Nov 05 Health Alerts
Avian influenza – situation in Indonesia, China
Tuesday, 29 November, 2005
Indonesia
The Ministry of Health in Indonesia has confirmed a further case of human infection with the H5N1 avian influenza virus. The case is a 16-year-old boy from West Java Province. He developed symptoms of fever and cough on 6 November, followed by breathing difficulties a few days later. He was hospitalized on 16 November and remains in stable condition.
A field investigation of this case determined that two siblings had died 5 days before his hospitalization. His two brothers, aged 7 and 20 years, had onset of illness on 3 November and died on 11 November, following symptoms of fever and breathing difficulty. The presumptive diagnosis was typhoid fever. No samples were taken before burial, which precludes definitive diagnosis. WHO reports laboratory-confirmed cases only.
No other cases of influenza-like illness were detected in the 80 households of the village.
The field investigation found that chickens in the family household had died during the two weeks preceding onset of illness in the deceased brothers. Samples from animals have been collected for testing and the investigation continues.
The newly confirmed case brings the total number in Indonesia to 12. Of these cases, 7 were fatal.
China
At the invitation of the Chinese Ministry of Health, WHO is participating in a joint mission to Anhui Province to investigate circumstances surrounding the recent detection of two human cases of H5N1 infection in that province. Both cases, which were confirmed by laboratory tests earlier this month, occurred in female farmers aged 24 and 35 years. Both cases were fatal.
The team will be gathering information about the sources of exposure in these two cases and will also assess the effectiveness of public health measures introduced in the areas. The two cases lived some distance apart; no link between the two cases is thought to exist.
China has recently experienced a recurrence of outbreaks of highly pathogenic H5N1 avian influenza in poultry. Beginning in mid-October of this year, officials have reported 25 fresh outbreaks in poultry in nine provinces. To date, the country has reported 3 laboratory-confirmed cases of human infection, of which two were fatal.
Source: World Health Organization
Hong Kong extends temperature surveillance
Monday, 28 November, 2005
The Government of Hong Kong website has announced that subsequent to the re-activation of temperature screening of people arriving in Hong Kong at Lo Wu and Lok Ma Chau on November 18, arriving passengers at Sha Tau Kok and China Ferry Terminal will also be subject to temperature screening from 25 November as a precautionary measure to reduce the chance of spread of avian influenza.
Avian Flu hits Aceh
Monday, 28 November, 2005
Numerous newspaper reports today refer to the Indonesian Ministry for Agriculture's confirmation that bird flu has emerged on Aceh. Although 20 other provinces in Indonesia have been affected by the virus its appearance in Aceh is particularly worrying as thousands of people are still living in crowded refuge camps as a result of last year's tsunami. Authorities have so far been reluctant to conduct mass culling because of economic reasons. Authorities have enforced biosecurity measures at chicken farms and have performed vaccinations in the three affected districts.
Virologist' Statement
Monday, 28 November, 2005
Related article: Virologist claims that China is under-reporting, Friday, 25 November, 2005
In a statement published by the International Society for Infectious Diseases Dr Masato Tashiro sought to correct the misinformation conveyed by the Frankfurter Allgemeine's report as cited in our Health Alert yesterday.
"I stated that WHO's official numbers of H5N1 human cases are only based on laboratory confirmed cases. It should be therefore an iceberg phenomenon. Due to poorly organized surveillance and information sharing systems in many affected countries including China, it is reasonable to consider that more cases have occurred actually. We have heard many 'rumors' or unauthorized information which we cannot confirm. In this context, I talked about a few examples of non-authorized information and rumors about Asian countries which I received through private channels."
The burden of the Health Alert does not differ from this statement.
Virologist claims that China is under-reporting
Friday, 25 November, 2005
According to the German newspaper 'Frankfurter Allgemeine' an eminent Japanese virologist and World Health Organisation consultant Dr. Masato Tashiro has claimed that China is hiding the true extent of the avian influenza affecting humans. He had recently returned from a visit to Hunan province where a "reliable source" had informed him of the true nature of H5N1 infections in China claiming substantially more humans affected. This was not an official statement but was part of a speech at a retirement function for a fellow virologist at the University of Marburg.
There have been recurrent reports of human cases of avian influenza in China. Thus far, none have been independently substantiated and only three cases have been confirmed. If the newspaper report is correct the claim, coming as it does from a WHO-supported virologist, is astonishing. However, as it is based on second-hand information it clearly requires further authentication and hopefully a clearer picture will emerge.
Avian influenza and fighting cocks
Wednesday, 23 November, 2005
Cockfighting is a popular sport in rural Thailand and many other countries in the region. Restrictions on the movement of birds in avian flu affected regions has had to include restrictions on the transport of fighting cocks and a temporary ban was imposed on all cockfighting in Thailand. This ban is about to be lifted and cockfighting competitions are expected to resume from New Year’s Day 2006 if owners register their roosters and have their health checked. However, it is estimated that only some 40,000 out of a million birds have been so registered.
