MSNBC WP: Dark side to good news on bird flu

[Guest guest]

>WP: Dark side to good news on bird flu

>More than a year after avian flu emerged in East

>Asia, killing more than two-thirds of the people

>with confirmed cases, Vietnamese doctors are

>reporting that the mortality rate in their

>country has dropped substantially, raising the

>possibility the virus could spread more easily

>and cause a global pandemic.

>http://www.msnbc.msn.com/id/7593132/

 

Dark side to good news on bird flu

As virus becomes less lethal, it could gain mobility

By Alan Sipress

The Washington Post

Updated: 11:16 p.m. ET April 22, 2005

 

 

HANOI - Nguyen Sy Tuan can barely talk. His

wasted frame is tucked beneath a thin white sheet

on the hospital cot. His cheeks are sunken and

his bulging eyes stare blankly at the ceiling.

But the young man has begun to eat rice again and

can finally breathe without a mechanical

ventilator, a dramatic turnaround for a bird flu

patient whose doctors had assumed would die.

 

More than a year after avian influenza emerged in

East Asia, killing more than two-thirds of the

people with confirmed cases, Vietnamese doctors

are reporting that the mortality rate in their

country has dropped substantially.

 

An ominous turn

But while this is good news for survivors, it

could mean the outbreak of bird flu in Southeast

Asia is taking an ominous turn. If a disease

quickly kills almost everyone it infects, it has

little chance of spreading very far, according to

international health experts. The less lethal

bird flu becomes, they say, the more likely it is

to develop into the global pandemic they fear,

potentially killing tens of millions of people.

 

" The virus could be adapting to humans, " said

Peter Horby, an epidemiologist with the World

Health Organization in Hanoi, the Vietnamese

capital. " There's a number of indications it

could be moving toward a more dangerous virus. "

 

The mortality rate for bird flu in Vietnam this

year is about 35 percent, almost exactly half

that of last year, according to Health Ministry

statistics. The mortality rate of the 1918

Spanish flu pandemic, by comparison, was less

than 5 percent, but the outbreak killed an

estimated 40 million people worldwide.

 

Officials said the drop in the bird flu mortality

rate was more marked in northern Vietnam than in

the south. While the virus in southern Vietnam is

still killing at the same pace as last year, the

rate in the area around Hanoi and elsewhere in

the north has dropped from that level to as low

as 20 percent. Vietnamese health experts said

their suspicion that the disease is shifting is

further supported by preliminary research showing

a genetic change in the virus in the north

resulting in the production of a protein with one

fewer amino acids than in the south.

 

A virus on the move?

Health researchers believe that nearly all the 52

people known to have died of bird flu in

Southeast Asia caught the virus from infected

poultry. But with more clusters of cases among

families reported in Vietnam this year -

including that of Tuan, his sister and their

grandfather - experts say they are growing

increasingly suspicious that the disease has

begun passing from one human to another.

 

Also worrying is the discovery of at least five

cases, including that of Tuan's grandfather, in

which people tested positive for bird flu but

showed no symptoms. This could make it more

difficult to contain an epidemic because people

could transmit the disease without anyone

realizing it.

 

Last year, U.S. researchers reported that ducks

in Southeast Asia had begun carrying the bird flu

virus without showing symptoms. Now, scientists

in Vietnam have found numerous asymptomatic cases

in the country's vast chicken population,

according to Nguyen Tran Hien, director of the

National Institute of Hygiene and Epidemiology.

 

" It seems that the virus may adapt in humans and

in poultry a little bit. Therefore, the symptoms

are not as severe as before, " Hien said. " Also,

the transmission may be faster and easier. "

 

Moreover, the existing virus strain is not the

only threat. Each human case also presents a

chance for the bird flu virus to swap genetic

material with an ordinary flu bug - if the person

becomes infected with both strains at the same

time - potentially creating a new hybrid that is

highly lethal and even easier to catch.

