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2/3/06
The World Health Organization (WHO) reported today 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 January 17, 2006. Test results have now confirmed her infection. Specimens from the girl’s 39-year-old uncle, who died on January 27, 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 dispatched 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 rumors, and address public concerns. Rumors of possible human cases in other parts of the country have been systematically followed up. To date, no such rumors 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.
1/31/06
The World Health Organization (WHO) reported today 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 January 17 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 January 24 and died of a severe respiratory disease on January 27,
2006.
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 neighborhood, 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 January 18.
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 Vietnam in December 2003.
China
5/30/07
The World Health Organization reported today the Ministry of
Health in
China
has reported a new case of human infection with the H5N1 avian
influenza virus. The case was confirmed by the national
laboratory on May 23, 2007.
The 19-year
old male soldier, serving in
Fujian
province, developed fever and pneumonia-like symptoms on May 9
and was hospitalized on May 14.
There is no
initial indication to suggest he had contact with sick birds
prior to becoming unwell. Close contacts have been placed under
medical observation and all remain well.
Of the 25
cases confirmed to date in
China
, 15 have been fatal.
3/29/07
The World Health Organization reported today the Ministry of Health in China has reported a new fatal case of human infection with the H5N1 avian influenza virus. The case has been confirmed by the national laboratory.
The 16-year-male from Anhui province developed fever and pneumonia-like symptoms on March and 17, was hospitalized on March 20 and died on March 27.
There is no initial indication to suggest he had contact with sick birds prior to becoming unwell and investigations to identify the source of his exposure are ongoing. Close contacts have been placed under medical observation and all remain well.
Of the 24 cases confirmed to date in China, 15 have been fatal.
3/1/07
The World Health Organization reported today the Ministry of Health in China has reported one case of human infection with the H5N1 avian influenza virus.
The case is a 44-year-old woman from Jian'ou county, Fujian province. She became ill with fever and pneumonia on February 18 and was hospitalized on February 22 where she remains in critical condition. The case was laboratory confirmed by the Fujian provincial laboratory on February 26 and by the national laboratory the next day.
Information provided to WHO indicates that she is a farmer who kept birds in her back yard and was possibly exposed to sick birds. An investigation is under way to determine if this exposure was the source of her infection. Close contacts have been placed under medical observation.
Of the 23 cases confirmed to date in China, 14 have been fatal.
1/10/07
The World Health Organization reported today the Ministry of Health in China has confirmed a case of human infection with the H5N1 avian influenza virus. The case is a 37 year old man from Tunxi in Anhui Province. He became symptomatic on December 10, 2006 and was hospitalized on December 17, 2006. The patient was discharged on January 6, 2007 and is recovering well.
Information provided to WHO indicates that he was a farmer and may have kept a number of birds in his back yard. No information on possible exposure to diseased birds as the source of his infection is presently available, but an investigation is under way. Close contacts were placed under medical observation but are all well and were released on December 29.
Of the 22 cases confirmed to date in China, 14 have been fatal.
8/14/06
The World Health Organization (WHO) reported today the Ministry of Health in China has confirmed the country’s 21st case of human infection with the H5N1 avian influenza virus.
The case occurred in a 62-year-old male farmer from the north-western province of Xinjiang. He developed symptoms on June 19 and died on July 12. Initial tests on patient specimens produced negative results. As a precautionary measure, tests were repeated during July and August and eventually produced positive results, which were confirmed today by the Ministry of Health.
An epidemiological investigation of the case was unable to uncover a history of exposure to dead or diseased birds. The man had no history of travel during the month prior to symptom onset. No recent poultry outbreaks have been reported in the vicinity of the man’s home. Xinjiang Province had not previously reported a human case.
Of the 21 cases confirmed to date in China, 14 have been fatal.
8/8/06
The World Health Organization (WHO) reported today the Ministry of Health in China has today retrospectively confirmed a human case of H5N1 infection dating back to November 2003. The case occurred in a 24-year-old member of the military service based in Beijing. The man developed symptoms on November 25, 2003 and was hospitalized with pneumonia in Beijing. His condition deteriorated rapidly and he died of severe respiratory disease on December 3, 2003.
Confirmation of this case marks the earliest known instance of human H5N1 infection in mainland China, and is now the first confirmed case in the present outbreak. Previously, the first confirmed cases were thought to have occurred in Viet Nam in December 2003.
The case was initially reported by several Chinese researchers, affiliated with the military services, in a June 2006 letter to the New England Journal of Medicine. According to that communication, doctors initially suspected the man might have been infected with the SARS virus. Although WHO declared the SARS outbreak over in July 2003, suspicions were high that the virus might return during the cooler months.
Specimens tested for SARS infection prior to the man’s death were negative, but the cause of death remained undetermined. As stated in the published letter, stored specimens from the man subsequently tested positive for H5N1 infection. Successful isolation of the virus from these specimens was also reported.
As the man’s illness was initially thought to be
SARS, no history of possible poultry exposure was taken. The source of his H5N1 infection remains uncertain, particularly as no poultry outbreaks of H5N1 avian influenza have been reported in Beijing.
The Ministry of Health informed WHO that it had been unaware of these tests and their results prior to publication of the research letter. In line with WHO recommendations, confirmatory testing in a laboratory affiliated with the Ministry of Health was arranged. Following an official request, WHO sent laboratory experts to consult with national experts performing the tests. That joint undertaking, conducted in late July, confirmed the man’s infection with the H5N1 virus. These findings were further reviewed by a panel of experts, which concluded that the man’s H5N1 infection was now laboratory confirmed.
Prior to this announcement, the first official laboratory-confirmed H5N1 case on the Chinese mainland occurred in Hunan Province in October 2005 and was reported to WHO in mid-November 2005.
Retrospective confirmation of the case brings the cumulative total in China to 20. Of these cases, 13 have been fatal.
6/19/06
The World Health Organization (WHO) reported today the Ministry of Health in China has confirmed the country’s 19th case of human infection with the H5N1 avian influenza virus.
The patient is a 31-year-old man employed as a truck driver in Shenzhen City, Guangdong Province, near the border with Hong Kong. He developed symptoms on June 3 and was hospitalized on June 9. He remains hospitalized, in critical condition, with severe pneumonia.
Investigation of his source of infection is under way. Preliminary reports indicate the man visited a local market where live poultry are sold on several occasions prior to symptom onset. However, health authorities have not been able to determine whether he was exposed to infected poultry at that market or elsewhere. H5N1 infections in poultry have not been officially reported in the area.
Of the 19 laboratory-confirmed cases in China reported to date, 12 have been fatal.
4/28/06
The World Health Organization (WHO) reported today the Ministry of Health in China has reported the country’s 18th case of human infection with the H5N1 avian influenza virus. The patient is an 8-year-old girl from the south-western province of Sichuan. She developed symptoms of fever and pneumonia on April 16 and remains hospitalized.
According to the Ministry of Health, an initial investigation determined that poultry deaths recently occurred near the child’s home.
Of the 18 laboratory-confirmed cases in China, 12 have been fatal.
4/21/06
The World Health Organization (WHO) reported today the Ministry of Health in China has informed WHO of the country’s 12th death from H5N1 avian influenza. The death occurred in a previously reported case, a 21-year-old man from Hubei Province. He died of severe respiratory disease on April 19.
Of the 17 laboratory-confirmed cases in China, 12 have been fatal.
4/20/06
The World Health Organization (WHO) reported today the Ministry of Health in China has confirmed the country’s 17th case of human infection with the H5N1 avian influenza virus. The case occurred in a 21-year-old male migrant worker employed in Wuhan City, Hubei Province. He developed symptoms on April 1. He is presently hospitalized in critical condition.
The man’s source of exposure is under investigation. No poultry outbreaks have been reported in Hubei Province since November 2005. His close contacts have been placed under medical observation.
To date, China has reported 17 cases of H5N1 infection. Of these, 11 have been fatal.
3/27/06
The World Health Organization (WHO) reported today the Ministry of Health in China has confirmed the country’s 16th case of human infection with the H5N1 avian influenza virus. The case, which was fatal, occurred in a 29-year-old female migrant worker. She was hospitalized in Shanghai on March 15 with symptoms of pneumonia and died on March 21.
This is the first case reported in Shanghai. Her source of infection is under investigation. No poultry outbreaks have been reported in the Shanghai area since February 2004.
According to Chinese authorities, the woman’s close contacts have been placed under medical observation.
3/8/06
The World Health Organization reported today the Ministry of Health in China has reported the country’s 10th death from H5N1 avian influenza. The patient, a 9-year-old girl from the eastern province of
Zhejiang, developed symptoms on February 10 and died on March 6. This case was previously announced by Chinese authorities on February 27, when the patient was listed as in critical condition.
To date, China has reported 15 laboratory-confirmed cases of human infection with the H5N1 avian influenza virus. Of these, 10 have been fatal.
3/7/06
The World Health Organization reported today the Ministry of Health in China has reported an additional laboratory confirmed case of human infection with the H5N1 avian influenza virus.
The case occurred in a 32-year-old man from the southern province of Guangdong. He developed symptoms of fever on February 22 followed by pneumonia. His condition deteriorated rapidly and he died on March 2, 2006.
He was unemployed. No outbreaks in poultry have been reported in Guangdong Province since 2004. To date, China has reported 15 laboratory confirmed cases. Of these, nine have been fatal. Two patients remain in critical condition.
The newly confirmed case is the first reported from Guangdong Province.
2/27/06
The World Health Organization reported today the Ministry of Health in China has reported two additional laboratory confirmed cases of human infection with the H5N1 avian influenza virus. Both patients are in critical condition.
The first patient is a 9-year-old girl from the eastern province of Zhejiang. She developed symptoms on February 10. Symptom onset followed a visit to relatives in the adjacent province of Anhui. No animal outbreaks have been reported in Zhejiang Province since 2004.
The second patient is a 26-year-old female farmer from Anhui Province. She developed symptoms on February 11 following contact with diseased poultry. Local agricultural officials have reported isolation of the H5N1 virus in samples from dead poultry in her neighborhood.
To date, China has reported 14 laboratory-confirmed cases. Of these, eight have been fatal.
The H5N1 virus is now considered to be endemic in birds in large parts of China. The WHO is working with national authorities to increase public awareness of the disease, encourage populations to report outbreaks, and warn people to avoid contact with dead or ill birds.
2/13/06
The World Health Organization reported today the Ministry of Health in China has reported the country’s 12th laboratory confirmed case of human infection with the H5N1 avian influenza virus.
The case occurred in a 20-year-old female farmer from the south-central province of Hunan. She developed symptoms on January 27 and was subsequently hospitalized with severe pneumonia. The onset of symptoms followed the culling of poultry raised by her household. She died on February 4, 2006.
To date, China has reported 12 laboratory-confirmed cases. Of these, eight have been fatal.
2/9/06
The World Health Organization reported today 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 January 10 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 of 2005.
Three poultry outbreaks have been reported so far this year: one in Sichuan Province on January 3, one in Guizhou Province on January 10, and one in Shanxi Province on February 8.
1/25/06
The World Health Organization reported today 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 January 12 and was hospitalized with symptoms of pneumonia. Authorities say her condition deteriorated rapidly, and she died on January 23, 2006.
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 kilometers 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.
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.
1/19/06
The World Health Organization reported today 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 January 3, was hospitalized on January 10 with symptoms of fever and pneumonia, and died on January 11, 2006.
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.
1/10/06
The World Health Organization reported today 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 December 24, 2005 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 December 7, and a 35-year-old man from Jiangxi Province, reported on December 16, 2005.
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 kilometers 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. Of the eight confirmed cases in China, five have now died.
12/30/05
The World Health Organization reported today the Ministry of Health in China has confirmed an additional case of human infection on the mainland with the H5N1 avian influenza virus. The case is a 41-year-old woman from the south-eastern province of
Fujian. She developed symptoms of fever followed by pneumonia on December 6, and was admitted to hospital two days later. The patient died on December 21, 2005.
