Entries in cluster (2)

Chinese hospital pays settlement with father of second bird flu death

Dr. Henry Niman may have stumbled onto something interesting.  In his Recombinomics commentary of Saturday, he has identified a cash settlement from the hospital treating the first known H7N9 patients. 

Dr. Niman cited an article from the South China Morning Post.  Here's the headline and some copy:

Dead man's family claims bird flu cover-up by hospital

Wu Demao was bewildered when he heard that his son-in-law, Wu Liangliang, who died on March 10 at Shanghai No 5 People's Hospital, was a victim of H7N9 bird flu.

"No one has so far officially informed us of the true cause of his death," Wu said. "It was one of our relatives who told us that the local television had reported that my son-in-law died of a new strain of bird flu."

Wu Liangliang, 27, from Yancheng in Jiangsu, was the second man found to have caught H7N9 flu in Shanghai, the city government announced at a press conference on Tuesday, giving only his family name.

He arrived in Shanghai in February to visit his parents-in-law and helped Wu Demao, a pork vendor at a wet market on Jinggu Road in Minhang district.

Wu Liangliang suffered from high fever in late February and initial treatment by a nearby clinic and the No5 People's Hospital proved unsuccessful. He was admitted on March 1.

 Doctors told the family he had pneumonia and he was not put into quarantine, Wu Demao said. (Bold mine)

The hospital paid the family 130,000 yuan (HK$161,000) in compensation on March 26, saying it was for humanitarian reasons and for its minor responsibility in Wu Liangliang's treatment, without elaborating.

As we call it in the good ol' U. S. of A.:  This is a settlement.  Or a payoff. Somehow, the hospital found it necessary to compensate the family for the young man's death. 

Now why would the hospital proffer such an offer?  Perhaps it is because they feel responsible for the young man's death.  From Dr. Niman's commentary:

The above comments describe a payment to the family of the second H7N9 case (27M) who lived in the Minghang District and died at the Shanghai Number Five People’s Hospital in Minhang.  The first confirmed case (87M) was also treated on the same floor of the hospital.  In addition, his two sons (69M and 55M) were also treated at the hospital, so the family of the second victim claimed that their relative had been infected at the hospital by one of the three family members being treated at the hospital.

SARS was transmitted to unwitting patients via the HVAC systems in hospitals.  This happened in both China and Toronto.  Because they were in normal hospitals and not in negative-pressure isolation, the HVAC systems carried the virus to adjacent rooms -- and innocent patients who were there for unrelated reasons. 

In other cases, SARS virus was carried by the medical personnel themselves, who were unaware that a novel coronavirius was being spread by their own interaction with patients.

It appears that the latter may have been the case here.  The hospital, with its settlement, is inferring some culpability in the young man's death. 

It also raises more questions about the route of transmissibility of this virus.  We know influenza is transmissible from contact with contaminated solid surfaces.  This unique case would seem to indicate that the virus can be spread by more than just inhaling a chicken or a pigeon.  The young man was in a wet market, but working pork, not birds (hmmm...).  Lord knows, a wet market has lots of opportunity for comtamination.  trhat is why the Chinese have, basically, shut down all wet markets and eliminated the poultry and disinfected the markets.

Vietnam's Na Tao hamlet: Ground Zero for latest bird flu cluster

The world press is beginning to focus on the province of Bak Kan (or Bac Can), Vietnam.  Bak Kan is in the extreme north of Vietnam, near the Chinese border.  Last week, I blogged on the potential H5N1 bird flu cluster that was threatening to emerge within that province. Just scroll down to read my previous blog.

Following my blog, a second story appeared regarding a second human infection.  It was dated at 6:01 PM, 04/09/2010.  It appears below, and the link to the VOV story is in the headline:

Another A/H5N1 infection case reported in Bac Kan

Bac Kan province has confirmed a second A/H5N1-infection case in Na Tao hamlet, Nhu Co commune, Cho Moi district.  The patient, Nguyen Thi Thanh Thu, 27, visited a bird flu-infected area four or five days before being diagnosed with the deadly virus.

The healthcare centre in Cho Moi district has reported nine suspected cases, eight of them from Na Tao hamlet. (bold mine) All nine showed symptoms of high fever, breathing difficulty and coughing.

