Clinical Updates
22 March 2007
Avian influenza (H5N1) – human cases in Egypt and Lao People’s Democratic Republic
Egypt
The Egyptian Ministry of Health and Population has reported three human cases of H5N1 avian influenza [1-3].
- A four year old boy from Ad Daqahliyah governorate who developed symptoms on 7 March 2007, and was admitted to hospital on 8 March where he remains in a stable condition.
- A 10 year old girl from Aswan governorate who was admitted to hospital on 13 March 2007 where she remains in a stable condition.
- A two year old boy from Aswan governorate who developed symptoms on 15 March 2007, and was admitted to hospital on 16 March where he remains in a stable condition. No epidemiological link has been found between this boy and the 10 year old girl from the same area.
All cases are known to have had contact with sick poultry shortly before the onset of their symptoms.
Lao People’s Democratic Republic
On 16 March 2007, the Ministry of Health in Lao People’s Democratic Republic reported a human case of H5N1 avian influenza in a 42 year old woman from Vientiane province [4]. The woman developed symptoms on 26 February 2007 and died in hospital on 4 March. Tests undertaken as part of the investigation into the source of the woman’s exposure have found a duck positive for H5 influenza in the woman’s household.
On 8 March 2007, the Ministry of Health confirmed the country’s first human death from H5N1 avian influenza [5]. The patient was a 15 year old girl, previously reported [6], from Vientiane. She died on the 7 March 2007 in hospital in northern Thailand.
Global Case Totals
The global total of laboratory cases reported by the WHO as of 20 March 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_03_20/en/index.html
COUNTRY |
HUMAN CASES as of 20 March 2007 |
DEATHS |
|||||
2003 |
2004 |
2005 |
2006 |
2007 |
TOTAL |
||
Azerbaijan |
0 |
0 |
0 |
8 |
0 |
8 |
5 |
Cambodia |
0 |
0 |
4 |
2 |
0 |
6 |
6 |
China |
1 |
0 |
8 |
13 |
1 |
23 |
14 |
Djibouti |
0 |
0 |
0 |
1 |
0 |
1 |
0 |
Egypt |
0 |
0 |
0 |
18 |
8 |
26 |
13 |
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 |
18 |
281 |
169 |
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
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 remain 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 [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. 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 [9].
References
1. World Health Organization. Avian influenza – situation in Egypt – update 8. 12 March 2007. [accessed 22 March 2007]. Available at http://www.who.int/csr/don/2007_03_12/en/index.html
2. World Health Organization. Avian influenza – situation in Egypt – update 9. 19 March 2007. [accessed 22 March 2007] Available at http://www.who.int/csr/don/2007_03_19/en/index.html
3. World Health Organization. Avian influenza – situation in Egypt – update 10. 20 March 2007. [accessed 22 March 2007] Available at http://www.who.int/csr/don/2007_03_20/en/index.html
4. World Health Organization. Avian influenza – situation in Lao People’s Democratic Republic – update 2. 16 March 2007. [accessed 22 March 2007]. Available at http://www.who.int/csr/don/2007_03_16/en/index.html
5. World Health Organization. Avian influenza – situation in Lao People’s Democratic Republic – update. 8 March 2007. [accessed 22 March 2007] Available at http://www.who.int/csr/don/2007_03_08/en/index.html
6. NaTHNaC clinical update. Avian influenza (H5N1) – human cases in China, Egypt and Lao People’s Democratic Republic. 2 March 2007. [accessed 22 March 2007]. Available at http://www.nathnac.org/pro/clinical_updates/avianinfluenza
7. NaTHNaC Health Information Sheets. Avian influenza – advice for travellers. 4 July 2006. [accessed 22 March 2007] Available at http://www.nathnac.org/pro/factsheets/avianinfluenza_advice_
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. 1 March 2007 [accessed 22 March 2007] Available at http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPA
9. 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 febrile respiratory illness after close contact with sick, dying or dead birds: recognition, investigation and initial management. 1 March 2007 (reviewed 6 February 2007) [accessed 22 March 2007]. Available online at: http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPA
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