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Investigation of avian influenza (H5N1) outbreak in humans--Thailand, 2004
Darin Areechokchai1, C Jiraphongsa, Y Laosiritaworn
1Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand. doggyrin@health3.moph.go.th
Introduction:
Beginning in late 2003, a substantial outbreak of influenza A (H5N1) virus spread among poultry in Thailand. On January 23, 2004, the Ministry of Public Health (MPH) detected the first confirmed human case of H5N1 infection in humans.
Methods:
During February-November 2004, the MPH's Bureau of Epidemiology and provincial health offices worked together to investigate the H5N1 outbreak in humans. Two studies were conducted: a descriptive study to describe clinical manifestations and epidemiologic characteristic of the cases and a matched case-control study to determine risk factors for persons who might subsequently become ill with H5N1.
Results:
A total of 16 patients with confirmed H5N1 were identified for the case-control study. Fever and respiratory symptoms predominated. Leucopenia and thrombocytopenia were present respectively in nine (100%) and four (44%) persons aged <15 years. Direct touching of unexpectedly dead poultry was the most significant risk factor (odds ratio = 29.0; 95% confidence interval = 2.7-308.2). Overall mortality was 75%; mortality for persons aged <15 years was 90%, compared with 57% for persons aged > or =15 years.
Conclusion:
Avian influenza was more severe in children, who should avoid handling dead poultry during epizootics. Early avian influenza in children resembled the more common dengue fever, but presence of cough and absence of hemoconcentration distinguished avian influenza, which often progressed rapidly to acute respiratory distress syndrome, requiring intensive care.
Insights
The 2004 H5N1 avian influenza outbreak in Thailand was severe, especially in children. Direct contact with dead poultry was a major risk factor, leading to high mortality rates.
Area of Science:
- Epidemiology
- Infectious Diseases
- Public Health
Background:
- A significant outbreak of influenza A (H5N1) virus occurred in poultry in Thailand starting in late 2003.
- The first human case of H5N1 infection was confirmed on January 23, 2004.
Purpose of the Study:
- To describe the clinical manifestations and epidemiological characteristics of human H5N1 cases.
- To identify risk factors associated with H5N1 infection.
Main Methods:
- A descriptive study and a matched case-control study were conducted.
- Data were collected from February to November 2004.
Main Results:
- Fever and respiratory symptoms were predominant in the 16 confirmed H5N1 cases.
- Direct contact with dead poultry was a significant risk factor (OR=29.0).
- Overall mortality was 75%, with 90% mortality in children under 15.
Conclusions:
- Avian influenza (H5N1) was more severe in children.
- Children should avoid handling dead poultry during outbreaks.
- Early H5N1 in children can mimic dengue fever but is distinguished by cough and rapid progression to acute respiratory distress syndrome.
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