Vietnam - Khanh Hoa: Student with H5N1 avian flu infection has reportedly died - possible infection from poultry or wild birds mentioned - March 22+

[Shiloh]

Source: https://tuoitre.vn/khanh-hoa-co-ca-nhiem-cum-a-h5-tren-nguoi-chua-ro-nguon-lay-20240321194840447.htm

March 21, 2024 20:21 GMT+7
Khanh Hoa has a case of influenza A H5 infection in humans with an unknown source of infection
author
MINH CHIEN


According to a report from Ninh Hoa Town Medical Center, a patient infected with influenza A H5 named B.T.D. (21 years old, residing in Ninh Trung commune, Ninh Hoa town).

The patient is currently a student at Nha Trang University, temporarily residing in the school's dormitory. Outside of studying, the patient worked as a waitress at a restaurant in Nha Trang City.

The disease started on March 11, when the patient returned home to Ninh Trung commune, with symptoms of fever and mild cough. The patient bought his own medicine and treatment at local medical facilities, but his illness did not improve.

On March 17, the disease became more severe so the family took the patient to Khanh Hoa Provincial General Hospital, where he was treated at the general internal medicine - neurology department. The disease became more severe so he was transferred to the intensive care unit - intensive care unit. poison.

On March 19, the Provincial General Hospital took patient samples and sent them to the Pasteur Institute of Nha Trang for testing, then the results showed that the patient was infected with influenza A H5.

Currently, the patient is in serious condition and is being quarantined and treated at the Provincial Hospital of Tropical Diseases.

Mr. Ton That Toan - deputy director of the Center for Disease Control of Khanh Hoa province - said the patient is being actively monitored and treated.

The medical unit tested 6 people in the same patient's room and the results were negative for influenza A H5 virus.

The patient's family also did not have symptoms of influenza A H5.
How is influenza A H5 transmitted?

According to the Center for Disease Control of Khanh Hoa province, influenza A H5 is an influenza virus transmitted from poultry to humans through breathing or direct contact with secretions (saliva, mucus or feces) from animals. infected.

When the virus attacks the human body, it will enter the host cell, then quickly replicate itself throughout the body. This causes the patient's immune system to weaken quickly, even leading to death.

People infected with influenza A H5 often have similar symptoms to regular influenza infection and include a few more dangerous signs. Symptoms of influenza A H5 in humans usually begin within 2 - 5 days from the time the virus invades, such as high fever, headache, chills, fast heartbeat, feeling short of breath, chest pain, cough…

Flu A H5 symptoms became more severe afterward. At this time, the patient may have acute respiratory failure with symptoms such as rapid breathing, difficulty breathing, pale skin, even feeling pain all over the body, coma...
It is necessary to find the source of influenza A H5 infection soon

According to Mr. Ton That Toan, this is the first case of influenza A H5 infection of the year in Khanh Hoa province.

"Currently, specialized agencies have not yet found the source of infection, because the poultry flocks around the patient's house have not shown any unusual signs such as mass deaths. Previously, the Ninh Hoa town veterinary clinic sent samples to the animal. Hospital in Da Nang for testing to find the cause," Mr. Toan said.

Also according to Mr. Toan, in the immediate future, we will actively treat patients, in addition, we must soon find the source of the virus to proceed with treatment.​

 

[Michael Coston]

Vietnamese Media Reports: A/H5 Case Reported In University Student In Khánh Hòa​​​​​​​​

Vietnamese Media Reports: A/H5 Case Reported In University Student In Khánh Hòa​

Credit Wikipedia



#17,961

Overnight dozens of Vietnamese language media outlets - including state sponsored media - have carried reports of a university student who is currently hospitalized in serious condition, who has tested positive for A/H5 (n-type unknown).

Despite this avalanche of media coverage, I've yet to find anything official posted on the Vietnamese Ministry of Health (and other govt. health-related) websites, nor anything posted on the Nha Trang University website.​

While I would urge caution until these reports can be verified by the Vietnamese government, the WHO, or by our own CDC, the reports I've seen appear credible and consistent.

The following (translated) report comes from VOV.vn (Voice of Vietnam) .

People who had close contact with Influenza A/H5 patients tested negative
Friday, 11:03, March 22, 2024

VOV.VN - On March 22, Khanh Hoa Provincial Center for Disease Control (CDC) said that the province had just recorded 1 case of influenza A/H5 infection. Initially, 6 people staying in the same dormitory room with the patient tested negative for Influenza A/H5.

More than 10 days ago, patient with CKD., 21 years old, residing in Ninh Hoa town, student at Nha Trang University, Khanh Hoa province had fever and mild cough. After that, the patient bought the medicine himself in Nha Trang city and took it but his illness did not improve.

On March 15, the patient returned home and went to Ninh Hoa Town Medical Center for examination, was diagnosed with pharyngitis - laryngitis, monitored for dengue fever and recommended hospitalization. The patient did not agree to be hospitalized and was prescribed outpatient medication.

After 1 day, the patient became more tired so he was taken to the emergency room at Ninh Hoa Regional General Hospital. At this time, the patient had a high fever, abdominal pain and became seriously ill, and was taken to Khanh Hoa Provincial General Hospital for treatment. On March 20, test results of patient samples from Nha Trang Pasteur Institute were positive for influenza A/H5. Currently, the patient's condition is severe and is being isolated for treatment at Khanh Hoa Provincial Hospital of Tropical Diseases.

