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Thai Binh Bird Flu Patients Details
March 8, 2005
>> [From the ages of the patients described in the 2 reports, their only
identification, it is probable that the male nurse is a previously
described case whose occupation is now being considered as a relevant
factor in his case history. This is verified by the most recent WHO update
(below) - Mod.CP] <<
Although there are major transparency and testing problems in southeast Asia with regard to bird flu, the details on identities in the Thai Binh cases has been well publicized in media reports.
Although the family name of all of the disclosed Thai Binh cases has been Nguyen, there has not been an overlap on the patient's age or other two names. It is unclear why ProMed considers the 26 year old male nurse, Nguyen Dinh Dan, to be a previous case. The other recent cases from Thai Binh are 36M Nguyen Thanh Chung, 69M Nguyen Khac Teo, as well as the two siblings, 21M Nguyen Sy Tuan and 14F Nguyen Thi Ngoan.
The recent WHO update discussed one of the cases in the New England Journal of Medicine, which was a case that did not present as a respiratory case, and was not initially tested for H5N1. This case was from February 2004, while the nurse is from February 2005. The 2004 case is yet another example of an initial failure to detect H5N1 in a positive patient. Like many of the other 10 bimodal clusters, the index case was not tested. This is yet another example of a case that was clearly positive for H5N1, but was not included in the official H5N1 tally in the past, and will not be added in the WHO update.
The familial clusters represent over one third of the reported H5N1 cases. Although the index case died in all familial clusters, and each cluster includes at least one laboratory confirmed H5N1 family member, many of the cases are excluded because they were never tested.
The lack of testing, combined with false negatives, seriously underestimates the H5N1 cases in Vietnam and Thailand. Similarly, laboratory confirmed cases in Thailand from last year are not included in WHO tallies. The WHO has failed to test meningococcemia cases in the Philippines as well as other patients who have symptoms of dengue fever. Dengue fever was the incorrect diagnosis of the index case in Thailand described as the best example of human-to-human transmission of H5N1. Most of the hemorrhagic dengue fever cases in southeast Asia have also not been tested for H5N1.
The true spread of H5N1 inside and outside of Vietnam and Thailand is largely unknown.