Health Professionals

Clinical Updates

4 January 2007

Avian influenza (H5N1) – human cases in Egypt, Indonesia, Pakistan, and Viet Nam

 

Egypt

The Ministry of Health has confirmed five human cases of H5N1 avian influenza.

  • A 25 year old female from Beni Suef Governorate who died in hospital on 25 December 2007 [1]. The source of her exposure is currently being investigated.
  • A 50 year old female from Dumyat Governorate who was hospitalised on 24 December 2007 and died on 31 December [2,3]. She is known to have had contact with sick and dead poultry.
  • A 22 year old female from Menufia Governorate who was hospitalised on 26 December 2007 and is currently recovering [2]. She is known to have had contact with sick and dead poultry.
  • A 25 year old female from Daqahliya Governorate who developed symptoms on 26 December 2007 and died in hospital on 30 December [4]. She is known to have had contact with sick and dead poultry.
  • A 36 year old female from Menufia Governorate who developed symptoms on 26 December 2007 and died in hospital on 31 December [4]. She is known to have had contact with sick and dead poultry.

Indonesia

The Ministry of Health has reported a human case of H5N1 avian influenza in a 24 year old female from West Jakarta [5]. She developed symptoms on 14 December 2007 and died in hospital on 25 December. The source of her exposure is currently under investigation.

Pakistan

The first human case of H5N1 avian influenza in Pakistan has been laboratory confirmed [6]. The case was a 25 year old male from the Peshawar area who developed symptoms on 21 November 2007 and died on 28 November. He was part of a cluster of suspected cases that were reported on 19 December 2007 [7]. The World Health Organization (WHO) has been assisting with the investigation of this case and the other suspected cases.

Viet Nam

The Ministry of Health has confirmed a human case of H5N1 avian influenza in a four year old boy from Son La province [8]. The boy developed symptoms on 7 December 2007 and died in hospital on 16 December. The source of his exposure is currently under investigation.

Global case totals

The global total of confirmed human cases of avian influenza A/H5N1 reported by the WHO as of 3 January 2008 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_2008_01_03/en/index.html

COUNTRY

HUMAN CASES as of 3 January 2008

DEATHS

2003

2004

2005

2006

2007

TOTAL

Azerbaijan

0

0

0

8

0

8

5

Cambodia

0

0

4

2

1

7

7

China

1

0

8

13

5

27

17

Djibouti

0

0

0

1

0

1

0

Egypt

0

0

0

18

25

43

19

Indonesia

0

0

20

55

41

116

94

Iraq

0

0

0

3

0

3

2

Lao PDR

0

0

0

0

2

2

2

Myanmar

0

0

0

0

1

1

0

Nigeria

0

0

0

0

1

1

1

Pakistan

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

8

101

47

TOTALS

4

46

98

115

85

348

216 (62%)

 

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Advice for travellers

Examination of human cases of avian influenza indicates 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 are no restrictions for travel to countries with avian influenza. Nevertheless, travellers should exercise precautions [9].

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 [10]. 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 has also published a second algorithm for the management of persons resident in the UK or arriving from areas not known to have avian influenza H5N1 [11].

Both algorithms provide guidance for physicians on the recognition, investigation and initial management of persons with a history of fever and respiratory symptoms, after close contact with sick, dying or dead birds within seven days of presentation.

References

1. World Health Organization. Avian influenza – situation in Egypt. 26 December 2007. [Accessed 4 January 2008]. Available at http://www.who.int/csr/don/2007_12_26a/en/index.html

2. World Health Organization. Avian influenza – situation in Egypt. 28 December 2007. [Accessed 4 January 2008]. Available at http://www.who.int/csr/don/2007_12_28a/en/index.html

3. World Health Organization. Avian influenza – situation in Egypt – update 3. 3 January 2008. [Accessed 4 January 2008.] Available at http://www.who.int/csr/don/2008_01_03/en/index.html

4. World Health Organization. Avian influenza – situation in Egypt – update 2. 2 January 2008. [Accessed 4 January 2008]. Available at http://www.who.int/csr/don/2008_01_02/en/index.html

5. World Health Organization. Avian influenza – situation in Indonesia – update 28. 26 December 2007. [Accessed 4 January 2008]. Available at http://www.who.int/csr/don/2007_12_26/en/index.html

6. World Health Organization. Avian influenza – situation in Pakistan – update. 27 December 2007. [Accessed 4 January 2008]. Available at http://www.who.int/csr/don/2007_12_27/en/index.html

7. World Health Organization. Avian influenza – situation in Viet Nam. 28 December 2007. [Accessed 4 January 2008]. Available at http://www.who.int/csr/don/2007_12_28/en/index.html

8. NaTHNaC. Avian influenza (H5N1) – human cases in China, Indonesia, Myanmar and Pakistan. 19 December 2007. [Accessed 4 January 2008]. Available at http://www.nathnac.org/pro/clinical_updates/flu_191207.htm

9. NaTHNaC. Avian influenza – advice for travellers. 4 July 2006. [Accessed 4 January 2008]. Available at http://www.nathnac.org/pro/factsheets/avianinfluenza_advice_

040707.htm

10. 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. 18 December 2007 [accessed 4 January 2008] Available at http://www.hpa.org.uk/web/HPAweb&HPAweb

Standard/HPAweb_C/1195733851442

11. Health Protection Agency. Algorithm for the management of persons resident in the UK or arriving from areas not known to have avian influenza H5N1 presenting with a febrile respiratory illness after close contact with sick, dying or dead birds: recognition, investigation and initial management. 7 September 2007 [accessed 4 January 2008] Available at http://www.hpa.org.uk/web/HPAweb&HPAweb

Standard/HPAweb_C/1195733851442