Surveillance and outbreak alert

Avian influenza

Avian influenza in the South-East Asia Region in 2013

Since the avian influenza A (H5N1) virus had re-emerged in 2003 and 2004, after the first report of infection in humans in 1997 during a poultry outbreak in Hong Kong SAR, China, it has spread from Asia to Europe and Africa. Globally, among the 15 countries that reported human cases of avian influenza A (H5N1) virus infection, 4 countries were in South-East Asia Region, i.e. Bangladesh, Myanmar, Indonesia and Thailand.

Report of human cases

In the South-East Asia Region, the total number of human avian influenza A (H5N1) cases reported since the beginning of 2004 till 31 December 2013 is 228 with 181 fatalities. In 2013 alone, there were 4 cases, with 4 fatalities, of human influenza A H5N1 reported to WHO from Bangladesh and Indonesia.

On 7 April 2013, Bangladesh reported the seventh case of laboratory-confirmed Influenza A (H5N1). This was a 1 year 11 months old male child from Chauddogram, Comilla District, Chittagong Division. Detailed outbreak investigation revealed strong epidemiological link with backyard poultry deaths.

The total number of human avian influenza A (H5N1) cases reported in Bangladesh since May 2008 till December 2013 is 7 with 1 fatality.

Other three separated cases of laboratory-confirmed cases of avian influenza A (H5N1) were reported from Indonesia during June to November 2013. The first case was a male child, 2 years and 56 months old, with the date of onset on 10 June 2013 and died on 19 June 2013. The second case was a 28 years old man with the onset on 16 September 2013 and died on 27 September 2013. The last case was a 31 years old woman with the date of onset from 1 November 2013 and died on 11 November 2013. All cases however were reported from Bekasi, West Java Province, and had history of direct or in-direct contact with live birds.

The total number of human avian influenza A (H5N1) cases reported in Indonesia since the beginning of 2005 till December 2013 is 195 with 163 fatalities.

Risk assessment

Sporadic cases or small clusters of human cases are possible as long as the viruses are circulating in poultry, especially in people exposed to infected household poultry or contaminated environments. Controlling circulation of the H5N1 virus in poultry is therefore essential to reducing the risk of human infection. As the H5N1 virus continues to circulate in some poultry populations, control will require long-term commitments from member states and strong coordination between animal and public health authorities.

Table 1 - List of reported cases of avian influenza A H5N1 virus infection in South-East Asia Region during 2013


Country Province Age (years) Sex Date of onset Date of Hospitalization Oseltamivir treatment Start date Date of death Exposure to
Bangladesh Chittagong 2 M 2-11-13 2-12-13 NA NA Sick or dead poultry
Indonesia West Java 2 M 6-10-13 6-17-13 NA 6-19-13 Live bird market
Indonesia West Java 28 M 9-16-13 9-20-13 NA 9-27-13 Song birds and pigeons
Indonesia West Java 31 F 01/11/20131 11-6-13 NA 11-11-13 Pet bird, poultry in neighbourhood, market and pigeons

Table 2 - Reported human cases due to avian influenza A (H5N1) from countries of South-East Asia Region, 2004-2013


2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Total cases (deaths)
Bangladesh 0 0 0 0 1 (0) 0 0 2 (0) 3 (0) 1 (1) 7 (1)
Indonesia 0 20 (13) 55 (45) 42 (37) 24 (20) 21 (19) 9 (7) 12 (10) 9 (9) 3 (3) 195 (163)
Myanmar 0 0 0 1 (0) 0 0 0 0 0 0 1 (0)
Thailand 17 (12) 5 (2) 3 (3) 0 0 0 0 0 0 0 25 (17)
Total 17 (12) 25 (15) 58 (48) 43 (37) 25 (20) 21 (19) 9 (7) 14 (10) 12 (9) 4(4) 228 (181)

Graph A - Reported human cases due to avian influenza A (H5N1) from countries of South-East Asia Region, 2004-2013

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Regional Adviser, DSE
World Health Organization
South East Asia Region
WHO House, I P Estate
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Fax: +91 11 2370 5663
Email: outbreak@searo.who.int