SEP 06 Health Alerts
Avian Influenza situation in Indonesia - update 34
28/09/06
The patient reported in update 33 has now been reported as dying bringing the number of deaths to 52 out of the total to date of 68 confirmed cases.
Avian Influenza - situation in Thailand - update 2
27/09/06
The Ministry of Public Health in Thailand has confirmed the country's 25th case of human infection with the H5N1 avian influenza virus. The case, which was fatal, was the third detected this year and the third fatality.
The case occurred in a 59-year-old farmer from Nong Bua Lam Phu Province in the north-eastern part of the country. He developed fever on 14 July, was hospitalized on 21 July, and died on 10 August. Possible H5N1 infection was suspected when relatives reported the sudden death, in the days prior to symptom onset, of several fighting cocks raised by the farmer. Local veterinary authorities noted a number of poultry outbreaks in the area.
Repeated tests on samples taken from his upper respiratory tract were negative by PCR for all influenza A viruses, including H5N1. He was treated with the antiviral drug, oseltamivir. Virus was eventually isolated from lung samples taken at autopsy.
Of the 25 cases confirmed to date in Thailand, 17 have been fatal.
Poultry outbreaks were confirmed in two provinces of Thailand in late July of this year following a lull in outbreaks dating back to 9 November 2005.
Avian Influenza situation in Indonesia - update 33
27/09/06
The Ministry of Health in Indonesia has confirmed the country's 68th case of human infection with the H5N1 avian influenza virus. The patient is a 20-year-old male from Bandung, West Java. He developed symptoms of fever and cough on 17 September and was hospitalized on 24 September. He remains hospitalized.
The man's 23-year-old brother developed symptoms on 16 September. He died of respiratory disease on 24 September, two hours after admission to hospital. Infection with the H5N1 virus is suspected for the 23-year-old male, but cannot be confirmed as no samples were collected for testing. Both men had direct contact with dead chickens when feeding carcasses to their dogs. Local agricultural authorities also found evidence of H5 infection in household birds.
A third sibling, a 15-year-old female, was hospitalized on 25 September after developing symptoms of fever and cough. Initial test results received on 27 September were negative for the H5 virus subtype and positive for the H1 subtype, indicating an infection with normal seasonal influenza. She remains hospitalized in a stable condition.
Of the 68 cases confirmed to date in Indonesia, 51 have been fatal.
WHO - situation in Indonesia - update 32
27/09/06
The Ministry of Health in Indonesia has confirmed two additional cases of human infection with the H5N1 avian influenza virus. Both cases were fatal.
The first case occurred in an 11-year-old boy from East Java Province. He developed symptoms of fever and cough on 16 September, was hospitalized on 18 September, and died the same day. Poultry in the child's household began dying in the month prior to symptom onset, and poultry deaths continued thereafter in his neighborhood.
The second case occurred in a 9-year-old boy from South Jakarta. He developed symptoms of fever and a runny nose on 13 September, was hospitalized on 20 September, and died on 22 September. His history showed recent contact with sick chickens, which he kept as pets.
Of the 67 cases confirmed to date in Indonesia, 51 have been fatal.
WHO - situation in Iraq - update 5
20/09/06
The Ministry of Health in Iraq has retrospectively confirmed the country's third case of human infection with the H5N1 avian influenza virus. The case, a 3-year-old boy, was hospitalized in Baghdad on 15 March 2006. His illness was mild and he fully recovered.
During its outbreak, which is now considered over, Iraq faced problems in the shipment of specimens for external verification of diagnostic tests. For the retrospectively confirmed case, initial test results were inconclusive, possibly as a result of sample deterioration during shipment. Repeated testing, using different methods, was needed for diagnostic confirmation.
The two cases previously confirmed in Iraq occurred in January 2006. Both cases were fatal.
Avian Influenza retrospectively confirmed in Indonesia
18/09/06
Two further cases of H5N1 infection have been notified as a result of follow-up blood tests in Indonesia . One involved a five-year old from East Bekasi in West Java province who died in March. The second case occurred in Solok in West Sumatra province where the infection was diagnosed in a 27-year old male with mild symptoms who was tested following identification of the disease in his sister in May. These two cases bring the totals for Indonesia to 65 of whom 49 have died.
Adjusted Indonesian Update
012/09/06
The Indonesian Ministry of Health in Indonesia has confirmed a new case of human infection with the avian influenza virus in a 14-year-old female from Makassar , South Sulawesi Province . She developed symptoms on 18 June, was hospitalized on 23 June and died on 24 June. This case was detected through the Ministry's routine influenza surveillance system. In addition the World Health Organisation has retrospectively confirmed that two cases reported in 2005 met the revised criteria, requiring serological testing, for the diagnosis of H5N1 infection. One patient was an 8 year old girl from Tangerang in Banten province who died on 14 July 2005 and the other was a 45-year old man from Magelang, Central Java who has since recovered.
The adjusted figures for Indonesia now show that 63 cases have been confirmed since the first cases were reported in 2005. Of these 48 have died.
General Health Alert
05/09/06
An article on the difficulties in tracing contacts and controlling an outbreak of avian flu in humans can be found: HERE
According to the international Society for Infectious Diseases this article provides a useful resume of the investigation of the
cluster of human cases of H5N1 avian influenza virus infection which involved 8 members of an extended family in the village of Kubu Sembilang in the province of North Sumatra. For the 1st time, there was clear evidence of passage of virus from one person to another and onward transmission to a 3rd member of an extended family. It should be emphasized, however, that no
other comparable cluster of cases has been identified in Indonesia or elsewhere. There has been no evidence to date that the H5N1 avian virus is evolving to a form more easily transmitted from human to human. Similarity of the genetic constitution of close relatives still seems to be the determining factor in susceptibility to infection.
