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2004 WHO Situation Updates - Avian Influenza Archive

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Avian Influenza - Assessment of the current situation


30 July 2004

After a period of quiescence in Southeast Asia, outbreaks of highly pathogenic avian influenza (A/H5N1) are again being reported in chickens and ducks in China, Indonesia, Thailand and Viet Nam. In Thailand, outbreaks have been reported in 21 of 76 provinces; and in Viet Nam outbreaks were reported in the northern, central and southern parts of the country. These outbreaks, many without apparent epidemiological links to each other, suggest A/H5N1 is now widely prevalent and is very likely to have become endemic.


The outbreaks in birds pose a significant threat to human health.
As WHO has stated since the first A/H5N1 outbreaks were reported, this virus has the potential to ignite a global influenza pandemic in humans. In a number of these outbreaks since the beginning of 2004, the virus has jumped from infected chickens or ducks directly to humans. These direct human infections have produced severe and sometimes fatal outcomes. WHO's continuing concern is that this virus may reassort its genes with those from a human influenza virus, thereby acquiring the ability to move easily from human to human and thus triggering a pandemic.


Recent media reports have occasionally suggested the presence of new human cases of A/H5N1. WHO has received no information substantiating these reports.


At a meeting in Bangkok which ended today, the Food and Agriculture Organization (FAO), in association with the World Organization for Animal Health (OIE) and WHO, announced plans to launch a new regional veterinary influenza network. WHO welcomes this initiative as this network aims to strengthen surveillance in animals and should provide more rapid diagnosis of the disease.


The FAO/OIE regional animal laboratory network will closely link with the WHO's global influenza programme to allow for more rapid sharing of virus samples. Faster and broader sharing of samples will enable WHO to monitor for changes in the virus which could diminish the effectiveness of the human vaccine currently under development. To date, such sample exchanges have been retarded in some affected countries.


The risk of emergence of a new human pandemic virus will remain as long as the avian influenza virus exists in the environment. Without significant increase in control efforts at national and international levels, it may be years before the virus is eradicated. While these control efforts continue, WHO reemphasizes the need to monitor the health of people on these front lines. Thus, WHO-coordinated preparedness activities will continue and WHO encourages members states to start or continue with their own influenza pandemic preparedness plans.



http://www.who.int/csr/don/2004_07_30/en/print.html

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Three fatal human cases of avian influenza confirmed in Viet Nam


12 August 2004

The Ministry of Health in Viet Nam has today informed WHO that three recent deaths from influenza-like illness in Viet Nam were caused by infection with avian influenza. These are the first officially reported cases of avian influenza in Viet Nam since late February.


The three cases are among a group of patients, admitted to hospitals in Viet Nam between 19 July and 8 August, that have been under investigation by health authorities.


Initial tests have identified the virus as belonging to the H5 subtype. Further testing is needed to determine whether the virus belongs to the same H5N1 strain that caused 22 cases, with 15 deaths, in Viet Nam and 12 cases, with 8 deaths, in Thailand earlier this year.


To date, H5N1 is the only strain of the H5 subtype known to jump directly from infected poultry to cause illness in humans.


Two of the fatal cases occurred in the northern Ha Tay province. The third case occurred in the southern province of Hau Giang. Staff from the WHO country office in Viet Nam will be meeting with the Ministry of Health tomorrow to gather further details about these cases and work out plans for addressing the situation. The government has today announced an initial series of measures aimed at controlling the disease in poultry and preventing further cases in humans.


WHO regards it as particularly important that viruses from these cases be made available for further analysis by laboratories in the WHO Global Influenza Surveillance Network. Further studies can help determine whether the virus has mutated and thus yield valuable information about the further evolution of the outbreak, the risks to humans, and the best preventive measures. Studies of the virus are also important in the further development, presently under way, of an effective human vaccine.


