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Six Deaths in Vietnam
August 12, 2004
The six deaths in Vietnam raise significant concerns. Three have been confirmed as H5, while the other 3 died before samples could be collected. However, the other 3 deaths were from the same province as one of the confirmed cases and three of the cases in the south were from the same family. All six deaths occurred between July 30 and August 3, 2004. Four cases were located south of Ho Chi Minh City, while two cases, four and one year old sisters, were near Hanoi.
The simultaneous outbreaks in the north and south, involving two families, raise concerns about additional cases. Moreover all six reported cases were fatal, raising the case fatality rate even higher. It seems likely that there are additional unreported cases, in view of the distance between the confirmed cases.
Sequence analysis of the isolates from Vietnam and Thailand indicated that the H5N1 viruses had acquired polymorhisms not found in any H5N1 isolates outside of Vietnam and Thailand. These Vietnam and Thailand-specific polymorphisms were found in all 8 genes. Although the polymorphisms were not found in H5N1 isolates, they were found in common avian sero-types H9N2 and H6N1 as well as human sero-types H1N1, H1N2, and H3N2.
These polymorphisms are cause for concern because of the large numbers of human fatalities in Vietnam and Thailand and the re-emergence on new fatal cases in northern and southern Vietnam