Northwest Frontier Province (Peshawar): The Ministry of Health reported 8 human H5N1 cases of H5N1 (Dec. 15), and at least two more possible cases. The 8 have tested positive according to the national laboratory; the samples are being forwarded to a WHO reference lab for confirmation. These are the first reported human H5N1 cases in Pakistan.
*Note: The news reports were inconsistent about which of these two brothers tested positive. The reports consistently state that: (a) both died, (b) samples were taken from only one of them, and (c) the other brother showed similar symptoms and is suspected of having succumbed to H5N1.
- Although the news reports are inconsistent, it appears that the 8 suspected (initial positive tests) cases are:
- Dr. Ishtiaq Durrania, a veterinarian, became ill late October or early November, recovered
- The vet's brother, Mohammad Owais Durrani, who became ill after caring for the vet, and died Nov. 29*
- The vet's brother, Mohammed Tariq, who had mild symptoms and recovered
- A cousin who had mild symptoms and recovered
- Another cousin (at least 1 of these 2 cousins is female) who had mild symptoms and recovered
- A man who was involved in culling poultry on the same or a neighboring farm (recovered)
- The man's niece, who was also involved in culling poultry (recovered)
- A male farm-worker from Mansehra, who is hospitalized
- Suspected case (not tested):
The vet's brother, Mohammad Ilyas Durrani, who became ill after caring for the vet, and died Nov. 19*
- Suspected case (test pending):
A female doctor who treated members of the family. She tested positive for H5N1, but she was not tested with the standard diagnostic assay used to detect H5N1 infection so more testing is needed to determine if the doctor is indeed positive.
- Under observation at a hospital in Abbottabad:
The farm-worker's daughter and another male.
- Suspected cases but tested negative:
A fourth (unnamed) brother of the vet, and this brother's son, both of whom live in the U.S. and traveled to Pakistan to attend the funeral of the brother(s). When they returned to New York, they experienced respiratory symptoms and reported their exposure to their doctor. Their samples were tested by the CDC and came back negative for H5N1.
WHO spokesperson Gregory Hartl said investigations are still underway to try to determine how the various people became infected, but human-to-human spread cannot be ruled out.
Multiple poultry outbreaks of H5N1 influenza have been occurring in Pakistan since 2006. In 2007, there have also been outbreaks in wild birds. H5 avian influenza was found on a chicken farm about 25km from the federal capital of Islamabad; more than 10,000 chickens have been culled (Dec. 9).
Shan State (Kyaing Tone Townships): The Ministry of Health confirmed the country's first human H5N1 case, a 7yo girl who has since recovered (Dec. 14). The case was found through routine surveillance following an outbreak of H5N1 in poultry in the area in mid-November.
Jiangsu (Nanjing): After 2 human H5N1 cases (a 24yo man and his 52yo father) were confirmed last week, poultry markets have been prohibited from keeping live chickens overnight, and some small markets have been prohibited from selling any live chickens (Dec. 9), even though the official Xinhua news agency earlier reported that the son had had no contact with dead poultry and there had been no reported poultry outbreak in the province (Dec. 9). The father and son were reported to have eaten undercooked chicken in a restaurant in Nanjing shortly before the son became ill (Dec. 9).
Other than the father, no additional human cases have been reported as of Dec. 15 from people having contact with either patient since the son became ill on Nov. 24. Joanna Brent, a WHO spokeswoman, said that "there is no strong indication of human-to-human transmission. But because this possibility cannot be ruled out, the WHO is monitoring this case closely."
Hong Kong: A sick heron found in a wildlife refuge on Dec. 5 (which died the next day) tested positive for H5N1, leading to a temporary closure of the Mai Po Nature Reserve to visitors (Dec. 13).
Indonesia: Java Island
Banten: The World Health Organization confirmed that a 28yo woman from Tangerang died of H5N1 on Dec. 10. She is reported to have made and used organic fertilizer made chicken feces for her ornamental plant business. Residents of her hometown were prohibited from participating in the funeral procession. The people who buried her wore full PPE; the PPE was burned after the burial (Dec. 11).
