Clinical Updates
19 December 2007
Avian influenza (H5N1) – human cases in China, Indonesia, Myanmar, and Pakistan
China
The Ministry of Health has confirmed a human case of H5N1 avian influenza in a 52 year old man from Jiangsu province [1]. He developed symptoms on 3 December 2007 and is currently receiving hospital treatment.
The man is the father of the 24 year old man with H5N1 avian influenza who was previously reported, and who died on 2 December 2007.
Indonesia
The Ministry of Health has confirmed two human cases of H5N1 avian influenza.
A 28 year old female from Banten province developed symptoms on 1 December 2007, and died in hospital on 12 December [2]. The source of her infection is under investigation. She worked as a roadside seller and chickens are known to have been in the vicinity of her work place.
A 47 year old man from Banten province who developed symptoms on 2 December 2007 and died in hospital on 13 December [3,4]. The source of his exposure is under investigation.
Myanmar
The Ministry of Health has confirmed the country’s first case of human H5N1 avian influenza in a seven year old girl from Shan State (East) [5]. The girl developed symptoms on 21 November 2007 and was hospitalised on 27 November. She has since made a full recovery.
The case was detected during routine surveillance following an outbreak of H5N1 amongst poultry in the area in mid November. The source of the girl’s infection is under investigation. Initial findings indicate poultry die-off in the vicinity of her home shortly before the onset of symptoms.
Pakistan
The Ministry of Health has informed the World Health Organization (WHO) of eight suspected human cases of H5N1 avian influenza in the Peshawar area of the country [6]. The cases were detected following culling operations in response to outbreaks of avian influenza amongst poultry. Samples from the suspected cases have tested positive for H5N1 in a national laboratory. Further testing and confirmation is being carried out at a WHO reference laboratory. One of the suspected cases has made a full recovery; two others have died. These are the first reported cases of human avian influenza in Pakistan.
The Ministry of Health has put into place epidemiological investigations and control measures, assisted by WHO.
Global Case Totals
The global total of confirmed human cases of avian influenza A/H5N1 reported by the WHO as of 18 December 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_ta
The cases in Pakistan [6] will be added to this table if they are confirmed by the WHO reference laboratory.
COUNTRY |
HUMAN CASES as of 18 December 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 |
5 |
27 |
17 |
Djibouti |
0 |
0 |
0 |
1 |
0 |
1 |
0 |
Egypt |
0 |
0 |
0 |
18 |
20 |
38 |
15 |
Indonesia |
0 |
0 |
20 |
55 |
40 |
115 |
93 |
Iraq |
0 |
0 |
0 |
3 |
0 |
3 |
2 |
Lao PDR |
0 |
0 |
0 |
0 |
2 |
2 |
2 |
Myanmar |
0 |
0 |
0 |
0 |
1 |
1 |
0 |
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 |
7 |
100 |
46 |
TOTALS |
4 |
46 |
98 |
115 |
77 |
340 |
209 (61%) |
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 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 [7].
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 [8]. 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 [9].
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 – update 5. 9 December 2007. [Accessed 19 December 2007]. Available at http://www.who.int/csr/don/2007_12_09/en/index.html
2. World Health Organization. Avian influenza – situation in Indonesia – update 25. 12 December 2007. [Accessed 19 December 2007]. Available at http://www.who.int/csr/don/2007_12_12/en/index.html
3. World Health Organization. Avian influenza – situation in Indonesia – update 26. 13 December 2007. [Accessed 19 December 2007]. Available at http://www.who.int/csr/don/2007_12_13/en/index.html
4. World Health Organization. Avian influenza – situation in Indonesia – update 27. 18 December 2007. [Accessed 19 December 2007]. Available at http://www.who.int/csr/don/2007_12_18/en/index.html
5. World Health Organization. Avian influenza – situation in Myanmar. 14 December 2007. [Accessed 19 December 2007]. Available at http://www.who.int/csr/don/2007_12_14/en/index.html
6. World Health Organization. Avian influenza – situation in Pakistan. 15 December 2007. [Accessed 19 December 2007]. Available at http://www.who.int/csr/don/2007_12_15/en/index.html
7. NaTHNaC Health Information Sheets. Avian influenza – advice for travellers. 4 July 2006. [Accessed 19 December 2007]. Available at http://www.nathnac.org/pro/factsheets/avianinfluenza_advice_04
8. 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. 3 December 2007 [accessed 19 December 2007] Available at http://www.hpa.org.uk/web/HPAweb&HPAweb
Standard/HPAweb_C/1195733851442
9. 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. 7 September 2007 [accessed 19 December 2007] Available at http://www.hpa.org.uk/web/HPAweb&HPAweb
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