Vietnam bird flu puzzle has many missing pieces

The Hanoi Hilton's club sandwich no longer features chicken.

The chief bird flu fighter in the northern Thai Binh province, where a cluster of human cases has caused concern, is trying to stop chickens from crossing the road to reach - and infect - the other side.

A survivor in the province swears never again to eat fowl.

But a longtime chicken seller can't understand what the fuss is all about and the elder sister of another survivor ate chicken in Hanoi while her brother struggled for life on a respirator.

There are as many bird flu voices in Vietnam at the moment as the cackling and crowing of the millions of fowl - chickens, ducks, geese, quail - that dot the land and rice paddy fields.

After 15 deaths in Vietnam since December 2004 out of 41 patients stricken in that period by the H5N1 bird flu virus, chicken is mainly off the menu and under the microscope.

Since the disease first hit Asia in late 2003, killing since then a total of 36 Vietnamese, the communist nation has reported a total of 68 human infections among a population of 82 million.

In the same time, 12 Thais and four Cambodians have also died of the virus including a 20-year-old Cambodian woman who was a rushed to a hospital in Vietnam last week.

The World Health Organisation (WHO) says the virus could mutate into a form that could pass easily between humans and cause a worldwide pandemic in which millions could die.

THE DOCTORS

Doctor Pham Van Diu, director of the Centre of Preventive Medicine in Thai Binh, 110 km (68 miles) south-east of Hanoi and the site of three bird flu "cluster" outbreaks this year, is in the front line of the battle.

Diu, who has worked in the Red River Delta province since 1984, seeing it safely through such scourges as bubonic plague, cholera, polio and dengue fever, admits he is perplexed.

"It is a big jigsaw puzzle and there is not just one piece missing but many pieces missing," he says.

Why do people who slaughter chickens, and would seem most at risk, seem immune? Why does the flu seem to strike mainly within families? Why have there been no foreigners among the stricken?

"When it first appeared we thought it was SARS," he said. "But it didn't follow rules of past diseases like many victims, more dead, as well as less time and space between outbreaks."

He says strict measures to control movement of poultry, isolation of cases and public awareness allowing early diagnosis have helped Vietnam control the spread for the moment.

Diu said last year 1.5 million birds were slaughtered in a cull of the sick. In the first three months of this year, only 15,000 have been slaughtered.