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More Tests in Vietnam

.Additional testing is in progress or planned in both northern and southern Vietnam.  However, there are significant questions raised by media reports on prior cases. In Hau Giang samples were only available from one of the first four cases.  However, the 19 year old brother was initially seen at a general hospital prior to transfer to the center specializing in Tuberculosis and Lung Diseases.  Even though he was young, had symptoms of avian flu, and was from a province experiencing outbreaks of avian flu, no samples were collected.  Similarly, there were no samples collected from his cousin, who was from the sample province and had the same symptoms.  Likewise, an unrelated 24F was also at the same hospital with the same symptoms from the same province, yet there are no available samples.

Now, almost a month after the first admission on July 19, additional deaths of children or young adults are being investigated, although in many cases samples are not available:

"Specimens from a small number of additional patients, from both northern and southern parts of the country, are ... being tested," WHO said.

The authorities were also exploring cases of severe pneumonia in an unspecified number of children and young adults, which mostly resulted in death over the past three weeks, according to the Geneva-based organisation.

"Specimens are not available for all of the fatal cases," it said in a statement."

Tests that are H5 or H5N1 positive have been obtained in both northern and southern Vietnam, although northern Vietnam has no reported cases of avian flu, even though one of the fatalities ate sick birds prior to onset of symptoms and chickens of a neighbor of the other northern fatality have died.

Only of the above suggests that more cases will test positive and the current outbreak in Vietnam may be more serious than the earlier outbreak.  Further recombination by H5N1 isolates would not be surprising.  The avian influenza population in Asia is extremely unstable and the H5N1 isolates from earlier in the year have acquired polymorphisms previously seen only in non-H5N1 isolates, such as H1N1, H1N2, and H3N2 from humans and swine, or H9N2, N9N1, and H6N1 found in other avian species.

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