Thorough epidemiological and clinical investigation of these cases and their contacts is needed to improve understanding of the risks to humans.
Earlier this year, Viet Nam reported outbreaks of highly pathogenic H5N1 avian influenza in poultry in 57 of the country?s 64 provinces, resulting in the death or destruction of more than 43 million poultry. After a period of quiescence, Viet Nam reported fresh outbreaks in poultry in July in provinces in northern, central, and southern parts of the country.


Outbreaks were also reported in July in China, Indonesia, and Thailand.


The confirmation of these latest human cases underscores the risk of virus transmission to humans from infected poultry. This risk will continue as long as outbreaks are occurring in poultry. Of greatest concern is the risk that continuing transmission of the virus to humans will give avian and influenza viruses an opportunity to exchange genes, potentially giving rise to a new virus with pandemic potential.



http://www.who.int/csr/don/2004_08_12/en/print.html

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Human cases of avian influenza: situation in Viet Nam


13 August 2004

More details about the three deaths from avian influenza announced yesterday are now available.


The cases in the northern Ha Tay province were a four-year-old boy, who died on 2 August, and an 11-month-old girl, who died on 4 August. The case in the southern Hau Giang province was a 25-year-old woman, who died on 6 August. Specimens from this patient have now tested positive for the H5N1 strain of avian influenza.


WHO has also been informed that specimens from a small number of additional patients, from both northern and southern parts of the country, are also being tested. The government has been investigating cases of severe pneumonia, most of which have been fatal, that have been detected in children and young adults over the past three weeks.


Specimens are not available for all of the fatal cases.


In epidemiological investigations carried out today, specimens were taken from household contacts of confirmed cases. All contacts remain healthy. Investigators have also sampled poultry and other domestic animals near the households. Results from these and other studies will shed some light on the sources of infection and modes of transmission in the present outbreak.


WHO is working closely with national authorities and is being informed as test results become available. Multiple tests are often required before results can be considered conclusive.


In its communications with the Ministry of Health, WHO has offered full assistance in sending specimens to WHO international reference laboratories for test verification and further analysis.



http://www.who.int/csr/don/2004_08_13/en/print.html
 
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Avian influenza ? situation in Viet Nam


18 August 2004

In the present outbreak in Viet Nam, first reported last week, three fatal human cases of avian influenza have now been laboratory confirmed, two in the north and one in the south. For two of these cases, further testing has identified the H5N1 strain as the causative agent. The most recent case died on 6 August and no new cases have been identified since then.


With support from the Ministry of Health in Viet Nam, arrangements are under way to send specimens from these cases to a laboratory in the WHO Global Influenza Surveillance Network. The laboratory will perform gene sequencing and other analyses of the virus in order to yield information immediately relevant to assessment of the public health risk.


Studies will determine whether the virus responsible for these cases has mutated. It is particularly important to learn whether the H5N1 virus strain remains entirely of avian origin.


Following a meeting held earlier this week, health officials in Viet Nam have called for close cooperation between WHO and the country?s two institutes equipped to test specimens for avian influenza. These are the National Institute of Hygiene and Epidemiology in Hanoi and the Pasteur Institute in Ho Chi Minh City. This cooperation is expected to expedite the sharing of test results on any additional cases that might require investigation.


A small team of WHO staff will be traveling to Viet Nam over the weekend. The team will be working closely with the Ministry of Health to assess the present risk to public health and to work out plans to strengthen surveillance capacity for the detection of human cases.



http://www.who.int/csr/don/2004_08_18/en/print.html

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Avian influenza: H5N1 detected in pigs in China


20 August 2004

A researcher from China?s Harbin Veterinary Research Institute has today presented initial evidence that pigs from farms in parts of China have been infected with the H5N1 strain of avian influenza. The findings, set out in a table and without further supporting data, were presented today at an international symposium on SARS and avian influenza held in Beijing.


WHO has requested confirmation and further details about this study.


Pigs are known to be susceptible to infection with avian influenza viruses. However, natural infection of pigs with the H5N1 strain has not been previously reported.


