Western Pacific Regional Office of the World Health Organization

Western Pacific Regional Office of the World Health Organization Avian Influenza Weekly Update Number 420 (14 February 2014) http://www.wpro.who.int/emerging_diseases/avianinfluenza/en/index.html Human infection with avian influenza A(H5N1) virus During the reporting period 6 to 14 February 2014, there were two cases of human infection with avian influenza A (H5N1) virus reported in the Western Pacific Region, one from Viet Nam and one from Cambodia. On 6 February 2014, the National Focal Point for IHR of Viet Nam notified the WHO of a new human death of avian influenza that was confirmed positive with the influenza A(H5N1) virus in January 2014. The patient was a 60 year old female from Dong Thap province. She developed symptoms of fever, cough and shortness of breath on 22 January 2014 and was hospitalized on 27 January 2014 with a diagnosis of pneumonia. The patient died on 28 January 2014. Pasteur Institute of Ho Chi Minh tested her specimen to be positive for avian influenza A(H5N1) virus on 29 January 2014. Epidemiological investigation identified that she had slaughtered a dead duck prior to onset. The duck was given by her son-in-law and there were abnormal deaths among poultry in her son-in-law s household. Pasteur Institute of Ho Chi Minh city in collaboration with Provincial Health Department has conducted monitoring and surveillance of close contacts. Provincial health unit has collaborated with animal health unit to take prevention and control measures on poultry. On 11 February 2014, the National Focal Point for IHR of Cambodia notified the WHO of a new human case of avian influenza that was confirmed positive with the influenza A(H5N1) virus on 8 Feb 2014: The patients was an 8 year old male from Snourl district, Kratie province. He developed symptoms of fever, sore throat and running nose on 31 Jan 2014 and was hospitalized on 6 Feb 2014. Tamiflu was started on 7 Feb 2014 but the patient died on 7 Feb 2014. His specimens were confirmed positive for avian influenza A (H5N1) virus by Institut Pasteur du Cambodge on 8 Feb 2014. The epidemiological investigation identified he had direct contact with dead chickens 3 days before getting sick and around 350 chickens, ducks and geese died in the village in mid-january. Animal health have taken sample of sick and dead chickens and sent to the National Veterinary Research Institute (NaVRI) on 9 Feb 2014 and started disinfection in the area on 10 Feb 2014. His 2 year old sister developed similar symptoms on 1 Feb 2014 and was admitted to the same hospital on 6 Feb 2014. She died on 7 Feb 2014. Specimens 1

were not collected from her. She also had direct contact with dead poultry. The National and local Rapid Response Teams (RRTs) are conducting outbreak investigation and responses following the national protocol. Source: - http://www.cdcmoh.gov.kh/pressrelease/49-pressrelease.eng.pdf Since 2003, 654 cases have been reported from 16 countries worldwide, of which 388 were fatal (CFR 59.3%). Since 2003, 224 cases have been reported from 4 countries in the Western Pacific Region, of which 130 were fatal (CFR 58.0%). Among the countries in the Western Pacific Region with more than 10 reported cases, Cambodia had the highest CFR of 69.4% (34 out of 49). Table 1: Cumulative Number of Confirmed Human Cases (C) and Deaths (D) of Avian Influenza A(H5N1) virus infection reported to WHO (1 January 2003 to 14 February 2014), Western Pacific Region. Country 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Total C D C D C D C D 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 1 1 8 8 3 3 26 14 2 1 49 34 China 1 1 0 0 8 5 13 8 5 3 4 4 7 4 2 1 1 1 2 1 2 2 1 0 46 30 Lao PDR 0 0 0 0 0 0 0 0 2 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 Viet Nam 3 3 29 20 61 19 0 0 8 5 6 5 5 5 7 2 0 0 4 2 2 1 2 2 127 64 Total 4 4 29 20 73 28 15 10 16 11 11 9 13 9 10 4 9 9 9 6 30 17 5 3 224 130 Total number of cases includes number of deaths. WHO reports only laboratory-confirmed cases. For global cumulative number of confirmed human cases and deaths of Avian Influenza A(H5N1) virus infection reported to WHO, see: http://www.who.int/influenza/human_animal_interface/h5n1_cumulative_table_archives/en/index.html For further information on the latest global avian influenza A(H5N1) situation and WHO monthly risk assessment: http://www.who.int/influenza/human_animal_interface/h5n1_cumulative_table_archives/en/index.html 2

