17 April 2007

Avian influenza (H5N1) – human cases in Egypt and Cambodia

Egypt

On 10 April 2007, the Egyptian Ministry of Health and Population reported two human cases of H5N1 avian influenza [1].

The first is a two year old girl from Menia governorate who developed symptoms on 3 April 2007. She was admitted to hospital the following day and remains in a stable condition. Initial investigations indicate that she had contact with poultry shortly before the onset of symptoms.

The second case is a 15 year old girl from Cairo governorate who developed symptoms on 30 March. She was admitted to hospital on 5 April and died on 11 April 2007 [2].

Cambodia

On 10 April 2007, the Ministry of Health reported a human case of H5N1 avian influenza in a 13 year old girl from Kampong Cham province [3]. She developed symptoms on 2 April and died in hospital on 5 April 2007. Initial investigations indicate the presence of sick poultry in the village and in the girl’s home during the weeks before developing symptoms.

This is the first human case of H5N1 infection to occur in Cambodia during 2007.

Global Case Totals

The global total of laboratory cases reported by the WHO as of 11 April 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_04_11/en/index.html

COUNTRY	HUMAN CASES as of 11 April 2007						DEATHS
	2003	2004	2005	2006	2007	TOTAL
Azerbaijan	0	0	0	8	0	8	5
Cambodia	0	0	4	2	1	7	7
China	1	0	8	13	2	24	15
Djibouti	0	0	0	1	0	1	0
Egypt	0	0	0	18	16	34	14
Indonesia	0	0	19	56	6	81	63
Iraq	0	0	0	3	0	3	2
Lao PDR	0	0	0	0	2	2	2
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	28	291	172

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 on the WHO website at: http://www.who.int/csr/disease/avian_influenza/Timeline_

2007_03_20.pdf

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 are no restrictions for travel to countries with avian influenza. Nevertheless, travellers should exercise precautions [4].

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 [5]. 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 [6].

References

1. World Health Organization. Avian influenza – situation in Egypt – update 14. 10 April 2007. [accessed 17 April 2007] Available at http://www.who.int/csr/don/2007_04_10/en/index.html

2. World Health Organization. Avian influenza – situation in Egypt – update 15. 11 April 2007 [accessed 17 April 2007] Available at http://www.who.int/csr/don/2007_04_11/en/index.html

3. World Health Organization. Avian influenza – situation in Cambodia 10 April 2007. [accessed 17 April 2007] Available at http://www.who.int/csr/don/2007_04_10a/en/index.html

4. NaTHNaC Health Information Sheets. Avian influenza - advice for travellers to affected areas. 4 July 2007. [accessed 17 April 2007] Available at http://www.nathnac.org/pro/factsheets/avianinfluenza_

advice_040707.htm

5. 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. 2 April 2007 [accessed 17 April 2007] Available at http://www.hpa.org.uk/infections/topics_az/influenza/avian/

algorithm.htm

6. 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 a febrile illness after close contact with sick, dying or dead birds: recognition, investigation and initial management. 6 September 2006 [accessed 17 April 2007] Available at http://www.hpa.org.uk/infections/topics_az/influenza/avian/

documents/F3notraveltoH5N1060906.pdf