From a tourist point of view it would be wise to extend the recommendation to avoid poultry farms and "wet" markets to avoiding Cockfighting competitions (especially illegal ones) and to watch out for roosters transported on local buses.
Avian Influenza Website Launch
Tuesday, 22 November, 2005
Federal Minister for Health and Ageing, the Hon Tony Abbott, today launched a new bird flu website for Australian employers, employees and travellers at a national conference run by the Australian Industry Group.
Developed by Australia’s leading national occupational and travel health organisation-the HSA Group-the website aims to help companies keep operating in the event of a flu pandemic and provide guidance to Australians working and travelling overseas. Dr Tony Gherardin, senior medical adviser and travel health specialist with the HSA Group, said all businesses would be impacted by a flu pandemic. ‘Some estimates suggest up to 40% of workers could be affected. A pandemic may last several months and see high levels of sick leave, supply chains cut, and closure of public transport, schools and some businesses,’ Dr Gherardin said.
‘Nobody can accurately predict when an influenza pandemic will occur. But it’s more than 35 years since the last one, and experts agree that current bird flu outbreaks greatly increase the chance-Australian industry needs to be undertaking pandemic planning now.’
The new website includes:
- advice on developing corporate pandemic plans to minimise the effects on staff and the bottom line
- a threat meter, updates on affected countries, travel health tips
- general information on avian flu, pandemics, vaccines and treatment.
Speaking at the launch, Minister Abbott said the new website would be a valuable resource for business planning. ‘The government is doing all that it reasonably can to ensure Australia is equipped to deal with a pandemic, should it occur. But it is also important that other areas of society, including industry, play a role and I commend and congratulate the HSA Group on this initiative,’ Minister Abbott said.
Sections of industry are already aware of the need for planning. The HSA Group has been inundated with calls from concerned clients. ‘There has been a lot of hype recently about bird flu,’ Dr Gherardin said. ‘We hope our website contributes to a better understanding of the risks, helps business planning and removes some of the fear and uncertainty.’ The new website can be accessed at www.avianinfluenza.com.au
Temperature screening for incoming travellers - Hong Kong
Monday, 21 November, 2005
Temperature screening for incoming travellers is being reactivated in a phased manner by the Hong Kong Government. This screening is apparently being aimed at travellers entering Hong Kong from Hunan and Anhui. There may be some phased increase in temperature screening over the next few weeks or months. Temperature screening will also be implemented at other immigration control points including Man Kam To, Sha Tau Kok, Hung Hom Train Station, China Ferry Terminal in Tsim Sha Tsui and Hong Kong-Macao Ferry Terminal in Sheung Wan at later stages. Further information is available at http://www.info.gov.hk/dh/new/index.htm in the News Bulletin Section.
Bird flu in humans reported from China
Friday, 18 November, 2005
This is posted direct from the World Health Organisation site 17 November 2005
The Ministry of Health in China has confirmed the country’s first two human cases of infection with the H5N1 avian influenza virus. The first case is a 9-year-old boy from the southern province of Hunan. He was hospitalized with respiratory symptoms on 17 October and has since returned home, fully recovered.
The second case is a 24-year old woman who worked as a poultry farmer in the south-eastern province of Anhui. She developed symptoms on 1 November, was hospitalized with severe pneumonia on 7 November, and died on 10 November.
Testing was conducted by the Chinese Centre for Disease Control and Prevention in Beijing.
An additional two possible human cases have been investigated in Hunan Province. The first is the boy’s 12-year-old sister. She was hospitalized on 16 October and died the following day of severe bilateral pneumonia and acute respiratory distress syndrome. Samples from the girl are inadequate for testing, and the cause of her death will probably never be known with certainty. Although evidence pointing to H5N1 infection is considered substantial by Chinese experts, WHO reports only laboratory-confirmed cases.
The additional case under investigation in Hunan is a 36-year-old schoolteacher. He was hospitalized with pneumonia on 24 October. Definitive test results are pending. A WHO team with expertise in virology and laboratory diagnosis has collaborated with national experts in the investigation of the cases in Hunan.
Avian Infuenza update Kuwait
Monday, 14 November, 2005
Health authorities have confirmed that one of 2 birds found infected with bird flu in Kuwait has the H5N1 strain of the virus. The infected bird was a migrating flamingo found on a Kuwait beach. The other was an imported falcon found to have the milder H5N2 variant. The infected birds in Kuwait are the 1st known cases of the virus in the Persian Gulf region.
Avian Influenza update China
Monday, 14 November, 2005
China has reported a new outbreak of the deadly H5N1 strain of bird flu in poultry in its northeast, the 7th in the country since the beginning of October 2005. About 300 chickens have died since 6 Nov 2005 in Beining in Liaoning province, where there had already been 3 outbreaks, the Agriculture Ministry said in a statement posted on its website. China has yet to report a human case of bird flu.