On December 13, initial laboratory tests on samples from the patient tested negative for H5N1. But further tests on December 23 – including PCR tests carried out at the Chinese Center for Disease Control in Beijing – showed positive results. The virus was also isolated from the patient. Close contacts who have been placed under medical observation have not displayed any symptoms, health authorities report.
Agricultural authorities so far have not been able to confirm the presence of the H5 virus subtype in poultry in the vicinity of the patient’s residence or place of work. Investigators have not been able to confirm any direct contact between the patient and poultry prior to the onset of illness. The investigation, however, is continuing and answers to these and other questions are still being sought.
This is China’s seventh laboratory-confirmed human case. Of these cases, three have been fatal (including this latest case). To date, China has reported human cases in six provinces and regions: Hunan,
Anhui, Guangxi, Liaoning, Jiangxi and Fujian.To date, China has reported human cases in six provinces and regions: Hunan,
Anhui, Guangxi, Liaoning, Jiangxi and Fujian.
12/16/05
The World Health Organization reported today the Ministry of Health in China has confirmed an additional case of human infection with the H5N1 avian influenza virus. The case is a 35-year-old man from the south-eastern province of
Jiangxi. He developed symptoms of fever on December 4, 2005 followed by pneumonia. He remains hospitalized and is receiving intensive care.
Agricultural authorities have confirmed the presence of the H5 virus subtype in ducks in the vicinity of the patient’s residence. Family members and close contacts have been placed under medical observation.
To date, China has reported human cases in five provinces and regions: Hunan,
Anhui, Guangxi, Liaoning,and Jiangxi.
12/9/05
The World Health Organization reported today the Ministry of Health in China has confirmed a further case of human infection with the H5N1 avian influenza virus. The case is a 31-year-old female farmer from the north-eastern province of
Liaoning. She developed symptoms on October 30 and subsequently underwent extensive hospital care for severe pneumonia and acute respiratory distress. She recovered and was discharged from hospital on November 29, 2005.
Initial tests on this case produced negative results for infection with the H5 virus subtype. Diagnostic confirmation was made following antibody testing using a microneutralization test. Using this test, a positive diagnosis is made when antibody levels in a blood sample taken late in illness are at least four times higher than those found in a sample taken early in illness. Diagnostic confirmation using antibody tests, though reliable, is thus slower than that achieved using direct tests for virus RNA.
Beginning in late October, Chinese authorities have reported several outbreaks of highly pathogenic H5N1 avian influenza in poultry in Liaoning Province. Investigation of this case has linked the woman’s infection to direct exposure to diseased poultry. Agricultural authorities have detected the H5N1 virus in samples taken from poultry in the province.
As a precaution, local authorities placed contacts of the woman under medical observation pending definitive laboratory results. No signs of influenza-like illness were detected, and all contacts have now been released from observation. This is China’s fifth laboratory-confirmed case; the cases have been reported from four provinces:
Anhui, Hunan, Guangxi, and Liaoning.
12/8/05
The World Health Organization reported today the Ministry of
Health in China has confirmed a further case of human infection
with the H5N1 avian influenza virus. The case occurred in a
10-year-old girl from the southern province of Guangxi. She
developed symptoms of fever and cough on November 23, 2005,
followed by pneumonia. She remains in the hospital and she is
receiving care.
Local health authorities have
launched several investigations to determine the source of
exposure and to search for further cases in both the child’s
village of residence and the surrounding areas. To date,
monitoring of health status has revealed no additional cases of
influenza-like illness. The Chinese Ministry of Health is
supporting this investigation with an expert team.
11/25/05
The Ministry of Health in China has confirmed a further case of human infection with the H5N1 avian influenza virus. The case, which was fatal, occurred in a 35-year-old woman who worked as a farmer in the south-eastern province of
Anhui. She developed symptoms on November 11, was hospitalized on November 15, and died on November 22,
2005.
This is the third laboratory-confirmed case reported in China and the second from Anhui Province. Of these cases, two have been fatal.
The Chinese Ministry of Health has invited WHO to participate in a joint mission to Anhui Province. The mission will review laboratory findings and investigate the exposure histories of the two cases reported there.
11/17/05
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 October 17, 2005 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 November 1, was hospitalized with severe pneumonia on November 7, and died on November 10, 2005. 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 October 16 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 October 24 and 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.
Surveillance for human cases in China intensified over the past month following a recurrence of highly pathogenic H5N1 avian influenza in poultry. Since October 19, China has reported 11 fresh outbreaks of the disease in six provinces, from Liaoning in the northeast of the country to Xinjiang in the far west. Hunan and Anhui – the two provinces with confirmed cases – are among the recently affected provinces.
Egypt
6/25/07
The World Health Organization reported the Egyptian Ministry of Health and Population has confirmed a new human case of avian influenza A(H5N1) virus infection. The case has been confirmed by the Egyptian Central Public Health Laboratory and by the WHO H5 Reference Laboratory, US Naval Medical Research Unit No.3 (NAMRU-3).
The case is a 4 year old male from Qena Governorate. He developed symptoms on 20 June and was admitted to hospital on June 21. He is receiving treatment and is in a stable condition. Initial investigations into the source of his infection indicate exposure to dead poultry.
Of the 37 cases confirmed to date in Egypt, 15 have been fatal.
6/12/07
The World Health Organization reported the Egyptian Ministry of Health and Population has confirmed 2 new human cases of avian influenza A(H5N1) virus infection. Theses cases have been confirmed by the Egyptian Central Public Health Laboratory and by the WHO H5 Reference Laboratory, US Naval Medical Research Unit No.3 (NAMRU-3).
The first case is a 10 year old female from Qena Governorate. She developed symptoms on June 1, was admitted to hospital on June 6 and died on June 9, 2007. Initial investigations into the source of her infection indicate exposure to dead birds.
The second case is a 4 year old female from Qena Governorate. She developed symptoms on June 7 and was admitted to hospital on June 10. She is receiving treatment and is in a stable condition. Initial investigations into the source of her infection indicate exposure to dead birds.
Of the 36 cases confirmed to date in Egypt, 15 have been fatal.
Egypt -- 4/12/07
The World Health Organization reported the Egyptian Ministry of Health and Population has announced the death of the 15 year old female reported on April 10th.
Of the 34 cases confirmed to date in Egypt, 14 have been fatal.
4/10/07
The World Health Organization reported the Egyptian Ministry of Health and Population has announced two new human cases of avian influenza A(H5N1) virus infection. The cases have been confirmed by the Egyptian Central Public Health Laboratory and by the US Naval Medical Research Unit No.3 (NAMRU-3).
The first case, a 2-year-old female from Menia Governorate, developed symptoms on April 3 and was admitted to hospital the following day. She is currently in a stable condition. Initial investigations into the source of her infection indicate recent contact with backyard poultry.
The second case is a 15-year-old female from Cairo Governorate. She developed symptoms on March 30 and was admitted to hospital on April 5 where she remains in a critical condition.
Of the 34 cases confirmed to date in Egypt, 13 have been fatal.
4/2/07
The World Health Organization reported the Ministry of Health and Population has announced three new human cases of avian influenza A(H5N1) virus infection. The cases have been confirmed by the Egyptian Central Public Health Laboratory and by the US Naval Medical Research Unit No.3 (NAMRU-3).
The first case, a 4-year-old boy from Qena Governorate, is the brother of the 6-year-old girl whose infection was reported on March 28. He developed symptoms on March 26 and was admitted to hospital on March 29. The second case, a 7-year-old boy from Sohag Governorate, developed symptoms on March 26 and was hospitalized on March 29. The third case is a 4-year-old girl from Qalubiea Governorate. She developed symptoms on March 29 and was admitted to hospital the following day.
All three children are receiving treatment and remain in a stable condition. Investigations into the sources of exposure indicate a history of contact with dead birds in each case. Contacts of the children are under surveillance and all remain healthy.
Of the 32 cases confirmed to date in Egypt, 13 have been fatal.
3/29/07
The World Health Organization reported the Egyptian Ministry of Health and Population has announced two new human cases of avian influenza A(H5N1) virus infection. The cases have been confirmed by the Egyptian Central Public Health Laboratory and by the US Naval Medical Research Unit No.3 (NAMRU-3).
The first case, a 6-year-old girl from Qena Governorate, was admitted to hospital on March 25 with symptoms. The second case, a 5-year-old boy from Menia Governorate, was also hospitalised with symptoms on March 25. Both children remain in a stable condition. Initial investigations indicate exposure to sick birds in both cases.
Of the 29 cases confirmed to date in Egypt, 13 have been fatal.
3/27/07
The World Health Organization reported the Egyptian Ministry of Health and Population has announced a new human case of avian influenza A(H5N1) virus infection. The case has been confirmed by the Egyptian Central Public Health Laboratory and by the US Naval Medical Research Unit No.3 (NAMRU-3).
The 3-year-old girl from Aswan Governorate developed symptoms on March 22 and was hospitalized on March 24 where she remains in a stable condition. Investigations indicate a history of contact with backyard poultry. The case is not linked epidemiologically to either of the two recent cases in Aswan Governorate that were announced on March 19 and 20.
Of the 27 cases confirmed to date in Egypt, 13 have been fatal.
3/20/07
The World Health Organization reported the Egyptian Ministry of Health and Population has announced a new human case of avian influenza A(H5N1) virus infection. The case was confirmed by the Egyptian Central Public Health Laboratory and by the US Naval Medical Research Unit No.3 (NAMRU-3).
The 2-year-old boy from Aswan Governorate developed symptoms on March 15. He was admitted to hospital the following day where he remains in a stable condition. Investigations indicate a history of contact with backyard poultry. No epidemiological link has been found between this case and that of the 10-year-old-girl from the same area that was announced on March 19, 2007.
Of the 26 cases confirmed to date in Egypt, 13 have been fatal.
3/19/07
The World Health Organization reported the Egyptian Ministry of Health and Population has announced a new human case of avian influenza A(H5N1) virus infection. The case was confirmed by the Egyptian Central Public Health Laboratory and by the US Naval Medical Research Unit No.3 (NAMRU-3).
The 10-year-old girl from Aswan Governorate, was admitted to hospital with symptoms on March 13 and her condition remains stable. Investigations indicate that she had recently been exposed to sick poultry. Contacts of the girl are being kept under observation.
Of the 25 cases confirmed to date in Egypt, 13 have been fatal.
3/13/07
The World Health Organization reported the Egyptian Ministry of Health and Population has announced a new human case of avian influenza A(H5N1) virus infection. The case was confirmed by the Egyptian Central Public Health Laboratory and by the US Naval Medical Research Unit No.3 (NAMRU-3).
The 4-year-old boy was from Ad Daqahliyah Governorate. He developed symptoms on March 7, 2007, was admitted to hospital on March 8 and his condition remains stable. The boy was exposed to sick birds during the first three days of March. Contacts of the boy remain healthy and are being closely monitored.
Of the 24 cases confirmed to date in Egypt, 13 have been fatal.
3/1/07
The World Health Organization reported the Egyptian Ministry of Health and Population has announced a new human case of avian influenza A(H5N1) virus infection. The case was confirmed by the Egyptian Central Public Health Laboratory and by the US Naval Medical Research Unit No.3 (NAMRU-3).
The 4-year-old girl was from Dakahlea Governorate. She developed symptoms on February 25, was admitted to hospital on February 26 and her condition remains stable. The girl was exposed to sick birds at her home one week prior to the onset of symptoms. Contacts of the girl remain healthy and are being closely monitored.
Of the 23 cases confirmed to date in Egypt, 13 have been fatal.
2/19/07
The World Health Organization reported the Egyptian Ministry of Health and Population has announced a new human case of avian influenza A (H5N1) virus infection. The case was confirmed by the Egyptian Central Public Health Laboratory and by the US Naval Medical Research Unit No.3 (NAMRU-3).
