11 April 2006

 

Avian influenza - human cases in Egypt, Indonesia and Cambodia

 

Egypt

The World Health Organization (WHO) confirmed that four patients reported by the Egyptian Ministry of Health as infected with avian influenza A/H5N1, have tested positive at a WHO collaborating laboratory in the UK [1]. The four cases were previously reported by WHO [2,3]. Two of the patients died, and two have made a full recovery.

The Ministry of Health has reported seven other cases of human infection with H5N1 [1, 4]. These await external confirmation by WHO.

These additional patients are:

• an 18 year old girl from Kafr El Sheikh who remains in hospital
• a six year old girl and her 18 month old sister from Kafr El Sheik who remain hospitalised
• a 31 year old Egyptian man who works in Jordan. The man recently visited his hometown in Egypt’s Fayoum governorate, where outbreaks of avian influenza are occurring in poultry. Whilst there he assisted with the slaughtering of poultry. He developed symptoms of respiratory disease on 30 March and remains hospitalised in Jordan. Given the exposure history and what is known about the incubation period of avian influenza, health authorities in Egypt and Jordan have concluded that the man almost certainly acquired his infection in Egypt.
• a 16 month old girl from the southern governorate of Suhaj who remains hospitalised in a stable condition
• an eight year old boy from Qaliubiya governorate who remains hospitalised in a stable condition.
• an 18 year old girl from Minufiyah governorate. She developed symptoms on 29 March and was hospitalised on 5 April, but died the following day.

Indonesia

The Ministry of Health in Indonesia has confirmed a case of avian influenza in a 20 month old girl from Kapuk in West Jakarta. She developed symptoms of fever and cough on 17 March, was hospitalised on 22 March and died the following day [5]. Field investigations have discovered reports of deaths amongst a chicken flock near to the girl’s home shortly before the onset of her symptoms.

Cambodia

The Ministry of Health in Cambodia has confirmed a case of avian influenza in a 12 year old boy from the south-eastern province of Prey Veng [6]. He developed symptoms of fever and headache on 29 March and was hospitalised in Phnom Penh on 4 April where he died the following day.

Numerous chickens and some ducks in the boy’s neighbourhood are known to have died in recent weeks. It has been reported that the boy gathered dead chickens for distribution to villagers for consumption. Twenty-five close contacts of the boy have been identified; all remain well, and house-to-house surveillance for signs of influenza-like illness is continuing.

Global Case Totals

The global total of laboratory-confirmed cases reported by the WHO as of 6 April 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_04_06/en/index.html

COUNTRY	HUMAN CASES as of 6 April 2006					DEATHS
	2003	2004	2005	2006	TOTAL
Azerbaijan	0	0	0	7	7	5
Cambodia	0	0	4	2	6	6
China	0	0	8	8	16	11
Egypt	0	0	0	4	4	2
Indonesia	0	0	17	13	30	23
Iraq	0	0	0	2	2	2
Thailand	0	17	5	0	22	14
Turkey	0	0	0	12	12	4
Viet Nam	3	29	61	0	93	42
TOTALS	3	46	95	48	192	109

WHO will adjust the figures in its cumulative number of cases in Egypt following results of external verification.

 

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 consumption of 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 [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.

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 Egypt - update 2. 3 April 2006. [cited 11 April 2006]. Available online at http://www.who.int/csr/don/2006_04_03/en/index.html

2. World Health Organization. Avian influenza - situation in Egypt. 20 March 2006. [cited 11 April 2006] Available online at http://www.who.int/csr/don/2006_03_20/en/index.html

3. World Health Organization. Avian influenza - situation in Egypt - update. 29 March 2006. [cited 11 April 2006] Available online at http://www.who.int/csr/don/2006_03_29/en/index.html

4. World Health Organization. Avian influenza - situation in Egypt - update 3. 6 April 2006. [cited 11 April 2006] Available online at http://www.who.int/csr/don/2006_04_06a/en/index.html

5. World Health Organization. Avian influenza - situation in Indonesia - update 8. 4 April 2006. [cited 11 April 2006] Available online at http://www.who.int/csr/don/2006_04_04/en/index.html

6. World Health Organization. Avian influenza - situation in Cambodia - update. 6 April 2006. [cited 11 April 2006]. Available online at http://www.who.int/csr/don/2006_04_06/en/index.html

7. NaTHNaC. Avian influenza - advice for travellers to affected areas. 7 April 2006. [cited 11 April 2006] Available at http://www.NaTHNaC.org/pro/clinical_updates/

avianinfluenza_traveladvice_070406.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. 7 April 2006 [cited 11 April 2006] Available online at http://www.hpa.org.uk/infections/topics_az/influenza/avian/

algorithm.htm