Human infection with avian influenza A(H7N9) virus During the reporting period 7 to 14 February 2014, 37 cases (3 deaths) of human infection with avian influenza A (H7N9) virus were reported from China and Hong Kong SAR in the Western Pacific Region. Among the 37 cases, the median age was 60 years, ranging from 5-84 years, with a male to female ratio of 3.6:1. See the Annex for detailed information of the cases. Map below shows the total number of cases of human infection with avian influenza A(H7N9) virus by provinces/municipality/sar in China during the reporting period 7 to 14 February 2014: "The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement." 3

During the reporting period 7 to 14 February 2014, there was a confirmed case of H7N9 human infection in a tourist reported in Sabah, Malaysia in the Western Pacific Region. On 12 Feb, the Ministry of Health confirmed the first Influenza A (H7N9) case in the country. The case was a 67-year-old female tourist from China, who had travelled from Guangdong, China, to Kuala Lumpur. The patient had received initial treatment in China for symptoms of fever, cough, joint pain and weakness on 30 January 2014; four days, prior to arriving in Kuala Lumpur on 3 February 2014. A sample from this patient tested positive for the Influenza A (H7N9) virus. At the time of the press release, the patient was in a stable condition and was receiving treatment at the intensive care unit of a hospital. Source: - http://www.moh.gov.my/index.php/database_stores/attach_download/337/479 Other relevant findings Confirmed H7N9 infection in poultry and environmental samples in China In addition, during the reporting period 7 to 14 February 2014, national authorities and OIE reported the presence of A(H7N9) in poultry and environmental samples in Guangxi, Guangdong, Hunan and Zhejiang province. Specimens collected from apparently healthy poultry in Jinhua livestock trade market, Guigang City, Guangxi Province (4 chickens); Xuzhen live bird market, Xingning City, Meizhou City, Guangdong Province (1 chicken), Live bird market, Miluo City, Yueyang City, Hunan Province (1 duck, 2 chickens); Heping wholesale market, Xiangzhou City, Zhuhai City, Guangdong (2 chickens) tested positive for H7N9; and 1 environment specimen from Zhugong Lake agriculture products market, Zhuji City, Zhejiang Province, tested positive for H7N9. In addition, 3 out of 1 684 serum samples and 4 out of 386 virological samples collected from a total of 28 sampling locations in Guangxi Province during the third part of January 2014, tested positive. Sources: - http://www.oie.int/wahis_2/public/wahid.php/reviewreport/review?page_refer=mapfullevent Report&reportid=14746 - http://www.moa.gov.cn/sjzz/syj/dwyqdt/jczt/201402/t20140208_3753906.htm H7N9 surveillance and control measures in China Anhui Province: Anqing City authorities temporarily closed live animal markets in high risk areas. Hunan Province: 4

o Miluo City of Yueyang City, Hunan Province closed market for 1 week from 6 to 13 o February 2014. Jiangyong County, Yongzhou City has temporarily closed 2 existing farmers markets. Guangdong Province: Zhongshan City closed the live bird markets for 2 weeks. According to the Director of the Prevention and control of infectious diseases, local areas where human cases were reported, such as in Huaiji County, Zhaoqing City, environmental specimens collected and tested, from all live poultry stalls in the county, were 100% positive for H7N9, during the time that the cases appeared. Sources: - http://www.gov.cn/jrzg/2014-02/09/content_2582106.htm - http://www.yueyang.gov.cn/xqdt/mls/content_231222.html - http://www.yzcity.gov.cn/art/2014/2/10/art_2161_355877.html - http://www.zs.gov.cn/main/zwgk/newsview/index.action?id=143649 - http://www.guangzhou.gov.cn/node_2190/node_2222/2014/02/11/1392085476420083.shtml H7N9 surveillance and control measures in Viet Nam (Media Report) Lao Cai Province: Measures to prevent the spread of H7N9 and H10N8 viruses crossing the border from China have been rolled out. The provincial animal health branch has taken samples of sick poultry at five border markets in Lao Cai city, Bao Thang and Bat Xat. The provincial health department is planning to buy new preventive tools and Tamiflu. Measures have been put in place to manage passengers travelling through the Lao Cai international border gate. Sources: - http://en.vietnamplus.vn/home/localities-take-measures-against-bird-flu/20142/46056.vnplus To date, there has been no evidence of sustained human-to-human transmission. It is expected that there may be further sporadic cases of human infection with the virus. Affected provinces and municipalities continue to maintain surveillance and response activities. WHO does not advise special screening at points of entry with regard to this event, nor does it recommend any travel restrictions be applied. WHO continues to work closely with national authorities and technical partners to gain a better understanding of this disease in humans and will continue to provide updated information as the situation evolves. For more information on human infection with avian influenza A(H7N9) virus, visit: - http://www.wpro.who.int/outbreaks_emergencies/h7n9/en/index.html - http://www.who.int/influenza/human_animal_interface/influenza_h7n9/en/index.html 5

