[Flu Pandemic] Vietnamese avian flu case likely person-to-person transmission

[NoCarrier]

Vietnamese avian flu case likely person-to-person transmission

http://cnews.canoe.ca/CNEWS/Canada/2005/01/21/906161-cp.html

Authorities in Vietnam are investigating the possibility of limited human-to-human transmission of avian influenza in the case of two brothers, one of whom was confirmed Friday as the country's seventh death from the H5N1 virus in the past three weeks.

The head of the World Health Organization's global influenza program said he believes the investigation will show the older brother infected the younger one. The younger man nursed his older brother and only fell ill nine days after his brother, suggesting they did not become infected from the same source.

"I would think it's rather likely that the second one got infected from the first one, because of these nine days' difference," Dr. Klaus Stohr said from Geneva.

The older man, 46, died Jan. 10 in Hanoi. Vietnamese authorities only confirmed him as a case of H5N1 on Friday, after a retesting of samples showed proof of infection. He had originally tested negative for the virus.

His brother, 42, remains in hospital but appears to be on the mend.

To date, there is no evidence the virus spread beyond the brothers, Stohr said, adding Vietnamese disease investigators looked for but did not find signs of more extensive human transmission.

"There has been no significant increase in respiratory disease in these villages. And that's reassuring."

Sustained transmission over several generations would indicate that the virus had undergone genetic changes that allowed it to more easily infect humans - a development that could trigger the pandemic the world's influenza experts have been warning is imminent.

There have been at least four previous cases dating back to 1997 where limited person-to-person transmission of H5N1 is believed to have occurred.

Experts worry naysayers may be tempted to point to these cases of limited transmission to argue the H5N1 virus does not have the potential to trigger a pandemic. That would be an unsafe assumption, they warned Friday.

"I still am absolutely convinced that it is still just a matter of time in Southeast Asia before this thing blows," said Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

"One day we're likely to wake up and find a number of people in a given household, in a particular work area, in a given village where we've got evidence of widespread transmission - and we no longer can account for that through bird-to-human transmission."

Stohr said he understands the temptation to try to downplay the pandemic potential.

"I would like to believe that it's not going to happen. I would like to believe we will continue to see individual cases which are not going to be transmitted. I would like to believe this virus is not reassorting," he said.

"Unfortunately all the data we have would tell us otherwise.... There is too much at stake just to hope for luck."

There have been 52 confirmed human cases of H5N1 influenza in the past year, all in Thailand and Vietnam; 39 of the people died.

 

[NoCarrier]

Suspected human-to-human bird flu transmission in Vietnam

http://www.newscientist.com/article.ns?id=dn6912

Two more people in Vietnam have been confirmed to have contracted the H5N1 bird flu virus, as the known death toll in the country since the start of 2005 has risen to seven. There are at least seven more cases suspected.

Worryingly, two cases now in hospital might have caught the virus from another person, not from an infected fowl. Overall, these cases also suggest that many human infections with H5N1 may not have been diagnosed, partly because tests are not reliable or widely available.

The more people that have the virus, the more chances it will have to adapt to humans and possibly unleash a pandemic, warned Hans Troedsson of the World Health Organization in Vietnam. The WHO's biggest bird flu fear is that the virus will evolve to spread from human to human. Troedsson called it a "disappointment [that] the international community is not responding more adequately to the threat".

At the start of this week, six human cases of H5N1 flu had been diagnosed in Vietnam since the start of 2005. All have now died. Moreover, a 47-year-old man who died last week in Hanoi had twice tested negative for H5N1. He is now reported to have tested positive the third time around.

This suggests that H5N1 is being wrongly ruled out in many suspected cases. The man was only re-tested because his younger brother, who had been caring for him, had also fallen ill. The brother's initial test for H5N1 also came back negative, but two subsequent tests were positive.
No contact

The official Chinese news agency Xinhua reports that the brother, who is in stable condition and expected to recover, had no contact with chickens, and did not live near a flu outbreak in poultry.

That, and the fact that he fell ill some two weeks after his brother, suggests he might have contracted the virus from his sibling. A third family member, a younger brother, is now also in hospital with suspected bird flu.

