EBOLA Situation Report(Sitrep No 3) as at 08.00 Hrs; 18

May 2011

Summary of cases Luwero Other Districts
National
Total
18th May 2011

Hospital Kampala Bugiri

1. Epidemiology/Laboratory( Situation in the field):
Cases

•

The putative index patient was a 12 year old female from Nakisamata village,
Ngalonkalu Parish, Zirobwe sub-county, Luwero district who passed away on
6th May 2011 following a febrile hemorrhagic illness that lasted six days.
Laboratory investigations done through both real time PCR testing and
Antigen detection by ELISA confirmed Sudan Ebola virus (SEBOV).

•

Three of the contacts to the putative index patient developed and are being
observed.

•

One of these contacts had a positive blood slide for malaria and a negative
PCR test for Ebola. The blood samples for the other two contacts are being
analyzed at UVRI. Two contacts are reported to be improving on treatment
with antimalarials.

•

Two alert cases have been reported as indicated below:

-

The first alert case was a soldier at Bombo military hospital on ARVs and
anti-TB treatment who developed bleeding while on admission and died on

14th May 2011. Laboratory investigations on this case revealed a
thrombocytopenia with a negative test result for Ebola by PCR.

-

The second alert case has been reported by Mulago hospital today(17TH

May 2011). The patient is a 29 year old male from Muwafu zone, Makindye
Division, Kampala. He was admitted on 16 May 2011 with history of
vomiting blood and bloody diarrhea for one day without fever or headache.
He gave no history of travel or contact with a patient in the recent past.
The patient is improving on rehydration and ciprofloxacin. The blood
sample obtained tested negative for Ebola by PCR and ELISA Antigen
testing.

•

One suspect case was admitted in Bombo GMH in the evening of
17/May//2011; a 10 year old girl from Ngalonkalu village, Zirobwe sub-county
who presented with four days history of fever, vomiting with epistaxis and
abdominal pain. The child has been isolated and blood drawn for
investigations.

•

A new suspect case has been reported in an 8 year old male from Busoga
village, Buwunga sub-county, Bugiri district who presented early today with a
three days history of fever, measles like rash, bleeding gums and epistaxis.
The hospital has requested to be supported by the national rapid response
team since they don’t have anticeptics, gloves, or PPEs.

Contact Tracing

•

A total of 25 contacts are being followed up in Luwero; 12 in Bombo General
Military Hospital; 3 in Kisakye clinic, Zirobwe Town; 9 in Nakisamata village,
Zirobwe sub-county; and 1 in Negulumye village, Wakiso district.

•

All these contacts were followed up yesterday (17th May 2011) with just three
of them manifesting with fever and are reported to be improving on
antimalarials.

•

None of the febrile contacts has tested positive for Ebola.

Specimen collection

•

Seven blood samples have been obtained.

•

Only one 14% (1/7) sample has tested positive for Sudan Ebola virus
(SEBOV) through both real time PCR testing and Antigen detection by ELISA.

•

All these samples have been tested at Uganda Virus Institute, Entebbe and
aliquots have been shipped to CDC Atlanta, USA.

Continued investigation

•

Further investigations into potential source of the current outbreak were
conducted by a joint MoH, WHO, CDC team in Nakisamatta village:

o

Household bats were identified in the house of the putative index case.

o

Bats were also identified in the neighboring Ngalonkalu Primary school and
neighboring houses that are under construction.

o

The team visited the area where the family of the putative index case went
for gardening and collect firewood and observed that the area was close to
thickets that harbor monkeys.

o

An ecological team from CDC is in the country and has been engaged to
trap bats in the area. The locals have been alerted to keep away from the
infested structures.

Continued surveillance

•

All the listed contacts are being monitored on a daily basis to ensure that they
are isolated as soon as they manifest with symptoms.

•

All the districts on the contact pathway have been put on high alert

•

Surveillance tools based on Ebola experience have been adapted and will be
distributed to all affected districts starting today. These are: Case definitions,

Case reporting forms and contact tracing sheets and follow up forms..

Panic as Ebola spreads into another district

Friday, May 20th, 2011
By PATRICK JARAMOGI
Panic is the word that can best be used to describe the state at which the residents of Luwero are living in following the reported outbreak of Ebola last week. The strange twist to the epidemic that left a 12 year-old girl dead is its source of origin. Health experts including senior World Health Organisation (WHO) doctors are puzzled with the origin of the deadly disease, which has been identified as Sudan straight (Sudan Ebola). This type of Ebola has a killing rate of up to 60 percent (fatality).
The ministry of Health has, following the outbreak of the disease moved in fast to curb infections and control deaths, though they are still dogged by logistical problems. Luwero District Health Officer Dr Joseph Okware described the situation as “tense” but “calm”. He told a team of officials from the Health ministry, Centre for Disease Control, The African Field Epidemiology Network (AFNET) and WHO that the outbreak had indeed caused panic and anxiety among the locals. “Ebola is not an easy enemy to fight. We need cooperation and dialogue and networking to address it,” said Okware at the Luwero district headquarters on Tuesday.

He confirmed that Kate Nakiguli, the 12 year-old girl indeed died of Ebola. Nakiguli, formerly a primary five pupil at Ngalo nkalu primary school in Zirobwe, Luwero district succumbed to death on the May 6 at the Bombo military hospital where she was admitted. Okware said the 23 people who had had contacts with Nakiguli have been isolated and are being monitored closely.

