25 February 2008

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

China

The Ministry of Health has reported two human cases of H5N1 avian influenza [1,2].

• A 22 year old male from Hunan province who developed symptoms on 16 January 2008 and died in hospital on 24 January. Investigations into the source of his infection are ongoing.
• A 41 year old male from Guangxi Autonomous Region who developed symptoms on 12 February and died on 20 February. He had contact with sick and dead poultry before the onset of symptoms.

Indonesia

The Ministry of Health has reported 13 human cases of H5N1 avian influenza since January 2008.

• A 16 year old female from West Java province who developed symptoms on 30 December 2007 and died in hospital on 15 January 2008 [3,4]. Chickens died in the girl’s neighbourhood before she became unwell.
• A 32 year old female from Banten province who developed symptoms on 3 January 2008 and died in hospital on 10 January [5]. The woman had contact with poultry before the onset of her symptoms.
• An eight year old male from Banten province who developed symptoms on 7 January 2008 and died in hospital on 18 January [6]. Initial reports indicate that he lived in close proximity to a chicken slaughter house.
• A 30 year old male from Banten province who developed symptoms on 13 January 2008 and died in hospital on 24 January [7,8]. Investigations into the source of his infection are ongoing.
• A 31 year old female from Jakarta province who developed symptoms on 18 January 2008 and died in hospital on 31 January [9,10]. She visited a wet market where live poultry were sold shortly before the onset of her symptoms.
• A nine year old male from West Java province who developed symptoms on 16 January 2008 and died in hospital on 27 January 2008 [9]. He lived next door to a wet market where poultry are sold.
• A 32 year old male from Banten province who developed symptoms on 17 January 2008 and died in hospital on 29 January [9, 11]. Investigations into the source of his infection are ongoing.
• A 23 year old female from Jakarta province who developed symptoms on 19 January 2008 and died on 27 January [9]. Investigations into the source of her infection are ongoing.
• A 29 year old female from Banten province who developed symptoms on 22 January 2008 and died in hospital on 2 February [12]. Investigations into the source of her infection are ongoing.
• A 38 year old female from Jakarta province who developed symptoms on 23 January 2008 and is currently in hospital [12]. Investigations into the source of her infection are ongoing. The woman’s 15 year old daughter has also been confirmed as suffering from H5N1 avian influenza and is currently in a critical condition in hospital [13]. As well as being in close contact with her mother, she also spent time in close proximity to chickens before the onset of her symptoms. Samples from these birds are being analysed.
• A 16 year old male from Central Java province who developed symptoms on 3 February 2008 and died in hospital on 10 February [14]. Prior to his illness the boy was exposed to sick and dead poultry.
• A three year old boy from Jakarta province who developed symptoms on 3 February 2008 and died in hospital on 15 February [14]. Investigations have discovered that chickens and a pet bird died in the neighbourhood before the onset of his symptoms.

Viet Nam

The Ministry of Health has reported three human cases of H5N1 avian influenza.

• A 34 year old male from Tuyen Quang province who developed symptoms on 10 January 2008 and died in hospital on 18 January [15].
• A 40 year old male from Hai Duong province who developed symptoms on 2 February 2008 and died in hospital on 13 February [16].
• A 27 year old male from Ninh Binh province who developed symptoms on 3 February 2008 and died in hospital on 14 February [17].

All three cases are known to have had contact with sick and dead poultry prior to the onset of their symptoms.

Global case totals

The global total of confirmed human cases of avian influenza A/H5N1 reported by the WHO as of 22 February 2008 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_2008_02_22/en/index.html

 

COUNTRY		HUMAN CASES as of 22 February 2008						DEATHS
	2003	2004	2005	2006	2007	2008	TOTAL
Azerbaijan	0	0	0	8	0	0	8	5
Cambodia	0	0	4	2	1	0	7	7
China	1	0	8	13	5	2	29	19
Djibouti	0	0	0	1	0	0	1	0
Egypt	0	0	0	18	25	0	43	19
Indonesia	0	0	20	55	42	12	129	105
Iraq	0	0	0	3	0	0	3	2
Lao PDR	0	0	0	0	2	0	2	2
Myanmar	0	0	0	0	1	0	1	0
Nigeria	0	0	0	0	1	0	1	1
Pakistan	0	0	0	0	1	0	1	1
Thailand	0	17	5	3	0	0	25	17
Turkey	0	0	0	12	0	0	12	4
Viet Nam	3	29	61	0	8	3	104	50
TOTALS	4	46	98	115	86	17	366	232 (63%)

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 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 [18].

