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2006 WHO Situation Updates - Avian Influenza Archive

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Avian influenza ? situation in Djibouti


12 May 2006

The Ministry of Health in Djibouti has confirmed the country?s first case of human infection with the H5N1 avian influenza virus. The patient is a 2-year-old girl from a small rural village in Arta district. She developed symptoms on 23 April. She is presently in a stable condition with persistent symptoms.


Three tests conducted on 10 May by the Cairo-based US Naval Medical Research Unit 3 (NAMRU-3) confirmed the child?s infection with the H5N1 virus. She is the first case of human infection reported in the Horn of Africa.


Three of the child?s siblings are under investigation for possible infection and are also receiving care. Samples have been taken and are being sent to NAMRU-3 for testing.


Health authorities in Djibouti initiated surveillance for human cases following reports of a small number of chicken deaths in early April. NAMRU-3 has also confirmed the presence of H5N1 virus in samples from three chickens.


Surveillance for additional human and animal cases is presently under way, but is hindered by the country?s lack of resources and of epidemiological and laboratory capacities. The search for human cases has been further complicated by a concurrent outbreak of dengue fever, which can mask the occurrence of other febrile illnesses with abrupt onset of symptoms, including H5N1 infection.


The situation in animals is poorly understood. Most of the country?s population is concentrated in the Djibouti district, where many households keep small numbers of poultry. Poultry production in other parts of the country is limited. High mortality in poultry flocks has not been detected to date.


At the request of the Ministry of Health, WHO is arranging urgent support for the country?s investigation and response to the outbreak.



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Avian influenza ? situation in Indonesia ? update 12


18 May 2006

The Ministry of Health in Indonesia has confirmed an additional seven cases of human infection with the H5N1 avian influenza virus. Six of the cases were fatal.


One fatal case, in a 38-year-old woman, occurred in the city of Surabaya, in East Java. She developed symptoms on 2 May, was hospitalized on 7 May, and died on 12 May. The case is the first reported from this area.


The remaining six cases are from the village of Kubu Sembelang in the Karo district of North Sumatra. All six are members of an extended family, and all but one lived in neighbouring houses.


Associated with the Kubu Sembelang outbreak is a seventh family member, a 37-year-old woman. She developed symptoms on 27 April and died of respiratory disease on 4 May. No specimens were obtained before her burial, and the cause of her death cannot be confirmed. She is, however, considered the initial case in this family cluster.


The six confirmed cases in Sumatra include the woman?s two sons, aged 15 and 17 years, who died respectively on 9 May and 12 May. The 28-year-old sister of the initial case died on 10 May. This sister had an 18-month-old girl, who died on 14 May. The fifth confirmed case, who is still alive, is the 25-year-old brother of the initial case. The sixth confirmed case is the 10-year-old nephew of the initial case. He died on 13 May.


One additional family member, who had been hospitalized, has subsequently been ruled out based on both negative laboratory results and the absence of clinical symptoms compatible with H5N1 infection.


This is the largest cluster of cases, closely related in time and place, reported to date in any country and is being carefully investigated by Indonesia?s ministries of health and agriculture and by WHO epidemiologists. The source of exposure for the initial case is still under investigation, with exposure to infected poultry or an environment contaminated by their faeces considered the most plausible source.


The likely source of infection for the additional cases has not yet been determined. Multiple hypotheses are being investigated. Apart from living in close proximity to each other, the cases in this cluster are known to have participated in a family gathering around 29 April. The cases may have acquired their infection from a shared environmental exposure yet to be identified. The possibility of limited human-to-human transmission cannot be ruled out at present.


Investigators at the outbreak site have found no evidence that infection has spread beyond members of this single extended family. No influenza-like illness has been identified in health care workers or other persons in close contact with the patients. If human-to-human transmission has occurred, it has not been either efficient or sustained.


The newly confirmed cases bring the total in Indonesia to 40. Of these cases, 31 have been fatal.



