Clinical Updates
6 June 2007
Avian influenza (H5N1) – human cases in Indonesia and China
Indonesia
The Ministry of Health of Indonesia has reported two human cases of H5N1 avian influenza [1,2].
The first is a five year old girl from Central Java province who developed symptoms on 8 May 2007 and died in hospital on 17 May. The second is a 45 year old man, also from Central Java province who developed symptoms on 17 May and died in hospital on 28 May. Initial investigations into the source of infection for both cases indicate exposure to sick poultry.
China
The Ministry of Health of China has reported a human case of H5N1 avian influenza in a 19 year old male soldier serving in Fujian province [3]. He developed symptoms on 9 May 2007 and died in hospital on 3 June [4]. There is no indication at present that he had contact with poultry prior to the onset of symptoms. Close contacts have been put under observation and remain well.
Global Case Totals
The global total of laboratory cases reported by the WHO as of 4 June 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_06_04/en/index.html
COUNTRY |
HUMAN CASES as of 4 June 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 |
3 |
25 |
16 |
Djibouti |
0 |
0 |
0 |
1 |
0 |
1 |
0 |
Egypt |
0 |
0 |
0 |
18 |
16 |
34 |
14 |
Indonesia |
0 |
0 |
20 |
55 |
23 |
98 |
78 |
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 |
98 |
115 |
46 |
309 |
188 (67%) |
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/
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 H5N1 avian influenza [7].
References
1. World Health Organization. Avian influenza – situation in Indonesia – update 7. 24 May 2007 [accessed 6 June 2007]. Available at http://www.who.int/csr/don/2007_05_24/en/index.html
2. World Health Organization. Avian influenza – situation in Indonesia – update 8. 31 May 2007 [accessed 6 June 2007] available at http://www.who.int/csr/don/2007_05_31/en/index.html
3. World Health Organization. Avian influenza – situation in China – update 2. 30 May 2007 [accessed 6 June 2007]. Available at http://www.who.int/csr/don/2007_05_30/en/index.html
4. World Health Organization. Avian influenza – situation in China – update 3. 4 June 2007 [accessed 6 June 2007]. Available at http://www.who.int/csr/don/2007_06_04a/en/index.html
5. NaTHNaC Health Information Sheets. Avian influenza – advice for travellers. 4 July 2006. [accessed 6 June 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. 16 May 2007 [accessed 6 June 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 6 June 2007]. Available online at: http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPA
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