Saturday, February 2, 2013

WHO Avian influenza – situation in Cambodia – update

The Ministry of Health (MoH) of the Kingdom of Cambodia reported five new human cases of avian influenza that were confirmed positive for the H5N1 virus in January 2013.
Case details include an 8 month old male from Phnom Penh with onset 9 Jan 2013, a 17 year old female from Takeo Province with onset 11 January, a 35 year old male from Kong Pisey district, Kampong Speu Province with onset 13 January, a 17 month old female from Kong Pisey district, Kampong Speu Province with onset 13 January and a 9 year old female from Toeuk Chhou district, Kampot province with onset on 15 January 2013.
The cases all presented with fever, cough and other ILI symptoms. Four of the cases died, with 1 case, the 8 month old male, recovering after only experiencing mild ILI. Laboratory samples were tested by the National Institute of Public Health's laboratory and by the Institut Pasteur du Cambodge.
Preliminary evidence does not support human-to-human transmission and four of the cases are known to have had close contact with sick/dead poultry.
The Ministry of Health's Rapid Response Teams (RRT) have gone to the hospitals and the field to identify the patients’ close contacts, any epidemiological linkage among the five cases and initiate preventive treatment as required. In addition, public health education campaigns are being conducted in the villages to inform families on how to protect themselves from contracting avian influenza. The teams are checking records for evidence of increased ILI activity in the local health centres or any increase in number of SARI cases from the affected areas. Results from testing of those who have ILI symptoms among close contacts for A/H5N1 influenza to date were negative. There is enhanced surveillance for ILI and SARI in local health centre and hospital for a further two weeks. Health education messages have been distributed to the community. The World Health Organization is actively assisting the Ministry of Health in their investigations. 

Thursday, January 31, 2013

Vietnam: World Press Freedom - 2nd on list after China for degradation of journalists

[Coincidentally, we have 4 human cases reported of H5N1 Bird Flu out of Vietnam in 2012, and that was last winter.]:

 Vietnam continues ranked 172/179 countries assessed on the charts on the World Press Freedom Index 2013 by Reporters Without Borders (RSF) implementation. Protection of human rights organizations based in France commented that the press freedom situation in Vietnam is increasingly severe degradation and Vietnam from the third position has jumped to second in the list of countries imprisoned many netizens in the world, after China. During an interview with Tra Mi the English language, Benjamin Ismail, Director for Asia-Pacific in the organization RSF, said :
We also update the number of netizens imprisoned in Vietnam for the new information that we can confirm. Vietnam is the second country in the world has the most imprisoned netizens, behind only China. To compare the proportion of the population, Vietnam is the world's biggest prison for netizens. Last year, Vietnam ranked third in the list of countries imprisoned many netizens in the world, after China and Iran, but jumped to second in the past year.At present, Vietnam has 34 netizens imprisoned and at least 12 bloggers, netizens have been sentenced to the sentence up to the maximum 13 years in prison while the number of journalists or netizens imprisoned in years ago was about 19 ​​people. This proves that the suppression of the Communist Party of Vietnam for freedom of the press and freedom of expression of citizens rising. VOA: The point is considered the most notable on the situation of freedom newspapers in Vietnam in the past year, sir?


Cambodia: Cases Are Not Linked

January 31, 2013
Government officials met Tuesday in Phnom Penh to outline a strategy to prevent the spread of bird flu as millions prepare to travel from the provinces—where five cases of the virus have been reported in the past two weeks—to attend the late King Father No­ro­dom Sihanouk’s cremation in Phnom Penh.
The meeting was attended by the Ministry of Agriculture, the Ministry of Health, the World Health Organization (WHO), the Food and Agriculture Organi­za­tion and the Center for Disease Control (CDC).
“These are poor people coming from provinces. There is some likelihood they will bring their own food and own poultry,” Son­ny Krishnan, spokesman for the WHO in Cambodia, said of the es­ti­mated 1.5 million people who are expected to arrive for the cremation on February 4.
“We are advising them that if you have to cook chicken, cook it well. We do hope animal health people will do inspections on the movement of poultry,” Mr. Krish­nan said.
The WHO on Tuesday confirmed that four people have died in the past two weeks from the H5N1 virus, also called bird flu, and that they all became infected from contact with live poultry. An 8-month-old boy from Phnom Penh’s Pur Sen­chey district survived infection from the normally lethal virus.
The WHO noted that in all ca­s­es, chickens were reported as be­ing sick or dying in the area, and that no entomological link be­tween the five reported cases had been found.

