195 flu cases - 1 confirmed H5N1

I didn't see this posted - this may be a big heads' up:

http://www.thanhniennews.com/healthy/?catid=8&newsid=5663

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Bird flu hits central province, 195 locals show symptoms


A commune in central Vietnam has been severely hit by the bird flu, with 195 patients showing symptoms and two children testing positive with the virus, reported a top provincial official.
Two siblings from the province’s Chau Hoa commune of Quang Binh province had tested positive for the H5N1 strain of bird flu, said Mai Xuan Thu, vice chairman of the provincial People’s Committee on March 20.

The older sister, Hoang Lan Huong, 13, died from the bird flu on March 9, while the brother, Hoang Trong Duong, 5, is in serious condition at the Hue Central Hospital.

BIRD FLU RECURRENCE

Vietnam confirms 5-year-old boy tests positive for bird flu
Vietnam reports one more suspected bird flu case
Concerns mount as Chinese chickens illegally flow into Vietnam
Vietnam nurse tested negative of bird flu
Meanwhile, there are 195 other local residents who have shown symptoms of the flu, said Ms. Thu.

It is not yet clear whether these people, some of who had reportedly eaten sick chickens, have the symptoms of the deadly bird flu or the normal flu.

Of the 195 patients showing symptoms, 108 are from Kinh Chau village while the rest live in other villages in Chau Hoa commune.

The outbreak hit the province’s Kinh Chau village in Chau Hoa commune just ahead of the Lunar New Year holidays which started Feb. 9.

The province is currently trying to stop the spread of the influenza by culling all poultry in the commune.

(Reported by Tung Lam – Translated by Minh Phat)***

WHO needs to get in there now & test - is this indeed flu? If so, is it H5N1? If not what IS the subtype - that sounds like a robust subtype, (assuming it's flu), if the Vietnames GOVT. is reporting this.

These cases have apparently been reported over the past month - since the end of Tet. I can't find any blasted population figures for the main village affected but the commune has a total of roughly 10k people reported in 1999:

http://www.danang.gov.vn/home/view.asp?id=78&id_theloai=386&id_tin=3362

There's a commentary or 2 at Recombinomics dealing with this initial familar cluster:

http://www.recombinomics.com/News/03200504/H5N1_Quang_Binh_195.html


This one definitely woke me up...

Thanks CanadaSue, as always, your data is so very appreciated!!!!

All of these cases DO have a avian vector, right? Or am I still half asleep and in denial?

DM

Dunno, DustMusher

I checked Vietnam news - just a 'straight up' report of the ONE case - the 5 yo boy. Sister died of pneumonia - that's it from them on this issue. This article states SOME had eaten sick chickens. That was why I was trying to get info on the village or barring that, the commune. How much commercial agriculture goes on, is it reasonable to expect most people keep family flocks, (probably), basic level of health...

I can't find anything. All I could find was that the leading city in the province has train service, (daily), to both Ho Chi Minh City & Hanoi & that 1 main highway offers bus service so... I can't even comment on local transportation as a possible factor in spread. I have a really detailed atlas & am going to try & find the name of the village. It's not indexed but knowing the province is a start.

Vietnam doesn't report human cases - not the number, when they occur, any substrains found although frankly, I doubt they do any testing of this sort. They're not even bothering testing for H5N1 when to me it would be clearly indicated. This may be H3N2 - the 2 newer ones this year may be hitting hard there & the base state of health is generally poor. Even if it's 'only' H3N2, the fact that we have even one confirmed H5N1 may mean, (assuming the presence of H3N2), a higher opportunity for recombination. If it IS H5N1 - it's clearly gone H-H, (human to human), at least in this limited area.

Now if that's the case, I am HOPING this area does what needs doing. The province is a popular tourist destination - I was able to get that much & guess what? This is prime tourist season - groan. We may learn more from tourists coming home than the government will tell us in the next little while. YThe fact that these cases have occurred over a month is both, in my opinion, good & bad. There hasn't been an explosion of cases, (not reported anyway), but a month means if it is H5N1 - it's potentially 'stanbilizing' nicely in human hosts.

One thing to keep in mind.. the WHO are always present as GUESTS of a country. They may have certain restrictions set on their activities or what they can publicly report as well as limited access to patients, case files, lab reports... they cannot compel any nation to do anything & I hope they have folks on their local team well versed in Vietnamese culture, politics & diplomacy. This could be a very tricky time...

This needs a bump- if a significant number of these cases are indeed H5N1-then this could be one the most important news stories you'll read in awhile. DO NOT take this for granted, folks! It bears watching, very closely- a pandemic may have significant deleterious effects on your life in the near future.

Please keep this hread bumped up so everyone gets a chance to see it.