“Eleven people are from the clinic in Zirobwe where she was admitted first, nine from the girls village in Ngalo nkalu, two from Bombo military barracks, and one person from where the burial took place in Wakiso,” said Okware. He said two other suspected cases, one of a one and half year old baby and that of a mortuary attendant attached to military hospital in Bombo had been reported, though the laboratory results indicated that they had malaria.
The acting director general Health services, Dr. Denis Lwamafa said government was taking the immediate measures to handle the situation. “As government moves in to take control measurers, it is very important that we take precaution and appropriate risk handling of Ebola,” he said. He said surveillance is going to be expanded to exceed Luwero. He urged the district leaders to ensure that burial arrangements are handled well by a team of experts to curb on infections. “We need to be strict while handling Ebola victims. Only body bags must be used. Avoid social gatherings and shaking of hands,” he said.

The National Task Force head, Dr. Anthony Mbonye said the surveillance will be expanded to include surrounding districts of Wakiso, Nakasongola, Nakaseke, Mukono and Kampala. “We can’t only take care of Luwero because we are not certain of the source and the spread that is why we are expanding surveillance to the other five districts neighboring Luwero. Funds are being channeled for surveillance and monitoring,” said Mbonye. He said government was closely working with WHO, AFENET and the MS Spain to ensure that Ebola is contained.
The AFENET senior epidemiologist Dr Monica Musonero Musanza said they would commit funds for training the health workers and communication for the surveillance team on ground. “We have funds to support government with training and communication because these are vital in curbing spread. We are also sending a team of experts on the ground to trace for the exact source of this Ebola,” said Musanza. But government and other development partners seek to control the spread of the killer Ebola in Luwero and its suburbs, reported emerged that another Ebola case had been reported in Bugiri, a town in eastern Uganda.
The Ebola virus is highly contagious and causes a range of symptoms including fever, vomiting, diarrhoea, generalised pain or malaise and in many cases internal and external bleeding. The 30 people who are believed to have had contact with the deceased have not yet developed symptoms according to the ministry of Health officials. “They are currently being monitored and isolated from the public,” said Mbonye. Mbonye said that preliminary investigations have showed that this Ebola virus is similar to the one that broke out in Sudan, thus named Sudan Ebola.

The other subtype is the Congo Ebola which also attacked the western district of Bundibugyo in 2007 claiming 37 lives including a senior doctor Jonah Kule. In 2000 Ebola outbreak in Gulu left at least 170 people dead. These earlier ones had a fatality rate of over 80 percent. Mbonye said that there also ongoing investigations to find out whether the index case got into contact with moneys or bats, the known reservoirs of the Ebola virus.

Following the outbreak, government has reactivated the National Ebola Task Force (NETF) to coordinate the fight against the disease at the national level. District task forces are also in the process of being formed according to Mbonye, who is the chairperson of the NETF. Immigration officials at all the country’s border posts have been put on alert and the neighbouring countries have been notified about the outbreak.

According to Joachim Saweka, World Health Organisation (WHO) representative here, tight border controls are not yet necessary although the immigration officers should be on alert. With some people reluctant to disclose their exact areas of origin for fear of being inconvenienced and perhaps quarantined, it remains a challenge how the immigration staff will handle the situation. According Saweka, a team of experts from WHO are also on the way to Uganda to beef up the team which is already camped in the affected district. A ministry of Health statement issued on Thursday urged the public to stay calm as all possible measures are being undertaken to control the situation. The ministry urged the public to avoid direct contact with body fluids of a person suffering from Ebola by using protective materials like gloves and masks. The public is also urged to bury people who have died of Ebola immediately and avoid feasting and funerals.
Government has also stocked the necessary drug supplies and logistics for case management. Isolation facilities have also been set up in the affected district. “Any claim of somebody bleeding should not just be disregarded but should be rushed to the nearest health centre and then from there we are already working with the health system to try to instruct how to deal with these cases,” said Saweka.

Ebola Hits Uganda again

Posted by Andy on 5/20/11 •
It all began with the death of a young girl from Zirobwe, a sub county in Bamunanika district of Uganda. The doctors later found out that the young girl died from Ebola, a deadly diseases which had never been so close to the capital of Uganda.
The Ebola case in Zirobwe came as a shock to many. Zirobwe is less than 30 miles from the capital city of Uganda- Kampala. The mother of the victim reported that the dead girl used to frequent the forest. Research has in the past linked Ebola virus to monkeys.
An isolation center was set up in Bombo which is just 20 miles from Kampala, the capital. More than 30 people who were believed to have come into contact with the deceased where have been isolated in the area

Two days ago, a young girl lost her life after the doctors in Gombe suspected that she had Ebola. It was later discovered that the girl had died from poisonous substance she had consumed. Actually, she was admitted with 5 others who had taken the substance with her. The doctors neglected all of them which led to the death of one. The fear of Ebola has now engulfed the country

Ebola Haemorrhagic Fever Epidemic DREF operation

---

20 May 2011

CHF 133,744 has been allocated from the Federation’s Disaster Relief Emergency Fund (DREF) to support the national society in delivering immediate assistance to some 1,731,900 beneficiaries (targeted population for information dissemination campaign). Unearmarked funds to repay DREF are encouraged.
Summary: An Ebola haemorrhagic fever epidemic has been reported in Luwero District of Uganda. One death so far has been reported with two suspected cases in the isolation unit at Bombo military hospital since the outbreak was confirmed on 13 May by the Ugandan Ministry of Health (MoH). The World Health Organization (WHO), MoH, MSF and the Uganda Red Cross Society (URCS) are active in the affected area. The four agencies have conducted preliminary assessments and highlighted the main gaps that need to be addressed for the epidemic to be brought under control.
This operation is expected to be implemented over three months, and will therefore be completed by August 2011; a Final Report will be made available by November 2011 (three months after the end of the Operation).http://reliefweb.int/node/402927

