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More Mild Bird Flu Cases in Northern Vietnam
June 14, 2005
>> The Ministry of Health in Viet Nam has confirmed an additional 3 human cases of infection with H5N1 avian influenza. The cases were detected during the last two weeks of May. All three patients are from Hanoi and remain alive. No further data about these cases have been provided. <<
The above comment from the latest WHO update on Vietnam describes three more milder H5N1 cases in northern Vietnam. More geographical or familial relationships were not provided, but the trend in northern Vietnam has been set since the beginning of the year. The clusters are larger and more frequent and the cases are milder. These milder cases are similar to severe cases of human flu and therefore many H5N1 human infections in northern Vietnam may go undetected.
Sequence data from northern Vietnam included an HA cleavage site missing an ARG. This missing basic amino acid matches the cleavage site from 2003 and 2004 isolates in Hong Kong and southeastern China, raising the possibility that mild human H5N1 cases are also in China. The homology with 2005 Thailand isolates also raises the possibility of more human infections there also.
Recent comments on the sequence of H5N1 from bar headed geese at Qinghai Lake also linked bird flu there to H5N1 in southeastern China. The bar headed geese winter in India and Bangladesh and fly over Tibet to nest at Qinghai Lake in May and June. Recently there have been meningitis outbreaks in northern India, which coincide in time and location with the bar headed geese migration.
Interestingly, the crested eagles smuggled into Belgium from Thailand had sequences matching those in Thialand, but the eagles originated in Tibet.
The linkage by time location and sequence of H5N1 cases throughout southern and eastern Asia raise serious questions about H5N1 monitoring of birds and people. The scandalously poor monitoring significantly compromises flu pandemic containment strategies.