Clinical Updates
11 August 2006
Avian influenza - human cases in Indonesia, China and Thailand
Indonesia
The Ministry of Health in Indonesia has confirmed three cases of human avian influenza [1,2,3].
The first newly reported case occurred in a 44 year old man from Jakarta province who developed symptoms on 10 July 2006 and died on 12 July [1]. The second case was a 16 year old male from West Java province who developed symptoms on 26 July and died in hospital on 7 August [2]. Investigations have found that both of these cases had contact with poultry in their neighbourhoods before the onset of symptoms.
The third case was a 17 year old woman from Jakarta province who developed symptoms on 28 July and died in hospital on 8 August [3]. An investigation into the source of infection has found that the woman kept pet pigeons inside her home, and several neighbouring households maintained flocks of backyard poultry. Samples from the birds have been collected and will be tested for H5N1.
China
The Ministry of Health in China has retrospectively confirmed a case of human avian influenza [4]. The case occurred in a 24 year old man who was serving in the military and was based in Beijing. He developed symptoms on 25 November 2003 and died on 3 December 2003. This case is now the earliest known occurrence of human H5N1 infection.
This case was initially reported in a letter to the New England Journal of Medicine in June 2006 [5], but was not known to the Ministry of Health. According to the New England Journal report the man’s illness was initially thought to be SARS, however, stored specimens were subsequently tested and found to be positive for avian influenza H5N1. In line with World Health Organization (WHO) recommendations, the diagnosis has been confirmed in a Ministry of Health affiliated laboratory. Prior to this announcement, the first official laboratory-confirmed H5N1 case on the Chinese mainland occurred in Hunan Province in October 2005. WHO have now added this case to their cumulative table of confirmed cases of human avian influenza.
Thailand
The Ministry of Public Health in Thailand has confirmed two cases of human avian influenza [6,7].
The first case occurred in a 17 year old man from Phichit province who developed symptoms on 15 July 2006 and died in hospital on 24 July [6].
The second case occurred in a 27 year old man from Uthai Thani province who developed symptoms on 24 July and died on 3 August [7].
Previous to these two cases there have been no reports of human avian influenza in Thailand for a period of eight months. However, recent outbreaks of H5N1 in poultry have occurred in both provinces, and these cases are known to have direct contact with sick or dead chickens.
Global Cases Totals
The global total of laboratory cases reported by WHO as of 9 August 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_ta
COUNTRY |
HUMAN CASES as of 20 June 2006 |
DEATHS |
||||
2003 |
2004 |
2005 |
2006 |
TOTAL |
||
Azerbaijan |
0 |
0 |
0 |
8 |
8 |
5 |
Cambodia |
0 |
0 |
4 |
2 |
6 |
6 |
China |
1 |
0 |
8 |
11 |
20 |
13 |
Djibouti |
0 |
0 |
0 |
1 |
1 |
0 |
Egypt |
0 |
0 |
0 |
14 |
14 |
6 |
Indonesia |
0 |
0 |
17 |
39 |
56 |
44 |
Iraq |
0 |
0 |
0 |
2 |
2 |
2 |
Thailand |
0 |
17 |
5 |
2 |
24 |
16 |
Turkey |
0 |
0 |
0 |
12 |
12 |
4 |
Viet Nam |
3 |
29 |
61 |
0 |
93 |
42 |
TOTALS |
4 |
46 |
95 |
91 |
236 |
138 |
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, 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 [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. 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 [10].
References
1. World Health Organization. Avian influenza - situation in Indonesia - update 23. 20 July 2006 [cited 10 August 2006] Available online at http://www.who.int/csr/don/2006_07_20/en/index.html
2. World Health Organization. Avian influenza - situation in Indonesia - update 24. 8 August 2006 [cited 10 August 2006] Available online at http://www.who.int/csr/don/2006_08_08a/en/index.html
3. World Health Organization. Avian influenza - situation in Indonesia - update 25. 9 August 2006 [cited 10 August 2006] Available online at http://www.who.int/csr/don/2006_08_09/en/index.html
4. World Health Organization. Avian influenza - situation in China - update 13. 8 August 2006 [cited 10 August 2006] Available online at http://www.who.int/csr/don/2006_08_08/en/index.html
5. Zhu Q, Qin E, Wang W et al. fatal infection with influenza A (H5N1) virus in China. N Engl J Med. 2006; 354: 2731 - 2732. [cited 10 August 2006] Available online at http://content.nejm.org/cgi/reprint/354/25/2731.pdf
6. World Health Organization. Avian influenza - situation in Thailand. 26 July 2006 [cited 10 August 2006] Available online at http://www.who.int/csr/don/2006_07_26/en/index.html
7. World Health Organization. Avian influenza - situation in Thailand - update. 7 August 2006 [cited 10 August 2006] Available online at http://www.who.int/csr/don/2006_08_07/en/index.html
8. NaTHNaC. Avian influenza - advice for travellers to affected areas. 4 July 2006. [cited 10 August 2006] Available online at http://www.NaTHNaC.org/pro/clinical_updates/avianinfluenza_advi
9. 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. 14 July 2006 [cited 10 August 2006] Available online at: http://www.hpa.org.uk/infections/topics_az/influenza/avian/algorit
10. 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. 19 June 2006 [cited 11 August 2006]. Available online at: http://www.hpa.org.uk/infections/topics_az/influenza/avian/docum
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