The only case of probable human-to-human transmission confirmed in the Asian outbreak was in Thailand in 2004, when a mother contracted the disease after nursing her sick child in hospital.

But Nguyen Tran Hien, head of Vietnam's National Institute of Epidemiology and Hygiene, told journalists on Friday that it was too early to conclude that the cases were due to human-to-human transmission. A week before the eldest brother fell ill, the family is said to have slaughtered and eaten a duck, which can harbour the virus without showing symptoms.
Sputum samples

The cases in Vietnam underscore the difficulties in diagnosing the virus, which might mean human cases are more widespread than previously thought.

Tawee Chotpitayasunondh of Queen Sirikit National Institute of Child Health in Bangkok, Thailand, and colleagues report in the journal Emerging Infectious Diseases that in a fifth of the suspected H5N1 cases in Thailand that tested negative, the sputum samples taken for testing were "inadequate".

The team concluded that the small number of human cases reported, despite the massive spread of the virus in poultry across east Asia, is because the illness is hard to distinguish from common pneumonia and because specific diagnostic tests are not widely available.

The virus continues to spread among poultry in Vietnam, with 29 new outbreaks reported by the Ministry of Agriculture on Wednesday alone. And this week Thailand reported its first outbreak in poultry for two months, in the east of the country, as well as a suspected human case.

 

[NoCarrier]

Bird flu claims seventh life in Vietnam

http://www.chinapost.com.tw/i_latestdetail.asp?id=25875

Vietnam on Friday confirmed its seventh human bird flu death in three weeks, prompting the U.N. health organization to warn that the virus could turn into a global pandemic that would eclipse the devastation caused by last month's Asian tsunami.

A 47-year-old man from northern Thai Binh province died of bird flu in Hanoi on Jan. 10, about 10 days after developing a high fever and coughing, officials said.

The victim's younger brother, who cared for him in the hospital, has also tested positive for bird flu and is hospitalized in stable condition, able to sit up in his bed and talk.

With three new bird flu deaths confirmed this week, the U.N.-affiliated World Health Organization expressed concern about the high fatality rate -- more than 70 percent of those infected have died -- and the lack of research to answer critical questions about how it is transmitted, especially since no vaccine or effective treatment exists.

"We've got to be very careful that we don't lose sight of, or control of, the bird flu health threat which could have much greater public health implications than the tsunami," said William L. Aldis, the WHO's top representative in Thailand.

The Dec. 26 tsunami that struck a dozen nations has killed between 158,000 and 221,000 people and overshadowed the resurgence of bird flu in Vietnam and Thailand, which on Thursday reported its first case among poultry in two months.

The string of deaths in Vietnam renewed concerns that the virus could combine with a human flu virus and create a new version that is easily transmitted among people, although there is no evidence this has happened yet. Human cases generally have been traced to direct contact with sick birds.

But as more human bird flu cases occur, the chances become greater for the deadly virus to acquire more ability to be transmitted from person to person. That could spark the next global pandemic -- possibly killing millions, WHO experts have warned.

"If we continue to experience these frequent new outbreaks with the virus spread both in poultry and people, it finally might result in an awful virus strain that could become a pandemic with a horrendous outcome," said Hans Troedsson, WHO's representative in Vietnam.

"The more frequently we get outbreaks, the higher risk we have to infect." he said.

Vietnam has reported seven bird flu deaths since Dec. 30. The latest victim marks the first death in northern Vietnam and brings the toll to 27 in Vietnam over the past year. In Thailand, 12 people died of the disease last year.

Pham Van Diu, director of Thai Binh Preventive Medicine Center, said a week before the latest victim developed a high fever and coughing, the family slaughtered a duck and ate blood pudding made from it. No other relatives have developed symptoms, he added.

Outbreaks among poultry have re-emerged in recent months across Vietnam, killing or forcing the slaughter of more than 360,000 birds. WHO has warned the outbreak could worsen as Vietnam's Lunar New Year celebrations approach. It is the busiest time of the year for the transport of people and poultry.

