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As noted in the articles linked above, Thailand has gone on full alert and expanded avian flu screening centers and procedures. The deaths and avian flu symptoms in the Pranee family are a clear warning signal as were the three fatalities in the Pham family in Vietnam. Although 5 members of these two families died, only samples from the older Vietnamese sister were collected, and it was H5N1 positive.
The warning signals have been extensive. Last season H5N1 infections were reported throughout Asia. This was followed by reports of re-assortments between H5N1 and H9N2 sero-types as well as expanded host ranges. Molecular analysis also identified recombination between H5N1 and H9N2 isolates as well as acquisition of polymorphisms typically found in mammalian isolates. Recently reported data from the H7N7 outbreak in The Netherlands in 2003 also showed that human to human transmission did not requite acquisition of human H or N genes.
Early detection of human to human transmission of H5N1 is critical, and expended screening by Thailand is welcome news.