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Avian influenza ? situation in Egypt - update 8


18 May 2006

The Ministry of Health in Egypt has confirmed the country?s 14th case of human infection with the H5N1 avian influenza virus. The case occurred in a 75-year-old woman from the Al Minya governorate. She developed symptoms on 11 May and died on 18 May.


As with all other cases in Egypt, her infection has been linked to exposure to diseased birds.


Of the 14 cases in Egypt, six have been fatal.



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Avian influenza ? situation in Indonesia ? update 13


19 May 2006

The Ministry of Health in Indonesia has confirmed an additional case of human infection with the H5N1 avian influenza virus. The case occurred in a 12-year-old boy from Bekasi in East Jakarta. He was hospitalized on 7 May and died on 13 May.


An investigation is under way to determine the source of his infection.
The newly confirmed case brings the total in Indonesia to 41. Of these cases, 32 have been fatal.



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Avian influenza ? situation in Indonesia ? update 14


23 May 2006

The Ministry of Health in Indonesia has confirmed an additional case of human infection with the H5N1 avian influenza virus. The case occurred in a 32-year-old man. He developed symptoms on 15 May and died on 22 May.


The case is part of a family cluster in the Kubu Sembelang village, Karo District, of North Sumatra. The man is the seventh member of an extended family to become infected with the H5N1 virus and the sixth to die. An additional person, who was the first member of the family to fall ill, died of respiratory disease on 4 May. No specimens were taken prior to her burial and the cause of her death cannot be determined. However, as her clinical course was compatible with H5N1 infection, epidemiologists at the outbreak site include this woman as the initial case in the cluster.


The newly confirmed case is a brother of the initial case. Specimens were taken on 21 May and flown the same day to Jakarta. Tests run overnight confirmed his infection. His 10-year-old son died of H5N1 infection on 13 May. The father was closely involved in caring for his son, and this contact is considered a possible source of infection.


Although the investigation is continuing, preliminary findings indicate that three of the confirmed cases spent the night of 29 April in a small room together with the initial case at a time when she was symptomatic and coughing frequently. These cases include the woman?s two sons and a second brother, aged 25 years, who is the sole surviving case among infected members of this family. Other infected family members lived in adjacent homes.


All confirmed cases in the cluster can be directly linked to close and prolonged exposure to a patient during a phase of severe illness. Although human-to-human transmission cannot be ruled out, the search for a possible alternative source of exposure is continuing.


Both the Ministry of Health and WHO are concerned about the situation in Kubu Sembelang and have intensified investigation and response activities. Priority is now being given to the search for additional cases of influenza-like illness in other family members, close contacts, and the general community. To date, the investigation has found no evidence of spread within the general community and no evidence that efficient human-to-human transmission has occurred.


Analysis of viruses


Full genetic sequencing of two viruses isolated from cases in this cluster has been completed by WHO H5 reference laboratories in Hong Kong and the USA. Sequencing of all eight gene segments found no evidence of genetic reassortment with human or pig influenza viruses and no evidence of significant mutations. The viruses showed no mutations associated with resistance to the neuraminidase inhibitors, including oseltamivir (Tamiflu).


The human viruses from this cluster are genetically similar to viruses isolated from poultry in North Sumatra during a previous outbreak.



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Avian influenza ? situation in Indonesia ? update 15


29 May 2006

The Ministry of Health in Indonesia has confirmed an additional six cases of human infection with the H5N1 avian influenza virus. Three of these cases were fatal.


None of the newly confirmed cases is associated with the family cluster in Karo, North Sumatra. The cases are widely dispersed geographically (see map below).


One newly confirmed case is an 18-year-old man from East Java Province. He developed symptoms on 6 May and was hospitalized on 17 May. He is now recovering. The investigation found a history of exposure to dead chickens in his home within the week prior to symptom onset. No further cases of influenza-like illness have been identified during the investigation and monitoring of his close contacts.


