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Quang Ninh Physician Death Linked to H5N1

Recombinomics Commentary

April 6, 2005

>> ``We've recommended that health-care workers are adequately protected and monitored, and that's what we'd recommend for this hospital in Quang Ninh,'' Horby said.

Initial tests on two patients who received treatment at the Vietnam-Sweden hospital in Quang Ninh province have been positive for H5N1, while a third patient is classified as a suspected case, according to Le Quang Dang, deputy director of the Quang Ninh provincial health department. Two of the three Quang Ninh patient cases are now hospitalized in Hanoi, he said.

At least two of the three patients were known to have had contact with poultry, while the deceased doctor had no known contact with poultry, Dang said. The doctor was also not known to have had contact with any of the three suspected bird-flu patients, he said.

``He worked in a different ward,'' Dang said. ``We don't think there's any connection between the doctor's case and the cases of these three other people.'' <<

The linkage of the 34 year-old physician to a facility with two confirmed and one suspect bird flu case is clearly cause for concern. The physician's death was so sudden that he was being tested for SARS.  He was admitted on Friday and died on Sunday.  Although test results have not been released, four cases at the same hospital over a short time frame create a geographical cluster in Quang Ninh.  Since these are the only four cases reported in the province, yet are all at Vietnam-Sweden Hospital, the suspicion level is extremely high.  It coincides with the executive order in the United States authorizing quarantine of bird flu patients.

The death is the first reported fatality for a health care worker closely linked to H5N1.  There were two previous cases in Thai Binh.  Although the second health care worker in the Thai Binh cluster tested negative, there was little doubt that both had been infected with bird flu.  They were both at a facility that treated two confirmed cases, and the index case of the familial cluster was a patient treated by the first health care worker.  In that cluster, only the index case remains hospitalized.  His sister and the two health care workers recovered.

The physician fatality, linked to three patients not treated by the physician, is a classic example of efficient transmission of a virus in a health care setting (nosocomial infection).

The death of a health care work linked to a hospital where there was no reported contact with H5N1 patients is a clear example of efficient human-to-human transmission of H5N1 avian influenza.

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