13 January 2006

Avian Influenza in Turkey: Update

On 12 January 2006, the WHO revised the human avian influenza case total for Turkey, and released information about the isolates of influenza A/H5N1 virus from two fatal cases [1].

Case totals

There have now been a total of 18 cases of human avian influenza confirmed in Turkey (see table). Two cases in four and six-year old children were confirmed on 12 January; the cases are from Sanliurfa and Siirt provinces. The third additional case was previously reported as suspected [2]. This case was the 12-year old sibling of the first two fatalities, who died of the disease on 7 January 2006.

Viral Gene Sequencing

The viral sequencing for the isolates from the first two fatal cases has been reported by the WHO Collaborating Centre for Reference and Research on Influenza at the MRC National Institute for Medical Research in Mill Hill, London. This analysis indicates that the viruses are very similar to those isolated from migratory birds in China beginning in April 2005. One of the two isolates shows mutations at the receptor binding site. Similar mutations have been seen in isolates from the Hong Kong outbreak in 2003 and from Viet Nam in 2005, and are not unexpected. The Turkish isolates were sensitive to both oseltamivir (Tamiflu®) and to amantadine, an older anti-viral agent.

There is no indication that avian influenza in Turkey has spread by any other means than from bird to human. All cases at present are associated with exposure to sick or dead wild birds and poultry. The Turkish outbreak does afford the opportunity to investigate the clinical manifestations of human avian influenza more thoroughly and whether there are mild or asymptomatic cases, and the full mode of transmission of the virus.

Advice for travellers

There remain no restrictions for travel to Turkey or to other countries that have been infected with avian influenza. Nevertheless, travellers should exercise precautions that have been previously 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].

Cases of Avian Influenza in Turkey

 

Case	Province	Date of report (2006)	Avian influenza subtype	Outcome (to date)
14 y.o. male*	Agri	5 January	H5N1	Deceased
15 y.o. female*	Agri	5 January	H5N1	Deceased
5 y.o.	Agri	7 January	H5N1	Alive
8 y.o.	Agri	7 January	H5N1	Alive
2 y.o. male**	Ankara	8 January	H5	Alive
5 y.o. male**	Ankara	8 January	H5	Alive
65 y.o. male	Ankara	8 January	H5	Alive
9 y.o. female***	Agri	8 January	H5	Alive
3 y.o. male***	Agri	8 January	H5	Alive
5 cases; age and sex not specified	Kastamonu, Corum, Samsun & Van	9 January	H5	Alive
37 y.o. female	Sivas	10 January	H5	Alive
4 y.o. & 6 y.o.	Sanliurfa & Siirt	12 January	H5	Alive
12 y.o. female*	Agri	Suspected 7 January, confirmed 12 January	H5	Deceased

* Siblings

** Siblings

*** Siblings

References

1. World Health Organization. Avian influenza - situation in Turkey - update 4. Sequencing of human virus. 12 January 2006. [cited 13 January 2006] Available at: http://www.who.int/csr/don/2006_01_12/en/index.html

2. World Health Organization. Avian influenza - situation in Turkey. 7 January 2006. [cited 13 January 2006] Available at http://www.who.int/csr/don/2006_01_07/en/index.html

3. NaTHNaC. Avian influenza - Advice for travellers to affected areas. 4 November 2005. [cited 13 January 2006] Available at http://www.NaTHNaC.org/pro/clinical_updates/

avianinfluenza_advice_041105.htm

4. 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. 12 January 2006. [cited 13 January 2006] Available at http://www.hpa.org.uk/infections/topics_az/influenza/avian/algorit

hm.htm