The situation

The Ugandan Ministry of Health (MoH) and the World Health Organization (WHO) have confirmed an
outbreak of Ebola haemorrhagic fever in the Luwero District located in the central region of Uganda
neighbouring Wasiko, Kayunga, Nakaseke, Nakasongola and Kampala Districts just along the highway to
Northern Uganda and Sounthern Sudan. One death (index case) has been reported and 23 suspected
contacts so far from the military hospital: of these, two suspected cases have so far been reported and have
been admitted to Bombo military hospital in Luwero District, the clinic that attended to the deceased victim
and the village members.
The initial assessment has not yet identified the source of the outbreak, but the national task force has
singled out six districts neighbouring Luwero for active case search, surveillance and social mobilization for
the Ebola outbreak. The Ugandan MoH and WHO have sent blood samples of the other cases admitted to
referral laboratories in Entebbe, and more tests are being conducted to provide detailed information on the
suspects.
Ebola Sudan, the type confirmed at this time in Uganda, is a highly contagious killer disease in the category
of viral haemorrhagic fevers, with no known cure and with high fatality rate of up to 90% of people exposed
to infection. Its symptoms include high fever, headaches, muscular pain, diarrhoea, reduced urine and
extensive bleeding through body openings such as nose, eyes, ears, gums and sexual organs. It is spread
through direct physical contact with body fluids of an infected person or consumption of animals carrying the
virus.
Uganda was last affected by Ebola in 2007 and 2008 in Bundibugyo where over 180 people were infected
resulting in 36 deaths including health workers. In 2000 and 2001, over 800 people were infected in Gulu
and Masindi Districts and more than 150 deaths were reported including health workers.

Coordination and partnerships

The MoH, URCS and other partners have conducted a preliminary needs and capacity assessment in
Luwero. The assessment has identified gaps as outlined below:

•

A national taskforce has been set up in Kampala coordinated by the MoH and similar task forces
have been formed in Luwero and surrounding districts. Experts from the WHO are already in
Uganda working closely with the Ugandan MoH to contain the epidemic and more are on the
way. WHO is providing technical support to the MoH and is coordinating the international
response.

•

An isolation unit has been established in Bombo military hospital equipped with protective tools
(50 Personal Protective Equipment (PPE) Kits) provided by the Centre for Disease Control
(CDC) to be used by those handling suspected Ebola cases.

•

Save the Children has rehabilited the isolation units in Bombo military hospital.
Two meetings so far have been organized and attended by partners to forge a way forward and the following
action points have been agreed on:

•

Community mobilization and sensitization of the populations on the symptoms and preventive
measures of Ebola in the six districts of Luwero (the epicentre), Kampala, Nakasongola, Wakiso,
Mukono/Kayunga and Nakaseke.

•

Information, education and communication materials that are context-specific and produced in
local languages.

•

Active community surveillance case search and referral of contacts in the community.

•

Being a permanent member of the social mobilization sub-committee of the national and district
level epidemic task forces, URCS has been requested to lead in these related activities in the
Ebola operation.

•

CDC in collaboration with Central Public Health Laboratory (CPHL) will continue to received
samples from the affected districts in Northern Uganda and will continue supporting the
Government of Uganda in screening samples in response to outbreaks

•

WHO country office with the MoH are part of the response team supporting the case
management - including drugs and sundry medical supplies for the treatment of Ebola cases,
PPE kits for the health workers and people involved in the response case management,
monitoring the trend of the disease, capacity building with experts in the field.

•

The MoH deployed technical officers to support case management, surveillance and referral

activities in the affected districts...

Red Cross and Red Crescent action

Actions to date of the Uganda Red Cross Society Ebola Action Team:

•

Mobilized 50 volunteers in Luwero Branch (the epicentre) and 10 volunteers each from the other
affected branches to be trained in social mobilization and active case research in the
community.

•

Actively participates in the national and district task force planning meetings for the Ebola
response (as a member of the communications and social mobilization team) in Luwero and
Kampala.

•

Provided some 30 PPE kits to MoH to assist in the Ebola response and established a URCS

Ebola task force which is meeting every day....

Although the only indexed case so far is that of the 12-year-old girl confirmed in Luwero district, the WHO
threshold requires that only one laboratory confirmed case represents an epidemic and WHO recommends a
mass emergency response campaign for all residents within the affected districts. Uganda has over 95

districts with Kampala having the highest population of over 1.2m people.

Due to the high level of illiteracy in the affected rural and peri-urban populations in Luwero there is generally
a low level of community awareness on the risk factors of Ebola fever transmission, its identification,
prevention and control strategies. This has led to panic in the affected communities. The general conditions
that exacerbate the Ebola fever situation are:

•

Due to low level of education, majority of the people in the affected communities lack knowledge
and understanding of the disease and what they need to do to avoid contracting it.

•

The high incidence of poverty forces the residents to spend time in the bush hunting wild
animals for alternative diet as well as income and grazing. This means that the majority of
residents in the affected communities are exposed to fruits and animal diet that could expose
them to the deadly virus.

•

There is a general lack of resources for response. The NTF developed a plan of action that
requires USD 2.2m to facilitate the planned activities, where over 50 percent of the funds are
required for case management and the protective gears.

•

Active surveillance and community follow-up cases needs support. This calls for intensive
health promotion campaign to sensitize the affected and/or at risk communities and creates
public awareness about Ebola fever disease, the risk factors for its transmission, its prevention

and control among the people in central Uganda...

Suspected Ebola case in Bugiri

By Dan Wandera

Friday, May 20 2011 at 00:00

A new suspected case of Ebola has been reported in Bugiri District, hardly a week after a 12-year-old girl died of the disease, the ministry of health said in a statement yesterday.
The patient, who is admitted to Bugiri Hospital had fever, measles-like rashes and a bleeding gum—all symptoms of Ebola.
Meanwhile, 25 people in Luweero, who had direct contact with the deceased girl remain under close monitoring.