The 5-year-old boy from Sharkia Governorate was admitted to hospital with symptoms on February 14, and his condition remains stable. The boy was exposed to sick birds one week prior to the onset of symptoms. Contacts of the boy remain healthy and have been placed under close observation.
Of the 22 cases confirmed to date in Egypt, 13 have been fatal.
2/16/07
The World Health Organization reported the Egyptian Ministry of Health and Population has confirmed the country's 13th death from H5N1 avian influenza. The 37-year-old female whose infection was announced on February 15, died today.
Of the 21 cases confirmed to date in Egypt, 13 have been fatal.
2/15/07
The World Health Organization reported the Egyptian Ministry of Health and Population has announced a new human case of avian influenza A(H5N1) virus infection. The case was confirmed by the Egyptian Central Public Health Laboratory and by the US Naval Medical Research Unit No.3 (NAMRU-3).
The 37-year-old female from Fayyoum Governorate was admitted to hospital with symptoms on February 12, 2007 and her condition remains stable. She was involved in the slaughter and defeathering of sick birds one week prior to the onset of illness.
Of the 21 cases confirmed to date in Egypt, 12 have been fatal.
2/6/07
The World Health Organization reported the Egyptian Ministry of Health and Population has announced a new human case of avian influenza A(H5N1) virus infection. The case was confirmed by the Egyptian Central Public Health Laboratory and by the US Naval Medical Research Unit No.3 (NAMRU-3).
The 17-year-old female from Fayyoum Governorate developed symptoms on January 25, 2007 and was initially treated for seasonal influenza. She was hospitalized on February 1 with fever and breathing difficulties, and died on February 2, 2007. Initial investigations into the source of her exposure indicate the presence of sick and dead poultry at her home in the days prior to the onset of symptoms.
Of the 20 cases confirmed to date in Egypt, 12 have been fatal.
1/22/07
The World Health Organization reported the Egyptian Ministry of Health and Population has announced a new human case of avian influenza A (H5N1) virus infection. The case was confirmed by the Egyptian Central Public Health Laboratory and by the US Naval Medical Research Unit No.3 (NAMRU-3).
The 27-year-old woman from Beni Sweif Governate developed symptoms on January 9 and died in the hospital on January 19,
2007.
Initial investigations indicate the presence of sick and dead poultry at her residence in the days prior to the onset of illness.
Of the 19 cases confirmed to date in Egypt, 11 have been fatal.
1/18/07
The World Health Organization reported the Egyptian Ministry of Health and Population has informed WHO that viruses with a genetic mutation, linked in laboratory testing to moderately reduced susceptibility to
oseltamivir, have been discovered in two persons previously reported with H5N1 infections in Egypt. Both patients had been on treatment with oseltamivir for two days before the clinical samples that yielded the viruses were taken.
The two patients from whom samples were taken were a 16 year-old female and a 26 year-old male from Gharbiyah Province, Egypt. They were a niece and uncle, respectively, who lived in the same house. The girl was admitted to a hospital on December 19, 2006, while the man was admitted on December 17. On December 21, they began receiving 2 tablets per day of
oseltamivir. On December 23 they were moved to a referral hospital. The samples which have so far been tested were taken from the two patients on December 23, 2006. The girl died on December 25 and the man died on December 28, 2006.
In this and all other H5N1 investigations there is close, ongoing coordination between Egypt's Ministry of Health and Population
(MOH&P) and WHO. It was Egypt's monitoring and rapid virological analysis conducted at the Central Public Health Laboratory in Cairo that initially allowed the diagnoses of H5N1 to be made. Confirmatory testing and genetic sequencing was done at NAMRU-3 and at two WHO Collaborating Centers located in Atlanta, USA and London, UK.
At this time there is no indication that oseltamivir resistance is widespread in Egypt or elsewhere. WHO is not making any changes in antiviral treatment recommendations for H5N1-infected persons published in June 2006 because the clinical level of resistance of these mutations is not yet well established. Current laboratory testing suggests that the level of reduced susceptibility is moderate. This mutation has previously been identified in Viet Nam in one case in 2005. Moreover, these mutations are not associated with any known change in the transmissibility of the virus between humans. Based on these considerations, the public health implications at this time are limited. Finally, these findings do not indicate a need for a change in phase level. The WHO pandemic preparedness level remains at three.
The Egyptian authorities, WHO and its Collaborating Centers will continue to share with the public all relevant information from the on-going investigations and analyses as soon as it becomes available.
12/27/06
The World Health Organization reported the Egyptian Ministry of Health and Population has informed WHO of three new human cases of avian influenza A(H5N1) virus infection. All three cases belong to one extended family in Gharbiyah province, 80 kilometers northwest of the capital city, Cairo. While being transferred and cared for at the country's designated avian influenza hospital, a 30 year-old female, a 15 year-old girl and a 26 year-old male died. The most recent death occurred on December 27. The cases reportedly had contact with sick poultry (ducks).
Clinical specimens from the three cases were tested positive for avian influenza A(H5N1) virus by Egyptian Central Public Health Laboratory. The virus was also detected in specimens from two of the three patients by US Naval Medical Research Unit No.3 (NAMRU-3). The samples will be sent to WHO Collaborating Centre for further testing including virus characterization.
The Egyptian Ministry of Health and Population is conducting further investigations and has initiated public health measures. The other family members remain healthy and have been placed under close observation.
10/11/06
The World Health Organization reported today the Ministry of Health in Egypt has confirmed the country’s first case of human infection with the H5N1 virus since May of this year.
The patient is a 39-year-old woman from the Gharbiya governorate in the Nile Delta. She developed symptoms on September 30 and was hospitalized on October 4. She subsequently developed pneumonia. She remains hospitalized in stable condition.
Her recent history includes the home slaughter and de-feathering of around a dozen ducks when signs of illness and deaths began to occur in the flock.
Egypt reported a recurrence of poultry outbreaks in backyard flocks in September 2006.
Previous human cases occurred from late March 2006 through May. To date, the country has reported 15 cases, of which 6 were fatal.
5/18/06
The World Health Organization (WHO) reported the Ministry of Health in Egypt has confirmed the country’s 14th case of human infection with the H5N1 avian influenza virus. The case occurred in a 75-year-old woman from the Al Minya governorate. She developed symptoms on May 11 and died on May 18. As with all other cases in Egypt, her infection has been linked to exposure to diseased birds.
Of the 14 cases in Egypt, six have been fatal.
5/8/06
The World Health Organization (WHO) reported the Ministry of Health in Egypt announced the country’s 5th death from H5N1 avian influenza on May 5. The death occurred in a previously reported case, a 27-year-old woman from Cairo. She was hospitalized on May 1 and died on May 4.
5/4/06
The World Health Organization (WHO) reported the Ministry of Health in Egypt has announced the country’s 13th case of human infection with the H5N1 avian influenza virus. Tests conducted by both the national public health laboratory and the Cairo-based US Naval Medical Research Unit 3 (NAMRU-3) produced positive results.
The patient is a 27-year-old woman from Cairo who was hospitalized with bilateral pneumonia on May 1, 2006 where she is presently in stable condition. Her infection has been linked to exposure to diseased poultry during a recent visit to the Minufiyah governorate. While there, she stayed in a household where numerous chickens were slaughtered.
The woman is the first new case in Egypt reported since early April.
Of the 13 laboratory-confirmed cases in Egypt, four were fatal. Eight patients have fully recovered and been discharged from hospital.
4/21/06
The World Health Organization (WHO) reported the Ministry of Health in Egypt has informed WHO of the country’s fourth death from H5N1 avian influenza. The death occurred in a previously announced patient, an 18-year-old girl from the northern governorate of
Minufiyah. She developed symptoms on April 5 and died on April 14.
The Ministry of Health regards cases as confirmed when positive results are obtained in two laboratories: the country’s national public health laboratory and the Cairo-based US Naval Medical Research Unit 3 (NAMRU-3). Test results on the country’s initial cases have been fully validated by a WHO collaborating laboratory in the United Kingdom. All cases confirmed by the Ministry of Health are now listed in the WHO cumulative table of laboratory-confirmed cases.
Of the 12 cases in Egypt, four patients have died and one remains hospitalized in stable condition. Seven patients have fully recovered and been discharged from hospital.
4/18/06
The World Health Organization (WHO) reported April 13th that the Ministry of Health in Egypt has informed WHO of the country’s 12th case of human infection with the H5N1 avian influenza virus. The patient is an 18-year-old girl from the northern governorate of
Minufiyah. She developed symptoms on April 5 and was hospitalized on April 11. She remains hospitalized in stable condition. As with all other cases in Egypt, her infection has been linked to direct contact with diseased birds.
Samples from the patient tested positive for H5N1 infection in the country's Central Public Health Laboratory and the Cairo-based US Naval Medical Research Unit 3 (NAMRU-3).
Of the 12 cases in Egypt, three have died and four remain hospitalized. Five patients have fully recovered and been discharged from hospital.
4/7/06
The World Health Organization (WHO) reported today the Ministry of Health in Egypt has announced the country’s 11th case of human infection with the H5N1 avian virus and its third death. The case occurred in an 18-year-old girl from the Minufiyah governorate, north of Cairo. She developed symptoms on March 29, was hospitalized on April 5 and died on the April 6.
Tests conducted by the country’s Central Public Health Laboratory were positive for H5N1 infection.
To date, Egyptian health authorities have confirmed 11 human cases of H5N1 infection. Three of these cases were fatal. In a pattern similar to that seen elsewhere, all case have occurred in children and young adults, and all have a history of close contact with dead or diseased poultry.
The eighth case is a 31-year-old Egyptian national who works in Jordan. The man recently visited his hometown in Fayoum governorate, south of Cairo, where poultry outbreaks were officially confirmed during the last week of February. While there, he participated in the slaughter of poultry. He returned to Jordan on March 29, following two days of travel by ferry boat. He was hospitalized with symptoms of respiratory disease on March 30. He remains hospitalized in Jordan in stable condition. Given his exposure history and what is known about the incubation period of this disease, health authorities in both Egypt and Jordan have concluded that the man almost certainly acquired his infection while in Egypt.
The ninth case, announced by the government on April 5, is a 16-month-old girl from the southern governorate of
Sohaj. The child’s infection was detected on April 4. She is presently hospitalized in stable condition.
The tenth case, announced today, is an 8-year-old boy from the Qaliubiya governorate near Cairo. He is presently hospitalized in stable condition.
4/3/06
The World Health Organization (WHO) reported today the samples from four patients, previously announced by the Egyptian Ministry of Health as infected with the H5N1 avian influenza virus, have now been tested in a WHO collaborating laboratory in the United Kingdom. Positive H5N1 results were obtained for all four patients. WHO has updated its cumulative number of cases accordingly.
The four cases were described in WHO updates issued on March 20 and March 29. Two of the patients died. Two patients fully recovered and have now been discharged from hospital.
A fifth patient, previously announced by the Ministry of Health, remains hospitalized. External diagnostic confirmation of this patient, an 18-year-old girl from the Kafr El-Sheikh governorate, is pending.
On April 2, Egyptian authorities announced that an additional two residents of Kafr El-Sheikh, a 6-year-old girl and her 18-month-old sister, were shown to have H5N1 infections in local laboratory tests. Further diagnostic confirmation is pending. Both girls remain hospitalized in stable condition.
Egypt is the ninth country to report laboratory-confirmed human cases in the current outbreak, which began in Vietnam in December 2003. Four of these countries reported their first human cases this year: Turkey, Iraq,
Azerbaijan and Egypt.
3/29/06
The
World Health Organization (WHO) reported today the Ministry of
Health in
Egypt
has confirmed the country’s second fatal case of human
infection with the H5N1 avian influenza virus.
The death
occurred in a 30-year-old woman from the Qaliubiya governorate
near
Cairo
. She developed symptoms on March 12 following the home
slaughter of chickens. She was hospitalized on March 16 and died
on March 27.