Avian Influenza update Thailand
Monday, 14 November, 2005
An 18-month-old boy in Bangkok became ill soon after the death of 3 fighting cocks and a chicken kept in his household in the Bangkok suburb of Minburi. The boy's 65-year-old grandmother also has symptoms, and test results on her were awaited. This is Thailand's fourth case in the month whereas before mid-October the country had gone a year without a human case. There have now been 21 reported cases of human infection in Thailand.
Avian flu Indonesia update
Wednesday, 9 November, 2005
The World Health Organisation update on 7th November reports confirmation by the Indonesian Ministry of Health of two human cases of H5N1 infection in Tangerang near Jakarta. A 19-year old girl was taken ill on 19th October, admitted to hospital on 26 October and died two days later. Her 8-year old brother developed symptoms on 25 October and is reported to be in a good condition in hospital. Indonesia has now confirmed 9 cases with 5 deaths.
WHO guidelines regarding Avian Influenza
Wednesday, 9 November, 2005
Updated November 6 2005
This is a summary of the updated World health Organisation recommendations. These recommendations may change according to change in the epidemiological situation and related risk assessments.
WHO does not recommend any restrictions on travel to any areas affected by H5N1 avian influenza.
WHO does not recommend travel restrictions to areas experiencing outbreaks of highly pathogenic H5N1 avian influenza in birds, including countries which have reported associated cases of human infection.
WHO does not recommend screening of travellers coming from H5N1 affected areas.
WHO does not, at present, recommend the routine screening of travellers coming from affected areas.
WHO advises travellers to avoid contact with high-risk environments in affected countries.
Travellers to areas affected by avian influenza in birds are not considered to be at elevated risk of infection unless direct and unprotected exposure to infected birds (including feathers, faeces and under-cooked meat and egg products) occurs.
Travellers to affected areas should avoid contact with live animal markets and poultry farms and any free-ranging or caged poultry. Populations in affected countries are advised to avoid contact with dead migratory birds or wild birds showing signs of disease.
Direct contact with infected poultry, or surfaces and objects contaminated by their droppings, is considered the main route of human infection. Exposure risk is considered highest during slaughter, de-feathering, butchering, and preparation of poultry for cooking. There is no evidence that properly cooked poultry or poultry products can be a source of infection.
Travellers should contact their local health providers or national health authorities for supplementary information.
Avian influenza Human cases: updated summary
Friday, 4 November, 2005
As published by the International Society for Infectious Diseases here is a summary of human cases of H5N1 influenza infections notified worldwide since December 2004, together with World Health Organisation confirmations: (latest reports in brackets)
Vietnam (29 October)
- Bird to human reported cases: 67 with 23 deaths
- WHO-confirmed cases: 64 cases with 21 deaths
- Human-to-human infection reported as possible, but still under investigation.
Indonesia (24 October)
- Bird-to-human reported cases: 85 cases with 9 deaths
- WHO-confirmed cases: 7 cases with 4 deaths
- Human-to-human infection: none reported.
- Many cases notified as bird flu turned out to be typhoid infections and others are still under investigation.
Thailand (31 October)
- Bird-to-human reported cases: 3 cases with one death
- WHO-confirmed cases: 3 cases and one death
- Human-to-human infection: one case with one death suspected.
Cambodia (19 April)
- Bird-to-human: 4 cases with 4 deaths
- WHO-confirmed: 4 cases with 4 deaths
- Human-to-human infection reported: Nil
China (27 October)
- No cases reported
Japan bird flu is a different form
Tuesday, 1 November, 2005
Signs of bird flu have led to plans to cull thousands of birds in the Ibraki prefecture in northern Japan. ( Japan reported its first outbreak of bird flu in 70 years in July 2004.) The Ibraki outbreak has been shown to be caused by an H5N2 virus which is not the virulent H5N1 strain. Interestingly the spread has been attributed to a mobile meat processor which collects chickens from several farms. There are good reasons for suspecting that the infection has been brought into the country through the use of an illegal vaccine.
New bird flu outbreak in Northeast Thailand
Tuesday, 1 November, 2005
Outbreaks were confirmed in Kalasin's Yang Talat and Huai Mek districts on Tuesday [ 25 Oct 2005] and Thursday [ 27 Oct 2005]. The affected coops and all property within 5 km have been put under quarantine until mid-November 2005. The Livestock Development Department director is quoted as saying that livestock officials and the police were questioning the birds' owners. "We want to know where the roosters were before falling ill and how the owners smuggled the chickens outside the province without permission from provincial livestock officers."
The department had set up 32 checkpoints nationwide to control movement of fowl between the 5 poultry zones designated in Thailand, but owners of fighting cocks were hiding the birds in cars, which were beyond the officers' ability to interdict, he said. "Safeguards against the bird flu outbreak have already been put in place, but cooperation from people is the most important thing we need at the moment," the director said.