Two additional cases occurred in a 10-year-old girl and her 18-year-old brother from Bandung, West Java. Both children developed symptoms on 16 May, were hospitalized on 22 May, and died on 23 May. Both children had a history of close contact with sick and dying chickens at their home in the week before symptom onset. The identical onset dates strongly suggest that they acquired their infection following a shared exposure to poultry, and not from each other. Follow-up of contacts has not identified further cases of influenza-like illness.


An additional case occurred in a 39-year-old man from West Jakarta. He developed symptoms on 9 May, was hospitalized on 16 May, and died on 19 May. The investigation determined that the man cleaned pigeon faeces from blocked roof gutters at his home shortly before symptom onset. No further potential source of exposure was identified.


The remaining two patients are a 43-year-old man from South Jakarta, who developed symptoms on 6 May, and a 15-year-old girl from West Sumatra, who developed symptoms on 17 May. The 43-year-old man has recovered and been discharged from hospital. The 15-year-old girl remains hospitalized. The sources of exposure for these two cases are under investigation.


The newly confirmed cases bring the cumulative total in Indonesia to 48. Of these cases, 36 were fatal.


Maps showing the location of Indonesia?s H5N1 cases can be found on the WHO Indonesia avian influenza web site .



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Avian influenza ? situation in Indonesia ? update 16


31 May 2006

Situation update

Indonesian health authorities and WHO have further strengthened their response to the family cluster of cases in Kubu Simbelang village, Karo District, North Sumatra. As of today, 54 surviving family members and other close contacts of cases have been identified and placed under voluntary home quarantine. All of these people, with the exception of pregnant women and infants, are receiving the antiviral drug, oseltamivir, for prophylactic purposes. Public health teams visit these people daily, checking for symptoms.


In addition, active house-to-house surveillance for influenza-like illness is being conducted throughout the village, which has around 400 households. A command post for fever surveillance has been functioning in the village since last week.


As of today, no new cases suggestive of H5N1 infection have been detected since 22 May. This finding is important as it indicates that the virus has not spread beyond the members of this single extended family. No hospital staff involved in the care of patients, in some instances without adequate personal protective equipment, have developed the disease. The last person in the cluster, who developed symptoms on 15 May and died on 22 May, refused hospitalization. He moved between two villages while ill, accompanied by his wife. The wife is under surveillance and has not developed symptoms.


Despite multiple opportunities for the virus to spread to other family members, health care workers or into the general community, it has not, on present evidence, done so.


Current level of pandemic alert

Based on an assessment of present evidence, WHO has concluded that the current level of pandemic alert is appropriate and does not need to change. The level of pandemic alert remains at phase 3. This phase pertains to a situation in which occasional human infections with a novel influenza virus are occurring, but there is no evidence that the virus is spreading in an efficient and sustained manner from one person to another.


WHO has recommended continued close monitoring of the situation in Kubu Simbelang for the two weeks following 22 May, the date when the last known case in the cluster died. As a precautionary measure, Indonesian authorities have decided to extend this recommended period to three weeks.


Preliminary results of the investigation

This information differs in some details from information released in previous updates, but is derived from extensive investigations by senior national and international epidemiologists, from WHO and the US Centers for Disease Control and Prevention, who have developed a clearer picture of the situation.


The cluster involves an initial case and seven subsequent laboratory-confirmed cases. All cases are members of an extended family: sisters and brothers and their children. Family members resided in four households. Three households were next-door neighbours in the village of Kubu Simbelang, Karo District, North Sumatra. The fourth household was located about 10 kilometres away in the nearby village of Kabanjahe.


The initial case in the cluster was a 37-year-old woman who sold fruits and chillies at a market in the village of Tigapanah. Her stand was located about 15 metres away from a stand where live chickens were sold. The investigation uncovered no reports of poultry die-offs in the market.


However, the woman kept a small number of backyard chickens, allowed into the house at night. Three of her chickens reportedly died before she became ill. She is also known to have used chicken faeces from these household chickens as fertilizer in her garden.


A parallel agricultural investigation has not, to date, detected H5N1 virus in PCR tests of approximately 80 samples from poultry, other livestock and domestic pets, and chicken fertilizer taken from the vicinity.


