31 January 2006

 

Avian influenza H5N1 - Human cases in Iraq, Turkey, Indonesia and China

 

Iraq

The Ministry of Health in Iraq has confirmed the country’s first case of human H5N1 avian influenza [1]. It occurred in a 15 year old girl who died on 17 January following a severe respiratory illness. The girl’s uncle who cared for her, developed symptoms on 24 January and died of a severe respiratory illness on 27 January. A third case in an unrelated 54 year old woman from the same area is under investigation. The first case received preliminary confirmation as H5N1 by a US Naval Medial Research Laboratory in Cairo; the latter two cases are being tested.

The 15 year old girl and her uncle resided in the town of Raniya near Sulaimaniyah in the north of the country, close to the border with Turkey. Poultry deaths have been reported in their neighbourhood, and the girl had exposure to diseased birds, however H5N1 has not yet been confirmed in any birds in Iraq.

An international team is being assembled to assist the Ministry of Health in its investigations of these cases and in developing an appropriate public health response.

Turkey

On 18 January 2006, the World Health Organization (WHO) reported the 21st cases of human avian influenza in Turkey [2].

The case is a four year old boy from the district of Dogubeyazit in Agri province in eastern Turkey. He developed symptoms on 5 January and was hospitalised on 13 January in Erzurum province where he is undergoing treatment.

Of the 21 cases reported in Turkey, 12 have now been confirmed as H5N1 by the WHO collaborating laboratory in Mill Hill, London [3].

 

Indonesia

On 23 January, the Ministry of Health in Indonesia confirmed an additional two cases of human avian influenza H5N1 [4]. This brings the total in Indonesia to 19, of which 14 have been fatal.

The newly confirmed cases are in a 13 year old girl and her four year old brother. Both children died. Two other family members, a 14 year old sister and their 43 year old father are in hospital with respiratory symptoms and are being tested for avian influenza.

An investigation has found evidence of a large outbreak of avian influenza amongst poultry in the family’s neighbourhood. All family members had contact with diseased and dead birds. All contacts have been traced and are being monitored.

China

On 25 January the Ministry of Health in China confirmed the country’s 10th case of human avian influenza H5N1 [5].

The case occurred in a 29 year old woman from Chengdu city in Sichuan province. She developed symptoms on 12 January and died in hospital on 23 January. This is the second case from Sichuan province [6].

Efforts are underway to determine the source of these two infections. Although an outbreak of H5N1 in poultry was confirmed in the province in late December, no poultry outbreaks have occurred in the vicinity of the two human cases. Because there is not an obvious link with diseased poultry, WHO is recommending that in China, testing for H5N1 should be undertaken in all cases of severe respiratory disease having no alternative diagnosis.

Global Case Totals

The global total of World Health Organization-confirmed cases is in the table and can be found on their website [7].  WHO will continue to adjust the number of cases and deaths in Turkey and Iraq (which does not yet appear on the official list) as these cases are confirmed by the WHO-collaborating laboratory in Mill Hill, London.

 

COUNTRY	CASES as of 30 January 2006					DEATHS
	2003	2004	2005	2006	TOTAL
Cambodia	0	0	4	0	4	4
China	0	0	8	2	10	7
Indonesia	0	0	16	3	19	14
Thailand	0	17	5	0	22	14
Viet Nam	3	29	61	0	93	42
Turkey	0	0	0	12	12	4
TOTALS	3	46	94	17	160	85

 

Advice for travellers

There remain no restrictions for travel to countries that have been infected with avian influenza. Nevertheless, travellers should exercise precautions that have been previously posted [8]. Travellers who return ill with a respiratory illness should inform their physicians of their travel history. This includes travellers who return from all areas of Turkey and who have had close contact with poultry or wild birds.  Physicians should evaluate them according to the protocol established by the Health Protection Agency (HPA) [9].

References

1. World Health Organization. Avian influenza - situation in Iraq. 30 January 2006. [cited 31 January 2006] Available online at:

http://www.who.int/csr/don/2006_01_30a/en/index.html

2. World Health Organization. Avian influenza - situation in Turkey - update 6. 18 January 2006. [cited 30 January 2006] Available online at http://www.who.int/csr/don/2006_01_18/en/index.html

3. World Health Organizartion. Avian influenza - situation in Turkey - update 7. 30 January 2006. [cited 31 January 2006] Available online at: http://www.who.int/csr/don/2006_01_18/en/index.html

4. World Health Organization. Avian influenza - situation in Indonesia - update. 23 January 2006. [cited 30 January 2006] Available online at http://www.who.int/csr/don/2006_01_23/en/index.html

5. World Health Organization. Avian influenza - situation in China - update 2. 25 January 2006. [cited 30 January 2006]. Available online at http://www.who.int/csr/don/2006_01_25a/en/index.html

6. World Health Organization. Avian influenza - situation in China - update. 19 January 2006. [cited 31 January 2006]. Available online at

http://www.who.int/csr/don/2006_01_19/en/index.html

7. World Health Organization. Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO. 14 January 2006. [cited 31 January 2006] Available at: http://www.who.int/csr/disease/avian_influenza/country/

cases_table_2006_01_14/en/index.html

8. NaTHNaC. Avian influenza - advice for travellers to affected areas. 4 November 2005. [cited 30 January 2006] Available at: http://www.NaTHNaC.org/pro/clinical_updates/

avianinfluenza_advice_041105.htm

9. Health Protection Agency. Algorithm for the management of returning travellers from countries affected by avian influenza presenting with a febrile illness: recognition, investigation and initial management. 12 January 2006. [cited 30 January 2006] Available at http://www.hpa.org.uk/web/HPAweb&HPA

webStandard/HPAweb_C/1195733851442