The
country’s first case, previously
reported, occurred in a 30-year-old woman, also from
Qaliubiya, who died on March 17.
Tests
conducted by the Cairo-based US Naval Medical Research Unit 3
(NAMRU-3) have confirmed an additional three cases.
A
32-year-old man, who worked on a farm where poultry were
recently culled, developed symptoms on March 16 and was
hospitalized the same day. He has since recovered.
A
17-year-old boy, whose father runs a poultry farm in the
Gharbiya governorate in the Nile Delta, developed symptoms on
March 18 and was hospitalized the following day. He has since
recovered.
The fifth
case is an 18-year-old girl from the Kafr El-Sheikh governorate.
She developed symptoms following the slaughter of sick backyard
poultry. She was hospitalized on March 25.
At present,
the Ministry of Health has confirmed all five cases based on
results from the NAMRU-3 laboratory. Samples from these cases
have been sent to a WHO collaborating laboratory in the
United Kingdom
for diagnostic verification. WHO will adjust the figures in its
cumulative number of cases following the results of this
external verification. Test results are expected later this
week.
Health
authorities have screened more than 350 people who were contacts
of these patients or had a recent history of exposure to
diseased birds. All test results have been negative for H5N1
infection.
Egypt
has a large population of poultry, many of which are kept on
roof terraces in close proximity to humans. H5N1 outbreaks in
poultry have now been reported in 19 of the country’s 26
governorates. Since the first outbreak was confirmed on February
17, more than 25 million birds have died or been destroyed.
3/20/06
The World Health Organization reported today the Ministry of Health in Egypt has confirmed the country’s first case of human infection with the H5N1 avian influenza virus.
The case occurred in a 30-year-old woman from the Gaiubia governorate near Cairo. She developed symptoms in early March following close contact with diseased chickens, ducks, and a turkey in the household flock. She was hospitalized on March 16 and died the following day.
Monitoring of the woman’s family members and close contacts has found no signs of influenza-like illness. Testing was conducted by the US Naval Medical Research Unit (NAMRU-3), which is based in Cairo. Samples are being sent abroad for diagnostic verification and further analysis by a WHO collaborating laboratory. WHO will adjust the figures in its cumulative number of cases following the results of this external verification.
Egypt confirmed its first H5N1 outbreak in poultry on February 17. The virus has since been reported in 18 of the country’s 26 governorates. In Egypt, poultry are often kept in close proximity to households, also in urban areas.
Indonesia
7/11/07
The World Health Organization reported today the Ministry of Health of Indonesia has announced a new case of human infection of H5N1 avian influenza. A 6-year-old male from Banten Province developed symptoms on July 1 and was hospitalized on July 5 where he died on July 8. The Ministry of Health is currently investigating the source of infection.
Of the 102 cases confirmed to date in Indonesia, 81 have been fatal.
6/25/07
The World Health Organization reported today the Ministry of Health of Indonesia has announced a new case of human infection of H5N1 avian influenza. A 3-year-old female from Riau Province developed symptoms on June 18 and has since recovered. Investigations into the source of her infection indicate exposure to sick and dead poultry.
Of the 101 cases confirmed to date in Indonesia, 80 have been fatal.
6/6/07
The World Health Organization reported today the Ministry of Health of Indonesia has announced a new case of human infection of H5N1 avian influenza. A 16-year-old female from Kendal district, Central Java province developed symptoms on May 21, was hospitalized on May 25 and died in the hospital on May 29, 2007. Initial investigations into the source of her infection indicate exposure to dead poultry.
Of the 99 cases confirmed to date in Indonesia, 79 have been fatal.
5/31/07
The World Health Organization reported today the Ministry of Health of Indonesia has announced a new case of human infection of H5N1 avian influenza. A 45-year-old male from Grobogan district, Central Java Province developed symptoms on May 17, was hospitalized on May 26 and died in hospital on May 28, 2007. Initial investigations into the source of his infection indicate exposure to dead poultry.
Of the 98 cases confirmed to date in Indonesia, 78 have been fatal.
5/24/07
The World Health Organization reported today the Ministry of Health of Indonesia has announced a new case of human infection of H5N1 avian influenza. A 5-year-old female from Wonogiri district, Central Java Province developed symptoms on May 8, was hospitalized on May 15 and died in the hospital on May 17. Initial investigations into the source of her infection indicate exposure to dead poultry.
Of the 97 cases confirmed to date in Indonesia, 77 have been fatal.
5/16/07
The World Health Organization reported today they can now confirm 15 additional cases, including 13 deaths of human infection with H5N1 avian influenza that occurred in Indonesia from the end of January 2007 up to the present and has updated its table of confirmed human cases accordingly.
Testing for H5N1 influenza virus infections is not done routinely by many laboratories and among the laboratories that do test for H5N1, experience and levels of diagnostic capacities can vary. WHO had previously required external confirmation of laboratory results from Indonesia, but following a formal on-site assessment of the capacity of national laboratory in Jakarta to diagnose H5 avian influenza viruses, WHO will now accept the results from the national laboratory, in collaboration with the Eijkman Institute without further external confirmation.
The assessment was carried out by a WHO team of virologists and laboratory scientists from the WHO Collaborating Centre in Tokyo, Japan, the national influenza centers of India and Thailand, the WHO Regional Office for South-East Asia and the WHO Country Office of Indonesia.
Of the 96 cases confirmed to date in Indonesia, 76 have been fatal.
1/29/07
The World Health Organization reported today the Ministry of Health of Indonesia has announced a new case of human infection of H5N1 avian influenza. A 6-year-old female from Magelang District in Central Java Province developed symptoms on January 8 and died in hospital on January 19, 2007. Initial investigations into the source of her infection indicate exposure to dead poultry.
Of the 81 cases confirmed to date in Indonesia, 63 have been fatal.
1/22/07
The World Health Organization reported today the Ministry of Health of Indonesia has announced a new case of human infection of H5N1 avian influenza. A 26-year-old woman from West Java Province developed symptoms on January 11 and died in the hospital on January 19, 2007. Initial investigations of the source of her infection indicate that the woman had been involved in the slaughter of sick chickens in the days prior to symptom onset.
Of the 80 cases confirmed to date in Indonesia, 62 have been fatal.
1/15/07
The World Health Organization reported today the Ministry of Health of Indonesia has confirmed the death of a 22-year-old woman from Tangerang City, Banten Province. The woman, whose infection was announced on January 12, died later that same day.
The Ministry of Health has also confirmed two additional cases of human infection of H5N1 avian influenza.
A 22-year-old woman from South Jakarta developed symptoms on January 6, 2007 and died on January 12, 2007. Investigations into the source of her exposure found reports of bird deaths near her home in the days prior to symptom onset.
The 18-year-old son of the 37-year-old woman from Tangerang City, Banten Province has now also been confirmed as infected with H5N1 avian influenza. He remains in hospital in a critical condition. Investigations into the source of his infection indicate similar environmental exposure as his mother.
Of the 79 cases confirmed to date in Indonesia, 61 have been fatal.
1/12/07
The World Health Organization reported today the Ministry of Health in Indonesia has confirmed the country's 59th death from H5N1 avian influenza. The 38 year old woman from
Tangerang, Banten Province whose infection was announced on January 9, died in hospital on January 11, 2007.
The Ministry of Health has also confirmed a new case of human infection with the H5N1 avian influenza virus. The 22 year old woman from Banten Province developed symptoms on January 3, 2007 and remains in hospital. An initial investigation into the source of her exposure found reports of chicken deaths near her home in the days prior to symptom onset.
Of the 77 cases confirmed to date in Indonesia, 59 have been fatal.
1/11/07
The World Health Organization reported today the Ministry of Health in Indonesia has confirmed the country's 58th death from H5N1 avian influenza. The 14 year old boy from West Jakarta, whose infection was announced on January 9, died on January 10 after being hospitalized.
Of the 76 cases confirmed to date in Indonesia, 58 have been fatal.
1/9/07
The World Health Organization reported today the Ministry of Health in Indonesia has confirmed an additional two cases of human infection with the H5N1 avian influenza virus.
The first newly-confirmed case is a 14 year old male from West Jakarta. He developed symptoms on December 31, 2006 and was hospitalized on January 4, 2007, he remains hospitalized. Deaths among poultry in the neighborhood have recently been reported. The source of exposure is currently under investigation.
The second case is a 37 year old female from
Tangerang, Banten Province. She developed symptoms on January 1, 2007 and was hospitalized on January 6, 2007. She remains in intensive care. Initial investigations suggest sick poultry as the possible source of infection.
Of the 76 cases confirmed to date in Indonesia, 57 have been fatal.
11/29/06
The World Health Organization reported today the Ministry of Health in Indonesia has confirmed the country's 57th death from H5N1 avian influenza. The 35-year-old female, whose infection was announced on November 13, died early in the morning on November 28 in hospital.
Of the 74 cases confirmed to date in Indonesia, 57 have been fatal.
11/15/06
The World Health Organization reported today the Ministry of Health in Indonesia has confirmed an additional two cases of human infection with the H5N1 avian influenza virus.
The first newly-confirmed case is a 35-year-old female from Tangerang in Banten Province. She developed symptoms on November 7 and was hospitalized on November 10. She remains hospitalized. Her source of exposure is currently under investigation.
The second case occurred in a 30-month-old male from Karawang in West Java Province. He developed symptoms on November 5, was hospitalized on November 10, and died on November 13. An initial investigation of his exposure source found reports of chicken deaths near his home in the days prior to symptom onset.
Of the 74 cases confirmed to date in Indonesia, 56 have been
fatal.
10/16/06
The World Health Organization reported today the Ministry of Health in Indonesia has confirmed an additional three cases of human infection with the H5N1 avian influenza virus. All three cases were fatal.
The first newly confirmed case occurred in a 67-year-old woman from West Java Province. She developed symptoms on October 3, was hospitalized on October 7 and died on October 15. Diagnosis was complicated by the presence of chronic diseases. Chickens reportedly died in her household and neighborhood prior to symptom onset.
The second case was an 11-year-old male from South Jakarta, Jakarta Province. He developed symptoms on October 2, was hospitalized on October 5 and died on October 14. His recent history included exposure to dead chickens in his neighborhood.
The third case was a 27-year-old female from Central Java Province. She developed symptoms on October 8, was hospitalized on October 12 and died on October 13. The source of her exposure is currently under investigation.
Of the 72 cases confirmed to date in Indonesia, 55 have been fatal.
10/3/06
The World Health Organization reported today the Ministry of Health in Indonesia has confirmed the country’s 69th case of human infection with the H5N1 avian influenza virus.
The case is a 21-year-old female from East Java Province. She developed symptoms on September 19 and was hospitalized on September 25; she remains hospitalized.
She is the sister of a confirmed H5N1 case, an 11-year-old male who died on September 18. Following that fatal case, health authorities initiated contact tracing, and on September 24 they received reports of symptoms in the sister. In line with the national protocol, she was immediately given the antiviral drug, oseltamivir, and isolated in hospital.
The source of her infection is presently under investigation. Poultry deaths in the family's household were noted both before and during the illness of the brother. The woman was likely exposed to these poultry as well as to her brother.
Of the 69 cases confirmed to date in Indonesia, 52 have been fatal.
9/28/06
The World Health Organization reported today the Ministry of Health in Indonesia has confirmed the country’s 52nd death from H5N1 avian influenza. The 20-year-old man, whose infection was announced on September 27, died early in the morning of September 28.
Of the 68 cases confirmed to date in Indonesia, 52 have been fatal.
9/27/06
The World Health Organization reported today 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 September 17 and was hospitalized on September 24, he remains hospitalized.
The man’s 23-year-old brother developed symptoms on September 16. He died of respiratory disease on September 24, 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 September 25 after developing symptoms of fever and cough. Initial test results received on September 27 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.
