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Influenza A(H5N1) - Multistate (world) - Monitoring human cases (ECDC/CDTR, February 14 2014, edited)

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  • Influenza A(H5N1) - Multistate (world) - Monitoring human cases (ECDC/CDTR, February 14 2014, edited)

    [Source: European Centre for Disease Prevention and Control (ECDC), full PDF document: (LINK). Edited.]


    COMMUNICABLE DISEASE THREATS REPORT

    Week 7, 9-15 February 2014

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    Influenza A(H5N1) - Multistate (world) - Monitoring human cases

    Opening date: 15 June 2005 Latest update: 13 February 2014


    Epidemiological summary

    In the latest monthly update published on 24 January 2014, WHO acknowledged the fatal case of influenza A(H5N1) reported on 8 January 2014 in Canada and provided additional information.

    The case had an onset of disease on 27 December, when travelling back to Canada, presented with rapidly progressing pneumonia and encephalitis on 1 January 2014 and died on 3 January 2014. This is the first case of infection with H5N1 virus reported in the Americas. Although exposure to the virus most likely happened in Beijing, no clear history of exposure to poultry or poultry-contaminated environments has been reported to date.

    No further cases have been identified through contact follow-up and investigation around this case.

    As of 13 February 2014, forty-two human cases with influenza A(H5N1) virus infection have been laboratory-confirmed worldwide since the beginning of 2013.

    The countries affected during this period are Cambodia (28), Egypt (4), Indonesia (3), China (2), Vietnam (3), Bangladesh (1) Canada ex China (1). Among these cases, 27 were fatal, 15 of which are from Cambodia.

    The last case of influenza A(H5N1) in China was reported in February 2013.

    From 2003 through to 13 February 2014, 652 laboratory-confirmed human cases with avian influenza A(H5N1) virus infection have been officially reported from 16 countries. Of these cases, 387 have died.

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    ECDC assessment

    The risk of secondary cases and co-primary cases among the close contacts of the Canadian case reported is considered to be very low since more than 20 days have passed since the onset of disease, transmission of A(H5N1) on board aircrafts has never been documented, and there is no evidence of sustained human-to-human transmission of A(H5N1) ever occurring. The risk of healthcare-associated transmission in Canada is considered to be very low.

    The evidence points to an isolated case who was infected following exposure in China, although the source and mode of transmission has not yet been established. A(H5N1) is a strain of avian influenza that occasionally crosses the species barrier and infects humans. Sporadic cases originating in areas where A(H5N1) transmission has been documented in the recent past are therefore not unexpected.

    Although the case reported from Canada had an atypical clinical presentation and exposure to potentially infected birds has not been established, these circumstances do not change the ECDC recommendations that: Europeans travelling to China and South-East Asia should avoid live poultry markets and any contact with chickens, ducks, wild birds, and their droppings. This reduces the risk of exposure not only to A(H5N1) but also to A(H7N9). Poultry meat and eggs should be well cooked.

    Hong Kong reported the world's first outbreak of bird flu among humans in 1997, when six people died. Most human infections are the result of direct contact with infected birds, and countries with large poultry populations in close contact with humans are considered to be most at risk of bird flu outbreaks. There are currently no indications of a significant change in the epidemiology associated with any clade or strain of the A(H5N1) virus from a human health perspective. This assessment is based on the absence of sustained human-to-human transmission, and on the observation that there is no apparent change in the size of clusters or reports of chains of infection. However, vigilance for avian influenza in domestic poultry and wild birds in Europe remains important.


    Actions

    ECDC follows the worldwide A(H5N1) situation through epidemic intelligence activities in order to identify significant changes in the epidemiology of the virus. ECDC re-assesses the potential of a changing risk for A(H5N1) to humans on a regular basis. WHO is now reporting H5N1 cases on a monthly basis. ECDC will continue monthly reporting in the CDTR to coincide with WHO reporting.

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