Cambodia MOH Reports 12th H5N1 Case of 2025

 

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A few minutes ago the Cambodian MOH announced their 12th case of H5N1 - and the 9th case in just over a month - this time involving a 5-year-old boy from Kampot Province who had contact with sick chickens. 

I've posted the screenshot, followed by a translation. 

(translation)

Kingdom of Cambodia

Nation Religion King

Ministry of Health

A case of bird flu in a 5-year-old child

The Ministry of Health of the Kingdom of Cambodia would like to inform the public: There is another case of bird flu in a 5-year-old boy who was confirmed positive for the H5N1 avian influenza virus by the National Institute of Public Health on July 3, 2025. The patient lives in Kamakor Village, Sam Lahn Commune, Angkor Chey District, Kampot Province, and has symptoms of fever, cough, shortness of breath, and difficulty breathing. 

This is the 12th case for 2025 in the Kingdom of Cambodia. The patient is currently under intensive care by medical staff. According to inquiries, the patient's family has about 40 chickens, as well as 2 sick and dead chickens. The boy likes to play with the chickens every day.

The emergency response teams of the national and sub-national ministries of health have been collaborating with the provincial agriculture departments and local authorities at all levels to actively investigate the outbreak of bird flu and respond according to technical methods and protocols, find sources of transmission in both animals and humans, and search for suspected cases and contacts to prevent further transmission in the community. They have also distributed Tamiflu to close contacts and conducted health education campaigns among residents in the affected villages.

The Ministry of Health would like to remind all citizens to always pay attention to and be vigilant about bird flu because H5N1 bird flu continues to threaten the health of our citizens. We would also like to inform you that if you have a fever, cough, sputum discharge, or difficulty breathing and have a history of contact with sick or dead chickens or ducks within 14 days before the start of the symptoms, do not go to gatherings or crowded places and seek consultation and treatment at the nearest health center or hospital immediately. Avoid delaying this, which puts you at high risk of eventual death.        

The elusive 11th case - which has yet to be publicly announced by the MOH - was identified two days ago thanks to the expert sleuthing of Lisa Schnirring at CIDRAP, whose article H5N1 sickens another in Cambodia reported:

. . .  a 19-month-old boy from Takeo province who died from his infection, according to a line list in a weekly avian flu update from Hong Kong’s Centre for Health Protection (CHP). The group said the case was reported on June 30.

Also, a weekly avian flu update from the World Health Organization (WHO) Western Pacific region office said the boy’s infection was one of two from Takeo province for the week ending June 26 and that his illness onset date was June 7. 

Reports of multiple human infections across several provinces of Cambodia all within a matter of a few weeks suggests the virus - which is reportedly a new reassortment of an older clade of the H5N1 virus recently renamed 2.3.2.1e) - is spreading rapidly through local poultry. 

So far most cases report close contact with sick or dead poultry, and there is no evidence to suggest human-to-human transmission of the virus.

But every spillover into humans is another opportunity for the virus to mutate and adapt to a human host, so we'll be watching this outbreak carefully.

 

Nature Comms: Monkeypox Virus Spreads from Cell-to-Cell and Leads to Neuronal Death in Human Neural Organoids

 

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While we are often reassured that most viral illnesses are `self-limiting' diseases, which will resolve over time, we continue to see evidence that some viral infections can produce significant long-term sequelae, including neurogenerative diseases. 

In the decade following the 1918 H1N1 pandemic - which killed tens of millions of people - the world experienced another type of epidemic; an explosion in cases of Encephalitis Lethargica, and Parkinson's disease, affecting millions (see The Lancet: COVID-19: Can We Learn From Encephalitis Lethargica?).

Its legacy was depicted in the 1990 fictionalized movie Awakenings, which was based on Oliver Sacks' 1973 memoir. In it, he described patients who had been comatose for 40 years who were treated with L-DOPA in the 1960s, and briefly recovered, only to slip back into a catatonic state.

While a direct link to the 1918 pandemic has never been established, similar outbreaks have been reported throughout history, including febris comatosa which sparked a severe epidemic in London between 1673 and 1675, and in the wake of the 1889–1890 influenza pandemic, a severe wave of somnolent illnesses (nicknamed the "Nona") appeared in Italy. 

Very early in the 2020 COVID pandemic we began to see concerns raised over potential long-term neurological damage due to the SARS-CoV-2 virus (see J. Neurology: COVID-19 As A Potential Risk Factor For Chronic Neurological Disorders), and 5 years later we continue to see evidence of substantial sequelae.

