Irin News: Reporting 4th Cambodian H5N1 Case

 

 

 

IRIN (Integrated Regional Information Networks)was founded in 1995, and is part of the UN Office for the Coordination of Humanitarian Affairs.  While technically a part of the UN, it maintains editorial independence, and its reports do not necessarily reflect the views of the United Nations and its agencies, not its member states.

 

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UPDATED : We now have a second news source on this story VOA News On 4th Cambodian H5N1 Case

 

Burying the lede just a little, a report appears in Irin News this morning on an awareness campaign on bird flu prevention in Cambodia, that bumps the number of new cases from the three we learned about on Friday (see WHO/ Cambodian MOH Statement On H5N1 Cases) to four.

 

Caveat: A quick scan of the Cambodian MOH  and Cambodian CDC sites, and other news sources this morning, has yet to turn up confirmation of this report.

 

Irin News, is generally a pretty reliable source, but I would view this report with caution until we get official confirmation (see update VOA News On 4th Cambodian H5N1 Case).

 

The story indicates that a second case was confirmed yesterday (Jan 27th) from Kampong Speu Province, when a 17-month old girl tested positive. 

 

We have no word on her condition, although the article continues to cite two fatal cases.

 

Some excerpts from the report, but follow the link to read it in its entirety. I’ll have more when you return.

 

 

Cambodian bird flu deaths prompt awareness drive

PHNOM PENH, 28 January 2013 (IRIN) - Health authorities in Cambodia will bolster public awareness campaigns on H5N1 avian influenza after four people became infected in January, resulting in two fatalities.

 

“Ongoing public awareness campaigns need to be reinforced through TV and radio,” Sok Touch, director of Cambodia’s Communicable Disease Control Department (CDC), told IRIN on 28 January, calling on people to be vigilant. “We’re planning on doing this immediately as there is no room for complacency.”

 

The four cases of H5N1 avian influenza, commonly known as bird flu, are the first confirmed in Cambodia this year. There were three recorded cases (all fatal) in 2012.

Since 2005, 24 people have been infected resulting in 21 deaths, according to WHO, with over half of the infections in children under 14.

According to a joint statement from the Ministry of Health and World Health Organization (WHO) on 25 January, an eight-month-old boy from the capital Phnom Penh recovered after being infected with bird flu, while a 15-year-old girl from southwestern Takeo Province and a 35-year-old man from southwestern Kampong Speu Province died after contracting the virus.

The CDC said the boy had contact with chickens at a market, but the girl from Takeo and the man from Kampong Speu both fell ill after cooking dead chickens gathered from their villages.

A fourth case, also in Kampong Speu, was confirmed by the Ministry of Health on 27 January, when a 17-month-old girl tested positive for H5N1.

“We are working closely with the Ministry of Health to enhance surveillance of H5N1,” said Sonny Krishnan, communications officer with WHO in Phnom Penh, adding that WHO did not know yet if there was a link between the cases of the girl and 35-year-old man.

(Continue . . .)

 

 

If confirmed by the World Health Organization, this 4th reported case will make the 25th known human infection from Cambodia, 21 of which have been fatal.

 

How many human H5N1 infections (and deaths) have really occurred in Cambodia, and around the world, is a matter of some debate.

 

While the evidence for there being a lot of mild cases is sparse (see The Great CFR Divide), it does seem likely that we are missing some number of cases.

 

Last year, in WHO: 2012 World Health Statistics Report, we looked at the lack of disease and mortality information available from many low-resource countries.

 

Among low income countries, only about 1% of deaths (and their causes) are recorded, while just 34 countries – representing 15% of the world’s population – produce high quality cause-of-death documentation.

 

 

The truth is there  much ambiguity regarding the true prevalence of nearly all diseases around the world.

 

In 2010, at a time when the WHO estimated there to be roughly 15,000 malarial deaths each year in India, a study appeared in The Lancet which claimed the real death toll was likely 10-fold higher (see Lancet: India's Invisible Malaria Burden).