Wednesday, January 30, 2013

CIDRAP Flu News Scan for January 30th

hat-tip H5N1 Crofs Blog:

Cambodia: Contacts of Victims Monitored


The WHO's Krishnan said health teams have monitored the condition of people who came in contact with the victims, adding that all had tested negative for the virus. The government has also boosted the number of television and radio spots warning of avian flu and telling people how to protect themselves, and staff at health clinics in the affected provinces will receive refresher training on avian flu in February.
Population influx
However, two imminent events will add to the challenges of containing the spread of the disease.

The first is the February 4 cremation of Norodom Sihanouk, the country's revered former king, in Phnom Penh. The government expects that more than a million people will travel to the capital to pay their respects. Many will bring food, including live poultry.

The other is Chinese New Year on February 10. In preparation for the festival, large numbers of chickens and ducks are usually transported ahead of that date to markets in the cities and towns.

Either event could promote the spread of the disease. On Tuesday, government and UN health experts met to work out how best to prevent that. Krishnan said officials would hand out information leaflets to people coming to the capital to warn them of the risks and advise them how to avoid contracting the disease. That includes not eating birds that have died from illness, and cooking poultry thoroughly.

Most of the efforts underway are designed to ensure that people do not get infected with avian flu in the first place. Once they do, the chances of recovery are slim - not least due to the country's weak healthcare system. In total, 23 Cambodians out of 26 infected to date with avian flu have died - a fatality rate close on 90 percent, and well above the global figure of nearly 60 percent.

Egypt: 6 Human Cases H5N1 in 2012

The Ministry of Health and Population for the death of a woman in Beheira, a result bird flu, bringing the total dead within a year since January 2012 to January 2013, is 6 cases, and that a decrease of 63% from the same period a year which preceded, bringing the total number of deaths since the emergence of the disease in 2006 to 61 cases.

Tuesday, January 29, 2013

2009 H1N1 Pandemic Infected 1 in 5 People, Experts Estimate

January 29, 2013
At least 20% of all people, and almost half (46%) of all children aged 5 to 19 years, were infected with H1N1 influenza during the first year of the 2009 pandemic, according to a meta-analysis of data from 27 seroepidemiological studies. The studies analyzed approximately 90,000 serologic samples from 19 countries including the United States, United Kingdom, Australia, Canada, China, and India.
Maria D. Van Kerhove, PhD, a liaison between the Global Influenza Programme at the World Health Organization in Geneva, Switzerland, and the Medical Research Council Centre for Outbreak Analysis and Modelling at Imperial College London in the United Kingdom, and colleagues published their findings in an article published online January 21 in Influenza and Other Respiratory Viruses.
Before the pandemic, the overall age-adjusted prevalence of elevated cross-reactive H1N1pandemic (pdm) antibodies was 5% (95% confidence interval [CI], 3% - 7%). The prevalence increased as individuals aged (0 - 4 years old, 1% [95% CI, 0.3% - 4%]; 5 - 19 years old, 4% [95% CI, 1% - 9%]; 20 - 44 years old, 5% [95% CI, 3% - 8%]; and 45 - 64 years old, 5% [95% CI, 2% - 9%]). Prevalence was the highest in individuals at least 65 years old (14%; 95% CI, 8% - 24%).


New Norovirus Strain Causing Most Norovirus Outbreaks in United States

Monday, 28 January 2013

Not yet known if strain will cause more outbreaks than previous years

Atlanta, GA--(ENEWSPF)--January 28, 2013. A new strain of norovirus called GII.4 Sydney was the leading cause of norovirus outbreaks in the United States from September to December 2012, according to a study published in Morbidity and Mortality Weekly Report released by the Centers for Disease Control and Prevention. The new strain was detected in Australia in March 2012, and caused outbreaks in that country and several other countries.

CDC researchers analyzed 2012 data collected through CaliciNet on norovirus strains associated with outbreaks in the United States. They found that of the 266 norovirus outbreaks reported during the last four months of 2012, 141 were caused by the GII.4 Sydney strain.