BMC Neurology: Long-term Neurological and Cognitive Impact of COVID-19: A Systematic Review and Meta-analysis in over 4 Million Patients

In early 2023, in Neuron: Virus Exposure and Neurodegenerative Disease Risk Across National Biobanks, we looked at a large study, published in Cell Neuron, which found a statistical linkage between viral illnesses and developing neurodegenerative diseases later in life.

Also in 2023 - in a Current Opinion In Neurology article (Chronic and delayed neurological manifestations of persistent infections by Pandya & Johnson) - the authors wrote:

Summary 

Viral encephalitis has been closely associated with the later development of neurodegenerative diseases and persistent viral infections of the CNS can result in severe and debilitating symptoms. Further, persistent infections may result in the development of autoreactive lymphocytes and autoimmune mediated tissue damage. Diagnosis of persistent viral infections of the CNS remains challenging and treatment options are limited.

The development of additional testing modalities as well as novel antiviral agents and vaccines against these persistent infections remains a crucial research goal.

Many people trivialize viral infections; assuming that if you survive the acute phase of the illness, no long-term damage was done. Increasingly, however, the evidence  suggests that chronic or repeated viral infections may sometimes do significant, even irreparable, harm. 

This from the NIH.

Links found between viruses and neurodegenerative diseases

At a Glance

• Researchers found associations between certain viral illnesses and the risk of Alzheimer’s and other neurodegenerative diseases. 

• The results suggest that some neurodegenerative disease might be avoided by preventing infection with influenza and other viruses.

While we have statistical linkage between these viral infections and neurodegenerative diseases, the exact mechanism(s) of how these infections damage the brain (which admittedly, is likely multifactorial) has remained elusive. 

In a breakthrough a dozen years ago, human neural organoids (aka hNOs) were first created from lab-grown stem cells, which can simulate the architecture and functionality of the human brain (cite).

This made it possible to monitor, in real time, the pathogenic impact of viral infections on `living' brain tissue (see here, here, here, and here). While not a perfect analog for the human brain, these lab grown organoids provide a useful in vitro model for studying brain development and neurological disorders. 

All of which brings us to a new study, published over the weekend in Nature Comms, which - using hNOs - describes how the Monkeypox virus can spread within these human neural organoids, and lead to neuronal death. 

While considered a relatively mild `self-limiting' disease, Mpox clade IIb infections have been linked to more serious illness (see Neurological manifestations of an emerging zoonosis-Human monkeypox virus: A systematic review by Sajjad Ahmed Khan, Surya Bahadur Parajuli, Vivek K Rauniyar )

Due to its length and complexity, I've only posted the abstract and some excerpts.  I've also posted a link and some excerpts from a press release from the University of Bern.

Monkeypox virus spreads from cell-to-cell and leads to neuronal death in human neural organoids

Isabel Schultz-Pernice, Amal Fahmi, Francisco Brito, Matthias Liniger, Yen-Chi Chiu, Teodora David, Blandina I. Oliveira Esteves, Antoinette Golomingi, Beatrice Zumkehr, Markus Gerber, Damian Jandrasits, Roland Züst, Selina Steiner, Carlos Wotzkow, Fabian Blank, Olivier B. Engler, Artur Summerfield, Nicolas Ruggli, David Baud & Marco P. Alves

Nature Communications volume 16, Article number: 5376 (2025) Cite this article

Abstract

In 2022-23, the world witnessed the largest recorded outbreak of monkeypox virus (MPXV). Neurological manifestations were reported alongside the detection of MPXV DNA and MPXV-specific antibodies in the cerebrospinal fluid of patients. 

Here, we analyze the susceptibility of neural tissue to MPXV using human neural organoids (hNOs) exposed to a clade IIb isolate. We report susceptibility of several cell types to the virus, including neural progenitor cells and neurons. The virus efficiently replicates in hNOs, as indicated by the exponential increase of infectious viral titers and establishment of viral factories. 

Our findings reveal focal enrichment of viral antigen alongside accumulation of cell-associated infectious virus, suggesting viral cell-to-cell spread. Using an mNeonGreen-expressing recombinant MPXV, we confirm cell-associated virus transmission. We furthermore show the formation of beads in infected neurites, a phenomenon associated with neurodegenerative disorders. Bead appearance precedes neurite-initiated cell death, as confirmed through live-cell imaging.

