Worrying new case of bird flu in Vietnam

In an alarming new development (AP via USA Today), a 42 year old nurse from Thai Binh province was hospitalized Thursday with symptoms of bird flu -- high fever, cough and evidence of pneumonia. The most worrisome element of this case is that she cared for the same 21 year old patient as another bird flu victim, a 26 year old male nurse. They are all part of a larger cluster which includes the younger (14 year old) sister of the patient and his grandfather (80 years old). The grandfather is apparently healthy, although infected, while the others are all hospitalized in serious condition. Two doctors and two nurses who also cared for the patient are now being monitored. All are reported as healthy at this point.

Earlier we noted that the first signs of a mutated virus that could move more easily from person to person might not be an increase in the numbers of cases or clusters, per se, but an increase in the size of clusters. If this case is confirmed (and it seems highly likely this is a true case), this is now a five person cluster, the largest so far reported.

This comes at a time when it is acknowledged the authorities in Vietnam have not been providing timely information to WHO about new cases in the country. The government in Vietnam has only just now notified WHO about 10 cases (already known and reported on here and elsewhere but not counted by WHO in its official tally) after a silent interval of five weeks. The newly notified cases, however, do not include cases that have arisen since mid-December 2004:

That has raised concerns that agency officials might learn of dangerous changes in the virus's transmission pattern - if such changes occur - too late to try to stop or slow the development of a flu pandemic that would be expected to kill millions around the globe.

[snip]

The latest report from Vietnam does not cover seven people who had fallen ill in January but who were initially ruled out as H5N1 cases. Retesting of samples from those people suggested they were infected by the virus.

"We're still looking to get more details about these cases. But we expect to get those shortly too," said Dick Thompson, director of communications for the WHO's communicable diseases branch.

While the WHO welcomed the new numbers, it is still waiting for crucial information about the cases from the Vietnamese Ministry of Health.

The agency needs to know what kind of field investigations are being done to determine the details surrounding each human case so that it can better assess what is going on with the virus and whether the risk of a pandemic arising has increased. Raw numbers aren't enough to go on, Stohr said.

"It's a question of seeing that the right things are being done," he explained.

"If a case is positive in a hospital, fine. That's not the piece of information which will allow you to decide whether rapid intervention is necessary now or not.

"The piece of information is: Has somebody gone to the village? Do you know whether the husband, the family members, the neighbour is still OK? Is there something cooking in the village?"

Vietnam has not yet provided that level of detail, but Stohr said the WHO will persist.

"We will keep on insisting that a full spectrum of information is being shared." (Helen Branswell via CNews [Canada])

Given these concerns, it is hard to understand why WHO continues to reassure the world, when in fact it is still in the dark about the situation.

Update, 3/13/05 3 pm EST: Bill (hat tip), in Comments, calls attention to a fresh story from Thanhnien News (Vietnam) reporting that the second nurse has tested negative for bird flu. This is reassuring but I think there are two reasons to be cautious. Thanhnien News is the official publication of the Vietnam National Youth Federation. Its editorial slant has tended to downplay bird flu concerns. Moreover, "negative" test results from Vietnamese laboratories have frequently become "positive" results on later retesting or by other laboratories. We will keep our eye on this.