 

" We are concerned that if the virus is changing,

maybe a new virus is coming in the future, " Hien

said.

 

Two survivors

Tuan, 21, left his home among the glistening

paddies of northern Vietnam's rice-growing region

more than a year ago for Haiphong, on the coast,

where he worked harvesting seaweed for use in

local cuisine. In early February, he returned to

his family's simple brick house to celebrate the

Tet New Year holiday.

 

According to his doctors, Tuan slaughtered a

chicken for a festival meal, cutting its neck

while his 14-year-old sister clutched the wings

and legs. The bird was likely infected, and soon

the siblings were, too.

 

Tuan started running a high fever about four days

later, his wizened father recounted between puffs

on a traditional bowl pipe in the family's

one-room home.

 

When Tuan started coughing and had trouble

breathing, he was taken to the local health

center in Thai Thuy district. X-rays showed a

white smudge on his left lung. Tuan was

transferred after less than a day to a larger

hospital in the provincial capital. There, the

doctors concluded he had contracted the H5N1

strain of avian influenza and immediately rushed

him to the tropical disease institute at Hanoi's

Bach Mai Hospital.

 

By the time he arrived, X-rays showed, the white

smudge had clouded the entire lung. Soon it took

over the other one as well. " From one day to the

next day, it spread very quickly, " recalled

Nguyen Thi Tuong Van, deputy director of the Bach

Mai intensive care unit.

 

After 10 days, with his breathing failing, the

doctors inserted a tube in Tuan's throat and put

him on a ventilator. The infection spread to his

kidneys and liver.

 

" We thought it was very likely the bird flu would

kill him, " Van said. " Then, when it seemed the

situation couldn't get much worse, it started to

get better. Two weeks later, when he didn't die,

I thought maybe we could cure him. "

 

Tuan's sister, Nguyen Thi Ngoan, a tall,

mischievous 14-year-old with large black eyes,

fell sick several days after her brother and also

recovered.

 

At the district health center, X-rays revealed

her lungs were clear, but a subsequent blood test

was positive for bird flu. She was transferred to

the Hanoi hospital, where she lay in the cot

beside her brother and her temperature soared to

105 degrees.

 

But the fever broke after four days and returned

to normal within two weeks, her doctors said.

Ngoan went back to school in late March as a

local celebrity, teased by her peers as " Miss H5. "

 

A vital question

Vietnamese and international health officials say

they are confident that the mortality rate has

dropped but are not sure by how much. Better

screening and wider public awareness of bird flu

could mean health workers are catching and

recovering from milder cases that would have gone

unreported a year ago. WHO officials have

complained, however, that Vietnam is reluctant to

provide detailed information about human cases.

Senior Health Ministry officials respond that

reports are provided in accord with national

regulations.

 

The question now is whether bird flu in Vietnam has begun passing among humans.

 

If it has, Nguyen Duc Tinh, a nurse who treated

Tuan at the Thai Thuy district health center and

fell sick with bird flu soon after, would be a

likely instance. Tinh, 26, said he had no contact

with poultry for a month beforehand despite

government accounts attributing his illness to

infected chickens.

 

Tinh said he was the hospital staff member who

had the closest contact with Tuan during his

brief stay at the health center, taking his blood

pressure and temperature, giving him injections

and helping him walk. Within a week, Tinh had

developed muscle aches and a high fever, symptoms

of what he believed was a common flu. But when

the fever subsided and then returned two days

later, he grew alarmed.

 

" Then I suspected I had bird flu, " he recalled,

his brown eyes widening. " I was really, really

afraid of dying. "

 

But just two weeks after joining Tuan in the

Hanoi hospital, Tinh was discharged and went back

to his village.

 

" I had lost hope when the fever came a second

time, " he said. " When I returned to my home town,

I felt as if I were born again. "

© 2005 The Washington Post Company

 

© 2005 MSNBC.com

 

URL: http://www.msnbc.msn.com/id/7593132/

--