 

Millions of people die each year around the world without ever receiving modern medical care, much less sophisticated lab testing for exotic diseases. Living in mostly rural areas of developing countries, they are often buried quickly with no cause of death identified.

 

So while we carefully track individual cases of H5N1 infection, we do so with the knowledge that we are probably not counting all of the cases that occur.

 

Although we continue to see scattered human infections around the globe, and the virus continues to evolve (see H5N1: An Increasingly Complex Family Tree), for now H5N1 is primarily a threat to poultry and to a lesser extent (in parts of Asia and the Middle East) to people who have direct contact with infected birds.

 

The virus remains poorly adapted to human physiology, and despite ample opportunities to cause illness in humans, only causes rare, sporadic infections.

 

The concern, of course, is that over time the virus will adapt further and pose a pandemic threat to humans. So we watch its progress with great interest, looking for any signs that the virus is better adapting to human hosts.

IRIN: Cambodia’s Bird Flu Risk "under control" - Experts

 

 

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From IRIN (Integrated Regional Information Networks), which was founded in 1995 and is part of the UN Office for the Coordination of Humanitarian Affairs, we get a report on Cambodia’s efforts to contain and control their recent outbreaks of H5N1 bird flu.

 

As of April 16th, Cambodia had reported 4 human infections with the H5N1 virus in 2011, all fatal. 

 

Prior to that, Cambodia had reported 4 cases (all fatal) in 2005, 2 cases in 2006 (again, all fatal), and in 2007, 2008, 2009, and 2010 they reported 1 case each year, with 3 of those surviving.

 

 

While four isolated cases does not a crisis make, this sudden uptick after four relatively quiet years has raised concerns that the virus might be on the ascendant again in Southeast Asia.

 

This update comes via IRIN.

 

CAMBODIA: Bird flu risk "under control", say health experts

PHNOM PENH, 18 April 2011 (IRIN) - Health officials in Cambodia stress that they have not let down their guard against H5N1, despite four fatal cases of human avian flu this year, and are confident the community-based detection, surveillance and containment model remains robust and effective.

 

"There is no cause for alarm," Chea Nora, a technical officer within the Emerging Disease Surveillance and Response unit at the World Health Organization (WHO) in Phnom Penh, told IRIN. "Even though Cambodia is the only country [in the Mekong region] that has had cases this year, H5N1 is well under control here."

 

The four deaths, in February and March, were the first reported cases of H5N1 in Cambodia since April last year and raised the number of cases in the country to 14 since 2005, 12 of which have been fatal, according to the communicable disease department at Cambodia's Ministry of Health.

 

Nora said it was important to note that the cases occurred in different areas of the country, that laboratory tests indicated the virus was neither mutating nor getting stronger, and that the avian flu season, which corresponds with the dry season in Cambodia, from November to May, is nearing its end.

 

However, he said interviews with villagers had revealed that some believed H5N1 was no longer a threat because there were no more radio alerts, which had been part of the national awareness campaign funded by USAID and the German government.

 

(Continue . . . )

 

 

The fact that these four cases emanated from three separate provinces is reassuring in that there appears to be no evidence of community spread of the virus among humans.

 

By the same token, the fact that the virus has been acquired (presumably from infected chickens/ducks) in three provinces this year speaks to how widespread the virus apparently is in poultry. 

 

While a few limited awareness campaigns continue, the message is often lost on a population to whom hunger, malaria, dengue, and diarrheal diseases take a much greater toll. 

 

As this article points out, rising food insecurity in Cambodia (and around the world) probably increases the chances that families will consume sick or dying poultry rather than destroy them.

 

Although we continue to see isolated human infections around the world, for now H5N1 is primarily a threat to poultry.

The virus remains poorly adapted to human physiology, and despite ample opportunities in places like Egypt and Indonesia, only causes rare, sporadic infections.

 

The concern, of course, is that over time that may change. 

 

And so the world remains at Pre-pandemic Phase III on the H5N1 virus, and we continue to watch for signs that the virus is adapting to humans.

 

IRIN: Indonesia’s Avian Flu Challenge

 

 

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Via IRIN humanitarian news and analysis this morning, a short feature on some of the reasons why Indonesia’s case fatality rate for avian flu is an astounding 83%.

