Cambodia Reports 9th H5N1 Case of 2024

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For the second time in less than a week Cambodia's MOH has announced an H5N1 infection; this time in a 16 y.o. girl who is reportedly in serious condition.  This case, as was the last, lives in Svay Rieng Province, albeit in a different village. 

While we don't have word on the exact clade of these two most recent H5N1 cases, they are very likely the older 2.3.2.1c clade of H5N1, which predates the emergence of clade 2.3.4.4b and has been identified in all of the other cases reported from Cambodia.

Today's case is the 15th in just 18 months, all of which have come after Cambodia going nearly a decade without a case.  The announcement, posted on the Cambodian MOH Facebook page - and the translation - follow:

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

Cases of bird flu in 16-year-old girl

The Ministry of Health would like to inform the public that there is another case of bird flu in a 16-year-old girl and has been confirmed as H5N1 bird flu virus (H5N1) from the National Institute of Public Health and the Institute. Pasteur on August 3, 2024, residing in Chamkar Leav village, Prey Koki commune, Chantrea district, Svay Rieng province. The girl had a fever, cough, sore throat, fatigue, and difficulty breathing. 

Currently, the patient's condition is serious and is receiving intensive care by doctors. According to the interrogation, about four days before the onset of the illness at the neighbor's house and the patient's house, there were nine dead chickens and used to cook, the girl touched and held the dead chickens.

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. According to technical methods and protocols, continue to search for sources of transmission in both animals and humans, and continue to search for suspected cases and exposure to prevent transmission to others in the community, as well as distribute Tamillu 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 consultation and treatment at the local level. 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.

Preventive measures: Wash your hands often with soap and water before eating and after contact with birds. Keep children away from birds and birds away from home. Do not eat sick or dead birds and all birds. Made for eating, must be cooked well.

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.

Although Cambodia is doing an admirable job of reporting these hospitalized cases, it is entirely possible that some milder infections are going unreported. 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.