Family cluster of avian flu cases reported in Vietnam

Mar 29, 2005 (CIDRAP News) – Initial testing indicates that all five members of a family of chicken farmers near Haiphong, Vietnam, have avian influenza, the World Health Organization (WHO) and news services said today.

"These cases, which include the parents and their three young daughters, are undergoing further investigation following initial tests indicating infection with the H5 subtype of avian influenza," the WHO said in a statement. "Reports indicate outbreaks of avian influenza in poultry in the vicinity."

An Agence France-Press (AFP) report said the family members were in stable condition in Haiphong's Viet Tiep Hospital. An unnamed physician at the hospital was quoted as saying, "Initial tests showed they are positive for H5N1. We are treating them according to plans but we need final confirmation from Hanoi."

If the cases are confirmed, they apparently will represent the largest family cluster since human cases of H5N1 avian flu began occurring in Asia in early 2004.

A woman who lives near the family is also being treated for suspected avian flu, another doctor from the Haiphong hospital told AFP. The Chinese news agency Xinhua further reported that a child from the same commune as the other six people is hospitalized.

A field investigation of the family cases is under way, WHO reported. "Thorough investigation of all such clusters is essential to determine possible changes in the behavior of the virus and thus support assessment of the risk of an influenza pandemic," the agency said.

The statement also said, "There is currently no evidence that the H5N1 virus is spreading easily from person to person."

The WHO also reported today that the Vietnamese Ministry of Health has formally confirmed several avian flu cases that were previously reported by the news media. The agency listed the people involved as a 5-year-old boy from the central province of Quang Binh, a 17-year-old girl from the northern province of Nam Dinh (who died Mar 23), and a 40-year-old woman from the northern province of Quang Ninh. An earlier case also has been confirmed, the WHO said, but the agency did not describe that person.

The WHO also provided a limited update on the investigation of media-reported cases of flu-like illness in Quang Binh province. The agency is awaiting test results but said the number of illnesses appears much smaller than the 195 cases first reported by local media.

If the Haiphong family is included, the unofficial count of avian flu cases has risen to 79, including 49 deaths, since late 2003. That includes 60 cases with 35 deaths in Vietnam, 17 cases with 12 deaths in Thailand, and 2 fatal cases in Cambodia.

Meanwhile, poultry and politics were taking center stage elsewhere in Southeast Asia, as officials sought to contain outbreaks in Cambodia and North Korea.

Using bullhorns and battery-powered tape players mounted on motorbikes, health workers in Cambodia are going from house to house in Cambodia's Kampot province, said Sok Touch, director of the Health Ministry's communicable disease control department, in an interview for an Associated Press (AP) story today.

"They are telling people not to touch sick or dead birds and that if they have any suspected bird flu symptoms, such as fever and cough, they should go to the nearest healthcare center," he said. Both Cambodians who died of avian flu lived in Kampot province.

An investigation continues in Kampot into the Mar 22 death of Meas Ran, 28, WHO announced today. The agency said Cambodian officials formally confirmed his previously reported case today. Authorities have learned he had contact with sick poultry, but apparently he did not pass the disease to others. Thirty-three of his family members, neighbors, and healthcare providers have tested negative for avian flu, WHO said.

Elsewhere, the WHO had been in talks with North Korea about preventing human cases of avian flu even before the recent announcement that the country slaughtered hundreds of thousands of poultry sick with avian flu, according to AFP. North Korea's state media have said no human cases have occurred there.

"The WHO had offered its help to the country to prepare for human cases of avian flu," WHO spokeswoman Fadela Chaib told reporters, but didn't say whether the offer had been accepted.

Another WHO official in Asia said the agency sought to obtain a sample of the virus in North Korea for testing, AFP reported today.

Although avian flu is killing poultry in five Asian countries, only two of them have maintained timely reporting of the cases to the World Organization for Animal Health (OIE), as shown on OIE Web site. Thailand reported the deaths or culling of 50 chickens in Sukhothai province from Mar 9 to 17, and Indonesia reported an outbreak among chickens for the week ending Mar 11.

North Korea hasn't notified OIE but is working with the United Nation's Food and Agriculture Organization, AFP reported today. Other countries appear to be lagging in OIE notification: Vietnam made its most recent report on Feb 28, and Cambodia made its most recent report on Sep 22, 2004.

See also:

Mar 29 WHO news release
http://www.who.int/csr/don/2005_03_29b/en/

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