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]