Accordingly, hNO-transcriptome analysis reveals alterations in cellular homeostasis and upregulation of neurodegeneration-associated transcripts, despite scarcity of inflammatory and antiviral responses. Notably, tecovirimat treatment of MPXV-infected hNOs significantly reduces infectious virus loads.

Our findings suggest that viral disruption of neuritic transport drives neuronal degeneration, potentially contributing to MPXV neuropathology and revealing targets for therapeutic intervention.

       (SNIP)

Taken together, we show that human neural tissue, modeled in a complex 3D environment, is susceptible to infection with a contemporary clade IIb MPXV isolate. We show that viral replication factories are successfully established, resulting in a productive replication of MPXV within organoid cells. Furthermore, we find that viral antigen localizes not only to cell somata, but also to filaments of variable nature.

We propose that MPXV preferentially spreads from cell-to-cell, exploiting not only previously described mechanisms but also through neuritic transport, as demonstrated through live-cell imaging visualization of virus propagation dynamics. We furthermore report neuritic bead formation in virus-harboring axons and dendrites, previously documented to represent sites of virus egress and cell-to-cell transmission, as well as signs of neuronal injury.

Notably, bead formation precedes virus-induced neuronal death, which is initiated through neurite degeneration. The transcriptional landscape of MPXV-infected neural cultures suggests repurposing of tissue to favor viral propagation, characterized by disrupted cell homeostasis, limited antiviral and inflammatory responses, and upregulation of transcripts associated with neurodegenerative processes and synaptic reorganization.

Notably, tecovirimat treatment effectively limits viral spread but does not rescue the deleterious effects of neuron-to-neuron MPXV dissemination. Our findings identify a novel mechanism of MPXV spread in human neural tissue, shed light on potential factors contributing to mpox-encephalitis neuropathology, and provide a foundation for further exploration of orthopoxvirus neurobiology.

        (Continue . . . )


This press release from the University of Bern.

Can the monkeypox virus infect the human brain?

A new study led by researchers from the Institute of Virology and Immunology (IVI) and the University of Bern in collaboration with the Lausanne University Hospital and the Spiez Federal Laboratory shows that the monkeypox virus can spread efficiently in brain organoids, causing neuronal cell death. The study provides important insights into a previously unexplored aspect of MPXV infections.

(SNIP)

A team of researchers from the Institute of Virology and Immunology (IVI) and the University of Bern, in collaboration with the Lausanne University Hospital and the Spiez Federal Laboratory, has demonstrated for the first time that the MPXV can efficiently spread from cell to cell in brain organoids, leading to neuronal cell death. The study, supported by the Multidisciplinary Center of Infectious Diseases (MCID) at the University of Bern, was recently published in the journal Nature Communications.

       (Continue . . . )

One of the reasons why I get the flu shot every year, have stayed current with COVID shots - and still wear a mask in crowded indoor places - is that each year the evidence linking repeated viral infections to neurodegenerative diseases grows stronger.

While I can't do anything about my age, genetics, or past viral exposures, these proactive measures may help protect me going forward.

At least, that's the hope.  

Switzerland Unveils New Pandemic Plan

 

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During the first decade of the 21st century - when H5N1 was raging in Asia - there were huge pushes for pandemic planning, but after the relatively mild 2009 H1N1 pandemic, most were relegated to some dusty drawer, and forgotten.

The CDC/HHS updated their pandemic plans in 2017 (see CDC/HHS Community Pandemic Mitigation Plan - 2017), but around the country (and around the world), actual pandemic preparedness had been largely put on a back burner.

In August of 2019, in WHO: Survey Of Pandemic Preparedness In Member States, we saw the dismal results of a two-year survey of global pandemic preparedness.

Sadly, only just over half (n=104, or 54%) of member states responded. And of those, just 92 stated they had a national pandemic plan. Nearly half (48%) of those plans were created prior to the 2009 pandemic, and have not been updated since.

Only 40% of the responding countries reported having tested their pandemic preparedness plans - through simulated exercises - in the previous 5 years, nearly all were influenza-centric plans. 

Much like the IHR 2005 compliance (see Lancet Preprint: National Surveillance for Novel Diseases - A Systematic Analysis of 195 Countries), all of this was self-reported, and in retrospect some of their readiness appears to have been  badly `overstated'.