As soon as there was information, CDC Khanh Hoa approached the investigation, handled the case, and guided the patient's family on epidemic prevention measures. At the same time, make a list of 14 officials at the Provincial General Hospital and 6 officials at the Hospital of Tropical Diseases to monitor health, disinfect examination and treatment areas, transport vehicles and monitor health. health of the patient's family. CDC Khanh Hoa also disinfected with Chloramin B the living room and rooms in the dormitory of Nha Trang University - where the patient is studying, making a list of 6 roommates and 60 students studying in the same class. with patients to conduct health monitoring. At the same time, 6 samples were taken from people in the same dorm room as the patient and tested, and the results were negative for influenza A.

Doctor Ton That Toan, Deputy Director in charge of the Center for Disease Control of Khanh Hoa province, said: "The patient has a high fever, the test sent has identified Influenza A H5, currently the patient is being treated." . 6 people in the same room at Nha Trang University dormitory, all tested negative. Influenza A H5 is transmitted from poultry, the patient's area did not detect dead poultry. We are coordinating The Department of Veterinary Medicine controls poultry flocks to have the best treatment plan."​

Other (quite similar) reports are available at the following links:

A student in Nha Trang was discovered infected with avian influenza A/H5

Khanh Hoa: A/H5 bird flu detected in humans​

Male student infected with influenza A/H5​

Assuming these reports are confirmed, there is still a lot we don't know about this case. A/H5 can cover a lot of territory, including several clades of H5N1 (2.3.2.1c, 2.3.4.4b, etc.) , H5N6 (which so far has been limited to 90 cases China and 1 case in Laos), and potentially other subtypes due to reassortment.

How this student was exposed is another big unanswered question.​

Stay tuned, hopefully we'll have some answers sooner rather than later.



https://afludiary.blogspot.com/2024/03/vietnamese-media-reports-ah5-case.html
​

 

[Pathfinder]

Translation Google

KHANH HOA: 01 HUMAN CASE OF INFLUENZA A/H5 INFECTION


March 22, 2024

Khanh Hoa: 01 human case of influenza A/H5 infection

According to a report from the Provincial Center for Disease Control (CDC) Khanh Hoa, the province has just recorded 1 case of influenza A/H5 infection. Upon receiving the information, CDC conducted an epidemiological investigation and promptly implemented epidemic prevention measures.

Influenza AH5​

Patient infected with influenza A/H5 named BTD. (21 years old, residing in Ninh Trung commune, Ninh Hoa town), the patient started getting sick on March 11, with symptoms of fever and mild cough. The patient bought himself medicine (in Nha Trang) but the illness did not improve.

On March 15, the patient returned home and only had contact with his mother and younger sister, then went for medical examination at Facility 2 of Ninh Hoa Town Medical Center to be diagnosed with acute pharyngitis - laryngitis/ dengue fever monitoring. Dengue blood and recommended hospitalization. However, patients who do not agree should be prescribed outpatient medication. After 1 day, the patient was very tired so he went to the Emergency Department of Ninh Hoa Regional General Hospital with high fever, abdominal pain around the navel, loose stools, and was diagnosed with intestinal infection and sepsis with warning signs. reported and transferred to the Department of Infectious Diseases for treatment.

On March 17, the disease became severe so patient D. was transferred to Khanh Hoa Provincial General Hospital, Intensive Care - Poison Control Department for treatment and had samples sent to Nha Trang Pasteur Institute for testing.

On March 20, test results from the Pasteur Institute tested positive for influenza A/H5. Currently, the patient is in serious condition and is being quarantined for treatment at the Provincial Hospital of Tropical Diseases.

Representatives of the Department of Health, Nha Trang Pasteur Institute, Provincial Department of Animal Health and CDC
met to deploy disease prevention and control​

As soon as there was information, on the evening of March 20, CDC approached, investigated, handled the case, and instructed the patient's family on epidemic prevention measures. At the same time, make a list of 14 officials at the Provincial General Hospital and 6 officials at the Hospital for Tropical Diseases to monitor health and disinfect examination and treatment areas and transport vehicles. Make a list of the patient's family members including 4 people (mother, aunt and sister) to monitor health.

On March 21, CDC disinfected with Chloramin B the living room and rooms in the dormitory of Nha Trang University - where the patient was studying, making a list of 6 roommates and 60 students studying together. class with patients to conduct health monitoring. At the same time, 6 samples were taken from people in the same dorm room as the patient and tested, and the results were negative for influenza A.



​https://www.ksbtkhanhhoa.vn/TinTuc/ChiTiet/8267

 

[Michael Coston]

Vietnam: 21 y.o. University Student Reportedly Died From A/H5

Credit Wikipedia

#17,963

Twenty-four hours after the first report (see here), Vietnamese media are now reporting the student infected with H5Nx has died after 8 days of treatment. Thus far, there are no new updates on the Khánh Hòa CDC website since yesterday's announcement.

The following (translated) report comes once again from VOV.vn (Voice of Vietnam), and provides an update into the epidemiological investigation.​

I'll have more after the break on what we know - or think we know - about the fatality rate

Suffering from influenza A/H5, a 21-year-old male student in Khanh Hoa died
Saturday, 14:54, March 23, 2024

VOV.VN - A 21-year-old male student in a dormitory at Nha Trang University (Khanh Hoa) tested positive for influenza A/H5 with an unknown source of infection and died after 8 days of treatment.

At noon on March 23, a representative of Khanh Hoa Provincial Hospital of Tropical Diseases said that a male BD patient (21 years old, residing in Ninh Hoa town) infected with avian influenza A/H5 while being treated at the hospital died on March 23. morning of the same day.

