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Overnight (U.S. time) the Western Pacific Regional Office (WPRO) of the World Health Organization, and the Cambodian Ministry of Health released a statement clarifying the current H5N1 case count in that country.
The number of cases detected over the past three weeks now stands at five, with four of them fatalities. While these 5 cases are spread across 4 provinces, they are generally located in the southern region of the country.
You’ll find details on the first three cases here, along with my coverage here and here. An epidemiological investigation into how these cases came about is underway.
Fourth and fifth new human cases of avian influenza H5N1 in Cambodia in 2013
Joint news release of the Ministry of Health of the Kingdom of Cambodia and World Health Organization
PHNOM PENH, 29 January 2013 - The Ministry of Health (MoH) of the Kingdom of Cambodia wishes to advise members of the public that two new more cases of avian influenza has been confirmed positive for the H5N1 virus.
The fourth case is a 17-month-old girl from Prey Nheat village, Prey Nheat commune, Kong Pisey district in Kampong Speu province has been diagnosed with H5N1 influenza on 26th January 2013 by Institut Pasteur du Cambodge. She developed symptoms on 13th January 2013 with fever, cough, runny nose, and vomiting. She was initially treated by local private practitioners. Her condition worsened and she was admitted to Kantha Bopha Hospital on 17th January with fever, cough, somnolence, and dyspnoea. Unfortunately, despite intensive medical care, she died on 28th January. There is evidence of recent deaths among poultry in the village and the girl had history of coming into contact with poultry prior to becoming sick.
In the fifth case, a 9-year-old girl from Thmei village, Thmei commune, Toeuk Chhou district, Kampot province has been diagnosed with H5N1 influenza on 28th January 2013 by Institut Pasteur du Cambodge. She became sick on 19th January, 2013 suffering with fever and cough. She was initially treated by local private practitioners. Her condition worsened and she was admitted to Kantha Bopha Hospital with fever cough, somnolence and dyspnoea on 27th January. Despite intensive medical care, the patient died on 28th January. There is evidence of recent deaths among poultry in the village. This girl is the twenty-six person in Cambodia to become infected with H5N1 virus, and the fifth person this year and the twenty-three person to die from complications of the disease. Of all the twenty six cases, 17 were children under 14, and seventeen of the twenty six confirmed cases occurred in females.
"Avian influenza H5N1 is still a threat to the health of Cambodians. This is the fourth and the fifth cases of H5N1 infection in human in early this year, and children still seem to be most vulnerable. I urge parents and guardians to keep children away from sick or dead poultry, discourage them from playing in areas where poultry stay and wash their hands often. If they have fast or difficulty breathing, they should be brought to medical attention at the nearest health facilities and attending physicians be made aware of any exposure to sick or dead poultry." said HE Mam Bunheng, Minister of Health.
The Ministry of Health's Rapid Response Teams (RRT) have gone to the hospitals and the field to identify the patient’s close contacts, any epidemiological linkage among the three cases and initiate preventive treatment as required. In addition, public health education campaigns are being conducted in the villages to inform families on how to protect themselves from contracting avian influenza. The government's message is - wash hands often; keep children away from poultry; keep poultry away from living areas; do not eat sick poultry; and all poultry eaten should be well cooked.
Given the number of cases in recent weeks, and the call for greater scrutiny and testing of hospitalized patients, it would not be unreasonable to expect that more cases may turn up.
The standard caveat remains, that so far H5N1 remains primarily adapted to avian physiology, and only rarely infects humans.
While the investigations continue, so far, there are no indications of human-to-human spread among these recent cases in Cambodia.
As I wrote last Saturday in cases in Health Vigilance For The Chinese New Years, concerns over infectious disease always run higher during this annual holiday. This time of year people and poultry are on the move across much of Asia, and so we’ll be watching carefully for signs of increase or geographic spread of H5N1 infections over the next few weeks.
