Bird flu cluster-Indonesia

15 February 2006

date animals humans

1996 Highly pathogenic H5N1 virus is isolated

from a farmed goose in Guangdong

Province, China.

1997 Outbreaks of highly pathogenic H5N1 are

reported in poultry at farms and wet

markets in Hong Kong.

Human infections with H5N1 are reported

in Hong Kong. Altogether, 18 cases (6

fatal) are reported in the first known

instance of human infection with this

virus.

Feb 03 Two cases of H5N1 (one fatal) are

confirmed in a Hong Kong family with a

recent travel history to Fujian Province,

China. A third family member died of

severe respiratory disease while in

mainland China, but no samples were

taken.

date animals humans

Mid-03 H5N1 virus begins to cause outbreaks in

Asia, but these go undetected and

unreported.

Dec 03 Two tigers and two leopards, fed on fresh

chicken carcasses, die unexpectedly at a

zoo in Thailand. Subsequent investigation

identifies H5N1 in tissue samples. This is

the first report of influenza causing

disease and death in big cats.

pathogenic H5N1 as cause of poultry

deaths at three farms.

human cases of severe respiratory disease

with high fatality. Sporadic cases are

reported through mid-March.

cases of human infection with

H5N1. Sporadic cases are reported

through mid-March.

2

1 Feb 04 Investigation of a family cluster of cases,

which occurred in Viet Nam in early

January, cannot rule out the possibility of

limited human-to-human transmission.

20 Feb 04 Anecdotal evidences suggests H5N1

infection in a single household of

domestic cats in Thailand.

Case studies of 10 patients in Viet Nam

point to close contact with infected

poultry as the probable source of infection

in most cases, but conclude that, in two

family clusters, limited human-to-human

transmission within the family cannot be

ruled out.

Mid-March

04

Reports of human cases end. In total, 12

cases (8 fatal) occurred in Thailand, and

23 cases (16 fatal) occurred in Viet Nam.

date animals humans

Jun/Jul 04 China, Indonesia, Thailand and Viet Nam

report recurrence of H5N1 in poultry.

Research identifies the dominant Z

genotype in poultry, considers possible

role of wild birds in spread, and

concludes that H5N1 has found a new

ecological niche in poultry, but is not yet

fully adapted to this host.

Research shows that H5N1 has become

progressively more lethal for mammals

and can kill wild waterfowl, long

considered a disease-free natural

reservoir.

A case report is published indicating

atypical human H5N1 infection in

Thailand (from March 04), with fever and

diarrhoea but no respiratory symptoms.

The report suggests that the clinical

spectrum of disease may be broader than

previously thought.

3

23 Jul 04 Japan announces control of the H5N1

poultry outbreak and is considered

disease-free by OIE.

fatal. Dates of hospital admission are from

19 July to 8 August.

Chinese researchers report preliminary

findings of H5N1 infection in pigs. No

evidence suggests that pig infections are

widespread, and the finding appears to

have limited epidemiological

significance.

Research shows that domestic cats

experimentally infected with H5N1

develop severe disease and can spread

infection to other cats. Prior to this

research, domestic cats were considered

resistant to disease from all influenza A

viruses.

7 Sept 04 A 4th fatal case is reported in Viet Nam.

infection.

21 Sept 04 Republic of Korea announces control of

the H5N1 poultry outbreak and is

considered disease-free by OIE.

28 Sept 04 Thailand confirms 2 further human cases.

4 Oct 04 Thailand confirms 4th human case.

11 Oct 04 Outbreak begins in zoo tigers in Thailand

said to have been fed chicken carcasses.

Altogether, 147 tigers out of a population

of 441 die or are euthanized.

22 Oct 04 Highly pathogenic H5N1 is confirmed in

two eagles illegally imported into Europe

(Brussels) from Thailand.

25 Oct 04 Thailand confirms 5th and final case in

second wave.

Research confirms that domestic ducks

can act as silent reservoirs, excreting

large quantities of highly pathogenic virus

yet showing few if any signs of illness.

Nov 04 No further human cases are reported.

Altogether, 5 cases (4 fatal) occurred in

Thailand, and 4 cases (4 fatal) occurred in

Viet Nam in this second wave.

4

date animals humans

Dec 04 Poultry outbreaks ongoing in Indonesia,

Thailand, and Vietnam and possibly also

in Cambodia and Lao PDR.

3 Jan 05 Malaysia (Peninsular) announces control

of the H5N1 poultry outbreak and is now

considered disease-free by OIE.

6 Jan 05 Viet Nam reports 2 further cases.

14 Jan 05 Total cases in Viet Nam rise to 6.

Sporadic cases continue to be reported

over the coming months, making Viet

Nam the hardest hit country.

Research concludes that a girl in Thailand

probably passed the virus to at least her

mother in Sept 04, causing fatal disease.

This is the first published account of

probable secondary human transmission,

resulting in severe disease, of any avian

influenza virus.

which is fatal.

Research retrospectively identifies at least

one fatal atypical case in Viet Nam (from

Feb 04), presenting with diarrhoea and

encephalitis, but normal chest X-rays.

29 Marc 05 Cambodia reports its 2nd case, also fatal.

12 Apr 05 Cambodia reports its 3rd case, also fatal.

30 April 05 Wild birds begin dying at Qinghai Lake

in central China, where hundreds of

thousands of migratory birds congregate.

Altogether, 6,345 birds from different

species die in the coming weeks.

4 May 05 Cambodia reports its 4th case, also fatal.

8 June 05 China reports poultry outbreak in

Xinjiang Autonomous Region.

5

30 Jun 05 A WHO investigative team finds no

evidence that H5N1 has improved its

transmissibility in humans in Viet Nam.