“When we received the results of the patient being infected with influenza A/H5, we consulted with the Central Tropical Disease Hospitals, Ho Chi Minh City Tropical Diseases Hospital, and Khanh Hoa Provincial General Hospital but could not save the patient's life because of the condition. The disease has progressed seriously, the lungs have become fibrotic," said a representative of this hospital.

(SNIP previously known timeline)​

According to the CDC of Khanh Hoa province, after receiving epidemiological information, the unit guided the patient's family on epidemic prevention measures, monitored health, and disinfected examination and treatment areas and transport vehicles. transfer.

In addition, the patient's family members, including his mother, aunt and sister, are also closely monitored for his health.

Rooms and suites in the dormitories at Nha Trang University, where the patient is studying, were also sprayed with Chloramin B to disinfect.

In addition, the CDC of Khanh Hoa province said that the results of five samples taken on March 21, from poultry flocks (including two samples from the chicken flock in the patient's house, one sample from the duck flock 50m away from the house, two samples from the flock of birds in the patient's house). where the patient often goes) all tested negative for the A/H5 virus.

Six patient samples from people in the same room as the patient at Nha Trang University are currently negative for influenza A/H5; Test results and daily health monitoring of people exposed to cases of influenza A/H5 infection are also stable, no suspicious symptoms of the disease have been detected.

This is the first case of influenza A/H5 recorded in Vietnam since the beginning of the year.​

At this point we still don't know what clade, or even subtype, of H5 Vietnam is dealing with. The most obvious choices are:

• H5N1 clade 2.3.2.1c (which has caused recent cases/deaths in Cambodia)
• H5N6 clade 2.3.4.4h, which has reportedly caused roughly 90 infections and dozens of deaths in China since 2014
• and newer H5N1 clade 2.3.4.4b (which is currently circulating globally) but has a more limited history of infecting humans.

It is possible, but less likely, that they are dealing with some other subtype, clade, or variant. More precise laboratory results should be available in a few days.

While it is true that the fatality rate of known (i.e. hospitalized and tested) cases of H5Nx has hovered around the 50% mark, what is not known is how many mild or moderately ill cases go unidentified.

Seroprevalence studies suggest those numbers may be substantial (see Serological Analysis in Humans in Malaysian Borneo Suggests Prior Exposure to H5 Avian Influenza), which would produce a much lower CFR.​

A look at H5N1 cases over the past 20 years also shows a wide disparity between the fatality rates of different countries, with Indonesia reporting a staggering 84% CFR (168 deaths out of 200 cases), while Egypt came in at 33% (120 out of 359 cases).

Exactly what accounts for this difference isn't known, although different clades circulating in each country - along with earlier treatment, and better medical care - are likely contributing factors. H5 is an HA Group type 1
​

While the reasons aren't entirely clear, younger people (< 40) seem to be more susceptible to H5 infections while the opposite appears true for H7N9 (see H7N9: The Riddle Of The Ages).





Eight years ago, in Science: Protection Against Novel Flu Subtypes Via Childhood HA Imprinting, we looked at research which suggested the influenza HA Group type (1 or 2) you are first exposed to makes a significant, and lasting, impression on your immune system


H5 is an HA Group type 1 while H7 viruses fall in group 2.

• Those born prior to the mid-1960s were almost certainly first exposed to Group 1 flu viruses (H1N1 or H2N2)
• Those born after 1968 and before 1977 would have been exposed to Group 2 (H3N2)
• After 1977, both Group 1 and 2 viruses co-circulated, meaning the first exposure could have been to either one.

This suggests that those born before 1968 may carry some degree of limited protection against H5 infection. That said, any advantage of being born in the 1950s is probably being gradually offset by advancing age and comorbidities, and may not be as pronounced today as it was 20 years ago.

For now, the good news is that the virus has yet to figure out human physiology sufficiently to transmit efficiently from human-to-human.​

The bad news is, the virus keeps on trying.

https://afludiary.blogspot.com/2024/03/vietnam-21-yo-university-student.html​

 

[Shiloh]

Source: https://ddc-moph-go-th.translate.goog/oic/news.php?news=41838&deptcode=oic&news_views=263&_x _tr_sl=th&_x_tr_tl=en&_x_tr_hl=en&_x_tr_pto=sc
Source: https://ddc.moph.go.th/oic/news.php?news=41838&deptcode=oic&news_views=263

Avian influenza in people in Vietnam in Ninh Hoa and Nha Trang, Khanh Hoa Province. Vietnam (Information as of 23 March 2024)

March 23, 2024
267 View

Public Health Emergency Operations Center Vietnam notified via WhatsApp of the ASEAN EOC network on March 23, 2024 at 12.02 p.m.

On March 20, 2024, a 21-year-old H5Nx bird flu patient was found in Khanh Wah Province. Laboratory test results He was found to be a confirmed patient of the highly pathogenic bird flu H5N1 and had died in the morning of March 23, 2024. The history of exposure is not yet known but there has been hunting of wild birds in the past 1 to 5 months. At this time, further investigation is being conducted into close contacts.

Summary by: Office for International Cooperation (OIC), Department of Disease Control​

 

[Shiloh]

Source: https://cand-com-vn.translate.goog/...tr_sl=vi&_x_tr_tl=en&_x_tr_hl=en&_x_tr_pto=sc


The male student who died from influenza A/H5N1 was trapping wild birds
Sunday, March 24, 2024, 19:32

According to the epidemiological investigation, a 21-year-old male student (Khanh Hoa) died of influenza A/H5N1 before Lunar New Year while hunting wild birds. This is the second case of influenza A/H5N1 since 2014.