The ministry said one person who got in contact with the girl was treated for malaria and is improving.
In a statement yesterday, the ministry said, two other people who got in contact with the girl “have their samples being analysed for Ebola”.

Dr Denis Rwamafa, the commissioner for national disease control, said districts that are at high risk of the disease are, Luweero, Wakiso, Kampala, Mukono, Nakaseke and Nakasongola.

“We are enhancing surveillance and have expanded the monitoring to all the six-risk districts until the 42 days expire as the mandatory period to declare an area Ebola free,” said Dr Rwamafa.

A team of health experts on Tuesday visited Luweero to reinforce the emergency health teams set up to respond to the Ebola outbreak in the district and possible outbreaks across the country.

Ebola is a highly-contagious disease that spreads fast when one gets in contact with body fluids of an infected person.
All district task forces have been asked to reactivate their responses to any possible outbreak of the virus.

Ebola Raids Gombe

5/19/11

Ebola has been recently heard in Bombo and Zirobwe in Luweero district.
It has now raided Gombe Sub county and 5 children from the same family have been admitted at Gombe Hospital with Ebola signs and symptoms. Unfortunately one has died before receiving treatment.

Ebola on Saturday killed a 12 year old girl at bombo military hospital
Efforts have been made by the Ministry of Health to fight the disease and funds have been assigned at Bombo military hospital.
Ebola signs and symptoms include fever, bleeding through all body openings, vomiting, diarrhea, abdominal pain, headache, rash, red eyes and it comes into contact with infected bloody fluids like saliva, blood, stool, vomit, urine and sweat.

Ebola epidemic reaches Busoga

20110519 4:12:12 PM EST

A new suspected case of Ebola has been reported in Busoga village in Bugiri district, eastern Uganda.

The patient who is currently admitted at Bugiri hospital is reported to have fever, measles-like rashes and a bleeding gum.
The director general of general health services Dr. Dennis Lwamafa in a statement released this evening however said there haven't been any new cases confirmed so far.

He says the ministry of health continues to monitor and observe the 25 people who got in contact with 12 year old girl, who died of the virus in Luwero district.

Lwamafa adds that, all district and hospital task forces should re-activate and liaise with the National task force to initiate a coordinated response to contain the outbreak.

He reveals that government and other development partners have committed funds, equipment and human resources to respond to the outbreak.

Bombo hospital health worker gets Ebola

One of the health workers who handled a girl who is alleged to have died of Ebola on May 6 has been suspected to have contracted the same disease.
The nurse whose name was not yet identifiedat the time of compiling the story is said to be having all the symptoms of Ebola such as bleeding in every opening of the body and vomiting.
The Bombo hospital has set aside special shelters and wards for the people suspected to be having the diseases.

Last week, the Ministry of Health reported that it is monitoring 33 people who participated in handling the girl

Study: Pigs susceptible to deadly Ebola strain

Robert Roos News Editor

May 13, 2011 (CIDRAP News) – Canadian researchers have shown that an Ebola virus species that can kill humans can also infect pigs and spread among them, raising the specter of Ebola virus as a potential foodborne pathogen.

The researchers infected two groups of pigs with a high dose of the Zaire Ebola virus ("ZEBOV"), a strain that is up to 90% fatal in humans, according to a report published in the Journal of Infectious Diseases. The pigs became ill to varying degrees, with severe signs in some cases, and they transmitted the virus to other pigs that were previously unexposed.

A US expert who wrote a commentary on the findings said the probability of Ebola virus becoming a foodborne pathogen is small but can't be dismissed for now.

Ebola kills girl in Uganda, more cases expected

KAMPALA: The rare and deadly Ebola virus has killed a 12-year-old Ugandan girl, and health officials said on Saturday they expected more cases.
The girl from Luwero district, 75 km north of the capital Kampala, died on May 6, said Anthony Mbonye, the government’s commissioner for community health, in the first outbreak of the virus in Uganda in four years.
“Laboratory investigations have confirmed Ebola to be the primary cause of the illness and death. So there is one case reported but we expect other cases,” he said.
“Just one case is considered an epidemic because it can spread quickly and it is highly fatal.”
The last time Uganda was hit by Ebola – a disease in which those infected often bleed to death – it killed 37 people.
Mbonye said this was the closest a case had ever been reported to Kampala.
Ugandan health officials are following up 33 people who were in contact with the girl, he said.

Deadly Ebola breaks out in Uganda, kills one, 30 monitored

Deadly Ebola breaks out in Uganda, kills one, 30 monitored!

KAMPALA, May 14 (Xinhua) -- The deadly Ebola hemorrhagic fever has broken out in Uganda, killing one person and leaving over 30 others being monitored by health officials, ministry of health announced here on Saturday.
The epicenter of the outbreak is in the central Ugandan district of Luwero located about 50 km north of the capital Kampala.
According to Anthony Mbonye, head of the community health department at the ministry of health, a 12 year old girl in Zirombwe Sub-county developed symptoms of Ebola and when she was admitted at a military hospital in the district, laboratory test confirmed that it was Ebola.
The Ebola virus is highly contagious and causes a range of symptoms including fever, vomiting, diarrhea, generalized pain or malaise and in many cases internal and external bleeding.
The girl died on May 6 and about 30 people who she got contact with are being asked to not get into contact with the public as health officials monitor them for about 21 days.
The 30 people have not yet developed the symptoms but if they do, they will be isolated from the public.
Mbonye said that preliminary investigations have showed that this Ebola virus is similar to the one that broke out in Sudan, thus named Sudan Ebola.
The epicenter of the outbreak is also located along the high way to southern Sudan.
This viral subtype has a human case fatality rate of 60 percent meaning that it will kill 60 percent of the infected people.

