Cambodia - 2 confirmed H5N1 deaths infected in Prey Veng province - contacts monitored in Banteay Meanchey Province

[Treyfish]

Tuesday, 22 February 2011 20:14 Khuon Leakhana and Thet Sambath


Banteay Meanchey provincial authorities fear an outbreak of avian influenza (H5N1) after a mother and her child died two weeks ago and seven more were hospitalised.
Samples taken from Prak Sophorn, 21, who died on February 13, and her 11-month old son, Sun Nga, who died on February 15, were sent to the World Health Organization for testing and results are expected soon.
“I am waiting for laboratory results to clarify the cause and hope to know by the end of the day,” Dr Nima Asgari, public health specialist at the WHO, said today.
Keo Sopheaktra, director of Banteay Meanchey province’s health department, said the mother and son became sick after eating infected chicken.
“They both had a fever, cough and difficulty breathing before they passed away.”

He said seven villagers who helped clean Prak Sophorn’s body for cremation have been admitted to the Mongkol Borei district hospital for treatment after each developed a fever and cough.
Director of the Mongkol Borei district hospital Ho Serey Vitthyu said the seven are recovering well.http://www.phnompenhpost.com/index.p...-outbreak.html

[Treyfish]

Re: Cambodia - Suspected bird flu - 2 deaths , 7 hospitalized - Samples sent to WHO

The previous positive confirmed case on feb 9th, in a different province.
Bf is in more than 1 place in Cambodia.

A five-year-old girl from Phnom Penh?s Russei Keo district has died of respiratory complications after contracting the avian influenza A(H5N1) virus, commonly known as bird flu, according to a joint statement from the Ministry of Health and the World Health Organisation.http://www.phnompenhpost.com/index.p...-bird-flu.html

[sharon sanders]

Re: Cambodia - Suspected bird flu - 2 deaths , 7 hospitalized - Samples sent to WHO

Please see -

WHO, Avian influenza ? situation in Cambodia (Feb 9 2011, edited)

[Laidback Al]

Re: Cambodia - Suspected bird flu - 2 deaths , 7 hospitalized - Banteay Meanchey province - Samples sent to WHO

General map of Cambodia showing the locations of confirmed human H5N1 cases.

[alert]

Re: Cambodia - Suspected bird flu - 2 deaths , 7 hospitalized - Banteay Meanchey province - Samples sent to WHO

http://www.promedmail.org/pls/apex/f?p=2400:1001:3588994279193521::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,87208

Archive Number 20110222.0585
Published Date 22-FEB-2011
Subject PRO/AH/EDR> Avian influenza, human (12): Cambodia (BM), susp.


AVIAN INFLUENZA, HUMAN (12): CAMBODIA (BANTEAY MEANCHEY), SUSPECTED
************************************************** *****************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Tue 22 Feb 2011
Source: The Phnom Penh Post [edited]
<http://www.phnompenhpost.com/index.php/2011022246918/National-news/doctors-fear-bird-flu-outbreak.html>


Doctors fear bird flu outbreak
------------------------------
Banteay Meanchey provincial authorities fear an outbreak of avian
influenza (H5N1) after a mother and her child died 2 weeks ago and 7
more were hospitalised. Samples taken from the 21-year-old mother,
who died on 13 Feb 2011, and her 11-month-old son, who died on 15 Feb
2011, [have been] sent to the World Health Organization for testing
and results are expected soon.

"I am waiting for laboratory results to clarify the cause and hope to
know by the end of the day [22 Feb 2011]," Dr Nima Asgari, public
health specialist at the WHO, said today.

Keo Sopheaktra, director of Banteay Meanchey province's health
department, said the mother and son became sick after eating infected
chicken. "They both had a fever, cough and difficulty breathing
before they passed away."

He said 7 villagers who helped clean the mother's body for cremation
have been admitted to the Mongkol Borei district hospital for
treatment after each developed a fever and cough. Director of the
Mongkol Borei district hospital Ho Serey Vitthyu said the 7 are
recovering well.

--
Communicated by:
ProMED Rapporteur Mary Marshall

[Since 2003 to 18 Feb 2011, the number of human cases of avian
A/(H5N1) influenza virus infection reported from 15 countries
worldwide is 520, of whom 307 were fatal (CFR 59.0 percent). Among
the countries with more than 10 reported cases, Indonesia had the
highest CFR of 82.5 percent (141 out of 171). Age distribution of the
reported cases ranged from 3 months to 81 years old (median 19 years,
n=499. The age group most affected was 0-9 years of age (29.1
percent, 145/499), relative to other age groups (10-19; 20-29; 30-39;
40-49; 50-59; 60-69; 70+ years). The highest CFR (73.4 percent) was
among persons 10-19 years of age and lowest (25.0 percent) was among
persons aged 70 and above. F53 percent of the cases were female
(263/495). Exposure to diseased poultry has been a common theme
(<http://www.wpro.who.int/NR/rdonlyres/806DD8BD-2820-41E5-818C-4156702C6573/0/AIWeekly269WPRO18Feb2011.pdf>).

