Clinical Updates
4 April 2007
Avian influenza (H5N1) - human cases in Egypt and China
Egypt
The Egyptian Ministry of Health and Population has reported six human cases of H5N1 avian influenza since 27 March 2007 [1-3].
- A three year old girl from Aswan governorate developed respiratory symptoms on 22 March 2007 and was admitted to hospital on 24 March.
- A six year old girl and her four year old brother from Qena governorate. The girl was admitted to hospital on 25 March, and her brother was admitted on 29 March.
- A five year old boy from Menia governorate who was admitted to hospital on 25 March.
- A seven year old boy from Sohag governorate who developed symptoms on the 26 March and was admitted to hospital on 29 March.
- A four year old girl from Qalybiya governorate who developed symptoms on 29 March and was admitted to hospital on 30 March.
All children are currently receiving treatment and remain in a stable condition.
Initial investigations indicate that all six cases had close contact with sick or dead poultry shortly before the onset of symptoms.
China
On 29 March 2007, the Ministry of Health reported a human case of H5N1 avian influenza in a 16 year old man from Anhui province [4]. He developed symptoms on 17 March 2007 and died in hospital on 27 March. Investigations into the source of his exposure are ongoing.
Global Case Totals
The global total of laboratory cases reported by the WHO as of 2 April 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_04_02/en/index.html
COUNTRY |
HUMAN CASES as of 2 April 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 |
2 |
24 |
15 |
Djibouti |
0 |
0 |
0 |
1 |
0 |
1 |
0 |
Egypt |
0 |
0 |
0 |
18 |
14 |
32 |
13 |
Indonesia |
0 |
0 |
19 |
56 |
6 |
81 |
63 |
Iraq |
0 |
0 |
0 |
3 |
0 |
3 |
2 |
Lao PDR |
0 |
0 |
0 |
0 |
2 |
2 |
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 |
25 |
288 |
170 |
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
A H5N1 avian influenza timeline of major events is also available on the WHO website at http://www.who.int/csr/disease/avian_influenza/Timeline_2007
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 are no restrictions for travel to countries with avian influenza. Nevertheless, travellers should exercise precautions [5].
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 [6]. 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 [7].
References
1. World Health Organization. Avian influenza – situation in Egypt – update 11. 27 March 2007. [accessed 4 April 2007]. Available at http://www.who.int/csr/don/2007_03_27/en/index.html
2. World Health Organization. Avian influenza – situation in Egypt – update 12. 28 March 2007. [accessed 4 April 2007]. Available at http://www.who.int/csr/don/2007_03_28/en/index.html
3. World Health Organization. Avian influenza – situation in Egypt – update 13. 2 April 2007. [accessed 4 April 2007] Available at http://www.who.int/csr/don/2007_04_02/en/index.html
4. World Health Organization. Avian influenza – situation in China – update. 29 March 2007. [accessed 4 April 2007] Available at http://www.who.int/csr/don/2007_03_29/en/index.html
5. NaTHNaC Health Information Sheets. Avian influenza – advice for travellers. 4 July 2006. [accessed 4 April 2007] Available at http://www.nathnac.org/pro/factsheets/avianinfluenza_advice_
6. 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. 2 April 2007 [accessed 4 April 2007] Available at http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPA
7. 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 February 2007 [accessed 4 April 2007]. Available online at: http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPA
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