Total C D C D C D C D C D C D C D C D C D

Western Pacific Regional Office of the World Health Organization Avian Influenza Update Number 220 (Feb 2 2010) 1. Latest information on human Avian Influenza cases Between November 2003 and Feb 2 2010, human cases of avian influenza have been reported from 15 countries around the world to WHO and its numbers has reached 471 (Table 1). In 2008, a total of 44 cases were confirmed by WHO. Indonesia had the highest number of reported cases (24 cases or 54.5%), followed by Egypt (8 cases or 18.2%).In 2009, a total of 72 cases (32 death cases) were confirmed by WHO so far. 39 cases are reported from Egypt, 20 cases from Indonesia, 7 cases from China, 5 cases from Vietnam and 1 cases from Cambodia. In 2010, 4 cases have been reported by Egypt. Among 471 reported cases overall, 282 have died; case fatal rate (CFR) of 59.9%. Among the countries with more than 10 reported cases, Indonesia had the highest CFR of 83.2% (134 out of 161). Age distribution of the reported cases ranged from 3 months to 81 years old (median 18.0 years old, n=451), with 90.7% (409 out of 451) of patients being 39 years of age or younger. The highest CFR was among persons 10-19 years of age and lowest was among person age 50 and above. Gender was essentially equally distributed (Female case 231 or 51.7%, n=447). Table 1: Cumulative Number of Confirmed Human Cases of Avian Influenza A (H5N1) Reported to WHO As of Jan 28, 2010 (Change from previous report are highlighted in yellow) country WPRO 2003 2004 2005 2006 2007 2008 2009 2010 Total C D C D C D C D C D C D C D C D C D Cambodia 0 0 0 0 4 4 2 2 1 1 1 0 1 0 0 0 9 7 China 1 1 0 0 8 5 13 8 5 3 4 4 7 4 0 0 38 25 Lao PDR 0 0 0 0 0 0 0 0 2 2 0 0 0 0 0 0 2 2 Viet Nam 3 3 29 20 61 19 0 0 8 5 6 5 5 5 0 0 112 57 SEARO Bangladesh 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 Indonesia 0 0 0 0 20 13 55 45 42 37 24 20 20 19 0 0 161 134 Myanmar 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 Thailand 0 0 17 12 5 2 3 3 0 0 0 0 0 0 0 0 25 17 EMRO Djibouti 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 Egypt 0 0 0 0 0 0 18 10 25 9 8 4 39 4 4 0 94 27 Iraq 0 0 0 0 0 0 3 2 0 0 0 0 0 0 0 0 3 2 Pakistan 0 0 0 0 0 0 0 0 3 1 0 0 0 0 0 0 3 1 EURO Azerbaijan 0 0 0 0 0 0 8 5 0 0 0 0 0 0 0 0 8 5 Turkey 0 0 0 0 0 0 12 4 0 0 0 0 0 0 0 0 12 4 AFRO Nigeria 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 1 1 Total 4 4 46 32 98 43 115 79 88 59 44 33 72 32 0 0 471 282 Total number of cases includes number of deaths. C=case, D=Death WHO reports only laboratory-confirmed case. All dates refer to onset of illness. http://www.who.int/csr/disease/avian_influenza/country/en/index.html 1

Current Human H5N1 situations in each country (Updated on 2 Feb 2010) Azerbaijan On March 21, 2006, eight patients of H5N1 virus infection had been confirmed; five of them died. Six of the patients resided in a small settlement in Daikyand in Salyan Rayon in the southeastern part of the country. Bangladesh The confirmed case verified by WHO on 28 May 2008 was a 16-month-old male from Komalapur, Dhaka. He developed symptom on 27 Jan 2008, and was finally recovered. The case was exposed to live and slaughtered chickens at his home. Cambodia To date, Cambodia has reported 9 cases, of which 7 