23 May 2006

 

Avian influenza - human cases in Djibouti, Egypt and Indonesia

 

Djibouti

The Ministry of Health in Djibouti has confirmed the country’s first case of human avian influenza H5N1 in a two year old girl from a rural village in Arta district [1]. The girl developed symptoms on 23 April and is currently in a stable condition.

Testing for avian influenza was conducted by the US Naval Medical Research Unit 3 (NAMRU-3) in Cairo. This is the first human infection to be reported from the Horn of Africa.

Three of the girl’s siblings are currently under investigation and samples have been sent to NAMRU-3 for testing. NAMRU-3 has also confirmed the presence of H5N1 in samples from three chickens. Surveillance for additional human and animal cases is underway.

Egypt

The Ministry of Health in Egypt has confirmed avian influenza in a 75 year old woman from Al Minya governorate [2]. The woman developed symptoms on 11 May and died on 18 May. Her infection has been linked to exposure to diseased birds.

Indonesia

The Ministry of Health in Indonesia has confirmed eight cases of human avian influenza [3,4].

Six of the cases are members of an extended family from the village of Kubu Sembelang in North Sumatra. All but one lived in neighbouring houses. The initial case of this outbreak is considered to be a 37 year old woman who died from respiratory disease on 4 May, however, since no specimens were obtained before her burial the cause of her death cannot be determined. The other six cases include:

• The two sons of the initial case, aged 15 and 17 years, who died on 9 May and 12 May respectively.
• The 28 year old sister of the initial case who died on 10 May and the sister’s 18 month old daughter who died on 14 May.
• The 25 year old brother of the initial case who is still alive.
• The 10 year old nephew of the initial case who died on 13 May.

This is the largest cluster of cases to have been reported in any country and is being carefully investigated by Indonesia’s ministries of health and agriculture assisted by epidemiologists from the World Health Organization (WHO). The source of infection for the initial case is still under investigation; exposure to infected poultry is considered the most likely source.

The source of infection for the other family members has not yet been identified. Multiple hypotheses are being investigated, and limited human-to-human transmission cannot be ruled out at present. However, if human to human transmission has occurred it has neither been efficient nor sustained, and there is no evidence that infection has spread beyond members of this single extended family.

The remaining two cases reported from Indonesia occurred in a 38 year old woman from Surabaya city in East Java who developed symptoms on 2 May and died in hospital on 12 May [3], and in a 12 year old boy from Bekasi in East Java who was hospitalised on 7 May and died on 13 May [4].

 

Global Case Totals

The global total of laboratory-confirmed cases reported by the WHO as of 19 May 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_05_19/en/index.html

 

COUNTRY	HUMAN CASES as of 19 May 2006					DEATHS
	2003	2004	2005	2006	TOTAL
Azerbaijan	0	0	0	8	8	5
Cambodia	0	0	4	2	6	6
China	0	0	8	10	18	12
Djibouti	0	0	0	1	1	0
Egypt	0	0	0	14	14	6
Indonesia	0	0	17	24	41	32
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	73	217	123

 

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 with avian influenza. Nevertheless, travellers should exercise precautions [5].

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 [6]. 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 Djibouti. 12 May 2006. [cited 23 May 2006] Available online at http://www.who.int/csr/don/2006_05_12/en/index.html

2. World Health Organization. Avian influenza - situation in Egypt - update 8. 18 May 2006. [cited 23 May 2006] Available online at  http://www.who.int/csr/don/2006_05_18c/en/index.html

3. World Health Organization. Avian influenza - situation in Indonesia - update 12. 18 May 2006 [cited 23 May 2006] Available online at http://www.who.int/csr/don/2006_05_18b/en/index.html

4. World Health Organization. Avian influenza - situation in Indonesia - update 13. 19 May 2006 [cited 23 May 2006] Available online at http://www.who.int/csr/don/2006_05_19/en/index.html

5. NaTHNaC. Avian influenza - advice for travellers to affected areas. 7 April 2006. [cited 23 May 2006] Available online at http://www.NaTHNaC.org/pro/clinical_updates/

avianinfluenza_traveladvice_070406.htm

6. 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. 22 May 2006 [cited 23 May 2006] Available online at http://www.hpa.org.uk/infections/topics_az/influenza/avian/

algorithm.htm