Potential risk of bird flu infection to humans

According to a report from the Department of Preventive Medicine (Ministry of Health), a 21-year-old male student died from influenza A/H5N1 residing in Tan Ninh village, Ninh Trung commune, Ninh Hoa town, Khanh Hoa province.

On March 11, the young man showed symptoms of fever and cough and self-treated but the symptoms did not improve. After that, the patient came for examination and treatment at Ninh Hoa Medical Center on March 16-17 and was transferred to Khanh Hoa General Hospital for treatment with a diagnosis of pneumonia.

On March 19, the Khanh Hoa Center for Disease Control (CDC) took samples from the patient for testing, and the results were positive for influenza A/H5. Confirmation results from Nha Trang Pasteur Institute on March 22 also determined that the patient was positive for influenza A/H5N1.​..

 

[sharon sanders]

hat tip @crof


21:05, March 24, 2024


Strengthen prevention and control of avian influenza

HONG DANG


Despite being actively treated, the patient positive for influenza A/H5 died more than 10 days after symptoms appeared. During this period, veterinary agencies and localities urgently organized surveillance of avian influenza epidemic and investigated epidemiological factors to soon find the source of infection; At the same time, strengthen solutions to prevent and control avian influenza.

Urgently prevent epidemics and investigate the source of infection

According to the leader of the Provincial Department of Animal Husbandry and Veterinary Medicine, on March 21, the department coordinated with the Animal Husbandry and Veterinary Station of Ninh Hoa town and City. Nha Trang conducted epidemiological investigations and organized sampling and monitoring of poultry flocks related to the patient. Accordingly, pharyngeal swab samples and poultry feces were collected at the patient's house (Tan Ninh village, Ninh Trung commune, Ninh Hoa town), households adjacent to the patient's house, and shops selling ornamental birds in the surrounding area. Approach Nha Trang University (where the patient temporarily resides) to send for testing.

On March 22, the test results of the Department of Animal Health Region IV did not detect the H5N1 avian influenza virus in the test samples. On the same day, the working group of the Department of Animal Health Region IV, the Provincial Department of Animal Husbandry and Veterinary Medicine, and the Provincial Center for Disease Control conducted a field inspection in Tan Ninh village; Working with the People's Committee of Ninh Hoa town to implement the prevention and control of avian influenza epidemic in Ninh Trung commune. At the same time, closely coordinate with the Provincial Center for Disease Control and localities to urgently deploy epidemic prevention solutions and conduct investigations to find the source of infection.

Regarding the bird flu situation, according to a report from the Department of Animal Health, from the beginning of the year until now, the country has recorded 6 outbreaks in 6 provinces, including: Bac Ninh, Ninh Binh, Khanh Hoa, Ba Ria - Vung Tau, Long An and Tien Giang. The number of sick poultry is 8,069, the number of dead and destroyed poultry is 8,924. In particular, in the province, an outbreak of avian influenza A/H5N1 appeared in 2 poultry farming households in Xuan Phu 1 village, Suoi Tien commune, Dien Khanh district. On February 15, the People's Committee of Suoi Tien commune organized the destruction of the entire chicken flock of the above two households with 961 chickens. Since then, there have been no new outbreaks in the province. However, specialized agencies warn that the risk of avian influenza outbreak is very high, because currently, adverse weather changes reduce the resistance of livestock, creating conditions for pathogens to develop and spread. and cause disease; Raising conditions of smallholder farming establishments are still limited; Pathogens circulating at high rates such as strains of avian influenza A/H5 virus (H5N1, H5N6...). In 2023, through proactive surveillance, 11/312 samples containing H5N1 avian influenza virus were detected in poultry traded at markets in high-risk areas.

Peak disinfection and vaccination for poultry

According to Mr. Le Thang - Director of the Provincial Department of Animal Husbandry and Veterinary Medicine, the province will carry out the peak month of general cleaning, disinfection and detoxification of the livestock environment starting from March 5. The Branch also implemented the first phase of avian flu vaccination in 2024 with nearly 400,000 doses of vaccine issued to localities for vaccination from March 15. Of which, Ninh Hoa Town Animal Husbandry and Veterinary Station received 224,400 doses of vaccine.

Specialized agencies also proactively organize monitoring of avian influenza epidemics, especially in high-risk areas and bird-buying shops to warn, detect early and completely handle new epidemics as soon as possible. appear; Coordinate with local authorities to strictly handle cases of hiding or not reporting animals suspected of being infected with bird flu, affecting people and the community. At the same time, instruct commune-level veterinary staff and farmers to regularly monitor poultry health and vaccinate against avian influenza according to regulations.

In addition, to proactively prevent and fight avian flu epidemics, the Provincial Department of Animal Husbandry and Veterinary Medicine advised the Department of Agriculture and Rural Development to issue documents directing district-level People's Committees and relevant agencies to urgently Resolutely and synchronously deploy solutions to prevent and control avian influenza epidemic in accordance with regulations; proactively monitor epidemics, early detect suspected cases of bird flu, share information and coordinate investigations, take samples for testing, determine the cause of poultry outbreaks and localize treatment , limit the spread. At the same time, increase information, propaganda and guidance for people to proactively monitor poultry showing signs of illness, suspected illness, unusual death..., promptly detect and report to the authorities and veterinary agencies. and deploy solutions to prevent and control epidemics; Absolutely do not trade, slaughter, consume diseased poultry, throw poultry carcasses or untreated waste into the environment; Daily general cleaning, spraying disinfectant or using lime powder to disinfect the farming area...

