Avian influenza in Vietnam calls for preparations of a pandemic

Since the third wave of human cases of H5N1 avian influenza began in Vietnam in mid-December 2004, 49 cases have been reported. Of these cases, 17 were fatal.
A Vietnamese study has shown that there are signs of greater human to human transmission of bird flu. This has prompted the UN health agency to call on countries around the world to continue with their preparations for a threatened flu pandemic.

Since January 2004, when human cases of H5N1 avian influenza were first reported in the current outbreak, 97 cases and 53 deaths have been reported in Viet Nam, Thailand and Cambodia. Viet Nam, with 76 cases and 37 deaths, has been the most severely affected country, followed by Thailand, with 17 cases and 12 deaths, and Cambodia, with 4 cases and 4 deaths.

WHO said it had asked Vietnam’s ministry of health for more information on individual cases. Rapid field investigation of new cases, especially when these occur in clusters, remains essential to assess possible changes in transmission patterns that could indicate improved pandemic potential of the virus.

The World Health Organization’s (WHO) top influenza expert, Klaus Stohr says there have been enough warnings that another pandemic is coming, and health organisations should continue with preparations for a pandemic.

The emergence of the H5N1 bird flu virus among humans in Asia has raised fears that a new deadlier strain of flu might spread rapidly around the world on a similar scale to pandemics in the last century.

The study, which carried through to April 2005, of bird flu outbreaks in people in Vietnam, suggests an evolution of infections by the H5N1 virus.

The WHO examined the findings with experts from Cambodia, Thailand and Vietnam earlier this month, and has called for an immediate boost in monitoring for possible pandemic influenza in all countries affected by H5N1 in birds.

A report on the study says that the changes in the epidemiological patterns are consistent with the possibility that recently emerging H5N1 viruses may be more infectious for humans.

The UN health agency says that while that meant a greater number of people might be infected by poultry, there was also evidence that human-to-human infections, which have been found several times since the strain was first detected in Hong Kong in 1997, was strengthening, which raises the possibility that avian flu viruses are becoming more capable of human-to-human transmission.

Guenael Rodier, head of WHO communicable diseases, says even though the report was in a ‘grey zone ‘ and the implications are not clear cut, the viruses appear to be continuing to evolve and pose a continuing and potentially growing pandemic threat.

The WHO is concerned because a pandemic strain may develop through a series of small steps that taken individually might not be enough to signal clearly that an epidemic was about to start.

The pattern of changes observed in North Vietnam included more and larger human clusters of the disease, an increasing mean age of the victims and the lower fatality rate.

Mr Rodier says they expect that a pandemic virus will adapt better to humans, but will be less severe and transmit better.

The report also suggests from analysis of genes from both avian and human forms of H5N1 from several countries that there are changes in the virus.

Stohr said three suspected asymptomatic cases in Vietnam, where people are infected with the virus but do not fall ill, were unusual and it was not clear if they were contagious. He said it would be scientifically surprising if asymptomatic carriers were found.

Other interpretations for the trends observed in Vietnam were raised, including transmission through contaminated water or food or infection from poultry that carried the virus but did not show symptoms, or greater persistence of the virus in the environment.