The initial case developed symptoms on 24 April, was hospitalized on 2 May, and died on 4 May. No samples were collected for testing prior to her burial, but she is considered part of the cluster as her clinical course was compatible with H5N1 infection.


The initial case had one sister and three brothers. The sister and two of the brothers subsequently developed infection. The remaining cases occurred among children in these families.


The confirmed cases include five males and two females with an average age of 19 years (range from 1 to 32 years). Six out of the seven confirmed cases developed symptoms between 3 May and 5 May. These cases include two sons of the initial case, her brother from Kabanjahe, her sister, the sister?s baby, and the son of a second brother living in an adjacent house. This second brother, the last case in the cluster, developed symptoms on 15 May. Six out of the seven cases were fatal.


Exposures

On the night of 29 April, nine family members spent the night in a small room with the initial case at a time when she was severely ill, prostrate, and coughing heavily. These family members included the initial case and her three sons; the brother from Kabanjahe village, his wife, and their two children; the 21-year-old daughter of another brother (who did not become infected); and another young male visitor. Following this event, three family members ? the woman?s two sons and the visiting brother from Kabanjahe ? developed symptoms from 5 to 6 days later.


The woman?s sister, who lived in an adjacent house, developed symptoms at the same time, as did her 18-month-old daughter. Prior to symptom onset, this sister, accompanied by her daughter, provided close personal care of the initial case.


The last case in the cluster provided close care for his son throughout his hospital stay, from 9?13 May. The son was a frequent visitor in the home of the initial case and was present there on 29 April.



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Avian influenza ? situation in Indonesia ? update 17


6 June 2006

For the past four days, Indonesian health authorities and WHO have been monitoring cases of influenza-like illness in four nurses who were involved in the care of confirmed H5N1 patients.


Test results have now convincingly ruled out H5N1 infection in all four nurses.


Two of the nurses cared for siblings, a 10-year-old girl and her 18-year-old brother, who were hospitalized in Bandung, West Java, on 22 May and died the following day. Test results for both nurses are negative for H5N1 infection. One nurse was shown to be infected with a seasonal influenza A (H1N1) virus, which is now circulating widely throughout Indonesia. The second nurse experienced only mild and transient symptoms, but was tested urgently as a precautionary measure. Her test results were also negative for H5N1 infection.


The two additional nurses, who work at a hospital in Medan, North Sumatra, were involved in the care of confirmed H5N1 cases among members of an extended family from the village of Kubu Simbelang in Karo District. One of the nurses, a 34-year-old woman, experienced only mild symptoms and has subsequently tested negative for H5N1 infection. The second nurse, a 42-year-old woman, developed influenza-like illness on 1 June. Test results received today are also negative for H5N1 infection.


The speed and thoroughness with which influenza-like illness in these nurses was investigated are indicative of the heightened concern among Indonesian health authorities. The negative test results for all four nurses provide reassuring evidence that the virus is not spreading efficiently or sustainably among humans at present.



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Avian influenza ? situation in Indonesia ? update 18


6 June 2006

The Ministry of Health in Indonesia has confirmed the country?s 49th case of human infection with the H5N1 avian influenza virus.


The case occurred in a 15-year-old boy from Tasikmalaya District, West Java Province. He developed symptoms on 24 May, was hospitalized on 26 May, and died on 30 May.


An investigation conducted by provincial health authorities found a history of contact with sick and dying chickens in the boy?s household in the week before the onset of his symptoms. Monitoring of family members and close contacts has detected no cases of influenza-like illness.


Of the 49 cases confirmed to date in Indonesia, 37 have been fatal.


The H5N1 virus is considered firmly entrenched in poultry throughout much of Indonesia. Unless this situation is urgently and comprehensively addressed, sporadic human cases will continue to occur.


The newly confirmed case is one of several where exposure occurred despite a clear signal of a high-risk situation arising from poultry deaths. Pending better control of the disease in animals, WHO and officials in the Ministry of Health see an urgent need to improve public awareness of this disease, the risk factors for infection, and the behaviours that should be avoided.