were fatal. The last confirmed case by WHO was on 18 Dec 2009, a 57- year-old male from Ponhea Kreak District, Kampong Cham Province. He developed symptoms on 11 Dec. He was admitted a Hospital on 16 December. China China has reported 38 cases, of which 25 has been fatal (CFR 65.8%). Latest case confirmed by WHO was on 2 Feb 2009, a 21-year-old female from Hunan province. This is the third case linked to Hunan province, but no evidence of epidemiological link among these three cases at this point. China has reported 7 cases of human AI in 2009 and 4 of them have been fatal. Djibouti Only H5N1 case reported so far from Djibouti was in May 2006. The case was 2 years old female from Arta district. Death of chickens in the same are has been reported, confirmed H5N1 infection afterwards. Egypt To date, Egypt has reported 94 cases. 94th case of human AI was 45 years old male from Shargea Governorate. His symptoms started on 12 January 2010. He was admitted to hospital on 19 January 2010. His condition is stable. Investigation revealed that the case had exposure to sick and dead poultry. Indonesia To date, Indonesia has reported 161 cases, of which 134 were fatal. Indonesia had the highest case fatality rate among countries with more than ten cases of confirmed human H5N1 infection. On 30 Dec, MoH reported 20 cases with 19 deaths as a cumulative total in 2009. On On 22 Jan, 2009, two new confirmed cases were announced by MoH (29y F, Banten, 5y F, West Java) and both cases has passed away due to the H5N1 infection. Iraq Three cases of H5N1 confirmed case has been reported to WHO from Iraq so far and all of them were in 2006. Two cases were fatal. Lao PDR To date, Lao PDR has reported 2 fatal cases in 2007. The last confirmed case by WHO was on 16 Mar 2007, a 42 year-oldfemale from Vientiane Province. She developed symptoms on 26 Feb, was hospitalized on 28 Feb, and died on 4 March. Myanmar Myanmar has reported only 1 case up to this point. This case was confirmed by WHO on 14 Dec 2007. A 7-year-old female from Kyaing Tone Township, Shan State (East) developed symptom on 21 Nov, hospitalized on 27 Nov, and has recovered. Nigeria Nigeria has reported 1 case in 2007. This case was confirmed by WHO on 3 Feb 2007. The case was a 22-year-old female from Lagos who died on 16 Jan 2007. Pakistan Pakistan has reported 3 cases of human H5N1 in 2007, family cluster in Peshawar. All 3 cases were confirmed by either serology test or PCR. There was one fatal case which had close contact with one of the confirmed cases, although no sample was available; considered as a probable case. Thailand To date, Thailand has reported 25 cases, of which 17 were fatal. The last confirmed case which was verified by WHO was on 27 Sep 2006, a 59-year-old male from Nong Bua Lam Phu Province. He developed symptoms on 14 July 2006, was hospitalized on 24 July, and died on 10 August 2006. Turkey 2

In 2006, Turkey reported 12 cases of H5N1 human infection. Of these cases, four were fatal. All four were residents of Dogubayazit in Agri Province in the eastern part of the country. No case has been reported since then. The Turkish government has launched an intensive public awareness campaign early in 2006. Viet Nam The latest confirmed case is a 23 year old man from Dien Bien Phu city, Dien Bien Province. He developed symptoms on 18 November, was hospitalized at Dien Bien general hospital and died on 28 November 2009. 3

