15 February 2007

Avian influenza H5N1 - human cases in Egypt, Indonesia and Nigeria

 

Egypt

Since 22 January 2007, the Egyptian Ministry of Health and Population has confirmed two human cases of H5N1 avian influenza [1,2].

The first is 27 year old woman from Bani Suwayf Governate who developed symptoms on 9 January 2007 and died in hospital on 19 January.

The second case is a 17 year old woman from Al Fayyum Governate who developed symptoms on 25 January 2007 and died in hospital on 2 February.

Initial investigations indicate the presence of sick and dead poultry in the premises of both women.

Viruses with moderately reduced susceptibility to oseltamivir have been discovered in two persons previously reported with H5N1 infections in Egypt [3].

Both patients were part of the same family from Al Gharbiyah Governate, and died in hospital in December 2006.

The World Health Organization (WHO) report that there is no indication that oseltamivir is widespread in Egypt or elsewhere, and is not making any changes in antiviral treatment recommendations for infected persons. Furthermore, these virus mutations are not associated with any change in its transmission between humans.

Indonesia

Since 22 January 2007, the Ministry of Health of Indonesia confirmed two human cases of H5N1 avian influenza [4,5].

The first is 32 year old woman from West Java province who developed symptoms on 11 January 2007 and died in hospital on 19 January.

The second is a six year old girl from Central Java province who developed symptoms on 8 January and died in hospital on 19 January.

Initial investigations indicate that both patients had contact with sick poultry shortly before the onset of their symptoms.

Nigeria

On 31 January 2007, the government of Nigeria announced the death of a 22 year old woman from suspected avian influenza infection [6].

The woman from Lagos died on 16 January 2007. Her diagnosis of H5N1 infection was confirmed by the WHO Collaborating Centre for Reference and Research on Influenza in London on 3 February [7].

Investigations are underway to identify the source of her infection.    

The woman’s mother died on 4 January 2007 with similar symptoms; however, no samples were taken. Samples taken from other contacts have all tested negative by the WHO Collaborating Centre.

Global Case Totals

The global total of laboratory cases reported by WHO as of 6 February 2007 is in the table below and can be found on the WHO website at: http://www.who.int/csr/disease/avian_influenza/country/

cases_table_2007_02_06/en/index.html

COUNTRY	HUMAN CASES as of 6 February 2007						DEATHS
	2003	2004	2005	2006	2007	TOTAL
Azerbaijan	0	0	0	8	0	8	5
Cambodia	0	0	4	2	0	6	6
China	1	0	8	13	0	22	14
Djibouti	0	0	0	1	0	1	0
Egypt	0	0	0	18	2	20	12
Indonesia	0	0	19	56	6	81	63
Iraq	0	0	0	3	0	3	2
Nigeria	0	0	0	0	1	1	1
Thailand	0	17	5	3	0	25	17
Turkey	0	0	0	12	0	12	4
Viet Nam	3	29	61	0	0	93	42
TOTALS	4	46	97	116	9	272	166

 

WHO case definitions for human infections with influenza A (H5N1) virus are available on the WHO website at http://www.who.int/csr/disease/avian_influenza/guidelines/

case_definition2006_08_29/en/index.html

Advice for travellers

Examination of human cases of avian influenza has indicated that the greatest risk for transmission from birds to humans comes when there is close human contact with domestic poultry. This is particularly so in settings of diseased household flocks and when there has been slaughtering, de-feathering, and preparation of poultry for consumption. No cases have been linked to consumption of properly cooked meat or eggs.

There remain no restrictions for travel to countries with avian influenza. Nevertheless, travellers should exercise precautions [8].

The Health Protection Agency (HPA), Centre for Infections has published an algorithm for the management of travellers or visitors arriving from countries (or areas within countries) affected by avian influenza [9]. These regions are revised as new information is provided from the WHO and the World Organisation for Animal Health (OIE) on detection of avian influenza. Countries may be removed from the list if they have been declared free of avian influenza.

The HPA algorithm provides guidance on the recognition, investigation and management of persons with fever or history of fever and respiratory symptoms, and who have had an exposure to persons or birds with suspected avian influenza (H5N1) within seven days of the development of their symptoms. Physicians who see persons whom they suspect may have avian influenza should evaluate them according to this algorithm. The HPA has published a second algorithm to reflect the situation of a traveller from an area (including within the UK) where there is no known avian influenza [10].

References

1. World Health Organization. Avian influenza - situation in Egypt - update 2. 22 January 2007. [cited 15 February 2007] Available at http://www.who.int/csr/don/2007_01_22a/en/index.html

2. World Health Organization. Avian influenza - situation in Egypt - update 3.     6 February 2007. [cited 15 February 2007] Available at http://www.who.int/csr/don/2007_02_06/en/index.html

3. World Health Organization. Avian influenza - situation in Egypt - update.     18 January 2007. [cited 15 February 2007] Available at http://www.who.int/csr/don/2007_01_18/en/index.html

4. World Health Organization. Avian influenza - situation in Indonesia - update 4. 22 January 2007. [cited 15 February 2007] Available at http://www.who.int/csr/don/2007_01_22/en/index.html

5. World Health Organization. Avian influenza - situation in Indonesia  - update 5. 29 January 2007. [cited 15 February 2007] Available at http://www.who.int/csr/don/2007_01_29/en/index.html

6. World Health Organization. Avian influenza - situation in Nigeria. 31 January 2007. [cited 15 February 2007] Available at http://www.who.int/csr/don/2007_01_31a/en/index.html

7. World Health Organization. Avian influenza - situation in Nigeria - update.     3 February 2007. [cited 15 February 2007] Available at http://www.who.int/csr/don/2007_02_03/en/index.html

8. NaTHNaC. Avian influenza - advice for travellers to affected areas. 4 July 2006. [cited 15 February 2007] Available at http://www.NaTHNaC.org/pro/clinical_updates/

avianinfluenza_advice.htm

9. Health Protection Agency. Algorithm for the management of returning travellers and visitors from countries affected by avian influenza (H5N1) presenting with a febrile respiratory illness: recognition, investigation and initial management. 6 February 2007 [cited 15 February 2007] Available at http://www.hpa.org.uk/web/HPAweb&HPAweb

Standard/HPAweb_C/1195733851442

10. Health Protection Agency. Algorithm for the management of persons resident in the UK arriving from areas not known to have avian influenza H5N1 presenting with febrile respiratory illness after close contact with sick, dying or dead birds: recognition, investigation and initial management. 6 September 2006 (reviewed 6 February 2007) [cited 15 February 2007]. Available online at: http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPA

web_C/1195733851442

Link

WHO Avian Influenza site: http://www.who.int/csr/disease/avian_influenza/en/