WHO H5N1 Indonesia Update

Avian influenza – situation in Indonesia - update 4

13 May 2011 - The Ministry of Health of Indonesia has announced a confirmed case of human infection with avian influenza A(H5N1) virus.

The case is an 8-year old female from West Jakarta district, DKI Jakarta Province. She developed symptoms on 1 April, was admitted to a health care facility on 4 April and referred to a hospital on 8 April. She died on 11 April.

Epidemiological investigation identified a possible risk factor as exposure to wild bird faeces found around the house. In addition, during the week before the child developed symptoms, her mother purchased chickens from a local market.

Laboratory tests have confirmed infection with avian influenza A(H5N1) virus.

Of the 177 cases confirmed to date in Indonesia, 146 have been fatal.

70 Percent Patient Suspect Bird Flu from Padang

Sabtu, 07/05/2011 14:12

"Bird flu patient isolation room Dr M Djamil Padang was almost full due to surge in patients from several districts in the Valley," said Gustafianof, Head of Public Relations Dr M Djamil Padang, in his room, yesterday (6 / 5).

Until yesterday, Dr M Djamil still caring for two patients, of whom, GD, 11 months, provided Indrapura Pancungsoal District, South Coast District, which is planned to return home on Friday (6 / 5). The good news, test results from Balitbangkes RI showed negative results.

Lena 33, GD's parents said he would increase awareness of their pets (birds), who died suddenly. Apparently a big impact, GD fortunately no bird flu positive."We do not notice trivial things like chickens died suddenly," he said.

While Lutfi new entry on At 13:45 pm yesterday (5 / 5) yesterday from Lubukmangindu Karagahan, Lubuk cone Agam, already getting food handling drug therapy. While blood samples have been sent to Balitbangkes RI, yesterday (6 / 5).

Watchlist Padang Ekspres, on the isolation room, family room and out patients, both the guard and visited without using a mask

Expert warns of threat from deadly bird flu

ew strain of H1N1 also active in region

Published: 29/04/2011 at 12:00 AM
Newspaper section: News

A flu expert has warned that the deadly H5N1 bird flu virus strain could re-emerge in the country if stringent measures to prevent the spread of the disease are not taken.

The warning was issued yesterday at a health conference entitled ''The Emerging and Re-emerging Diseases: Situation, Lessons and Management'' held by Mahidol University.

Tawee Chotpitayasunond of the Queen Sirikit National Institute of Child Health told participants at the conference that the World Health Organisation (WHO) had reported 36 bird flu cases in humans over the past four months in four countries _ Cambodia, Bangladesh, Indonesia and Egypt.

Of the total, 16 had died and five of them were Cambodian nationals.

According to the WHO report, two of the five who died in February were a 21-year-old woman and her 11-month-old son. They had been sent for medical treatment at a hospital in Cambodia's Banteay Meanchey province, opposite Thailand's Aranyaprathet district of Sa Kaeo province. An investigation found the mother had contracted the virus from an H5N1-infected chicken she had killed and eaten.

When the deaths came to light, Thai health and livestock authorities immediately stepped up measures to prevent the spread of the disease in humans and poultry and to control the trade of eggs and poultry along the Thai-Cambodian border.

The reported number of bird flu cases in humans in the four-month period is higher than the 40 cases worldwide last year. Therefore, the prevalence of bird flu was likely to remain at least as severe as in the previous outbreak when it was at 60-70%, Dr Tawee said.

''If [Thailand] doesn't take stringent measures to prevent the flu spreading, particularly in areas where previous outbreaks have taken place, the virus may return to harm [Thai] people after years of having disappeared,'' he said.

He added the situation could turn into something similar to what was happening in Cambodia and Indonesia where the number of people who have died from bird flu has been rising continuously since the start of this year.

There have been no bird flu cases in humans in Thailand since July 2006 after previous outbreaks between 2004 and 2006. During that time, 27 infections were reported and 17 people died.

In a related matter, WHO Southeast Asia regional director Samlee Plianbangchang also warned there was another strain of the H1N1 influenza virus active in the region.

Dr Samlee said the deadly flu virus might re-emerge in Thailand and other developing countries at any time if these countries lacked effective surveillance.

Yong Puworawan, head of Chulalongkorn University's Centre of Excellence in Clinical Virology, said there were now signs that the H1N1 virus had become resistant to the anti-viral drug oseltamivir.

Following monitoring of the three waves of H1N1 flu outbreaks during 2009 and 2010, the drug resistance rate had shown signs of increasing.

Dr Yong said that in the first wave there were no drug-resistant cases, whereas the drug resistance rate of the H1N1 flu virus during the second and third waves was at 0.2% and 0.8% of the 1,200 cases of the H1N1 virus, respectively, he said.

The virologist, however, remained confident that the medicine was still effective in treating influenza because H1N1 had become a seasonal flu and about 40-50% of the Thai population had already been vaccinated.

Kaltim Diskes Team Go Two People Suspect Bird Flu

Friday, April 29, 2011 Tenggarong

- Today, Friday (4/29/2011), Public Health Service team (Diskes) East Kalimantan Province Archilia chaired by Dr. S Dahlan, Kasi Control of Communicable Diseases (P2M) will come to two persons of Makarti Village, District Marangkayu, Kukar, who stated suspect bird flu.