The male patient (residing in Ninh Trung commune, Ninh Hoa) is a student at a university. His symptoms began on March 11. He bought himself medicine and took it without improvement. Four days later, the patient came for examination at facility 2 of Ninh Hoa Town Medical Center and was diagnosed with acute pharyngitis - laryngitis and monitored for dengue fever. The doctor recommended hospitalization, but the patient requested outpatient treatment. On March 16, the patient had a fever and was very tired, so he went to the Emergency Department of Ninh Hoa Regional General Hospital and was diagnosed with intestinal infection, sepsis, and monitored for dengue hemorrhagic fever. On the morning of March 17, the patient became seriously ill and was transferred to the Provincial General Hospital. On March 20, a patient's specimen at Nha Trang Pasteur Institute tested positive for influenza A/H5, and the patient was transferred to the Provincial Hospital of Tropical Diseases for treatment. On March 23, due to severe illness, the patient died.​

source: https://baokhanhhoa.vn/xa-hoi/202403/tang-cuong-phong-chong-benh-cum-gia-cam-802373a/


​

 

[sharon sanders]

Please see:

FluTrackers 2016+ Global H5N1 Human Cases List​

Vietnam: 2024 Avian flu in poultry​

 

[sharon sanders]

Next door to Vietnam two of the recent Cambodian 2024 H5N1 human cases were in Kratie province and had contact with sick poultry:

Cambodia - Male, 9, died, Kratié province Death

Cambodia - Male, 16, brother of case above, Kratié province​

source: FluTrackers 2016+ Global H5N1 Human Cases List​


It is about 400 miles from Kratie province in Cambodia to Ninh Hoa town, Khanh Hoa province in Vietnam. It is almost a straight line through the Phnom Prich Wildlife Sanctuary which is part of one of the largest protected areas in Southeast Asia. Kratie province in Cambodia abuts this sanctuary on the west:

"Phnom Prich Wildlife Sanctuary (Khmer: ដែនជម្រកសត្វព្រៃភ្នំព្រេច) is a 2,218.18 km[SUP]2[/SUP] (856.44 sq mi) large protected area in eastern Cambodia that was established in 1993.[SUP][2][/SUP][SUP][1][/SUP] It is part of maybe the largest protected area complex in southeast Asia.[SUP][3][/SUP] Phnom Prich Wildlife Sanctuary borders Mondulkiri Protected Forest to the north and Keo Seima Wildlife Sanctuary to the south.​" link
​


Krong Kracheh on the left middle of the map is Kratie City in Kratie province. Ninh Hoa on the right middle of the map is where the current human infection occurred. In the middle is the large wildlife sanctuary.

https://www.google.com/maps/place/Phnum+Prech+Wildlife+Sanctuary/@12.7644664,105.8481176,8z/data=!4m6!3m5!1s0x3172bda4f973fe2b:0xc7737d52be162 ed5!8m2!3d12.7591089!4d106.8650395!16s%2Fm%2F07k5g 1s?entry=ttu

 

[Michael Coston]

Vietnam MOH Statement: Epidemiological Investigation Into Human H5N1 Infection

Credit Wikipedia

#17,965

Overnight Vietnam's Ministry of Health published a detailed report on the fatal A/H5 case reported on Friday (see here, here, and here), one which answers several pressing questions.

• First, it confirms the subtype as H5N1, although the clade remains unspecified.
• Second, it provides a plausible route of infection; the patient trapped wild birds both before and after the Lunar New Year Celebration.
• And third, no new infections have been detected (although monitoring of close contacts continues).

First the (translated) statement, after which I'll have brief comment.

​Information about cases of Influenza A(H5N1) in Khanh Hoa

25/03/2024

The Department of Preventive Medicine announces a case of influenza A(H5N1) as follows:

Male patient, 21 years old, residing in Tan Ninh village, Ninh Trung commune, Ninh Hoa town, Khanh Hoa province. On March 11, 2024, the patient developed symptoms of fever and cough and self-treated but the symptoms did not improve. The patient came for examination and treatment at Ninh Hoa Medical Center on March 16-17, 2024, then the patient was transferred to Khanh Hoa General Hospital for treatment with a diagnosis of pneumonia. On March 19, 2024, Khanh Hoa Center for Disease Control took patient samples for testing; According to test results on March 20, 2024, the patient was positive for influenza A/H5 and confirmation results from Nha Trang Pasteur Institute on March 22, 2024 determined that the patient was positive for influenza A(H5N1). Due to the serious progression of the disease, the patient died on March 23, 2024.

According to the results of the epidemiological investigation, on the occasion before and after the Lunar New Year 2024, the patient went to trap wild birds near the area where the patient lived; There were no sick or dead poultry around the area where the patient's family lived. Cases of close contact with patients are listed and their health monitored daily; To date, no new cases have been detected.

This is the second case of influenza A(H5N1) since 2014 after many years of no human cases being recorded in Vietnam. Previously, in October 2022, 01 case of influenza A(H5N1) in humans was recorded in Phu Tho. Accumulated from 2003 to present, the country has recorded 128 people infected with influenza A(H5N1), of which 65 died (50.8%).