A 47yo man from Tangerang who was confirmed positive for H5N1 died on Dec. 13. He had recently returned to Banten from Pandeglang in West Java and Medan in Sumatra, where he is reported to have bought 2 ducks and brought them home.
Including these two cases, 11 of the 40 human H5N1 cases in Indonesia this year have occurred in Banten province, and 10 of the 11 in Banten have occurred in Tangerang district (which is about 20km west of Jakarta). Since 2005, the Banten Department of Health has reported 19 human cases of H5N1, 16 of which have been fatal (Dec. 12).
Indonesia: Sumatra Island
Riau: A suspected H5N1 case (52F) from Siak regency was hospitalized but is reported to be improving (Dec. 15).
Other Avian Influenza Outbreaks in Animals
Uganda (Ebola outbreak)
- Poland: The 4th and 5th outbreaks of H5N1 bird flu virus have been found in the Masovian province (Zuromin region), about 50 km (30 miles) from 3 sites found earlier this month. Thirty thousand chickens at the 4th farm were infected and 80,000 others in nearby farms will be culled (Dec. 9). The 5th outbreak was found on a farm with 360,000 birds (Dec. 10). In the Warmia-Masuria province, H5N1 was found on a small farm of about 40 birds near Elblag (Dec. 12), and in wild birds (a stork and two buzzards) at a wild bird rehabilitation center in Orneta (Dec. 14).
- Egypt: Bird flu was found on a poultry farm in Sharqia governate for the second time in 6 months; the farm has been closed (Dec. 9). The higher bird flu committee declared a state of emergency on Dec. 11 in "anticipation of the break through of bird flu".
- Germany: Scientists have identified three distinct variants of the H5N1 virus in wild birds in Germany, two of which might have been brought in by wild birds migrating from Russia (Dec. 10). Two domestic chickens tested positive for H5N1 in the Oberhavel region of Brandenburg state (Dec. 15).
- South Korea (Gyeonggi province): Bird flu (type unknown) has been identified on a duck farm in Paju, about 25 miles north of Seoul (Dec. 11).
- Russia (Southern Federal District): 35,000 chickens have died of flu at the Gulyai-Borisovskaya farm in the Rostov Region since December 5 (Dec. 11).
- Viet Nam: H5N1 has reoccurred in the northern Bac Giang province, killing over 1,000 ducks in the two districts of Viet Yen and Yen Dung (Dec. 12).
- Saudi Arabia: The agriculture ministry ordered 13,500 ostriches to be destroyed following a new outbreak of bird flu in the Al-Kharj region (Dec. 15).
As of Dec. 15, there have been 120 cases and 35 deaths (including 5 health care workers). Although the rate of new cases is slowing, the number of deaths is continuing to grow (Dec. 13). The outbreak timeline and case summaries from 11/23-12/8 are here.
- Kampala: Fourteen students at Kyambogo University attended a funeral of a relative who died of Ebola in Bundibugyo. After these students returned to the university (and freely mixed with other students), public health authorities urged the university to isolate these students for medical surveillance. The university is now looking for all 14 students (Dec. 8).
- The Uganda Muslim Supreme Council has warned Muslims not to wash bodies of people who die in areas suspected to have Ebola (Dec. 10).
- Bundibugyo District: The only bank in the district, Stanbic Bank, has closed its premises for fear of its staff contracting Ebola; nongovernmental organizations such as Goal Uganda and Save the Children have also temporarily stopped business in Bundibugyo (Dec. 11).
- Kampala: Bus and taxi operators are being asked to disinfect the tires and interiors of their vehicles to reduce the risk of spread of Ebola (Dec. 11).
- DRC closes border: Health authorities in the Democratic Republic of Congo closed the lake and land border with Uganda and shut down two markets as a precautionary measure to prevent the spread of Ebola from Uganda (Dec. 14).
Other Illness Outbreaks in Humans
- Viet Nam (An Giang province): 34 patients aged 6 mos. to 46 years old have been hospitalized with an unknown disease; symptoms include contorted mouth, glassy eyes and mild paralysis (Dec. 11). Although clinical symptoms are similar to Japanese encephalitis, tests for this disease have come up negative.