Provincial teams will be accompanied by field officers of the Department of Animal Husbandry and Animal Health Kukar. "The team will carry the drug, device health checks and education facilities," said Eka Soni, Chairman of the Impact of Avian Influenza Investigation Team from the Ministry of Health, on Friday (29/04/2011).

As reported previously, as many as 20 thousand chickens died suddenly and tested positive for bird flu after the rapid test (rapid test) against a number of samples of chickens in the village of Makarti, Marangkayu. The spread of bird flu affecting poultry in the region has adversely affected

Bird flu still entrenched in India, 5 other countries: FAO

PTI, Apr 22, 2011, 07.49pm IST

NEW DELHI: United Nations body FAO has said the contagious Avian flu virus H5N1, which causes bird flu, still remains firmly entrenched in India and five other countries because of unhygienic trade practises.

"...the virus remains firmly entrenched in Bangladesh, China, Egypt, India, Indonesia and Vietnam," Food and Agriculture Organisation (FAO) said in a statement.

"Eliminating the highly pathogenic H5N1 avian influenza virus from poultry in the six countries where it remains endemic will take 10 or more years," it added.

According to FAO, the factors responsible for the entrenchment of the virus are complex production and market chains, with poultry reared and sold under conditions that afford little protection from influenza viruses.

Quality of public and private veterinary and animal production services and the level of commitment in dealing with H5N1 were other factors, it said.

H5N1 strain of highly contagious avian influenza (H5N1 HPAI) reported in 60 countries reached its peak in 2006. However, presently the virus has been stamped out in most of the countries, the statement added.

WHO Avian influenza - situation in Egypt - update 51

21 April 2011 - On 16 April 2011, the Ministry of Health of Egypt notified WHO of two new cases of human infection with avian influenza A (H5N1) virus.

The first case was a 29 years-old male from Fayoum Governorate Wadi Elrian area who developed symptoms on 1 April , was hospitalized on 4 April and died on 7 April.

The second case was a one -and-a -half year-old male child from Fayoum Governorate, Sennores District who developed symptoms on 9 April and was hospitalized on 11 April. He is under treatment and is in stable condition.

All the cases received oseltamivir treatment at the time of hospitalization.

Investigations into the source of infection indicate that both the cases had exposure to sick and/or dead poultry suspected to have avian influenza. There is no epidemiological link identified between these two cases.

The cases were confirmed by the Egyptian Central Public Health Laboratories, a National Influenza Center of the WHO Global Influenza Surveillance Network.

Of the 143 cases confirmed to date in Egypt, 47 have been fatal .

WHO Avian influenza – situation in Cambodia - update 3

21 April 2011 - The Ministry of Health (MoH) of the Kingdom of Cambodia has announced a confirmed case of human infection with avian influenza A(H5N1) virus.

The case was a 5 year old girl from Pea Raing district, Prey Veng Province. She developed symptoms on 11 April, was initially treated by local private practitioners with no effect and was later admitted to Kantha Bopha Children Hospital on 13 April. Despite all intensive care, she died on 16 April, four days after admission.

There have been reports of poultry die off in her village. The girl is the fifteenth person in Cambodia to become infected with the H5N1 virus and the thirteenth to die from complications of the disease. All five cases of H5N1 infections in humans in Cambodia this year have been fatal.

Specimens from 53 contacts of the cases were collected and are being tested by the National Institute for Public Health laboratory.

A new death in Cambodia...H5N1 Confirmed

A little 5 year old daughter died of bird flu in Cambodia, bringing to five the number of deaths from this disease in the country since the beginning of the year.
The child in the province of Prey Veng (southeast), died April 16, said Thursday the Department of Health and the World Health Organization (WHO

WHO confirms 5 H5N1 cases in Egypt, Bangladesh

Jim Wappes Editorial Director

Apr 11, 2011 (CIDRAP News) – The World Health Organization (WHO) today confirmed four new H5N1 avian flu cases in Egypt—including a fatality—and one nonfatal case in Bangladesh.

The cases raise Egypt's H5N1 case total this year to 22 and Bangladesh's to 2. In addition, the WHO posted an official notice on its Web site today of a Cambodia case that it had jointly confirmed with Cambodia's Ministry of Health last week.

4 Egyptian cases, 1 death
The WHO revealed this information on the four Egyptian case-patients:

• A 20-year-old woman from Beheira governorate fell ill Mar 14 and was hospitalized Mar 19. She was listed in critical condition and died Mar 28.
• A 2-year-old girl from Menoufia governorate had symptoms Mar 26 and was hospitalized Mar 27. She is listed in stable condition and still under treatment.
• A 55-year-old woman from Beheira governorate first experienced symptoms Mar 20 and was hospitalized Mar 22. She recovered and was discharged Apr 5, according to the report.
• A 1-year-old boy from Fayoum governorate first had symptoms Mar 20 and was hospitalized Mar 28. He is still under treatment in stable condition.

Source investigations revealed that all had exposure to sick or dead poultry suspected to have avian influenza, according to the WHO report. In addition, all four had received oseltamivr (Tamiflu) in the hospital.

In the past 2 weeks the WHO has confirmed 11 Egyptian cases, including 2 fatalities. Five of those 11 patients have been from Beheira governorate.

Of the 22 H5N1 cases this year in Egypt, 6 have been fatal. Since 2006 the country has logged 141 WHO-confirmed H5N1 cases and 46 deaths, second only to Indonesia (176) in total cases and third to Indonesia (145) and Vietnam (59) in fatal cases.

Bangladesh's 2nd case in 2011
The WHO also reported that Bangladesh's Ministry of Health and Family Welfare has confirmed the country's second H5N1 case this year, in a 2-year-old boy from Kamalapur, Dhaka.

