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Vietnam-Sweden Hospital H5N1 Cluster in Quang Ninh

Recombinomics Commentary

April 6, 2005

The most recent and most significant cause for concern regarding human transmission of bird flu centers on Quang Ninh province in general, and the Vietnam-Sweden Hospital in particular.  The first reported confirmed H5N1 case in Quang Ninh was Nguyen Thi Lan.  The 40 year-old female was admitted to the Institute for Tropical Diseases in Hanoi on March 17, 2005.  It is not clear if she was first admitted to a local hospital in Quang Ninh, such as the Vietnam-Sweden hospital in Uong Bi.

A 34 year-old male physician, Ho Dai Nghia, worked at Vietnam-Sweden hospital and suddenly developed acute respiratory pneumonia on April 1.  He died on April 3 and is being tested for SARS and H5N1.

Recently, two other patients tested positive for H5N1 at Vietnam-Sweden hospital, and were transferred to Hanoi, while a third suspect patient is still at Vietnam-Sweden hospital in Uong Bi.

Thus, these five patients form a geographical cluster in Quang Ninh, and at least four have been in Vietnam-Sweden hospital at about the same time.  It is not clear which patients infected other patients.  Five patients in the same area who were hospitalized over a two week period, and four of the five possibly in the same hospital at the same time, demonstrates efficient H5N1 transmission.

More details on the disease onset dates and tests of patient and health care worker contacts at the hospital would be useful.  A cluster on bird flu cases in a hospital setting is a major signal for the start of a pandemic.  The number of confirmed or suspected H5N1 cases in the north are high and clustered. 

In the most recent OIE report from Vietnam, there were no H5N1 infected poultry reported in Quang Ninh or Haiphong.  The number of infected birds in Thai Binh was very low.  However, these three adjacent provinces have generated the longest H5N1 transmission chain, likely nurse to nurse transmission, simultaneous infection of an entire family, and the first hospital cluster of unrelated patients, which links to the first reported health care worker death.

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