Vietnam Family of Five Catches Bird Flu

[pandemic_1918]

Vietnam Family of Five Catches Bird Flu

http://news.scotsman.com/latest.cfm?id=4321459

Vietnam health officials said today that five members of a family that ran a chicken farm in northern Vietnam have tested positive for bird flu.

Initial tests showed the H5N1 virus was present in samples taken from a 35-year-old man, his 32-year-old wife and their three daughters, aged 10 years, 4 years, and 4 months, said Nguyen Van Vy, director of Haiphong Health Department.

The family, admitted to Viet Tiep Hospital on March 22 with flu symptoms, had raised more than 400 chickens. About half of the poultry began dying at the beginning of the month and the family then ate some of the chickens, he said.

Though doctors can’t completely rule out human to human transmission, they believe that the family contracted the illness through direct contact with the sick birds, said Nguyen Tran Hien, director of the Institute of Hygiene and Epidemiology. Hien said final results on the tests were still pending.

“I’m not very worried (about human-to-human transmission) because they all got sick at the same time so it’s more likely that they got infected from the same source,” he said........

[pandemic_1918]

1. The Flu Pandemic Has Started

The missing ingredient for a flu pandemic was efficient transmission of H5N1 to humans. The ingredient is no longer missing.

The Flu Pandemic of 2005 has officially begun.

[mike_c]

3. not necessarily...

...transmission from birds to humans is only the initial step, but not the one that necessarily commits a pandemic. Recombination with a human-to-human strain will be the event that could start a pandemic. Personally, I think it's inevitable, but this case looks more like bird-to-human transmission. It's still a highly fatal disease, but it hasn't really kicked off yet.

[pandemic_1918]

6. The Key Is Efficient Transmission to Humans

Human to human transmisison of H5N1 is MUCH more efficient (3 logs) than bird to human. The pandemic begins when thousands of people are infected by birds. Human to human will quicky follow.

[mike_c]

10. huh?? I haven't seen any evidence that h2h transmission is...

...efficient (yet). Anything but. MILLIONS of birds have died in SE Asia, but fewer than 100 humans. The human mortality rate has been exceptionally high, but h2b infection rates are low so far (although recent data about asymptomatic humans positive for H5N1 exposure makes this an unknown variable, really). Avian flue has a high likelihood of sparking a pandemic, but I haven't seen anything but speculation about h2h transmission yet. When that happens, it could be very bad.

[pandemic_1918]

14. H2H Transmission

If you haven't seen H2H transmission, you haven't been paying attention. Over 1/3 of reported H5N1 human cases are in clusters. Up until this family of 5, they were all bimodal (index case gets sick and then 1-2 weeks later a family member gets sick). Bimodal signals human to human (WHO only admits it when pressed),

Notice how quote today on family was that it WASN'T H2H because they all got sick at the same time? Anyone paying attention knows that

bimodal = H2H (human to human)

unimodal = common source

[mike_c]

22. I said "**efficient** h2h transmission...."

I've been paying plenty of attention. H5N1 is a ticking bomb. So far though, I think it's still ticking. I don't think the critical recombinant virus has gotten into the herd (us) yet.

See my comments below about the dual lines of evidence regarding h2h transmissibility and virulence. There's no point in repeating them here.

[Occulus]

2. the ignorance? stupidity? is stunning...

"About half of the poultry began dying at the beginning of the month and the family then ate some of the chickens, he said."

I mean..... just......... wow.

[malmapus]

4. Agree with you there...

would think some common sense would be involved

[Trillo]

5. Probably didn't want them to go to waste.

Scarcity as a mindset has its consequences.

[pandemic_1918]

8. Lots of Sick Chickens Are Eaten

Lots of sick chickens are eaten in Asia. The key fact is that this time all family members (including 4 month old who probably didn't eat chicken) were infected at the SAME time. There has NOT been a common source previously. Even the nonsense about duck blood pudding did not produce symptoms at the same time (the blood pudding was nonsense and the current family shows what common source looks like = especially when the common source EFFICIENTLY transmits

http://news.google.com/news?hl=en&lr=&tab=wn&ie=UTF-8&q=h5n1+haiphong+family

[mike_c]

11. I'm sorry, but you've got part of this confused....

The common source of infection was the contaminated chicken they ate. The baby likely either ate some chicken or was infected by unsanitary food handling. There is no evidence in this case of h2h transmission, or MUCH more importantly, H5N1 recombination with human virulent influenza strains.

on edit-- when half the people in their village, or in the same hospital die-- that will be the start of it.

[pandemic_1918]

15. 3 Neighbors in Hospital

No confusion here. Efficient transmission to humans is the start of the pandemic.

In addition to the 5 family members, 3 neighbors were admitted a few days later (around the 25th).