So far in 2011 one confirmed fatal case of avian A/(H5N1) virus
infection has Benni confirmed in Cambodia, bringing the overall total
number of cases to 11 with 9 fatalities. If the 2 new suspected cases
described in the above press report are confirmed the total for
Cambodia will become 13 cases and 11 fatalities, giving a very high CFR.

[JimO]

Re: Cambodia - Suspected bird flu - 2 deaths , 7 hospitalized - Banteay Meanchey province - Samples sent to WHO

I don't know very much about H5N1, but I assume that the mother and child contracted the virus while cleaning and preparing the bird for cooking. It seems that the virus wouldn't survive cooking temps and can it even take hold in the digestive tract?

Does anyone know if there have been reports of other cases associated with the 5-yo in Phenom Pen? If not, then perhaps the title should be changed to ... - 3 deaths, 7 hospitalized.

What jumps out at me is that seven people contracted the virus by cleaning her body for cremation. That sounds like very efficient H2H transmission. Have there been any similar H2H transmissions on that scale before?

Although pH1N1 has been my person focus for the past two years, I still believe the greatest pandemic threat is a variant of H5N1 that adapts to humans.

[Laidback Al]

Re: Cambodia - Banteay Meanchey Province, suspected bird flu - 2 deaths, 7 hospitalized - Samples sent to WHO

Many people have contracted H5N1 from just handling infected poultry. There have been some cases of infection from eating infected poultry and even consuming duck blood pudding. At least one individual contracted H5N1 from infected feathers, the individual handmade official shuttlecocks for badminton. Most infections seem to occur as respiratory infections, some of them in the lower tract.

In order to trace contacts of infected individuals and to watch for H2H outbreaks, media reported cases from separate geographic areas are followed in separate threads here at FT.

Seven people infected from body cleansing would suggest H2H transmssion. However, as yet, none of these cases, neither the seven nor the two dead individuals have been confirmed with H5N1.

With a CFR of about .6, an H5N1 pandemic would pose the greatest health threat to the world since the 1918 pandemic. At that CFR, and with easy transmissibility, as many as a billion people could die.

[Giuseppe]

Re: Cambodia - Banteay Meanchey Province, suspected bird flu - 2 deaths, 7 hospitalized - Samples sent to WHO

Many people have contracted H5N1 from just handling infected poultry. There have been some cases of infection from eating infected poultry and even consuming duck blood pudding. At least one individual contracted H5N1 from infected feathers, the individual handmade official shuttlecocks for badminton. Most infections seem to occur as respiratory infections, some of them in the lower tract.

In order to trace contacts of infected individuals and to watch for H2H outbreaks, media reported cases from separate geographic areas are followed in separate threads here at FT.

Seven people infected from body cleansing would suggest H2H transmssion. However, as yet, none of these cases, neither the seven nor the two dead individuals have been confirmed with H5N1.

With a CFR of about .6, an H5N1 pandemic would pose the greatest health threat to the world since the 1918 pandemic. At that CFR, and with easy transmissibility, as many as a billion people could die.

The possible outcome of a future influenza pandemic sustained by a transmissible A(H5N1)-derivative virus cannot be predicted.

As every season teaches to us, influenza viruses demonstrate highly variable activity, attack rate and virulence.

The actual epidemiological behaviour of A(H5N1) avian influenza virus is not yet fully understood, and its full clinical spectrum of disease is also poorly known.

Before to start a doomsday prediction about an unknown future, a little bit of caution is well advised.

[alert]

Re: Cambodia - Banteay Meanchey Province, suspected bird flu - 2 deaths, 7 hospitalized - Samples sent to WHO

IMO, it is not clear that the H5N1 virus is involved in this incident at all. This could be H1N1, and the exposure to poultry might be coincidental. Alternatively, the two fatalities might be due to H5N1, but the illness in the contacts might not. That fact that all seven seem to be "recovering well" might argue against them all being infected with H5N1.

[sharon sanders]

Re: Cambodia - Banteay Meanchey Province, suspected bird flu - 2 deaths, 7 hospitalized - Samples sent to WHO

It is H5N1, not H1N1, referenced here.

The lethality of H5N1 is a threat to global health. Whether it evolves genetically to be more transmissible or it recombines/reassorts with other flu types, it is a concern to be tracked.

[Giuseppe]

Re: Cambodia - Banteay Meanchey Province, suspected bird flu - 2 deaths, 7 hospitalized - Samples sent to WHO

It is H5N1, not H1N1, referenced here.

The lethality of H5N1 is a threat to global health. Whether it evolves genetically to be more transmissible or it recombines/reassorts with other flu types, it is a concern to be tracked.

Tracking, yes!

Predictions, not!

[CopitoSP]

Re: Cambodia - Banteay Meanchey Province - 2 Fatal cases test positive for H5N1 and 7 cases hospitalized with suspected H5N1 - Samples sent to WHO

Cambodian mother, son die of bird flu


Published: 23/02/2011 at 08:07 PM


Bird flu has claimed three lives in Cambodia this month, with a mother and her 11-month-old son becoming the latest victims of the virus, officials said Wednesday.