In the world, from the end of 2023 until now, many outbreaks of avian influenza in animals have been recorded in all regions, mainly due to the influenza A (H5N1) virus strain. In Cambodia, continued to record cases of influenza A(H5N1) in humans since the end of 2023. Domestically, according to information from the Department of Animal Health - Ministry of Agriculture and Rural Development, avian influenza epidemic is still recorded sporadically in poultry flocks in many localities across the country. From the beginning of 2024 until now, 06 bird flu outbreaks have been recorded in 06 provinces and cities including Bac Ninh, Ninh Binh, Khanh Hoa, Ba Ria - Vung Tau, Long An and Tien Giang. Besides, this time is the changing season, and unusual weather changes are favorable conditions for pathogens to grow. The Ministry of Health said that in the coming time, there is still a potential risk of avian flu infection to humans.

There is currently no specific treatment for avian influenza in humans and no vaccine to prevent the disease. Currently there is no evidence that influenza A(H5N1) is transmitted from person to person. The A(H5N1) virus is a highly virulent strain of influenza, infected people often develop severe disease and die at a high rate (~50%). ). To proactively prevent and control influenza A(H5N1) transmitted from poultry to humans, people need to well implement the following measures:​

1. Do not eat poultry or poultry products that are sick, dead or of unknown origin; Make sure to eat cooked food and drink boiled water; Wash hands with soap before eating.​

2. Do not slaughter, transport, buy or sell poultry and poultry products of unknown origin.​

3. When discovering sick or dead poultry, absolutely do not slaughter or use it, but must immediately notify the local authorities and veterinary unit in the area.​

4. Limit contact, slaughter, and eating of wild animals, especially birds.​

5. When you have flu symptoms such as fever, cough, chest pain, difficulty breathing related to poultry, you must immediately go to a medical facility for timely consultation, examination and treatment.​

Editorial board of the website of the Department of Preventive Medicine​

While direct or indirect contact with infected poultry has long been viewed as the biggest risk factor for contracting avian flu, increasingly we are seeing warnings about the risks posed by wild birds.

• Last week, in UK Guidance for the Public: Minimize Contact with Wild Birds, that stresses avoiding contact, and if that isn't possible, the value of wearing of PPEs (gloves, eye protection & masks, etc.), and the importance of post-contact disinfection.
• Eight days ago we looked at a seroprevalence study in Borneo which found wild birds likely responsible for H5N1 transmission to humans
• And contact with wild birds continues to be the most likely route of transmission for 2023's H5N1 case in Brazil. In The first case of human infection with H5N1 avian Influenza A virus in Chile, researchers wrote:

• • An epidemiological investigation being conducted by the Ministry of Health ascertained that the patient’s residence is located one block from the seashore where seabirds infected with H5N1 viruses had previously been detected. For that reason, an infection of environmental origin is suspected.

The risks to humans from infected birds likely remains quite low, but that risk is arguably higher for dogs and cats which roam outside (see Netherlands: Utrecht University Study Of Stray & Domestic Cats For Evidence Of HPAI H5N1 Exposure), which could provide additional routes of human exposure.

While rare, people have contracted avian flu from pets in the past (see J Infect Dis: Serological Evidence Of H7N2 Infection Among Animal Shelter Workers, NYC 2016), and we've seen guidance from both the CDC (see Bird Flu in Pets and Other Animals) and the UK's DEFRA on the importance of keeping pets safe from H5N1.​

All of these are considerations to which - until relatively recently - people living in the Americas, and much of Europe, had to give little thought. But, at least in the short term, this appears to be our `new normal'.

https://afludiary.blogspot.com/2024/03/vietnam-moh-statement-epidemiological.html
​

 

[Treyfish]

The male student in Nha Trang who died from influenza A/H5 used to trap birds


Trung Thi
Monday, March 25, 2024 - 22:26

..The patient's family informed that in the past, when he had free time, the male student had a habit of trapping birds on weekends, so the authorities suspected that the source of infection to the patient was from wild birds...

"When the male patient became sick, his family released the bird, so it was difficult for the Department of Animal Husbandry and Veterinary Medicine to trace him," said Dr. Toan....
​:tiphat: https://dantri.com.vn/suc-khoe/nam-...um-ah5-tung-di-bay-chim-20240325210224980.htm

 

[Treyfish]

13:55, March 23, 2024
The patient positive for influenza A/H5 died

​
...We coordinate with Ninh Hoa Medical Center, Nha Trang Medical Center, Chi The Department of Animal Husbandry and Veterinary Medicine is conducting an investigation to find the source of infection. The room and rooms in the Nha Trang University dormitory where the patient lived were disinfected with Chloramin B on March 20.

Establishing a list 6 roommates, 60 students studying in the same class as the patient to monitor health. At the same time, take 6 samples from people living in the same dormitory room with the patient at Nha Trang University for testing. , tested negative for influenza A.


Take 5 disease samples from the poultry flock (including two samples from the chicken flock in the patient's house, one sample from the duck flock 50 m away from the house, two samples from the bird flock in the place where the patient often goes). ) tests all showed negative results for A/H5 virus.

A list of 14 medical staff at the Provincial General Hospital and 6 medical staff at the Provincial Hospital of Tropical Diseases, and 4 family members of the patient have been made. (including: mother, aunt and sister) to monitor health;...