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Avian influenza ? situation in Indonesia ? update 19


15 June 2006

The Ministry of Health in Indonesia has confirmed the country?s 50th case of human infection with the H5N1 avian influenza virus.


The case, which was fatal, occurred in a 7-year-old girl from Tangerang district, Banten Province. She developed symptoms on 26 May, was hospitalized on 30 May, and died on 1 June. Her 10-year-old brother died of respiratory disease on 29 May, but no specimens were taken for testing and the cause of his death cannot be determined.


An investigation found a history of chicken deaths in the household and neighbourhood prior to symptom onset. Laboratory testing of surviving family members and close contacts has been conducted and no further cases were found.


Of the 50 cases confirmed to date in Indonesia, 38 have been fatal.



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Avian influenza ? situation in China ? update 12


16 June 2006

The Ministry of Health in China has confirmed the country?s 19th case of human infection with the H5N1 avian influenza virus.


The patient is a 31-year-old man employed as a truck driver in Shenzhen City, Guangdong Province, near the border with Hong Kong. He developed symptoms on 3 June and was hospitalized on 9 June. He remains hospitalized, in critical condition, with severe pneumonia.


Investigation of his source of infection is under way. Preliminary reports indicate the man visited a local market where live poultry are sold on several occasions prior to symptom onset. However, health authorities have not been able to determine whether he was exposed to infected poultry at that market or elsewhere. H5N1 infections in poultry have not been officially reported in the area.


Of the 19 laboratory-confirmed cases in China reported to date, 12 have been fatal.



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Avian influenza ? situation in Indonesia ? update 20


20 June 2006

The Ministry of Health in Indonesia has confirmed the country?s 51st case of human infection with the H5N1 avian influenza virus.


The case, which was fatal, occurred in a 13-year-old boy from South Jakarta. He developed symptoms on 9 June one week after helping his grandfather slaughter diseased chickens at the family home. The boy was hospitalized on 13 June and died on 14 June.


The grandfather remains healthy. Contact tracing and monitoring are under way to ensure no further cases arise from this exposure setting.


Of the 51 cases confirmed to date in Indonesia, 39 have been fatal.


Expert consultation

WHO, FAO, and the Indonesian ministries of health and agriculture are jointly convening an expert consultation in Jakarta from 21 to 23 June. The consultation is being held, at the request of the government?s national commission on avian influenza and pandemic influenza, to assess the avian influenza situation in poultry and humans.


The consultation, which will be attended by more than 40 national and international experts, will review measures for addressing the widespread presence of the virus in poultry and offer advice on strategies for reducing the number of human cases. The experts will also examine epidemiological and virological data collected during a month-long investigation of a cluster of cases among family members in the Kubu Simbelang village of North Sumatra.


More than three weeks (two times the maximum incubation period) have passed since the last case in the cluster died on 22 May. Daily house-to-house monitoring for influenza-like illness was conducted throughout the village and in health care facilities where patients were treated, and no further cases were detected. While these findings indicate no significant changes in the epidemiology of the disease, results from investigation of the cluster will be reviewed as they may yield lessons useful in the investigation and interpretation of other large clusters where human-to-human transmission is suspected.


Several viruses have been isolated from the seven confirmed cases in the cluster and these have been fully sequenced at WHO reference laboratories in Hong Kong and the USA. Experts from these laboratories will be presenting their findings for review during the consultation.



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Avian influenza ? epidemiology of human H5N1 cases reported to WHO


30 June 2006

This week?s issue of the Weekly Epidemiological Record, published online by WHO, sets out results from the first analysis of epidemiological data on all 205 laboratory-confirmed H5N1 cases officially reported to WHO by onset date from December 2003 to 30 April 2006.


Data used in the analysis were collected for surveillance purposes. Quality, reliability and format were not consistent across data from different countries. Despite this limitation, several conclusions could be reached.

