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Efficient Transmission of H5N1 in Northeast Vietnam

Recombinomics Commentary

April 7, 2005

>>  I know that many of you have dedicated your careers to this field. In the short time that I have been Secretary of Health and Human Services, I have become acutely aware of the disastrous public health impact that an influenza pandemic could have throughout the world. This is one of the most urgent health challenges we face, and I've made it a top HHS priority. Recently, I increased my briefing frequency on the flu to daily......

In order to increase our readiness against a pandemic strain of influenza, last Friday, on my recommendation, President Bush added pandemic influenza to the list of quarantinable events. This gives HHS the authority to take steps to prevent people with a new or reemerging influenza virus from infecting others by stopping them at our borders. <<

The above remarks by US Health and Human Services Secretary Mike Leavitt, support the comment that an H5N1 infection of a 34 year-old physician at Vietnam-Sweden hospital in Quang Ninh led to the executive order of April 1, allowing the US to quarantine bird flu cases.

The monitoring of the outbreak in the US has been elevated to a daily briefing, which almost certainly includes additional notifications of unusual events.  Therefore, when the physician developed Acute Respiratory Distress Syndrome (ARDS) on Friday, April 1, in Vietnam (Thursday night in the US), he was probably tested with a quick test for H5N1.  When he tested positive, an alert was issued.

This alert then went to HHS in the US, which resulted in the recommendation for the executive order, which was signed on April 1.

It is unclear if the three suspect bird flu cases at the hospital were patients who were recently admitted because of bird flu symptoms, or were patients who were tested because there was a concern about further H5N1 transmission within the hospital.

In either event, ARDS, followed by death on Sunday without a known source, has provided yet another signal that the flu pandemic of 2005 has begun.  H5N1 that is efficiently transmitted to humans appears to be generating a range of outcomes.  The family of five in Haiphong appears to be on the way to recovery.  Results on their neighbors, admitted on or about March 25, have not been released.  The family of five was H5N1 positive, clearly showing efficient transmission.

Although there has been minimal or no reporting of H5N1 in poultry in Thai Binh, Haiphong, and Quang Ninh provinces, the three adjacent provinces each have set a record related to efficient transmission (longest transmission chain, largest cluster admitted on the same day, first fatal infection of a health care worker - from an unknown source).

Thus, H5N1 is clearly transmitting efficiently in northeastern Vietnam.  However, since many of the cases are mild, most of this transmission is not being detected and/or reported.  The time between this efficient transmission in northeast Vietnam, and a pandemic resulting in millions of fatalities may be weeks or months, but the efficient transmission is the missing requirement for the start of the pandemic, and that requirement has now been met.

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