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2006 WHO Situation Updates - Avian Influenza Archive

MHSC

MHSC

Senior Moderator
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Avian influenza – situation in Turkey


5 January 2006

The Ministry of Health in Turkey has confirmed its first two cases of human infection with avian influenza caused by the H5 virus subtype. Both cases were fatal.


The first case was a 14-year-old boy from the rural district of Dogubayazit, in the eastern province of Agri, which borders the Islamic Republic of Iran and Armenia. He was hospitalized in Van Province on 1 January and died the same day. The second case was his 15-year-old sister, also hospitalized on 1 January. She died on 5 January.


Earlier this week, Turkish authorities had ruled out avian influenza in these cases based on preliminary test results from samples taken from the nose and throat. Subsequent tests of additional patient specimens taken from the lungs produced positive results. Patient samples were sent today to a WHO collaborating centre in the United Kingdom for further analysis. The samples have now arrived; results are expected within the next days.


Turkish health authorities have informed WHO that, since 1 January, a total of 11 patients (including the two confirmed fatal cases) have been hospitalized in Van Province with symptoms suggesting infection with avian influenza. Most patients are children between the ages of six and fifteen years and all reside in the Dogubayazit district. Two of the children are siblings of the two confirmed cases.


Following a request by the Ministry of Health, an initial team of experts from WHO, the European Centre for Disease Prevention and Control and the European Commission is travelling today to Turkey to collaborate with the authorities in their investigation of the situation.


Initial information about the confirmed cases suggests that the children acquired their infection following close contact with chickens. Deaths of chickens are known to have occurred in the Dogubayazit district near the end of last year. Although no poultry outbreak has been officially reported in the district, a confirmed outbreak of H5N1 avian influenza in chickens and ducks was reported on 27 December in the adjacent province of Igdir.
National authorities have informed WHO that Dogubayazit district has been placed under quarantine; no people or animals are allowed to move in or out of the district. Culling operations are currently under way.


The two Turkish cases mark the first confirmed reports of human infection with avian influenza outside East Asia. Since January 2004, a total of 142 human cases of H5N1 infection have been reported in Viet Nam, Thailand, Cambodia, Indonesia, and China. The cases in Turkey bring the number of affected countries to six, from which 144 cases have now been reported.


Turkey reported its first outbreak of H5N1 avian influenza in poultry in mid-October of last year. That outbreak, which occurred in the northwestern part of the country, was attributed to contact between domestic poultry and migratory waterfowl. The outbreak in Igdir and other suspected outbreaks in this part of the country are thought to have occurred following introduction of the virus by migratory birds. The region, which has several large lakes, is known to lie along migratory routes.



http://www.who.int/csr/don/2006_01_05/en/print.html



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Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO


5 January 2006

<table border="2" cellpadding="2" width="100%"> <tbody><tr> <td rowspan="2" width="11%">Date of onset</td> <td colspan="2" align="center" width="12%">Cambodia</td> <td colspan="2" align="center" width="22%"> China</td> <td colspan="2" align="center" width="22%">
Indonesia​
</td> <td colspan="2" align="center" width="16%">Thailand</td> <td colspan="2" align="center" width="16%">Turkey</td> <td colspan="2" align="center" width="22%">
Viet Nam​
</td> <td colspan="2" align="center" width="23%">Total</td> </tr> <tr> <td align="center" width="5%">cases</td> <td align="center" width="6%">deaths</td> <td align="center" width="6%">cases</td> <td align="center" width="7%">deaths</td> <td align="center" width="11%">cases</td> <td align="center" width="11%">deaths</td> <td align="center" width="11%">cases</td> <td align="center" width="7%">deaths</td> <td align="center" width="11%">cases</td> <td align="center" width="7%">deaths</td> <td align="center" width="11%">cases</td> <td align="center" width="11%">deaths</td> <td align="center" width="11%">cases</td> <td align="center" width="12%">deaths</td> </tr> <tr> <td width="11%">2003</td> <td align="center" width="5%">0</td> <td align="center" width="6%">0</td> <td align="center" width="6%">0</td> <td align="center" width="7%">0</td> <td align="center" width="11%"> 0</td> <td align="center" width="11%">0</td> <td align="center" width="11%">0</td> <td align="center" width="7%">0</td> <td align="center" width="11%">0</td> <td align="center" width="7%">0</td> <td align="center" width="11%">3</td> <td align="center" width="11%">3</td> <td align="center" width="11%">3</td> <td align="center" width="12%">3</td> </tr> <tr> <td width="11%">2004</td> <td align="center" width="5%">0</td> <td align="center" width="6%">0</td> <td align="center" width="6%">0</td> <td align="center" width="7%">0</td> <td align="center" width="11%"> 0</td> <td align="center" width="11%">0</td> <td align="center" width="11%">17</td> <td align="center" width="7%">12</td> <td align="center" width="11%">0</td> <td align="center" width="7%">0</td> <td align="center" width="11%">29</td> <td align="center" width="11%">20</td> <td align="center" width="11%">46</td> <td align="center" width="12%">32</td> </tr> <tr> <td width="11%">2005</td> <td align="center" width="5%">4</td> <td align="center" width="6%">4</td> <td align="center" width="6%">7</td> <td align="center" width="7%">3</td> <td align="center" width="11%"> 16</td> <td align="center" width="11%">11</td> <td align="center" width="11%"> 5</td> <td align="center" width="7%">2</td> <td align="center" width="11%"> 0</td> <td align="center" width="7%">0</td> <td align="center" width="11%"> 61</td> <td align="center" width="11%">19</td> <td align="center" width="11%"> 93</td> <td align="center" width="12%"> 39</td> </tr> <tr> <td width="11%">2006</td> <td align="center" width="5%">0</td> <td align="center" width="6%">0</td> <td align="center" width="6%">0</td> <td align="center" width="7%">0</td> <td align="center" width="11%"> 0</td> <td align="center" width="11%">0</td> <td align="center" width="11%"> 0</td> <td align="center" width="7%">0</td> <td align="center" width="11%"> 2</td> <td align="center" width="7%">2</td> <td align="center" width="11%"> 0</td> <td align="center" width="11%">0</td> <td align="center" width="11%"> 2</td> <td align="center" width="12%"> 2</td> </tr> <tr> <td width="11%">Total</td> <td align="center" width="5%">4</td> <td align="center" width="6%">4</td> <td align="center" width="6%">7</td> <td align="center" width="7%">3</td> <td align="center" width="11%"> 16</td> <td align="center" width="11%">11</td> <td align="center" width="11%"> 22</td> <td align="center" width="7%">14</td> <td align="center" width="11%"> 2</td> <td align="center" width="7%">2</td> <td align="center" width="11%"> 93</td> <td align="center" width="11%">42</td> <td align="center" width="11%"> 144</td> <td align="center" width="12%"> 76</td> </tr> </tbody></table> Total number of cases includes number of deaths.
WHO reports only laboratory-confirmed cases.
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Avian influenza – situation in Turkey - update


