Thursday, June 16, 2005

Silence from Vietnamese officials

The alarming reports of six new cases of H5N1 hospitalized in northern Vietnam and possible transmission to a doctor have so far not been confirmed by Vietnamese authorities. This is either very good news or very bad news. The best news (not likely) is that this is a mistaken report. The bad news is that the report is accurate but that Vietnamese authorities are again unforgivably tardy in their response to WHO's urgent request for information.
. . . Dr. Klaus Stohr warned that unless the WHO receives case information on a more rapid basis, hopes of trying to extinguish an emerging pandemic at source will be jeopardized.

"We want to use this window of opportunity for early intervention . . . (but) we have to start moving when the window is opening and not when it's closing," Stohr said from Geneva, adding the world would have perhaps 20 to 30 days in which to launch a full-scale response.

"And if we would from the beginning see that the system is not tailored to keeping us within this time schedule, then one has to rethink about the feasibility of the option." (via
Ira Longini's (Emory University) mathematical analysis of the efficacy of rapid intervention in the event of the start of an outbreak is still under review at a scientific journal so most of us cannot evaluate how reliable it is. Given the urgency of the situation, Longini should consider the unorthodox move of posting it on his website prior to acceptance at the journal. The paper reportedly shows that prompt use of antivirals and quarantine might avert an emerging pandemic if used in the first few generations of a virus whose human to human spread had a relatively low reproductive number and a slow start in a rural area.
"In a rural area, you could intervene within say three weeks of the first symptomatic case. At that point, containment is still possible," Longini said.

But both he and Stohr stressed the plan could only work if the world moves quickly.

And the recent lengthy delays between the first media reports of human cases of H5N1 influenza and official confirmation from the Vietnamese government do not bode well for an early intervention strategy.

For instance, despite media reports of six "newly detected" human cases being treated in Hanoi hospitals - and word that a doctor treating the patients might also have become infected - authorities in Vietnam were silent Wednesday.
The Longini tactic may or may not work (in my own view, based on some familiarity with this kind of modeling work, it is a long shot, but desperate circumstances call for desperate measures and it would certainly be worth the attempt).

Reportedly WHO in country staff have tried to speak to Vietnam's Ministry of Health about the reports but have not been successful.

This is inexcusable and irresponsible behavior on the part of the Vietnamese government.

Update, 7 pm EDST, 6/16/05:

From WHO:

16 June 2005

WHO is aware of media reports that six additional patients infected with H5N1 avian influenza are undergoing treatment in a Hanoi hospital and that a health care worker at the same hospital may also be infected. While these reports have not yet been officially confirmed by national authorities, they appear to be accurate.

WHO is seeking confirmation and further information from the Ministry of Health.