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Quang Binh Bird Flu Isolations in Hue Continue To Rise

Recombinomics Commentary
March 24, 2005

>>  health inspectors found 37 people with fever in Chau Hoa commune in the central province of Quang Binh.....

Dinh said a 16-month-old boy from Chau Hoa was in hospital with suspected bird flu, while five other villagers are under supervision, including the aunt of the 13-year-old girl who died.

The woman had a slight fever after tending to her niece, Dinh said, but she appeared to be getting better.

Authorities are also searching for a 41-year-old man from Chau Hoa who walked out of a hospital on Wednesday where he and other suspected bird flu cases were held for observation.

"The patient is in the group of bird flu suspects so we have informed local authorities to monitor his case," Bui Duc Phu, deputy director of the Hue Central Hospital told Reuters.  <<

The number of bird suspect cases hospitalized or under observation continues to grow.  The 16 month old boy described above is the fifth reported hospitalized case.  The other four are the index case who has died, her brother who has confirmed H5N1, a 41 year old male with high fever on Monday, and a case from an adjacent district, Quang Trach, hospitalized March 17.  It is unclear if the patient who walked out of the hospital is the same patient hospitalized with high fever on March 21.

The symptoms in the aunt of the index case raise the size of the familial cluster to three.  The milder symptoms may be similar to members of the familial cluster case in Thai Binh, who were H5N1 positive for antibodies, but had mild or no bird flu symptoms.

These later reports do not mention a third sibling, who was mentioned in initial reports.  It is not clear if there is a third sibling, although recent ProMed reports have indicated that the third sibling was a younger sister and cited her good health as a reason for doubting that the Quang Binh index case was infected by H5N1. 

The latest Reuters report indicates that the number of Choa Hau commune members under observation is now at 37.  These cases were among the 195 initially described with flu-like symptoms.  Remarkably, the 195 patients were edited out of the media report of the Choa Hau outbreak posted by ProMed.  It is unfortunate that a widely read infectious disease publication would allow editors to remove relevant information.  The 195 flu cases contradict the editor's view that the reports of a looming flu pandemic are a hysterical response to infections in a few Vietnamese who are genetically predisposed to bird flu infections.

Testing of these Choa Hau commune members should provide valuable information on the H5N1 infection rate in this small community.  Use of a sensitive H5N1 PCR similar to the one used at NIID in Tokyo to identify false negatives would be useful.  If the suspect cases are confirmed to be H5N1 infected, it would raise serious questions about the lack of reported cases in southern Vietnam.  There has been only one reported case since news reports of human cases in southern Vietnam abruptly stopped just prior to the February 9 start of the Tet Lunar New Year activities.

The report today of a third bird flu death in Kampot, Cambodia is in a geographical cluster adjacent to Ha Tien in Kien Giang province in Vietnam, the location of a recent suspected bird flu fatality.  This suggests that consumption of sick birds is widespread, and infections in Vietnam are not limited to the small number of reported cases.  Moreover, cases in this area have been described as complex, which may limit testing and detection of H5N1 infections.

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