UPDATED 1800hrs 3/23/25
The Cambodian MOH website (see translation above) has confirmed the death of the 3 year-old boy reported as infected with H5N1 earlier today.
#18,385
H5N1 reports out of Cambodia have slowed the past 6 months, but for the 3rd time since the first of the year we are hearing of a case - once again of a toddler - this time from Kratie Province (see map above).
January's case involved a 28-year-old male from Kampong Cham Province, while February's case was reported in a 2-year-old boy from Prey Veng province. Both of which were fatal.
After going nearly a decade without a reported case, over the past 24 months Cambodia has reported 19 cases.
Cambodia's avian flu resurgence appears to have begun with an older (2.3.2.1c) clade of H5N1, but last April in - FAO Statement On Reassortment Between H5N1 Clade 2.3.4.4b & Clade 2.3.2.1c Viruses In Mekong Delta Region - we learned that a new genotype - made up of this older clade and the newer 2.3.4.4b clade of H5N1 - had emerged in Southeast Asia.
Of these 19 recent cases, only 4 have been in adults and 3 of them survived. Among the 15 children and adolescents infected - while several had mild symptoms - most were severe and nearly half (n=7) have died.
A sobering reminder that H5 viruses have a history of affecting younger individuals more severely.
First today's announcement (and translation) posted on the Cambodian MOH Facebook page, after which I'll have more.
(translation)
Kingdom of Cambodia
Ministry of Health
Press Release
On
Bird flu in 3-year-old and 6-month-old boys
The Ministry of Health of the Kingdom of Cambodia would like to inform the public that there is one case of bird flu in a boy aged 3 years and 6 months and confirmed positive for H5N1 bird flu virus from the National Institute of Public Health on March 22, 2025 in Prek Ta Am village, Bos Leav commune, Chit Borei district, Kratie province. The boy was taken to hospital in critical condition with fever, cough and severe fatigue, including difficulty breathing. Currently, the condition and progression of pediatric diseases is serious and is being treated by a team of doctors with the utmost care. According to the interrogation, the patient's family raised chickens and had about five dead chickens, and some were sick, and family members cooked dead chickens for cooking.
The Ministry of Health's national and sub-national emergency response teams have been working closely with provincial agriculture departments and local authorities to actively investigate the outbreak of bird flu and respond to 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.
The Ministry of Health would like to remind all citizens to be careful of bird flu because H5N1 bird flu continues to threaten the health of our people, and also to inform you if you have a fever, cough, runny nose or shortness of breath and have a history of contact with sick or dead chickens during the 14 days before the onset of symptoms and people do not go to the meeting. Seek medical treatment at a nearby health center or hospital immediately to avoid delays, leading to a higher risk of eventual death.
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.
How to prevent:
Do not touch or eat sick or dead chickens and wear gloves and a mask or cover your nose with a scarf before handling chickens and soaking them in boiling water before rinsing.
Adhere to the practice of washing hands frequently before handling food, especially after contact with lice, poultry or other objects that may be a source of infection.
Cook well before eating, especially poultry and eggs. Do not eat chicken or duck eggs and keep raw and cooked foods separate and clean cooking utensils properly.
If there are many sick or dead chickens at home or in the village and there is fever, cough, runny nose or shortness of breath, seek immediate consultation and treatment at a nearby health center or hospital to avoid delays, leading to a higher risk of eventual death.
Therefore, the public should be aware of and take care of their health in the above preventive ways. The Ministry of Health will continue to provide information on public health issues through the Ministry of Health's official social media, as well as the Department of Infectious Diseases' official Facebook page and website www.cdcmoh.gov.kh.
For more information, please contact the Ministry of Health's emergency hotline number 115 toll-free.
While the reasons behind this sudden resurgence of H5N1 in Cambodia are probably many and varied, a 2023 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.
The sharing, and cooking, of sick or dying poultry is something we've seen reported previously with these outbreaks, and was a major risk cited by that study. The authors noted:
- Cambodia's higher-risk behaviors or vulnerability groups need priority intervention to reduce infectious and zoonotic diseases.
- Furthermore, we noticed that 23% of participants cooked sick or dead poultries for their families.
- This study found that 49% reported poultry illness and deaths to local authorities.
Although we see assurances from the USDA and other agencies that `Avian influenza is not transmissible by eating properly prepared poultry, so properly prepared and cooked poultry and eggs are safe to eat.' - there is a catch.
As we've discussed previously (see Mixed Messaging On HPAI Food Safety), there appears to be some risk entailed in the preparation of raw poultry. Particularly from birds raised at home raised or purchased from live markets.Transmission
The most common way for the virus to enter a territory is through migratory wild birds. The main risk factor for transmission from birds to humans is direct or indirect contact with infected animals or with environments and surfaces contaminated by feces. Plucking, handling infected poultry carcasses, and preparing poultry for consumption, especially in domestic settings, may also be risk factors.
And last year the WHO published Interim Guidance to Reduce the Risk of Infection in People Exposed to Avian Influenza Viruses, which lists a number of `risk factors', including:
- keep live poultry in their backyards or homes, or who purchase live birds at markets;
- slaughter, de-feather and/or butcher poultry or other animals at home;
Although it gets mentioned, far more attention needs to be paid to safe food handling practices in this time of HPAI. Unfortunately, very little is published specifically about H5N1 safety during food preparation, with links usually to generic `safe poultry handling' advice.
- handle and prepare raw poultry for further cooking and consumption;
While the risks from store-bought poultry here in the United States are likely still low, that too could change over time. Making it better to develop and practice good food safety habits now, before they are needed.
