Nine H5N1 Bird Flu Cases
In Northern Vietnam
From Patricia A. Doyle, PhD
Recombinomics Commentary
By Dr. Henry L. Niman, PhD
"Six people were admitted to our institute last week. They have been tested positive to H5N1. Now, we're treating eight bird flu patients in all," a nurse at the Institute of Tropical Diseases in Hanoi capital city said on condition of anonymity.
Among the eight patients, seven are showing good signs of recovery, and one is in critical health condition, the nurse said, adding that a doctor at the institute, who has taken specimens from bird flu patients for testing, has temperature, one of the disease's symptoms.
The above comments describe nine H5N1 bird flu patients at the Institute of Tropical Diseases in Hanoi. Two would appear to be patients admitted in May. Three such patients were described in the latest WHO update. Six more were admitted last week, and wire service reports indicate H5N1 has been confirmed in these six. The physician would represent the 9th confirmed or suspect case. Since detail is lacking, there may be additional patients admitted this week, who have not been confirmed
Since there is no detail on gender, age, or location on the new patients, it is unclear how clustered these cases are, other than the relationship of the physician to the patients. However, if the physician is H5N1 positive, then the transmission from patient to physician would provide another data point indicating human-to-human transmission in northern Vietnam is getting more efficient. The last reported physician with bird flu symptoms was the 34 year old physician at Vietnam Swedish hospital who developed Acute Respiratory Distress on April 1 and died two days later.
Although cluster data on the latest group of patients in Hanoi is not available, the large number of cases in northern Vietnam extends the observations on larger numbers of milder cases, and is cause for concern that H5N1 in northern Vietnam is more efficiently transmitting human-to-human.
More Mild Bird Flu Cases in Northern Vietnam
Recombinomics Commentary
By Dr. Henry L. Niman, PhD
June 14, 2005
The Ministry of Health in Viet Nam has confirmed an additional 3 human cases of infection with H5N1 avian influenza. The cases were detected during the last two weeks of May. All three patients are from Hanoi and remain alive. No further data about these cases have been provided.
The above comment from the latest WHO update on Vietnam describes three more milder H5N1 cases in northern Vietnam. More geographical or familial relationships were not provided, but the trend in northern Vietnam has been set since the beginning of the year. The clusters are larger and more frequent and the cases are milder. These milder cases are similar to severe cases of human flu and therefore many H5N1 human infections in northern Vietnam may go undetected.
Sequence data from northern Vietnam included an HA cleavage site missing an ARG. This missing basic amino acid matches the cleavage site from 2003 and 2004 isolates in Hong Kong and southeastern China, raising the possibility that mild human H5N1 cases are also in China. The homology with 2005 Thailand isolates also raises the possibility of more human infections there also.
Recent comments on the sequence of H5N1 from bar headed geese at Qinghai Lake also linked bird flu there to H5N1 in southeastern China. The bar headed geese winter in India and Bangladesh and fly over Tibet to nest at Qinghai Lake in May and June. Recently there have been meningitis outbreaks in northern India, which coincide in time and location with the bar headed geese migration.
Interestingly, the crested eagles smuggled into Belgium from Thailand had sequences matching those in Thialand, but the eagles originated in Tibet.
The linkage by time location and sequence of H5N1 cases throughout southern and eastern Asia raise serious questions about H5N1 monitoring of birds and people. The scandalously poor monitoring significantly compromises flu pandemic containment strategies.
H5N1 in Qinghai Similar to H5N1 in Southeastern China
Recombinomics Commentary
By Dr. Henry L. Niman, PhD
June 13, 2005
Lab director Chen Huanlan says it is "not a new viral genotype" but similar to the viral strains found in southeast China last year Guan Yi, a virologist at the University of Hong Kong, says the finding raises questions about "how the virus got there." <<
Although the question of how the H5N1 in Qinghai got there is a good question, questions of where H5N1 is in 2005 is also of considerable importance. The initial bird flu casualties at Qinghai Lake were bar headed geese, which winter in India and Bangladesh. Both countries have filed statements in 2004 with OIE indicating they were H5N1 free, the declaration from India mere stated that the 250 pigeons that dies in northeast India, near Bangladesh tested negative for H5N1. However, false negatives in northern and southern Vietnam were common as were false negatives in Thailand. Thus, in the absence of a cause of death for the pigeons, the negative data remains suspect
Moreover, China has claimed to have been H5N1 free this year, but a ProMed report from Fujian province described dying domestic geese with symptoms that sounded remarkably like bird flu. These geese were not tested, but merely replaced with geese from Jiangsu and Jiangxi, which also died with the same symptoms, suggesting H5N1 infections in eastern China are widespread.
In addition, recent reports described the HA cleavage site in isolates from foul in Gungdong Province, also in southeastern China. Those isolates had cleavage sites that matched the common sequence in genotype Z, found throughout Asia in 2004, as well as a sequence that had lost a lysine, which matched isolated in Shanghai, Shantou, and Hunnan Provinces. Another sequence in Guangdong was missing a lysine, which matched earlier isolates from Yunnan and Hong Kong isolates, as well as more recent isolates from Yunnan, Japan, in 2004 as well as northern Vietnam and possibly Thailand in 2005, again raising questions about the absence of H5N1 in eastern China
Although China, India, and Bangladesh all claim to be H5N1 free, the unprecedented bird deaths in migratory birds in Qinghai Lake, followed by the deaths of domestic geese in Xinjiang suggest monitoring of H5N1 in Asia has been, and remains, scandalously poor.
Patricia A. Doyle, PhD
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