Tight cluster of 8 = pandemic

http://news.google.com/news?hl=en&lr=&tab=wn&ie=UTF-8&q=h5n1+Kien+Thuy

[mike_c]

21. no, efficient transmission *among* humans is necessary...

...before the pandemic starts. Not "transmission to humans." And there is no clear evidence in this case that transmission "to humans" from infected chickens has become any more efficient-- these people all handled and consumed infected meat. It sounds as though you are confusing bird-to-human and human-to-human transmissibility. This cluster is easily explained by a common source of b2h infection-- that doesn't mean it isn't the belwether of a recombinant strain with high efficiency h2h transmission, but it likewise doesn't mean that it is.

H5N1 will go off sooner or later, but there's little to be gained by continually sounding the specific alarm that this or that case is the bomb unless you're the public health person who's trying to isolate that particular case.

[pandemic_1918]

23. Efficient Transmission Among Humans

Three neighbors of the family are also in the hospital. That's 8 people in the hospital and who knows how many who are infected at home. This is efficient human to human transmission.

http://www.recombinomics.com/News/03290503/H5N1_Kien_Thuy_Neighbors.html

Can you cite another H5N1 example of an entire family showing up at the hospital on the same day?

I didn't think so.

[mike_c]

24. for crying out loud, they all shared the same source of infected...

...meat. Can you cite another example in which a group of people sat down at the table together to share an H5N1 contaminated meal and they didn't all become infected? Such cases probably exist due to variation in transmission efficiency and host susceptibility, but that's a bit beside the point. This is basic epidemiology-- if 10 people drink from a poisoned well and they all get sick, that doesn't mean that they transmitted the poison to one another.

[Media_Lies_Daily]

30. And you know that they shared the same infected meat because....

...we're being told that by a country that is trying to keep the lid on a bad situation. Additionally, they were very slow to report that they had a problem in the first place.

Is that really what you expect us to believe?

Here's what I think. I think that Vietnam has been having a problem with Avian Flu infecting humans for about a year. They didn't recognize they had a problem at first. Once they did realize they had a problem, they didn't realize that it was as bad as it was. Then they kept it quiet and tried to handle the situation on their own, just like the Chinese tried to deal with the SARS problem.

Why did Vietnam suppress the information? Because they didn't want to discourage trade and tourism, and they certainly didn't want it known that they had screwed up when the disease first emerged among humans.

[gkhouston]

32. all good questions

I'm still trying to wrap my mind around the idea of the 4-month old eating chicken. Babies are generally not that fond of meat, especially that young. Wouldn't it be more likely that the baby contracted the illness from the mother via breastfeeding?

[mike_c]

34. eating the meat is only one means of transmission....

Unsanitary food handling is just as likely, including the possibility of hand-breast-infant transmission if the baby was eating no solid food at all, or even more likely, simple mother to infant transmission through breast milk-- remember, humans don't have immunity to H5N1, so the mother would have no way to prevent shedding virus into her milk if she was nursing while infected.

[mike_c]

33. the republic of vietnam is not capable of suppressing an H5N1...

...epidemic if the virus recombines with an easily transmissible human flu strain. It's an open question whether another nation might be able to do it in the early stages of an outbreak, as in SARS, but there is considerable doubt about this among public health officials, even for highly developed countries. There is no way Vietnam could do what you're suggesting. Vietnam's most important role in this drama lies in their willingness to cooperate with the WHO and their ability to provide reasonably good health care to a relative few infected humans-- that's why I said watch out for Laos, Cambodia, and North Korea, because they're either less cooperative or less capable of isolating patients in time.

You are correct in saying that Vietnam has been experiencing human infections for the last year-- Vietnam is at the center of the bird flu epizootic, and there is limited b2h transmissibility so far, so this makes sense-- but there is little or no unambiguous evidence that they have experienced any degree of h2h transmission of recombined H5N1. Vietnam's public health agencies would be overwhelmed very quickly by a recombinant human strain-- and they know it. They are at the epicenter of a potential avian flu pandemic-- they CANNOT benefit by concealing a recombinant virus and don't have the capacity to do so anyway. Tourism? It'll be a charnal house. Yes, they might have been reluctant to cooperate at the very beginning, but now Vietnam is one of the WHO's best partners. The most recent international conferance on H5N1 was held in Siagon, for example.

[pandemic_1918]

36. Eating Contaminated Meat in Vietnam is Common

Eating chickens that have died from bird flu in Vietnam is VERY common. The meal is frequently cited as a source of infection for various familial clusters. However these meals, including the often cited duck blood pudding meals, do NOT create common source clusters (multiple family members developing symptoms at the same time).

As I said before, can you cite ONE prior example?

I didn't think so.

[mike_c]

41. well, if you're right...