7 January 2006

The Ministry of Health in Turkey has confirmed an additional two cases of human infection with the H5N1 avian influenza virus. Both cases are children, aged five and eight years, and both are hospitalized. This brings the total number of laboratory confirmed cases in Turkey to four. Two of these cases were fatal.


A WHO collaborating laboratory in the United Kingdom has today confirmed detection of the H5N1 virus in samples taken from the two fatal cases.
The Ministry of Health has also announced a third death, presumably caused by the H5N1 virus, in a 12-year-old girl. The girl, who died on 6 January, is a sibling of the two children who died. A fourth child in the family, a six-year-old boy, is also hospitalized. Tests on samples from these patients are ongoing; neither is laboratory confirmed at present.


According to Turkish authorities, some 30 patients are being treated and evaluated for possible H5N1 infection at a hospital in Van Province. Most of the patients are children, and the majority come from the rural district of Dogubayazit.


Plans for a team of international experts to travel today to Van Province have been deferred because of adverse weather conditions. Government officials are assisting the team in finding a rapid mode of transportation to the affected area in the eastern part of the country.


To date, all evidence indicates that patients have acquired their infections following close contact with diseased poultry. Contact between people and poultry has likely increased during the present cold weather, when the custom among many rural households is to bring poultry into their homes. Tests have shown that the virus can survive in bird faeces for at least 35 days at low temperatures (4<sup>o</sup>C).


Based on experiences during the avian H5N1 outbreaks in Asia, behaviours that carry an especially high risk of infection include the slaughtering, defeathering, butchering, and preparation for consumption of diseased poultry. These behaviours tend to occur most frequently in rural areas where populations traditionally slaughter and consume birds once deaths or signs of illness are seen in poultry flocks.


In recent days, vigilance for outbreaks of the disease in poultry has increased considerably. Outbreaks of highly pathogenic H5N1 avian influenza have now been confirmed in six provinces in the eastern and south-eastern part of the country. Outbreaks at additional sites in the area are under investigation.


Avoidance of high-risk behaviours remains the most important way for local populations to protect themselves from infection.



http://www.who.int/csr/don/2006_01_07/en/print.html



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Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO


7 January 2006

<table border="2" cellpadding="2" width="100%"> <tbody><tr> <td rowspan="2" width="11%">Date of onset</td> <td colspan="2" align="center" width="12%">Cambodia</td> <td colspan="2" align="center" width="22%"> China</td> <td colspan="2" align="center" width="22%">
Indonesia​
</td> <td colspan="2" align="center" width="16%">Thailand</td> <td colspan="2" align="center" width="16%">Turkey</td> <td colspan="2" align="center" width="22%">
Viet Nam​
</td> <td colspan="2" align="center" width="23%">Total</td> </tr> <tr> <td align="center" width="5%">cases</td> <td align="center" width="6%">deaths</td> <td align="center" width="6%">cases</td> <td align="center" width="7%">deaths</td> <td align="center" width="11%">cases</td> <td align="center" width="11%">deaths</td> <td align="center" width="11%">cases</td> <td align="center" width="7%">deaths</td> <td align="center" width="11%">cases</td> <td align="center" width="7%">deaths</td> <td align="center" width="11%">cases</td> <td align="center" width="11%">deaths</td> <td align="center" width="11%">cases</td> <td align="center" width="12%">deaths</td> </tr> <tr> <td width="11%">2003</td> <td align="center" width="5%">0</td> <td align="center" width="6%">0</td> <td align="center" width="6%">0</td> <td align="center" width="7%">0</td> <td align="center" width="11%"> 0</td> <td align="center" width="11%">0</td> <td align="center" width="11%">0</td> <td align="center" width="7%">0</td> <td align="center" width="11%">0</td> <td align="center" width="7%">0</td> <td align="center" width="11%">3</td> <td align="center" width="11%">3</td> <td align="center" width="11%">3</td> <td align="center" width="12%">3</td> </tr> <tr> <td width="11%">2004</td> <td align="center" width="5%">0</td> <td align="center" width="6%">0</td> <td align="center" width="6%">0</td> <td align="center" width="7%">0</td> <td align="center" width="11%"> 0</td> <td align="center" width="11%">0</td> <td align="center" width="11%">17</td> <td align="center" width="7%">12</td> <td align="center" width="11%">0</td> <td align="center" width="7%">0</td> <td align="center" width="11%">29</td> <td align="center" width="11%">20</td> <td align="center" width="11%">46</td> <td align="center" width="12%">32</td> </tr> <tr> <td width="11%">2005</td> <td align="center" width="5%">4</td> <td align="center" width="6%">4</td> <td align="center" width="6%">7</td> <td align="center" width="7%">3</td> <td align="center" width="11%"> 16</td> <td align="center" width="11%">11</td> <td align="center" width="11%"> 5</td> <td align="center" width="7%">2</td> <td align="center" width="11%"> 0</td> <td align="center" width="7%">0</td> <td align="center" width="11%"> 61</td> <td align="center" width="11%">19</td> <td align="center" width="11%"> 93</td> <td align="center" width="12%"> 39</td> </tr> <tr> <td width="11%">2006</td> <td align="center" width="5%">0</td> <td align="center" width="6%">0</td> <td align="center" width="6%">0</td> <td align="center" width="7%">0</td> <td align="center" width="11%"> 0</td> <td align="center" width="11%">0</td> <td align="center" width="11%"> 0</td> <td align="center" width="7%">0</td> <td align="center" width="11%"> 4</td> <td align="center" width="7%">2</td> <td align="center" width="11%"> 0</td> <td align="center" width="11%">0</td> <td align="center" width="11%"> 4</td> <td align="center" width="12%"> 2</td> </tr> <tr> <td width="11%">Total</td> <td align="center" width="5%">4</td> <td align="center" width="6%">4</td> <td align="center" width="6%">7</td> <td align="center" width="7%">3</td> <td align="center" width="11%"> 16</td> <td align="center" width="11%">11</td> <td align="center" width="11%"> 22</td> <td align="center" width="7%">14</td> <td align="center" width="11%"> 4</td> <td align="center" width="7%">2</td> <td align="center" width="11%"> 93</td> <td align="center" width="11%">42</td> <td align="center" width="11%"> 146</td> <td align="center" width="12%"> 76</td> </tr> </tbody></table> Total number of cases includes number of deaths.
WHO reports only laboratory-confirmed cases.
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Avian influenza ? situation in Turkey - update 2


9 January 2006

Laboratory tests conducted in Turkey have confirmed detection of the H5 subtype of avian influenza virus in samples from an additional 10 patients. Five of these cases were announced by the Ministry of Health yesterday and an additional five were announced today. Most patients are children and all have been hospitalized for treatment and evaluation.


Of the five patients announced on Sunday, three are from Ankara Province and include two brothers, aged five and two years, and a 65-year-old man. All three patients are hospitalized in Ankara. The additional two cases, a nine-year-old girl and her three-year-old brother, are from the Dogubeyazit district in Agri Province, and are hospitalized in the city of Van.


The five cases announced today are from Kastamonu, Corum, and Samsun provinces, bordering the Black Sea in the north-central part of the country, and from Van Province.


This brings the total number of cases in Turkey, confirmed by laboratory tests there, to 14. Of these patients, two have died. WHO will add these numbers to its cumulative total following further verification by an external H5 reference laboratory.


The quality of laboratory testing at Turkey?s National Influenza Centre in Ankara is high. Results from tests conducted there last week were fully confirmed by a WHO collaborating laboratory in the United Kingdom. WHO considers it likely that test results on the newly announced cases will be confirmed by the UK laboratory, where samples are being sent for further analysis. H5N1 is the only strain within the H5 subtype known to infect humans. In the event of a confirmed H5N1 outbreak in birds, it is expected that human cases of avian influenza will be caused by the same virus strain.


The initial WHO team, accompanied by the Turkish Minister of Health, arrived in Van Province yesterday evening. The team is now investigating the epidemiological situation, assessing risk factors and control measures, and discussing with local authorities the possible need for additional equipment and supplies. The team will also be assessing patients at the Van hospital where some 38 people are currently being treated and evaluated for possible H5N1 infection.


The initial investigation has found no evidence that the virus has increased its transmissibility or is spreading from person to person. Most persons under investigation are children, often from the same family, and almost all have a documented link to dead or diseased poultry.


Outbreaks in poultry are now known to be occurring in several parts of the country. In recent days, the Ministry of Agriculture has confirmed H5N1 outbreaks in birds in 10 of the country?s 81 provinces. Extensive culling is under way, and several other possible outbreaks are under investigation.


With the agreement of the Ministry of Health, two epidemiologists and two experts in laboratory diagnosis will join the initial WHO team in the next few days. Given the present high level of awareness of the disease and its presence in poultry in several parts of the country, the number of people concerned about possible exposure is expected to increase. This additional support should expedite understanding of the epidemiological situation and increase the capacity to rapidly confirm or rule out persons under investigation for possible infection.



http://www.who.int/csr/don/2006_01_09/en/print.html

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Avian influenza ? situation in China


10 January 2006

The Ministry of Health in China has confirmed the country?s eighth case of human infection with the H5N1 avian influenza virus. The patient is a six-year-old boy from the southern province of Hunan. He developed symptoms of fever and pneumonia on 24 December and is presently hospitalized in stable condition.