A few months later, the world was put to the test with a novel coronavirus, and discovered that you need more than just a glossy document in order to be prepared. 

While most of the world remains woefully unprepared for the next pandemic - with concerns rising over an invigorated H5N1 virus - we have started to see some small signs of increased preparedness. 

• Last summer both South Korea and Japan issued revised pandemic plans

• Last November Hong Kong held a Coordinated Avian Flu Drill `Amazonite'.

• Last April the ECDC published ECDC Guidance: Recommendations for Preparedness Planning for Public Health Threats,

• Over the past year, PAHO (Pan American Health Organization) has repeatedly urged its member nations to proactively prepare to deal with a potential influenza pandemic

• and recently the WHO ratified a 2025 Pandemic Agreement.

Additionally, a number of countries and regions have purchased (or arranged to purchase) limited quantities of H5N1 vaccine.

• In 2023 Japan announced plans to stockpile about 10 million doses.
• The United States ordered about 4.8 million doses last summer, enough for about 2.4 million people.
• The EU announced plans to acquire 650,000 doses
• Last December the UK announced plans to purchase 5 million doses,
• Five months ago Canada's PHAC Announced Plans To Purchase 500,000 doses Of H5N1 Vaccine.
• And 2 months ago the EU Commission Paved The Way For More H5N1 Vaccine Purchases

Yesterday Switzerland announced a major revision to their pandemic plan - the first since before the COVID pandemic.  Notably, this new plan is not influenza-specific, but focuses on `respiratory-borne pathogens' (see excerpt below). 

The current pandemic plan no longer refers to a single pathogen, but rather to the transmission routes of respiratory pathogens. The plan takes into account the requirements of the Epidemics Act, which is currently being revised, as well as the One Health approach. 

This, as you might expect, is an massive document (the summary alone is 35 pages), and the full report is spread across multiple online documents.  Most of this is of interest only to the Swiss stakeholders, so I'll forego posting excerpts here. 

Follow this link to read more.

Whether these plans - or the vaccines and antivirals being stockpiled - will be adequate or appropriate for the next global health crisis remains to be seen.  As we've seen before, No Pandemic Plan Survives Contact With A Novel Virus.

But having a framework for dealing with a crisis, and running realistic exercises, can be invaluable when the next pandemic strikes.

Most of these pandemic plans are created by - and for - national governments.  What planning may be going on at state/province/or local levels - or for the private sector - is harder to discern. 

Hopefully, more nations around the world are taking note and will act. 

But pandemic planning isn't just for governments or agencies. Ideally, businesses - both large and small - civic organizations, and even families should be making pandemic plans as well (see Does Your Company Have A CPO?).

While it may be years before the next pandemic emerges - as we've seen - the world can change literally overnight.  And once that happens, the options for preparedness rapidly wane. 

Sadly, many of the older CDC pandemic guidance documents have broken links, have been `retired', or are difficult to find.  After some searching I was able to find:

• The CDC's Get your household ready for pandemic influenza - April 2017.

• British Columbia Gov. has a 17-page Household Pandemic Preparedness Guide

• And Ready.gov also provides a pandemic preparedness section.

For more on what you and your family can do to prepare for the next global health crisis, you may wish to revisit:

A Personal Pre-Pandemic Plan

J. Virology: Genetic Resilience or Resistance in Poultry Against Avian Influenza Virus: Mirage or Reality?

2005 cover of CSIRO’s Livestock Research Magazine

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Like the creation of a truly universal flu vaccine, the quest for an avian flu-resistant chicken (and other poultry species) is one of the holy grails of influenza virology. 

Nearly 13 years ago, in CSIRO: The Quest For Flu Resistant Poultry, I featured a 2005 Livestock Research Magazine cover (above), where Cambridge University virologist Laurence Tiley had stated, “The tools to make poultry resistant to flu infection already exist”.

His bigger concern was whether they could persuade the public of the benefits of Genetically Modified (GM) poultry, which remains a touchy subject. 

By 2012, additional work had been done on the creation of transgenic chickens; which would hopefully not only be resistant to H5N1, but could pass that resistance onto their chicks (see Silencing the bird flu gene: scientists prep live hen trials in The Conversation).

But just as predictions of a commercially available universal flu vaccine being just 5 years away have thus far proved optimistic, the road to flu-resistant poultry has hit repeated roadblocks.  