“The new strain spread rapidly across the United States from September to December 2012,” said Dr. Aron Hall, epidemiologist, CDC’s Division of Viral Diseases (DVD). “The proportion of reported outbreaks caused by this strain increased dramatically from 19 percent in September to 58 percent in December.”


Norovirus: Georgia - Atlanta


Fulton County health officials say they've investigated several outbreaks of norovirus associated with food service workers.
CBS Atlanta reports ( that the Fulton County Department of Health and Wellness has investigated several outbreaks of the gastrointestinal disease associated with food service establishments in the county, which is home to Atlanta.
Symptoms include nausea, vomiting, diarrhea and stomach cramping. Some people may have fever, chills, headache, muscle aches and a general sense of tiredness


Health services issues warning about new strain of norovirus

Metro Atlanta restaurants are on high alert after Fulton County health officials issued a norovirus warning on Tuesday.
"There are 20 people that we have definitely been able to link to these specific outbreaks. I would anticipate that is a very tiny tip of a very large iceberg," said Fulton County Medical Director Dr. Matthew McKenna.


Norovirus: Washington D.C.


The worst flu season in years is giving way to another highly contagious infection. It is a new strain of the norovirus, and so far, thousands of people across the country, including hundreds in our area, have been sickened.

Read more:

Norovirus: Indiana

January 29, 2013

PRINCETON—With 43 reported deaths to date, the flu season is Indiana’s deadliest in five years, but state health officials say the symptoms some people may be having aren’t influenza afterall; rather, they may have the norovirus or “stomach flu.”
The Indiana State Dept. of Health reported a new strain of norovirus is making its way across throughout Europe and North America. The new strain, GII.4 Sydney, originated in Australia. 

Norovirus: New Jersey

January 29, 2013

Sick and tired: Stomach virus spreads across N.J. on heels of flu spike

State health officials report a spike in outbreaks of the norovirus, a disease that has no connection to the influenza virus that has sent three times as many New Jerseyans to local emergency rooms than last year.

FAO: Flashback: US increases funding to combat influenza and emerging disease threats

US increases funding to combat influenza and emerging disease threats

Continued partnership will strengthen countries' preparedness, surveillance and response

October 2012

Funding will also go to regional coordination to combat avian influenza and to support surveillance and prevention in Cambodia, Lao PDR, Nepal and Myanmar, which are threatened by the disease's continuing persistence in neighbouring countries. 

These countries continue to have sporadic outbreaks, indicating the H5N1 virus continues to circulate in poultry and remains a threat to poultry production, human health and the livelihoods of millions of vulnerable farmers who depend on poultry raising for their basic food needs and a means of making a living.

"The US Government has been key in generating international support to combat avian influenza and to reduce the chances for a human pandemic by assisting FAO and others to address the threat in animals before it spills over into humans. Such support for basic prevention measures is rare, yet most sensible and cost effective," said FAO Chief Veterinary Officer Juan Lubroth.

Emerging pandemic threats

Thanks in large part to the USAID-FAO partnership, since avian influenza grew to proportions of a global crisis between 2004 and 2006, the scientific community has gained a deeper understanding of what drives disease emergence and thus the measures to take to prevent disease. 

Due to the speed with which animal-origin pathogens such as H5N1, severe acute respiratory syndrome (SARS) in 2002-2003 and the H1N1 influenza pandemic in 2009, caused by a virus that had combined elements of avian, swine and human origin, USAID launched its "Emerging Pandemic Threats (EPT) programme.

Through EPT's "Identify" component, support is funnelled to countries to strengthen the capacities of national and regional laboratory networks to diagnose and characterize different types of influenza virus threats. 

This continues to be especially important in Southeast Asia, where new virus strains continue to emerge, which can eventually develop into a direct threat for human health and perpetuate poultry losses. In addition, as viruses adapt, poultry vaccines against H5N1 can lose their effectiveness, leaving domestic poultry vulnerable to disease.

FAO: World risks new bird flu surge if countries drop their guard

29 January 2013, Rome - The world risks a repeat of the disastrous 2006 bird flu outbreaks unless surveillance and control of this and other dangerous animal diseases is strengthened globally, FAO warns.

"The continuing international economic downturn means less money is available for prevention of H5N1 bird flu and other threats of animal origin.  This is not only true for international organizations but also countries themselves," says FAO Chief Veterinary Officer Juan Lubroth"Even though everyone knows that prevention is better than cure, I am worried because in the current climate governments are unable to keep up their guard."

