Kratie Province – Credit Wikipedia
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Crof picked up the media report overnight (see Cambodia: Two siblings die from H5N1 on the same day), but we now have the Cambodian MOH statement regarding these deaths. While both children were hospitalized with similar symptoms, and both died within hours of each other, no samples were taken and tested from the younger sibling to confirm H5N1.
First some excerpts from the MOH statement, after which I’ll have a bit more.
2nd New Human Case of Avian Influenza H5N1 in Cambodia in 2014
12 February 2014The Ministry of Health (MoH) of the Kingdom of Cambodia wishes to advise members of the public that one new human case of avian influenza has been confirmed for the H5Nl virus. This is the 2nd case this year and the 49th person to become infected with the H5N1 virus in Cambodia. The case is from Kratie province and died on 7th February. Of the 49 confirmed cases, 37 were children under 14, and 27 of the 49 were female. In addition, since the first case happened in Cambodia in 2005 there were only 15 cases survived.
The 2nd case this year, a 8-year-old boy from Kbal Trach village, Sre Cha commune, Snourl district, Kratie province, was tested positive for H5N1 human avian influenza on 8th February 2014 by Institut Pasteur du Cambodge. The boy had onset fever, sore throat and running nose on 31st January 2014, his parents sought treatment at a private clinic in his village. His condition worsened and the boy was admitted to Memot Referral Hospital on 6th February. On 7th February, the boy had symptoms of fever, sore throat, cough, abdominal pain, diarrhea, dyspnea and somnolence, and was transferred to Kampong Cham Hospital at 1: 00 am. Tamiflu was administered on the same day. Despite intensive medical care, the boy died on 7th February (around 6.00 pm).
The cases younger sister, 2 year old, started with similar symptoms on 1st February. Her condition worsened also and she was admitted to ths same hospitals together with her brother. She had symptoms fever, sore throat, cough, abdominal pain, diarrhea, dsypnea, and somnolence. The girl died around 4:00 a.m. February 7th. Specimens were not collected, therefore could not be tested for H5N1.
Last year Cambodia reported the largest number of human H5N1 infections in the world, with 26 cases (see Cambodian MOH Announces Two New H5N1 Cases) as of mid-November. This was a major increase for that country, which had reported only 21 cases in the previous 7 years.
After a lull lasting a couple of months, last week Cambodia Reported Their 1st H5N1 Case Of 2014, in a 5-year-old boy from Kampong Thom province.
Last December the World Health Organization released their monthly Influenza at the human - animal interface report, which had this to say regarding Cambodia’s recent surge in H5N1 cases.
Influenza at the human-animal interface
Summary and assessment as of 10 December 2013(EXCEPT)
In Cambodia, the reported incidence of human cases has increased in 2013 (26 cases in 2013 compared with 21 cases from 2005 through December 2012). This might be due to improvements in surveillance and physician awareness or to a potential increased circulation of the virus in poultry. The case fatality rate among reported cases, however, has decreased (54% in 2013 compared with 90% over all previous years).
Before 2013, H5N1 viruses from clade 1.1 predominated in Cambodia. Analysis of isolates from human cases and birds from the beginning of 2013 revealed the emergence of a new H5N1 genotype resulting from the reassortment of clade 1.1 and clade 2.3.2.1 viruses.
The link between the emergence of this reassortant virus and the increase in human cases observed in 2013 is yet to be determined.
Although the number of cases of H5N1 infection in Cambodia continues to mount, these cases have been widely scattered, making it likely that these are sporadic transmissions from birds or the environment rather than a sign of increased human-to-human transmission.
For now, H5N1 remains poorly adapted to humans - only rarely being passed from one person to another - and is primarily a threat to poultry.
But when we see upticks in human cases like this one, it is a reminder that emerging influenza viruses are an ongoing threat, and that we need to watch them closely for any signs that they may be becoming better adapted to humans.
