Still more bird flu in Viet Nam - and Thailand

With the death of an 18 year old woman, the toll from bird flu in Viet Nam has now reached six since early December. Xinhua Net (PR China) is reporting that WHO has been told by Viet Namese officials there are up to ten more suspect cases under investigation, four in the North (Hanoi), two of which are on respirators. Viet Nam has banned imported poultry and distributed hundreds of thousands of informational brochures warning against eating sick birds or coming in contact with them. This is a time (Lunar New Year) when poultry is a traditional holiday dish throughout the country, a symbolic offering to a family's ancestors. The disease continues to spread among poultry as well, with a reported case in a chicken in neighboring Thailand, an indication the epidemic is moving beyond Viet Nam. Thailand is on high alert. Migratory wildfowl such as ducks may be the source.

Appropriately, WHO is increasing the urgency of its warnings:

. . . recent epidemiological and laboratory studies revealed unusual features that "suggest that the virus may be evolving in ways that increasingly favour the start of a pandemic", the agency said in a report to its bi-annual executive board, which is meeting this week. (via Reuters)

Among the worrisome changes are an increase in environmental persistence and survival of the virus, an expanding range of species, including mammals, and the presence of the virus in migratory wildfowl, especially ducks, that are themselves healthy but excrete large amounts of virus highly pathogenic for chickens. The common practice of keeping backyard domestic chickens and ducks in rural areas means there is a potential for substantial human exposure. One scenario of great concern would be co-infection of a person with both H5N1 avian virus and a commonly circulating human strain (e.g., H1N1 or H3N2). The result could be a reassortment of genes leading to a new avian virus adapted to and easily transmissible between humans. If such an event were to occur it is possible the new virus would be less virulent in humans than the current H5N1 but no one knows. The worst case is a 1918 style (or worse) pandemic with a highly contagious influenza virus against which there is no natural immunity in humans.

If this happens, most locales are unprepared. As WHO notes,

"Many of the public health interventions that successfully contained SARS (Severe Acute Respiratory Syndrome) will not be effective against a disease that is far more contagious, has a short incubation period, and can be transmitted before the onset of symptoms," [WHO] said.

Travel restrictions, quarantines and tracing of cases will be the main tools to protect populations, pending a boost in vaccine supplies, according to the WHO. "Each day gained could mean an additional five million doses of vaccines," it said. (Reuters)

It continues to be dismaying, if not "scandalous," that there is no greater sense of urgency coming from CDC or DHHS.

Update, 1/21/05, 2:30 pm EST: Henry Niman is now reporting on a seventh death, this time in Hanoi, thus the first in the North. As usual, he has details and sober Commentary. China Post has a pointed quote from WHO's representative in Thailand, Hans Troedsson:

"It's a bit of a disappointment to have this outbreak and the international community not responding more adequately to this threat," Troedsson said. "If you had this situation in Europe or London or New York ... you can imagine how much resources would be put toward this."

WHO has a team of four people in Vietnam working on the bird flu outbreak.

The news just keeps getting worse.