9 January 2006

Additional human cases of avian influenza A (H5N1) confirmed in Turkey

WHO reported on 7 January 2006 that the Ministry of Health in Turkey has confirmed an additional two cases of human infection with the H5N1 avian influenza virus [1]. The two cases are in children, aged five and eight years, and both are hospitalized. This brings the total number of laboratory confirmed cases of H5N1 infection in Turkey to four. Two of these cases, reported previously [2], have been fatal.

The Turkish Ministry of Health also announced a third death, presumably caused by the H5N1 virus, in a 12-year-old girl [2]. The girl, who died on 6 January, is a sibling of the two children who died. A fourth child in the family, a six-year-old boy, is also hospitalized. Tests on samples from these patients are ongoing; neither is laboratory confirmed at present.

According to Turkish authorities, there are several additional patients being treated and evaluated for possible H5N1 infection at a hospital in Van Province. Most of these are children, and the majority come from the rural district of Dogubayazit - the area associated with the family deaths.

Unconfirmed media reports have also claimed that there are five additional cases of human avian influenza detected in provinces near the Black Sea. Earlier, according to the same source, two children and an adult tested positive for avian influenza in the Turkish capital Ankara. They are reportedly from an area outside of the capital.

To date, all evidence indicates that patients have acquired their infections following close contact with diseased poultry. Contact between people and poultry has likely increased during the present cold weather, when the custom among many rural households is to bring poultry into their homes. Based on experiences during the avian H5N1 outbreaks in Asia, behaviours that carry an especially high risk of infection include the slaughtering, defeathering, butchering, and preparation for consumption of diseased poultry.

There are collaborative efforts to confirm the actual number of cases attributed to influenza A/H5N1, and the mode of influenza acquisition for confirmed cases. This information should be forthcoming as the week progresses. In addition, extensive efforts are being undertaken to control the outbreaks in poultry.

On 8 January the World Organisation for Animal Health (OIE) reported on outbreaks of avian flu in bird populations in Turkey (Table) [3]. This indicates spread of infection to eight provinces.

Country	Location	Date of report	Species infected
Turkey	Igdir Province, Aralik District	27 Dec 2005	Chickens & ducks
Turkey	Igdir Province, Merkez District	5 Jan 2006 *	Chickens
Turkey	Erzurum Province, Horasan District	5 Jan 2006 *	Chickens
Turkey	Erzurum Province, Senkaya & Merkez Districts	8 Jan 2006 *	Domestic poultry
Turkey	Sanliurfa Province, Hilvan District	5 Jan 2006	Domestic poultry
Turkey	Agri Province, Dogubeyazit District	6 Jan 2006 *	Chickens, turkeys & geese
Turkey	Agri Province, Eleskirt & Hamur Districts	8 Jan 2006 *	Domestic poultry
Turkey	Ankara Province, Nallihan District	8 Jan 2006 *	Wild ducks
Turkey	Bursa Province, Gürsu District	8 Jan 2006 *	Domestic poultry
Turkey	Bitlis Province, Adilcevaz District	8 Jan 2006 *	Wild birds
Turkey	Yozgat Province, Akdagmadeni District	8 Jan 2006 *	Domestic poultry

* This is avian influenza A/H5, the N subtype has not yet been determined.

Advice for Travellers

While there are no travel restrictions to Turkey or to other countries that have been infected with avian influenza, travellers should exercise precautions that have been posted [4]. Travellers who return ill with a respiratory illness should inform their physicians of their travel history. This includes travellers who return from all areas of Turkey and who have had close contact with poultry or wild birds.  Physicians should evaluate them according to the protocol established by the Health Protection Agency (HPA) [5].

References

1 World Health Organization. Avian influenza - situation in Turkey. 7 January 2006. [cited 9 January 2006] Available at http://www.who.int/csr/don/2006_01_07/en/index.html

2. NaTHNaC. Human avian influenza in Turkey. 6 January 2006. [cited 9 January 2006] Available at http://www.NaTHNaC.org/pro/clinical_updates/Turkey_060106.htm

3. World Organisation for Animal Health. Turkey. Follow-up Report 6. 8 January 2006. Cited 9 January 2006. Available at: http://www.oie.int/downld/AVIAN%20INFLUENZA/

Turkey%20Follow-up%20report%20No6.pdf

4. NaTHNaC. Avian influenza - Advice for travellers to affected areas. 4 November 2005. [cited 6 January 2006] Available at http://www.NaTHNaC.org/pro/clinical_updates

/avianinfluenza_advice_041105.htm

5. 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. 5 January 2006. [cited 6 January 2006] Available at http://www.hpa.org.uk/web/HPAweb&HPA

webStandard/HPAweb_C/1195733851442