9 February 2006

 

Avian influenza - human cases in Indonesia and Iraq

 

 

Indonesia

On 6 February 2006, the ministry of Health in Indonesia confirmed four cases of human infection with avian influenza H5N1, two of which were fatal [1].

The first fatal case occurred in a 22 year old man from West Java who died on 26 January. He worked as a banana vendor at a market in East Java where poultry meat was sold. The second fatal case occurred in a 15 year old boy from West Java who died on 1 February. Deaths in poultry were reported near both of these patient’s homes.

The third case is a nine year old girl from West Java who was hospitalised on 19 January and has since recovered. She lives in a village neighbouring that where two fatal cases in siblings were confirmed on 23 January 2006 [2]. Poultry deaths were also reported in her village prior to the onset of her symptoms.

The fourth case is a five year old boy from Lampung Province who developed symptoms in October 2005, and has made a full recovery. He is the brother of a 20 year old man who was confirmed as having H5N1 infection in late September 2005 [3], and who also made a full recovery. Both brothers had direct contact with diseased chickens. The initial diagnostic tests on the five year old proved inconclusive; retrospective confirmation of the child’s infection relied on antibody testing.

These newly confirmed cases bring the total in Indonesia to 23, of which 16 have died.

Iraq

On 7 February 2006, the World Health Organization (WHO) reported that two patients under investigation in the Sulaimaniyah area of Northern Iraq for possible H5N1 infection have died [4]. Specimens from one of these cases, a 39 year old uncle of the previously confirmed case [5], have tested positive for H5N1 in a local laboratory. However, his infection is yet to be confirmed by a WHO reference laboratory. Other patients who are in hospitals in the area are being evaluated for avian influenza.

An additional possible case has occurred is a 13 year old boy from the Omara area in southern Iraq who developed symptoms on 1 February, was hospitalised with severe pneumonia on 5 February and died the same day. Samples from the boy have been taken.

A WHO-led team of experts has arrived in northern Iraq to assess the situation and establish a list of support needs in the area. Antiviral drugs have begun to arrive, and ways of strengthening the local diagnostic testing capacity are being explored. Poultry cases of avian influenza were reported in the area on 2 February, and intensive culling is now underway.

 

Global Case Totals

The global total of World Health Organization-confirmed cases is in the table below, and can be found on their website [6].  WHO will continue to adjust the number of cases and deaths in Iraq and Turkey as these cases are confirmed by a WHO reference laboratory.

 

COUNTRY	CASES as of 6 February 2006					DEATHS
	2003	2004	2005	2006	TOTAL
Cambodia	0	0	4	0	4	4
China	0	0	8	2	10	7
Indonesia	0	0	17	6	23	16
Thailand	0	17	5	0	22	14
Viet Nam	3	29	61	0	93	42
Turkey	0	0	0	12	12	4
Iraq	0	0	0	1	1	1
TOTALS	3	46	95	21	165	88

Advice for travellers

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 [7]. Anyone arriving in the UK with a respiratory illness, who has been travelling or living in affected countries and who has had close contact with poultry or wild birds should inform their physicians of their travel history. This now includes travellers who return from all areas of Turkey, northern Cyprus, north-east Iraq, and Kaduna state in Nigeria. Physicians should evaluate them according to the protocol established by the Health Protection Agency (HPA) [8].

 

References

1. World Health Organization. Avian influenza - situation in Indonesia - update 2. 6 February 2006. [cited 9 February 2006] Available at: http://www.who.int/csr/don/2006_02_06/en/index.html

2. World Health Organization. Avian influenza - situation in Indonesia - update. 23 January 2006. [cited 9 February 2006] Available at: http://www.who.int/csr/don/2006_01_23/en/index.html

3. World Health Organization. Avian influenza - situation in Indonesia - update 33. 10 October 2005. [cited 9 February 2006] Available at: http://www.who.int/csr/don/2005_10_10/en/index.html

4. World Health Organization.  Avian influenza - situation in Iraq - update 2. 7 February 2006. [cited 9 February 2006] Available at: http://www.who.int/csr/don/2006_02_07/en/index.html

5. World Health Organization. Avian influenza - situation in Iraq - update. 2 February 2006. [cited 9 February 2006] Available at: http://www.who.int/csr/don/2006_02_02/en/index.html

6. World Health Organization. Cumulative number of confirmed human cases of avian influenza A/(H5N1) reported to WHO. 6 February 2006. [cited 9 February 2006] Available at: http://www.who.int/csr/disease/avian_influenza/country/

cases_table_2006_02_06/en/index.html

7. NaTHNaC. Avian influenza - advice for travellers to affected areas. 4 November 2006. [cited 8 February 2006] Available at: http://www.NaTHNaC.org/travel/news/avianinfluenza_advice.htm

8. 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. 8 February 2006. [cited 9 February 2006] Available at: http://www.hpa.org.uk/web/HPAweb&HPA

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