:tiphat: https://baokhanhhoa.vn/xa-hoi/202403/benh-nhan-duong-tinh-voi-cum-ah5-da-tu-vong-7f314f4/

 

[Treyfish]

It is suspected that wild birds are the source of infection causing male students to contract influenza A/H5

C.DAN
19:29, March 25, 2024 [TABLE="class: rl unset, width: 445"]
[TR]
[TD="colspan: 2"]The patient positive for influenza A/H5 died[/TD]
[/TR]
[/TABLE]
On the evening of March 25, according to doctor Ton That Toan - Deputy Director in charge of the Provincial Center for Disease Control (CDC) Khanh Hoa, the epidemiological investigation showed that the male patient had a habit of often trapping wild birds. wild birds on the weekend, while poultry in the house and around the patient's living area did not show signs of illness or death, so the authorities suspected that the source of infection to the patient was from wild birds. "When the male patient became sick, his family had already released the bird, so it was difficult for the Department of Animal Husbandry and Veterinary Medicine to trace him" - Dr. Toan said.

Also according to Dr. Toan, before the above epidemiological investigation information, the authorities also speculated that there were cases of male students bringing trapped wild birds to sell at bird collection points near the university and near their homes, so they should expand. took samples, but so far all screening samples have shown negative results for influenza A/H5N1. Family members and patients who have been in contact through the follow-up period are all healthy to date.....:tiphat: https://baokhanhhoa.vn/xa-hoi/202403/nghi-van-chim-hoang-da-la-nguon-lay-khien-nam-sinh-mac-cum-ah5-6f8593f/​

 

[sharon sanders]

bump this

 

[Pathfinder]

Translation Google

Thursday, March 28, 2024 | 08:06A - A A + |

Deaths due to rabies increased abnormally, influenza A/H5N1 returned, the two ministries reminded to drastically prevent the epidemic
...
Regarding the bird flu epidemic, according to Mr. Duc, influenza A/H5N1 was first recorded in 2003, Vietnam is one of the heavily affected countries in the world.

There have been many waves of epidemics, the highest peak was in 2004-2009 when 112 cases were recorded, including 57 deaths. In March 2024, Vietnam recorded a death due to influenza A/H5N1. Cumulatively to date, Vietnam has recorded 129 cases and 65 deaths (about 50%).

Regarding influenza A/H7N9, there are currently no recorded cases of the disease entering Vietnam in either poultry or humans. Our country has not recorded influenza A/H5N6, A/H5N8 and A/H9N2 spreading to humans, although outbreaks in poultry have been recorded.

Director Hoang Minh Duc emphasized that there is still no vaccine or specific treatment for the disease; The mortality rate is very high, about 50%. Avian flu has the risk of causing continuing pandemics. The ability to spread between animals and humans is confirmed in influenza strains A(H5N6), A(H5N1), A(H5N8) and other types.

In addition, recently, an increase in Influenza A (H5N1) cases in humans has continued to be recorded in some countries: Cambodia (from February 2023), China and Vietnam.

"The simultaneous circulation of viruses along with increased adaptation in mammals is a worrying factor that could cause epidemics to increase in the near future. Therefore, units need to continue to improve disease control in poultry flocks, preventing the risk of disease spreading" - Mr. Duc said.

The risk of disease outbreaks transmitted from animals to humans continues to occur

The Ministry of Health and the Ministry of Agriculture and Rural Development believe that in the coming time, the risk of disease outbreaks transmitted from animals to humans will continue to occur.
...

http://soytequangninh.gov.vn/menu-s...tang-bat-thuong-cum-a-h5n1-tro-lai-hai-b.html

 

[sharon sanders]

bump this

 

[Pathfinder]

Avian Influenza A(H5N1) - Viet Nam

2 April 2024

Situation at a Glance

The World Health Organization (WHO) was notified about a case of human infection with an influenza A(H5N1) virus on 25 March 2024 by the national authorities of Viet Nam. The patient, who had no underlying medical conditions, developed symptoms on 11 March and died on 23 March. Exposure to birds was ascertained to have taken place in the third week of February. Samples collected from close contacts tested negative for influenza A(H5N1) virus. This is the first human infection with an avian influenza A (H5N1) virus reported in Viet Nam since 2022. According to the International Health Regulations (IHR) 2005, a human infection caused by a novel influenza A virus subtype is an event that has the potential for high public health impact and must be notified to the WHO. Based on available information, WHO assesses the risk to the general population posed by this virus as low.

Description of the Situation


On 25 March 2024, Viet Nam National Focal Point (NFP) for International Health Regulations (IHR) notified the World Health Organization (WHO) of one case of human infection with an influenza A(H5N1) virus in a 21-year-old male with no underlying conditions from Khanh Hoa Province, Viet Nam.

The case developed a fever and cough on 11 March 2024 and was admitted on 15 March to a local hospital due to persistent symptoms, including abdominal pain and diarrhoea. On 17 March, his condition worsened, and he was transferred to the Intensive Care Unit (ICU) of a provincial hospital. On 20 March, the patient was transferred to another provincial hospital with a diagnosis of severe pneumonia, severe sepsis, and acute respiratory distress syndrome. The case died on 23 March.

On 19 March, samples were taken for real-time polymerase chain reaction (RT-PCR) testing by the Pasteur Institut in Nha Trang, which resulted in a positive result for the influenza (H5) virus. On 22 March, genomic sequencing conducted by the Pasteur Institut of Nha Trang revealed the presence of the avian influenza A (H5N1) virus.

Initial results from the case investigation revealed that during the second and third weeks of February 2024, the case went bird hunting. Between that time and the onset of illness, no contact with dead or sick poultry nor contact with anyone exhibiting similar symptoms was reported. Among close contacts traced, no further cases of influenza A(H5N1) were detected.

Epidemiology


Animal influenza viruses normally circulate in animals but can also infect humans. Infections in humans have primarily been acquired through direct contact with infected animals or contaminated environments. Depending on the original host, influenza A viruses can be classified as avian influenza, swine influenza, or other types of animal influenza viruses.

