8 September 2006

 

Avian influenza - human cases in Indonesia and China

 

Indonesia

The Ministry of Health in Indonesia has confirmed four cases of human avian influenza. [1-4].

Three of the newly reported cases occurred in Garut district in West Java:

• A 17 year old man who developed symptoms on 26 July 2006 and is currently recovering.  
• A nine year old girl who developed symptoms on 1 August and died in hospital on 15 August.
• A 35 year old woman who developed symptoms on 8 August and died in hospital shortly after her admission on 17 August.

In addition, the 20 year old cousin of the first case died from severe pneumonia on 5 August. As no samples were taken, the cause of his illness remains uncertain. However, avian influenza is strongly suspected based on epidemiological and clinical findings.

These cases have been investigated by experts and the overall situation in the district has been assessed. There are known to have been recent deaths of chickens and ducks in the area, and all three confirmed cases had documented exposure to diseased chickens. To date, there is no evidence to suggest human-to-human transmission has occurred.

The fourth newly reported case occurred in a six year old girl from Bekasi in West Java province. She developed symptoms on 6 August and is recovering. The source of her infection is under investigation.

China

The Ministry of Health in China has confirmed a case of human avian influenza [5]. The case occurred in a 62 year old man from Xinjiang Uygur Autonomous Region in the north-west of China. He developed symptoms on 19 June and died on 12 July. Initial tests on specimens were negative for H5N1, but as a precaution tests were repeated and eventually produced positive results which have been confirmed by the Ministry of Health.

No recent poultry deaths have been reported in the area and the source of the man’s infection is unknown.

Global Cases Totals

The global total of laboratory cases reported by the World Health Organization (WHO) as of 23 August 2006 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_2006_08_23/en/index.html

COUNTRY	HUMAN CASES as of 23 August 2006					DEATHS
	2003	2004	2005	2006	TOTAL
Azerbaijan	0	0	0	8	8	5
Cambodia	0	0	4	2	6	6
China	1	1	8	12	21	14
Djibouti	0	0	0	1	1	0
Egypt	0	0	0	14	14	6
Indonesia	0	0	17	43	60	46
Iraq	0	0	0	2	2	2
Thailand	0	17	5	2	24	16
Turkey	0	0	0	12	12	4
Viet Nam	3	29	61	0	93	42
TOTALS	4	46	95	96	241	141

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 [6].

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 [7]. 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 [8].

References

1. World Health Organization. Avian influenza - situation in Indonesia - update 26. 14 August 2006. [cited 6 September 2006] Available at http://www.who.int/csr/don/2006_08_14a/en/index.html

2. World Health Organization. Avian influenza - situation in Indonesia - update 27. 17 August 2006. [cited 6 September 2006] Available at http://www.who.int/csr/don/2006_08_17/en/index.html

3. World Health Organization. Avian influenza - situation in Indonesia - update 28. 21 August 2006. [cited 6 September 2006] Available at http://www.who.int/csr/don/2006_08_21/en/index.html

4. World Health Organization. Avian influenza - situation in Indonesia - update 29. 23 August 2006. [cited 6 September 2006] Available at http://www.who.int/csr/don/2006_08_23/en/index.html

5. World Health Organization. Avian influenza - situation in China - update 14. 14 August 2006. [cited 6 September 2006] Available at http://www.who.int/csr/don/2006_08_14/en/index.html

6. NaTHNaC. Avian influenza - advice for travellers to affected areas. 4 July 2006. [cited 6 September 2006] Available online at http://www.NaTHNaC.org/pro/clinical_updates/

avianinfluenza_advice.htm

7. 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. 6 September 2006 [cited 6 September 2006] Available online at: http://www.hpa.org.uk/infections/topics_az/influenza/avian/

algorithm.htm

8. 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 6 September 2006]. Available online at: http://www.hpa.org.uk/infections/topics_az/influenza/avian/

documents/F3notraveltoH5N1060906.pdf