2. Latest information on Avian Influenza outbreaks in poultry References for this section; OIE WAHID Weekly Disease Information Reports http://www.oie.int/wahid-prod/public.php?page=weekly_report_index&admin=0 FAO ECTAD HPAI SITUATION UPDATE (EMPRES/GLEWS); official report ONLY Update on Avian Influenza in Animals (Type H5) http://www.oie.int/downld/avian%20influenza/a_ai-asia.htm New event and human AI related animal AI Event (19 Jan 2009 2 Feb 2010) Vietnam: Two bird flu outbreak in Dien Bien province,occurred on Jan 14, two farms,thanh Hung: 855 susceptible, 500 deaths,thanh Yen: 550 susceptible, 300 deaths. One bird flu outbreak in Soc Trang province on Jan 18 2010,Thanh Quoi: farm, 500 susceptible, 350 deaths. H5N1 HPAI outbreaks occurred on 23 January 2010 in poultry from four households of Tran Hoi Commune and Tran Van, Thoi Town, Tran Van Thoi District, Ca Mau Province. In total, 207 chickens and 112 ducks were culled.also on 23 January 2010, 188 ducks were found infected in Tran Loc Bac, Thoi Binh District, Ca Mau Province. India: Three bird flu outbreak in West Bengal province, India. Occurred on Jan 14. Khargram: 25439 susceptible, 379 deaths; Burwan: 56108 susceptible, 190 deaths. Occurred on Jan 19. Khargram: 16099 susceptible, 280 deaths,backyard poultry in small village Bangladesh: (FAO officer and News)Akmal Poultry Farm at Ranigram of Sirajganj Sadar Upazila,Sirajganj District, Rajshahi, was affected by HPAI on 27January 2010. Around 1,200 birds infected with died in last three days and around 1,800 birds were culled. District health officials confirmed detection of bird flu after test at laboratory in Dhaka. (Government of Bangladesh, FAO Field Officer and ProMED)An outbreak of H5N1 HPAI has been reported in Lata poultry farm, Khetlal, Fakirpara, Joypurhat, Rajshahi, 500-1,000 metres away from the index farm. 150 birds died and 475 birds have been culled. Samples were positive by RapidAntigen Test to influenza A. Samples were shipped to the National Reference Laboratory (Bangladesh Livestock Research Institute) on 24 January 2010. Summary of confirmed HPAI H5N1 outbreaks in WPRO/SEARO reported by OIE in 2009-2010 (new events are highlighted in yellow) Country Affected Areas (H5N1) in 2009-2010 Date/Place of Latest Outbreak Affected Populations Western Pacific Region Cambodia (since 22 Dec 2009): KampongCham 22 Dec 2009): KampongCham Back yard poultry China (since 1 Feb 2009);Xinjiang, (since 8 May 2009): QINGHAI Hong Kong China (since 29 Jan 2009); Lantau Island, (since 27 Apr 2009) Tuen Mun (4 Jan 2010) Pat sin Leng country park 4 June 2009 QINGHAI Wild species, Birds 4 Jan 2010 Pat sin Leng country park 29 Jan 2009 Lantau Island 27 Apr 2009: Tuen Mun Japan 8 May 2008 AOMORI Swans Korea (Rep. of) 12 May 2008 KYONGSANG- BUKDO Dead Chickens,duck s,gooses, and other any kinds of birds were found on the beach Native broiler chickens Lao PDR (since 5 Feb 2009);phongsaly 5 Feb 2009 phongsaly back yard chicken 4