"It's a bit of a disappointment to have this outbreak and the international community not responding more adequately to this threat," Troedsson said. "If you had this situation in Europe or London or New York ... you can imagine how much resources would be put toward this."

WHO has a team of four people in Vietnam working on the bird flu outbreak.

 

[NoCarrier]

Flu pandemic - are we ready?

http://www.mlive.com/news/aanews/index.ssf?/base/features-0/110623743136070.xml

To some of the world's top influenza experts, avian flu in Asia has been like an ominous drum roll for a possible new human flu strain that could sweep the globe. Last year, the bug prevalent in Asian poultry and other birds showed it occasionally could sicken and kill people, too, with 50 confirmed cases of avian flu in humans and 37 deaths since late January 2004, according to the World Health Organization. Nearly all these people caught avian flu from contact with birds, not other people. But many experts worry the avian virus could give rise to a human flu virus able to pass freely from person to person.

Yet it's likely the world won't be ready when the next human flu pandemic happens. At a University of Michigan symposium Monday, some of the world's pre-eminent flu experts and top officials at the Centers for Disease Control and Prevention will gather to discuss the implications of the recent avian flu outbreaks, development and distribution of a vaccine and other preparations for a possible pandemic.

A flu pandemic would send 134 million to 233 million people to the doctor's office and 1.5 million to 5.2 million to the hospital in high-income countries, and its effects would be more devastating and harder to manage in poorer countries, WHO estimates. About 2 million to 7 million would die worldwide, and substantially more if the new flu strain is very virulent, the organization says.

The U-M symposium "will be the definitive national conference on flu," says Matthew Boulton, an associate dean at the U-M School of Public Health and director of the U-M Bioterrorism Preparedness Initiative. The initiative's training unit is offering the event as one of its courses for health workers and others involved in emergency preparedness. The public is welcome to attend at no charge.

Speakers include Keiji Fukuda, the top influenza epidemiologist at the CDC; Linda Lambert, acting chief of the flu and respiratory diseases unit at the National Institute of Allergy and Infectious Diseases; J. Malik Peiris, chief of virology at Queen Mary Hospital, Hong Kong; and Arnold Monto, a U-M public health professor and noted expert on influenza.

Warning signs of a pandemic

The World Health Organization has stated that an influenza pandemic is inevitable and that nations are not prepared to deal with it. The group has urged health authorities to press for adequate surveillance and an international stockpile of antiviral drugs, plus more extensive vaccination programs.

The avian flu outbreaks in Vietnam and Thailand in 2004 have made some experts, including the CDC's Fukuda, concerned that the H5N1 bird virus, having already proved transmissible to humans, has the potential to evolve into a virus that humans can pass on to each other. For that to happen, parts of an avian flu virus need to mix with those in a human flu virus. That genetic mixing can occur in an infected human or animal.

A new human flu virus strain created this way can quickly spread around the globe, because people lack immunity to it. That's what happened in each of the three flu pandemics in the 20th century: the 1918 Spanish flu pandemic, which killed an estimated 20 million to 50 million people; the 1957 Asian flu pandemic, which killed around 1 million; and the 1968 Hong Kong flu pandemic, in which 1 million to 4 million died.

Although nearly all the people who caught avian flu last year were apparently infected through contact with poultry, there was at least one alarming exception.

Last September, a woman in Thailand died of avian flu after caring for her daughter, who also died from the virus. The mother had no known contact with birds. Monto has written about the case for an upcoming issue of the New England Journal of Medicine.

Some experts think the H5N1 avian flu strain is not likely to give rise to a flu pandemic, because it has so far appeared in relatively few humans despite widespread close contact between people and poultry across Asia. If they're right, then avian flu may at least prompt preparations for a pandemic down the road.

How to prepare

National and state response plans exist to address the increased needs for ambulances and hospital beds during a massive flu outbreak, Boulton says. The Washtenaw County Public Health Department is preparing a pandemic response plan.

