16 August 2007

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

Indonesia

The Ministry of Health confirmed two human cases of H5N1 avian influenza since July 2007 [1,2].

The first was a six year old girl from Banten province who developed symptoms on 23 June 2007 and died in hospital on 8 July. The source of her infection is thought to be an outbreak amongst chickens near the school that she attended [1].

The second was a 29 year old woman from Jembrana district, Bali province, who developed symptoms on 3 August 2007 and died in hospital on 12 August [2]. The source of her infection is thought to be contact with sick and dead poultry shortly before the onset of her symptoms. The woman’s five year old daughter became unwell with a respiratory illness in the days preceding the onset of her symptoms, and died on 3 August. She was not tested for avian influenza. This is the first Indonesian case to be reported from Bali province. Jembrana district lies approximately 100 km from Bali’s main city Denapsar.   

Egypt

On 25 July 2007, the Ministry of Health and Population confirmed a human case of H5N1 avian influenza in a 25 year old woman from Damietta province [3]. The woman developed symptoms on 20 July 2007 and, as of the date of the report, was in a stable condition in hospital. The source of her infection is thought to be contact with sick and dead poultry shortly before the onset of her symptoms.

 

Global Case Totals

The global total of laboratory cases reported by the WHO as of 14 August 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_08_14/en/index.html

COUNTRY	HUMAN CASES as of 14 August 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	20	38	15
Indonesia	0	0	20	55	28	103	82
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	2	95	42
TOTALS	4	46	98	115	57	320	193 (60%)

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 [4].

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 [5]. 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 [6].

References

1. World Health Organization. Avian influenza – situation in Indonesia – update 12. 11 July 2007. [Accessed 16 August 2007]. Available at http://www.who.int/csr/don/2007_07_11/en/index.html

2. World Health Organization. Avian influenza – situation in Indonesia – update 12. 14 August 2007. [Accessed 16 August 2007]. Available at http://www.who.int/csr/don/2007_08_14a/en/index.html

3. World Health Organization. Avian influenza – situation in Egypt – update 19. 25 July 2007. [Accessed 16 August 2007]. Available at http://www.who.int/csr/don/2007_07_25/en/index.html

4. NaTHNaC Health Information Sheets. Avian influenza – advice for travellers. 4 July 2006. [accessed 16 August 2007]. Available at http://www.nathnac.org/pro/factsheets/

avianinfluenza_advice_040707.htm

5. 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. 26 July 2007 [accessed 16 August 2007] Available at http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPA

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6. 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. 6 September 2006 [accessed 16 August 2007] Available at http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPA

web_C/1195733851442