12 October 2006

Avian influenza - human cases in Egypt, Indonesia and Thailand

Egypt

As of 11 October 2006, the Ministry of Health in Egypt has confirmed a new case of H5N1 avian influenza in humans. The case occurred in a 39 year old woman from the Gharbiya governorate. She developed symptoms on 30 September 2006 and was hospitalised 4 October 2006. She remains in hospital in a stable condition. Prior to the onset of symptoms she was involved in the slaughtering and defeathering of ducks, some of which were ill or had died. This brings the total number of cases in Egypt to 15, all of which have been in 2006 [1].

Indonesia

The Ministry of Health in Indonesia have confirmed four new cases of H5N1 avian influenza in humans [2-5], bringing the total reported in 2006 to 50, of which 40 have been fatal.

The first confirmed case was in a nine year old boy from South Jakarta. He developed symptoms on the 13 September and died on 22 September 2006. The boy had a history of contact with sick and dying poultry in his home prior to the onset of symptoms [2].

The second case was in 11 year old boy from East Java province, who developed symptoms on 16 September and died on 18 September 2006 [2]. After his death, contact tracing was carried out and on 25 September 2006, the boy’s 21 year old sister was hospitalised after reports that she had symptoms of influenza. She tested positive for H5N1 avian influenza and remains hospitalised. Poultry deaths were noted in the family’s household before and during the boy’s illness [3].

On 27 September 2006, the WHO reported the confirmation of the fourth case of avian influenza in a human. A 20 year old man from Bandung in West Java developed symptoms on 17 September and died on 27 September 2006 [4]. The man’s brother had died following similar symptoms on 24 September 2006, although testing for H5N1 was not carried out and therefore the infection cannot be confirmed. The man’s sister was also hospitalised on suspicion of avian influenza infection but tests later showed that she was suffering from seasonal influenza and not avian influenza [5].

Thailand

The Ministry of Health in Thailand have detected a new human case of avian influenza bringing the total cases reported in 2006 to three, all of which have been fatal. The case, a 59 year old farmer from Nong Bua Lam Phu province, developed symptoms on 14 July 2006 and died of severe pneumonia on 10 August 2006. Repeated tests for H5N1 avian influenza, most of which were done after he had received Oseltamivir, were negative. The disease was finally confirmed from lung samples taken at autopsy. The man had a history of contact with poultry and relatives reported sudden deaths of poultry in the days prior to the onset of his symptoms [6].

Global Cases Totals

The global total of laboratory cases reported by the World Health Organization (WHO) as of 11 October 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 ble_2006_10_11/en/index.html  

COUNTRY	HUMAN CASES as of 11 October 2006					DEATHS
	2003	2004	2005	2006	TOTAL
Azerbaijan	0	0	0	8	8	5
Cambodia	0	0	4	2	6	6
China	1	1	8	12	21	14
Djibouti	0	0	0	1	1	0
Egypt	0	0	0	15	15	6
Indonesia	0	0	19	50	69	52
Iraq	0	0	0	3	3	2
Thailand	0	17	5	3	25	17
Turkey	0	0	0	12	12	4
Viet Nam	3	29	61	0	93	42
TOTALS	4	46	97	106	252	148

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 9. 11 October 2006. [cited 12 October 2006] Available online at http://www.who.int/csr/don/2006_10_11/en/index.html

2. World Health Organization. Avian influenza - situation in Indonesia - update 32. 25 September 2006. [cited 9 October 2006] Available online at http://www.who.int/csr/don/2006_09_25/en/index.html

3. World Health Organization. Avian influenza - situation in Indonesia - update 35. 3 October 2006. [cited 9 October 2006] Available online at http://www.who.int/csr/don/2006_10_03/en/index.html

4. World Health Organization. Avian influenza - situation in Indonesia - update 34. 28 September 2006. [cited 9 October 2006] Available online at http://www.who.int/csr/don/2006_09_28/en/index.html

5. World Health Organization. Avian influenza - situation in Indonesia - update 33. 27 September 2006. [cited 9 October 2006] Available online at http://www.who.int/csr/don/2006_09_27a/en/index.html 

6. World Health Organization. Avian influenza - situation in Thailand - update 2. 27 September 2006. [cited 9 October 2006] Available online at http://www.who.int/csr/don/2006_09_27/en/index.html

7. NaTHNaC. Avian influenza - advice for travellers to affected areas. 4 July 2006. [cited 21 September 2006] Available online at http://www.NaTHNaC.org/pro/clinical_updates/avianinfluenza_advic e.htm

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. 6 September 2006 [cited 21 September 2006] Available online at: http://www.hpa.org.uk/infections/topics_az/influenza/avian/algori thm.htm

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. 6 September 2006 [cited 21 September 2006]. Available online at: http://www.hpa.org.uk/infections/topics_az/influenza/avian/docum ents/F3notraveltoH5N1060906.pdf