Chinese authorities have also reported that two cases, previously announced, have subsequently died. The deaths occurred in a 10-year-old girl from the Guangxi region, reported on 7 December, and a 35-year-old man from Jiangxi Province, reported on 16 December.


Of the eight confirmed cases in China, five have now died.


Initial investigation of the newly confirmed case has identified recent poultry deaths in the family flock as the likely source of exposure, though no poultry outbreaks have been officially reported in the area. Close contacts have been placed under medical observation and none has shown symptoms of infection to date.


This is the second confirmed case from Hunan Province. The earlier Hunan case, which was one of the first two reported in China in mid-November 2005, lived around 300 kilometres away from the present case.


In addition to Hunan, provinces and regions reporting human cases of H5N1 infection include Anhui, Guangxi, Liaoning, Jiangxi, and Fujian.



http://www.who.int/csr/don/2006_01_10/en/print.html
 
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Avian influenza ? situation in Turkey - update 3


10 January 2006

Tests conducted in Turkish laboratories have confirmed the country?s 15th case of human infection with the H5N1 avian influenza virus. The patient is a 37-year-old woman with a history of exposure to diseased chickens. She resides in the central province of Sivas, the seventh province to report cases. Although no poultry outbreaks have been officially reported in this province, it is located near areas with confirmed outbreaks in birds.


The situation in birds continues to evolve, with several new outbreaks under investigation in new parts of the country. All evidence to date indicates that patients have acquired their infections following close contact with diseased birds.


The Turkish government has launched an intensive public awareness campaign. Better public understanding of the disease, supported by more complete data on disease activity in birds, could help to reduce the risk of additional human cases, pending control of the disease in birds. As the majority of confirmed cases and persons under investigation are children, it is particularly important that messages about high-risk behaviours reach children.


Some 100,000 treatment courses of oseltamivir (Tamiflu) arrived in Turkey Friday evening. This supply, which is being used for both the treatment of patients and prophylaxis of persons at risk, is considered by Turkish health officials to be adequate for responding to the current situation. WHO has organized additional support for laboratory diagnostic work, and this will be arriving within the next day or two.


Dr Marc Danzon, the WHO Director for its European office, will be arriving in Ankara tomorrow to confer with the country?s Minster of Health. They will assess the situation together and review needs for further support.



http://www.who.int/csr/don/2006_01_10a/en/print.html
 
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Avian influenza ? situation in Turkey - update 4
Sequencing of human virus


12 January 2006

Laboratory tests conducted in Turkey have confirmed detection of the H5 subtype of avian influenza virus in samples from an additional two patients. The patients are residents of Sanliurfa Province, near the southern border with Syria, and Siirt Province, which is adjacent to Van in the eastern part of the country. Human cases have now been reported from nine of the country?s 81 provinces.


Both patients are young children, aged four and six years, and both have a documented history of direct contact with diseased birds. In Sanliurfa Province, outbreaks in backyard poultry are now thought to date back to late November 2005. Altogether, agricultural officials have confirmed poultry outbreaks in 11 provinces and are investigating possible outbreaks in an additional 14 provinces across the country.


Laboratory tests completed today in Turkey have detected the H5 virus subtype in post-mortem specimens taken from a 12-year-old girl, from Agri Province, who died 7 January. The child was the sibling of two other patients who died earlier. Their infection with the H5N1 virus was subsequently confirmed by a WHO collaborating laboratory in the United Kingdom.


The Ministry of Health is now reporting 18 laboratory-confirmed cases, of which three, all from the same family, have been fatal.


Arrangements have been made to send specimens from several patients to the UK collaborating laboratory for further analysis. Due to official holidays in Turkey, specimens are not expected to arrive in the UK before Monday. The head of the collaborating laboratory is now in Ankara to support diagnostic work at the country?s national influenza centre. Ways are being sought to expedite the testing of patient samples. High awareness of the disease in the Turkish population, combined with almost daily reports of poultry outbreaks in new areas, has resulted in a large number of people concerned about exposure and seeking reassurance.


The rapid assessment of patients with a possible exposure history is providing a unique opportunity to learn more about the disease in humans. It is also generating data that can be used to assess the efficacy of antiviral drugs, as most people with an exposure history or respiratory symptoms are receiving oseltamivir either prophylactically or very early after the onset of symptoms.


Members of the international teams, in Van Province and Ankara, are today working with local experts to plan relevant studies. These studies should deepen understanding of the epidemiology of the disease, including the possibility that any human-to-human transmission may have occurred, the vulnerability to infection of health care workers and other occupationally-exposed groups, and the possibility that milder forms of the disease might be occurring in the general population.


All available evidence indicates that no sustained human-to-human transmission has occurred. As in Asia, contact with infected birds is the principal source of infection. The risk of infection for travellers to Turkey is negligible provided direct contact with dead or diseased domestic and wild birds is avoided.



Gene sequencing information on human viruses

The WHO Collaborating Centre for Reference and Research on influenza at the MRC National Institute for Medical Research in Mill Hill, London, has today completed genetic and antigenic analyses of viruses recovered from the first two fatal human cases in the Turkish outbreak.


