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Human infection with avian influenza A(H5N6) virus – China
Between Dec. 30, 2015 and Jan. 2, 2016, the National Health and Family Planning Commission (NHFPC) of China notified the World Health Organization (WHO) of two additional laboratory-confirmed cases of human infection with avian influenza A(H5N6) virus.
1. The first case is a 26-year-old female from Baoan District, Shenzhen City, with onset date of Dec. 24. The patient was admitted to hospital on Dec. 27 and is now in critical condition.
2. The second case is a 40-year-old female from Duanzhou District, Zhaoqing City, with onset date of Dec. 22. The patient was admitted to hospital on Dec. 28 and is now in critical condition.
The Chinese government has taken the following surveillance and control measures: making every effort to treat the patient; collecting and testing the specimens of the patient, carrying out viral isolation and whole genome sequencing and comparison; conducting epidemiological investigation; tracing, managing and observing the close contacts of the patient; strengthening surveillance of unexplained pneumonia and routine sentinel surveillance of influenza; strengthening the etiological surveillance of influenza/avian influenza virus.
WHO continues to closely monitor the influenza A(H5N6) situation and conduct risk assessments. So far, the overall risk associated with avian influenza A(H5N6) viruses has not changed.
WHO advises that travelers to countries with known outbreaks of avian influenza should avoid poultry farms, or contact with animals in live bird markets, or entering areas where poultry may be slaughtered, or contact with any surfaces that appear to be contaminated with feces from poultry or other animals. Travelers should also wash their hands often with soap and water. Travelers should follow good food safety and good food hygiene practices.
WHO does not advise special screening at points of entry with regard to this event, nor does it currently recommend any travel or trade restrictions. As always, a diagnosis of infection with an avian influenza virus should be considered in individuals who develop severe acute respiratory symptoms while travelling or soon after returning from an area where avian influenza is a concern.
WHO encourages countries to continue strengthening influenza surveillance, including surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns, in order to ensure reporting of human infections under the IHR (2005), and continue national health preparedness actions.
Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia
Between Nov. 29 and Dec. 17, 2015, the National IHR Focal Point for the Kingdom of Saudi Arabia notified WHO of four additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including two deaths.
1. A 48-year-old male from Najran city developed symptoms on Dec. 10 and on Dec. 15 was admitted to hospital. The patient tested positive for MERS-CoV on Dec. 16 and died on Dec. 18. She had comorbidities and a history of frequent contact with camels and consumption of their raw milk.
2. A 41-year-old, non-national female from Buridah city developed symptoms on Dec. 13 and, on Dec. 14, was admitted to hospital. The patient, who has no comorbidities, tested positive for MERS-CoV on Dec. 15. Currently, she is in stable condition in a negative pressure isolation room on a ward. The patient has a history of contact with a MERS-CoV case (see case no. 4 below). She has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms.
3. A 21-year-old female from Riyadh city developed symptoms on Nov. 25 and on Nov. 30 was admitted to hospital. The patient, who has no comorbid conditions, tested positive for MERS-CoV on Dec. 1. Currently, she is in critical condition in the ICU. Investigation of history of exposure to known risk factors in the 14 days prior to the onset of symptoms is ongoing.
4. A 35-year-old female in Buridah city developed symptoms on Nov. 22 and on Nov. 27 was admitted to hospital. The patient tested positive for MERS-CoV and died on Dec. 5. She had comorbidities.
Globally, since September 2012, WHO has been notified of 1,625 laboratory-confirmed cases of infection with MERS-CoV, including at least 586 related deaths.
Based on the current situation and available information, WHO encourages all of its member states to continue their surveillance for acute respiratory infections and to carefully review any unusual patterns.
Infection prevention and control measures are critical to prevent the possible spread of MERS-CoV in healthcare facilities. It is not always possible to identify patients with MERS-CoV early because like other respiratory infections, the early symptoms of MERS-CoV are non-specific. Therefore, health-care workers should always apply standard precautions consistently with all patients, regardless of their diagnosis. Droplet precautions should be added to the standard precautions when providing care to patients with symptoms of acute respiratory infection; contact precautions and eye protection should be added when caring for probable or confirmed cases of MERS-CoV infection; airborne precautions should be applied when performing aerosol generating procedures.
Until more is understood about MERS-CoV, people with diabetes, renal failure, chronic lung disease, and immunocompromised persons are considered to be at high risk of severe disease from MERSCoV infection. Therefore, these people should avoid close contact with animals, particularly camels, when visiting farms, markets, or barn areas where the virus is known to be potentially circulating. General hygiene measures, such as regular hand washing before and after touching animals and avoiding contact with sick animals, should be adhered to.
Food hygiene practices should be observed. People should avoid drinking raw camel milk or camel urine, or eating meat that has not been properly cooked.
WHO remains vigilant and is monitoring the situation. Given the lack of evidence of sustained human-to-human transmission in the community, WHO does not recommend travel or trade restrictions with regard to this event. Raising awareness about MERS-CoV among travellers to and from affected countries is good public health practice.