Wednesday, January 11, 2023

Ecuador MOH Confirms Human Infection with HPAI H5


On December 1st both Peru and Ecuador declared animal health emergencies following the arrival - for the first time - of HPAI H5 in migratory birds. Three days later PAHO - the Pan-American Health Organization - issued an Epidemiological Update: Outbreaks of Avian Influenza and Public Health Implications - 3 Dec 2022, which recommended: 

". . . . monitoring the occurrence of influenza-like illness (ILI) or severe acute respiratory infection (SARI) in people exposed to birds (domestic, wild, or in captivity) infected with influenza viruses".

While the details are scant, overnight Ecuador's Ministry of Public Health announced the first detection of HPAI H5 infection in a human in South America; identified in a 9 year-old girl from the province of Bolivar.  

No details on when she was infected, her symptoms, or her current condition, are provided. 

Presumably more details will be released, either by the  MOH, PAHO, or WHO.   The Spanish language announcement graphic is followed by a rough translation.  I'll return with a postscript after the break. 



Republic of Ecuador

Ministry of Public Health

January 10, 2022

Health entities maintain active surveillance in case of bird flu.

Within the framework of the epidemiological alert issued by the Ministry of Public Health (MSP) on December 15, 2022 due to the circulation of avian influenza in poultry, it was confirmed in the laboratory of the National Institute for Research and Public Health (INSPI). ) the first case of influenza A-H5 (avian flu) in a 9-year-old girl, in the province of BolĂ­var. 

It is presumed that the infection occurred through direct contact with birds that carried the virus.

The MSP together with the Phytosanitary and Zoosanitary Regulation and Control Agency (Agrocalidad) carried out the epidemiological fence, both human and animal, in the identified risk areas. So far no other cases have been reported in humans.

The health and epidemiological control entities continue to work on the application of preventive measures to prevent the transmission and spread of the avian influenza virus. For this reason,vaccination actions against human influenza have been carried out in populations at risk and in people in contact with poultry.

The Ministry of Public Health recommends strengthening biosecurity measures such as hand washing, use of a mask, and vaccination against human influenza. Also remember that the consumption of chicken meat and eggs do not represent any risk to human health.

A call is made to the public to go to the nearest health center if they present symptoms such as: fever, cough, sore throat. Finally, it is requested to report if you know of cases of farms or homes where there are sick or dead birds and avoid handling them.



Six weeks ago, in   UK APHA: Technical risk assessment for avian influenza (human health): influenza A H5N1, that agency illustrated the difficulty in picking up sporadic cases - and even family clusters - of HPAI H5 infection, writing:

There is insufficient information to judge the risk of asymptomatic or mild disease due to limited testing in human contacts of infected birds.


There is insufficient information to assess the occurrence of limited human-to-human transmission such as transmission within households. 

As a result, that assessment stated: At present there are no indicators of increasing risk to human health; however, this is a low confidence assessment. They also caution that `The risk assessment is dynamic and requires regular review during this period of unusually high levels of transmission in birds.'

The reality is, although this is only the 7th officially recognized human infection with this clade ( of H5N1, it probably happens more often than we know.  Many infections are presumably mild, and those infected are never tested. 

Up until two weeks ago the narrative was that human infection with this HPAI H5 virus was mild, and often asymptomatic, but that changed with the release of the WHO Rapid Risk Assessment on A(H5N1) clade viruses, which reported on two severe cases (1 in China (fatal), and 1 in Vietnam). 

So far, we've not seen any evidence that this virus is transmitting efficiently in humans, or of any community spread. Unless, and until that happens, HPAI H5 presents a very low threat to public health. 

But the virus continues to reassort, and evolve into new genotypes, and what we can say about the virus today may not hold true tomorrow.  

Stay tuned.