#18,167
While news has been quiet out of Cambodia since the flurry of 5 H5N1 cases reported last January and February, today their Ministry of Health has announced a 6th case for 2024. This makes the same number of cases over the first 6 months of this year equal to last year's total (n=6).
All of these recent Cambodian cases have been due to the older 2.3.2.1c clade of H5N1, which predates the emergence of clade 2.3.4.4b which is currently plaguing American cattle and birds and mammals around the world. Exactly what is behind its resurgence after nearly a decade isn't clear.
The (translated) statement from the Cambodian MOH follows, after which I'll return with a bit more.
Kingdom of Cambodia, Nation, Religion, King
Ministry of Health
Press Release on Avian Influenza Cases in 3-Year-Old Boy
The Ministry of Health would like to inform the public that there is one case of bird flu in a 3-year-old boy and was confirmed positive for the H5N1 bird flu virus from the National Institutes of Public Health and the Institut Pasteur. On July 5, 2024, living in Po village, Prasat Choan Chum commune, Kirivong district, Takeo province. The boy had a fever, a cough, tiredness, and difficulty breathing. At present, the patient's condition has improved and he is receiving intensive care by doctors. According to the interrogation, about 10 days ago, there was a dead chicken in the village, and at home, the patient brought food to eat, the boy touched and held the dead chicken.
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. In accordance with the methods and technical protocols, continue to search for sources of transmission in both animals and humans, and continue to search for suspected and affected cases to prevent transmission to others in the community, and distribute Tamiflu to close contacts. And conduct health education campaigns for the people in the above-mentioned villages.
The Ministry of Health would like to remind all people to always pay attention to bird flu because H5N1 bird flu continues to threaten the health of our people and also would like to inform you if you have a fever, cough. Sneezing or shortness of breath and a history of contact with sick or dead chickens during the 14 days before the onset of symptoms, do not go to crowded places or towns and seek local consultation and treatment. Health nearest you 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 timely hospitalization. Although it is not easily transmitted from person to person, if it can metabolize it can be as contagious as the seasonal flu.
Prevention: Wash your hands often with soap and water before eating and after contact with birds. Keep children away from birds and birds away from living. Do not eat sick or dead birds and all animals. 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 www.cdcmoh.gov.kh.
For more information, please contact the Ministry of Health Hotline 115 toll-free.
Saturday, 1st of Asat month, year of Rong Chhasak, BE 2561, Phnom Penh, July 6, 2024
Royal Government + Ministry of HealthGovernment + Ministry of Health
Cambodia
While Cambodia is doing an admirable job of reporting these hospitalized cases, it is entirely possible that some milder infections are going unreported. Of the 12 cases reported over the past 18 months, 5 have died, 4 were classified as `severe', 2 were `mild', and one was `asymptomatic'.
Severe or critical cases are far more likely to be hospitalized, tested, and confirmed as H5N1 positive. All of which makes it difficult to know how many people are really being infected, and what the fatality rate truly is.
Last year, in UK Novel Flu Surveillance: Quantifying TTD, the HKHSA described some of the challenges in detecting or confirming community spread of H5N1 - even in the UK - until after dozens, or even hundreds, of cases had occurred.
While H5N1 clade 2.3.4.4b has most of the world's attention - clade 2.3.2.1c in Cambodia, the recently imported (ex India) clade 2.3.2.1a case in Australia, and > 90 H5N6 cases in China - remind us that HPAI H5 continues to evolve along multiple concurrent pathways.
All have the potential to reassort with other viruses (including human seasonal flu), and new clades, subclades, genotypes, and subtypes are likely to emerge over time.
Which is why, as important as it is that we take the H5N1 in cattle threat seriously, it isn't the only pandemic threat simmering out there. Any pandemic plans we make must be nimble enough to deal with the unexpected, coming out of left field.
