16 April 2008

Avian influenza (H5N1) – human cases in Egypt, Indonesia, Pakistan and Viet Nam

Egypt

The Ministry of Health and Population has confirmed two human cases of H5N1 avian influenza [1,2].

• A 19 year old male from Behera Governorate who developed symptoms on 30 March 2008 and died in hospital on 4 April.
• A 30 year old female from Cairo Governorate who developed symptoms on 2 April 2008 and died in hospital on 11 April.

Both cases had contact with sick and dead poultry before the onset of symptoms.

Indonesia

The Ministry of Health has confirmed three human cases of H5N1 avian influenza [3]:

• A 15 year old male from West Java province who developed symptoms on 19 March 2008 and died on 26 March.
• An 11 year old girl from West Java province who developed symptoms on 19 March 2008 and died on 28 March.
• A 21 month girl from West Sumatra province who developed symptoms on 17 March 2008 and is currently recovering in hospital.

The source of infection for all three cases is currently under investigation.

Pakistan

H5N1 avian influenza has been laboratory confirmed in two members of a family cluster previously reported in Peshawar in December 2007 [4,5]. This brings the total of confirmed cases in this cluster to three, with an additional suspected case reported for which samples were not available.

Investigations into this family cluster suggest that limited human-to-human transmission is likely to have occurred. However, the outbreak was neither sustained nor did it extend into the community.

The three laboratory confirmed cases have been added to the World Health Organization (WHO) table of cumulative human cases of avian influenza.

Viet Nam

The Ministry of Health has confirmed a human case of H5N1 avian influenza in an 11 year old male from Ha Nam province [6]. He developed symptoms on 4 March 2008 and died in hospital on 14 March. The boy is known to have had contact with sick and dead poultry before the onset of symptoms.

Global case totals

The global total of confirmed human cases of avian influenza A/H5N1 reported by WHO as of 8 April 2008 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_2008_04_15/en/index.html

COUNTRY	HUMAN CASES as of 15 April 2008							DEATHS
	2003	2004	2005	2006	2007	2008	TOTAL
Azerbaijan	0	0	0	8	0	0	8	5
Cambodia	0	0	4	2	1	0	7	7
China	1	0	8	13	5	3	30	20
Djibouti	0	0	0	1	0	0	1	0
Egypt	0	0	0	18	25	6	49	22
Indonesia	0	0	20	55	42	15	132	107
Iraq	0	0	0	3	0	0	3	2
Lao PDR	0	0	0	0	2	0	2	2
Myanmar	0	0	0	0	1	0	1	0
Nigeria	0	0	0	0	1	0	1	1
Pakistan	0	0	0	0	3	0	3	1
Thailand	0	17	5	3	0	0	25	17
Turkey	0	0	0	12	0	0	12	4
Viet Nam	3	29	61	0	8	5	105	52
TOTALS	4	46	98	115	88	28	380	240(63%)

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

An H5N1 avian influenza timeline of major events is also available at: http://www.who.int/csr/disease/avian_influenza/ai_timeline/en/

index.html

Advice for travellers

Examination of human cases of avian influenza indicates 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 are 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. 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 has also published a second algorithm for the management of persons resident in the UK or arriving from areas not known to have avian influenza H5N1.

Both algorithms provide guidance for physicians on the recognition, investigation and initial management of persons with a history of fever and respiratory symptoms, after close contact with sick, dying or dead birds within seven days of presentation. The algorithms can be found on the HPA avian influenza guidelines webpage at http://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPA

web_C/1195733851442?p=1160495617107

References

1. World Health Organization. Avian influenza – situation in Egypt – update 8. 8 April 2008. [Accessed 16 April 2008]. Available at http://www.who.int/csr/don/2008_04_08/en/index.html

2. World Health Organization. Avian influenza – situation in Egypt – update 9. 15 April 2008. [Accessed 16 April 2008]. Available at http://www.who.int/csr/don/2008_04_15/en/index.html

3. World Health Organization. Avian influenza – situation in Indonesia – update 41. 2 April 2008. [Accessed 16 April 2008]. Available at http://www.who.int/csr/don/2008_04_02/en/index.html

4. NaTHNaC. Avian influenza (H5N1) – human cases in China, Indonesia, Myanmar and Pakistan. 19 December 2007. [Accessed 16 April 2008]. Available at http://www.nathnac.org/pro/clinical_updates/flu_191207.htm

5. World Health Organization. Avian influenza – situation in Pakistan – update 2. 3 April 2008. [Accessed 16 April 2008]. Available at http://www.who.int/csr/don/2008_04_03/en/index.html

6. World Health Organization. Avian influenza – situation in Viet Nam – update 5. 18 March 2008. [Accessed 16 April 2008]. Available at http://www.who.int/csr/don/2008_03_18/en/index.html

7. NaTHNaC. Avian influenza – advice for travellers. 4 July 2006. [Accessed 16 April 2008]. Available at http://www.nathnac.org/pro/factsheets/avianinfluenza_advice

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