He experienced avian-flu symptoms Mar 1 and visited the country's influenza sentinel surveillance site on Mar 9, where samples were obtained. The country's Institute of Epidemiology, Disease Control and Research confirmed H5N1 in the samples.

A detailed investigation revealed exposure to sick poultry but no other cases.

The WHO confirmed Bangladesh's previous case, in a 16-month-old girl, on Mar 16, the same day that the 2-year-old's now-confirmed infection was reported in the media. Today's WHO report states, "Although the case is from the same locality as the previous case they had no direct contact with each other."

Bangladesh's only other H5N1 case was confirmed in 2008. It, too, was nonfatal.

Cambodia's latest case logged
In a third report released today, the WHO verified, as reported in the media Apr 6, that Cambodia's Ministry of Health in conjunction with the WHO has confirmed a fatal H5N1 case in an 11-year-old girl in the Steung Trang district of Kampong Cham Province.

She first experienced symptoms Mar 22 and was first treated by local villagers before being admitted to a local hospital Mar 29. Upon treatment failure she was transferred to a regional hospital Mar 31, where she died the same day.

The report did not specify her treatment but said all contacts with the girl have tested negative for H5N1 infection.

Hers is the fourth H5N1 case in Cambodia this year, and all have proved fatal. Since 2005 the country has confirmed 14 H5N1 cases, including 12 deaths.

With the additional cases, the global H5N1 count has reached 549 cases and 320 deaths. Thirty-three of those cases and 14 of the deaths came this year.

See also:

Apr 11 WHO Egyptian report

Apr 11 WHO Bangladeshi report

Apr 11 WHO Cambodian report

WHO global H5N1 case count

WHO: Countries agree to share flu virus samples after 4 years of talks

By The Associated Press
GENEVA — The World Health Organization says countries have agreed on a deal to share flu virus samples after almost four years of fractious talks on the issue.

[click on title for full article]

WHO Avian influenza - situation in Egypt - update 50

11 April 2011 - The Ministry of Health of Egypt has announced four new confirmed cases of human infection with avian influenza A(H5N1) virus.

The first case is a 20 years old female from Behaira Governorate. She developed symptoms on 14 March and was hospitalized on 19 March. She was in a critical condition and died on 28 March.

The second case is a two years old female from Menofeya Governorate. She developed symptoms on 26 March and was hospitalized on 27 March. She is still under treatment and in a stable condition.

The third case is a 55 year old female from Behaira Governorate. She developed symptoms on 20 March and was hospitalized on 22 March. She recovered and was discharged on 5 April.

The fourth case is a 1 year old male from Fayoum Governorate He developed symptoms on 20 March and was hospitalized on 28 March. He is still under treatment and in a stable condition.

All the cases received oseltamivir treatment at the time of hospitalization.

Investigations into the source of infection indicate that the cases had exposure to sick and/or dead poultry suspected to have avian influenza.

The cases were confirmed by the Egyptian Central Public Health Laboratories, a National Influenza Center of the WHO Global Influenza Surveillance Network.

Of the 141 cases confirmed to date in Egypt, 46 have been fatal

China bird flu virus detected in poultry farms, health monitoring of personnel have been called for the livestock industry to enhance personal health

Source: Public Relations Office of Public Relations Date: 2011/4/13 H7N3 detected in domestic poultry farms for bird flu, disease Control Board to ensure people's health, has conducted health-related personnel and the prevention and treatment visits, there are no workers have health exception, but still ongoing work related to staff health monitoring . One after another recently detected in domestic poultry farms such as H5N2 and H7N3 avian influenza virus, coupled with numerous reports of human H5N1 influenza international sporadic cases of avian flu pandemic risk still exists

More birds destroyed in Bangladesh

Gazipur, Apr 13 (bdnwews24.com)
—A total of 17,279 poultry birds of a farm have been culled and 4,298 eggs destroyed at Gajaria in Sreepur upazila following the detection of bird flu infection. Upazila livestock officer A K M Ataur Rahman told bdnews24.com that the culling and dumping drive at Ferdous Poultry Farm began on Wednesday morning after the samples of the dead chickens were found H5N1-positive in a lab test on Tuesday.

Egypt Analysis

Previously posted here

His Chest Hospital Damanhour Lady of the Mahmudiyah claims Nihad Bassiouni Mahmoud housewife infected with symptoms of bird flu with fever - cough - sore throat - muscle pain and difficulty breathing Vtm isolated and took a sample and sent to central laboratories for analysis, which reported positive sample and the injury of Mrs. disease. The hospital received 3 cases infected with the disease during the past two weeks.

I believe the cases referred to above are these, reported by WHO:

Confirmed #128

Name: 17 yo female

From: Behira Gov.

Adm: 3/1

Onset: 2/27

Notes: Stable condition. WHO Update #46

Confirmed #133

Name: 4 yo female

From: Behira Gov.

Adm: 3/7

Onset: 3/5

Notes: Recovered & discharged. WHO Update #48.

Confirmed #134

Name: 1 yo male

From: Behira Gov.

Adm: 2/16

Onset: 2/14

Notes: Discharged 2/22. WHO Update #49.

Confirmed #135

Name: 3 yo female

From: Behaira Gov.

Adm: 3/12

Onset: 3/10

Notes: Discharged 3/18. WHO Update #49

(WHO note: The previous two cases are from the same district but different villages and they are not relatives)

WHO Avian influenza - situation in Egypt - update 49

[WHO Update #48 just came out on April 2nd, with 3 confirmed.]

6 April 2011 - The Ministry of Health of Egypt has announced four new confirmed cases of human infection with avian influenza A(H5N1) virus.

The first case is a one year old male from Behaira Governorate. He developed symptoms on 14 February, was hospitalized on 16 February. He recovered and was discharged on 22 February.

