WHO confirms China H5N1 case; Indonesia reports another death

Jun 16, 2006 (CIDRAP News) – The World Health Organization (WHO) confirmed today that a 31-year-old man in China's Guangdong province has avian influenza. And Indonesia's Health Ministry, citing local tests, said today that a 14-year-old boy from Jakarta died of the disease, according to news services.

The 31-year-old, a truck driver from Shenzhen near the Hong Kong border, has China's 19th case of avian flu, 12 of which have been fatal, according to WHO data. He remained hospitalized in critical condition, the WHO said.

This is the first avian flu case reported in China since April 27, when the WHO confirmed H5N1 in an 8-year-old girl who had been hospitalized April 16 in the southwestern province of Sichuan.

The worldwide count has now reached 227 avian flu cases with 129 fatalities, according to the WHO.

The WHO said today that the source of the man's infection is still being investigated but that preliminary reports indicate that he visited a local live-poultry market several times. But the agency added that the deadly H5N1 virus has not been officially reported in area poultry.

The fact that the man apparently did not have close or prolonged contact with poultry—and that he became infected at a warm time of year instead of the traditional October-to-March flu season—has some Chinese officials worried that the virus has changed become more infectious, according to news reports.

"We have a suspicion, but we have not confirmed it yet, that the virus might have become more virulent and more widespread than we had expected," said Hong Kong Health Secretary York Chow, as quoted by Agence France-Presse (AFP) today. "If that is the case, the risk for humans to be infected in the future is higher."

Chow and other local experts have raised the possibility that human infections in China may stem from contact with poultry that are carrying the virus but not appearing sick, according to a Reuters story today.

Lo Wing-lok, a Hong Kong infectious disease expert, said the Chinese government must explain how the 31-year-old became infected when it has reported no avian flu outbreaks among birds in the area, according to Reuters.

"They ought to come up with a reasonable explanation how this man came to be infected," he told Reuters. "Blanket denials don’t help at all. When they deny, we have to think twice about accepting."

Wing-lok also called on China to disclose how it conducts disease surveillance in domestic poultry, according to the Reuters story. "I don't know if there is insufficient surveillance or if the data is too frightening to be disclosed," he said.

In Indonesia, the 14-year-old boy from south Jakarta died Jun 14 of what local tests indicated was H5N1 avian flu, an Indonesian Health Ministry official said today, according to news services.

If the local test results are confirmed by a WHO-accredited lab, his will become Indonesia's 51st case and 39th death, all in 2005 and 2006, according to WHO statistics.

"The boy was admitted to the hospital Jun 14 after suffering from flu-like symptoms, and he died on the same day," Nyoman Kandun, director-general of the Health Ministry said today, according to a Reuters report. Kandun said the boy had had contact with sick poultry.

Case cluster survivor undergoes neuro testing
Elsewhere in Indonesia, the lone survivor among at least seven family members who suffered avian flu in North Sumatra last month is now being tested for rare neurologic complications of the disease, according to Bloomberg news.

Jones Ginting underwent magnetic resonance imaging (MRI) of his brain yesterday, Bloomberg reported today. The report referred to Ginting's having neurologic symptoms but did not specify what they were.

Ginting is a patient at Adam Malik Hospital in Medan, the capital of North Sumatra province. If neurologic disease is confirmed, his would be one of few human H5N1 cases known to have involved the central nervous system (CNS), according to Bloomberg. The Feb 17, 2005, issue of The New England Journal of Medicine reported on a Vietnamese boy who died of H5N1 in 2004 and had encephalitis (see link to CIDRAP News story below).

"It's not clear whether he's suffering from a brain infection," said hospital deputy director Nur Rasyid Lubis, as quoted by Bloomberg.

"It's unusual for bird flu patients to undergo an MRI scan," added Sari Setiogi, a spokesperson for the WHO in Jakarta. She said Ginting's neurologic symptoms might have been caused by an unrelated illness, according to the Bloomberg article.

See also:

WHO statement on China case
http://www.who.int/csr/don/2006_06_16/en/index.html

Feb 16, 2005, CIDRAP News story "Avian flu caused encephalitis in Vietnamese boy"

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