9/25/06
The World Health Organization reported today 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 September 16 was hospitalized on September 18, he 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 September 13, was hospitalized on September 20, and died on September 22. His history showed recent contact with sick chickens, which he kept as pets.
9/14/06
The World Health Organization reported today the Ministry of Health in Indonesia has confirmed two additional cases of human infection with the H5N1 avian influenza virus. These cases occurred in March and May 2006.
The first case occurred in a five-year-old male from East Bekasi, West Java Province. He developed symptoms on March 4, 2006, was admitted to hospital on March 6, and died on March 19. Test results, using two different assays, showed high antibody titer for H5N1 on consecutive serum samples taken on days 11 and 15 of his illness. These test results are consistent with new WHO criteria for laboratory confirmation. A field investigation at the time found that the case was exposed to diseased poultry in the vicinity of his home, where some birds tested positive for the H5 virus subtype.
The second case is a 27-year-old male from
Solok, West Sumatra Province. This case was identified during the tracing of contacts of the man’s sister, a 15-year-old female who developed symptoms on May 17, 2006 and was subsequently confirmed to be H5N1 infected. Her brother spent six days caring for her during her hospital stay. The brother developed mild symptoms of cough and abdominal discomfort, with no fever, on May 28, 2006; his symptoms remained mild and he recovered within a few days.
Despite his mild and atypical symptoms, the brother was tested as part of the Ministry of Health’s protocol for contact tracing and the management of any contacts with symptoms. He was given a five-day course of oseltamivir beginning on June 1 and was placed in voluntary isolation pending recovery.
Initial tests of samples collected from the 27-year-old male were negative for H5N1 infection. In August, follow-up testing of paired-serum samples found a fourfold rise in neutralization antibody titer for H5N1, a test result which meets the WHO criteria for laboratory confirmation.
The 27-year-old male reported no contact with diseased or dead poultry in the days prior to symptom onset as he spent most of his time at the hospital. The investigation determined that he had exposure to his sister during her hospital stay, and that human-to-human transmission could not be ruled out as the source of his infection.
The retrospectively confirmed cases bring the total in Indonesia to 65. Of these cases, 49 have been fatal.
9/8/06
The World Health Organization reported today the Ministry of Health in Indonesia has confirmed a new case of human infection with the H5N1 avian influenza virus. The case is a 14-year-old female from
Makassar, South Sulawesi Province. She developed symptoms on June 18, was hospitalized on June 23 and died on June 24. The case had contact with poultry near her home and was detected through the Ministry’s routine influenza surveillance system.
In addition to the above case and following the recent revision of case definitions for H5N1 infection, WHO is adding two cases in Indonesia, dating back to June and November of 2005. Inclusion of these two cases now aligns figures given for Indonesia in the WHO cumulative table of laboratory-confirmed cases with those officially issued by the Ministry of Health. Prior to the revision, the cases did not meet the WHO case definition for serologically confirmed avian influenza H5N1 infection.
The first retrospectively confirmed case was an 8-year-old female from Tangerang in Banten Province. She developed symptoms on June 24, 2005 and died on July 14, 2005. She was part of a family cluster reported to WHO in July 2005.
The second retrospectively confirmed case is a 45-year-old male from Magelang, Central Java Province. He developed symptoms on November 25, 2005 following direct contact with diseased poultry and subsequently recovered.
The retrospectively confirmed cases bring the total in Indonesia to 63. Of these cases, 48 have been fatal.
8/23/06
The World Health Organization reported today the Ministry of Health in Indonesia has confirmed the country’s 60th case of human infection with the H5N1 avian influenza virus.
The case is a 6-year-old female from Bekasi, West Java Province. She developed symptoms on 6 August and was hospitalized on August 11. She remains hospitalized but is recovering. The source of her infection is currently under investigation.
Of the 60 cases confirmed to date in Indonesia, 46 have been fatal.
8/21/06
The World Health Organization reported today the Ministry of Health in Indonesia has confirmed the country’s 59th case of human infection with the H5N1 avian influenza virus.
The case occurred in a 35-year-old woman from the remote sub district of Cikelet, West Java Province. She was hospitalized with severe respiratory disease on August 17 and died shortly after admission.
She is the third confirmed case from this sub-district to be reported in the past week.
Preliminary findings from the Cikelet investigation
A team of experts is presently in the Cikelet sub district investigating the outbreak and monitoring for further cases. Three hamlets are the focus of investigation.
The Cikelet sub district consists of around 20 isolated hamlets, each with a population of around 200 to 400 persons, many living in large extended families. The hamlets sit in a basin surrounded by steep mountains with rocky winding paths best accessed by foot or horseback.
In this area, mortality from endemic diseases, especially malaria, is common, access to health care is poor, and medical records of deaths are scanty or non-existent.
Prior to late June 2006, no mass die-offs of poultry are known to have occurred in the area. At that time, live chickens were purchased from an outside market in preparation for a religious feast and were integrated into local flocks. Shortly thereafter, chickens began dying in large numbers in an outbreak that continued throughout July and the first week of August, gradually spreading from one hamlet to another.
As the population had no experience with this disease, high-risk behaviors commonly occurred during the disposal of carcasses or the preparation of sick or dead birds for consumption. These exposures are, at present, thought to be the source of infection for most confirmed or suspected cases.
Deaths from respiratory illness are known to have occurred in late July and early August, but no samples were taken and medical records are generally poor. Though some of these undiagnosed deaths occurred in family members of confirmed cases, the investigation has found no evidence of human-to-human transmission and no evidence that the virus is spreading more easily from birds to humans.
The cooperation of residents is good, house-to-house surveillance for febrile illness is continuing, and specimens have been taken from symptomatic persons and sent for testing. The team is well-supplied with antiviral drugs, and these are being administered prophylactically to close contacts of cases and therapeutically to persons showing symptoms of influenza-like illness.
Of the 59 cases confirmed to date in Indonesia, 46 have been fatal.
8/17/06
The World Health Organization reported today the Ministry of Health in Indonesia has confirmed the country’s 58th case of human infection with the H5N1 avian influenza virus.
The case occurred in a 9-year-old girl from a remote village in Garut district, West Java Province. She developed symptoms on August 1, was hospitalized on August 14 and died on August 15. Recent chicken deaths were reported in her household.
Three hamlets within the village are currently under investigation. An additional case from the village, but from another hamlet, was confirmed by the Ministry of Health on August 14. This 17-year-old male developed symptoms on July 26 and is now recovering. Another death from severe respiratory disease occurred on August 5 in a 20-year-old neighbor, who is also now known to be a cousin. As no samples were taken for testing, the cause of his illness remains uncertain. Based on epidemiological and clinical findings, however, infection with the H5N1 virus is strongly suspected.
As both young men developed symptoms on the same day (July 26), epidemiologists assume that they acquired their infection from a shared environmental source. The currently recognized incubation period for H5N1 infection of 2 to 8 days makes human-human transmission between the two highly improbable.
Teams from local health authorities, the Ministry of Health, and WHO are currently in the three hamlets investigating these cases and assessing the overall situation. Team members include experts in animal health. Recent die-offs of poultry are known to have occurred in the village, and all three cases described above had documented exposure to diseased chickens.
Heightened awareness in the hamlets, supported by the presence of well-equipped teams, has led to the presentation of additional persons for medical evaluation. Specimens have been taken and tests are being conducted. Rumors of additional deaths from respiratory disease in the hamlets in late July and early August are also being investigated.
Although the village is remote and access by road is difficult, good communications from the field have been established with the Ministry of Health and WHO.
Of the 58 cases confirmed to date in Indonesia, 45 have been fatal.
8/14/06
The World Health Organization reported today the Ministry of Health in Indonesia has confirmed the country’s 57th case of human infection with the H5N1 avian influenza virus.
The case is a 17-year-old male from a remote village in Garut district, West Java Province. He developed symptoms on July 26 and was referred to hospital on August 9. At the hospital, medical staff suspected H5N1 infection based on his respiratory symptoms and a history of exposure to dead poultry. Because of this suspicion, specimens were collected from the patient and sent for testing. Results received on August 12 were positive for H5N1 infection. The patient is presently recovering.
A thorough field investigation found that chicken and duck deaths occurred in the patient’s household and neighborhood during the week prior to the onset of symptoms. The case reportedly had direct contact with diseased chickens during the disposal of carcasses.
The investigation also obtained information about a 20-year-old male who lived in a neighboring household where chickens were also dying. The man developed symptoms on July 26 and sought care at the local health center on August 5. He died of respiratory disease on August 6, before arrangements could be made for transfer to hospital and before samples could be taken for testing. The cause of his illness and death remain undetermined.
Of the 57 cases confirmed to date in Indonesia, 44 have been fatal.
8/9/06
The World Health Organization reported today the Ministry of Health in Indonesia has confirmed the country’s 56th case of human infection with the H5N1 avian influenza virus.
The case occurred in a 17-year-old female from Jakarta Province. She developed symptoms on July 28, was hospitalized on August 4, and died on August 8.
An investigation into her source of infection found that pet pigeons were kept inside her home and that several neighboring households maintained flocks of backyard poultry.
Animal health authorities have collected samples from birds in the neighborhood and these will be tested as part of the continuing investigation.
Of the 56 cases confirmed to date in Indonesia, 44 have been fatal.
8/8/06
The World Health Organization reported today the Ministry of Health in Indonesia has confirmed the country’s 55th case of human infection with the H5N1 avian influenza virus.
The case occurred a 16-year-old male from West Java Province. He developed symptoms on July 26, was hospitalized on August 4, and died on August 7.
Prior to symptom onset, the case had contact with sick and dying chickens in his household. A joint investigation by health and agricultural officials detected the H5 virus subtype in chickens from the household. Family members and close contacts have been placed under surveillance.
Of the 55 cases confirmed to date in Indonesia, 43 have been fatal.
7/20/06
The World Health Organization reported today the Ministry of Health in Indonesia has confirmed the country’s 54th case of human infection with the H5N1 avian influenza virus.
The case, which was fatal, occurred in a 44-year-old man from East Jakarta, Jakarta Province. He developed symptoms on June 24, was hospitalized on July 10 and died on July 12.
The case may have acquired the infection from poultry around his home and animal health authorities have taken samples for testing. Another potential source of infection was a local wet market, which he regularly visited during the course of his work as the owner of a food stall.
Of the 54 cases confirmed to date in Indonesia, 42 have been fatal.
7/14/06
The World Health Organization reported today the Ministry of Health in Indonesia has confirmed the country's 53rd case of human infection with the H5N1 avian influenza virus.
The case, which was fatal, occurred in a 3-year-old girl from a suburb of Jakarta. She became ill on June 23, was hospitalized on July 5 and died the next day. Specimens collected from the girl were confirmed positive for H5N1 avian influenza virus.
An investigation found that the case handled chickens that had died in the neighborhood, to dispose of them, two days before the onset of her symptoms. Samples taken from chickens in the neighborhood were found to be positive. An investigation has found no further cases of influenza-like illness and monitoring of close contacts is under way.
Of the 53 cases confirmed to date in Indonesia, 41 have been fatal.
7/5/06
The World Health Organization reported today the Ministry of Health in Indonesia has confirmed the country's 52nd case of human infection with the H5N1 avian influenza virus.
The case, which was fatal, occurred in a 5-year-old boy from Tulungagung district, East Java Province. The boy became ill on June 8, was hospitalized on June 14 and died two days later on June 16.
An investigation found a history of chicken deaths in the boy's household two weeks before symptom onset. Laboratory testing of poultry in the sub-district confirmed the presence of H5N1 in chickens. Monitoring of close contacts has detected no further cases.
Of the 52 cases confirmed to date in Indonesia, 40 have been fatal.
6/20/06
The World Health Organization reported today the Ministry of Health in Indonesia has confirmed the country’s 51st case of human infection with the H5N1 avian influenza virus.
The case, which was fatal, occurred in a 13-year-old boy from South Jakarta. He developed symptoms on June 9 one week after helping his grandfather slaughter diseased chickens at the family home. The boy was hospitalized on June 13 and died on June 14.