The second case is a three years old female from Behaira Governorate. She developed symptoms on 10 March, was hospitalized on 12 March. She recovered and was discharged on 18 March. The previous two cases are from the same district but different villages and they are not relatives.

The third case a 34 year old female from Alexandria Governorate. She developed symptoms on 9 March and was hospitalized on 15th March. She is still under treatment in a stable condition.

The fourth case is a 30 years old female from Kafr El-Shaikh Governorate. She developed symptoms on 7 March and was hospitalized on 15 March. She recovered and was discharged on 27 March.

Investigations into the source of infection indicate that all cases had exposure to sick and/or dead poultry suspected to have avian influenza.

The cases were confirmed by the Egyptian Central Public Health Laboratories, a National Influenza Center of the WHO Global Influenza Surveillance Network.

Of the 137 cases confirmed to date in Egypt, 45 have been fatal.

Cambodian girl dies of H5N1

2011-04-06 20:03:57

PHNOM PENH, April 6 (Xinhua) -- Cambodia's Ministry of Health and the World Health Organization announced Wednesday that an 11- year old girl from the eastern province of Kompong Cham has died of avian influenza H5N1.

A joint statement sent to the media said the 11-year old girl from Kbal Au Village, Steung Trang District, Kompong Cham province died on March 31 as a result of respiratory complications after contracting human avian influenza virus H5N1.

"The girl is the 14th person in Cambodia to become infected with the H5N1 virus and the tenth to die from complications of the disease," the statement said.

The patient became sick on March 22 and she was initially treated by local villagers with no effect and was admitted to a local hospital on March 29 before she was later on March 31 sent to a hospital in Siem Reap province where she died just four hours after admission.

"Avian influenza is still a threat to the health of Cambodians - - early identification of potential patients is the fastest way of ensuring they can have correct treatment," said Minister of Health Mam Bunheng.

"I urge communities to be on the look-out for respiratory infection with history of contact with dead or sick poultry to promptly seek medical attention at the nearest health facilities," he added.

Scientists find superbugs in Delhi drinking water

By Kate Kelland, Health and Science Correspondent

LONDON | Thu Apr 7, 2011 3:57pm EDT

(Reuters) - A gene that makes bugs highly resistant to almost all known antibiotics has been found in bacteria in water supplies in New Delhi used by local people for drinking, washing and cooking, scientists said on Thursday.

The NDM 1 gene, which creates what some experts describe as "super superbugs," has spread to germs that cause cholera and dysentery, and is circulating freely in other bacteria in the Indian city capital of 14 million people, the researchers said.

-snip-

Vietnam: #H5N1 in Poultry

[excerpt]

On this occasion, Department of Animal Health also confirmed bird flu has occurred in the province of Tien Giang province, raising the total number of localities are translated to five provinces in the country.
2 and 30-3 in the past 29 days, the area Cai Lay District, Tien Giang province had appeared two bird flu outbreaks in Tan Binh and Tan Phu.

Specifically, in Tan Binh, the outbreak occurred on a 500 baby chickens are not vaccinated against bird flu, while in Tan Phu, avian influenza has occurred in two birds with a total of 690 children also not been vaccinated against bird flu. Department of Animal Health in cooperation with Tien Giang province local authorities have carried out the total destruction of infected poultry, while implementing urge measures of prevention and fight against bird flu. Thus, the five provinces where avian influenza is 21 days, including Quang Ngai, Quang Tri, Nam Dinh, Hai Phong, and Tien Giang.

Egypt: Lady bird flu infection in the lake [Damanhour]

His Chest Hospital Damanhour Lady of the Mahmudiyah claims Nihad Bassiouni Mahmoud housewife infected with symptoms of bird flu with fever - cough - sore throat - muscle pain and difficulty breathing Vtm isolated and took a sample and sent to central laboratories for analysis, which reported positive sample and the injury of Mrs. disease. The hospital received 3 cases infected with the disease during the past two weeks.

#Egypt: WHO Update - 3 New Confirmed Human Cases #H5N1

Avian influenza - situation in Egypt - update 48

29 March 2011 - The Ministry of Health of Egypt has announced three new confirmed cases of human infection with avian influenza A(H5N1) virus.

The first case is a 32 year old male from Suez Governorate. He developed symptoms on 8 March, was hospitalized on 12 March and died on 13 March.

The second case is a 28 year old female from Giza Governorate. She developed symptoms on 8 March and was hospitalized on 10 March. She is in a stable condition.

The third case is a 4 year old male from Behira Governorate. He developed symptoms on 5 March and was hospitalized on 7 March. He recovered and was discharged on 12 March.

Investigations into the source of infection indicate that the cases had exposure to sick and/or dead poultry suspected to have avian influenza.

The cases were confirmed by the Egyptian Central Public Health Laboratories, a National Influenza Center of the WHO Global Influenza Surveillance Network.

Of the 133 cases confirmed to date in Egypt, 45 have been fatal.

WHO Avian influenza – situation in Indonesia - update 3

1 April 2011 - The Ministry of Health of Indonesia has announced a confirmed case of human infection with avian influenza A(H5N1) virus.

The case is a 28 year old female from Gunung Kidul district, Yogyakarta Province. She developed symptoms on 1 March, was admitted to a health care facility on 6 March and referred to a hospital on 11 March. She died on 14 March.

The cases’ family owned chicken and ducks, and the case visited local village/town traditional market on a daily basis. There were many free roaming poultry in the neighborhood and it was reported there were chicken deaths in the previous months.

Laboratory tests have confirmed infection with avian influenza A(H5N1) virus.

Of the 176 cases confirmed to date in Indonesia, 145 have been fatal.