3 March 2006

 

Avian influenza - human cases in China, Indonesia and Iraq

 

China

The Ministry of health in China has confirmed four cases of human infection with avian influenza H5N1 since 9 February 2006 [1,2,3].

The first of these cases occurred in a 26 year old female farmer from the south-eastern province of Fujian. She developed symptoms on 10 January and was subsequently hospitalised where she remains in a stable condition. In common with many human avian influenza infections in China, this one occurred in an area where no recent poultry outbreaks have been reported.

The second case occurred in a 20 year old female farmer from the south-central province of Hunan. She developed symptoms on 27 January, was hospitalised with severe pneumonia, and died on 4 February. Before the onset of her symptoms, she is known to have assisted with the culling of poultry raised by her household

The third case is a nine year old girl from the eastern province of Zhejiang. She developed symptoms on 11 February and remains in a critical condition. The onset of symptoms occurred following a visit to relatives in the neighbouring province of Anhui.

The fourth case is a 26 year old female farmer from Anhui province. She developed symptoms on 11 February following contact with diseased poultry, and remains in a critical condition.

These newly confirmed cases bring the total in China to 14, of which eight have been fatal.

Indonesia

The Ministry of Health in Indonesia has confirmed four cases of human infection with avian influenza H5N1 since 13 February 2006 [4,5,6].

The first two cases occurred in women from different sub-districts of West Java province. The first was a 22 year old who developed symptoms on 25 January and died on 10 February. Her neighbours kept chickens; samples from these and from birds in a nearby market are being tested.

The second was a 27 year old who developed symptoms on 31 January and died on 10 February. Chickens are known to have died in the neighbourhood shortly before the onset of her symptoms.

The third case occurred in a 23 year old man from East Jakarta who was employed as an egg seller at a wet market. He developed symptoms on 5 February, was hospitalised on 7 February, and died on 10 February.

The fourth case was in a 27 year old woman from West Java province who developed symptoms on 13 February and died on 20 February.

Investigations found reports of chicken deaths in the neighbourhood shortly before the onset of her symptoms.

These newly confirmed cases bring the total in Indonesia to 27, of which 20 were fatal.

Iraq

A World Health Organization (WHO) collaborating laboratory in the United Kingdom has verified H5N1 avian influenza as the cause of death in a 39 year old man [7].

The case was previously announced by the Ministry of Health in Iraq [8], and brings the total number of confirmed human cases to two; both of which were fatal.

The UK laboratory is also conducting tests on samples taken from additional cases currently under investigation from the northern Iraqi provinces of Sulaimaniyah, and the southern provinces of Basra and Missan.

Global Case Totals

The global total of WHO-confirmed cases is in the table below, and can be found on their website [9]. 

COUNTRY	HUMAN CASES as of 1 March 2006					DEATHS
	2003	2004	2005	2006	TOTAL
Cambodia	0	0	4	0	4	4
China	0	0	8	6	14	8
Indonesia	0	0	17	10	27	20
Thailand	0	17	5	0	22	14
Viet Nam	3	29	61	0	93	42
Turkey	0	0	0	12	12	4
Iraq	0	0	0	2	2	2
TOTALS	3	46	95	30	174	94

Advice for travellers

Examination of previous 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, defeathering and preparation of poultry for consumption. No cases have been linked to properly cooked meat or eggs.

There remain no restrictions for travel to countries that have been infected with avian influenza. Nevertheless, travellers should exercise precautions that have been previously posted [10].

As the situation of avian influenza evolves, the Health Protection Agency (HPA), Centre for Infections continuously reviews the algorithm for the management of travellers or visitors arriving from countries (or areas within countries) affected by avian influenza [11]. These regions will be revised as new information from the WHO and OIE is forthcoming on detection 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 within seven days of their arrival in the UK. Physicians who see persons whom they suspect may have avian influenza, should evaluate them according to this algorithm.

 

References

1. World Health Organization. Avian influenza - situation in China - update 3. 9 February 2006. [cited 2 March 2006] Available at: http://www.who.int/csr/don/2006_02_09/en/index.html

2. World Health Organization. Avian influenza - situation in China - update 4. 13 February 2006. [cited 2 March 2006] Available at: http://www.who.int/csr/don/2006_02_13a/en/index.html

3. World Health Organization. Avian influenza - situation in China - update 5. 27 February 2006. [cited 2 March 2006] Available at: http://www.who.int/csr/don/2006_02_27a/en/index.html

4. World Health Organization. Avian influenza - situation in Indonesia - update 3. 13 February 2006. [cited 2 March 2006] Available at: http://www.who.int/csr/don/2006_02_13/en/index.html

5. World Health Organization. Avian influenza - situation in Indonesia - update 4. 20 February 2006. [cited 2 March 2006] Available at: http://www.who.int/csr/don/2006_02_20/en/index.html

6. World Health Organization. Avian influenza - situation in Indonesia - update 5. 27 February 2006. [cited 2 March 2006] Available at: http://www.who.int/csr/don/2006_02_27/en/index.html

7. World Health Organization. Avian influenza - situation in Iraq - update 4. 1 march 2006. [cited 2 March 2006] Available at: http://www.who.int/csr/don/2006_03_01a/en/index.html

8. NaTHNaC. Avian influenza - human cases in Indonesia and Iraq. 9 February 2006. {cited 2 March 2006] Available at: http://www.NaTHNaC.org/pro/clinical_updates/

avianinfluenza_Indonesia_Iraq_090206.htm

9. World Health Organization. Cumulative number of confirmed human cases of avian influenza A/(H5N1) reported to WHO. 1 March 2006. [cited 2 March 2006] Available at: http://www.who.int/csr/disease/avian_influenza/country

/cases_table_2006_03_01/en/index.html

10. NaTHNaC. Avian influenza - advice for travellers to affected areas. 4 November 2005. [cited 2 March 2006] Available at:  http://www.NaTHNaC.org/pro/clinical_updates

/avianinfluenza_advice_041105.htm

11. 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. 1 March 2006. [cited 2 March 2006] Available at: http://www.hpa.org.uk/infections/topics_az

/influenza/avian/algorithm.htm