Information provided to WHO indicates that these viruses are very similar to current avian H5N1 viruses isolated from birds in Turkey. They are also closely related to viruses isolated from the large outbreak in migratory birds that occurred at the Qinghai Lake nature reserve in China, beginning in late April of last year.


These analyses indicate that the Turkish viruses are sensitive to both classes of antiviral drugs, including oseltamivir and amantadine. WHO and collaborating experts will review the data on amantadine sensitivity. Oseltamivir remains the drug of first choice recommended by WHO.


Virus from one of the patients shows mutations at the receptor-binding site. One of the mutations has been seen previously in viruses isolated from a small outbreak in Hong Kong in 2003 (two cases, one of which was fatal) and from the 2005 outbreak in Viet Nam. Research has indicated that the Hong Kong 2003 viruses bind preferentially to human cell receptors more so than to avian cell receptors. Researchers at the Mill Hill laboratory anticipate that the Turkish virus will also have this characteristic.


Interpretation of the significance of this finding for human health will depend on clinical and epidemiological data now being gathered in Turkey.


All available evidence indicates that no sustained human-to-human transmission is occurring in any country experiencing human cases.


The present WHO level of pandemic alert remains at phase 3: human infections with a new virus subtype are occurring, but the vast majority of these infections are acquired directly from animals.



http://www.who.int/csr/don/2006_01_12/en/print.html

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Avian influenza ? situation in Indonesia


14 January 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 29-year-old woman who worked as a midwife at the maternity ward in a Jakarta hospital. She developed symptoms on 31 December, was hospitalized on 2 January, and died on 11 January.


Investigations conducted by the Ministry of Health and WHO found evidence of poultry deaths in her neighbourhood in the two weeks prior to onset of illness. Other findings indicate that the patient visited a live-bird market to select and purchase freshly slaughtered chicken in the days immediately prior to symptom onset. Investigations at these sites are continuing.


The possibility that the patient acquired her infection from an occupational exposure is considered unlikely. Investigations conducted today reveal that none of her co-workers was ill prior to the start of her illness. According to hospital records, no patients in the ward where she worked showed signs of influenza-like illness while hospitalized.


Contact tracing has been extensive for this case as the woman worked two shifts at the hospital at the time of symptom onset. At this stage, there is no evidence that she transmitted the infection to any patients under her care or to colleagues at the hospital. Similarly, there are no signs of illness in family members or neighbours. Health monitoring of contacts will continue until the maximum incubation period has ended.


The newly confirmed case is the 17th in Indonesia and the 12th fatality.



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Avian influenza ? situation in Turkey - update 5


16 January 2006

Laboratory tests conducted at Turkey?s national influenza centre in Ankara have confirmed two additional cases of human infection with the H5N1 avian influenza virus. The first newly confirmed case is a five-year-old boy from the district of Dogubayazit in Agri Province in the eastern part of the country. He remains hospitalized in a stable condition.


His 14-year-old sister died on 15 January of a respiratory disease with clinical features similar to those seen in H5N1 infection. Test results received today have confirmed her infection.


As with all other cases seen in Turkey to date, both children developed illness following direct exposure to diseased poultry.


Ducks began dying in the family?s household flock on 1 January. On that day, the girl, assisted by her brother, slaughtered a duck for food. Both children developed symptoms on 4 January and both were hospitalized on 11 January. No other family members have developed signs of illness. These newly confirmed cases bring the total in Turkey to 20, of which four were fatal. Of the 20 cases, 18 have been children in the age range of four to 18 years.


A large number of patient samples have been sent to a WHO collaborating laboratory in the United Kingdom for verification of diagnosis and further analysis. WHO will adjust the number of cases and deaths in Turkey in its cumulative table of laboratory-confirmed cases upon receipt of results from the UK laboratory.


New outbreaks in birds continue to be reported across the country. To date, poultry outbreaks of highly pathogenic H5N1 avian influenza have been confirmed in 12 of the country?s 81 provinces. Outbreaks in an additional 19 provinces are under investigation.



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Avian influenza ? situation in Turkey ? update 6


18 January 2006

Laboratory tests conducted at Turkey?s national influenza centre in Ankara have confirmed an additional case of human infection with the H5N1 avian influenza virus. The case is a 4-year-old boy from the district of Dogubayazit in Agri Province in the eastern part of the country. An outbreak in poultry began in the district in December 2005. The child developed symptoms on 5 January and was hospitalized on 13 January. He is being treated at a hospital in Erzurum Province.


Like the two cases confirmed on 16 January, also from Dogubayazit, exposure in this case occurred prior to the government?s launch of an intensive public education campaign. Rapid surveys conducted in the most severely affected eastern part of the country have found an almost universal awareness of the disease and of the risk factors for infection. This awareness has been accompanied by behavioural changes that are expected to reduce opportunities for human infections to occur.


As the virus is now known to be present in birds in many parts of the country, some additional human cases should be anticipated in the immediate future. The number of these cases is, however, expected to decline as high-risk behaviours become less common and culling operations, which are presently under way, reduce the number of infected birds.


The newly confirmed case brings the total in Turkey to 21. Of these cases, four were fatal. All four were residents of Dogubayazit.


A second shipment of laboratory specimens arrived yesterday at a WHO collaborating laboratory in the United Kingdom. Apart from providing diagnostic confirmation, the laboratory will undertake viral characterization and genetic and antigenic analyses of viruses. These studies help determine whether the virus is evolving. Antigenic analysis of the virus helps ensure that work on the development of a pandemic vaccine stays on track. Initial results are expected later this week.