...we'll know soon enough.

[Media_Lies_Daily]

18. I'm sorry, but pandemic_1918 has posted some pretty accurate....

...information to the board along with appearing to be pretty knowledgeable on the subject of diseases. I doubt seriously that he's gotten anything "confused".

I also think you need to do some homework on h2h transmissions involving Avian Flu. I think you will find more than enough information to tell you that h2h has already happened in Vietnam. Although the virus is not being transmitted h2h as efficiently as possible at this point in time, it may very well mutate to a form that will.

[mike_c]

19. that's the point....

Although the virus is not being transmitted h2h as efficiently as possible at this point in time, it may very well mutate to a form that will.

I've been following the progress of reported instances of both bird and human infections in SE Asia and so far there is little evidence of the critical recombination (which is far more likely than an equivalent spontaneous mutation) that will give H5N1 the h2h transmissibility of human influenza strains. ANY cluster MIGHT turn out to be the fuse that lights the bomb, but so far none have done so. This is very strong evidence that such recombination has not yet occurred. P18 is correct in that it is simply a matter of time before that happens.

on edit-- just to be epidemiologically correct, there is a very high likelihood that viral recombination HAS occurred between H5N1 and other flu strains, but so far it looks like the recombinant hasn't gotten out into the wild.

The P18 response above contains the statement: "cluster of 8 = pandemic." This is simply not true, unless it was meant to suggest that this cluster of eight might be the start of the pandemic, which is certainly possible, if a recombinant form of the virus has developed. That has been equally true of every case of human infection so far, and will be true of every subsequent one until that recombination occurs. BTW, the pandemic won't start until human cases begin appearing OUTSIDE the range of the current bird flu epizootic.

The statement that the common source of this cluster's infection indicates that recombination has occured is likewise in error. As I said, all of the members of this cluster might easily have been infected by birds or by **inefficient** h2h transmission.

The evidence for h2h transmission of H5N1 is ambiguous. On the one hand, there is pretty clear evidence of h2h transmission of highly virulent H5N1 with low efficiency-- plenty low enough to be kept isolated and under control if that's as far as it goes (that's why the pandemic hasn't started yet). That's unlikely to remain true forever, because that strain likely represents H5N1 that has NOT undergone recombination with flu in a host infected by both H5N1 and a highly h2h transmissible flu virus-- an event that is bound to happen sooner or later.

On the other hand, there is very sketchy evidence of possible h2h transmission of an unknown H5N1-like strain of unknown virulence and with unknown efficiency-- these are the asymptomatic or low symptomatic patients that test positive for H5N1 but present with run-of-the-mill flu symptoms or no symptoms at all. This suggests a parallel H5N1 lineage in humans, but we know very little about that possible viral strain-- it might not even exist.

Keep an eye on Laos, Cambodia, and North Korea. If H5N1 does a stealth manuever it is likely to come out of one of those countries.

[obxhead]

7. Judgement day is just around the corner.

No floods this time.
Look out.

[nadinbrzezinski]

9. Ok now we need to braek for Jacko and Shiavo

I mean you people looking at real news? Sarcasm off

That said, this is NOT good... one bit, I was todl by a friend that they expect this to get stateside fairly fast, not that FOX would tell you either way

[pandemic_1918]

16. One Flught Away

H5N1 (and Marburg) are just one flight away (dead returning passenger in Portugal from Angola has ProMed concerned).

[SleeplessinSoCal]

12. HIs endorsement won't help her. He's blamed for too much now.

[NNguyenMD]

13. Oseltamivir (trade name Tamiflu) I've heard is to have some activity

against bird flu. Unfortunately its a drug thats more availiable in Europe than the US, for what reasons I really don't know could just be that the market for it here isn't that big.

But you have to start talking it within the first 36 hours of symptom presentations otherwise its not helpful at all.

[pandemic_1918]

17. Tamiflu Available in US

Tamiflu is available in US (not for long). It is approved for prophylactic use, so if you have co-workers or family with flu, you can get a prescription from your MD (1 course of 10 pills plus refill) - the drug store even delivers it to your front door!

Only has a shelf life of about a year though.

[DemExpat]

26. UK (and Dutch) souces say it has 5 year shelf-life.

http://emc.medicines.org.uk/emc/assets/c/html/displaydoc.asp?documentid=10446

DemEx

[NNN0LHI]

20. Before anyone gets too worked up you may want to look at this thread

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=102x1332823

Lot of questions here, but few answers.

Don

[anarchy1999]

25. And away we go! Game on, no scientists left, died of natural or

unnatural causes. It truly is game on everyone. Here it comes.

[Theres-a]

27. Agreed.

[Silverhair]

28. No scientists? In his real life, pandemic_1918 is a noted

molecular biologist of international reputation whose speciality IS the flu virus. He has made several medical breakthroughts.