The grandfather remains healthy. Contact tracing and monitoring are under way to ensure no further cases arise from this exposure setting.
Of the 51 cases confirmed to date in Indonesia, 39 have been fatal.
Expert consultation
WHO, FAO, and the Indonesian ministries of health and agriculture are jointly convening an expert consultation in Jakarta from June 21-23. The consultation is being held, at the request of the government’s national commission on avian influenza and pandemic influenza, to assess the avian influenza situation in poultry and humans.
The consultation, which will be attended by more than 40 national and international experts, will review measures for addressing the widespread presence of the virus in poultry and offer advice on strategies for reducing the number of human cases. The experts will also examine epidemiological and virological data collected during a month-long investigation of a cluster of cases among family members in the Kubu Simbelang village of North Sumatra.
More than three weeks (two times the maximum incubation period) have passed since the last case in the cluster died on May 22. Daily house-to-house monitoring for influenza-like illness was conducted throughout the village and in health care facilities where patients were treated, and no further cases were detected. While these findings indicate no significant changes in the epidemiology of the disease, results from investigation of the cluster will be reviewed as they may yield lessons useful in the investigation and interpretation of other large clusters where human-to-human transmission is suspected.
Several viruses have been isolated from the seven confirmed cases in the cluster and these have been fully sequenced at WHO reference laboratories in Hong Kong and the USA. Experts from these laboratories will be presenting their findings for review during the consultation.
6/15/06
The World Health Organization reported today the Ministry of Health in Indonesia has confirmed the country’s 50th case of human infection with the H5N1 avian influenza virus.
The case, which was fatal, occurred in a 7-year-old girl from Tangerang district, Banten Province. She developed symptoms on May 26, was hospitalized on May 30, and died on June 1. Her 10-year-old brother died of respiratory disease on May 29, but no specimens were taken for testing and the cause of his death cannot be determined.
An investigation found a history of chicken deaths in the household and neighborhood prior to symptom onset. Laboratory testing of surviving family members and close contacts has been conducted and no further cases were found.
6/6/06
The World Health Organization reported today the Ministry of Health in Indonesia has confirmed the country’s 49th case of human infection with the H5N1 avian influenza virus.
The case occurred in a 15-year-old boy from Tasikmalaya District, West Java Province. He developed symptoms on May 24, was hospitalized on May 26, and died on May 30. An investigation conducted by provincial health authorities found a history of contact with sick and dying chickens in the boy’s household in the week before the onset of his symptoms. Monitoring of family members and close contacts has detected no cases of influenza-like illness.
Of the 49 cases confirmed to date in Indonesia, 37 have been fatal.
The H5N1 virus is considered firmly entrenched in poultry throughout much of Indonesia. Unless this situation is urgently and comprehensively addressed, sporadic human cases will continue to occur.
The newly confirmed case is one of several where exposure occurred despite a clear signal of a high-risk situation arising from poultry deaths. Pending better control of the disease in animals, WHO and officials in the Ministry of Health see an urgent need to improve public awareness of this disease, the risk factors for infection, and the behaviors that should be avoided.
In addition, the World Health Organization reported for the past four days, Indonesian health authorities and WHO have been monitoring cases of influenza-like illness in four nurses who were involved in the care of confirmed H5N1 patients.
Test results have now convincingly ruled out H5N1 infection in all four nurses.
Two of the nurses cared for siblings, a 10-year-old girl and her 18-year-old brother, who were hospitalized in Bandung, West Java, on May 22 and died the following day. Test results for both nurses are negative for H5N1 infection. One nurse was shown to be infected with a seasonal influenza A (H1N1) virus, which is now circulating widely throughout Indonesia. The second nurse experienced only mild and transient symptoms, but was tested urgently as a precautionary measure. Her test results were also negative for H5N1 infection.
The two additional nurses, who work at a hospital in Medan, North Sumatra, were involved in the care of confirmed H5N1 cases among members of an extended family from the village of Kubu Simbelang in Karo District. One of the nurses, a 34-year-old woman, experienced only mild symptoms and has subsequently tested negative for H5N1 infection. The second nurse, a 42-year-old woman, developed influenza-like illness on June 1. Test results received today are also negative for H5N1 infection.
The speed and thoroughness with which influenza-like illness in these nurses was investigated are indicative of the heightened concern among Indonesian health authorities. The negative test results for all four nurses provide reassuring evidence that the virus is not spreading efficiently or sustainably among humans at present.
5/31/06
The World Health Organization reported today Indonesian health authorities and the WHO have further strengthened their response to the family cluster of cases in Kubu Simbelang village, Karo District, North Sumatra. As of today, 54 surviving family members and other close contacts of cases have been identified and placed under voluntary home quarantine. All of these people, with the exception of pregnant women and infants, are receiving the antiviral drug, oseltamivir (Tamiflu), for prophylactic purposes. Public health teams visit these people daily, checking for symptoms.
In addition, active house-to-house surveillance for influenza-like illness is being conducted throughout the village, which has around 400 households. A command post for fever surveillance has been functioning in the village since last week.
As of today, no new cases suggestive of H5N1 infection have been detected since May 22. This finding is important as it indicates that the virus has not spread beyond the members of this single extended family. No hospital staff involved in the care of patients, in some instances without adequate personal protective equipment, have developed the disease. The last person in the cluster, who developed symptoms on May 15 and died on May 22, refused hospitalization. He moved between two villages while ill, accompanied by his wife. The wife is under surveillance and has not developed symptoms.
Despite multiple opportunities for the virus to spread to other family members, health care workers or into the general community, it has not, on present evidence, done so.
Current level of pandemic alert
Based on an assessment of present evidence, WHO has concluded that the current level of pandemic alert is appropriate and does not need to change. The level of pandemic alert remains at phase 3. This phase pertains to a situation in which occasional human infections with a novel influenza virus are occurring, but there is no evidence that the virus is spreading in an efficient and sustained manner from one person to another.
WHO has recommended continued close monitoring of the situation in Kubu Simbelang for the two weeks following May 22, the date when the last known case in the cluster died. As a precautionary measure, Indonesian authorities have decided to extend this recommended period to three weeks.
Preliminary results of the investigation
This information differs in some details from information released in previous updates, but is derived from extensive investigations by senior national and international epidemiologists, from WHO and the US Centers for Disease Control and Prevention, who have developed a clearer picture of the situation.
The cluster involves an initial case and seven subsequent laboratory-confirmed cases. All cases are members of an extended family: sisters and brothers and their children. Family members resided in four households. Three households were next-door neighbors in the village of Kubu Simbelang, Karo District, North Sumatra. The fourth household was located about 10 kilometers away in the nearby village of
Kabanjahe.
The initial case in the cluster was a 37-year-old woman who sold fruits and chillies at a market in the village of Tigapanah. Her stand was located about 15 meters away from a stand where live chickens were sold. The investigation uncovered no reports of poultry die-offs in the market. However, the woman kept a small number of backyard chickens, allowed into the house at night. Three of her chickens reportedly died before she became ill. She is also known to have used chicken feces from these household chickens as fertilizer in her garden.
A parallel agricultural investigation has not, to date, detected H5N1 virus in PCR tests of approximately 80 samples from poultry, other livestock and domestic pets, and chicken fertilizer taken from the vicinity.
The initial case developed symptoms on April 24, was hospitalized on May 2, and died on May 4. No samples were collected for testing prior to her burial, but she is considered part of the cluster as her clinical course was compatible with H5N1 infection. The initial case had one sister and three brothers. The sister and two of the brothers subsequently developed infection. The remaining cases occurred among children in these families.
The confirmed cases include five males and two females with an average age of 19 years (range from 1 to 32 years). Six out of the seven confirmed cases developed symptoms between May 3 and May 5. These cases include two sons of the initial case, her brother from
Kabanjahe, her sister, the sister’s baby, and the son of a second brother living in an adjacent house. This second brother, the last case in the cluster, developed symptoms on May 15. Six out of the seven cases were fatal.
Exposures
On the night of April 29, nine family members spent the night in a small room with the initial case at a time when she was severely ill, prostrate, and coughing heavily. These family members included the initial case and her three sons; the brother from Kabanjahe village, his wife, and their two children; the 21-year-old daughter of another brother (who did not become infected); and another young male visitor. Following this event, three family members – the woman’s two sons and the visiting brother from Kabanjahe – developed symptoms from 5 to 6 days later.
The woman’s sister, who lived in an adjacent house, developed symptoms at the same time, as did her 18-month-old daughter. Prior to symptom onset, this sister, accompanied by her daughter, provided close personal care of the initial case.
The last case in the cluster provided close care for his son throughout his hospital stay, from May 9-13. The son was a frequent visitor in the home of the initial case and was present there on April 29.
5/30/06
The World Health Organization reported today the Ministry of Health in Indonesia has confirmed an additional six cases of human infection with the H5N1 avian influenza virus. Three of these cases were fatal. None of the newly confirmed cases is associated with the family cluster in
Karo, North Sumatra. The cases are widely dispersed geographically.
One newly confirmed case is an 18-year-old man from East Java Province. He developed symptoms on May 6 and was hospitalized on May 17, he is now recovering. The investigation found a history of exposure to dead chickens in his home within the week prior to symptom onset. No further cases of influenza-like illness have been identified during the investigation and monitoring of his close contacts.
Two additional cases occurred in a 10-year-old girl and her 18-year-old brother from Bandung, West Java. Both children developed symptoms on May 16, were hospitalized on May 22, and died on May 23. Both children had a history of close contact with sick and dying chickens at their home in the week before symptom onset. The identical onset dates strongly suggest that they acquired their infection following a shared exposure to poultry, and not from each other. Follow-up of contacts has not identified further cases of influenza-like illness.
An additional case occurred in a 39-year-old man from West Jakarta. He developed symptoms on 9 May, was hospitalized on May 16, and died on May 19. The investigation determined that the man cleaned pigeon feces from blocked roof gutters at his home shortly before symptom onset. No further potential source of exposure was identified.
The remaining two patients are a 43-year-old man from South Jakarta, who developed symptoms on May 6, and a 15-year-old girl from West Sumatra, who developed symptoms on May 17. The 43-year-old man has recovered and been discharged from hospital. The 15-year-old girl remains hospitalized. The sources of exposure for these two cases are under investigation.
The newly confirmed cases bring the cumulative total in Indonesia to 48. Of these cases, 36 were fatal.
5/22/06
The World Health Organization reported today the Ministry of Health in Indonesia confirmed on May 19 an additional case of human infection with the H5N1 avian influenza virus. The case occurred in a 12-year-old boy from Bekasi in East Jakarta. He was hospitalized on May 7 and died on May 13.
An investigation is under way to determine the source of his infection.
The newly confirmed case brings the total in Indonesia to 41. Of these cases, 32 have been fatal.
5/18/06
The World Health Organization reported today the Ministry of Health in Indonesia has confirmed an additional seven cases of human infection with the H5N1 avian influenza virus. Six of the cases were fatal.
One fatal case, in a 38-year-old woman, occurred in the city of Surabaya, in East Java. She developed symptoms on May 2, was hospitalized on May 7 and died on May 12. The case is the first reported from this area.
The remaining six cases are from the village of Kubu Sembelang in the Karo district of North Sumatra. All six are members of an extended family, and all but one lived in neighboring houses.
Associated with the Kubu Sembelang outbreak is a seventh family member, a 37-year-old woman. She developed symptoms on April 27 and died of respiratory disease on May 4. No specimens were obtained before her burial, and the cause of her death cannot be confirmed. She is, however, considered the initial case in this family cluster.
The six confirmed cases in Sumatra include the woman’s two sons, aged 15 and 17 years, who died respectively on May 9 and May 12. The 28-year-old sister of the initial case died on May 10. This sister had an 18-month-old girl, who died on May 14. The fifth confirmed case, who is still alive, is the 25-year-old brother of the initial case. The sixth confirmed case is the 10-year-old nephew of the initial case. He died on May 13.