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Avian influenza ? situation in China - update


19 January 2006

The Ministry of Health in China has confirmed an additional case of human infection with the H5N1 avian influenza virus. The case occurred in a 35-year-old woman, from the south-central province of Sichuan, who had been employed as a poultry culler. She developed symptoms on 3 January, was hospitalized on 10 January with symptoms of fever and pneumonia, and died on 11 January.


Further investigation is under way to determine whether the woman may have acquired her infection during culling operations or as a result of direct exposure to infected birds in her village. She lived in a compound where eight families were housed in close quarters. Members of these families and other close contacts have been placed under medical observation. No signs of influenza-like illness have been reported to date.


The newly confirmed case is the ninth in China. Of these cases, 6 have been fatal. The cases have occurred in 7 provinces and regions: Anhui, Guangxi, Liaoning, Jiangxi, Fujian, Hunan, and Sichuan.



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Avian influenza ? situation in Indonesia - update


23 January 2006

The Ministry of Health in Indonesia has confirmed an additional 2 cases of human infection with the H5N1 avian influenza virus. Both cases were fatal.
The first patient was a 13-year-old girl. She developed symptoms on 6 January, was hospitalized on 12 January, and died on 14 January. The second patient was her four-year-old brother. He developed symptoms on 8 January, was hospitalized on 14 January, and died on 17 January.


Two other family members, a 14-year-old sister and the 43-year-old father, remain hospitalized with respiratory symptoms. The sister was hospitalized on 14 January and the father on 17 January. Samples from these cases are being tested to determine whether they were also infected with the H5N1 avian influenza virus.


Investigations conducted by the Ministry of Health and WHO found evidence of a large poultry outbreak in the family?s neighbourhood. Chickens kept by the family began to die three days before the first patient developed symptoms. All family members had close contact with the diseased chickens and assisted in the removal of dead birds.


Contacts have been traced, blood samples have been taken, and monitoring for signs of influenza-like illness continues. The authorities began culling operations in the area over the weekend. The newly confirmed cases bring the total in Indonesia to 19. Of these cases, 14 were fatal.



http://www.who.int/csr/don/2006_01_23/en/print.html

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Avian influenza ? situation in China ? update 2


25 January 2006

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


The case occurred in a 29-year-old woman from Chengdu City in the south-central province of Sichuan. She developed fever on 12 January and was hospitalized with symptoms of pneumonia. Authorities say her condition deteriorated rapidly, and she died on 23 January.


Information provided to WHO indicates that she was self-employed in a shop selling dry goods. No information on possible exposure to diseased birds as the source of her infection is presently available, but an investigation is under way. Close contacts have been placed under medical observation.


This is the second human case reported this year in China, both from Sichuan Province. The two Sichuan cases occurred in different prefectures located around 150 km apart. A confirmed outbreak of H5N1 in poultry began in late December in another part of the province. No outbreaks have been confirmed in the areas where the two human cases resided.


During 2005, Chinese agricultural authorities reported 32 outbreaks in poultry in 12 provinces, resulting in the culling of more than 24 million birds. The appearance of human cases in areas without reported poultry outbreaks is a cause for concern. WHO recommends that, in China, testing for possible H5N1 infection should be undertaken in all cases of severe respiratory disease having no alternative diagnosis, even when no poultry outbreak has been reported in the patient?s area of residence.


Of the ten cases confirmed in China, seven have been fatal. The cases have occurred in 7 provinces and regions: Anhui, Guangxi, Liaoning, Jiangxi, Fujian, Hunan, and Sichuan. No poultry outbreaks have been officially reported in two of these provinces.



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Avian influenza ? situation in Iraq


30 January 2006

The Ministry of Health in Iraq has confirmed the country?s first case of human infection with the H5N1 avian influenza virus. The case occurred in a 15-year-old girl who died on 17 January following a severe respiratory illness. Her symptoms were compatible with a diagnosis of H5N1 avian influenza.


Preliminary laboratory confirmation was provided by a US Naval Medical Research Unit located in Cairo, Egypt.


The girl?s 39-year-old uncle, who cared for her during her illness, developed symptoms on 24 January and died of a severe respiratory disease on 27 January.


Both patients resided in the town of Raniya near Sulaimaniyah in the northern part of the country, close to the border with Turkey. Poultry deaths were recently reported in their neighbourhood, but H5N1 avian influenza has not yet been confirmed in birds in any part of the country. Poultry samples have been sent for testing at an external laboratory.
A history of exposure to diseased birds has been found for the girl. The uncle?s source of infection is under investigation.


The Ministry of Health has further informed WHO of a third human case of respiratory illness that is under investigation for possible H5N1 infection. The patient is a 54-year-old woman, from the same area, who was hospitalized on 18 January.


Specimens are on their way to a WHO collaborating laboratory in the United Kingdom for diagnostic confirmation and further analysis.


An international team, including representatives of other UN agencies, is being assembled to assist the Ministry of Health in its investigation of the situation and its planning of an appropriate public health response. WHO staff within Iraq have been directly supporting the government?s operational response, which was launched shortly after the girl?s death.


Iraq is the seventh country to report human H5N1 infection in the current outbreak. The first human case occurred in Viet Nam in December 2003.



