30 March 2006

 

Avian influenza - human cases in Cambodia, China and Egypt

 

Cambodia

The Ministry of Health in Cambodia has confirmed a human case of avian influenza H5N1 [1].

The case occurred in a three year old girl from Kampong Speu province in southern Cambodia. The child developed a fever on 14 March, was hospitalised following a rapid deterioration in her condition on 20 March, and died the following day. Samples were sent to the Pasteur Institute in Cambodia where they tested positive for H5N1.

Officials from the Ministry of Health and the World Health Organization (WHO) are investigating the situation. Domestic poultry began dying in the girl’s village in February and she is known to have played with chickens.

Seven residents of the village have been placed under observation. All have fever but no respiratory symptoms and are known to have had contact with poultry or been involved in caring for the child.

This newly confirmed case brings the total in Cambodia to five, and is the first to occur in almost a year. The four previous cases occurred between January 2005 and April 2005.

China

The Ministry of Health in China has confirmed a case of human infection with avian influenza H5N1 [2].

The case was in a 29 year old female migrant worker in Shanghai. She developed symptoms of pneumonia on 15 March and died in hospital on 21 March.

This is the first case to be reported from Shanghai. No poultry cases have been reported in the area since February 2004, and the source of the woman’s infection is being investigated. According to Chinese authorities, close contacts of the woman have been placed under medical observation.

Egypt

The Ministry of Health in Egypt has confirmed a second case of human infection with avian influenza H5N1 [3].

A 30 year old woman from Qaliubiya governorate near Cairo developed symptoms on 12 March, was hospitalised on 16 March and died on 27 March.

The first human case in Egypt occurred in a 30 year old woman also from Qaliubiya, who died on 17 March [4].

The Cairo-based US Naval Medical Research Unit 3 (NAMRU-3) has confirmed an additional three cases; a 32 year old man who has made a full recovery, a 17 year old boy from Gharbiya governorate who has recovered, and an 18 year old girl from Kafr El-Sheik governorate who was hospitalised on 25 March.

Samples from the five cases have been sent to a WHO collaborating laboratory in the United Kingdom for diagnostic verification.

Outbreaks of H5N1 in poultry have been reported from 19 of Egypt’s 26 governorates. Since the first outbreak was confirmed on 17 February, more than 25 million birds have died or been destroyed.

 

Global Case Totals

The global total of laboratory-confirmed cases reported by the WHO as of 24 March 2006, 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_2006_03_24/en/index.html

COUNTRY	HUMAN CASES as of 24 March 2006					DEATHS
	2003	2004	2005	2006	TOTAL
Azerbaijan	0	0	0	7	7	5
Cambodia	0	0	4	1	5	5
China	0	0	8	8	16	11
Indonesia	0	0	17	12	29	22
Iraq	0	0	0	2	2	2
Thailand	0	17	5	0	22	14
Turkey	0	0	0	12	12	4
Viet Nam	3	29	61	0	93	42
TOTALS	3	46	95	42	186	105

 

WHO will adjust the figures in its cumulative number of cases to include Egypt following results of external verification.

 

Advice for travellers

Examination of previous 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, defeathering, and preparation of poultry for consumption. No cases have been linked to consumption of properly cooked meat or eggs.

There remain no restrictions for travel to countries that have been infected with avian influenza. Nevertheless, travellers should exercise precautions that have been previously posted [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.

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 within seven days of their arrival in the UK. Physicians who see persons whom they suspect may have avian influenza, should evaluate them according to this algorithm.

References

1. World Health Organization. Avian influenza - situation in Cambodia. 24 March 2006. [Cited 30 March 2006]. Available at: http://www.who.int/csr/don/2006_03_24/en/index.html

2. World Health Organization. Avian influenza - situation in China - update 8. 24 March 2006. [Cited 30 March 2006]. Available at: http://www.who.int/csr/don/2006_03_24c/en/index.html

3. World Health Organization. Avian influenza - situation in Egypt - update. 29 March 2006. [Cited 30 March 2006]. Available at: http://www.who.int/csr/don/2006_03_29/en/index.html

4. World Health Organization.  Avian influenza - situation in Egypt. 20 March 2006. [Cited 30 March 2006]. Available at: http://www.who.int/csr/don/2006_03_20/en/index.html

5. NaTHNaC. Avian influenza - advice for travellers to affected areas. 4 November 2005. [cited 30 March 2006] Available at:  http://www.NaTHNaC.org/pro/clinical_updates/avianinfluenza_advi ce_041105.htm

6. Health Protection Agency. Algorithm for the management of returning travellers from countries affected by avian influenza presenting with a febrile illness: recognition, investigation and initial management. 24 March 2006. [cited 30 March 2006] Available at: http://www.hpa.org.uk/web/HPAweb&HPA

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