Clinical Updates
17 January 2007
Avian influenza H5N1 - human cases in China, Egypt and Indonesia
China
On 10 January 2007, the Ministry of Health in China confirmed a case of H5N1 avian influenza in a 37 year old man from Tunxi in Anhui Province [1].
The man became unwell on 10 December 2006 and was hospitalised on 17 December. He was discharged on 6 January and is recovering. The man is a farmer and is thought to have kept a number of birds in his back yard. An investigation of possible exposure to sick birds as the source of his infection is under way.
Egypt
On 27 December 2006, the Egyptian Ministry of Health and Population confirmed three human cases of H5N1 avian influenza [2]. All three cases belong to one extended family from Gharbiyah province and have subsequently died. It is thought that the family members had contact with sick ducks before the onset of their symptoms.
Indonesia
Since 9 January 2007, the Ministry of Health in Indonesia has confirmed four cases of human infection with avian influenza H5N1 [3-6].
A 14 year old boy from West Jakarta who developed symptoms on 31 December 2006 and died in hospital on 10 January 2007.
A 37 year old woman from Banten province who developed symptoms on 1 January 2007, and died in hospital on 11 January. The woman’s 18 year old son has also been diagnosed with avian influenza H5N1 infection and is currently in a critical condition in hospital.
A 22 year old woman from Banten province who developed symptoms on 3 January 2007 and died in hospital on 12 January.
All four cases are thought to have had exposure to sick poultry shortly before the onset of symptoms.
Global Case Totals
The global total of laboratory cases reported by the World Health Organization (WHO) as of 15 January 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_table_2007_01_15/en/index.html
COUNTRY |
HUMAN CASES as of 15 January 2007 |
DEATHS |
|||||
2003 |
2004 |
2005 |
2006 |
2007 |
TOTAL |
||
Azerbaijan |
0 |
0 |
0 |
8 |
0 |
8 |
5 |
Cambodia |
0 |
0 |
4 |
2 |
0 |
6 |
6 |
China |
1 |
0 |
8 |
13 |
0 |
22 |
14 |
Djibouti |
0 |
0 |
0 |
1 |
0 |
1 |
0 |
Egypt |
0 |
0 |
0 |
18 |
0 |
18 |
10 |
Indonesia |
0 |
0 |
19 |
56 |
4 |
79 |
61 |
Iraq |
0 |
0 |
0 |
3 |
0 |
3 |
2 |
Thailand |
0 |
17 |
5 |
3 |
0 |
25 |
17 |
Turkey |
0 |
0 |
0 |
12 |
0 |
12 |
4 |
Viet Nam |
3 |
29 |
61 |
0 |
0 |
93 |
42 |
TOTALS |
4 |
46 |
97 |
116 |
4 |
267 |
161 |
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
Advice for travellers
Examination of 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, de-feathering, 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 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 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 (H5N1) within seven days of the development of their symptoms. Physicians who see persons whom they suspect may have avian influenza should evaluate them according to this algorithm. The HPA has published a second algorithm to reflect the situation of a traveller from an area (including within the UK) where there is no known avian influenza [9].
References
1. World Health Organization. Avian influenza - situation in China. 10 January 2007. [cited 17 January 2007] Available at http://www.who.int/csr/don/2007_01_10/en/index.html
2. World Health Organization. Avian influenza in Egypt. 27 December 2006. [cited 17 January 2007] Available at http://www.who.int/csr/don/2006_12_27a/en/index.html
3. World Health Organization. Avian influenza - situation in Indonesia. 9 January 2007. [cited 17 January 2007] Available at http://www.who.int/csr/don/2007_01_09/en/index.html
4. World Health Organization. Avian influenza - situation in Indonesia - update. 11 January 2007. [cited 17 January 2007] Available at http://www.who.int/csr/don/2007_01_11a/en/index.html
5. World Health Organization. Avian influenza - situation in Indonesia - update 2. 12 January 2007. [cited 17 January 2007] Available at http://www.who.int/csr/don/2007_01_12/en/index.html
6. World Health Organization. Avian influenza - situation in Indonesia - update 3. 15 January 2007. [cited 17 January 2007] Available at http://www.who.int/csr/don/2007_01_15/en/index.html
7. NaTHNaC. Avian influenza - advice for travellers to affected areas. 4 July 2006. [cited 17 January 2007] Available at http://www.NaTHNaC.org/pro/factsheets/avianinfluenza
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. 15 January 2007 [cited 17 January 2007] Available at http://www.hpa.org.uk/infections/topics_az/influenza/avian/
9. Health Protection Agency. Algorithm for the management of persons resident in the UK arriving from areas not known to have avian influenza H5N1 presenting with febrile respiratory illness after close contact with sick, dying or dead birds: recognition, investigation and initial management. 6 September 2006 [cited 17 January 2007]. Available online at: http://www.hpa.org.uk/infections/topics_az/influenza/avian/
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