One additional family member, who had been hospitalized, has subsequently been ruled out based on both negative laboratory results and the absence of clinical symptoms compatible with H5N1 infection.
This is the largest cluster of cases, closely related in time and place, reported to date in any country and is being carefully investigated by Indonesia’s ministries of health and agriculture and by WHO epidemiologists. The source of exposure for the initial case is still under investigation, with exposure to infected poultry or an environment contaminated by their feces considered the most plausible source.
The likely source of infection for the additional cases has not yet been determined. Multiple hypotheses are being investigated. Apart from living in close proximity to each other, the cases in this cluster are known to have participated in a family gathering around April 29. The cases may have acquired their infection from a shared environmental exposure yet to be identified. The possibility of limited human-to-human transmission cannot be ruled out at present.
Investigators at the outbreak site have found no evidence that infection has spread beyond members of this single extended family. No influenza-like illness has been identified in health care workers or other persons in close contact with the patients. If human-to-human transmission has occurred, it has not been either efficient or sustained.
The newly confirmed cases bring the total in Indonesia to 40. Of these cases, 31 have been fatal.
5/8/06
The World Health Organization reported today the Ministry of Health in Indonesia has confirmed the country’s 33rd case of human infection with the H5N1 avian influenza virus. The case, which was fatal, occurred in a 30-year-old man from Greater Jakarta. He developed symptoms on April 17, was hospitalized on April 21, and died on April 26.
An investigation to determine the source of his infection is continuing. He lived in close proximity to pens where animals, including poultry, were kept.
Of the 33 laboratory-confirmed cases in Indonesia, 25 have been fatal.
4/20/06
The World Health Organization reported today the Ministry of Health in Indonesia has confirmed the country’s 32nd case of human infection with the H5N1 avian influenza virus. The case occurred in a 24-year-old man from
Tangerang, near Greater Jakarta. He developed symptoms on March 29, was hospitalized on April 5 and died on April 8, 2006.
His source of exposure is presently under investigation.
Of the 32 laboratory-confirmed cases in Indonesia, 24 have been fatal.
4/12/06
The World Health Organization reported today the Ministry of Health in Indonesia has confirmed the country’s 31st case of human infection with the H5N1 avian influenza virus. The case occurred in a 23-year-old man employed as a poultry worker in West Java.
He developed symptoms on March 20 and has since fully recovered. Poultry deaths occurred in the two weeks preceding his visit to a farm.
Of the 31 laboratory-confirmed cases in Indonesia, 23 have been fatal.
4/4/06
The World Health Organization reported today the Ministry of Health in Indonesia has confirmed an additional case of human infection with the H5N1 avian influenza virus. The case, which was fatal, occurred in a 20-month-old girl who resided in
Kapuk, West Jakarta. She developed symptoms of fever and cough on March 17, was hospitalized on March 22, and died on March 23.
Field investigation found a history of deaths in a chicken flock near her home about one week prior to symptom onset. Chicken deaths in the neighborhood have continued, but the cause has not yet been identified. Family members and neighbors have been placed under observation and samples from these people have been taken for testing. Preliminary results are negative, but follow-up investigation is continuing.
The newly confirmed case brings the total in Indonesia to 30. Of these, 23 were fatal.
3/13/06
The World Health Organization reported today the Ministry of Health in Indonesia has confirmed an additional case of human infection with the H5N1 avian influenza virus. The case, which was fatal, occurred in a 12-year-old girl from
Boyolali, Central Java. She developed symptoms (fever) on February 19, was hospitalized on February 23, and died on March 1. Chickens in her household died in the days preceding symptom onset.
The girl’s 10-year-old brother also fell ill on February 19 and died on February 28. As his symptoms were compatible with a clinical diagnosis of dengue hemorrhagic fever, no testing for H5N1 was carried out. It will therefore never be known whether he may have died following co-infection with dengue and H5N1 avian influenza.
A local investigation was conducted and no additional cases or symptomatic contacts were found. Rapid tests detected the H5 virus subtype in chickens from the children’s household.
The newly confirmed case brings the total in Indonesia to 29. Of these, 22 were fatal.
3/13/06
The World Health Organization reported today the Ministry of Health in Indonesia has confirmed an additional case of human infection with the H5N1 avian influenza virus. The case, which was fatal, occurred in a 4-year-old boy from
Semerang, Central Java. He developed symptoms (fever) on February 10 and died on February 28, 2006.
A joint investigation involving provincial health and agricultural authorities found that chickens had died in the boy’s neighborhood in the days preceding symptom onset. No other human cases were identified in the family or neighborhood.
The newly confirmed case brings the total in Indonesia to 28. Of these, 21 were fatal.
Agricultural authorities have reported a recent increase in the number of poultry deaths in Central and East Java. These reports have led to heightened awareness of the risk of human cases and a higher level of clinical suspicion when patients present with respiratory symptoms.
The Ministry of Health and WHO are monitoring the situation closely. Many patients under investigation have subsequently been ruled out by tests conducted at local and WHO-affiliated laboratories.
2/27/06
The World Health Organization reported today the Ministry of Health in Indonesia has confirmed an additional case of human infection with the H5N1 avian influenza virus. The case, which was fatal, occurred in a 27-year-old woman from West Java Province. She developed symptoms on February 13 and died on February 20, 2006.
Investigations carried out by local authorities found reports of chicken deaths in the woman’s neighborhood four days prior to her onset of symptoms.
The newly confirmed case brings the total in Indonesia to 27. Of these, 20 were fatal.
2/24/06
The Ministry of Health and Family Welfare in India has informed the World Health Organization (WHO) that no human cases of H5N1 infection have been detected to date. Tests conducted on samples taken from persons under investigation and their close contacts have yielded no positive results as of today. This testing has been undertaken at the National Institute of Virology in Pune and the National Institute of Communicable Diseases in Delhi.
It was not clear if samples from a 27-year-old poultry worker from Gujarat State, said to have died of respiratory disease on February 17, were among those tested.
In India, as in all countries experiencing their first outbreaks of highly pathogenic H5N1 avian influenza, WHO strongly recommends that patient samples be sent to a WHO collaborating laboratory for diagnostic confirmation. Certainty about the status of human cases in a newly affected country is important for accurate risk assessment. In addition, analyses conducted by WHO approved laboratories can yield information about the possible evolution of the virus and clues about how the virus may have arrived in the country. Genetic and antigenic studies of circulating viruses also help ensure that work on the development of a pandemic vaccine stays on track.
On February 18, agricultural authorities in India had confirmed the country’s first outbreak of highly pathogenic H5N1 avian influenza in poultry. The disease was detected at several commercial farms in the Navapur sub-district in the western state of
Maharashtra.
Prior to that date, large numbers of poultry deaths, at more than 50 farms in the area, had been noted, but the cause was initially diagnosed as Newcastle disease. The outbreak is now thought to have begun on January 27, 2006. Agricultural authorities have reported that some backyard farms are also affected. Mass culling of birds at affected farms is continuing.
The Ministry of Health and Family Welfare has dispatched rapid response teams to Navapur and the neighboring areas. House-to-house searches for cases of influenza-like illness are being conducted. The government has equipped a Navapur hospital for the management, in isolation, of possible human cases. WHO was informed today that 12 patients with fever and respiratory illness in Navapur sub-district have been hospitalized for observation as a precautionary measure. An additional 3 patients have been hospitalized, also for observation, in the Vaira sub-district of the adjacent Gujarat state.
2/20/06
The World Health Organization reported today the Ministry of Health in Indonesia has confirmed an additional case of human infection with the H5N1 avian influenza virus. The case, which was fatal, occurred in a 23-year-old man from East Jakarta who was employed as an egg seller at a wet market. He developed symptoms on February 5, was hospitalized on February 7 and died on February 10, 2006. None of the contacts traced showed influenza-like illness.
The newly confirmed case brings the total in Indonesia to 26. Of these, 19 were fatal.
2/13/06
The World Health Organization reported today 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 January 25 and died on February 10, 2006. Her neighbors 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 January 31 and died on February 10. Deaths of chickens in her neighborhood were reported about four days prior to the onset of her symptoms. 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.
2/7/06
The World Health Organization reported today 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 January 26. He worked as a banana vendor at a market in East Jakarta where poultry meat was sold. Neighbors 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 February 1, 2006. 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 January 19 and has since recovered. She lived in a village neighboring that of the two fatal cases in siblings confirmed on January 23. 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.
1/23/06
The World Health Organization reported today 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 January 6, was hospitalized on January 12, and died on January 14, 2006. The second patient was her four-year-old brother. He developed symptoms on January 8, was hospitalized on January 14, and died on January 17, 2006.
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 January 14 and the father on January 17. 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 neighborhood. 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.
12/23/05
The World Health Organization reported today the Ministry of Health in Indonesia has confirmed two additional cases of human infection with the H5N1 avian influenza virus.
The first case occurred in an 8-year-old boy from Central Jakarta. He developed symptoms of fever and cough on December 8. He was hospitalized on December 13, and died on December 15, 2005.
Family members and close contacts were placed under observation and tested for possible infection, however, none have developed symptoms. Investigations have been undertaken to determine the source of the boy's exposure and samples from pigeons around his household are being tested.
The second case occurred in a 39-year-old man from East Jakarta. He first reported symptoms of fever, headache, cough and shortness of breath on December 9. He was hospitalized on December 11 and died on December 12, 2005.
Family members and close contacts were placed under observation. Investigations are being undertaken to determine the source of the man’s exposure. While he did not keep poultry in his household, chickens and other birds were found in his neighborhood. Samples from these birds have been taken and are undergoing tests to determine whether they may have been the source of infection.
12/14/05
The World Health Organization reported today the Ministry of Health in Indonesia has confirmed a further case of human infection with the H5N1 avian influenza virus. The case occurred in a 35-year-old man from West Jakarta. He developed symptoms of fever, cough and breathing difficulty on November 6, was hospitalized on November 9, and died on November 19, 2005.
Family members and close contacts were placed under observation and tested for possible infection. No evidence of additional cases has been detected.
Investigations have been undertaken to determine the source of the man’s exposure. While he did not keep poultry in his household, chickens and other birds were found in his neighborhood. Samples from these birds have been taken and are undergoing tests to determine whether they may have been the source of infection.
12/6/05
The World Health Organization reported today the Ministry of
Health in Indonesia has confirmed a further case of human
infection with the H5N1 avian influenza virus. The case occurred
in a 25-year-old woman from Tangerang (west of Jakarta). She
developed symptoms of fever and stomach discomfort on November
17, followed by cough and breathing difficulty. She was admitted
to hospital on November 23 and died on November 25, 2005.
A field investigation of this
case found a history of exposure to sick poultry around her
house. Testing of poultry and environmental samples has been
undertaken by the Ministry of Agriculture. Close contacts of the
woman are being monitored.
11/30/05
The World Health Organization reported today 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 November 6, followed by breathing difficulties a few days later. He was hospitalized on November 16, 2005 and remains in stable condition.
A field investigation of this case determined that two of his siblings had died 5 days before his hospitalization. His two brothers, aged 7 and 20 years, had onset of illness on November 3 and died on November 11, 2005, following symptoms of fever and breathing difficulty. The presumptive diagnosis was typhoid fever. No samples were taken before burial, which precludes definitive diagnosis. The 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.
11/17/05
The Ministry of Health in Indonesia has today confirmed a further two cases of human infection with the H5N1 avian influenza virus. Both cases were fatal.
The first newly confirmed case was a 16-year-old girl from Jakarta. She developed symptoms on November 4, was hospitalized on November 6, and died on November 8, 2005. The second case was a 20-year-old woman from Jakarta. She developed symptoms on November 5, was hospitalized on November 9, and died on November 12, 2005.
Both cases were confirmed by a WHO reference laboratory in Hong Kong. Field investigations are under way.
