2 March 2007

Avian influenza (H5N1) - human cases in China, Egypt and Lao People’s Democratic Republic

China

On 1 March 2007, the Ministry of Health in China reported a human case of H5N1 avian influenza in a 44 year old woman from Fujian province [1]. The woman developed symptoms on 18 February 2007, and was admitted to hospital on 22 February where she remains in a critical condition. The woman is a farmer who kept poultry in her backyard and was possibly exposed to sick birds before the onset of her symptoms.

Egypt

Since 15 February 2007, the Egyptian Ministry of Health and Population has reported three human cases of H5N1 avian influenza [2-4].

The three cases are:

• A 37 year old woman from Al Fayyum governorate who became unwell on 12 February 2007, and died in hospital on 15 February [5].
• A five year old boy from Sharkia governorate who became unwell on 14 February 2007 and is currently in a stable condition in hospital.
• A four year old girl from Dakahlieh governorate who became unwell on 25 February 2007 and is in a stable condition in hospital.

All three cases are known to have had contact with sick birds shortly before the onset of their symptoms.

Lao People’s Democratic Republic

On 19 February 2007, the Ministry of Health in Lao People’s Democratic Republic (PDR) announced the first human case of avian influenza H5N1 in a 15 year old girl from Vientiane [6].

The girl developed influenza-like symptoms on 10 February 2007 and initially received hospital care in Vientiane. She then sought medical care in neighbouring Thailand on 17 February and is currently in a stable condition in Nong Khai hospital in northern Thailand. Poultry deaths are known to have occurred in the girl’s neighbourhood and her close contacts have been identified and are being monitored.

Global Case Totals

The global total of laboratory cases reported by the WHO as of 1 March 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_03_01/en/index.html

COUNTRY	HUMAN CASES as of 1 March 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	1	23	14
Djibouti	0	0	0	1	0	1	0
Egypt	0	0	0	18	4	23	13
Indonesia	0	0	19	56	6	81	63
Iraq	0	0	0	3	0	3	2
Lao PDR	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	0	93	42
TOTALS	4	46	97	116	14	277	167

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. 1 March 2007. [cited 2 march 2007]. Available at http://www.who.int/csr/don/2007_03_01a/en/index.html

2. World Health Organization. Avian influenza - situation in Egypt - update 4. 15 February 2007. [cited 2 March 2007]. Available at http://www.who.int/csr/don/2007_02_15/en/index.html

3. World Health Organization. Avian influenza - situation in Egypt - update 6. 19 February 2007 [cited 2 March 2007]. Available at http://www.who.int/csr/don/2007_02_19/en/index.html

4. World Health Organization. Avian influenza - situation in Egypt - update 7. 1 March 2007 [cited 2 March 2007]. Available at http://www.who.int/csr/don/2007_03_01/en/index.html

5. World Health Organization. Avian influenza - situation in Egypt - update 5. 16 February 2007. [cited 2 March 2007]. Available at http://www.who.int/csr/don/2007_02_16/en/index.html

6. World Health Organization. Avian influenza - situation in Lao People’s Democratic Republic. 27 February 2007. [cited 2 March 2007]. Available at http://www.who.int/csr/don/2007_02_27/en/index.html

7. NaTHNaC. Avian influenza - advice for travellers to affected areas. 4 July 2006. [cited 15 February 2007] Available at http://www.NaTHNaC.org/pro/factsheets/

avianinfluenza_advice_040707.htm

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. 1 March 2007 [cited 2 March 2007] Available at http://www.hpa.org.uk/infections/topics_az/influenza/avian/

algorithm.htm

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. 1 March 2007 (reviewed 6 February 2007) [cited 2 March 2007]. Available online at: http://www.hpa.org.uk/infections/topics_az/influenza/avian/

documents/F3notraveltoH5N1060906.pdf