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Human to Human Transmission in Thai Binh Vietnam?

Recombinomics Commentary
February 27, 2005

>>  Vietnamese officials confirmed on Sunday that a 69-year-old man has died from bird flu, the 14th person to die from the disease this year.
The man, from northern Thai Binh province, was admitted to the provincial hospital on Feb. 19 with classic bird flu symptoms of high fever and breathing difficulties, said Pham Van Diu, director of Thai Binh Provincial Preventive Medicine Center…
Relatives of the latest victim said his whole family had eaten chicken, a traditional dish, during Lunar New Year festivities earlier this month, Diu said. None of them have reported any illness.  <<

The death of the 69M from confirmed H5N1 extends the Thai Binh geographical cluster to at least 4 confirmed cases this year.  The first case was the middle brother of the familial cluster that involved 3 brothers.  There has not been a confirmation of the youngest brother, who was initially positive according to media reports.  However, his older brothers were confirmed positive for H5N1 and both had symptoms.  The index case in that cluster died, although he was from Hanoi and not Thai Binh.  These cases were last month.

Within the past few days of this month there were three more cases from Thai Binh.  Two were siblings, and the older brother is in critical condition.  He appears to have developed symptoms earlier, which would create another bimodal distribution, the 11th in 11 clusters.  Bimodal distributions make a common course less likely.  Media reports are mixed on who had a blood pudding meal other than the index case.  However, like the index case last month which also involved blood pudding, it is an unlikely source because some who ate the meal did not get sick, and those who developed symptoms did so at different times.

As noted above, there also is no obvious source for the recently reported fatal H5N1 infection.  There have been additional clusters which are lacking a bird source for the index case.  A similar cluster in Thai Binh was also reported a year ago.  The index case was a teacher and had no known bird contact.

The lack of an identifiable source, coupled with the large number of cases with bimodal distribution, suggests that human-to-human transmission of H5N1 is much more common than indicated in comments to and by the media.

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