Sunday, January 28, 2024

Cambodia: MOH Announces 2nd H5N1 Case of 2024


Two days ago Cambodia reported their 1st H5N1 infection of 2024 - detected in a 3 y.o. boy in Prey Veng Province - and today their MOH has announced a 2nd case - this time in a 69 y.o. man - residing more than 150 miles to the north and west of Friday's case, in Siem Reap Province. 

After having gone 9 years without reporting any H5N1 infections, this makes the 8th case to be reported by Cambodia in less than a year.  

The reasons behind this recent uptick are unknown, but a recent study  (see Preprint: A Timely Survey of Knowledge, Attitudes, and Practices Related to Avian Influenza (H5N1) in Rural, Cambodia)  found very lax attitudes regarding avian flu among the rural population (e.g. 23% of participants cooked sick or dead poultries for their families).

As with the previous 6 cases, these two latest infections most likely stem from a clade H5N1 virus - an older lineage of avian flu which predates our current clade epizootic.   

The translated Press Release from the Cambodian MOH follows, after which I'll return with more.

Kingdom of Cambodia, Nation, Religion, King
Ministry of Health
Press Release

          69-year-old man infected with bird flu

The Ministry of Health of the Kingdom of Cambodia would like to inform the public that there is another case of bird flu in a 69-year-old man and was confirmed positive for H5N1 bird flu virus (H5N1) from the National Institute of Health. Public on January 27, 2024, residing in Pbat village, Prey Chrouk commune, Puok district, Siem Reap province. The patient is currently receiving intensive care from a team of doctors. According to the survey, the patient has raised about 50-60 chickens at home and has been dying for about two weeks.

The National and Sub-National Emergency Response Team of the Ministry of Health has been cooperating with the working groups of the Ministry of Agriculture, Forestry and Fisheries and the Ministry of Environment, local authorities at all levels to actively investigate the outbreak of bird flu and respond. Respond to methods and technical protocols, continue to search for sources of transmission on both animals and humans, and continue to search for suspected cases and affected people to prevent transmission to others in the community, and distribute Tamiflu to affected people. Close and conduct health education campaign for the people in the village where the incident occurred.
The Ministry of Health would like to remind all citizens to be careful about bird flu because H5N1 bird flu continues to threaten the health of our people and also would like to inform you if there are symptoms. Fever, cough, runny nose or shortness of breath and a history of contact with sick or dead chickens during the 14 days prior to the onset of symptoms, do not visit crowded places and seek consultation and examination. Get treatment at the nearest health facility as soon as possible. 
Transmission: H5N1 bird flu is a flu virus that is usually transmitted from sick birds to other birds, but can sometimes be transmitted from birds to humans through close contact with sick or dead birds. Avian influenza in humans is a serious disease that requires treatment at Hospital on time. Although it is not easily transmitted from person to person, if it can metabolize it can be as contagious as the seasonal flu.

Preventive measures: Government education messages include: Wash hands frequently with soap and water before eating and after contact with birds, keep children away from birds and keep birds away from living, do not eat birds. Sick or dead and all birds made for eating must be well cooked.

The Ministry of Health will continue to inform the public about information related to public health issues through the Telegram Channel and the official Facebook page of the Ministry of Health, as well as the official Facebook page of the Department of Infectious Diseases and the website
This site has health education materials that can be downloaded and used. For more information, contact the Ministry of Health's hotline number 115 for free.
Days Sunday, 3 Roach Khe Bos, Chhnang Thao, Panchasak, BE 2567, Phnom Penh, January 28, 2024

So far, we haven't seen any evidence of sustained or efficient human-to-human transmission of H5N1, but this recent uptick in clade infections warrants our attention.  The more times the virus spills over into humans, the more opportunities it will have to `figure us out', and better adapt to a human host. 

As we've seen the past few years with clade, the `right' reassortment or combination of antigenic changes can breathe new life into an existing lineage.

Whether that has happened with clade remains to be seen. But this is a reminder that while we are watching one threat (H5N1 clade, we could always get blindsided by something unexpected (e.g. H5N6, H10N3, H3N8, etc.) coming from out of left field.