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Quang Binh Bird Flu Cluster Increases Transmission Concerns

Recombinomics Commentary
March 18, 2005

>>  The boy's 13-year-old sister died at a local hospital Mar 9 after suffering symptoms like her brother's, according to the Than Nien News report, which cited the Associated Press as the source of that information. The director of the provincial preventive medicine center said no samples from the girl were taken, leaving the cause of her illness uncertain.

The boy's uncle, Hoang Thai An, said the family had eaten a dead chicken given them by a neighbor 3 weeks ago, the story said.

A report today by the Chinese news agency Xinhua gave a slightly different account. It said the family had slaughtered and eaten a chicken given them by relatives, and several days later all three children in the family fell ill. The report cited the newspaper Saigon Liberation as its source. <<

Although media accounts conflict on hospital admission dates, dates of death, and even the number of siblings infected, the cases clearly define another familial cluster that appears to be bimodal for disease onset dates.  Like the vast majority of the earlier clusters, no sample was collected on the index case and at least one family member has been confirmed to be H5N1 positive.  This cluster is of concern because it is in the Central Highlands and appears to be more severe than the recent Thai Binh clusters because one or two family members has already died. The confirmed case presented with infections in both lungs, but may be recovering.

However, the March 17 hospitalization of another suspect case from an adjacent district raises concerns about transmission to a health care worker, since one or more of the family members was initially treated locally.

The cases are difficult to monitor because the PCR assay in the south appears to only detect 20% of the H5N1 cases there, and the assays in the north also have generated a number of false negatives.

Details on the patient admitted on March 17 would be useful.  The clustering in time and space between the familial cluster and this new admission is clearly cause for concern.

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