Avian Influenza A (H5N1) : Human Case in the Middle East
Updated:
January 31, 2006
The Public Health Agency of Canada continues to closely monitor occurrences of avian influenza A (H5N1), or "bird flu", in birds and in humans in Asia, Europe, and the Middle East.
Situation Update: Iraq
Iraq 's Ministry of Health has confirmed through laboratory testing the country's first case of human infection with the H5N1 avian influenza virus. A 15 year-old girl, who resided in the town of Raniya, located in the northern part of the country close to the Turkish border, died on January 17 following severe respiratory disease. The girl had been in contact with diseased birds.
The girl's 39 year-old uncle, who resided in the same town and took care of her during her illness, died of a severe respiratory disease on January 27. The source of the man's illness has not been confirmed and is under investigation.
The Ministry of Health has further informed the WHO of a third human case of respiratory illness that is under investigation for possible H5N1 infection.
Although outbreaks of avian influenza A (H5N1) in birds have not yet been confirmed in Iraq, deaths in poultry populations were recently reported in the town of Raniya. Samples taken from poultry have been sent to an external laboratory for testing.
Avian Influenza H5N1 in Humans
At this time, human cases of avian influenza A (H5N1) have been reported in Vietnam, Thailand, Cambodia, Indonesia, China, Turkey, and Iraq. 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 all seven 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. 
Avian Influenza in Birds
Since mid-December 2003, several Asian countries have reported avian influenza A (H5N1) activity in poultry and wild birds. In July of 2005, the disease, which had previously been confined to Asia, was confirmed in birds in an increasing number of European countries.
According to the World Organization for Animal Health and based on criteria established in the Terrestrial Animal Health Code (2005), A (H5N1) large outbreaks among birds continue to persist in: Cambodia, China, Indonesia, Thailand, Vietnam, Russia, Kazakhstan, and Mongolia. More recently, the virus has been confirmed, in birds, in the previously unaffected countries of Turkey, Romania, Croatia, and Ukraine. For additional information about H5N1 and other avian influenza outbreaks among animals, visit the World Organization for Animal Health Web site.
Source: World Health Organization, World Organization for Animal Health, 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 that travellers to Cambodia, China, Indonesia, Thailand, Vietnam, Russia, Kazakhstan, Mongolia, Turkey, Romania, Croatia, Ukraine, and Iraq - where avian influenza A (H5N1) outbreaks in fowl and/or humans are confirmed, consider the following measures:
Get your annual flu-shot. At this time, there is no vaccine that protects against the avian influenza A ( H5N1 ) virus. While the current seasonal flu shot does not protect against the A (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 spread efficiently and against which humans would have no immunity.
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 poultry prepared for consumption is thoroughly cooked (juice runs clear and no visible pink meat) to eliminate the risk of infection. Internal temperatures for whole chicken 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 poultry 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. |
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 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 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
Information on Influenza from the Public Health Agency of Canada
- Advisory Committee Statements
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
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
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