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Avian influenza ? situation in Turkey ? update 7


30 January 2006

A WHO collaborating laboratory in the United Kingdom has now confirmed 12 of the 21 cases of H5N1 avian influenza previously announced by the Turkish Ministry of Health. All four fatalities are among the 12 confirmed cases.


Samples from the remaining 9 patients, confirmed as H5 positive in the Ankara laboratory, are undergoing further joint investigation by the Ankara and UK laboratories.


Testing for H5N1 infection is technically challenging, particularly under the conditions of an outbreak where large numbers of samples are submitted for testing and rapid results are needed to guide clinical decisions. Additional testing in a WHO collaborating laboratory may produce inconclusive or only weakly positive results. In such cases, clinical data about the patient are used to make a final assessment.



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Avian influenza ? situation in Iraq - Update


2 February 2006

Specimens from Iraq?s first reported case of human infection with the H5N1 avian influenza virus have now been tested at a WHO collaborating laboratory in the United Kingdom. The case was a 15-year-old girl from the northern part of the country who died of severe respiratory disease on 17 January. Test results have now confirmed her infection.


Specimens from the girl?s 39-year-old uncle, who died on 27 January, and a 54-year-old woman under treatment for respiratory illness are being sent to the UK laboratory but have not yet arrived.


A joint WHO/FAO/OIE team of international experts has been despatched to Iraq at the request of the Ministry of Health. The initial small team of epidemiologists and experts on animal disease will conduct a rapid assessment of the situation in the Sulaimaniyah area of northern Iraq. Because of the security situation, the team is not expected to arrive in the area until early next week.


At present, an additional two people, showing symptoms suggestive of H5N1 infection, have been hospitalized for treatment in the Sulaimaniyah area. Health officials, with support from WHO staff, have set up an emergency operations room to respond to the outbreak, investigate rumours, and address public concerns.


Rumours of possible human cases in other parts of the country have been systematically followed up. To date, no such rumours have been substantiated.


The detection of the country?s first human case occurred despite the absence of confirmed outbreaks of the disease in poultry. Detection of the case indicates a high level of awareness of the clinical features of this disease and good vigilance on the part of clinicians. It also points to an urgent need to investigate the extent of bird outbreaks in northern Iraq and possibly elsewhere. Team members with veterinary expertise will assess animal health issues and support the government in its efforts to control the spread of the disease in poultry.


Experiences with poultry outbreaks of highly pathogenic H5N1 avian influenza in other countries have shown how quickly this virus can establish itself in poultry populations and spread widely when detection and control measures are delayed. Poultry culling is under way in northern Iraq and large numbers of birds have already been destroyed.


WHO-led teams are currently conducting or completing field assessments in nine countries in the area: Armenia, Azerbaijan, Egypt, Georgia, Iran, Lebanon, Moldova, Syria, and Ukraine.



http://www.who.int/csr/don/2006_02_02/en/print.html


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Avian influenza ? situation in Indonesia - update 2


6 February 2006

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


The first fatal case was a 22-year-old man from West Java who died on 26 January. He worked as a banana vendor at a market in East Jakarta where poultry meat was sold. Neighbours near his home reported poultry deaths prior to his onset of symptoms.


The second fatal case was a 15-year-old boy from West Java who died on 1 February. Deaths in chickens near his home were reported in the week prior to symptom onset.


The third case is a nine-year old girl from West Java who was hospitalized on 19 January and has since recovered. She lived in a village neighbouring that of the two fatal cases in siblings confirmed on 23 January.


Investigation of those cases resulted in the girl?s prompt hospitalization and treatment. She has now fully recovered. Poultry deaths were reported in her village prior to symptom onset.


The fourth case is a five-year-old boy from Lampung Province who developed symptoms in October of last year and has since fully recovered. The child is the brother of a previously confirmed case, a 20-year-old man who developed symptoms in late September and likewise fully recovered. Both the child and his brother had direct exposure to diseased chickens during slaughtering. As initial diagnostic tests produced inconclusive results, retrospective confirmation of the child?s infection relied on antibody levels in acute blood samples taken during his illness and convalescent samples taken following recovery.


All three cases with recent symptom onset resided in West Java, where a resurgence of virus activity in birds has been reported.


The newly confirmed cases bring the total in Indonesia to 23. Of these cases, 16 were fatal.



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Avian influenza ? situation in Iraq - Update 2


7 February 2006

A WHO-led team of international experts, including veterinary expertise from FAO, is now in the Erbil and Sulaimaniyah area of northern Iraq, where a fatal human case of H5N1 infection was confirmed on 30 January.


Confirmed outbreaks of highly pathogenic H5N1 in poultry were reported in the area on 2 February.


The team has met with officials in the country?s ministries of health and agriculture and is now assessing the situation in hospitals, laboratories, and animals. A list of immediate needs for support has been established.


Government officials have expressed a need for emergency supplies and equipment, including antiviral drugs, and these have already begun to arrive in the country. A 24-hour emergency operations centre has been set up in the WHO regional office in Cairo to facilitate coordination and provide back-up support.


The transportation of patient samples for diagnostic confirmation has encountered difficulties. Ways to strengthen local testing capacity are being explored together with ways to expedite the shipment of samples to WHO reference laboratories. The team has noted a need to upgrade biosafety standards in local and national laboratories.


Intensive culling of poultry is under way in the area; improved diagnostic capacity for poultry is needed to focus these efforts better. Training to enhance the diagnostic capacity of veterinary laboratories and improve surveillance has already begun. Requests for essential supplies, including diagnostic reagents, are being met.