Continued strict vigilance is required, however, given that large reservoirs of the H5N1 virus still exist in some countries in Asia and the Middle East, in which the disease has become endemic. Without adequate controls, it could easily spread globally as it did at its peak in 2006, when  63 countries were affected. 

Investing makes sense

Investing more in prevention makes economic sense given the huge toll inflicted by a full-scale pandemic. Between 2003 and 2011 the disease killed or forced the culling of more than 400 million domestic chickens and ducks and caused an estimated $20 billion of economic damage.

Like several animal diseases, H5N1 can also be transmitted to humans. Between 2003 and 2011, it infected over 500 people and killed more than 300, according to the World Health Organization.  

"I see inaction in the face of very real threats to the health of animals and people," Lubroth says.

This is all the more regrettable as it has been shown that appropriate measures can completely eliminate H5N1 from the poultry sector and thus protect human health and welfare. Domestic poultry are now virus-free in most of the 63 countries infected in 2006, including Turkey, Hong Kong, Thailand and Nigeria. And, after many years of hard work and international financial commitment, substantial headway is finally being made against bird flu in Indonesia.

Growing threat

Another growing threat is Peste des Petits Ruminants, or PPR, a highly contagious disease that can decimate flocks of sheep and goats. "It is currently expanding in sub-Saharan Africa - causing havoc in the Democratic Republic of Congo among other countries - and is just starting to spill over into southern Africa," Lubroth says. "The damage could well be huge".

"The irony is that a perfectly good vaccine exists for PPR, but few people are using it," he adds.  Along with tight finances, lack of political will, and poor planning and coordination are other reasons why PPR and other animal diseases are often allowed to spread.

Investing in prevention means improving hygiene practices, market and border controls, and health security in farms and markets. It includes equipping laboratories and training staff to diagnose and respond to disease outbreaks, and in organizing efficient extension services to serve farmers' needs.

Despite tight budgets, international organizations should also try to do more through concerted action. "We need to come together to find ways to ensure the safety of the global food chain," Lubroth urges. 

"The costs - and the dangers - of not acting are just too high."

Cambodia: Poultry From Same Lot Likely Infected; Increased Trading for Chinese New Year


The three infections in two weeks compares starkly with 2012, when just three people were diagnosed with avian influenza in the entire year, down from eight cases in 2011. All three cases in 2012 led to the death of the patient.
The WHO, the Ministry of Health and animal health experts from the Ministry of Agriculture are currently trying to find a link between the three latest cases, said the WHO’s Sonny Krishnan.
It was likely that the avian influenza originated from the same group of poultry, but spread over three provinces due to increased trading in chickens before the forthcoming Chinese New Year on February 8, Mr. Krishnan said.
“What happens is that people get poultry from surrounding villages and if they can’t sell it, it’s transferred somewhere else,” he said.
“So Chinese New Year is a probable reason why the cases are so spread out.”

Cambodia: #H5N1 Avian Influenza Human Cases List

As you can see from this map, Kampot Province is directly below Kampong Speu.  The 9 yo is from Kampot.

Kampong Speu​
Date 1/27/13
Name:  35(M)
From:  Trapeang Sla village, Preah Nipean commune,  Kong Pisey district, Kampong Speu
Onset:  1/13
Adm:  Treated by private practioner
Adm:  1/21
Hospital:  Khmer-Soviet Friendship Hosp. Phnom Penh, sym's fever, dyspnea
DOD:   1/21
Notes:  Prepared sick chicken for food prior to being sick.
Confirmation:  1/23/13 - Positive

Date:  1/27/13
Name:  15(F)
From:  Snao village, Prey Kabass district, Takeo Province
Onset:  1/11/13
Adm:  Treated by private practioner.
Hospital:  Kantha Bopha
Adm:  1/17/13 sym's fever & shortness of breath.
DOD:  1/21/13
Notes:  Previous dead poultry in village.  Prepared sick chicken for food prior to being sick.
Confirmed:  1/22/13 - Positive

Name:  5 yo female
From:  Angk Krasang Village, Prey Lvea commune, Prey Kabass district, Takeo Province.
Onset:  1/25
Adm:  local private practitioner
Adm:  1/31 with fever, cough & dyspnoea
Hospital:  Kantha Bopha Hospital
Confirmed:  Positive, diagnosed on 2/7
DOD:  2/7
Notes:  recent deaths of poultry in village. 