In order to assess the implications for human health, it is important to know whether the reported infections in pigs are rare events, possibly caused by contact between pigs and wild birds. Wild aquatic birds, which are the natural reservoir of all influenza A viruses, can carry the H5N1 strain without developing symptoms, and are known to excrete large quantities of the virus in their faeces.


A comparison of the H5N1 strain isolated in pigs with strains recently circulating in poultry populations in parts of Asia is needed to determine whether the virus is being passed directly from poultry to pigs. Evidence of direct transmission of H5N1 from poultry to large numbers of pigs would be of particular concern, as this would increase opportunities for a new influenza virus with pandemic potential to emerge.


Pigs have been implicated in the emergence of new influenza viruses responsible for two of the previous century?s influenza pandemics. Pigs have receptors in their respiratory tract that make them susceptible to infection with human and avian influenza viruses. If a pig is simultaneously infected with both a human and an avian influenza virus, it can serve as a ?mixing vessel?, facilitating the exchange of genetic material between the two viruses in a process known as ?reassortment?. The resulting new virus, which will not be recognized by the human immune system, will have pandemic potential if it retains sufficient human genes to allow efficient human-to-human transmission, and if it causes severe disease in humans.


Confirmation of H5N1 infection in pigs would add complexity to the epidemiology of this disease, but needs to be viewed in perspective. During the peak of the poultry outbreak of H5N1 in Viet Nam earlier this year, extensive testing of pigs on farms where poultry were heavily infected failed to find evidence of infection in pigs. In addition, Hong Kong authorities regularly perform random testing for the H5 avian influenza virus subtype in pigs imported from mainland China. No infection in pigs has been detected to date.


WHO, in collaboration with FAO and OIE, will be assessing the implications of reported H5N1 infection in pigs as further details become available.



http://www.who.int/csr/don/2004_08_20/en/print.html

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Avian influenza - update: Implications of H5N1 infections in pigs in China


25 August 2004

Considering the widespread nature of the current H5N1 outbreak in Asia and the capability of influenza viruses to jump the species barriers, it is inevitable that H5N1 virus will be detected in some pigs. Pigs can be infected with both avian and human influenza A viruses-for instance, human influenza H3N2 viruses have been detected in pigs in Asia, Europe and Africa.


Some of these human and avian influenza viruses might become adapted to pigs and then begin circulating in pig populations. The co-circulation of avian, human, and pig viruses in pigs is of significant concern because of the potential for a genetic exchange, or "reassortment," of material between these viruses. Such an occurrence has the potential to produce a new, pandemic influenza strain.


Last week, a researcher at China's Harbin Veterinary Research Institute announced that pigs from farms in parts of China had been infected with the H5N1 strain of avian influenza (see previous report). China's Ministry of Agriculture has since confirmed the researcher's findings. What is unclear from the few studies which have been conducted is whether the H5N1 virus has already become established in pig populations in China.


Because the findings remain preliminary and are not necessarily indicative for widespread infection among pigs, assessing the consequences of this information for public health is difficult. Providing a detailed risk assessment of the current situation requires an understanding of the main factors influencing the potential for the emergence of a pandemic influenza strain: the prevalence of H5N1 and human H3N2 virus in pigs in Asia, and the likelihood of a reassorted virus and its possible pathogenicity.


The role of pigs in genetic reassortment is not fully understood. While there has been no known natural occurrence of reassortment of influenza viruses in pigs that resulted in a new pandemic strain, the probability of this occurrence is not negligible.


The chances for genetic reassortment depend upon both the duration of H5N1 circulation in pigs as well as the simultaneous presence of human and pig influenza A viruses (such as H3N2 or H1N1). As long as human and avian influenza viruses are co-circulating - whether in humans or in pigs - the possibility of an exchange of genetic material-exists.


