Vietnam reports two suspected bird flu cases
HANOI - Two people from Vietnam's northern region have just been hospitalized for being suspected of contracting bird flu virus strain H5N1. The two patients, one from Hai Duong province and the other from Nam Dinh province, were admitted to the Tropical Disease Institute in Hanoi capital on March 1 after suffering from fever and breathing difficulty, local newspaper Pioneer reported Wednesday.
The institute is treating three confirmed cases of H5N1 infections: a 35-year-old woman named Pham Thi Hoa from Hanoi, a 21-year-old man named Nguyen Sy Tuan from northern Thai Binh province, and the man's 14-year-old sister named Nguyen Thi Ngoan.Besides the two new suspected cases, it is treating a 36-year-old man from Thai Binh who is waiting for the final result of virus testing. Samples from the man were tested positive to the virus onthe first testing, but negative on the second.
Tuan, admitted to the institute on Feb. 22, is in poor health condition, but two other bird flu patients are showing signs of recovery. Tuan and Ngoan ate goose meat, while Hoa has frequently been present in live poultry markets in the city, working as a rubbish collector, said local doctors. In the most recent outbreak starting in late December 2004, Vietnam has detected 21 local people to contract H5N1, of whom 13 have died, according to local media. The country's Health Ministry,however, has confirmed 12 fatalities. Vietnam has also found that a Cambodian woman, who had received treatment in a Vietnamese hospital near her hometown, died of bird flu on Jan. 30.
Bird flu, which has killed and led to the forced culling of more than 1.5 million fowls in 35 cities and provinces in Vietnam since January, is subsiding. Fourteen out of the 35 localities have detected no new bird flu-affected spots for at least three weeks, according to Vietnam's Department of Animal Health.
Xinhua - March 2, 2005
WHO concerned lack of avian flu reports from Vietnam impedes risk assessment
TORONTO - A top World Health Organization official expressed concern Tuesday over Vietnam's lack of official reporting on recent human cases of the dangerous H5N1 avian flu strain, feared by flu experts as being poised to spark an influenza pandemic. Dr. Klaus Stohr suggested the absence of timely information from the country is impeding the WHO's ability to do risk assessment on a potential pandemic. The Vietnamese government has not reported a new human case to the agency since Feb. 2, Stohr revealed in an interview from Geneva. A number of cases have been reported though a variety of unofficial channels in the month since Vietnam last updated WHO.
The organization only uses government reports to tally its official case counts for diseases such as SARS or avian influenza. "It's something that we are certainly not satisfied with," Stohr, director of the WHO's global influenza program, said of the lack of official information on the reported new cases. "The situation is that WHO has a request by its member states to provide proper risk assessment, to help other member states of WHO . . . in assessing what's going on in Asia and provide advice to other member states. And without this information, this is very difficult."
Stohr said WHO officials have issued several requests, in writing and in person, to Vietnam's Ministry of Health for more up-to-date information. "We understand that our country office and the Ministry of Health are discussing better procedures for information sharing. And we are optimistic that this is going to help things for the future," he said. "But again, for the last 30 days .. . . we haven't had any official letter from the Ministry of Health, any official update."
Vietnamese and international Media reports would suggest WHO's case count is falling seriously behind what is happening on the ground. In the past week alone, four human cases have been reported. WHO's most recent case count - dated Feb. 2 - sets the number of human cases of H5N1 infection since January 2004 at 55, with 42 deaths.
But tallies kept by the Center for Infectious Disease Research and Policy at the University of Minnesota tell another story. Staff there have taken to combing a variety of official and unofficial sources to compile what they believe to be a more accurate count of the known human cases of the disease so far. Their sources include ProMed, an electronic forum on emerging diseases run by the International Society for Infectious Diseases, and mainstream Media reports that cite government officials. The centre - known as CIDRAP - suggests there have been 65 human cases since January 2004 and 46 of those people have died. "I think it has become so confusing to try to understand the reporting of cases in Southeast Asia by both official and unofficial sources that we felt it would be helpful for our readers to do it," said Dr. Michael Osterholm, director of the centre.
Osterholm said centre staff keep a meticulous list of information on each case to try to ensure that they don't accidentally end up counting cases twice. The editor of ProMed, Dr. Larry Madoff, said there are a variety of ways for organizations such as WHO to keep apprised of what is going with H5N1 in Asia. In addition to ProMed, there is GPHIN - the Global Public Health Intelligence Network - an Internet trolling program developed and maintained by Health Canada. But while Madoff believes confirmed cases will come to light, he said delays in official reporting can have repercussions.
"I think the fact that official agencies are . . . slow and careful in what they report can sometimes lead to delays that are not ideal for public health purposes," Madoff said from Boston. For instance, WHO has stockpiles of anti-viral drugs in various locations in Southeast Asia. Should it become apparent H5N1 is spreading from person to person - the remaining prerequisite for the strain to trigger a pandemic - the agency hopes to use the drugs to slow the virus's emergence from the region to give the world more time to prepare. But if the WHO isn't receiving prompt information about cases, that plan might be impossible to put in place. "One of the issues we have to really come to grips with is how would you blanket an area once the cow's out of the barn door ?" Osterholm said.
By Helen Branswell - The Canadian Press - March 1, 2005
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