The area has around 1.3 million poultry mainly raised by individual households, who depend on these animals for income and food. Discussions are under way to develop a compensation scheme that could lessen the hardship on these families.


The team found a good system in place for detecting and managing possible human cases, collecting specimens, and tracing and monitoring contacts. Some improvements in isolation wards are planned. Intensive training courses are being organized for hospital staff to ensure that proper measures for personal protection and infection control are in place.


Two patients hospitalized for observation have been discharged, though their condition continues to be monitored by local health teams. At present, 7 patients are being treated, in isolation, at hospitals in the area. Most of these patients have reported a history of direct contact with diseased poultry.


In addition to the confirmed fatal case, two patients under investigation for possible H5N1 infection have died. Specimens from one of these, the 39-year-old uncle of the confirmed case, have tested positive for H5N1 infection in a local laboratory; his infection has not yet been confirmed by a WHO reference laboratory.


A possible H5N1 case in the southern part of the country has been officially reported to WHO by the Ministry of Health. The case, a 13-year-old boy from the Omara area, developed symptoms on 1 February, was hospitalized with severe pneumonia on 5 February, and died the same day. Although no poultry deaths have been reported in the area, pet birds kept by the family are said to have died near the time of symptom onset.


Samples from the boy have been taken. The Minister of Health and a team from the country?s Centre for Disease Control will visit the Omara area tomorrow to investigate.



http://www.who.int/csr/don/2006_02_07/en/print.html

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Avian influenza - situation (birds) in Nigeria


8 February 2006

The confirmation of highly pathogenic H5N1 avian influenza in domestic birds in northern Nigeria marks the further geographical spread of this virus. Although all evidence to date indicates that the virus does not spread easily from birds to humans, careful monitoring of the situation is warranted.


Experience in several other countries has shown how quickly the H5N1 virus can spread and become firmly established in poultry. The ability of this virus to cause rare but severe disease in humans is well documented.
At present, the only confirmed H5N1 outbreak is thought to be confined to a large commercial farm, located in Kaduna State in the northern part of the country, where thousands of chickens were kept in battery cages. Investigations are urgently needed to determine whether the outbreak, which began almost a month ago, has spread from the farm to affect household flocks. Poultry deaths in the adjacent province of Kano have been reported, but the cause has not yet been determined.


The most immediate public health need is to reduce opportunities for human infections to occur. Investigations of human cases in Asia and elsewhere have identified close contact with diseased or dead household poultry as the most important source of human exposure to the virus.


In Nigeria, as in other parts of Africa, most village households maintain free-ranging flocks of poultry as a source of income and food. Close human contact with poultry is extensive.


If the virus has spread to household flocks in Nigeria, public information campaigns will be needed to warn populations to avoid high-risk behaviours, including the slaughtering, defeathering, butchering, and preparation for consumption of diseased poultry.


WHO is ready to respond to requests from Nigeria for support, including assessment teams and the provision of essential supplies and equipment. Infectious disease staff at WHO?s regional office in Harare, Zimbabwe held an emergency meeting today to assess the situation, plan a response, and evaluate the possible risk to other African countries. A team of experts experienced in the investigation of outbreaks has been placed on standby.
No clear information about the source of the Nigerian outbreak is presently available, but the country is known to lie along a flight route for birds migrating from central Asia.


Full sequence information about the virus in the Nigerian outbreak is expected later this week. This information will allow comparison with viruses that have caused human cases elsewhere and thus assist in the assessment of risks to human health. Sequence information may also shed some light on the origins of the outbreak.



http://www.who.int/csr/don/2006_02_08/en/print.html

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Avian influenza ? situation in China ? update 3


9 February 2006

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


The case is a 26-year-old female farmer from the south-eastern province of Fujian. She developed symptoms on 10 January and was subsequently hospitalized with pneumonia. She remains under treatment in stable condition.


Like many of the other cases in China, this one occurred in an area where no recent poultry outbreaks have been officially reported.


Of China?s eleven laboratory confirmed cases, seven have been fatal. The cases have occurred in seven provinces and regions: Anhui, Fujian, Guangxi, Jiangxi, Hunan, Liaoning, and Sichuan.


The continuing occurrence of sporadic human cases indicates that the virus is continuing to circulate in birds in at least some parts of the country. Since May 2005, agricultural authorities have reported 32 poultry outbreaks across the country, the majority of which were reported in October and November 2005.


Three poultry outbreaks have been reported so far this year: one in Sichuan Province on 3 January, one in Guizhou Province on 10 January, and one in Shanxi Province on 8 February.


The country?s first two confirmed human cases of H5N1 infection were reported in mid-November of last year.



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Avian influenza ? situation in Indonesia - update 3


13 February 2006
The Ministry of Health in Indonesia has confirmed an additional two cases of human infection with the H5N1 avian influenza virus. Both cases were fatal.


The first case occurred in a 22-year-old woman who developed symptoms on 25 January and died on 10 February. Her neighbours kept chickens. Samples from these chickens and from pet birds in a market near the woman?s home are being tested by Indonesia?s animal health authorities.


The second case occurred in a 27-year-old woman who developed symptoms on 31 January and died on 10 February. Deaths of chickens in her neighbourhood were reported four days prior to symptom onset.


The two women resided in different sub-districts of West Java Province.
The newly confirmed cases bring the total in Indonesia to 25. Of these, 18 were fatal.



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