Clinical Updates
18 November 2005
Avian influenza H5N1 - Human cases in China and Indonesia
China
The Ministry of Health in China has confirmed the country’s first two human cases of avian influenza A/H5N1 infection [1].
The first case is a nine year old boy from Hunan Province who developed respiratory symptoms on 17 October 2005, and has made a full recover following hospitalisation.
The second case is a 24 year old woman who worked as a poultry worker in Anhui Province. She developed symptoms on 1 November 2005, was hospitalised with severe pneumonia on 7 November and died on 10 November.
Two additional possible cases have been investigated in Hunan Province. The first is the 12 year old sister of the 9 year old boy described above. She died on 17 October of severe pneumonia. Samples taken were inadequate for testing and the exact cause of death is not likely to be determined. Although evidence of H5N1 infection is considered substantial in this case by Chinese experts, the World Health Organization (WHO) only reports laboratory confirmed cases.
The second possible case is a 36 year old school teacher from Hunan province who was hospitalised on 24 October. Definitive test results are pending.
China has recently experienced a reoccurrence of H5N1 infection amongst poultry, with 11 new outbreaks being reported since 19 October 2005. Six provinces have been affected including those of Hunan and Anhui. As a result, surveillance for human cases has intensified.
Indonesia
The Ministry of Health in Indonesia has confirmed a further two cases of human infection with H5N1 [1].
The first newly confirmed case is a 16 year old girl from Jakarta who developed symptoms on 4 November 2005. She was hospitalised two days later and died on 8 November.
The second case is a 20 year old woman also from Jakarta. She developed symptoms on 5 November and died in hospital on 12 November. Both cases were confirmed by a WHO laboratory in Hong Kong.
These newly confirmed cases bring the total in Indonesia to 11, of which seven have been fatal.
The total number of human cases of avian influenza A/H5N1 that have occurred in Cambodia (4), China (2), Indonesia (11), Thailand (21) and Viet Nam (92) is 130. Sixty-seven of these have died leading to an overall case fatality rate of 52%. A summary list of these cases may be found on the WHO site: http://www.who.int/csr/disease/avian_influenza/country/
cases_table_2005_11_17/en/index.html
Recommendations for travellers
Current recommendations fro travellers have been recently posted by NaTHNaC: Avian influenza - Advice for travellers to affected areas.
Reference
World Health Organization. Avian influenza - situation in China, Indonesia - update 41. 17 November 2005. Available at: http://www.who.int/csr/don/2005_11_17/en/index.html
Links
Guidelines on the management of travellers returning from avian influenza-infected regions with a febrile illness are available from the Health Protection Agency at: http://www.hpa.org.uk/infections/topics_az/avianinfluenza/
Up-to-date information on incidence of avian influenza in birds is available from the World Organization for Animal Health at http://www.oie.int/eng/en_index.htm and from the Animal Welfare page of the Department for Environment, Food and Rural Affairs at http://www.defra.gov.uk/animalh/diseases/notifiable/disease/ai/
A summary statement from NaTHNaC on cases on avian influenza in poultry and wildfowl can be found at: http://www.NaTHNaC.org/pro/clinical_updates/
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