Avian Influenza A (H5N1) Activity in Asia Human Cases - Vietnam

Updated: January 27, 2005

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

The World Health Organization (WHO) reports that laboratory results have confirmed 4 additional human cases of avian influenza H5N1 in Vietnam:

• 46-year-old resident of Thai Binh Province who developed symptoms on December 26 and died on January 9.

• 42-year-old brother to the 46-year-old listed above; a resident of Hanoi who was hospitalized on January 12 with respiratory symptoms and has since recovered.

• 35-year-old woman from the southern province of Dong Thap, who developed symptoms on January 14, was admitted to hospital on January 20, and died the following day.

• 17-year-old boy from the southern province of Bac Lieu, who was hospitalized on January 10 and died on January 14.

Health authorities in Vietnam are conducting an investigation into the cases involving the two brothers. As the source of infection has not yet been determined, officials are looking into the possibility that human-to-human transmission of the H5N1 virus may have occurred. The 42-year-old did provide bed-side care to his older brother. A second possibility is that both men became infected after consuming a family meal that consisted of raw duck blood and raw duck organs.

Inefficient, limited human-to-human transmission, although rare, is not uncommon and is consistent with what is currently understood about the H5N1 virus. Although human-to-human transmission may have occurred in three earlier cases in 2004, the cases involved prolonged face to face contact among family members and no wider transmission occurred.

Vietnam has reported a total of 10 laboratory confirmed human cases of A (H5N1) since mid-December 2004; of these 9 have been fatal.

In 2004, Thailand reported a total of 17 laboratory confirmed human cases of H5N1 with 12 deaths. No new cases have been reported from Thailand since October 25, 2004.

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 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.

As is routinely done, the Public Health Agency of Canada recommends that travellers to Asia seek an individual risk assessment consultation with their personal physician or travel medicine clinic at least 6 to 8 weeks prior to travel. The Public Health Agency of Canada also recommends that travellers obtain the influenza vaccine before travel.

The Public Health Agency of Canada recommends that travellers who become sick or feel unwell with respiratory or flu-like symptoms on their return 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.

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.

Additional Information

For more information on Avian Influenza A (H5N1) f rom the Public Health Agency of Canada:

• FAQ on Avian Influenza.
• For previous avian influenza travel health advisories, visit the Travel Medicine Program's Travel Advisory Archives.
• The Public Health Agency of Canada produces weekly FluWatch reports, summarizing influenza surveillance activities in Canada and abroad.

The World Health Organization has developed an avian influenza fact sheet

For information on human cases of A (H5N1), visit the World Health Organization's page on Confirmed Human Cases of Avian Influenza A (H5N1)

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