Avian Influenza A (H5N1) Situation Update

The Public Health Agency of Canada continues to closely monitor and report on occurrences of avian influenza A (H5N1), or "bird flu", in humans and in birds.

Human Infection with H5N1 in Azerbaijan

The WHO has confirmed 7 human cases of avian influenza with five deaths in Azerbaijan. Six of the cases occurred in Salyan Rayon in the south-eastern region of the country. The seventh case occurred in the western rayon of Tarter. Four of the cases from the Salyan Rayon lived either together or close to one another. The source of their infection is being investigated.

Outbreaks of H5N1 in poultry in Azerbaijan were confirmed on February 26, 2006.

Additional Countries Confirm H5N1 Infection in Birds

Recently, the World Organization for Animal Health (OIE) has received official notification of H5N1 avian influenza infection, in birds, from two additional countries: Israel and Sweden.

No human cases of H5N1 avian influenza infection have been reported from these countries. Despite the fact that the number of countries reporting H5N1 infection in birds continues to increase, it is important to note that all evidence to date indicates that the H5N1 virus does not spread easily from birds to humans.

Summary of H5N1 Avian Influenza Situation in Humans

At this time, human cases of avian influenza A (H5N1) have been reported in Vietnam, Thailand, Cambodia, Indonesia, China, Turkey, Iraq and Azerbaijan. Infection in humans has occurred in three distinct periods or waves of activity, since late-December 2003. The current wave of activity has been ongoing since December 16, 2004 and sporadic cases continue to be reported in these countries. For an updated account of human cases of H5N1by region and time period, visit: Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO.

Summary of H5N1 Avian Influenza Situation in wild and/or domestic birds*

In recent months, the avian influenza A H5N1 virus has been confirmed in wild birds in several countries in the following regions: Asia, Europe, and Africa. While this demonstrates the rapid and ongoing geographical spread of the virus, information to date has shown that the greatest risk to humans arises when the virus become established in small backyard poultry flocks, which allow continuing opportunities for close human contact, exposures, and infections to occur. To date, almost all cases have been linked to close contact with diseased household poultry flocks; there has been no evidence of direct transmission to humans from wild birds.

Table 1: Countries Officially Reporting Confirmed Cases of H5N1 in birds*

*According to the World Organization for Animal Health and based on criteria established in the Terrestrial Animal Health Code (2005 ). Official notification reports are available at the World Organization for Animal Health Web site.

** According to the World Health Organization (WHO)

Source: World Health Organization, World Organization for Animal Health (OIE), EU - Europa

Information on Avian Influenza A (H5N1)

Avian influenza A (H5N1) is a contagious viral infection that is thought to affect all species of birds; although rare, infection in humans can occur. The first documented infection of humans with the avian influenza A (H5N1) virus occurred in Hong Kong in 1997, when the strain caused severe respiratory disease in 18 humans, six of whom died. The infection in humans coincided with an epidemic of H5N1 in Hong Kong 's domestic poultry population.

Investigation into human cases of H5N1 suggests that direct contact with infected poultry has been the primary, if not exclusive, means of infection; although, in a small number of instances a link to direct contact with infected poultry was not identifiable. In a few cases, it would appear that human-to-human transmission may have occurred. However, such cases involved extended close personal contact with an infected individual (i.e. providing bedside care for an infected relative) and no further transmission occurred.

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 A (H5N1), studies done through the WHO Global Influenza Surveillance Network have shown that the anti-viral Oseltamivir may be effective in the treatment of A (H5N1).

Recommendations

As a precautionary measure, the Public Health Agency of Canada recommends that it would be prudent for travellers to countries listed in Table 1 of the advisory  to consider the following measures:

Avoid unnecessary contact with domestic poultry and wild birds. This includes poultry farms as well as markets where live and slaughtered animals such as chickens and ducks are sold, as these animals have been found to be carriers of the avian influenza A (H5N1) virus. Evidence suggests that the risk of infection is greatest in persons having direct contact with live and/or dead poultry including surfaces contaminated with their feces or secretions. Travellers should be aware that it is possible for the avian influenza A (H5N1) virus to stick to hair and clothing, and may be inhaled.

Ensure that all fowl (domestic poultry and/or wild birds) prepared for consumption is thoroughly cooked (juice runs clear and no visible pink meat) to eliminate the risk of infection. Internal temperatures for whole fowl and parts should reach 82°C-85°C. While to date there is no evidence that the virus is transmitted through contaminated food, it is always advisable to avoid undercooked or raw fowl dishes, including eggs and egg products.

Follow normal precautions regarding food storage, handling and preparation. Travellers are 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.

Get your annual flu-shot. At this time, there is no vaccine available that protects against the avian influenza A (H5N1) virus. The current seasonal flu vaccine does not protect against the avian (H5N1) virus. To avoid illness due to circulating human influenza viruses, travelers should consider immunization with the most current available seasonal flu vaccine.

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

• Ensure all birds and poultry products you wish to bring into Canada are eligible for entry and declare all animal products upon arrival.
• 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.

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 four to six weeks 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 cases of H5N1 are being reported are advised to specifically discuss the topics of seasonal influenza vaccination and anti-viral drugs, 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

• Avian Influenza information page
• FAQ on Avian Influenza
• Archived travel health advisories on avian influenza]

Information on Influenza from the Public Health Agency of Canada

Advisory Committee Statements

• Committee to Advise on Tropical Medicine and Travel (CATMAT) Statement on Travel, Influenza, and Prevention
• National Advisory Committee on Immunization (NACI) Statement on Influenza Vaccination for the 2005-2006 Season

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) from the World Health Organization (WHO) visit the WHO Avian Influenza Disease Page .

For an updated account of human cases of H5N1by region and time period, visit the following: Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO .

For international reports of the flu, visit the World Health Organization influenza web site .

For international reports of infected animals by country, visit the World Organization for Animal Health .