Progress continues to be made, however, on both fronts (see 2023's NIH: Clinical Trial of Universal Hexavalent Flu Vaccine Candidate Begins), and today we have a lengthy - and at times highly technical - review of recent strides in developing flu resilient and/or resistant chickens.

While we appear to be getting closer to those goals, there are still a lot of obstacles to overcome.  And assuming resistant poultry can eventually be produced, there is still the matter of acceptance by the public. 

Those looking for a deep-dive will want to follow the link and read the review in its entirety (warning: pack a lunch).  I'll have a brief postscript after the break. 

Genetic resilience or resistance in poultry against avian influenza virus: mirage or reality?

Authors: Paula R. Chen, Stephen N. White, Lianna R. Walker , Darrell R. Kapczynski , David L. Suarez  david.suarez@usda.govAuthors Info & Affiliations

https://doi.org/10.1128/jvi.00820-25

 ABSTRACT

The unprecedented global spread of the highly pathogenic avian influenza (HPAI) virus in wild birds, poultry, and mammalian species has challenged our control efforts. Alternative approaches to limit avian influenza viruses (AIV) include the development of resilient or resistant chickens. Genetically resilient birds may become infected but can overcome disease, whereas resistant birds prevent virus attachment or entry and do not become infected. 

The most intensively studied host gene is myxovirus-resistance (Mx), which is expressed via the interferon pathway. Both sensitive and resistant chicken Mx genotypes have been described, but this only provides limited resilience. Acidic nuclear phosphoprotein 32 family member A (ANP32A) has been demonstrated as a host cofactor for AIV replication via interaction with the polymerase. Small nucleotide changes within this gene have demonstrated some promise for the establishment of disease resilience. Certain MHC-defined genetic chicken lines have demonstrated increased resilience with higher innate immune responses, but HPAI-infected birds still have high morbidity and mortality. 

Alternatively, gene-edited or -transgenic chickens have had some success in increasing resilience. This strategy allows flexibility to include foreign genes, modification of existing genes, or combined approaches to block critical steps in the viral life cycle. Some candidate genes include solute carrier 35A1 (SLC35A1), retinoic acid-inducible gene I (RIG-I), and toll-like receptors 3 and 7 (TLR3/7), but animal testing needs to be conducted. 

Furthermore, existing hurdles for technology transfer to commercial application from either naturally occurring resistance genes or foreign genes remain high and will require acceptance by both the poultry industry and consumers.

        (SNIP)    

CONCLUSIONS

Many groups using multiple different approaches have tried to identify genetically resistant poultry with no success. Several genes have been identified that may increase genetic resilience, but because of the high virulence and genetic variability of HPAI viruses, no genes on their own are likely to provide enduring resilience to disease.

However, other genes involved in AIV infection in chickens are likely to be identified and validated. An even greater obstacle is to introduce these genetic changes into commercial lines, where genetic trade-offs for disease resistance will need to be weighed against many other production traits.

Future work will clarify these tradeoffs in the form of the potential correlated responses to selection for naturally occurring, gene-edited, or transgenic alleles. We note that gene editing and/or transgenic approaches can be used alone, in combination with naturally occurring variants and breeding, or as the first discovery step to implement through similar natural genetic variants and selective breeding. If successful, any of these approaches would provide additional tools to combat AIV and be immensely valuable to the poultry industry.

       (Continue . . .)

 

Finding ways to make livestock innately flu resistant - without the need for repeated vaccinations or a steady diet of antivirals - is an incredibly important goal, and worthy of pursuit. 

We've seen how quickly the overuse of antivirals can lead to resistance (see Nature's China's chicken farmers under fire for antiviral abuse), and vaccines must be continually updated if they are to be effective (see J. Virus Erad.: Ineffective Control Of LPAI H9N2 By Inactivated Poultry Vaccines - China).

While I don't expect a `genetic solution' will become available anytime soon, we do need to be taking the `long view' on avian flu control, since pharmacological solutions are both finite and incredibly fleeting. 

Cambodia Reports 4th H5N1 Infection In Siem Reap Province In Last 7 Days

 

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A week ago, we learned of a 41 year-old woman in critical condition with H5N1 from a small village in Siem Reap Province in Northern Cambodia. There were reportedly sick and dying chickens in her village. 

Two days ago, Cambodia Reported 2 More Human H5N1 Cases; both next door neighbors of the index case. 

This morning the Cambodian MOH is reporting a 4th case - also in Siem Reap Province - but this time about 3 km distant from the previous 3 cases.  Once again, this patient reportedly had contact with sick or dead chickens. 