  • The number of new countries reporting human cases increased from 4 to 9 after October 2005, following the geographical extension of outbreaks among avian populations.
  • Half of the cases occurred in people under the age of 20 years; 90% of cases occurred in people under the age of 40 years.
  • The overall case-fatality rate was 56%. Case fatality was high in all age groups but was highest in persons aged 10 to 39 years.
  • The case-fatality profile by age group differs from that seen in seasonal influenza, where mortality is highest in the elderly.
  • The overall case-fatality rate was highest in 2004 (73%), followed by 63% to date in 2006, and 43% in 2005.
  • Assessment of mortality rates and the time intervals between symptom onset and hospitalization and between symptom onset and death suggests that the illness pattern has not changed substantially during the three years.
  • Cases have occurred all year round. However, the incidence of human cases peaked, in each of the three years in which cases have occurred, during the period roughly corresponding to winter and spring in the northern hemisphere. If this pattern continues, an upsurge in cases could be anticipated starting in late 2006 or early 2007.
A more standardized collection of epidemiological data by countries and timely sharing of these data are needed to improve monitoring of the situation, risk assessment, and the management of H5N1 patients.

For more information


Epidemiology of WHO-confirmed human cases of avian A(H5N1) infection
30 June 2006, Weekly Epidemiological Record (WER) vol. 81, 26 (pp 249?260)



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Avian influenza ? situation in Indonesia ? update 21


4 July 2006

The Ministry of Health in Indonesia has confirmed the country's 52nd case of human infection with the H5N1 avian influenza virus.


The case, which was fatal, occurred in a 5-year-old boy from Tulungagung district, East Java Province. The boy became ill on 8 June, was hospitalized on 14 June and died two days later on 16 June.


An investigation found a history of chicken deaths in the boy's household two weeks before symptom onset. Laboratory testing of poultry in the sub-district confirmed the presence of H5N1 in chickens. Monitoring of close contacts has detected no further cases.


Of the 52 cases confirmed to date in Indonesia, 40 have been fatal.



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Avian influenza ? situation in Indonesia ? update 22


14 July 2006

The Ministry of Health in Indonesia has confirmed the country's 53 rd case of human infection with the H5N1 avian influenza virus.


The case, which was fatal, occurred in a 3-year-old girl from a suburb of Jakarta. She became ill on 23 June, was hospitalized on 5 July and died the next day. Specimens collected from the girl were confirmed positive for H5N1 avian influenza virus.


An investigation found that the case handled chickens that had died in the neighbourhood, to dispose of them, two days before the onset of her symptoms. Samples taken from chickens in the neighbourhood were found to be positive. An investigation has found no further cases of influenza-like illness and monitoring of close contacts is under way.


Of the 53 cases confirmed to date in Indonesia, 41 have been fatal.



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Avian influenza ? situation in Indonesia ? update 23


20 July 2006

The Ministry of Health in Indonesia has confirmed the country?s 54th case of human infection with the H5N1 avian influenza virus.


The case, which was fatal, occurred in a 44-year-old man from East Jakarta, Jakarta Province. He developed symptoms on 24 June, was hospitalized on 10 July, and died on 12 July.


The case may have acquired the infection from poultry around his home and animal health authorities have taken samples for testing. Another potential source of infection was a local wet market, which he regularly visited during the course of his work as the owner of a food stall.


Of the 54 cases confirmed to date in Indonesia, 42 have been fatal.



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Avian influenza ? situation in Thailand


26 July 2006

The Ministry of Public Health in Thailand has confirmed a case of human infection with H5N1 avian influenza. The patient, a 17-year-old man from Thap Khlo district of Phichit province in the north, developed symptoms on 15 July, was hospitalized on 20 July and died on 24 July.


On 10 July, the young man had buried the carcasses of dead chickens. This case coincides with a recurrence of a confirmed H5N1 outbreak in animals in the province. Control measures have been implemented to contain the animal outbreak and human surveillance has been strengthened. Field investigations have not found any indications of respiratory illness in close contacts of the young man.