Some thinking aloud I just was doing...

***Can't resolve a few things here...

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In 1999 the population of the entire commune, (administrative area), is listed as roughly 10,000 but 7 years later, the VILLAGE has a listed population of almost 28k... I can't get the fallingrain URL to open. Okay, even if the listed population is correct, that still makes for a remarkably LOW attack rate, even of the most garden variety human flu subtypes.

NoCarrier is quite right - why would this be worthy of mention by a GOVT. official when we can't obtain accurate & timely information about the really hairy stuff - H5N1 cases? The original translated article states:

***A commune in central Vietnam has been severely hit by the bird flu, with 195 patients showing symptoms and two children testing positive with the virus***.

So two children - according to this - have tested positive & a statement is made that up to 195 are ill - 'severely hit' makes its own statement. Symptoms are essentially the same for MOST cases, as has previously been documented & of this number, suspicions of bird flu to me would rest entirely on a couple of factors:

1) the 2 KNOWN positive tests

2) severity of symptoms; they progress to pretty bad for known H5N1 cases

3) proximity of these cases to index cluster

4) common exposures - eating sick chickens? same neighbourhoods?


The first cases struck just before Tet so we're looking at... roughly 5 weeks - 35 days... 195 cases in 45 days. I have to go back & compare to SARS - hate to do it as they don't transmit with the same efficiency nor do they have the same incubation times. I'm going to assume an average of 6 days incubation here & I'm going out on a limb - really not enough easily available data. We're talking 7 or 8 generations of transmission. Considering this is flu, that's poor efficiency transmission IF you assume these are the only cases. I'm not going to make that assumption. These 195 may be the sickest cases, the ones reported to medical authorities or for other reasons may represent only the tip of the iceberg.

Interestingly, no further deaths are mentioned. Ages of those stricken are not mentioned nor is the severity of illness remarked upon in this one article. How & where are they being cared for? Something is obviously noteworthy to the government or why bother mentioning this, as NoCarrier mentions? Why cull all poultry in the commune if H5N1 is NOT under serious consideration?

Back to transmissions - it's impossible to track how this has been spread. Even taking the 1 index case - straight mathematical spread, (can you tell I understand nothing of stats) - gives us roughly 1 person infecting 2 others every 6 days. That's way too simplistic, I think. More likely, small clusters of closely connected people are what is being experienced, but who knows? How about health care workers - are any of them ill?

Even if this is human strain flu why mention it at all? It's a given that recombination between H1, H2, H3 subtypes is a worry - whos' NOT been warning about that all along? Vietnam reports to no one. I also can't find what their flu season normally is & you'd be able to knock me over if anyone had hard data on subtypes. In some way - which way I'm not sure yet - this is 'big' news. If it's H5N1, H-H transmission is suddenly one hell of a lot more efficient than it was just 6 weeks ago.

This is why I mentioned SARS. SARS took a few months to become efficient - to go from how ever many index cases or clusters they had to 600 cases took slightly over 2 months. Assuming an exponential - very simplistic model - rise in cases with SARS. 1 person infecting 3 carries us from an index case through to roughly 600 or however many they really had - close enough considering I've got no data. The 1 infecting 3 more roughly works for this outbreak - assuming the case numbers & initial date given are correct.

If this is occurring H-H & normal patterns of care - where family members do the bulk of actual CARE is consistent, we should be somewhere between 350-500-550 cases by Friday. I'm assuming some would be cared for by only a few family members which might cut transmission. If it is H-H, culling poultry is tantamount to mounting a vigorous offence on barn doors with big locks....

Common flu this year the circulating H3N2 strains have primarily affected the 0-4, followed by 5-15 age groups in Europe - not sure about North America where I don't have access to age cohorts affected. Base levels of health are not outstanding & 2 dead kids, even from H3N2 wouldn't surprise me. But these tested out for H5N1. Now if there have honestly NOT been further deaths, I'd love to know how current cases are doing. It's been a month - have some of the earliest cases recovered? Completely? Are subsequent generations of infection NOT as sick?

That again is assuming a simply tripling of cases, (more or less), from the index case. It may not have happened or be happening that way at all. The index may have infected her brother, the virus, trickled down to a few more people over a week or 2, become easily H-H & NOW be exploding at a far higher rate of transmission than 1 in 2 or 1 in 3.

This thinking aloud isn't helpful I know, but illustrates the frustration of NOT having reliable data out of the affected area. I just checked WHO & ProMed - nothing yet but WHO only very rarely puts anything out on Sundays - not even during SARS did they do Sunday updates past the initial first terrifying weeks. I'm going to keep looking for news out of Vietnam. Interestingly - nothing from China on this either.***


Yes, pandemics do start in just this fashion.

Have a few other sites to check here...