News
2 October 2007
Avian influenza (H5N1) – human cases in Indonesia and Viet Nam.
Indonesia
The Ministry of Health of Indonesia has confirmed three human cases of H5N1 avian influenza since August 2007 [1-3].
A 17 year old woman from Banten province who developed symptoms on 9 August and died in hospital on 14 August [1]. The source of her infection is currently under investigation
A 28 year old woman from Bali province who developed symptoms on 14 August and died in hospital on 21 August [2]. The source of her infection is thought to be poultry that she collected from villages where outbreaks of avian influenza had occurred.
A 33 year old man from Riau province who developed symptoms on 25 August and died in hospital on 6 September [3]. The source of his infection is currently under investigation.
Viet Nam
The World Health Organization (WHO) has introduced an External Quality Assessment (EQA) Project for the detection of subtype influenza A virus by polymerase chain reaction (PCR). As a result, the criteria for accepting confirmed cases of influenza A (H5) infection have been amended.
Based on the amended criteria, the Ministry of Health of Viet Nam has confirmed five additional cases of human H5N1 avian influenza [4].
Age |
Gender |
Location |
Symptom onset |
Outcome |
29 |
Male |
Thanh Hoa |
30 May 2007 |
Recovered |
20 |
Male |
Ha Tay |
2 June 2007 |
Died 10 June 2007 |
28 |
Female |
Ha Nam |
3 June 2007 |
Died 21 June 2007 |
22 |
Female |
Ha Tay |
20 July 2007 |
Died 28 July 2007 |
15 |
Male |
Thanh Hoa |
27 July 2007 |
Died 3 August 2007 |
WHO have amended their table of cumulative number of confirmed human cases to include these cases.
A description of the EQA project can be found on the WHO website.
Global case totals
The global total of laboratory cases reported by the WHO as of 10 September 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_09_10/en/index.html
COUNTRY |
HUMAN CASES as of 10 September 2007 |
DEATHS |
|||||
2003 |
2004 |
2005 |
2006 |
2007 |
TOTAL |
||
Azerbaijan |
0 |
0 |
0 |
8 |
0 |
8 |
5 |
Cambodia |
0 |
0 |
4 |
2 |
1 |
7 |
7 |
China |
1 |
0 |
8 |
13 |
3 |
25 |
16 |
Djibouti |
0 |
0 |
0 |
1 |
0 |
1 |
0 |
Egypt |
0 |
0 |
0 |
18 |
20 |
38 |
15 |
Indonesia |
0 |
0 |
20 |
55 |
31 |
106 |
85 |
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 |
7 |
100 |
46 |
TOTALS |
4 |
46 |
98 |
115 |
65 |
328 |
200 (61%) |
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
An H5N1 avian influenza timeline of major events is also available on the WHO website at: http://www.who.int/csr/disease/avian_influenza/ai_timeline/en
Advice for travellers
Examination of human cases of avian influenza indicates 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 are 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. 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 H5N1 avian influenza [7].
References
1. World Health Organization. Avian influenza – situation in Indonesia – update 14. 16 August 2007. [Accessed 2 October 2007]. Available at http://www.who.int/csr/don/2007_08_16/en/index.html
2. World Health Organization. Avian influenza – situation in Indonesia – update 15. 23 August 2007. [Accessed 2 October 2007]. Available at http://www.who.int/csr/don/2007_08_23/en/index.html
3. World Health Organization. Avian influenza – situation in Indonesia – update 16. 10 September 2007. [Accessed 2 October 2007]. Available at http://www.who.int/csr/don/2007_09_10/en/index.html
4.World Health Organization. Avian influenza – situation in Viet Nam – update. 31 August 2007. [Accessed 2 October 2007]. Available at http://www.who.int/csr/don/2007_08_31/en/index.html
5. NaTHNaCNews. Avian influenza – advice for travellers. 4 July 2006. [Accessed 2 October 2007]. Available at http://www.nathnac.org/travel/news/avianinfluenza_travel
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. 30 August 2007. [Accessed 2 October 2007] Available at http://www.hpa.org.uk/infections/topics_az/influenza/avian/
documents/A3Respillnessalgorithm300807.pdf
7. Health Protection Agency. Algorithm for the management of persons resident in the UK or arriving from areas not known to have avian influenza H5N1 presenting with a febrile respiratory illness after close contact with sick, dying or dead birds: recognition, investigation and initial management. 7 September 2007. [Accessed 2 October 2007] Available at http://www.hpa.org.uk/infections/topics_az/influenza/avian/
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