11/7/05
The World Health Organization reported today that the Ministry of Health in Indonesia has confirmed two additional cases of human infection with H5N1 avian influenza. The first newly confirmed case was a 19-year-old woman from Tangerang, near Jakarta, who developed symptoms on October 19, was admitted to hospital on October 26, and died on October 28, 2005.
The second case is her 8-year-old brother. He developed symptoms on October 25 and remains hospitalized in good condition.
Field investigation has found evidence of sick and dying chickens in the residential area of the 8-year-old. His 19-year-old sister is known to have visited this area. Final results from an ongoing Ministry of Agriculture investigation are pending.
To date, Indonesia has confirmed 9 cases of human H5N1 infection of which 5 have been fatal.
Germany
2/28/06
The World Health Organization (WHO) reported authorities in Germany have announced detection of H5N1 avian influenza in a domestic cat. The cat was found dead over the weekend on the northern island of
Ruegen. Since mid-February, more than 100 wild birds have died on the island, and tests have confirmed H5N1 infection in several.
There is no present evidence that domestic cats play a role in the transmission cycle of H5N1 viruses. To date, no human case has been linked to exposure to a diseased cat. No outbreaks in domestic cats have been reported.
Unlike the case in domestic and wild birds, there is no evidence that domestic cats are a reservoir of the virus. All available evidence indicates that cat infections occur in association with H5N1 outbreaks in domestic or wild birds.
Experimental studies, published in September 2004, demonstrated that the H5N1 virus can infect domestic cats, and that cats can transmit the virus to other cats. In these experiments, the cats developed disease following direct inoculation of virus isolated from a fatal human case, and following the feeding of infected raw chicken.
The current H5N1 panzootic in birds, which began in mid-2003 in parts of South-East Asia, has been accompanied by a few anecdotal reports of H5N1 infection in domestic cats. In all such reports, eating raw infected poultry was considered the most likely source of infection for the cats.
Several published studies have demonstrated H5N1 infection in large cats kept in captivity. In December 2003, two tigers and two leopards, fed on fresh chicken carcasses, died unexpectedly at a zoo in Thailand. Subsequent investigation identified H5N1 in tissue samples.
In February 2004, the virus was detected in a clouded leopard that died at a zoo near Bangkok. A white tiger died from infection with the virus at the same zoo in March 2004.
In October 2004, captive tigers fed on fresh chicken carcasses began dying in large numbers at a zoo in Thailand. Altogether 147 tigers out of 441 died of infection or were euthanized. Subsequent investigation determined that at least some tiger-to-tiger transmission of the virus occurred.
Lao People’s Democratic Republic
3/9/07
The World Health Organization reported the Ministry of Health in Lao People's Democratic Republic has confirmed the country's first death from H5N1 avian influenza. The 15-year-old female from Vientiane, whose infection was announced February 27, died on March 7 after being hospitalized in neighboring Thailand.
Cambodia
4/7/06
The World Health Organization (WHO) reported today the Ministry of Health in Cambodia has confirmed the country’s sixth case of human infection with the H5N1 avian influenza virus. The case occurred in a 12-year-old boy from the south-eastern province of Prey
Veng, which borders Viet Nam.
The boy developed symptoms of fever and headache on March 29. He was initially treated at a private clinic, then hospitalized in Phnom Penh on April 4 and died on April 5. Samples from the boy tested positive for H5N1 infection at the Pasteur Institute in Cambodia.
A team from the Ministry of Health, WHO, and the Pasteur Institute investigated the situation in the child’s village yesterday. Numerous chicken deaths and some duck deaths were noted to have occurred in the neighborhood in recent weeks. The child reportedly gathered dead chickens for distribution to village families for consumption.
The investigative team identified 25 close contacts of the child. None of these people show signs of illness at present. House-to-house surveillance for signs of influenza-like illness is continuing.
This case is the sixth in Cambodia and the second this year. All six cases were fatal.
Nigeria
2/28/06
The World Health Organization (WHO) reported highly pathogenic H5N1 avian influenza has been confirmed in poultry in Niger, marking spread of the virus to a second country in sub-Saharan Africa.
During February, significant mortality of chickens and ducks was observed in five outbreaks in two administrative districts near the border with Nigeria. Positive test results were reported yesterday on samples taken from dead ducks in Magaria and Dan Barde, located in one of the two districts. Investigation of the additional outbreaks is under way. Staff at the WHO country office in Niger reported today that no human cases are presently under investigation for possible H5N1 infection.
In neighboring Nigeria, an outbreak in the northern part of the country was officially confirmed on 8 February, but is now known to have begun almost a month earlier. Detection of the virus in Niger confirms fears that conditions in West Africa, including late detection of outbreaks, the fluid movement of birds across borders, and low population awareness of the disease, will favor spread to additional countries.
Experience in all affected countries has shown how easily and rapidly the virus can become established in birds when detection is late and the introduction of control measures is delayed.
In Nigeria’s northern province of Kano, near the border with Niger, some 51 farms are now known to have been affected. In that country, four persons have been investigated to date for possible H5N1 infection. Local tests have ruled out infection in three of these cases, including one which was fatal.
Outbreaks in numerous other African countries are currently under investigation. Throughout most of Africa, rapid detection and investigation of outbreaks are hampered by the absence of an early warning system for avian influenza in animals or humans, inadequate diagnostic capacity, and difficulties in shipping specimens, both internally and abroad, for diagnostic confirmation.
Concern that human cases may occur in affected parts of Africa is high, given the close contact between people and poultry. Laboratory studies have shown that the virus presently circulating in Nigeria is virtually identical to viruses that have caused human cases and deaths elsewhere since the start of this year.
The continent has an estimated 1.1 billion chickens, mostly produced in backyard farming systems. Traditional practices, exacerbated by rural poverty, favor the home slaughter and consumption of birds when signs of illness appear in a flock. These behaviors carry a high risk of human exposures and infections. While most countries in Africa have a veterinary infrastructure that serves commercial farms, few have services extending to rural areas.
WHO is concerned that spread of the virus to additional parts of Africa will broaden opportunities for human cases to occur under circumstances where capacities to find, diagnose, investigate, and manage cases are limited. Each additional human case gives the virus an opportunity to evolve towards a form that spreads easily from person to person.
2/8/06
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 behaviors, 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.
Thailand
8/7/06
The World Health Organization reported today the Ministry of Public Health in Thailand has confirmed the country’s 24th case of human infection with the H5N1 avian influenza virus. The case, which was fatal, occurred in a 27-year-old man from the central province of Uthai
Thani. He developed symptoms on July 24, was hospitalized on July 30, and died on August 3.
Investigation of his source of infection revealed contact with household chickens, which began dying around one week prior to symptom onset.
This is the country’s second case of H5N1 infection, and second fatality, within the past two weeks. Confirmation of these cases follows an 8-month period in which no human cases were reported in the country.
Recent outbreaks in poultry have been officially reported in two provinces, Phichit and Nakhon
Phanom, located in the northern and north-eastern parts of the country.
7/26/06
The World Health Organization reported today the Ministry of Public Health in Thailand has confirmed a case of human infection with H5N1 avian influenza. The patient, a 17-year-old man from Thap Khlo district of Phichit province in the north, developed symptoms on July 15, was hospitalized on July 20 and died on July 24.
On July 10, the young man had buried the carcasses of dead chickens. This case coincides with a recurrence of a confirmed H5N1 outbreak in animals in the province. Control measures have been implemented to contain the animal outbreak and human surveillance has been strengthened. Field investigations have not found any indications of respiratory illness in close contacts of the young man.
This is the first human case of H5N1 infection reported from Thailand in 2006.
12/9/05
The World Health Organization reported today the Ministry of Public Health in Thailand has confirmed a further case of human infection with the H5N1 avian influenza virus. The case occurred in a 5-year-old boy, who developed symptoms on November 25, was hospitalized on December 5, and died on December 7, 2005. The child resided in the central province of
Nakhonnayok.
A thorough investigation of this case is currently under way. Early results suggest that the child may have acquired his infection from dead chickens in the neighborhood. His family members and neighbors have been placed under medical observation. All remain healthy to date.
11/14/05
The World Health Organization reported today the Ministry of Public Health in Thailand has confirmed a further case of human infection with H5N1 avian influenza. The case occurred in an 18 month old boy from a suburb of Bangkok. He developed symptoms on November 1 and was hospitalized on November 5 where he remains in good condition.
This is the fourth laboratory confirmed case in Thailand this year.
10/20/05
The World Health Organization reports today that the Ministry of Public Health in Thailand has confirmed its first case of human infection with H5N1 avian influenza since October 8, 2004. The patient, a 48-year old man from Kanchanaburi Province, developed symptoms on October 13, was hospitalized on October 17 and died on October 19, 2005.
Authorities have linked his infection to close contact with diseased poultry during slaughter. Poultry outbreaks in several Kanchanaburi villages were reported earlier this month. Samples from the patient will be sent for further analysis at a WHO reference laboratory.
The man’s 7-year-old son developed respiratory symptoms on October 16, he had assisted his father with de-feathering of the diseased birds. Test results on the child, who is presently hospitalized, are pending. Since the start of the outbreaks in Asia, Thailand has confirmed 18 cases, of which 13 have been fatal.
11/1/05
The Ministry of Public Health in Thailand has confirmed an additional case of human infection with H5N1 avian influenza.
The patient, a 50-year-old woman from Bangkok, developed symptoms on October 26 and was hospitalized on October 29, 2005. As of today, she remains hospitalized in satisfactory condition.
On October 23, this patient visited her husband in Nonthaburi Province, north of Bangkok, where backyard chickens had begun to die a few days earlier. Field investigations have not found any indications of respiratory illness in close contacts of the patient.
The woman is the third confirmed case reported in Thailand in the past month. These cases coincide with a recurrence of confirmed H5 outbreaks in poultry in 6 provinces, most of which are in the central part of the country, and point to the need to remain on high alert for the occurrence of human cases in all countries experiencing outbreaks in poultry.
Since the start of the outbreaks in Asia, Thailand has confirmed 20 cases, of which 13 have been fatal.
Turkey
1/16/06
The World Health Organization (WHO) reported today Laboratory tests conducted at Turkey’s national influenza center 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 January 15, 2006 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 January 1. On that day, the girl, assisted by her brother, slaughtered a duck for food. Both children developed symptoms on January 4 and both were hospitalized on January 11, 2006. 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.
1/12/06
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 January 7. 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.
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 travelers 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 Vietnam. 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.
1/9/06
The World Health Organization (WHO) reported today the Ministry of Health in Turkey has reported that laboratory tests conducted recently 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.
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.
1/5/06
The World Health Organization (WHO) reported today 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 January 1, 2006 and died the same day. The second case was his 15-year-old sister, also hospitalized on January 1 and died on January 5, 2006.
Turkish authorities had ruled out avian influenza earlier this week in these cases based on the preliminary test results from samples taken from the nose and throat. Subsequent tests of additional patient specimens taken from the lungs produced positive results; samples were sent today to a WHO collaborating center 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 January 1, 2006, 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 to fifteen years; all reside in the Dogubayazit district. Two of the children are siblings of the two confirmed cases described above.
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 traveling 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.
Vietnam
11/25/05
The Ministry of Health in Viet Nam has confirmed a further case of human infection with H5N1 avian influenza. The case is a 15-year-old boy from Hai Phong Province. He developed symptoms on November 14 and was hospitalized on November 16, 2005. He has been discharged from hospital and is recovering.
11/9/05
The World Health Organization reported today the Ministry of Health in Viet Nam has confirmed a further case of human infection with H5N1 avian influenza. The case occurred in a 35-year-old man from Hanoi who was hospitalized with respiratory symptoms on October 26 and died on October 29, 2005.
This is the first confirmed case in Viet Nam since late July of this year. This newly confirmed case coincides with a recurrence of outbreaks in poultry.
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