If a pandemic emerges, public health officials know how to wield three useful tools:

# Early detection of cases that can help limit outbreaks.

# Antiviral drugs.

# Vaccination.

The real questions are: Will they be allowed access to outbreak areas in time? Will there be adequate supplies of antiviral drugs? Are vaccine suppliers ready to develop a vaccine effective against the new strain - usually a six-month process - and produce large quantities to meet demand?

Monto, like others, is pleased that anti-viral drugs useful against flu are now included in national stockpiles to help deal with possible bioterrorism attacks. One drug, Tamaflu, is effective against the worrisome avian flu. But it would be a limited weapon in a pandemic, Monto says.

"Even if we wanted to pay whatever it cost, there wouldn't be enough in the world for the demand," he says. So, he adds, the question becomes, "If we have a pandemic, how do we use what little we have? The thinking is, we would use it to treat severe cases," rather than for prevention.

As the nation knows too well, flu vaccine can be in short supply too, even during a normal flu season.

In planning for a pandemic, the shortage this season was a clear wake-up call, says Ellen Clement, public health officer for Washtenaw County Public Health Department. One lesson, she says, is that "we are lacking in the basic infrastructure we need to ensure public health. It's a clear example of when government responsibilities are not necessarily served by the privatizing function. We could have been left with no producers."

Monto is part of a CDC effort to recommend ways to ensure flu vaccine will be available in the United States. That's not easy, since only two manufacturers, both based abroad, market flu vaccine here. Monto says that's partly due to market forces and U.S. drug approval procedures. He points to European companies that sell additional types of flu vaccines elsewhere in the world but don't find it profitable to market their products here because of lower prevailing prices than in Europe. He would like to see more flu vaccines licensed in the United States. In the meantime, he says, "The word on the street is there will be a shortage again next year."

If more Americans got flu shots each year, companies would find the U.S. market more attractive. The same is true of antiviral drugs for flu, which Monto thinks doctors underprescribe. Those changes in how the country deals with ordinary flu seasons would help us be better prepared for a pandemic, "because then there would be more of a supply, more interest in doing this," he says.

 

[fruit loop]

Deaths WILL be mostly in 3rd World Countries

Again, with flu, treat the symptoms. Most people recover quickly. The flu itself doesn't kill. Death is caused by secondary infections such as bronchitis and pneumonia.

3rd World Countries will probably have limited access to antibiotics and the fever reducing drugs necessary to treat the illness.

In the USA, we'd have less "overwhelming of the health care system" if we had less STUPID PEOPLE.

Parents insist on taking Baby Pumpkin to the doctor (thus using up an appointment that a person with a secondary infection needs) because "Baby Pumpkin has a fever!" Well, all they have to do is give Baby Pumpkin some pediatric tylenol and that's what they'll pay the doc and waste an appointment to be told.

If people would educate themselves and quit panicking, the health care system wouldn't be overwhelmed by people who really need it: the elderly, those with compromised immune systems, and people with secondary infections.

 

[NoCarrier]

Again, with flu, treat the symptoms. Most people recover quickly. The flu itself doesn't kill. Death is caused by secondary infections such as bronchitis and pneumonia.

It might not be true with a pandemic strain. Look at the symptoms of Spanish flu.

http://en.wikipedia.org/wiki/Spanish_Flu

"People without symptoms could be struck suddenly and be rendered too feeble to walk within hours; many would die the next day. Symptoms included a blue tint to the face and coughing up blood."

And we are talking about young healthy people.

 

[fruit loop]

The problem with that....

...is that it is unknown whether this was a "normal" symptom of this flu strain or a secondary infection.

It's also not known how long these people had really been sick. There are many, many documented instances of people who pretended to be well in order to get around the quarantine....remember, back then, if you didn't work, you didn't get paid.

This flu was not fatal to everyone. Many people did recover and did not get the hemorrhages like this, which leads me to believe it was a secondary infection.

 

[NoCarrier]

...is that it is unknown whether this was a "normal" symptom of this flu strain or a secondary infection.

It's also not known how long these people had really been sick. There are many, many documented instances of people who pretended to be well in order to get around the quarantine....remember, back then, if you didn't work, you didn't get paid.