To better understand the implications of the findings in China, WHO is encouraging that additional studies be conducted on H5N1 and other influenza A viruses in pigs in China, as well as in other countries which have experienced H5N1 avian influenza outbreaks. In addition, laboratory experiments would be required to shed some light on the probability for virus reassortment, the possible pathogenicity of a reassorted virus, and the chance that pigs will act as a pathway for the emergence of a potential pandemic strain. These results will help national and international public health authorities not only to assess the role pigs and humans play in the emergence of a new influenza pandemic virus from H5N1, but to structure the necessary public health interventions.



http://www.who.int/csr/don/2004_08_25/en/print.html

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Avian influenza – update: situation in Viet Nam


7 September 2004

WHO has received informal reports of a laboratory-confirmed fatal case of influenza A H5 infection in Viet Nam. The patient is thought to be a child who was hospitalized in Hanoi and who died over the weekend. Further details are awaited from official sources.


Detection of an H5 subtype of influenza A in a human should always arouse a very high level of suspicion that the case was caused by the H5N1 strain of avian influenza, particularly in a country with ongoing outbreaks of H5N1 in poultry. H5N1 is the only strain within the H5 subtype that has ever been shown to cause disease in humans.


Since August, Viet Nam has detected four human cases of H5 infection. These cases have occurred amidst recurring H5N1 outbreaks in poultry in several Asian countries.


Since January of this year, altogether 39 human cases have been reported from two countries, Viet Nam and Thailand. Of these cases, 28 have been fatal.



For more information

- Confirmed Human Cases of Avian Influenza A(H5N1) *
7 September 2004



http://www.who.int/csr/don/2004_09_07/en/print.html




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Confirmed Human Cases of Avian Influenza A(H5N1) *


7 September 2004

<table border="1" cellspacing="0" width="79%"> <tbody><tr> <td width="31%">
Country/Territory
</td> <td width="37%">
Total cases
</td> <td width="32%">
Deaths
</td> </tr> <tr> <td width="31%">Thailand</td> <td align="center" width="37%">12</td> <td align="center" width="32%">8</td> </tr> <tr> <td width="31%">Viet Nam</td> <td align="center" width="37%">27</td> <td align="center" width="32%">20</td> </tr> <tr> <td width="31%">Total</td> <td align="center" width="37%">39</td> <td align="center" width="32%">28</td> </tr> </tbody></table> * This updated table includes one fatal case that occurred in Viet Nam in mid-March but has only recently been officially confirmed.


The other changes reflect four recent cases, all fatal, reported from Viet Nam since early August. Of these four cases, three have been confirmed as caused by the H5N1 strain. For the remaining case, infection with influenza A H5 subtype has been laboratory confirmed.


Notes


Total number of cases includes number of deaths.
WHO reports only laboratory-confirmed cases.


http://www.who.int/csr/disease/avian_influenza/country/cases_table_2004_09_07/en/print.html
 
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Avian influenza – situation in Thailand


9 September 2004


Thailand's Ministry of Health reported today one recent human death caused by avian influenza A (H5N1). The case was an 18-year-old male, who had been exposed to sick chickens. He was from Prachinburi Province in eastern Thailand, a region which earlier this year experienced confirmed H5N1 outbreaks in poultry. He was admitted to hospital on 5 September and died from acute respiratory distress on 8 September. The Ministry of Health informed WHO of the death earlier today.


Specimens were tested by the National Institute of Health, Thailand and were found to be positive for influenza A (H5N1) by PCR. Experts from the Ministries of Agriculture and Public Health are currently in the field investigating the source of infection.



http://www.who.int/csr/don/2004_09_09/en/print.html




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Confirmed Human Cases of Avian Influenza A(H5N1) *


9 September 2004

<table border="1" cellspacing="0" width="79%"> <tbody><tr> <td width="31%">
Country/Territory
</td> <td width="37%">
Total cases
</td> <td width="32%">
Deaths
</td> </tr> <tr> <td width="31%">Thailand</td> <td align="center" width="37%">13</td> <td align="center" width="32%">9</td> </tr> <tr> <td width="31%">Viet Nam</td> <td align="center" width="37%">27</td> <td align="center" width="32%">20</td> </tr> <tr> <td width="31%">Total</td> <td align="center" width="37%">40</td> <td align="center" width="32%">29</td> </tr> </tbody></table> * This updated table includes one fatal case that occurred in Viet Nam in mid-March but has only recently been officially confirmed.