The first A/H5N1 case was detected in Bac Kan on April 5. The patient, Trung Van Hoa, 22, was also from Na Tao hamlet.

At present, local authorities and health agencies are intensifying emergency measures to sterilise infected areas and strictly monitor new outbreaks of the disease.

Cho Moi district has been given 700 doses of Tamiflu vaccine(bold mine) and enough medical equipment to ensure that necessary checkups and treatment can be provided to local patients.

  Now today, a copyrighted story has appeared via the Canadian Press.  It has also been picked up by AP and has gone worldwide.  Here is that story:

Bird flu sickens 2 in Vietnam; 11 others quarantined, recovering from flulike symptoms

By Tran Van Minh (CP) – 5 hours ago

HANOI, Vietnam — Two Vietnamese from a poor, mountainous area have been infected with bird flu, and 11 others were quarantined with flulike symptoms, health officials said Tuesday.

A 22-year-old man and a 27-month-old girl remain hospitalized after testing positive for the H5N1 virus, said Hoang Van Linh, deputy director of northern Bac Kan province's health department. He said the 11 others, some of whom were relatives of the confirmed cases, had fallen ill with fever, coughing and shortness of breath.

They were given the antiviral Tamiflu and have since recovered. He said they were tested for bird flu, but the results have not come back.

Dead chickens were reported at the homes of the two patients, and the toddler's family is believed to have slaughtered and eaten some of the infected poultry, according to the Ministry of Health's Web site. Ly Quoc Khach, an infectious disease official from the provincial health department, said all 11 people, members of the Tay and Nung ethnic minorities, had contact with the sick birds, and he said he did not believe there would be any reason to fear possible human-to-human transmission if they did test positive.

The 22-year-old man remains on a respirator after being hospitalized April 2, while the toddler, who was admitted two days later, is in stable condition, Hoang said. All of the sick people's homes in Ma Tao commune have since been disinfected, and the infected poultry have been slaughtered, Ly said.

Vietnam has been hit with a spate of fresh H5N1 outbreaks among poultry, and two people have died from the disease this year, according to the World health Organization, which confirms 59 deaths since late 2003.

The disease remains rare among people, with most cases linked to direct contact with infected poultry. But experts have long feared the virulent virus could mutate into a form that allows it to spread easily among people, possibly igniting a pandemic.

OK, time for award-winning commentary again.  Note that the Vietnamese press is listing three -- NOT two -- confirmed H5n1 cases.  Note also that the VoV article speaks of a Tamiflu blanket that has been applied over the entire district of Cho Moi, which includes the hamlet (and apparent epicenter of this bird flu outbreak), Na Tao.

Note that the total of suspected human bird flu patients is up to 11.  If we include the three previous cases, we have as many as 14 possibles.  This would make this the largest bird flu human cluster since 2008.

Bird flu is cropping up all over Asia again.  China is seeing a re-emergence, no doubt facilitated by illegal trade in smuggled birds (Google my blog of, oh, I dunno, maybe 2007 on that topic).  A veritable Ho Chi Minh trail of smuggling activity exists between China and Vietnam, the irony of which is not lost on Americans.

But I digress.  The Vietnamese government has acted quickly and decisively on the issue of Bak Kan.  They have applied a Tamiflu blanket over an area comprising 700 villagers.  They have eleven villagers in quarantine with clear symptoms of influenza, and three confirmed human cases. 

The next thing to look at is the timeline.  The first human case in Bak Kan was March 30th of this year.  The toddler was admitted two days after the first case.  The third confirmed case was "four or five days before being diagnosed with the virus," meaning some time possibly between the 30th of March and the 5th of April (the story was written on the 9th). 

The epicenter of the epicenter appears to be a commune within the hamlet.  Now I suppose it is possible that people would have eaten diseased poultry at the same time.  But the onset of symptoms is staggered by several day between the first and third cases.  This would cause me to speculate that you cannot exclude human-to-human contact.  And the simple fact that 700 surrounding villagers are currently on Tamiflu as a preventative would seem to support that hypothesis.

Hopefully, the reasonably transparent Vietnamese government will be very forthcoming with samples of this virus.  In light of the fact that H1N1v, aka swine flu, is still traversing those same remote hamlets of Asia, and in light of the jarring re-emergence of H5N1 bird flu across eastern Europe and Asia, we need to know:  Has bird flu mutated?