 

Compare that to the CFR from Egypt, which is 34%, and globally, which runs just about 60%.

 

 

Most of these are items mentioned here before;

 

• a reliance on traditional medicine
• a fear of hospitals (understandable considering how few bird flu patients come home)
• concerns over paying for medical care
• challenges posed by having 250 million people scattered across nearly 2 million sq km and thousands of islands

 

 

 

 

INDONESIA: Avian flu deadliest in the world

Indonesia- deadliest place in the world to be hit with avian flu

BANGKOK, 16 December 2010 (IRIN) - The number of deaths from avian flu in Indonesia is the highest worldwide, due to a slow response rate and surveillance challenges, say specialists.

(Continue . . . )

 

 

Alluded to, but not specifically mentioned in this article, has been the general ineffectiveness of many central government edicts which have been issued to try to control bird flu.

 

Perhaps most famously, in January of 2007, Jakarta announced an ambitious plan to remove, permanently, the backyard and residential raising of poultry throughout the nation, starting first in the capital.

 

Residents were given until February 1^st to sell, consume, or destroy their small flocks.

 

Even as the central government was announcing that this policy would be extended first to 9 provinces, then across the entirety of Indonesia, cracks in the coalition were developing.

 

Authorities in the Central Javan Province, Pandeglang regency and Cilegon municipality all stated they would not go along with this edict.

 

A few blogs from that time period include:

 

Eight Months After The Jakarta Poultry Ban

Indonesian Culling Plan Finding Resistance

Resistance to Indonesian Poultry Ban

 

With an estimated 350 million backyard chickens across the nation - and a population that depends heavily upon them for food security, barter, and as a source of income -  this plan was probably doomed from the start.

 

In the parlance of today’s twitterverse, it was an Epic Fail.

 

 

Whether well advised or not, this poultry eradication program’s failure illustrates just how difficult it is to get everyone on the same page when it comes to controlling the virus.

 

And so four years later, Indonesia’s poultry remains rife with H5N1, they have the highest (known) case fatality in the world, and permanent solutions to the problem remain as elusive as ever.

IRIN Analysis: Egypt’s Response To The Pandemic

 

 

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Very early on in the pandemic of 2009, a number of countries imposed tough – some would even say `harsh’ – methods to try to control its spread.

 

Thousands of schools were closed, travelers were separated from their families and quarantined, and in a few cases, airline flights to some countries were even canceled. 

 

A couple of examples examples include:

 

 

Beijing gets tough on flu prevention

By Li Xinran  |   2009-6-24  |

BUSINESSES, public institutions and government organizations in Beijing found of doing a poor job of implementing swine flu emergency measures will be fined up to 200,000 yuan (US$29,200), the city government said yesterday.

Travellers warned of new India swine flu measures

Monday, 22 June 2009: India

Rebecca Burns

Travellers to India from countries affected by swine flu (including the UK) are likely to be asked questions or be checked for symptoms by medical staff, according to the UK Foreign Office (FCO).

Travellers suspected of having H1N1 will be admitted to designated governemnt hospitals for compulsory quarantine, testing and treatment.

 

 

Eventually, most of these barriers were relaxed as the virus spread past them, and as the virulence of the virus became better understood.

 

In Egypt, the governmental reaction to the pandemic was extremely vigorous, and often controversial.  Heightened, perhaps, by legitimate concerns over the co-circulation of H5N1 `bird flu’ in that country.

 

For years, Egyptian Health officials had looked for an opportunity to eliminate pigs from their country.  With the emergence of a new strain of swine flu, and concerns that pigs could be vectors, the decision was quickly reached to eradicate hundreds of thousands of swine.

 

The unintended consequence – beyond the hardship placed on pig farmers by the destruction of their herds – is that their cities were overrun with the garbage that the pigs used to eat.

 

From IRIN (Integrated Regional Information Networks), which was founded in 1995 and is part of the UN Office for the Coordination of Humanitarian Affairs, we get analysis of Egypt’s reaction to the Swine Flu pandemic.