Latest information on seasonal influenza For latest information on the regional seasonal influenza situation: - http://www.wpro.who.int/emerging_diseases/influenza/en/index.html For latest information on the global seasonal influenza situation: Epidemiology: - http://www.who.int/influenza/surveillance_monitoring/updates/latest_update_gip_surveillance/ Virology: - http://www.who.int/influenza/gisrs_laboratory/updates/summaryreport Outbreaks in animals with avian influenza viruses with potential public health impact During the reporting period 7 to 14 February 2014, there was a report of a confirmed H5N1 HPAI outbreak in poultry in Svay Prey Village, Sandek Commune, Batheay District, Kampong Cham Province, Cambodia. An outbreak of H5N1 HPAI was reported on 13 February 2014. Owners of duck flocks reported that their ducks were sick and died in the village on 7 February 2014. Ten samples were taken from ducks and sent to NaVRI for diagnostic testing. A total of 4466 birds died and the remaining 784 birds destroyed. Disinfection of infected premises and dipping/spraying occurred. Source: - http://www.oie.int/wahis_2/public/wahid.php/reviewreport/review?page_refer=mapfullevent Report&reportid=14759 In addition, OIE reported confirmed outbreaks and additional information on H5N8 HPAI outbreaks in poultry in Chungcheongbuk-do, Chungcheongnam-do, Gyeonggi-do, Gyeongsangnam-do, Jeollabuk-Do, Jeollanam-do, Republic of Korea. A total of 17 outbreaks of H5N1 HPAI have been reported to OIE. This includes the previous 13 confirmed and one suspected H5N8 HPAI outbreaks reported in poultry in previous daily updates. In addition, three new outbreaks were reported in Chungcheongbuk-do (2) and Jeollanam-do (1). Source: - http://www.oie.int/wahis_2/public/wahid.php/reviewreport/review?page_refer=mapfulleventr eport&reportid=14703 6

For more information on avian influenza viruses in animals with potential public health impact: World Organisation of Animal Health (OIE) web page: http://www.oie.int/animal-health-inthe-world/web-portal-on-avian-influenza/ and http://www.oie.int/animal-health-in-theworld/update-on-avian-influenza Food and Agriculture Organization of the UN (FAO) webpage: Avian Influenza: http://www.fao.org/avianflu/en/index.html OFFLU: http://www.offlu.net/ EMPRES/FAO-GLEWS : http://empres-i.fao.org/empres-i/home 7

Annex During the reporting period 7 to 14 February 2014, 37 cases (3 deaths) of human infection with avian influenza A (H7N9) virus were reported from China and Hong Kong SAR in the Western Pacific Region. Table below shows details of the cases by province/municipality/sar: Province/Municipality/SAR Age Sex Date of onset Exposure to poultry Condition at notification Anhui 66 M 1-Feb Yes Critical 56 M 3-Feb Yes Deceased Beijing 73 M 30-Jan Yes Critical Fujian 81 M 30-Jan Yes Deceased Guangdong 36 F 25-Jan Yes Critical 59 F 27-Jan Yes Critical 48 M 28-Jan Yes Severe 81 F 31-Jan Yes Deceased 5 F 1-Feb Yes Recovered 62 M 1-Feb Yes Severe 46 M 4-Feb Yes Critical 65 M 4-Feb Yes Critical 11 M 5-Feb Yes Stable 8 M 6-Feb Yes Mild Guangxi 5 M 3-Feb Unknown Mild Hong Kong SAR 65 M 8-Feb Yes Critical Hunan 38 M 27-Jan Yes Critical 19 M 28-Jan Yes Severe 61 F 29-Jan Yes Critical 21 F 30-Jan Yes Critical 23 M 8-Feb Yes Severe Jiangsu 63 M 20-Jan Yes Critical 66 M 22-Jan Yes Critical 53 M 1-Feb Unknown Severe Zhejiang 76 F 24-Jan Unknown Critical 39 M 26-Jan Yes Severe 64 M 27-Jan Yes Severe 58 M 29-Jan Yes Severe 61 M 29-Jan Unknown Critical 62 M 29-Jan Yes Critical 8

54 M 1-Feb Yes Severe 47 F 3-Feb Yes Severe 67 M 3-Feb Unknown Critical 46 M 4-Feb Yes Severe 70 M 4-Feb Yes Critical 68 M 5-Feb Yes Severe 84 M 6-Feb Yes Critical For further information on individual cases, please refer to: http://www.who.int/csr/don/en/ 9