The other changes reflect four recent cases, all fatal, reported from Viet Nam since early August. Of these four cases, three have been confirmed as caused by the H5N1 strain. For the remaining case, infection with influenza A H5 subtype has been laboratory confirmed.


Notes


Total number of cases includes number of deaths.
WHO reports only laboratory-confirmed cases.

http://www.who.int/csr/disease/avian_influenza/country/cases_table_2004_09_09/en/print.html
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Avian influenza – situation in Thailand


28 September 2004


Two new cases confirmed

Since yesterday, the Ministry of Public Health in Thailand has confirmed two new cases of H5N1 avian influenza in humans. The cases are a 26-year-old woman, who died on 20 September, and her 32-year-old sister, who remains hospitalized in stable condition.


These new cases bring the total in Thailand confirmed since early September to three. Altogether, Thailand has reported 15 cases, of which 10 were fatal, since the first human cases were detected in January of this year.


Investigation of possible human-to-human transmission in a family cluster

The most recent cases are part of a family cluster of four cases under investigation to determine whether human-to-human transmission may have occurred. Immediate investigation of any possible human-to-human transmission is always needed to determine whether transmission has been efficient and sustained. Such a situation would be cause for alarm, as it might signal the start of an influenza pandemic. Inefficient, limited human-to-human transmission may occur on rare occasions and is in line with what is known, from epidemiological and laboratory investigations, about the possible behaviour of the H5N1 virus.


The initial case in the family cluster was an 11-year-old girl who died of pneumonia on 8 September. Thai authorities regard her as a probable case of H5N1; laboratory confirmation is not possible as no specimens from this patient are available for testing. The girl, who lived in the northern province of Kamphaeng Phet, resided with her 32-year-old aunt, whose infection has been confirmed. Both patients are known to have had contact with dead chickens.


The girl’s 26-year-old mother, whose infection is also now confirmed, resided in the Bangkok area, but provided bedside care for her daughter while hospitalized, up to the time of the child’s death. The mother fell ill upon her return to Bangkok, where she died on 20 September.
Thai officials have concluded that the mother could have acquired the infection either from some environmental source or while caring for her daughter, and that this represents a probable case of human-to-human transmission.


The family cluster also includes the 6-year-old son of the aunt of the initial case. He was hospitalized but is recovering, and samples are being tested.
Surveillance for additional cases, among health workers and in the wider community, has been greatly intensified in the province, and hospitals nationwide have been placed on heightened alert for further cases.


While the investigation of this family cluster provides evidence that human-to-human transmission may have occurred, evidence to date indicates that transmission of the virus among humans has been limited to family members and that no wider transmission in the community has occurred. Continued vigilance is needed to determine whether the epidemiological situation in humans remains stable.


Clinical samples taken from cases in the family cluster were immediately shared with a laboratory in the WHO Global Influenza Surveillance Network. Virus isolated from these samples will undergo genetic and antigenic analysis to determine whether the virus has evolved and, more specifically, whether it has acquired genes that allow improved transmissibility among humans.



http://www.who.int/csr/don/2004_09_28a/en/print.html




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Confirmed Human Cases of Avian Influenza A(H5N1) *


28 September 2004

<table border="1" cellspacing="0" width="79%"> <tbody><tr> <td width="31%">
Country/Territory
</td> <td width="37%">
Total cases
</td> <td width="32%">
Deaths
</td> </tr> <tr> <td width="31%">Thailand</td> <td align="center" width="37%">15</td> <td align="center" width="32%">10</td> </tr> <tr> <td width="31%">Viet Nam</td> <td align="center" width="37%">27</td> <td align="center" width="32%">20</td> </tr> <tr> <td width="31%">Total</td> <td align="center" width="37%">42</td> <td align="center" width="32%">30</td> </tr> </tbody></table> * This updated table includes one fatal case that occurred in Viet Nam in mid-March but has only recently been officially confirmed.