This flu was not fatal to everyone. Many people did recover and did not get the hemorrhages like this, which leads me to believe it was a secondary infection.

Well, not really, what killed most young healthy people was the "immune system" going berserk.

"Uncontrolled overdrive can make the immune system kill the body in order to save it, through excessive inflammation. The virus carrying the Spanish flu version of the HA gene produced high levels of cytokines in mice, Dr. Kawaoka says, and this is probably what led to the inflammation and lung damage that killed them."

http://www.nytimes.com/2004/10/07/s...ei=5070&oref=login&pagewanted=print&position=

 

[JPD]

From Promed:


Date: Fri 21 Jan 2005
From: ProMED-mail <promed@promedmail.org>
Source: Los Angeles Times, Fri 21 Jan 2005 [edited]
http://www.latimes.com/news/nationw...jan21,1,3416123.story?coll=la-headlines-world

Viet Nam: 7th Avian Influenza A (H5N1) Virus Infection Death
---------------------------------------------------
Viet Nam confirmed the 7th human death from avian influenza in 3 weeks, and
the World Health Organization is worried infection could spread rapidly
with the start of the 9 Feb 2005 9 Lunar New Year holiday. Chicken is the
centerpiece of Vietnamese meals during the festivities known as Tet. About
330 000 birds have died or been slaughtered this year in Vietnam because of
the virus infection.

******
[2]
Date: Fri 21 Jan 2005
From: ProMED-mail <promed@promedmail.org>
Source: Asia news online, Fri 21 Jan 2005 [edited]
<http://www.asianews.it/view.php?l=en&art=2392>


Viet Nam: 1st [suspected] Case of Human-to-human Transmission of Avian
Influenza in Hanoi
--------------------------------------------------
The Vietnamese health authorities confirmed on Fri 21 Jan 2005 that a man
hospitalised in Hanoi had tested positive for avian influenza, making it
the 1st case of the deadly disease in the capital and the north of the
country. 6 people have died from avian influenza in Viet Nam in the past 3
weeks, all of them from the south of the country. "The tests results were
positive," said Le Dang Ha, a professor at the Institute of Tropical
Diseases. The patient, 42, was in stable condition, he said.

The 6 who had died since 20 Dec 2004 had all been in close contact with
poultry. However the Hanoi patient had apparently not, Ha said. The man had
gone to the institute this month to take care of his brother, who had a
respiratory disease and died on 9 Jan 2005. Health authorities said on
Thursday the brother, 45, had tested negative for bird flu. However the
result would be rechecked, they said, amid fears of human-to-human
transmission of the virus.

The World Health Organisation has repeatedly warned that the virus, which
can pass from infected poultry to humans, could mutate into a highly
contagious human-to-human form that could trigger the next global human flu
pandemic.

******
[3]
Date: Fri 21 Jan 2005
From: ProMED-mail <promed@promedmail.org>
Source: Alertnet online, Reuters report, Fri 21 Jan 2005 [edited]
<http://www.alertnet.org/thenews/newsdesk/HAN280648.htm>


Viet Nam: Deceased Brother Now Believed to Have Died of Avian Influenza
-------------------------------------------------
A 47-year-old Vietnamese man has died of the same avian influenza virus
that has infected his younger brother, but officials played down fears of
human-to-human transmission of the disease, state-run media reported on Fri
21 Jan 2005. The man died on 9 Jan 2005 of a respiratory illness and
initial tests had shown he did not have avian influenza virus. But a senior
health official said further tests confirmed he died of the H5N1 virus,
which has killed 39 people in Asia in the last year. "The 3rd test by our
institute showed that the patient was positive for the H5N1 virus," Nguyen
Tran Hien, acting director of the National Institute of Hygiene and
Epidemiology, was quoted as saying by the state-run Lao Dong newspaper.

Officials at the institute declined to comment. The case has raised
concerns about possible human-to-human transmission of the virus, because
the patient's 42-year-old brother was infected with avian influenza virus
after caring for his older sibling at a Hanoi hospital earlier this month.
Lao Dong said further tests of the younger brother confirmed the presence
of the virulent poultry virus. He was hospitalised on 13 Jan 2005 and
doctors say he is recovering. "The possibility of H5N1 jumping from human
to human is only a hypothesis. We cannot yet make a conclusion that this
case is human-to-human transmission," Hien said.

