5 December 2007

Avian influenza (H5N1) – human cases in Indonesia and China

Indonesia

The Ministry of Health in Indonesia has confirmed seven cases of H5N1 avian influenza in humans since 1 October 2007.

• A 21 year old man who worked as an egg seller in a traditional market who developed symptoms on 18 September and died in hospital on 28 September 2007 [1].

• A 44 year old woman from Pekanbaru City, Riau Province who developed symptoms on 1 October and died on 6 October 2007. The source of her exposure is under investigation [2].

• A 31 year old man from Bengkalis District, Riau Province who developed symptoms on 31 October and died in hospital on 6 November 2007. The source of his exposure is under investigation [3].

During October and November 2007, four cases were confirmed in Tangerang District, Banten Province:

• A 12 year old boy who developed symptoms on 30 September and died on 13 October 2007. Prior to his illness he had direct contact with dead chickens outside his school [4, 5]. 
• A five year old girl who developed symptoms on 14 October and died in hospital on 22 October 2007. There were poultry deaths in the girl’s neighbourhood two weeks before the onset of her symptoms [6].
• A three year old boy who developed symptoms on 14 October 2007 and has since recovered. There had been poultry deaths in his household prior to his illness. The boy was living in the same district as, but had no contact with, the five year old girl aforementioned [7].
• A 30 year old woman who developed symptoms on 23 October and died in hospital on 3 November 2007. There were poultry deaths in her neighbourhood prior to her infection [8].

China

On 4 December 2007, a case of H5N1 avian influenza was reported in a 24 year old man from Jiangsu Province. He developed symptoms on 24 November and died on 2 December 2007. There is no initial indication to suggest he had contact with sick birds prior to becoming unwell [9].

Global case totals

The global total of laboratory cases reported by the WHO as of 4 December 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_12_04/en/index.html

COUNTRY	HUMAN CASES as of 12 November 2007						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	4	26	17
Djibouti	0	0	0	1	0	1	0
Egypt	0	0	0	18	20	38	15
Indonesia	0	0	20	55	38	113	91
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	7	100	46
TOTALS	4	46	98	115	73	336	207 (62%)

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

An H5N1 avian influenza timeline of major events is also available on the WHO website at: http://www.who.int/csr/disease/avian_influenza/ai_timeline/en/

index.html

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 [10].

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 [11]. 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 [12].

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 Indonesia – update 17. 2 October 2007. [Accessed 3 December 2007]. Available at http://www.who.int/csr/don/2007_10_02/en/index.html

2. World Health Organization. Avian influenza – situation in Indonesia – update 18. 8 October 2007. [Accessed 3 December 2007]. Available at http://www.who.int/csr/don/2007_10_08/en/index.html

3. World Health Organization. Avian influenza – situation in Indonesia – update 24. 12 November 2007. [Accessed 3 December 2007]. Available at http://www.who.int/csr/don/2007_11_12/en/index.html

4. World Health Organization. Avian influenza – situation in Indonesia – update 19. 12 October 2007. [Accessed 3 December 2007]. Available at http://www.who.int/csr/don/2007_10_12/en/index.html

5. World Health Organization. Avian influenza – situation in Indonesia – update 20. 17 October 2007. [Accessed 3 December 2007]. Available at  http://www.who.int/csr/don/2007_10_17/en/index.html

6. World Health Organization. Avian influenza – situation in Indonesia – update 21. 25 October 2007. [Accessed 3 December 2007]. Available at  http://www.who.int/csr/don/2007_10_25/en/index.html

7. World Health Organization. Avian influenza – situation in Indonesia – update 22. 31 October 2007. [Accessed 3 December 2007]. Available at  http://www.who.int/csr/don/2007_10_31/en/index.html

8. World Health Organization. Avian influenza – situation in Indonesia – update 23. 5 November 2007. [Accessed 3 December 2007]. Available at   http://www.who.int/csr/don/2007_11_05a/en/index.html

9. World Health Organization. Avian influenza – situation in China – update 4. 4 December 2007. [Accessed 5 December 2007]. Available at   http://www.who.int/csr/don/2007_12_04/en/index.html

10. NaTHNaC Health Information Sheets. Avian influenza – advice for travellers. 4 July 2006. [accessed 4 December 2007]. Available at http://www.nathnac.org/pro/factsheets/

avianinfluenza_advice_040707.htm

11. 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. 3 December 2007 [accessed 4 December 2007] Available at http://www.hpa.org.uk/web/HPAweb&HPAweb

Standard/HPAweb_C/1195733851442

12. 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 December 2007] Available at http://www.hpa.org.uk/web/HPAweb&HPAweb

Standard/HPAweb_C/1195733851442