This is the first human case of H5N1 infection reported from Thailand in 2006.



http://www.who.int/csr/don/2006_07_26/en/print.html

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Avian influenza ? situation in Thailand ? update


7 August 2006

The Ministry of Public Health in Thailand has confirmed the country?s 24th case of human infection with the H5N1 avian influenza virus. The case, which was fatal, occurred in a 27-year-old man from the central province of Uthai Thani. He developed symptoms on 24 July, was hospitalized on 30 July, and died on 3 August.


Investigation of his source of infection revealed contact with household chickens, which began dying around one week prior to symptom onset.


This is the country?s second case of H5N1 infection, and second fatality, within the past two weeks. Confirmation of these cases follows an 8-month period in which no human cases were reported in the country.


Recent outbreaks in poultry have been officially reported in two provinces, Phichit and Nakhon Phanom, located in the northern and north-eastern parts of the country.

http://www.who.int/csr/don/2006_08_07/en/print.html



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Avian influenza ? situation in Indonesia ? update 24


8 August 2006

The Ministry of Health in Indonesia has confirmed the country?s 55th case of human infection with the H5N1 avian influenza virus.


The case occurred a 16-year-old male from West Java Province. He developed symptoms on 26 July, was hospitalized on 4 August, and died on 7 August.


Prior to symptom onset, the case had contact with sick and dying chickens in his household. A joint investigation by health and agricultural officials detected the H5 virus subtype in chickens from the household. Family members and close contacts have been placed under surveillance.


Of the 55 cases confirmed to date in Indonesia, 43 have been fatal.



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Avian influenza ? situation in China ? update 13


8 August 2006

The Ministry of Health in China has today retrospectively confirmed a human case of H5N1 infection dating back to November 2003. The case occurred in a 24-year-old member of the military service based in Beijing. The man developed symptoms on 25 November 2003 and was hospitalized with pneumonia in Beijing. His condition deteriorated rapidly and he died of severe respiratory disease on 3 December 2003.


Confirmation of this case marks the earliest known instance of human H5N1 infection in mainland China, and is now the first confirmed case in the present outbreak. Previously, the first confirmed cases were thought to have occurred in Viet Nam in December 2003.


The case was initially reported by several Chinese researchers, affiliated with the military services, in a June 2006 letter to the New England Journal of Medicine. According to that communication, doctors initially suspected the man might have been infected with the SARS virus. Although WHO declared the SARS outbreak over in July 2003, suspicions were high that the virus might return during the cooler months.


Specimens tested for SARS infection prior to the man?s death were negative, but the cause of death remained undetermined. As stated in the published letter, stored specimens from the man subsequently tested positive for H5N1 infection. Successful isolation of the virus from these specimens was also reported.


As the man?s illness was initially thought to be SARS, no history of possible poultry exposure was taken. The source of his H5N1 infection remains uncertain, particularly as no poultry outbreaks of H5N1 avian influenza have been reported in Beijing.


The Ministry of Health informed WHO that it had been unaware of these tests and their results prior to publication of the research letter. In line with WHO recommendations, confirmatory testing in a laboratory affiliated with the Ministry of Health was arranged. Following an official request, WHO sent laboratory experts to consult with national experts performing the tests. That joint undertaking, conducted in late July, confirmed the man?s infection with the H5N1 virus. These findings were further reviewed by a panel of experts, which concluded that the man?s H5N1 infection was now laboratory confirmed.


Prior to this announcement, the first official laboratory-confirmed H5N1 case on the Chinese mainland occurred in Hunan Province in October 2005 and was reported to WHO in mid-November 2005.


The case has been added to the WHO cumulative table of confirmed cases. Retrospective confirmation of the case brings the cumulative total in China to 20. Of these cases, 13 have been fatal.


The Ministry of Health has informed WHO of its intention to strengthen communication mechanisms, and to ensure that more of the country?s research institutes are integrated into the reporting system. WHO will be providing support and guidance in these activities, as officially requested.



http://www.who.int/csr/don/2006_08_08/en/print.html

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