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Human to Human Transmission in Northern Vietnam At Phase 6?
June 17, 2005
>> LIZ FOSCHIA: The World Health Organisation says news of the infections is being reported locally in Vietnam.
Peter Cordingly is based in the organisation's Asia-Pacific headquarters in Manila.
PETER CORDINGLY: We've seen media reports of six people in a hospital in Hanoi being tested positive for H5N1. In fact we're not quite sure whether it's six patients plus one doctor, or five patients plus one doctor. The media reports are a little bit contradictory, and we don't have any official information from the Vietnamese to work on.
So basically we have to do our best guess work on this one. And this does worry us a little bit. If six people are infected in one hospital, this would be the first time we've seen this. There's no evidence so far, not even in the media reports, or anything we've seen to date, that suggests that there is human-to-human transmission going on in Vietnam.
But this one we will be looking at very carefully........
LIZ FOSCHIA: Is it the fact that it's a group of six people that's concerning?
PETER CORDINGLY: Yes. Clusters always send our blood pressure up. This is the biggest one. The previous one was five, so it's not an enormous jump, but they do catch our attention.
And we need to have very swift information on this, because while we don't know how a pandemic will start, it will almost certainly start through a cluster, so every cluster has to be very closely examined.
I should say that every one that has been closely examined to date has shown that poultry was the source of infection, and that may well be the case here as well. So basically we have to do our best guess work on this one. And this does worry us a little bit. If six people are infected in one hospital, this would be the first time we've seen this. There's no evidence so far, not even in the media reports, or anything we've seen to date, that suggests that there is human-to-human transmission going on in Vietnam.<<
The above comments by WHO are alarming, both because of the comments on prior human-to-human transmissions, as well as the lack of information on the explosion of cases in northern Vietnam.
There has been human-to-human transmission of H5N1 bird flu in Vietnam and Thailand since early 2004. Last season these transmissions were limited to family members and the clusters only involved 2-4 people within a family.
This season the clusters began to expand and transmission extended from patients to health care workers. Although comments on a possible poultry origin were made, there was virtually no evidence to support such a claim. The attempts to use meals at friends houses or blood pudding were embarrassing and did not reflect well on WHO's to objective analyze data.
The above comments are astonishing and demand changes in personnel at WHO.
However, over and above WHO's internal deficiencies on analyzing and reporting data, is their inability to gather current information. As noted above, they are relying on media reports, which can frequently be confusing, and the WHO's ability to analyze such reports are also of concern.
The media reports indicate that there are now 23 cases at the Institute for Tropical Medicine in Hanoi. As noted above, the prior reported record was 5 for a hospital. There appear to be 21 new cases admitted since last week.
Although details of these cases are not known, they are all from northern Vietnam and have been transferred to the same facility. Moreover, a healthcare worker has tested positive for H5N1, providing additional direct evidence of human-to-human transmission. The increase in the size of the clusters has already moved the pandemic in Northern Vietnam to phase 5.
The latest data appears to be moving the pandemic to phase 6. Third party reports from the western provinces of Qinghai and Xinjiang would also indicate the pandemic there has also moved to phase 6, and the H5N1 there may be more virulent than the version in northern Vietnam.
Clearly better monitoring, data analysis, and reporting of data is required by WHO. Their continued comments understanding the human-to-human transmission is well beyond scandalous.