Since the MOH lists this as the 11th case of 2025, there appears to be at least one case we are missing.  Earlier this month details on a case from last May were belatedly released, and so it is possible that information on this case is still in the pipeline. 

I've posted the screenshot from the Cambodia MOH Facebook page, followed by a translation.  I'll have more after the break. 

Kingdom of Cambodia

Nation Religion King

Ministry of Health

Press Release

Bird flu case in 36-year-old woman

The Ministry of Health of the Kingdom of Cambodia would like to inform the public: There is another case of bird flu in a 36-year-old woman who was confirmed positive for the H5N1 avian influenza virus by the Pasteur Institute of Cambodia on June 30, 2025. The patient lives in Daun Keo village, Daun Keo commune, Puok district, Siem Reap province and has symptoms of fever, cough, shortness of breath and difficulty breathing.

This is the 11th case for 2025 in the Kingdom of Cambodia and the 4th case in Siem Reap province (living in a different village, approximately three kilometers away from the previous 3 cases of bird flu). The patient is currently under intensive medical care. Investigations revealed that the patient had a sick and dead chicken at home, which the patient had handled and touched directly, and then buried it.

The emergency response teams of the national and sub-national ministries of health have been collaborating with the provincial agriculture departments and local authorities at all levels to actively investigate the outbreak of bird flu and respond according to technical methods and protocols, find sources of transmission in both animals and humans, and search for suspected cases and contacts to prevent further transmission in the community. They have also distributed Tamiflu to close contacts and conducted health education campaigns among residents in the affected villages.

The Ministry of Health would like to remind all citizens to always pay attention to and be vigilant about bird flu because H5N1 bird flu continues to threaten the health of our citizens. We would also like to inform you that if you have a fever, cough, sputum discharge, or difficulty breathing and have a history of contact with sick or dead chickens or ducks within 14 days before the start of the symptoms, do not go to gatherings or crowded places and seek consultation and treatment at the nearest health center or hospital immediately. Avoid delaying this, which puts you at high risk of eventual death.

How it is transmitted: H5N1 bird flu is a type of flu that is usually spread from sick birds to other birds, but it can sometimes be spread from birds to humans through close contact with sick or dead birds. Bird flu in humans is a serious illness that requires prompt hospital treatment. Although it is not easily transmitted from person to person, if it mutates, it can be contagious, just like seasonal flu.

How to prevent:

• Do not touch or eat sick or dead chickens and ducks. Wear gloves and a mask or cover your nose with a scarf before handling chickens for food. Then blanch them in boiling water before plucking their feathers.
• Adhere to hygiene practices, wash hands frequently before handling food, especially after touching animals, cleaning poultry feathers, or other objects that may be sources of contamination.
• Cook food thoroughly before eating, especially meat, poultry, and eggs. Do not eat raw or undercooked eggs, and keep raw and cooked foods separate. Clean cooking utensils properly.
• If there are many sick or dead chickens at home or in the village and they have symptoms of fever, cough, sputum discharge, or difficulty breathing, please urgently seek consultation and treatment at the nearest health center or hospital to avoid delay, which puts you at high risk of eventual death.

Therefore, the public is requested to be aware and take care of their health in the above preventive measures. The Ministry of Health will continue to provide information regarding public health issues on the Ministry of Health's official social media channels, as well as the official Facebook page of the Department of Communicable Disease Control and the website www.cdcmoh.gov.kh.

For more information, please contact the Ministry of Health's emergency hotline number 115 toll-free.

Tuesday, 6th day of the Asah month, year of the Monkey, B.E. 2569, Phnom Penh, July 1, 2025

This cluster - the first extended one we've seen in quite some time - is reminiscent of the type of bird flu activity we commonly saw between 2004-2016, particularly in places like Indonesia, Egypt, and Cambodia; large die offs of poultry, followed by community clusters of illness. 

Which may be due - at least, in part -  to the fact that these recent Cambodian cases appear to be due to a new reassortment of an older clade of the H5N1 virus (2.3.2.1c), recently renamed 2.3.2.1e.

While summertime outbreaks of avian flu are a bit unusual, the closer one gets to the equator, the more likely influenza is to circulate year-round.  Siem Reap Province is only about 13 degrees N. Latitude. 

Given the frequent contacts reported with sick or dead poultry, there is no evidence to suggest human-to-human transmission of the virus. 