Avian influenza virus infections in humans may cause diseases ranging from mild upper respiratory tract infection to more severe diseases and can be fatal. Conjunctivitis, gastrointestinal symptoms, encephalitis and encephalopathy have also been reported. There have also been several detections of A(H5N1) virus in asymptomatic persons who had exposure to infected birds in the days before a sample was collected.

Laboratory tests are required to diagnose human infection with influenza. WHO periodically updates technical guidance protocols for the detection of zoonotic influenza using molecular methods, e.g. RT-PCR. Evidence suggests that some antiviral drugs, notably neuraminidase inhibitors (oseltamivir, zanamivir), can reduce the duration of viral replication and improve prospects of survival in some cases.

From 2003 to 25 March 2024, a total of 888 worldwide human cases of infection of influenza A(H5N1), including 463 deaths, have been reported to WHO from 23 countries. Almost all cases of human infection with avian influenza A(H5N1) have been linked to close contact with infected live or dead birds, or contaminated environments.

Since 2003, 129 human infections with influenza A (H5N1), including 65 deaths, have been reported in Viet Nam. The most recent avian influenza A (H5) case was reported in October 2022 from Northern Province of Phu Tho, Viet Nam.

Public Health Response


The Government of Viet Nam has taken the following public health response actions:

• Conducting epidemiolocal investigation, and disinfection of the patient’s residence and suspected exposure areas.
• Contact tracing, isolation, testing and monitoring for close contacts of the patient.
• Testing of samples from chickens and ornamental birds near the patient’s residence. All samples collected from these birds have tested negative for influenza A(H5) viruses.
• Issuing an official letter requesting the Provincial Department of Health of Khanh Hoa province to prepare drugs (Oseltamivir), and other supplies, to timely support the local hospitals and authorities in patient management and containment of potential outbreaks.

WHO Risk Assessment


This is the first human infection with an avian influenza A (H5N1) virus reported in Viet Nam in 2024, and since 2022.

Most human cases of infection with avian influenza viruses reported to date have been due to exposure to infected poultry or contaminated environments.

Human infection can cause severe disease and has a high mortality rate. These A(H5N1) influenza viruses, belonging to different genetic groups, do not easily infect humans, and human-to-human transmission thus far appears unusual. As the virus continues to circulate in poultry, particularly in rural areas of Viet Nam, the potential for further sporadic human cases remains.

Currently, available epidemiological and virological evidence suggests that A(H5) viruses have not acquired the ability of sustained transmission among humans; thus, the likelihood of human-to-human spread is low.

Based on available information, WHO assesses the risk to the general population posed by this virus as low. The risk assessment will be reviewed if additional virological and epidemiological information becomes available.

WHO Advice


This event does not change the current WHO recommendations on public health measures and influenza surveillance.

The public should avoid contact with high-risk environments such as live animal markets/farms and live poultry, or surfaces that might be contaminated by poultry dropping. Additionally, it is recommended to maintain good hand hygiene with frequent washing or the use of alcohol- based hand sanitizer.

The general public and at-risk individuals should immediately report instances of sick or unexpected animal deaths to veterinary authorities. Consumption of sick or unexpectedly dead poultry should be avoided.

Any person who has had exposure to potentially infected birds or contaminated environments and feels unwell should seek health care promptly and inform their healthcare provider of their possible exposure.

Close analysis of the epidemiological situation, further characterization of the most recent influenza A(H5N1) viruses in both human and poultry populations, and serological investigations are critical to assessing associated risks to public health and promptly adjusting risk management measures.

There are no specific vaccines for influenza A(H5N1) in humans. However, candidate vaccines have been developed for pandemic preparedness in some countries. The WHO continues to update the list of zoonotic influenza candidate vaccine viruses (CVV), which are selected twice a year at the WHO consultation on influenza virus vaccine composition.

WHO advises against implementing travel or trade restrictions based on the current information available on this event. WHO does not advise special traveler screening at points of entry or other restrictions due to the current situation of influenza viruses at the human-animal interface.

State Parties to the International Health Regulations (2005) are required to immediately notify WHO of any laboratory-confirmed case of a recent human infection caused by a new subtype of influenza virus. Evidence of illness is not required for this notification.​

...

https://www.who.int/emergencies/disease-outbreak-news/item/2024-DON511

 

[sharon sanders]

Raj Rajnarayanan
@RajlabN
#H5N1 Clade 2.3.2.1c - #Vietnam New sequence from Khanh Hoa has intriguing #avianflu reassortment and PB2-E627K mammalian adaptation signature. PB2-E627K was absent in previously submitted avian sequences. Case description: https://fao.org/vietnam/news/detail-events/en/c/1680337/…

5:38 PM · Apr 5, 2024
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Raj Rajnarayanan
@RajlabN
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8h
more information on H5N1 Clade 2.3.2.1c from
@WHO
https://who.int/emergencies/disease-outbreak-news/item/2024-DON511…
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Raj Rajnarayanan
@RajlabN
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Case description

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Raj Rajnarayanan
@RajlabN
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Thanks to the labs that are testing, rapidly sequencing and submitting data to public databases (GISAID and others)!
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Raj Rajnarayanan
@RajlabN
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PB2 mutations of all the H5N1 Avian Flu Clade 2.3.2.1c sequences (Human, Chicken, Duck) uploaded from Vietnam recently PB2 E627K is found only in the human isolate & not in the avian species sequences previously (from 2023).

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