
February 24, 2005

>>  Twenty-one-year-old Nguyen Sy Tuan tested positive for the H5N1 virus Thursday afternoon, said Doctor Nguyen Hong Ha, head of the Emergency Unit of the Infectious Disease Ward from the Institute of Tropical Disease in Hanoi's Bach Mai hospital.

The man was admitted to hospital Tuesday with a high fever, breathing difficulties and considerable damage to his lungs, said the doctor. "He is in bad condition now and using a respirator."

His 14-year-old sister Nguyen Thi Ngoan was also found carrying the fatal virus, according to Nguyen Nhu Chien, director of Thai Binh provincial General Hospital where the girl is staying. "Her quick test result reported positive to H5N1, yesterday," the doctor said from Thai Binh province, 110 kilometres south of Hanoi.  The girl was in stable condition with a slight fever and could breathe normally at the moment, according to the doctor.

While the two siblings come from Thai Binh province, an area hit by bird flu, their household does not raise chickens. Health officials said they are continuing to try to find out how the siblings caught the disease.  <<

The above familial cluster is the second cluster linked to Thai Binh province.  The earlier cluster involved three brothers.  The origin of H5N1 in that cluster remains unclear.  Although the index case died and had slaughtered a duck a few days before symptoms, the duck was used to make a blood pudding which was eaten by three members of the family.  However, the brother-in-law who tasted the blood pudding did not develop symptoms, while the youngest brother, who did not eat the blood pudding tested positive, although reports of confirmation have been lacking and he did not develop symptoms.

In this latest case, onset dates have not been released, but the index case has more advanced disease and his sister appears to be at an earlier stage.  She has a mild fever and is stable.

The level of human-to-human transmission remains unclear.  Each of the earlier clusters was bimodal.  In each cluster one or more family members developed symptoms six or more days after the index case.  In all of the earlier clusters the index case died, and one or more family members were laboratory confirmed to be H5N1 positive.

Since this current cluster has no documented exposure to poultry, it raises the possibility of casual human-to-human transmission.

Determining the source of H5N1 for this current cluster would be useful.

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