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 . 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 .

The algorithms can be found on the HPA avian influenza guidelines webpage at http://www.hpa.org.uk/web/HPAweb&HPAweb

Standard/HPAweb_C/1195733851442

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 China. 20 February 2008. [Accessed 25 February 2008]. Available at http://www.who.int/csr/don/2008_02_20/en/index.html

2. World Health Organization. Avian influenza – situation in China – update. 22 February 2008. [Accessed 25 February 2008]. Available at http://www.who.int/csr/don/2008_02_22/en/index.html

3. World Health Organization. Avian influenza – situation in Indonesia – update 29. 11 January 2008. [Accessed 25 February 2008]. Available at http://www.who.int/csr/don/2008_01_11/en/index.html

4. World Health Organization. Avian influenza – situation in Indonesia – update 31. 18 January 2008. [Accessed 25 February 2008]. Available at http://www.who.int/csr/don/2008_01_18/en/index.html

5. World Health Organization. Avian influenza – situation in Indonesia – update 30. 15 January 2008. [Accessed 25 February 2008]. Available at http://www.who.int/csr/don/2008_01_15/en/index.html

6. World Health Organization. Avian influenza – situation in Indonesia – update 32. 21 January 2008. [Accessed 25 February 2008]. Available at http://www.who.int/csr/don/2008_01_21/en/index.html

7. World Health Organization. Avian influenza – situation in Indonesia – update 33. 23 January 2008. [Accessed 25 February 2008]. Available at http://www.who.int/csr/don/2008_01_23/en/index.html

8. World Health Organization. Avian influenza – situation in Indonesia – update 34. 24 January 2008. [Accessed 25 February 2008]. Available at http://www.who.int/csr/don/2008_01_24a/en/index.html

9. World Health Organization. Avian influenza – situation in Indonesia – update 35. 29 January 2008. [Accessed 25 February 2008]. Available at http://www.who.int/csr/don/2008_01_29/en/index.html

10. World Health Organization. Avian influenza – situation in Indonesia – update 37. 1 February 2008. [Accessed 25 February 2008]. Available at http://www.who.int/csr/don/2008_02_01/en/index.html

11. World Health Organization. Avian influenza – situation in Indonesia – update 36. 30 January 2008. [Accessed 25 February 2008]. Available at http://www.who.int/csr/don/2008_01_30/en/index.html

12. World Health Organization. Avian influenza – situation in Indonesia – update 38. 5 February 2008. [Accessed 25 February 2008]. Available at http://www.who.int/csr/don/2008_02_05/en/index.html

13. World Health Organization. Avian influenza – situation in Indonesia – update 39. 12 February 2008. [Accessed 25 February 2008]. Available at http://www.who.int/csr/don/2008_02_12/en/index.html

14. World Health Organization. Avian influenza – situation in Indonesia – update 40. 21 February 2008. [Accessed 25 February 2008]. Available at http://www.who.int/csr/don/2008_02_21a/en/index.html

15. World Health Organization. Avian influenza – situation in Viet Nam – update. 24 January 2008. [Accessed 25 February 2008]. Available at http://www.who.int/csr/don/2008_01_24/en/index.html

16. World Health Organization. Avian influenza – situation in Viet Nam – update 2. 15 February 2008. [Accessed 25 February 2008]. Available at http://www.who.int/csr/don/2008_02_15/en/index.html

17. World Health Organization. Avian influenza – situation in Viet Nam – update 3. 21 February 2008. [Accessed 25 February 2008]. Available at http://www.who.int/csr/don/2008_02_21/en/index.html

18. NaTHNaC. Avian influenza – advice for travellers. 4 July 2006. [Accessed 4 January 2008]. Available at http://www.nathnac.org/pro/factsheets/avianinfluenza_

advice_040707.htm