What the World Health Organisation (WHO) fears most is that the virus --
which has now killed 27 in Vietnam and 12 in Thailand -- could [undergo
reassortment] if it infected a person sick with ordinary flu, or got into
an animal such as a pig that was hosting a human influenza virus. If the
H5N1 were to [reassort genome sub-units] with a human influenza virus, it
could produce a strain capable of sweeping through a human population
without immunity, the WHO says. Millions could die worldwide.

But Hans Troedsson, Vietnam representative of the U.N. health agency, told
Reuters on Thursday that the virus has not mutated. He said doctors were
doing comprehensive investigations into the cases of the 2 brothers. He
said there would probably be isolated cases of human-to-human transmission,
but this did not necessarily spell disaster. If a cluster of infections
started to emerge, it might be regarded as evidence of human-to-human
transmission, he said.

******
[4]
Date: Fri 21 Jan 2005
From: ProMED-mail <promed@promedmail.org>
Source: Alertnet online, Reuters report, Fri 21 Jan 2005 [edited]
<http://www.alertnet.org/thenews/newsdesk/HKG71960.htm>


Viet Nam: WHO Suggests Adjacent Countries May be Harbouring Human Cases
--------------------------------------------------
The World Health Organisation (WHO) said on Fri 21 Jan 2005 that the avian
influenza virus that has killed 7 people in Viet Nam since December 2004
might already be in neighbouring countries. "These other countries like
Cambodia, Laos, and Myanmar do not have the infrastructure or capacity at
this stage to do the kind of surveillance that is necessary," Peter
Cordingley, spokesman for the Western Pacific region, told Reuters on Fri
21 Jan 2005. "There may have been human cases that weren't spotted and
reported," he said by telephone from Manila. Asked about China, he said:
"The Chinese government is taking this very seriously and has put a lot of
measures in place. Only time will tell us if it's been enough."

Vietnamese state media reported on Fri 21 Jan 2005 that a 47-year-old man
had died of the H5N1 virus infection, bringing to seven the number of
Vietnamese killed in the latest wave of outbreaks which have spread the
virus across much of the country. The death of the 47-year-old man from the
virus which has also infected his younger brother has raised concerns about
possible human-to-human transmission of the disease. Shigeru Omi, WHO
director for the Western Pacific Region, said in a telephone interview from
Geneva late on Thu 20 Jan 2005 that the outbreak confirmed the virus was
entrenched in the region as Viet Nam had been making large efforts to
control it. "If we leave it like this for long, the virus might find an
efficient way for human-to-human transmission, instead of sporadic
transmission as we've seen so far," he warned.

The WHO warned on Thu 20 Jan 2005 that the bird flu virus now endemic in
Asia appears to be evolving in ways that increasingly favour the start of a
deadly human influenza outbreak. It has become "hardier", surviving several
days longer in the environment, and evidence also suggested that it is
expanding its range of mammal hosts, including captive tigers and
experimentally-infected domestic cats, it added. Asked what WHO recommends
to prevent further spread, Cordingley said: "All countries that are at risk
have to raise surveillance of poultry to the highest possible level. If
there is an outbreak in poultry -- it doesn't matter how small -- they
[must] immediately identify it, kill all infected poultry, and establish
sanitary zones around the affected farms."

So far, only Viet Nam has reported human cases, in the 3rd wave of the
outbreak since early 2004, while Thailand confirmed a single chicken at an
isolated farm being infected this week. But Cordingley said there were no
reasons to believe they would not see a similar situation this year to one
year ago, when 9 countries were infected with H5N1 in poultry. WHO suspects
migratory birds and domestic ducks are playing a role in spreading the
virus, though they show no symptoms. Cordingley added that a Thai study
showed some of its human cases in 2004 were in areas with no known
outbreaks in chickens. He said vaccinations of poultry could be useful if
combined with other measures, but there was a limit. "Do the governments
really have the capacity to go around every farm and stick a needle into
chickens?," he asked.

