- "The seven people, all from southern Vietnam, didn't
have clinical or epidemiological factors typical of previous bird-flu cases,
the institute official said. One patient had tuberculosis.
- "Last month, the New England Journal of Medicine
reported on one case dating back to February 2004 where the victim exhibited
none of the classic respiratory symptoms associated with bird flu. Instead,
Oxford University researchers said the four-year-old boy had suffered from
encephalitis, or inflammation of the brain, before slipping into a coma.
His case was only discovered months later after researchers found his samples
among encephalitis victims.
- "Those findings suggested that avian influenza may
be more widespread than originally believed because the total number of
infections may have been underestimated."
- In the 1918 flu pandemic many of the patients were misdiagnosed
as having cholera, dengue fever, and typhoid. The recent false negatives
on atypical patients in southern Vietnam raise significant monitoring issues.
A repeat of the mistakes of 1918 is a definite concern.
- Many of the index cases in familial clusters were not
tested, and many other members initially tested negative, even though the
suspicion level was high due to typical bird flu symptoms or prior poultry
outbreaks in the region.
- The suspicion level in the atypical cases is markedly
lower. There has been a reluctance to H5N1 test unusual outbreaks of fatal
disease, such as the meningococcemia cases in the Philippines.
- Because pandemic vaccines have not been tested and anti-viral
medicines such as Tamiflu are in short supply, WHO has announced a strategy
of containment of bird flu through conventional contact tracing and quarantine,
coupled with prophylactic treatment with Tamiflu.
- However, the failure to monitor bird flu in Vietnam and
Thailand, as well as neighboring countries, limits the effectiveness of
such a strategy. The spread of H5N1 is poorly understood because of monitoring
deficiencies, which are still scandalously poor.
- © 2005 Recombinomics. All rights reserved.