The other changes reflect four recent cases, all fatal, reported from Viet Nam since early August. Of these four cases, three have been confirmed as caused by the H5N1 strain. For the remaining case, infection with influenza A H5 subtype has been laboratory confirmed.

Notes


Total number of cases includes number of deaths.
WHO reports only laboratory-confirmed cases.


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Avian influenza – situation in Thailand; status of pandemic vaccine development


4 October 2004

Situation in Thailand

The Ministry of Public Health in Thailand has today confirmed a further case of human infection with H5N1 avian influenza. The case, which was fatal, was a 9-year-old girl from the northern province of Phetchabun. She developed symptoms on 23 September, was hospitalized on 27 September, and died of severe respiratory disease on 3 October.


Investigation of the case has identified exposure to diseased chickens as the most likely cause of infection. Following the death of chickens in the child’s household, she assisted in preparation of the birds for cooking, including the plucking of feathers.


WHO stresses the importance of educating populations in affected countries, especially those living in remote rural areas, about the danger of contact with diseased birds.


Since the beginning of this year, Thailand has reported 16 laboratory confirmed cases of H5N1 infection, of which 11 have been fatal. Four of these cases have occurred during the past four weeks.


Last week, Thai officials announced a probable case of human-to-human transmission in a family cluster of cases. Analysis of specimens from this cluster is presently under way at a WHO collaborating laboratory to determine whether the virus has changed its genetic make-up. Heightened surveillance for further cases has provided no evidence that efficient and sustained human-to-human transmission is presently occurring in Thailand.


Status of vaccine development for an influenza pandemic

A vaccine could reduce the high morbidity and mortality normally associated with influenza pandemics, if available sufficiently early. Significant efforts are needed to expedite vaccine development and thus take advantage of this preventive option.


Progress is needed on three fronts. First, countries experiencing outbreaks need to rapidly share human and animal viruses with laboratories in the WHO Global Influenza Surveillance Network. Analysis of these viruses determines the possible need for changes in the prototype vaccine “seed” strains which WHO makes available to the pharmaceutical industry.


Second, companies need to engage in research on pandemic vaccine development that includes pilot production of small batches for clinical testing. National licensing agencies in Europe and North America have developed regulatory guidelines for industry.


Third, public health agencies need to engage in discussions with pharmaceutical companies to explore areas of common interest in vaccine development and identify areas where support is needed. Since 2003, when two cases of human H5N1 infection occurred in Hong Kong SAR, WHO has worked to identify and resolve problems in order to pave the way for rapid development and production of a pandemic vaccine.


Vaccine manufacturers respond to market forces. Companies may be reluctant to produce a vaccine for an event, such as a pandemic, that cannot be predicted with any certainty and might not be caused by currently circulating strains. Some uncertainty has also centered on rights to use the special technique of reverse genetics, a patented procedure, that is needed to produce the prototype “seed” vaccine against H5N1.


At the beginning of April 2004, WHO made the prototype seed strain for an H5N1 vaccine available to manufacturers. To date, only two of the world’s roughly 12 major companies producing influenza vaccines have taken work on a pandemic vaccine significantly forward. These two companies, Aventis Pasteur Inc. and Chiron Corp., both located in the USA, have produced small batches of vaccine for use in clinical trials. These trials, which require several months for the compilation and analysis of data, are needed to fine-tune vaccine composition, test safety, and meet other licensing requirements. Trials are not expected to begin before year-end.



http://www.who.int/csr/don/2004_10_04/en/print.html




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Cumulative Number of Confirmed Human Cases of Avian Influenza A(H5N1) since 28 January 2004