[Byline: Nao Nakanishi]

******
[5]
Date: 21 Jan 2005
From: ProMED-mail <promed@promedmail.org>
Source: Xinhuanet News Agency online, Fri 21 Jan 2005 [edited]
<http://news.xinhuanet.com/english/2005-01/21/content_2490508.htm>


Viet Nam: Human-to-human Transmission Suspected Following Reassessment of
Negative Test Result
---------------------------------------------------
Further testing has shown that a dead man from Viet Nam's northern Thai
Binh province had been infected with [the same strain of] avian influenza
as his younger brother, who is still alive, local newspaper Labor on Fri 21
Jan 2005 quoted the National Hygiene and Epidemiology Institute as saying:
"The 3rd test by our institute showed that samples from the 47-year-old man
were positive to H5N1," said Institute Director Nguyen Tran Hien, noting
that samples from his 42-year-old brother earlier tested positive for avian
influenza virus infection.

The younger brother had been looked after by his elder brother, who lived
in Hanoi before he died on 9 Jan 2005 at the Tropical Disease Institute in
the capital. "H5N1 spreading from person to person is merely hypothetical.
It can't be concluded that this is a human-to-human transmission case," the
director noted.

2 previous tests indicated that the elder brother had not been infected
with H5N1. On the contrary, the 1st testing of samples from the younger
brother showed that he had not contracted the virus, but the 2 following
tests proved that he is an avian influenza victim. The younger brother,
admitted to the Tropical Disease Institute on 13 Jan 2005 with symptoms of
high temperature and damaged lungs, is now in stable condition. His life
will certainly be saved, local doctors said, noting that he has had no
contact with fowls or lived in areas hit by bird flu.

On Thu 20 Jan 2005, the Tropical Disease Institute received 3 suspected
cases of avian influenza virus infection, of whom one is another younger
brother of the deceased [but the following WHO report states that this has
still to be confirmed - Mod.CP]. Now it is treating 7 patients, including 6
suspected cases. Also on Thursday, the Hanoi-based National Hospital of
Pediatrics received a 10-year-old child from northern Ha Tay province. The
patient is suspected to have contracted H5N1.

Viet Nam's Ministry of Health has confirmed 6 cases of avian influenza
infection between 28 Dec 2004 and 18 Jan 2005. All of them, who lived in
the southern region, died. On 19 Jan 2005, the younger brother was reported
as the 1st bird flu victim in the northern region, and the elder brother
the 2nd.

--
ProMED-mail
<promed@promedmail.org>

******
[6]
Date: Fri 21 Jan 2005
From: Marianne Hopp <mjhopp12@yahoo.com>
Source: World Health Organisation (WHO), CSR, Disease Outbreak News, Fri 21
Jan 2005 [edited]
<http://www.who.int/csr/don/2005_01_21/en/>


Viet Nam: Avian Influenza Situation- WHO Update 5
-------------------------------------------------
Laboratory results have confirmed avian influenza infection (H5 virus
subtype) in 2 brothers in the northern part of Viet Nam. The 1st case, a
46-year-old resident of Thai Binh Province, developed symptoms on 1 Jan
2005. He died on 9 Jan 2005.

His 42-year-old brother, a resident of Hanoi, developed symptoms on 10 Jan
2005, 9 days after his brother fell ill. He remains hospitalized in Hanoi
and is recovering. He is known to have provided bedside care for his
brother, who was treated at the same hospital in Hanoi. The investigation
surrounding the new cases is considering 2 hypotheses.

The 1st hypothesis includes the possibility that the 42-year-old man may
have acquired his infection directly from his brother. All evidence to date
suggests that isolated instances of limited, unsustained, human-to-human
transmission can be expected from avian influenza viruses.

Their occurrence does not call for any change in the present level of
pandemic alert. Intensified surveillance for respiratory symptoms in close
contacts of the 2 men has been initiated in both Tai Binh Province and
Hanoi, and it is reassuring that no cases of respiratory illness have so
far been detected among these people. Health authorities in Viet Nam have
launched an immediate investigation of the source of infection in the 2
brothers. WHO staff in that country are being kept closely informed.

