Clinical Updates
22 March 2006
Avian influenza - human cases in China, Indonesia, Azerbaijan and Egypt
China
The Ministry of Health in China has reported a case of human infection with avian influenza H5N1 in a 32 year old man from the southern Chinese province of Guangdong [1]. He developed symptoms on 22 February and died on 2 March.
No poultry cases have been reported in Guangdong since 2004, and this is the first human case from the province.
A nine year old girl from the eastern province of Zhejiang who was reported as a case of avian influenza by the Chinese Ministry of Health on 27 February, has subsequently died [2, 3].
This newly confirmed human case brings the total in China to fifteen, of which ten have been fatal.
Indonesia
The Ministry of Health in Indonesia has confirmed an additional two cases of human infection with avian influenza H5N1 [4,5].
The first case occurred in a four year old boy from Semerang in Central Java. He developed symptoms on 10 February and died on 28 February. An investigation found that chickens had died in the boy’s neighbourhood shortly before the onset of his symptoms.
The second case occurred in a 12 year old girl from Boyolali, also in Central Java. She developed symptoms on 19 February and died in hospital on 1 March.
The girl’s 12 year old brother became unwell on 19 February and died on 28 February. His symptoms were compatible with dengue haemorrhagic fever and therefore no testing for H5N1 was performed. It will therefore not be known whether he was also infected with H5N1 influenza virus.
These newly confirmed cases bring the total in Indonesia to 29, of which 22 were fatal.
Azerbaijan
WHO has confirmed seven cases human infection with avian influenza H5N1 in Azerbaijan following testing by the WHO collaborating laboratory in the United Kingdom [6].
Six of the cases occurred in residents of the small settlement of Daikyand in the Salyan district of south-east Azerbaijan. The first cases occurred in a 17 year old girl who died on 23 February. Her cousin, a 20 year old woman died on 3 March. The 16 year old brother of this woman died on 10 March and a 17 year old girl who was a close family friend died on 8 March.
The additional two cases in Salyan occurred in a 10 year old boy who has made a full recovery, and a 15 year old girl who is currently in hospital in a critical condition.
The seventh case occurred in a 21 year old woman from the western district of Tartar who died on 9 March.
Two additional patients from Salyan and the neighbouring district of Neftcala have been hospitalised with pneumonia. The results of diagnostic tests are pending.
A WHO team is currently in Azerbaijan investigating the situation in collaboration with the Ministry of Health. The team has found evidence that carcasses of numerous swans may have been collected by residents in Daikyand as a source of feathers. Defeathering of birds is a task usually undertaken by adolescent girls and young women in the community.
Egypt
The Ministry of Health in Egypt has confirmed the country’s first case of human infection with avian influenza H5N1 [7].
A 30 year old woman from the Qaliubiya governorate near Cairo developed symptoms in early March and died in hospital on 17 March. She is known to have had close contact with diseased chickens, ducks, and a turkey in a household flock shortly before the onset of her symptoms.
Testing was conducted by NAMRU-3 based in Cairo. Samples are to be sent to a WHO collaborating laboratory for diagnostic verification.
Egypt confirmed its first H5N1 outbreak amongst poultry on 17 February. The virus has since been detected in 18 of the country’s 26 governorates.
Global Case Totals
The global total of laboratory-confirmed cases reported by the WHO as of 13 March 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_03_21/en/index.html.
COUNTRY |
HUMAN CASES as of 21 March 2006 |
DEATHS |
||||
2003 |
2004 |
2005 |
2006 |
TOTAL |
||
Azerbaijan |
0 |
0 |
0 |
7 |
7 |
5 |
Cambodia |
0 |
0 |
4 |
0 |
4 |
4 |
China |
0 |
0 |
8 |
7 |
15 |
10 |
Indonesia |
0 |
0 |
17 |
12 |
29 |
22 |
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 |
30 |
184 |
103 |
WHO will adjust the figures in its cumulative number of cases to include 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 that have been previously posted [8].
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 [9]. 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 China - update 6. 6 March 2006. [cited 22 March 2006] Available at: http://www.who.int/csr/don/2006_03_06a/en/index.html
2. World Health Organization. Avian influenza - situation in China - update 7. 8 March 2006. [cited 22 March 2006] Available at: http://www.who.int/csr/don/2006_03_08/en/index.html
3. NaTHNaC. Avian influenza - human cases in China, Indonesia and Iraq. 3 March 2006. [cited 22 March 2006] Available at: http://www.NaTHNaC.org/pro/clinical_updates/
4. World Health Organization. Avian influenza - situation in Indonesia - update 6. 10 March 2006. [cited 22 March 2006] Available at: http://www.who.int/csr/don/2006_03_10/en/index.html
5. World Health Organization. Avian influenza - situation in Indonesia - update 7. 13 March 2006. [cited 22 March 2006] Available at: http://www.who.int/csr/don/2006_03_13/en/index.html
6. World Health Organization. Avian influenza - situation in Azerbaijan - update 2. 21 March 2006. [cited 22 March 2006] Available at: http://www.who.int/csr/don/2006_03_21a/en/index.html
7. World Health Organization. Avian influenza - situation in Egypt. 20 March 2006. [cited 22 March 2006] Available at: http://www.who.int/csr/don/2006_03_20/en/index.html
8. NaTHNaC. Avian influenza - advice for travellers to affected areas. 4 November 2005. [cited 22 March 2006] Available at: http://www.NaTHNaC.org/pro/clinical_updates/
avianinfluenza_advice_041105.htm
9. 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. 14 March 2006. [cited 22 March 2006] Available at: http://www.hpa.org.uk/infections/topics_az/influenza/avian/
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