Toddler in Djibouti has avian flu

May 12, 2006 (CIDRAP News) – A 2-year-old girl from a small rural village in Djibouti, on the border of Somalia, has been found to have the country's first case of H5N1 avian influenza, the World Health Organization (WHO) said today.

The girl fell sick on Apr 23. Tests by the Cairo-based US Naval Medical Research Unit 3 (NAMRU-3) confirmed May 10 that she was infected by the H5N1 virus, the WHO said. She was reported to be in stable condition with persistent symptoms.

The girl's infection makes Djibouti the second African country, after Egypt, with a confirmed human case. The global case count stands at 208, with 115 deaths, according to the WHO.

Siblings being monitored
The WHO also said, "Three of the child's siblings are under investigation for possible infection and are also receiving care." Samples from them are being tested by NAMRU-3.

Maria Cheng, a WHO spokeswoman, told Reuters news service that the siblings have "flu-like symptoms," according to a story today. The family kept chickens, she said.

Officials in Djibouti began surveillance for human cases after some chicken deaths were reported in early April, WHO said. Three samples from poultry have since tested positive for H5N1, NAMRU-3 confirmed, but the WHO said widespread poultry deaths have not been found.

Djibouti is a poor country and lacks epidemiologic and laboratory capacity. In addition, the country is also dealing with a dengue fever outbreak, which may hinder identification of suspected human H5N1 cases, the WHO said.

The toddler's case is the first known human H5N1 infection in the Horn of Africa. However, surveillance and reporting may be inconsistent among nearby countries, such as Eritrea, Ethiopia, and Somalia. For instance, Somalia's unstable government and virtually nonexistent healthcare infrastructure make surveillance for even routine health indicators inconsistent at best. Sudan has reported confirmed H5N1 outbreaks in poultry, according to the World Organization for Animal Health (OIE).

The Djibouti Ministry of Health has asked WHO to support investigation and response for H5N1, and WHO is "arranging urgent support," the agency noted.

No virus found in migratory birds
In other news, sampling from migratory birds returning to Europe from Africa shows the birds are not carrying H5N1 back into Europe this spring, according to a May 10 New York Times story. About 7,500 samples were collected from wild birds in Africa during the winter, but the virus was not found in a single one, the newspaper reported, citing health officials and scientists. Only a few cases of H5N1-infected birds have been found in Europe since April 1, the apex of the spring migration northward.

"It is quiet now in terms of cases, which is contrary to what many people had expected," said Ward Hagemeijer, an avian flu specialist with Wetlands International, a Netherlands-based group that conducted the sampling in Africa, as quoted in the Times.

European officials are easing rules meant to keep domestic poultry away from wild birds, allowing poultry to be moved back outdoors.

The news was heralded as a positive sign, but Juan Lubroth, an expert with the United Nations Food and Agriculture Organization (FAO) in Rome, said too little is known about the virus to draw broad conclusions.

"All we have are a few snapshots of the virus," he told the Times. "What we need is a movie of its life cycle."

See also:

WHO news release
http://www.who.int/csr/don/2006_05_12/en/index.html

OIE news report on Sudan outbreak
http://web.oie.int/wahis/reports/en_fup_0000004151_20060507_121544.pdf

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