H5N1 Re-emrgence in Patient in Northern Vietnam
Recombinomics Commentary
May 23, 2007
A 30-year-old man from northern Vinh Phuc province remains hospitalized and breathing through a respirator after testing positive for the H5N1 virus three days ago, said Tran Quy, director of Bach Mai hospital in Hanoi.
"The man is in critical condition," he said. "He has a high fever, difficulty breathing, coughing, and the X-ray of his lung was completely white. All these are typical bird flu symptoms."
Quy said the man was admitted to the hospital last week.
The above comments on a patient that has tested positive for H5N1 are cause for concern. Vietnam has not reported a human case since 2005. At that time Clade 1 H5N1 was circulating in southeast Asia. Human cases were reported in Vietnam, Thailand, and Cambodia. Although the only FDA approved H5N1 vaccine is against H5N1 from a 2004 patient in Vietnam, there are few recent reports of Clade 1 H5N1 in humans.
Instead, various versions of Clade 2 H5N1 have been reported in humans worldwide. Clade 2.1 is in Indonesia, Clade 2.3 is in China (Fujian strain), and Clade 2.2 is in wild birds (Qinghai strain) that have spread H5N1 to Europe, the Middle East, and Africa, resulting in reported human cases in Turkey, Iraq, Azerbaijan, Egypt, Djibouti, and Nigeria.
The clade 2.3 in China was reported to have spread into southeast Asia, but reported human cases in southeast have been limited to Thailand. H5N1 in humans in Vietnam would signal a significant change. Thus far, recent H5N1 infections were limited to birds, and the latest case signals a re-emergence in humans in the region.
The most recent H5N1 isolates in Vietnam were collected in December, 2006. These isolates were most closely related to prior Clade 1 isolates from 2004 and 2005.
The sequence of the H5N1 from the latest case would be useful.
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