Entries in cluster case (1)
All eyes on Vietnam for potential human bird flu cluster
Scott McPherson
in Egypt, H1N1, H5N1, Politics and government, Vietnam, bird flu, cluster case, influenza and infectious diseases, pandemic, swine flu
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Yesterday, Vietnam confirmed yet another human bird flu case. This time, however, this case bears watching, because it could signal something far more disconcerting than just a single human case.
From the proMED report:
The Director of the Bac Kan provincial Health Department, Nong Quoc Chi, confirmed an A (H5N1)-infected case on [5 Apr 2010]. The patient, [male], 22, from Na Tao hamlet, Nhu Co commune, Cho Moi district, is currently in critical condition. He is being treated at the [National Institute of Tropical and Infectious Diseases]. The patient got sick on [30 Mar 2010] with symptoms of high fever and cough. He was admitted to Bac Kan provincial hospital, and then sent to the [National Institute of Tropical and Infectious Diseases] on [3 Apr 2010] where he tested positive for the lethal strain of A (H5N1) virus.
At present, 4 other people in Nhu Co commune show similar symptoms of high fever and cough. They are under quarantine and being treated at Bac Kan provincial hospital.
The patient in question was taken ill on the 30th of March, and then sent to Hanoi when his condition worsened. The four suspected human bird flu cases are currently in quarantine at the provincial hospital in the provincial capital of Bak Kan. (Or Bac Can, as shown on map at left).
There are many unanswered questions. The most obvious of these is whether these four suspected cases are bird flu, or swine flu?
If these cases are indeed bird flu, has there been human-to-human chain transmission, or were these people all infected during the same timeframe by a single vector? Were they all infected by sick poultry, or were they sickened by a human infection?
OK, let's assume these four people were all H1N1/swine flu infections. That is not good news! That would mean that, once again, bird flu and swine flu had "rubbed elbows" in rural Vietnam. Search my Blogsite for the earlier known case, back in 2009.
According to the Vietnamese Department of Preventive Medicine and the Environment, there are no outbreaks of H1N1 anywhere in Vietnam. From VOA News:
No more A/H1N1 outbreaks in Vietnam
At a meeting reviewing the flu epidemic situation in Hanoi on March 31, the Deputy Director of the Department of Preventive Medicine and the Environment, Tran Khac Phu, confirmed that 11,208 people in the country had been infected with the virus as of March 31 and 58 of them had died.
Regarding the A/H5N1 flu, Phu said that there were no more confirmed cases last week, and the total number of such cases so far this year stands at five, including two deaths.
The A/H1N1 virus epidemic appears to have subsided and the country has not detected any mutations in the virus, said Associate Professor Dr. Nguyen Tran Hien, Director of the Central Institute of Hygiene and Epidemiology.
However, Hien urged localities to closely monitor for the A/H5N1 virus as it is still being found on poultry in several areas.
According to the World Health Organisation (WHO), by March 30, there had been 492 confirmed cases of A/H5N1 infection in 15 countries, resulting in 291 deaths.
Vietnam is actively looking for bird flu cases, so perhaps this is why they feel so confident that no H1N1 outbreaks have occurred. But this may be at odds with the WHO Vietnam report of February 10, 2010. that WHO report stated, matter-of-factly:
Pandemic (H1N1) 2009 is continuing to spread throughout Viet Nam. The spread of 
the virus to all countries, worldwide, is considered inevitable.
As of 10 February 2010, Viet Nam's Ministry of Health has received reports of 11,186 laboratory confirmed cases, including 58 deaths. (Bold WHO's)
It is important to note that this pandemic is currently referred to as of “moderate” severity based upon the global situation. The overwhelming majority of patients are recovering without the need for hospitalization or even medical care, the levels of severe cases are similar to the levels we expect for seasonal influenza, and the health care systems are able to cope with the number of people seeking care.
With the increasing spread of H1N1 in Viet Nam, we expect that there will be a number of people who have serious complications and some will die.
All-righty then! Is Vietnam's swine flu rate climbing or falling? This is not an unimportant question, because it is becoming apparent that Vietnam, more than any other nation save Egypt, may have the potential to be that flashpoint where H5 and H1 reassort. Vietnam has had, to date, prior to this report, 5 bird flu cases with 2 deaths. Egypt, in contrast, has had 18 human bird flu cases with 6 deaths. Both areas are of huge concern.
Let's all keep our eyes on this developing situation.