The 19-year-old woman died on February 12 while her baby died five days later, the Cambodian health ministry and the World Health Organization said in a joint statement. Tests confirmed both had contracted H5N1 avian influenza.

Earlier this month Cambodia reported its first bird flu fatality in nearly a year when a five-year-old girl in the capital died from the virus.

The new victims, from northwestern Banteay Meanchey province, were admitted to hospital with high fever and coughing days after "eating sick poultry'' while visiting relatives in southeastern Prey Veng province, the statement said.

It said the H5N1 avian influenza strain has killed more than 300 people worldwide since 2003. In Cambodia, the disease has claimed 11 lives.

http://www.bangkokpost.com/breakingnews/223154/cambodian-mother-son-die-bird-flu

[CopitoSP]

Re: Cambodia - Banteay Meanchey Province - Bird flu confirmed - 2 deaths, more samples taken by WHO

Bird flu deaths confirmed


WEDNESDAY, 23 FEBRUARY 2011 20:43 SUMMER WALKER AND THET SAMBATH


Ministry of Health and World Health Organisation officials confirmed today the deaths of a young mother and her 11-month-old son were the result of the A(H5N1) influenza virus, commonly known as bird flu.

A joint statement said that Prak Sophorn, 19, and her 11-month-old son were infected while handling poultry during a visit to relatives in Prey Veng province’s Rokar Chor village.

“The mother was admitted to a private clinic in Banteay Meanchey province but died as a result of complications of infection on 12 February,” the statement said, adding that her son died while being treated at a hospital in Siem Reap province on February 17.

The deaths bring to 11 the total number of people killed by bird flu in Cambodia since 2003, following the death earlier this month of a 5-year-old girl in Phnom Penh’s Russei Keo district.

A rapid response team was dispatched to Rokar Chor village today to interview people who might have had close contact with the deceased at the time of infection, the statement said.

Nima Asgari, a public health specialist at the WHO, said samples were taken from several people who might have been exposed to the virus, and that the team will continue to follow up for the next two weeks to cover the possible incubation period.

No one with bird flu-like symptoms has been reported in medical facilities in Prey Veng province since the deceased fell ill, Asgari said.

Villagers told the response team they had recently seen officials take samples from chickens in Prey Veng but that no connection to the two deaths had been confirmed.

Yos Mony, director of Prey Veng province’s department of agriculture, said samples are routinely taken in the province for avian influenza testing and that he was unaware of the details of the recent deaths.

There has not been an unusually large number of chicken deaths in the province of late, he added.

Seven people who prepared the body of Prak Sophorn for cremation were admitted to hospital last week in Banteay Meanchey but have been determined not to be at risk of bird flu infection and are not being tested for the virus, according to the Ministry of Health.

(...)

http://www.phnompenhpost.com/index.php/2011022346957/National-news/bird-flu-deaths-confirmed.html

[CopitoSP]

Re: Cambodia - Banteay Meanchey Province, suspected bird flu - 2 deaths, 7 hospitalized - Samples sent to WHO

Cambodian mother, son die from bird flu


PHNOM PENH - BIRD flu has claimed three lives in Cambodia this month, with a mother and her 11-month-old son becoming the latest victims of the virus, officials said on Wednesday.

The 19-year-old woman died on Feb 12 while her baby died five days later, the Cambodian health ministry and the World Health Organisation said in a joint statement. Tests confirmed both had contracted H5N1 avian influenza.

...

The new victims, from north-western Banteay Meanchey province, were admitted to hospital with high fever and coughing days after 'eating sick poultry' while visiting relatives in southeastern Prey Veng province, the statement said.

...

http://www.straitstimes.com/BreakingNews/SEAsia/Story/STIStory_638114.html

[JJackson]

Re: Cambodia - Banteay Meanchey Province, suspected bird flu - 2 deaths, 7 hospitalized - Samples sent to WHO

While I agree with IOH that it is tricky to predict how virulent a human pandemic strain might be based on the animal strain from which it was derived. I think Al is absolutely correct it is wholly reasonable to expect any strain derived from HP H5N1 to be vastly more virulent than one derived from any of the other strains which have caused mild infections in humans. Virulence in the odd zoonotic infection is not a guarantor of the level of virulence we might expect in an eventual pandemic strain but it is the best guide we have and a drop in CFR from over 50&#37; to under 3% - required to be less virulent than H1N1(1918) - is more than a little optimistic.

JimO wondered about the possibility of infection via the alimentary tract. While we do not know if this occurs it should be born in mind that unlike all other known pandemic, or candidate pandemic, strains H5N1 is HP. Two possibly limiting factors to infection are the distribution of host binding sugars and the host proteases needed for HA cleavage, the sugars are not uncommon but for LP strains only a very small subset of proteases can access the cleavage site. The HP cleavage site can be accessed by many proteases and this increased tissue tropism leaves open the possibility of infection in a wide range of host cell types beyond those in the respiratory tract we associate with all the flus we have met before.