 

 

Analysis: Did the government overreact to H1N1?

Photo: Amr Emam/IRIN

Piles of garbage being burned in Cairo's streets

CAIRO, 18 July 2010 (IRIN) - While a review is underway of how the World Health Organization (WHO) and national authorities handled last year’s outbreak of the H1N1 virus, also referred to as swine flu, medical experts in Egypt have criticized their government for overreacting to the pandemic, provoking unjustified fear and wasting millions of dollars-worth of much-needed public funds.

 

“Egypt is probably the only country in the world that acted in such an insane way towards the virus,” Saed Aun, a former preventive medicine advisor to the Egyptian health ministry, told IRIN. “The Egyptian government applied the wrong policies in dealing with the crisis.”

 

When H1N1 was first detected in a university dormitory in April 2009, the Egyptian Cabinet in May decided to cull all the nation’s more than 350,000 pigs obstensibly to avert the spread of the virus, although the link between H1N1 and pigs had not been officially established.

 

Apart from the enormous loss to pig farmers, the culling led to an accumulation of rubbish on the streets of the capital as pigs had been eating much of it previously.

 

(Continue . . . )

 

 

IRIN: Lessons Learned In Vietnam

 

 

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From IRIN (Integrated Regional Information Networks), which was founded in 1995 and is part of the UN Office for the Coordination of Humanitarian Affairs, we get this optimistic overview of the lessons learned by Vietnam from SARS, Bird Flu, and H1N1. 

 

This is admittedly a `softball’ piece, extolling the progress made by Vietnam in containing bird flu and downplaying the challenges that remain.  

 

Towards the end, mention is made of the ambivalence of farmers towards vaccinating their flocks, but the article is mostly upbeat.

 

Of course, compared to the `bad old days’ of 2004 and 2005, Vietnam has made significant progress in their fight against H5N1.  By 2006, they’d gone from being the worst afflicted country in the world to being viewed as the `poster child’ for successful bird flu containment.

 

But that victory was fleeting. 

 

After more than a year of quiescence, the virus retuned in 2007.  Since then, Vietnam has been engaged in a more-or-less constant battle with sporadic outbreaks of the virus in poultry, along with occasional human infections and fatalities.  

 

On the plus side (at least when grading on the curve) Vietnam does boast better disease surveillance, reporting, and treatment centers than do many of their neighboring countries and their CFR (case fatality ratio) among bird flu patients is 50% compared to the more than 80% fatality rate seen in Indonesia.

 

So the Vietnam story is not all bad.

 

Still, the virus remains endemic in that country, and as such, represents an ongoing threat.

 

That said, here is the IRIN story.

 

 

 

VIETNAM: Lessons learned from SARS, bird flu, H1N1

Photo: Biotec

Vietnam has worked hard at improving preparedness

HANOI, 22 April 2010 (IRIN) - Several years ago, when patients arrived at hospital with pneumonia that did not respond to standard antibiotics, doctors in Vietnam began to get scared.

 

Attacking perfectly healthy people, it was obvious that this was no ordinary illness. Patients, as well as health workers caring for them, were dying as epidemiologists raced to identify what was causing the disease.

 

“We were in a panic,” Nguyen Trung Cap, who was working at the National Institute for Tropical and Infectious Diseases in Hanoi when severe acute respiratory syndrome (SARS) struck Vietnam in 2003.

 

“We did not know if we would wake up in the morning and see people still alive.”

 

But Vietnam did survive, and indeed it weathered more devastating diseases to come.

 

In 2004, avian influenza arrived, hitting Vietnam particularly hard.

 

According to the World Health Organization (WHO), nearly 60 people in Vietnam had died of avian influenza as of 21 April, making Vietnam second only to Indonesia in terms of the number of human fatalities from the H5N1 virus.

 

When H1N1 influenza (popularly known as swine flu) emerged last year, Vietnam was hit yet again. But this time, say officials, it was prepared.

 

Early identification and quarantine measures helped curtail the spread of H1N1, officials say, reducing the number of people infected.

(Continue . . . )