Avian Influenza A (H5N1) : Human Activity in Asia

Updated : February 03, 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.

First Human Case of Avian Influenza A /H5 in Cambodia

The World Health Organization (WHO) reports that Cambodia has recorded its first human case of avian influenza A/H5.

The case involves a 25-year-old woman who developed respiratory symptoms on January 21, 2005 . The woman is from Kampot Province located in southern Cambodia, which borders southwestern Vietnam . She traveled to Vietnam for treatment on January 27 and died on January 30 in Kieng Giang Provincial Hospital . Preliminary tests conducted at the Pasteur Institute in Ho Chi Minh City, Viet Nam were positive for influenza A/H5. Further testing is underway to determine subtype (N1). The case is being investigated by the Cambodian Ministries of Health and of Agriculture and the WHO.

Additional Cases under investigation in Vietnam -

The World Health Organization (WHO) reports that three additional fatal human cases of H5N1 infection are under investigation in Vietnam .

A 10-year-old girl from the province of Long An ( Southern Vietnam )
A 13 year-old girl from the province of Dong Thap ( Southern Vietnam )
A male in his 30's from the Province of Phu Tho (Northern Vietnam )

The 13 year-old-girl from Dong Thap is the child of a previously confirmed case - her 35-year-old mother developed symptoms on January 14 and died on January 21. The possibility of human-to-human transmission can not be eliminated as the six-day period between symptom onset in the mother and child falls within the parameters of what has been seen with previous cluster cases. Health authorities in Vietnam will launch an investigation to determine the source of infection and look for signs of illness in close contacts of the girl or her mother.

Inefficient, limited human-to-human transmission is consistent with what is currently understood about the H5N1 virus. All probable cases of human-to-human transmission involved prolonged face to face contact among family members and no wider transmission occurred.

Laboratory Confirmed Human Case Count

Vietnam : Since mid-December 2004 - 10 cases including 9 deaths. The three cases mentioned above are pending confirmation and are not included in this count.

Thailand - 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 .

A cumulative case count since January 28, 2004 can be accessed via the World Health Organization's page on Confirmed Human Cases of Avian Influenza A (H5N1)

Source: World Health Organization

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

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	Last Updated: 2005-02-03		Important Notices