Malaysia (since 2 June 2007):SELANGOR Domestic poultry(chicken) Mongolia Viet Nam South-East Asian Region Ugii-nuur soum(since 22 May 2009) ARKHANGAI Tsetserleg soum( since 01/Aug/2009) Thanh Hoa, (since 3 Feb 2009 )Ca Mau; (since 3 Feb 2009 );Soc Trang, (since 3 Feb 2009 );Nghe An,(since 5 Feb 2009 ); QUANG TRI, (since 7 Feb), 2009 ) ;HAU GIANG,(since 8 Feb 2009 ); BAC NINH, (since 9 Feb 2009 ); Ninh Binh, (since 16 Feb 2009);Bac Lieu,(since 17 Feb 2009); Quang Ninh,(since 18 Feb 2009); Khanh Hoa, (since 18 Feb 2009); Dien Bien, (since 18 Mar 2009): Thanh Nua, Dien, Bien, Lai Chau, (since 14 Mar 2009): Thanh Luong, Dien Bien, Lai Chau, (since Mar 2009): Quarter No. 9, Hai Hoa, Mong Cai, Quang Ninh, (since 9 Mar 2009): Thanh Yen, Dien Bien, Lai Chau, ( since April 2009): Quan Hoa, Thanh Hoa, (20-22 Apr 2009): Son Tinh, Quang Ngai (22 Jun 2009) Quang Ninh: (since 21 Oct 2009)Dien Bien province: (since 25 Nov 2009) Thoi Binh (since 9 Dec 2009) Thai Nguyen (since 12 Dec 2009) Cao bang (since 17 Jan 2010) Ha Tinh, (since 14 Jan 2010) Dien Bien, (since 18 Jan 2010) Soc Trang; (since 23 Jan 2010) Ca Mau Bangladesh Rajshahi,(since5 Jan 2009); Mirpur, (since14 Jan 2009); Kurigram,(since15 Jan 2009);Chittagong, (since 26 Jan 2009 );Chittagong,(27Jan 2009-28 Jan 2009);Kurigram, (6 Feb 2009 7 Feb 2009);Dhaka,(since 15 Feb 2009); Manikgonj,(since 23 Feb 2009); Takurgaon, (since 28 Feb 2009); Gaibandha,(since 8 Mar 2009); netrokona, (since 14 Mar 2009); Comilla; Dinajpur, (since 26 March 2009); Patuakhali (since 24 March 2009); Chittagong (since 28 March 2009); Narayanganj (since 28 March 2009); Gaibandha (since 29 March 2009); Rangpur (since 29 March 2009); Gaibandha, (since 2 April,2009); Narsinghdi, (since 3 April 2009), (Since 15 Apr 2009): Dhaka, (Since 17 June 2009): Dhaka, (Since 1 July 2009): Chittagong (Since 29/Aug/2009) Chittagong; Rajshahi (Since 4 Jan 2010); Joypurhat, Khetlal Fakirpara (since Jan 23, 2010); Sirajgonj, Ranigram, Sirajgonj Sadar (since Jan 25, 2010) India Indonesia ASSAM, (since2 Jan 09);West Bengal, Darjeeling, (since16 Jan 2009); South Sikkim,(since29 Jan 2009);West Bengal,Coochbehar (since 29 Jan. 2009); West Bengal, Uttar Dinajpur (since 17 March 2009); West Bengal, Uttar Dinajpur (since 20 May 2009); West Bengal, Murshidabad district (since 12 Jan 2010) West Bengal, Khargram district (since 14 Jan 2010), West Bengal, Burwan district (since 14 Jan 2010), West Bengal, Khargram district (since 19 Jan 2010) (March 2009) Jawa Tengah (31 Aug 2009) Bali (28 Sep 2009) Java Tengah (between 11 and 29 Dec, 2009) South and Central Kalimantan. ARKHANGAI Tsetserleg soum( since 01/Aug/2009) (since 17 Jan 2010) Ha Tinh (since 23 Jan 2010) Ca Mau Sirajgonj, Ranigram, Sirajgonj Sadar (since Jan 25, 2010) West Bengal, Murshidabad district (since 12 Jan 2010), West Bengal, Khargram district (since 19 Jan 2010) (Dec 2009) Kalimantan A migratory swan Ducks, farm ducks Farm, bird Household poultry, chicken and duck backyard chickens and firm birds poultry; farm birds poultry, chicken Rural backyard poultry Native chickens Chicken Myanmar 23 Dec 2007 SHAN STATE Backyard poultry Nepal (Since 8 Jan 2009);JHAPA,(since 29 Jan 2009);Sindhul 29 Jan 2009 Sindhul Backyard 5

(Since 17 Feb 2009);JHAPA (Since 29/Aug/2009) Chittagong poultry Thailand 10 Nov 2008, UTHAI THANI Native chickens Pakistan 20 Jun 2008 NORTH-WEST FRONTIER Commercial Broiler flocks Source: EMPRES-i (FAO) 6