18 May 2007

Avian influenza (H5N1) – human cases in Indonesia

The World Health Organization (WHO) has confirmed 15 human cases of H5N1 avian influenza in Indonesia since 25 January 2007[1].

The cases were confirmed by the national laboratory in Jakarta. WHO had previously required external confirmation of laboratory results from Indonesia. However, following a formal assessment of the national laboratory in Jakarta, WHO will now accept the results without further external confirmation. As such, WHO has updated its table of confirmed human cases.

The newly confirmed cases are summarised below:

                           

Gender	Age	Location	Onset date	Outcome
M	30	West Java	25 Jan 07	Recovered
F	16	Central Jakarta	31 Jan 07	Recovered
F	20	West Java	2 Feb 07	Died
F	20	East Java	28 Feb 07	Died
M	16	West Java	4 Mar 07	Died
M	32	East Jakarta	9 Mar 07	Died
F	22	South Sumatra	10 Mar 07	Died
M	14	West Sumatra	15 Mar 07	Died
M	39	East Java	19 Mar 07	Died
F	29	Jakarta	20 Mar 07	Died
M	29	Central Java	24 Mar 07	Died
F	23	Jakarta	28 Mar 07	Died
F	15	Jakarta	28 Mar 07	Died
F	29	Riau	27 April 07	Died
F	26	North Sumatra	3 May 07	Died

Seven of the cases are known to have had contact with sick or dead poultry; the source of infection is unknown for the remaining eight.

Global Case Totals

The global total of laboratory cases reported by the WHO as of 16 May 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_05_16/en/index.html

COUNTRY	HUMAN CASES as of 16 May 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	2	24	15
Djibouti	0	0	0	1	0	1	0
Egypt	0	0	0	18	16	34	14
Indonesia	0	0	19	55	21	96	76
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	115	43	306	185

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 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 [2].

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 [3]. 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 [4].

References

1. World Health Organization. Avian influenza – situation in Indonesia – update 6. 16 May 2007. [accessed 18 May 2007] Available at http://www.who.int/csr/don/2007_05_16/en/index.html

2. NaTHNaC Health Information Sheets. Avian influenza - advice for travellers to affected areas. 4 July 2007. [accessed 18 May 2007] Available at http://www.nathnac.org/pro/factsheets/avianinfluenza_

advice_040707.htm

3. 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 18 May 2007] Available at http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPA

web_C/1195733851442

4. 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 a febrile illness after close contact with sick, dying or dead birds: recognition, investigation and initial management. 6 September 2006 [accessed 18 May 2007] Available at http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPA

web_C/1195733851442