4 October 2004

<table border="1" cellspacing="0" width="79%"> <tbody><tr> <td width="31%">
Country/Territory
</td> <td width="37%">
Total cases
</td> <td width="32%">
Deaths
</td> </tr> <tr> <td width="31%">Thailand</td> <td align="center" width="37%">16</td> <td align="center" width="32%">11</td> </tr> <tr> <td width="31%">Viet Nam</td> <td align="center" width="37%">27</td> <td align="center" width="32%">20</td> </tr> <tr> <td width="31%">Total</td> <td align="center" width="37%">43</td> <td align="center" width="32%">31</td> </tr> </tbody></table> Notes


Total number of cases includes number of deaths.
WHO reports only laboratory-confirmed cases.

http://www.who.int/csr/disease/avian_influenza/country/cases_table_2004_10_04/en/print.html


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Avian influenza – situation in Thailand; additional fatal case confirmed


25 October 2004

The Ministry of Public Health in Thailand has today confirmed an additional fatal case of human infection with H5N1 avian influenza. The patient was a 14-year-old girl from Sukhothai Province. She developed symptoms on 8 October and died on 19 October. Chickens at her household died suddenly in late September.


The girl’s death brings the total in Thailand to 17 cases, of which 12 have been fatal.



http://www.who.int/csr/don/2004_10_25/en/print.html




<hr style="border: 1px none ; height: 1px; background-color: rgb(0, 0, 0); width: 759px;" align="left">
Cumulative Number of Confirmed Human Cases of Avian Influenza A(H5N1) since 28 January 2004


25 October 2004

<table border="1" cellspacing="0" width="79%"> <tbody><tr> <td width="31%">
Country/Territory
</td> <td width="37%">
Total cases
</td> <td width="32%">
Deaths
</td> </tr> <tr> <td width="31%">Thailand</td> <td align="center" width="37%">17</td> <td align="center" width="32%">12</td> </tr> <tr> <td width="31%">Viet Nam</td> <td align="center" width="37%">27</td> <td align="center" width="32%">20</td> </tr> <tr> <td width="31%">Total</td> <td align="center" width="37%">44</td> <td align="center" width="32%">32</td> </tr> </tbody></table> Notes


Total number of cases includes number of deaths.
WHO reports only laboratory-confirmed cases.
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Re: WHO Situation Updates - Avian Influenza Archive

Re: WHO Situation Updates - Avian Influenza Archive

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Avian influenza ? situation in Asia: altered role of domestic ducks


29 October 2004

Countries experiencing outbreaks of H5N1 in poultry need to be aware that domestic ducks may have acquired an important role in the transmission of highly pathogenic H5N1 to other poultry and, possibly, to humans as well.


A new laboratory study of domestic ducks infected with several 2004 H5N1 viruses shows that, when compared with infections caused by viruses from 2003, domestic ducks are shedding more virus for longer periods. The majority are doing so without showing symptoms of illness.


Findings from this study also show that, compared to highly pathogenic avian influenza viruses from previous outbreaks, the recent H5N1 viruses survive several days longer in the environment.


The study found that the quantities of virus excreted by healthy-looking ducks approach those excreted by diseased ? and visibly very ill ? chickens. This suggests that domestic ducks might now be acting as a ?silent? reservoir for the H5N1 virus, which is highly pathogenic for chickens.<sup>1</sup>
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To date, no evidence has linked human H5N1 cases to exposure to asymptomatic domestic ducks. However, the laboratory findings come at a time when some human cases could not be traced to contact with diseased or dead poultry.


In terms of preventing further human cases, it is of public health concern that ducks may be infected and shed virus for long periods, yet issue no ?warning signal? in the form of visible signs and symptoms that alert people to take precautions. The concern is greatest in rural areas of affected countries, where free-ranging ducks and chickens often mingle, frequently sharing the same water supplies.


