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Pandemic Potential of Cluster of Five in Haiphong Vietnam

Recombinomics Commentary
March 25, 2005

>>  the afternoon edition of the Hanoi Moi (New Hanoi) daily said five members of one family were hospitalized on Wednesday in the northern port city of Haiphong with coughing and breathing difficulties.

Doctors suspected they had bird flu, the paper said. It quoted Nguyen Van Vy, director of Haiphong's Health Department, as saying poultry at the family's house had been slaughtered earlier to stop bird flu outbreaks.

Bird flu tests on the five were under way, Vy said. <<

The familial cluster of five in Haiphong has a very high pandemic potential.  Although these cases have not been officially confirmed, most media reports of hospitalized suspect bird flu patients are accurate, because a quick test can be run, and positives are usually confirmed.  Since the family members were admitted on Wednesday,  the director of the health department acknowledges the slaughter of poultry at the home, and doctors suspect bird flu, it is likely that the suspicions will be confirmed.

If the suspicions are confirmed the familial cluster will be the largest reported.  However, more significant is the fact that all family members were hospitalized on the same day.  Clearly details are lacking, but five hospitalizations on the same day suggest a common exposure and efficient transmission.  Haiphong is adjacent to Thai Binh, the location of the longest bird flu transmission chain to date. 

Although the cases have been milder with several discharges, there have been several familial clusters in Thai Binh, as well as clusters of the clusters.  These confirmed H5N1 infections have happened in a province that has been declared to be H5N1 free since February 5.  Moreover, the latest fatality in Vietnam was in Nam Dinh, which is also adjacent to Thai Binh.

In the latest report to OIE the number of H5N1 infected birds in Thai Binh was very low, and there were no reported cases in either Nam Dinh or Haiphong.  Thus, it appears that the clusters of cases in Thai Binh are now leading to additional cases in adjacent provinces, where there are no reported bird flu infections of poultry.

If the cases in Haiphong represent efficient transmission to humans, then there is significant cause for concern that the flu pandemic has begun.

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