25th and 26th new human case of avian influenza H5N1 in Cambodia in 2013

Joint news release between the Ministry of Health of the Kingdom of Cambodia and the World Health Organization

The Ministry of Health (MoH) of the Kingdom of Cambodia wishes to advise members of the public that two new human cases of avian influenza have been confirmed for the H5N1 virus. These are the 25th and 26th cases this year and the 46th and 47th people to become infected with the H5N1 virus in Cambodia. Case 25 is from Kampong Speu province and case 26 was from Pailin province. The Kampong Speu case is currently in a critical condition whereas the Pailin case has died. Of the 47 confirmed cases, 35 were children under 14, and 27 of the 47 were female. In addition, only 13 cases out of the 26 cases this year survived.

The 25th case, a 3-year-old boy from Veal Vong village, Sendey commune, Samrong Tang district, Kampong Speu province, was confirmed positive for H5N1 human avian influenza on 9th November 2013 by Institut Pasteur du Cambodge. The boy had onset fever on 5th November 2013, his parents sought treatment at a local private practitioner on 6th November, but his condition worsened.The boy was admitted to KanthaBopha Hospital, Phnom Penh, on 8th November 2013 with fever, cough, and dyspnoea. Laboratory samples were taken on 8th November and Tamiflu administered the same day.

Investigations in the village by the Ministry of Health's Rapid Response Teams (RRT) and the Ministry of Agriculture, Forestry and Fishery's (MAFF) Animal Health Task Force revealed chickens and ducks had been sick andlor dead for approximately three weeks prior to the boy's onset of illness. The boy helped carry dead chickens for his mother who was preparing a meal from the family. The mother regularly purchased sick and dead chickens from a local poultry farm.

The 26th case, a 29-year-old male from KaunDemrei village, SteungTrang commune, Salakrao district, Pailin province, was confirmed positive for H5N1 human avian influenza by Institut Pasteur du Cambodge on 9th November 2013. The man had onset fever, chills and headache on 26th October 2013 where he sought treatment at the local health centre. Treatment was provided to the case at a private clinic on 1st November until his condition continued to deteriorate. On 3rd November the case was admitted to Battambang Provincial hospital with fever, chills, headache, cough, chest pain. Laboratory samples were taken and Tamiflu was administered on 6th November. He continued to deteriorate with further symptoms of diarrhoea, vomiting, and seizures; hedied at the hospital on the 6th November.

Epidemiological investigations by the RRT and MAFF revealed that the case had direct contact with sick and dead poultry one week prior to illness onset. During the investigation multiple influenza like illness cases were detected in the village; laboratory testing of those cases to date indicated human influenza A/H1N1.

The Ministry of Health's RRTs and the Ministry of Agriculture, Forestry and Fishery's Animal Health Task Force are working together closely inboth villages to investigate and implement control measures. The RRTs are trying to identify the case's close contacts, any epidemiological linkage among the 26 cases and initiate preventive treatment as required.The Animal Health Task Force is investigating cases of poultry deaths in the village.

"Avian influenza H5NI remains a serious threat to the health of all Cambodians and more so for children, who seem to be most vulnerable and are at high risk. There have been 26 cases ofH5Nl infection in humans this year. Children often care for domestic poultry by feeding them, cleaning pens and gathering eggs. Children may also have closer contact with poultry as they often treat them as pets and also seem to be most vulnerable and are at high risk because they like to play where poultry are found. I urge parents and guardians to keep children awayfiom sick or deadpoultry andprevent them from playing with chickens and duck. Parents and guardians must also make sure children thoroughly wash their hands with soap and water before eating and after any contact with poultry. Hands may carry the virus that cannot be seen by the naked eye. Soap washes away the virus on hands. If children have fast or difficulty breathing, their parents should seek medical attention at the nearest health facility and attending physicians must be made aware of any exposure to sick or dead poultry, " said H.E. Dr. Mam Bunheng, Minister of Health.

A nationwide public health education campaign using radio has been launched in early October. Also, public health education campaigns are being conducted in Veal Vong village, Sendey commune, Samrong Tong district, Kampong Speu province and KaunDemrei village, SteungTrang commune, Salakrao district, Pailin province, using information,education and communications materials to inform families on how to protect themselves from contracting avian influenza. The government's message is - wash hands often with soap and water, before eating and after coming into contact with pou1try;keep children away from poultry; keep poultry away from living areas; do not eatdead or poultry; and all poultry eaten should be well cooked.

H5N1 influenza is a flu that normally spreads between sick poultry, but it can sometimes spread from poultry to humans. Human H5N1 avian influenza is a very serious disease that requires hospitalization. Although the virus currently does not easily spread among humans, if the virus changes it could easily be spread like seasonal influenza. Hence, early recognition of cases is important.

The Ministry of Health will continue to keep the public informed of developments via the MoH website www.cdcmoh.gov.kh where relevant health education materials can also be downloaded.

For more information on human influenza please call the MoH Influenza Hotline numbers: 115 (free call); 012 488 981 or 089 669 567

Ministry of Health
Dr Sok Touch:+855 12 856 848
Dr Ly Sovann: +855 12 825 424

World Health Organization
Dr Pieter JM van Maaren: +855 23 216 610
Dr Reiko Tsuyuoka: +855 23 216 610