Phnom Penh
Date:  1/27/13
Name:  8 month male
From:  Chrey Korng Village, Sangkat Chorm Chao, Khan Por Sen Chey, Phnom Penh
Onset:  1/8/13
Hospital:  National Pediatric Hosp.
Adm:  1/9 sym's fever, cough, runny nose, vomiting.
Notes:  Samples sent on 1/11.  History of contact with poultry.
DOD:  survived and recovered
Confirmed:  1/22/13 - positive

Kampong Speu
Date 1/28/13
Name:  17 month girl
From:  Kong Pisei district, Prey Nhat commune, Kampong Speu
Onset:  1/13, fever, runny nose, vomiting
Adm:  private practitioner
Adm:  1/17 fever, cough, somnolence & dyspnoea 
Hospital: Kantha Bopha
Phnom PenhNotes:  Recent poultry death in village.  Contact with poultry.
DOD:  1/28
Confirmed:  Positive 1/26

Kampot Province
Date 1/29/13
Name:  9 yo girl
From:  Thmei village, Thmei commune, Toeuk Chhou district, Kampot Province
Onset:  1/19, fever, cough
Adm:  Initially treated by a private practitioner
Adm:  1/27
Hospital:  Kantha Bopha with fever, cough, somnolence and dyspnoea
DOD:  1/28
Notes:   Poultry dead around village.
Confirmed:  Positive - 1/28

Cambodia: Two New Bird Flu Deaths


PHNOM PENH: Two Cambodian girls have died from bird flu, health authorities said Tuesday, raising the toll from the deadly infection in the kingdom to four so far this year.

The victims, a 17-month-old girl and a nine-year-old girl, from the southern provinces of Kampot and Kampong Speu, died Monday in hospital, the World Health Organization said in a joint statement with the Cambodian health ministry.

Tests on the girls, whose villages had recorded recent deaths among poultry, confirmed they had contracted the H5N1 strain of avian influenza, the statement added.

Last week Cambodia said two people -- a 15-year-old girl and a 35-year-old man, had died from the H5N1 strain contracted while preparing infected chicken.

Continued  here

Cambodia: MOH Update - Fourth & Fifth New Human Cases of Avian Influenza H5N1

Today we received another Press Release from the Ministry of Health of Cambodia and the World Health Organization.  Two more cases have been confirmed positive for H5N1 virus.

The fourth case, I have already posted on.  A 17-month girl, from Prey Nheat village, Prey Nheat Commune, Kong Pisey district in Kampong Speu Province.
Onset:  1/13, fever, cough, runny nose, vomiting
Adm:  Initially treated by a private practitioner
Adm:  1/17
Hospital:  Kantha Bopha with fever, cough, somnolence & dyspnoea
DOD:  1/28
Notes:  Poultry dead around village, contact with sick poultry
Confirmed:  Positive - 1/26

The fifth case:
Name:  9 yo girl
From:  Thmei village, Thmei commune, Toeuk Chhou district, Kampot Province
Onset:  1/19, fever, cough
Adm:  Initially treated by a private practitioner
Adm:  1/27
Hospital:  Kantha Bopha with fever, cough, somnolence and dyspnoea
DOD:  1/28
Notes:   Poultry dead around village.
Confirmed:  Positive - 1/28

For the full Press Release click  here

Monday, January 28, 2013

Cambodia: Update on 4th Human Case #H5N1

[The 35yo male that died, was also from Kong Pisei district.  He was from Preah Nipean commune.]

An official on the Ministry of Health’s human influenza hotline and a commune chief said yesterday a two-year-old girl from Kampong Speu was diagnosed with H5N1 on Saturday after being admitted to Kantha Bopha hospital in Phnom Penh, where a 15-year-old girl died of the virus last Monday.

Due to less-rigorous monitoring of the disease in other hospitals, the cases seen in Kantha Bopha hospital were likely just the “tip of the iceberg”, said Dr Philippe Buchy, head of the virology unit at the Institut Pasteur du Cambodge, the medical research centre that tested the recent cases. 

