Tran Tinh Hien, Nguyen Thanh Liem, Nguyen Thi Dung etc.,al. Avian Influenza A (H5N1) in 10 Patients in Vietnam. N. Engl. J. Med., Mar 2004; 350: 1179 - 1188
Avian Influenza A (H5N1) in 10 Patients in Vietnam
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Tran Tinh Hien, Nguyen Thanh Liem, Nguyen Thi Dung etc.,al. Avian Influenza A (H5N1) in 10 Patients in Vietnam. N. Engl. J. Med., Mar 2004; 350: 1179 - 1188
Avian Influenza A (H5N1) in 10 Patients in Vietnam
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Background Recent outbreaks of avian influenza A (H5N1) in poultry throughout Asia have had major economic and health repercussions. Human infections with this virus were identified in Vietnam in January 2004.
Methods We report the clinical features and preliminary epidemiologic findings among 10 patients with confirmed cases of avian influenza A (H5N1) who presented to hospitals in Ho Chi Minh City and Hanoi, Vietnam, in December 2003 and January 2004.
Results In all 10 cases, the diagnosis of influenza A (H5N1) was confirmed by means of viral culture or reverse transcriptase–polymerase chain reaction with primers specific for H5 and N1. None of the 10 patients (mean age, 13.7 years) had preexisting medical conditions. Nine of them had a clear history of direct contact with poultry (median time before onset of illness, three days). All patients presented with fever (temperature, 38.5 to 40.0°C), respiratory symptoms, and clinically significant lymphopenia (median lymphocyte count, 700 per cubic millimeter). The median platelet count was 75,500 per cubic millimeter. Seven patients had diarrhea. In all patients, there were marked abnormalities on chest radiography. There was no definitive evidence of human-to-human transmission. Eight patients died, one patient has recovered, and one is recovering.
Conclusions Influenza A (H5N1) infection, characterized by fever, respiratory symptoms, and lymphopenia, carries a high risk of death. Although in all 10 cases the infection appears to have been acquired directly from infected poultry, the potential exists for genetic reassortment with human influenzaviruses and the evolution of human-to-human transmission. Containment of influenza A (H5N1) in poultry throughout Asia is therefore urgently required.
Source Information
From the Hospital for Tropical Diseases (T.T.H., N.T.D., P.P.M., N.V.C., D.B.K., N.T. Truong) and the Oxford University Clinical Research Unit at the Hospital for Tropical Diseases (C.D., T.T.T., M.J., C.S., J.F.); Pediatric Hospital Number Two (V.C.D.); Health Service of Ho Chi Minh City (L.T.G.); the Pasteur Institute (N.T.K.T., L.H.S., L.V.T.); and the Preventive Medicine Center (N.D.T., L.H.N.) — all in Ho Chi Minh City, Vietnam; the National Pediatric Hospital (N.T.L., L.T.S., P.T.S., N.T. Thi, L.P.P., C.V.T.); and the National Institute of Hygiene and Epidemiology (H.T.L., L.T.Q.M.) — both in Hanoi, Vietnam; the Government Virus Unit, Department of Health, Hong Kong, China (P.C., W.L.); and the Vietnam Office, World Health Organization, Hanoi, Vietnam (P.H.).
This article was published at www.nejm.org on February 25, 2004.
Address reprint requests to Dr. Farrar at the Hospital for Tropical Diseases, 190 Ben Ham Tu, Quan 5, Ho Chi Minh City, Vietnam, or at jeremyjf@hcm.vnn.vn.
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