The new findings expand on recent evidence, based on characterization of H5N1 viruses from southern China, that domestic ducks have played a central role in generating and maintaining H5N1, in its highly pathogenic form, in parts of Asia.<sup>2</sup>
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Findings pointing to an altered role for domestic ducks join other recent evidence that the H5N1 virus circulating in parts of Asia has increased its pathogenicity in chickens and mice (a laboratory model for mammals), and has expanded its host range to include mammals, such as felines, not previously considered susceptible to infection.


Public health recommendations for affected countries

? Investigations of human cases should now include possible exposure to apparently healthy domestic ducks, as well as to diseased or dead poultry, as a risk factor for infection.


? Advice for people living in an affected area should be revised to include precautions for apparently healthy ducks similar to those for visibly ill poultry.


? Ducks should not be kept as pets or allowed to enter households.


? Water supplies for human use should not be drawn from open ponds used by domestic ducks and should be stored in ways that prevent contact with ducks.


? Once prepared and properly cooked, duck meat and eggs do not pose a risk to human health.


? Significant exposure can occur during home slaughtering and preparation prior to cooking, and these risks need to be addressed.


WHO, FAO, and OIE recognize that the altered role of domestic ducks in the transmission cycle of H5N1 should be addressed as it may complicate efforts to control the disease in poultry and prevent further human cases.
Research on the prevalence of asymptomatic infection in ducks in Asia is urgently needed. Such information will allow a focused approach to the prevention of human cases arising from exposure to apparently healthy domestic ducks.


The wider implications of the role played by domestic ducks are being jointly considered by FAO and OIE in formulating a long-term strategy for bringing the current outbreaks in poultry under control. With the H5N1 virus now endemic in parts of Asia, significant changes in farming practices may be needed to control the disease, especially in rural areas, and thus reduce opportunities for community-wide exposure.


In animals, surveillance remains the key to prevention and control, and this activity needs to be adequately supported.


FAO and OIE have recently issued comprehensive guidelines for responding to the outbreaks of H5N1 in poultry in Asia:


The two agencies are conducting research on the epidemiology of H5N1 infection in ducks and on the use of vaccination to control infection.


<sup>1</sup> In the past, outbreaks of highly pathogenic avian influenza in poultry began following the primary introduction of a virus, of low pathogenicity, probably carried by a wild bird. The virus then required several months of circulation in domestic poultry in order to mutate from a form causing very mild disease to a form causing highly pathogenic disease, with a mortality approaching 100%. Only viruses of the H5 and H7 subtypes are capable of mutating to cause highly pathogenic disease. In the present outbreaks, however, asymptomatic domestic ducks can directly introduce the virus, in its highly pathogenic form, to poultry flocks.


<sup>2</sup> Li KS, Wang J, Smith GJD et al. Genesis of a highly pathogenic and potentially pandemic H5N1 influenza virus in eastern Asia. Nature; 430 (8 July 2004): 209?13.
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Re: WHO Situation Updates - Avian Influenza Archive

Re: WHO Situation Updates - Avian Influenza Archive

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Avian influenza ? situation in Viet Nam


30 December 2004

WHO has received informal reports of a laboratory-confirmed case of H5N1 infection in Viet Nam.


The patient, who has been hospitalized since 26 December, is a 16-year-old girl who fell ill in the southern province of Tay Ninh.
Vietnamese authorities are investigating the source of her infection, including the possibility of contact with infected poultry.


This is the first human case of H5N1 detected in Viet Nam since early September. It coincides with several fresh poultry outbreaks reported in southern provinces in December. Recent poultry outbreaks in Tay Ninh Province have not been reported.


As avian influenza viruses become more active at cooler temperatures, further poultry outbreaks, possibly accompanied by sporadic human cases, can be anticipated.


Poultry marketing, transportation, and consumption increase in Viet Nam with the approach of the Lunar New Year in early February. These activities create conditions favouring the spread of poultry outbreaks and call for heightened control measures.


Since January of this year, 28 human cases have been detected in Viet Nam. Of these, 20 were fatal. Thailand has also reported human cases, bringing the total in Asia since the beginning of this year to 45 cases, of which 32 have been fatal.



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