Pregnant woman is Vietnam's latest H5N1 victim

Jul 31, 2007 (CIDRAP News) – A hospital official in Vietnam today said a 22-year-old woman who was 7 months pregnant died of H5N1 avian influenza 3 days ago, pushing the country's death toll from the disease this year to three.

Tran Thuy Hanh, director of Bach Mai Hospital in Hanoi, where the woman was a patient, told the Associated Press (AP) that tests confirmed she was infected with the H5N1 virus. She was admitted to the hospital Jul 24 with a lung infection and breathing difficulties and was placed on a ventilator.

The woman's case and three others (including two deaths) reported recently by Vietnamese officials have not yet been confirmed by the World Health Organization (WHO). Confirmation of those cases would bring the WHO count for Vietnam to 99 cases with 45 deaths. For now the WHO's Vietnam count is 95 cases with 42 deaths.

Hanh said the woman was from a farm in the northern province of Ha Tay, which is the largest poultry supplier to Hanoi, according to a Reuters report.

The woman had eaten chicken before she got sick, but it was unclear if she had been slaughtering birds, Hoang Duc Hanh, director of Ha Tay's preventive medicine center, told the AP. Reuters reported that there were no reported H5N1 outbreaks in poultry near the woman's home.

Ten of the woman's close contacts have been monitored for symptoms of infection and given oseltamivir (Tamiflu), Reuters reported.

Pregnant women in their second and third trimesters are known to be at increased risk for influenza complications, and health officials and pandemic planners worry about how to prevent and treat pandemic influenza in this group. Mortality rates in pregnant women during the 1918-19 pandemic ranged around 50%, compared to about 33% for the general population, according to a report in the May issue of Obstetrics & Gynecology.

At least two other pregnant women are among the WHO's confirmed H5N1 cases. One was a Chinese woman who was 4 months pregnant when she died in November 2005 after intensive supportive care failed, according to a report in a March 2006 issue of the New England Journal of Medicine (NEJM).The other was a 22-year-old Indonesian woman, reported by the country as its 76th H5N1 fatality, who was 4 months pregnant when she died in May.

In other news on human H5N1 cases, the WHO on Jul 25 confirmed Egypt's latest H5N1 case, in a 25-year-old woman from Damietta governorate who fell ill Jul 20 and was hospitalized the next day. The WHO report said she was in stable condition. Investigation into the source of her infection revealed exposure to sick and dead poultry the week before she got sick. The woman is Egypt's 38 case-patient, according to the WHO. The country has had 15 H5N1 deaths.

In bird-related H5N1 news, agriculture officials in France today reported that two wild swans that were found dead tested positive for the H5N1 virus, the AP reported. The swans were found three nights ago in the Moselle region in eastern France, about 9 miles from the site where three swans died of the disease in early July, the AP report said.

Elsewhere, animal-health officials in Myanmar on Jul 29 reported new H5N1 outbreaks on two poultry farms in Mon state, about 196 miles south of Rangoon, Agence-France Presse (AFP) reported. According to a Myanmar media report, officials culled 300 chickens on the farms, the AFP report said.

Myanmar had several poultry outbreaks earlier this year, but the latest outbreaks are the first since June.

See also:

Mar 30, 2006, NEJM report on lethal H5N1 infection in a pregnant woman
http://content.nejm.org/cgi/content/full/354/13/1421

May 14 CIDRAP News story "Indonesia reports 76th fatal H5N1 case"

November 2006 Emerging Infectious Diseases letter to the editor on influenza death rates in pregnant women

Abstract of May Obstetrics & Gynecology report on pandemic influenza and pregnancy

Jul 25 WHO report
http://www.who.int/csr/don/2007_07_25/en/index.html

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