And there are tens of thousands of scientists in various fields who are alive and healthy, including lots of others in the medical fields, including microbiology.

Take off the tinfoil hat.

[NNN0LHI]

29. Do you happen to know if he is employed by any drug companies?

Specifically any of the ones that produce vaccines for the flu virus? I am not trying to be nosy. I am just very curious?

Don

[Media_Lies_Daily]

31. No, you're trying to establish that a conspiracy exists among the drug....

...companies to frighten world governments into ordering huge amounts of anti-viral drugs to be manufactured and sold.

Am I getting close?

[mike_c]

35. then he/she should know the difference between...

...local shared infection through a common third agent and direct lateral transmission between infected hosts (or perhaps not-- there's no rule that says molecular biologists have to be competent epidemiologists as well). P18 certainly should know that a tight cluster of eight cases at the epicenter of the bird flu epizootic is not a human "pandemic" as was stated above.

I don't want to question P18's credentials, but I've got credentials too if it comes to that. I see a number of misstatements and apparent misunderstandings in the remarks made above. Maybe it's just sloppy communication.

[pandemic_1918]

37. Starting An H5N1 Pandemic

For H5N1 to evolve into a pandemic, the virus has to achieve efficient transmission to a human. WHO has already said today that they are launching an investigation, and since they have been investigating H5N1 in Vietnam since Dec 2003 and have yet to admit that 1/3 of the cases involve H2H, I don't expect anything soon.

However, 5 family members developing symptoms at the same time is a signal that efficient transmission to humans has been achieved (and it is further supported by the 3 hospitalized neighbors).

There have been 15-20 million bird culled in Vietnam and the reported cases are well below 100, Thus, B2H transmission is VERY inefficient. In contrast H2H transmission is about 10,000 to 100,000 fold more efficient (this is due largely to that fact that much of the H2H is from an index case to the relative giving care - close contact).

However, even these H2H transmission infect only 1 or 2 family members (usually 1).

The 5 family members that are H5N1 positive (and 3 neighbors) signals a MAJOR change in efficiencies, and the start of the pandemic.

[CAcyclist]

38. Really?

Because, as a veterinarian, I find his information and conclusions to be no better than any reasonably intelligent layperson.

To insist that a human to human transmission has occurred because this family got sick at the same time when the scientists who are investigating the case say that h2h hasn't occurred makes me think that he doesn't understand infectious disease very well.

I do agree that bird flu is probably our number one future health threat, but I don't think that day has come yet - at any rate, the evidence is not there yet.

Evidence of human to human transmission will be a person not exposed to the infected birds and only exposed to the infected people getting sick *after* an incubation period has passed. In fact, h2h transmission did happen last year, but the virus died out. H2H transmission is the next step towards a pandemic, but even then, its not a linear equation.

edited to include the staement that a 3 day delay between the family of five and the neighbors is not sufficient evidence of incubation of the virus because they are all on the same infected area. The neighbors probably were given dead birds from the original family to eat and they probably ate the birds.

[NNN0LHI]

39. A veterinarian? I am truly impressed

I went to school with a couple of guys who wanted to be veterinarians. They could not get accepted into the Schools of Veterinary Medicine they applied to.

They had to settle on becoming Medical Doctors. They are both practicing Medical Doctors today, and still wish they could have made it as veterinarians.

Congratulations. You did it.

Don

[pandemic_1918]

40. H2H Transmission

H2H transmission by H5N1 is not a new story. The Thailand example was written up in the New England Journal of Medicine several months ago, and covered by most major media including the NY Times and a few weeks ago in the New Yorker. If you don't know that story, there isn't much sense in going further or providing links.

There have been over a dozen family cluster, all bimodal distribution. Today WHO came out with a statement on the family of five. They mention limit H2H in earlier clusters.

Elementary descriptions of H2H epidemiology for H5N1 has been widely posted for over a year (started with the groom and his two sisters dying in Vietnam in January, 2004 in Thai Binh).

When you see the dead bodies piling up on curbs in the US, you will probably figure it out.

[anarchy1999]

42. Explain it all away to me and maybe I'll get rid of my tin foil, not!

http://www.rense.com/general62/list.htm

Dead Scientists And
Microbiologists - Master List

Please pay special attention to the 17 lost right after September 2001. 17 in just 4 months! Odds are astronomical and off the chart.

[Henny Penny]

43. North Korea

I find it worrying that this has broken out in North Korea- only on chicken farms, but still I fear that the govt. there will find this very difficult to deal with. They find it hard enough to feed their population without having to cull a lot of chickens and the temptation may be to sweep things under the carpet.



http://times.hankooki.com/lpage/opinion/200503/kt2005032920351754050.htm