Kampong Cham province – Credit Wikipedia
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Today Cambodia’s MOH is reporting their 4th & 5th confirmed H5N1 cases of 2014, that of two young girls (ages 10 & 11) from Kampong Cham Province (albeit villages in different districts). Unlike most of the H5N1 cases we’ve seen, these girls appear to have suffered relatively mild to moderate illness, and have both recovered.
While this brings the official case count to five for the year, we also had a strongly suspected case – that of a sibling of a confirmed case who died, but was never tested – from Kratie Province earlier this month (see Cambodia: 2 Deaths - 1 Confirmed H5N1, 1 Probable).
First some excerpts from the MOH statement, after which I’ll have a bit more.
4th and 5th New Human Case of Avian Influenza H5N1 in Cambodia in 201427 February 2014
The Ministry of Health (MoH) of the Kingdom of Cambodia wishes to advise members of the public that two (2) new human cases of avian influenza have been confirmed for the H5Nl virus. These are the 4th and 5th cases this year and the 51st and 52nd persons to become infected with the H5Nl virus in Cambodia. The cases are from Kampong Cham (newly named Tboung Khmun) province. Of the 52 confirmed cases, 40 were children under 14, and 29 of the 52 were female. In addition, since the first case happened in Cambodia in 2005 there were 18 cases survived.
The 4th case, a 10-year-old girl from Rorveang village, Knor Damborng commune, Cheung Prey district, Kampong Cham (newly named Tboung Khmun) province, was detected by the Naval Medical Research Unit 2 (NAMRU-2) through fever surveillance on 20th February and confirmed positive by Institut Pasteur du Cambodge on 20th February 2014. The girl had onset symptom of fever on 26th January 2014. Her mother bought medicine in the village. From the 27th January, she continued to develop symptoms and had fever, running nose, cough, and abdominal pain. On the 29th January, the health staff of the NAMRU-2 project took samples from the girl. Upon confirmation of H5Nl, she was referred toKampong Cham Provincial Hospital on 20th February and Tamiflu was administered on the same day. Currently, she recovered and had normal activities.The case had direct exposure with dead and sick poultry. Farm ducks in the village started to suddenly die around 15th January 2014. The mother of the case brought sick/dead ducks on the 25th January and the family prepared them, with the help of the case, for food the same day.
The 5th case, an 11-year-old girl from La Ork Village, Krek Commune, Ponhea Krek district, Kampong Cham (newly named Thoung Khmum) province, was detected by the Naval Medical Research Unit 2 (NAMRU-2) through fever surveillance on 20th February and confirmed positive by Insitut Pasteur du Cambodge on 29th February 2014. The girl had onset of symptoms of fever and cough on 9th February 2014. The health staff at the NAMRU-2 project took samples from the girl on the 10th February. Upon confirmation of H5N1, she was referred to Kampong Cham Provincial Hospital on 20th February and Tamiflu was administered on the same day. Currently, she recovered and had normal activities.
From the 7th to 10th February, all 30 chickens owned by family died around the house. The relatives reported that the girl had no direct contact, but the chickens died in close proximity to the case.
NAMRU-2 mentioned above is the Naval Medical Research Unit (#2) which previously had been based in Jakarta for nearly 40 years, but became ensnared in former Indonesian Health Minister Supari’s increasingly absurd political theatre, where she eventually accused the lab of espionage and ordered it closed (see NAMRU-2 Debate Turns Ugly)..
Diplomatic efforts to reopen the lab ultimately failed, and so the lab was temporarily relocated to Pearl Harbor in 2010, and then moved on to Cambodia last year.
Given the sudden uptick of human H5N1 cases in Cambodia over the past 3 years, the presence of NAMRU – which has dealt extensively with avian H5N1 previously in both Indonesia and Egypt (NAMRU-3) – is a decided plus. You can visit NAMRU’s website at the link below:
Despite the dramatic uptick in H5N1 cases reported out of Cambodia over the past couple of years, their sporadic nature and broad geographic distribution show no evidence of sustained or efficient community-level transmission, and the assumption is that the vast majority of these infections came from exposure to infected birds.
The World Health Organization’s most recent public health assessment on the H5N1 virus reads:
Overall public health risk assessment for avian influenza A(H5N1) viruses: Whenever influenza viruses are circulating in poultry, sporadic infections or small clusters of human cases are possible, especially in people exposed to infected household poultry or contaminated environments. This influenza A(H5N1) virus does not currently appear to transmit easily among people. As such, the risk of community-level spread of this virus remains low.
But viruses can change over time, and so could this assessment.
