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Second Confirmed H5N1 Bird Flu Fatality In Thailand

Recombinomics Commentary

August 3, 2006

more than 6,000 cases have been diagnosed this year, of which 300 were fatal, he said.

"Influenza, too, is worrying … there has been a significant rise in the mortality rate from the disease over the years," Thawat said.

A 27-year-old Thai man has died of bird flu, the country's second death this year and its 16th victim since the H5N1 virus swept across parts of Asia in late 2003, a senior health official said on Saturday.

The man died on Thursday in the province of Uthai Thani, 220 km north of Bangkok, after having contact with sick chickens, Prat Boonyawongvirot, permanent secretary in the Ministry of Public Health, told Reuters.

"It is confirmed that this man has died of H5N1," Prat said.

The above comments on the death of a 9 year old girl in Lon Buri and 27 year old in Uthai Thani are cause for concern.  Although the 9 year old had bird flu symptoms, she tested negative for H5N1.  However, the comments above described an alarmingly high case fatality rate of 5% for cases diagnosed as seasonal flu.  The high case fatality rate suggests H5N1 fatalities may be going undetected in Thailand.

In 2004 H5N1 was causing fatal cases in both Thailand and Vietnam. Although Thailand reported on 12 fatalities, a retrospective study indicated many patients with laboratory confirmed H5N1 were not included in the totals reported by Thailand or WHO.

In early 2005 fatal H5N1 cases reported in Vietnam.  However, most of the fatal cases in Vietnam were in southern Vietnam, where almost all patients died.  In contrast, the cases in the north were milder and the size of the clusters were larger, including a family of five in Haiphong.  Although all five family members tested positive for H5N1, they all recovered after a brief hospital stay.  Neighbors of the family were also hospitalized, but reports from Vietnam ceased.  Although 1000 serum samples were collected in northern and central Vietnam, the results from those tests were never disclosed.

The Manila meeting in May of 2005 described H5N1 in 2005 and noted that the H5N1 in northern Vietnam were similar to isolates from Thailand.  Although H5N1 was reported in birds in early 2005, there were no reported cases in humans in Thailand in early 2005.  The failure to report any human cases in Thailand raised the possibility that the cases were mild and not detected.

The above comments indicate that H5N1 fatalities are again being reported in Thailand.  There have now been two confirmed H5N1 positive fatalities.  However, the 5% case fatality rate in seasonal flu patients again raises concerns about under reporting of H5N1 cases.

More information on the sero-types of the fatal seasonal flu cases would be useful as would sequence information. The 5% case fatality rate is at a pandemic level and is cause for concern.

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