WHO confirms two H5N1 deaths, one a 2003 case in China

Aug 8, 2006 (CIDRAP News) – The global death toll from H5N1 avian influenza grew by two today when the World Health Organization (WHO) added a Chinese case dating back to 2003 and the Indonesian case reported yesterday involving a 16-year-old boy. Meanwhile, reports today say another H5N1 death has occurred in Indonesia, this one in a teen girl.

Retroactive confirmation of China's first avian flu death
Chinese researchers published findings in a June letter to the New England Journal of Medicine (NEJM) that a 24-year-old Beijing man died of avian influenza rather than severe acute respiratory syndrome (SARS) as originally thought. The WHO subsequently asked the Chinese Ministry of Health to investigate where the man caught the disease and whether there were any other deaths. The man's death occurred in November 2003, which was 2 years before China officially reported any human H5N1 cases to the WHO. In July of this year, China invited the United Nations to observe the tests that it conducted to investigate the man's death.

The confirmation tests were performed at a lab affiliated with the Chinese Health Ministry. The work was done by Chinese experts along with WHO representatives who were asked to participate. The WHO report said an expert panel reviewed the test findings.

The source of the man's illness is still uncertain, according to the WHO. Because he was initially thought to have SARS, no history of possible poultry exposure was taken. No poultry outbreaks of H5N1 infection have been reported in Beijing.

China told the WHO that it would strengthen its communication mechanisms and ensure that the country's research institutes are integrated into its communications. The health ministry said it first learned of the man's positive test when the results were published in NEJM.

China now has had 20 confirmed cases of H5N1 and 13 deaths, according to the latest WHO count.

WHO confirms yesterday's Indonesian death
Also today the WHO reference laboratory confirmed that a 16-year-old Indonesian boy from West Java province who died yesterday had H5N1 avian influenza (see Aug 7 CIDRAP News story).

The WHO confirmation makes it official that Indonesia has surpassed Vietnam as the country with the most avian flu deaths. The boy becomes Indonesia's 55th human case and its 43rd fatality, according to the WHO tally. Thirty-two of Indonesia's deaths have occurred this year alone; the remaining 11 occurred in 2005. (WHO records Vietnam as having 93 confirmed cases and 42 deaths.)

The boy's symptoms developed on Jul 26 and he was hospitalized on Aug 4. The WHO said investigators found that he had contact with sick and dying chickens in his household. A joint investigation by Indonesian health and agricultural officials identified the H5 virus subtype in chickens from the boy's household. His family members and close contacts have been placed under surveillance.

Indonesia reports another fatality
A spokesperson for the Indonesian Health Ministry told Deutsche Presse-Argentur (DPA) that a 17-year-old Indonesian girl from West Java, the same province as the 16-year-old boy who died yesterday, died from H5N1 avian influenza. She had been hospitalized over the weekend before she died today. An Indonesian health ministry spokesperson told DPA that two laboratories independently confirmed the girl's positive H5N1 results. BBC News reported this case as well, saying the girl was 16 years old and that only one laboratory had confirmed the case as H5N1. The case has not yet been recognized by WHO.

See also:

Aug 8 WHO update on China situation
http://www.who.int/csr/don/2006_08_08/en/index.html

Jun 22 NEJM letter regarding the Chinese case
http://content.nejm.org/cgi/content/full/354/25/2731

Aug 8 WHO update on Indonesian situation
http://www.who.int/csr/don/2006_08_08a/en/index.html

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