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Travel Health Advisory

Avian Influenza A (H5N1) : Activity in Asia

Updated: August 8, 2005

The Public Health Agency of Canada continues to closely monitor occurrences of avian influenza A (H5N1), or “bird flu”, in both fowl and humans in several Asian countries.

Summary of Human Cases

Human cases of avian influenza H5N1 have been reported in Vietnam, Thailand, Cambodia, and most recently Indonesia. The spread in humans is characterized by three distinct periods or waves of activity, since late-December 2003, when human cases were first reported.

Wave
Period
Cases, including death
1 2003-12-26 to 2004-03-10 35 cases, including 24 deaths
2 2004-07-19 to 2004-08-10 9 cases, including 8 deaths
3 2004-12-16 to present 68 cases, including 25 deaths

Indonesia - Human Cases

Wave 1: nil

Wave 2: nil

Wave 3: 1 case, including 1 death

To date, Indonesia has reported a total of 1 human case of avian influenza infection, including 1 death.

Vietnam - Human Cases

5 August 2005 - The Ministry of Health in Vietnam has confirmed an additional three cases of human infection with H5N1 avian influenza. One case was reported in Ha Tay Province, one in Tra Vinh Province, and one in Ho Chi Minh City. The patients from Tra Vinh and Ho Chi Minh City died.

Wave 1 - 23 cases, including 16 deaths

Wave 2 - 4 cases, including 4 deaths

Wave 3 - 63 cases, including 20 deaths

To date, Vietnam has reported a total of 90 human cases of avian influenza infection, including 40 deaths.

Cambodia - Human Cases

Wave 1: nil

Wave 2: nil

Wave 3: 4 cases, including 4 deaths.

To date, Cambodia has reported a total of 4 human cases of avian influenza infection, all of which have been fatal.

Thailand - Human Cases

Wave 1: 12 cases, including 8 deaths

Wave 2: 5 cases, including 4 deaths

Wave 3: nil

To date, Thailand has reported a total of 17 human cases of avian influenza infection, including 12 deaths. The last reported case in Thailand occurred in October of 2004.

The World Health Organization has developed a chart table depicting human case counts by region and time period.

Source:  World Health Organization

Information on Avian Influenza

Avian influenza is a contagious viral infection that can affect all species of birds but can, less commonly, infect humans.

The first documented infection of humans with an avian influenza virus occurred in Hong Kong in 1997, when the H5N1 strain caused severe respiratory disease in 18 humans, six of whom died. The infection in humans coincided with an epidemic of highly pathogenic avian influenza virus, caused by the same strain, in Hong Kong's poultry population.

At this time, there is no vaccine that protects against the avian influenza H5N1 virus. While the current seasonal flu shot does not protect against the avian influenza H5N1 virus, immunization with it may be of benefit for travellers to geographic regions where human cases of H5N1 are being reported. Individuals who are immunized with the seasonal influenza vaccine are less likely to contract seasonal influenza. This in turn reduces the likelihood of an immunized individual becoming infected with both human and avian forms of influenza at the same time. Should a person be infected with both viruses at the same time, there is a possibility that the two viruses could "mix" and mutate into a new virus that could be spread efficiently and against which, humans would have no immunity.

Several anti-viral drugs are available for the prevention and treatment of seasonal influenza in Canada. Although, none of the anti-viral drugs have been shown to prevent H5N1, studies done through the WHO Global Influenza Surveillance Network have shown that the anti-viral Oseltamivir may be effective in the treatment of H5N1.

Recommendations

As a precautionary measure, it would be prudent that travellers to Thailand, China, Cambodia, Vietnam, South Korea, Japan, Indonesia , and Laos, where avian influenza A (H5N1) outbreaks in fowl have been reported, consider the following measures:

The Public Health Agency of Canada advises that travellers to the countries mentioned above, not consume undercooked fowl, raw eggs, or lightly cooked egg products (such as runny eggs). Travellers should ensure that all food products listed above be well cooked before being consumed, as evidence suggests the virus becomes inactive when cooked. While to date there has been no evidence that the virus is transmitted through contaminated food, the above precautionary measure should be followed until further information is available.

Normal precautions regarding food storage, handling and preparation should be followed. Travellers are further advised to maintain high standards of hygiene, including thorough hand washing, particularly after having contacted eggs or undercooked fowl and egg products and to avoid cross contamination with other food products. Using hot, soapy water and lathering for at least 20 seconds is the single most important procedure for preventing infections. This is because disease-causing micro-organisms can frequently be found on the hands. Alternatively, travellers can use waterless, alcohol-based antiseptic hand rinses. If there is visible soiling, hands should be washed with soap and water before using waterless antiseptic hand rinses. If soap and water are unavailable, cleanse hands first with detergent-containing towelettes to remove visible soil.

The Public Health Agency of Canada recommends that travellers avoid unnecessary contact with live fowl. This includes poultry farms as well as markets where live animals such as chickens and ducks are sold, as these animals have been found to be carriers of the avian influenza virus. Travellers should be aware that it is possible for the avian influenza virus to stick to hair and clothing, and may be inhaled. Research has shown that the risk of direct transmission of H5N1 infection from birds to humans is greatest in persons having close contact with live, infected poultry.

Travellers are advised not to bring fowl or egg products from these affected countries into Canada.

Canadian Food Inspection Agency recommendations to prevent the introduction of avian flu into Canada's animal population:

  • Travellers who have visited a farm while in an affected country should ensure that clothing and footwear worn on the farm are free from soil and manure before entering Canada. Clothing should be laundered and footwear should be disinfected after arrival. More information is available at the Canadian Food Inspection Agency. Link opens in new window

As a reminder…

The Public Health Agency of Canada routinely recommends that Canadian international travellers seek the advice of their personal physician or travel clinic prior to international travel, regardless of destination, for an individual risk assessment to determine their individual health risks and their need for vaccination, preventative medication, and personal protective measures.

  • Travellers to geographic destinations where human cases of H5N1 are being reported are advised to specifically discuss the topics of seasonal influenza vaccination and the benefit of carrying Oseltamivir for the treatment of H5N1, as part of an individual risk assessment with their personal physician or travel clinic.

The Public Health Agency of Canada recommends, as well, that travellers who become sick or feel unwell on their return to Canada should seek a medical assessment with their personal physician. Travellers should inform their physician, without being asked, that they have been travelling or living outside of Canada, and where they have been.

Additional Information

Information on Avian Influenza from the Public Health Agency of Canada

Information on Influenza from the Public Health Agency of Canada

Other related information from the Public Health Agency of Canada

  • FluWatch weekly report summarizes influenza surveillance activities in Canada and abroad.
  • Antivirals

External Sources of Information

For additional information on Avian Influenza A (H5N1) f rom the World Health Organization (WHO) visit the WHO Avian Influenza Disease Page Link opens in new window

For international reports of the flu, visit the World Health Organization influenza web site Link opens in new window

For international reports of infected animals by country, visit the World Organization for Animal Health Link opens in new window

 

Last Updated: 2005-08-08 top