Research on viruses isolated from dead

birds in Qinghai Lake suggests the

outbreak was caused by a new H5N1

variant that may be more lethal to wild

birds and experimentally infected mice.

Research on viruses isolated from dead

birds in Qinghai Lake demonstrates

transmission of the virus among

migratory geese and suggests that the

virus may be carried along winter

migratory routes.

15 Jul 05 Tests on three civets that died in late June

in Viet Nam detect H5N1, marking the

first infection of this species with the

virus. The endangered Owston’s palm

civets were raised in captivity; source of

infection is unknown.

Infection in two other family members is

considered likely, but cannot be

laboratory confirmed. Subsequent

investigation is unable to determine the

source of infection.

pathogenic avian influenza, subsequently

confirmed as H5N1, in poultry in western

Siberia. The outbreak spreads to affect 6

administrative regions in Siberia. Dead

migratory birds are reported in the

vicinity of outbreaks.

highly pathogenic avian influenza,

subsequently confirmed as H5N1, in

poultry in areas adjacent to Siberia. Dead

migratory birds are reported in the

vicinity of outbreaks.

5 Aug 05 Viet Nam now has 64 confirmed cases in

the third wave, of which 21 were fatal.

10 Aug 05 China reports outbreak in Tibet

Autonomous Region.

migratory birds at two lakes. H5N1 is

subsequently identified in these birds.

16 Sept 05 Indonesia confirms its 2nd case.

6

22 Sept 05 Indonesia confirms its 3rd case.

29 Sept 05 Indonesia confirms its 4th case.

Research describes the clinical features of

H5N1 infection and reviews

recommendations for the management of

cases.

Research on the evolution of human and

animal viruses circulating in Asia in 2005

suggests that several amino acids located

near the receptor-binding site are

undergoing change, some of which may

affect antigenicity or transmissibility.

Research describes reconstruction of the

lethal 1918 pandemic virus, concludes

that this virus was entirely avian, and

finds some similarities with H5N1.

10 Oct 05 Indonesia confirms its 5th case.

13 Oct 05 Highly pathogenic H5N1 is confirmed in

15 Oct 05 Highly pathogenic H5N1 is confirmed in

19 Oct 05 China reports its first poultry outbreak

since August 2005. Several new

outbreaks are reported in the coming

weeks.

20 Oct 05 Taiwan, China, reports the detection of

highly pathogenic H5N1 in a cargo of

exotic songbirds smuggled from mainland

China.

October 2004.

23 Oct 05 Highly pathogenic H5N1 is confirmed in

an imported parrot, held in quarantine in

the UK, that died 3 days earlier.

24 Oct 05 Thailand and Indonesia report more cases.

July 2005.

23 Nov 05 China reports its third case. Sporadic

cases continue to be reported in the

coming weeks.

29 Nov 05 China reports more fresh outbreaks in

poultry. Since mid-October, 25 outbreaks

have been detected in 9 provinces,

resulting in the culling of around 20

million birds.

7

in domestic birds.

11 Nov 05 Kuwait detects highly pathogenic H5N1

in a single migratory flamingo, marking

the first report of this disease in the Gulf

region.

27 Dec 05 Turkey reports a fresh outbreak in the

eastern province of Igdir

Sporadic cases continue to be reported in

the coming weeks, but rapidly end.

23 Jan 06 Turkey reports poultry outbreaks in 11 of

the country’s 81 provinces.

backyard flocks in same province where

human case detected.

first detection of this virus in Africa.

birds.

H5N1 in wild birds (swans).

(swan).

13 Feb 06 China reports its 12th case and 8th

fatality. Many of these cases occurred in

areas with no reported outbreaks in

poultry.

Indonesia reports its 25th case and 18th

fatality.

(swans).

(swans)

(swans).

8

350:1179–88.

2 Li KS et al. Genesis of a highly pathogenic and potentially pandemic influenza virus in

3 Chen H et al. The evolution of H5N1 influenza viruses in ducks in southern China. Proc

Natl Acad Sci USA 2004; 101: 10452–57.

4 Apisarnthanarak A et al. Atypical avian influenza (H5N1). Emerg Infect Dis 2004; 10:

1321–24.

5 Verbal report at WHO international consultation.

6 Kuiken T et al. Avian H5N1 influenza in cats. Published online by Science:

www.sciencemag.org/cgi/content/abstract/1102287

7 Issued (prior to publication) on WHO website: Avian influenza – situation in Asia:

altered role of domestic ducks, 29 October 2004; available online at:

http://www.who.int/csr/don/2004_10_29/en/index.html

8 Ungchusak K et al. Probable person-to-person transmission of avian influenza A (H5N1).

N Engl J Med 2005; 352:4 333–40.

9 De Jong M et al. Fatal avian influenza A (H5N1) in a child presenting with diarrhea

followed by coma. N Engl J Med 2005; 352:7 686–91.

10 Liu J et al. Highly pathogenic H5N1 influenza virus infection in migratory birds. Science

2005. Published by Science online at:

www.sciencemag.org/cgi/contents/abstract/1115273

11 Chen H et al. H5N1 virus outbreak in migratory waterfowl. Nature 2005; 436: 191–92.

12 Writing Committee of the World Health Organization (WHO) Consultation on Human

Influenza A/H5. N Engl J Med 2005; 353:13 54–65.

13 World Health Organization Global Influenza Program Surveillance Network. Emerg

Infect Dis 2005; 11: 1515–21.

14 Taubenberger JK et al. Characterization of the 1918 influenza virus polymerase genes.

Nature 2005; 437: 889–93.

15 Tumpey et al. Characterization of the reconstructed 1918 Spanish influenza pandemic

virus. Science 2005; 310: 77–80.