Jan 28, 2005 (CIDRAP News) – A 32-year-old man from northern Vietnam died of avian influenza yesterday, and two more confirmed human cases of the disease were reported today, according to news services and the World Health Organization (WHO).

A doctor at Bach Mai hospital in Hanoi said the man, from Phu Tho province, had tested positive for the H5N1 flu strain, according to an Agence France-Presse (AFP) report.

The WHO announced it had received reports of confirmed cases in two girls but was awaiting confirmation by the Vietnamese Ministry of Health.

One patient is a 10-year-old girl from the southern province of Long An who fell ill on Jan 13. She was hospitalized on Jan 20 and remains in critical condition.

The second girl may represent another family cluster of avian flu, the WHO said. She is the 13-year-old daughter of a 35-year-old woman from Dong Thap province who died of H5N1 on Jan 21. The girl became ill Jan 20 and was hospitalized Jan 22; she is critically ill.

"In view of the six-day interval between dates of symptom onset in the mother and her child, limited human-to-human transmission, as seen during similar events in the past, cannot be ruled out at this stage," the WHO said. "All such clusters of cases, closely related in place and time, require urgent investigation to determine whether the epidemiological behavior of the virus might be changing in ways that could favor the onset of a pandemic."

The WHO said that if these last two cases are confirmed, it will bring the number of cases in Vietnam since mid-December to 12, of which 9 have been fatal. The WHO count doesn"e;t include the 32-year-old man.

If this family cluster is confirmed, it could be the third since last summer, including one in Thailand last September and another involving brothers in Vietnam earlier this month. Two cases of H5N1 have been confirmed in that cluster. A 46-year-old man died, but his 42-year-old brother, Nguyen Thanh Hung, survived and today left a Hanoi hospital, AFP reported. Whether their younger brother also contracted avian flu has been the subject of conflicting reports and remains under investigation.

The latest outbreaks have taken a toll on Vietnam"e;s poultry population as well. More than 812,000 poultry have been culled this year, AFP reported. Despite those efforts, avian flu has spread to 274 communes in 25 provinces and cities, Voice of Vietnam (VOV) news online reported yesterday.

Vietnam"e;s Veterinary Department on Jan 25 issued new instructions on the slaughter, transport, and trade of poultry, to be enforced nationwide, VOV said. Ho Chi Minh City has issued new regulations calling for the slaughter and freezing of about 300,000 chickens and further tightening of hygiene rules for raising the remaining 150,000 birds left in the city.

Riot police were sent to poultry checkpoints around Ho Chi Minh City, ABC News reported online today. The riot officers were backing up traffic police and market monitors operating the 24-hour checkpoints meant to stop infected or uncertified birds from entering the city.

Thousands of people are expected to travel widely in Vietnam next month for Tet, the new year celebration that traditionally involves meals with poultry.

WHO was not expected to issue a travel advisory for visitors to Vietnam, although more than 200,000 Vietnamese living abroad may return to the country for the holiday, the Associated Press (AP) reported today. WHO officials are recommending that people avoid all contact with sick birds and eat only thoroughly cooked poultry products.

Health officials have also recommended that people wear masks and gloves while slaughtering poultry, the AP reported.