The 2nd hypothesis is focusing on a possible direct source of
poultry-to-human transmission. Preliminary findings point to a family meal
in which a dish containing raw duck blood and raw organs was served. Public
health officials in Viet Nam have repeatedly advised against the
consumption of dishes made with fresh duck blood or with raw or
inadequately cooked poultry products. As a precautionary measure, similar
culinary practices involving dishes containing raw poultry parts or organs
should be avoided in all countries experiencing outbreaks of highly
pathogenic H5N1 avian influenza in poultry.

To date, most human cases linked to contact with poultry are thought to
have acquired their infection following exposure to dead or diseased birds
around households. Evidence suggests that particularly risky exposure
occurs during the slaughter, defeathering, and preparation of poultry for
cooking.

Proper cooking destroys the H5N1 virus. In general, WHO recommends that
poultry should be cooked until all parts reach an internal temperature of
70 deg C. No cases of H5N1 infection have been linked to the consumption of
thoroughly cooked poultry and egg products.

Media reports that a 3rd 35-year-old brother has been hospitalized have not
been confirmed.

These latest 2 cases bring the total in Viet Nam since mid-December 2004 to
8. Of these, 7 have died. The 18-year-old woman from Tien Giang Province,
announced previously, died on 19 Jan 2005.

--
ProMED-mail
<promed@promedmail.org>

[These reports confirm an 8th case and a 7th fatal human case of avian
influenza A (H5N1) virus infection in Viet Nam. Circumstantial evidence
suggests that there may have been transmission of infection between 2
brothers. If confirmed (which now seems unlikely, as the 2 brothers may
have shared inadequately cooked fowl), this would be the 1st evidence of
person-to-person transmission in Viet Nam. Up to the present there has
been only a single instance of possible person-to-person transmission, and
that was in Thailand in September 2004. No clusters of infection have been
observed in either country. As commented repeatedly in ProMED-mail, the
absence of seroprevalence studies in East Asian countries is an impediment
to a proper understanding of the risk to the human population in the area.
- Mod.CP]

 

[NoCarrier]

Bird flu pandemic could be more deadly than tsunami: WHO

http://www.cbc.ca/story/world/national/2005/01/21/newavianflu050121.html

HANOI - The death of a seventh person in Vietnam from bird flu may indicate the coming of a global pandemic that could cause more devastation than last month's tsunami, the World Health Organization says.

"If we continue to experience these frequent new outbreaks with the virus spread both in poultry and people, it finally might result in an awful virus strain that could become a pandemic with a horrendous outcome," said Hans Troedsson, WHO's representative in Vietnam.

A 47-year-old man from northern Thai Binh province became the seventh person in Vietnam to die of bird flu.

Three new bird flu deaths were confirmed this week, prompting concerns from WHO about the high fatality rate. More than 70 per cent of those infected have died.

"We've got to be very careful that we don't lose sight of, or control of, the bird flu health threat which could have much greater public health implications than the tsunami," said William L. Aldis, WHO's top representative in Thailand.

Some estimates have put the death toll from the Dec. 26 tsunami at 221,000 people. But WHO experts warn that millions could be killed in a bird flu pandemic.

WHO fears that the H5N1 bird flu virus could mutate into a deadly human form. It is urging countries and drug companies to speed development and production of a vaccine.

So far there are no signs that the virus is being transmitted easily between people. However, WHO says recent epidemiological and laboratory studies reveal unusual features suggesting that the virus may be evolving in ways that increasingly favour the start of a pandemic.

There are another nine suspected human cases of bird flu under investigation, including two in hospital in Ho Chi Minh City and four in Hanoi, two of which are in a critical condition.

Eighteen of Vietnam's 64 provinces and cities have been hit by the new outbreak of bird flu.

Since the end of 2003, outbreaks of bird flu have killed 38 people: 27 in Vietnam, and another 12 in Thailand.

It has also led to the death or culling of more than 120 million birds across Asia.