Local health officials had buried the burned birds outside the village, sprayed the village and distributed medicine to eradicate the virus, he said.
Officials in Kong Pisei district’s Prey Nhat commune, in Kampong Speu province, the home of the two-year-old confirmed on Saturday to be the fourth case of the year, were pushing similar measures, according to commune chief Chan Sun.
Sun said a lot of poultry in the commune tended to get sick during the dry season, and officials had told villagers not to cook or touch sick or dead birds.  
“They have to burn and bury the dead poultry,” he said. “We have also prohibited poultry buyers who usually come into the commune from buying chickens in the commune for a while until we are sure everything is safe.”

More than 40 chickens at the infected toddler’s house had fallen sick and died, and, as with the other three cases this month, health officials suspect contact with poultry had caused her to become ill.
“Health officials went to the girl’s and her neighbours’ houses this morning to spray and distribute medicines, and they tested some poultry,” Sun said. 

Cambodia: 4 Human Cases #H5N1 In One Month

Cambodia Ministry of Health Statement on 1/25/13

 This is a Press release dated 1/25/13. 

Joint Press Release Between The Ministry of Health Kingdom of Cambodia and the World Health Organization (WHO).

The Statement goes on to say the first case was an 8 month old from Chrey Korng Village, Sangkat Chorm Chao, Khan Por Sen Chey, Phnom Penh.  He developed symptoms on 1/8, was brought to the hospital on 1/9, samples were sent on 1/11, with results on 1/22. 

The 2nd case, a 15 year old female was from Snao Village, Snao Commune, Prey Kabass district in Takeo Province.  She becameill on 1/11, was initially treated by a private practitioner, and admitted to hospital on the 1th.  She died on the 21st.

The 3rd case was a 35 year old man from Trapeang Sla village, Preah Nipean commune, Kong Pisey district, Kampong Speu province.  He has his first symptoms on 1/13, was hospitalized on 1/21.  Being treated by a private practitioner beforehand.  He died shortly after the samples were taken, which was on 1/21/13.

There is a campaign underway to educate the public on avian influenza.  They are also checking close contacts, any epidemiological linkage among the three cases.

The whole statement can be found here.

Cambodia: 4th #H5N1 Confirmed Human Death

PHNOM PENH, 28 January 2013 (IRIN) - Health authorities in Cambodia will bolster public awareness campaigns on H5N1 avian influenza after four people became infected in January, resulting in two fatalities.

“Ongoing public awareness campaigns need to be reinforced through TV and radio,” Sok Touch, director of Cambodia’s Communicable Disease Control Department (CDC), told IRIN on 28 January, calling on people to be vigilant. “We’re planning on doing this immediately as there is no room for complacency.”

The four cases of H5N1 avian influenza, commonly known as bird flu, are the first confirmed in Cambodia this year. There were three recorded cases (all fatal) in 2012.

Since 2005, 24 people have been infected resulting in 21 deaths, according to WHO, with over half of the infections in children under 14.

According to a joint statement from the Ministry of Health and World Health Organization (WHO) on 25 January, an eight-month-old boy from the capital Phnom Penh recovered after being infected with bird flu, while a 15-year-old girl from southwestern Takeo Province and a 35-year-old man from southwestern Kampong Speu Province died after contracting the virus.

The CDC said the boy had contact with chickens at a market, but the girl from Takeo and the man from Kampong Speu both fell ill after cooking dead chickens gathered from their villages.

A fourth case, also in Kampong Speu, was confirmed by the Ministry of Health on 27 January, when a 17-month-old girl tested positive for H5N1.
“We are working closely with the Ministry of Health to enhance surveillance of H5N1,” said Sonny Krishnan, communications officer with WHO in Phnom Penh, adding that WHO did not know yet if there was a link between the cases of the girl and 35-year-old man.

“We just did a map of the two communes and they’re not far from each other, so there could be an indication of a movement of poultry," Krishnan said.

Philippe Buchy, head of virology at the Pasteur Institute in Phnom Penh, said the best way to avoid further infections was to contain infected poultry, which is complicated in Cambodia.

“The country is large, there is not the surveillance required; a lot of resources [that are needed]... are not available to monitor clearly the poultry deaths everywhere, especially in a country where most of the production is backyard,” he said.

An earlier report by the UN Food and Agriculture Organization (FAO) indicated that chickens are kept by 90-95 percent of rural households, providing an important source of protein and livelihoods for millions.

According to WHO, since 2003, there have been 613 laboratory confirmed cases of H5N1 with 362 related deaths worldwide.