Nevertheless, every human infection is another opportunity for the virus to better adapt to human physiology.  So we watch these cases - and clusters - with considerable interest. 

Stay tuned. 

 

ECDC: Updated Reporting Protocol for Zoonotic Influenza Virus

 

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A year ago, in the wake of the discovery of 3 (now > 6 dozen) human infections with H5N1 in the United States, the ECDC issued guidance for member nations on Enhanced Influenza Surveillance to Detect Avian Influenza Virus Infections in the EU/EEA During the Inter-Seasonal Period.

In that summary, the ECDC pointed out:

Sentinel surveillance systems are important for the monitoring of respiratory viruses in the EU/EEA, but these systems are not designed and are not sufficiently sensitive to identify a newly emerging virus such as avian influenza in the general population early enough for the purpose of implementing control measures in a timely way.

A conclusion not unlike what we saw in the 2023's UKHSA Technical Briefing #3, which found that it might take weeks - and hundreds of cases - before community spread of a novel flu could be confirmed using standard surveillance (see UK Novel Flu Surveillance: Quantifying TTD).

Last October, the ECDC released two additional guidance documents:

• ECDC Guidance For Testing & Identification Of Zoonotic Influenza Infections In Humans In The EU/EAA

• Surveillance & Targeted Testing for the Early Detection of Zoonotic Influenza in Humans During the Winter Period in the EU/EEA

As with similar guidance we've seen from the U.S. CDC, these are non-binding recommendations, and not all member states have the same capacity for testing and managing of cases. 

The ECDC uses EpiPulse - an online portal for European public health authorities to collect, analyze, and share infectious disease data - integrating several previously independent surveillance platforms; (The European Surveillance System (TESSy), the five Epidemic Intelligence Information System (EPIS) platforms and the Threat Tracking Tool (TTT). 

Over the weekend the ECDC published an updated, 28-page protocol for reporting zoonotic influenza infections to the TESSy database. I've reproduced the introduction below:

Introduction

An event of a human case infected with an influenza virus deriving from an animal source should be reported within 24 hours to the Early Warning and Response System (EWRS) which will cover the International Health Regulations (IHR) notification for EU/EEA countries. 

To complement the eventbased surveillance, TESSy reporting allows for a long-term collection of key indicators. Data to TESSy can be uploaded retrospectively when more information becomes available but should be done as soon as feasible to avoid major reporting delays.

This reporting protocol describes data collection for zoonotic influenza viruses. With the data collected, the aim is to support situational risk assessment and trends over time.

For the reporting of case-based data, the record type INFLZOO should be used. Case-based data is the preferential record type for reporting confirmed cases to TESSy. Aggregate data on zoonotic influenza (number of tested samples and number of detected cases by NA and HA subtype) can be uploaded to INFLZOOAGGR. This record type should ideally be used mainly for reported testing data. 

If a country is not able to report to the case-based record type above, then numerator data can also be reported to this record type.

Aim

To support the timely and complete reporting on number of samples tested, number of detected cases and key information of zoonotic influenza cases

Objectives

• To collect data on number of tested people.

• To help assess the onset of the disease, confirmation of the subtype of infection and severity.

• To provide information on exposure, treatment and outcome.

• To provide additional contextual information to help understand the case identification.

• To analyse trends over time.

Record types

The following record types exist for reporting of zoonotic influenza virus in TESSy:

1. INFLZOO for reporting of case-based data of zoonotic influenza virus

2. INFLZOOAGGR for reporting of aggregated data of zoonotic influenza virus

Variables for each record type are outlined in the annex of this reporting protocol.

        (Continue . . . )

Among the changes in this update are expansions to the metadata and codes used in these reports.   A list of changes (which includes animal exposures, exposure activities, and consumption of raw or unpasteurized animal products) follows:

The ECDC continues to urge member countries to improve their surveillance, testing, and reporting of zoonotic or novel flu infections; in humans and in animals. 

Last January, in  ECDC: Avian Flu - Virus mutations and Response Strategies, we looked at two new European avian flu initiatives; 

Avian influenza: EU agencies track virus mutations and analyse response strategies

Preparedness, prevention and control related to zoonotic avian influenza

But as far as what is happening across much of the rest of the world, infectious disease reporting remains sparse, and - for varied economic and political reasons -  only seems to be getting worse (see From Here To Impunity).

A reminder that `no news' isn't necessarily `good news'.