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Cousin of First Two H5N1 Positive Cases In Thailand Is Positive
October 26, 2005
Mr Chai Benphra, 44 years, village Phanom Tuang, the cousin of Mr Bang Orn, who is dead from bird flu a few days ago. This man was treated at DhornThum hospital in Nakhom Prathom. However, after doctors checked his blood, they found him positive for bird flu.
The above translation of a media report in Thailand indicates that the third person to test positive for H5N1 in Thailand is a cousin of the first two victims. The index case has died and his son is recovering. The cousin was carried into the hospital suggesting an advanced stage of the disease.
The time gap between disease onset in the father and son and the cousin suggest human-to-human transmission. The gap was 3 days between onset dates of the index case and his son, but the admission on the cousin indicates the time gap in this case is significant.
Prior to these three cases Thailand has claimed no human cases for 2005. However, there have been 1134 suspect cases, suggesting many H5N1 patients are testing negative.
Media reports now detail tourists from the French Island of Reunion who had visited a bird sanctuary in Thailand and then developed mild bird flu symptoms. The index case has tested positive for H5N1 and the two subsequent cases are under investigation.
H5N1 infection by causal contact is cause for concern. This contact sounds similar to the dozen hospitalized patients who had visited Ragunan Zoo in Jakarta. Indonesia has also had a large number of familial clusters that included H5N1 confirmed infections.
Many of the Ragunan visitors were PCR negative for H5N1. This was likely due to low viral loads in mild cases. 115 visitors with mild symptoms were turned away from the hospital without being tested. Others are initially admitted to primary care facilities where samples are not collected. By the time the patients transferred to an infectious disease hospital, the H5N1 has move out of the nose and throat and into the lings, resulting in false negative data.
H5N1 is silently spreading in Thailand and Indonesia and now issuing exported via tourists on commercial jets.
Screening early and often is required to identify the H5N1 spread in humans.