No new human infections with A/H5N1 in Turkey but national
measures and international support continue
There have been no new human cases of A/H5N1 diagnosed
in Turkey since mid-January, and only three patients were still receiving
care in hospital at 27 January,[1] but probable outbreaks of H5N1 infections
in poultry are still being detected and so the potential for further human
cases remains. The Turkish Ministry of Health is therefore continuing to recommend
and enforce the measures already taken to prevent more human infections. These
measures are essentially:
• Control of infection in birds
• Case finding, surveillance, laboratory confirmation, patient isolation
and infection control
• Community mobilisation and education to reduce risk of human exposure
to infected birds
Community mobilisation is the use of local healthcare providers, local
government, other social structures and the media to disseminate messages
effectively: these messages are to the effect that people should report
sick poultry and not have unnecessary close contact with domestic birds.
The message is particularly targeted at parents and children, as young children
have been disproportionately represented in the cases.
There has been considerable progress in culling domestic flocks, especially
in the areas where most of the human cases appeared in eastern Turkey, and
so the overall risk to humans in those areas has declined. People are continuing
to seek medical assessment to exclude infection with H5N1. Therefore, the
absence of new cases for some time indicates initial success of current
control measures.
The Turkish Ministry of Health has announced that H5N1 has been confirmed
in clinical samples from 12 patients by the national influenza reference
laboratory in Ankara (the National Influenza Centre, NIC) and the World
Health Organization (WHO) influenza reference laboratory in London (a WHO
collaborating centre). The 12 confirmed cases include the four patients
who died. There are an additional nine patients whose samples have tested
positive for A/H5 by the NIC, but which have not yet been confirmed by further
testing at the WHO influenza laboratory in London.[2] The prime objective
of the NIC’s initial testing was to support case finding and control of
the outbreak, using clinical data as well as the preliminary test results.
It was successful in supporting the control of the outbreak The NIC and
the WHO laboratories are now performing further tests on samples from patients,
including serology.
International support in outbreak control continues
When the first two human cases of influenza type A/H5N1 (bird ‘flu) were
reported by the Turkish Ministry of Health in the first week of January
2006 [3], the Turkish authorities made a request for assistance to the World
Health Organization (WHO). An international team of technical experts in
of the fields of outbreak investigation, laboratory diagnostics, veterinarian
epidemiology and infection control from WHO, the European Centre for Disease
Prevention and Control (ECDC) and the European Commission set out for Ankara
within 24 hours [4]. These experts formed the core of a WHO-led international
team which has been working with Turkish colleagues both in Ankara and in
Van province in eastern Turkey, where the greatest concentration of infected
patients received medical treatment.
With the agreement of the authorities in Turkey, specific work concerning
human health has been undertaken by the team, including:
The veterinary component of the team has been working intensively with
the Turkish Ministry of Agriculture. Much more work on animal health is
needed before what seems to be a complex pattern of infection in the bird
population can be adequately described. The extent of infection in birds
in Turkey has yet to be fully delineated by the Turkish authorities, but
may be extensive. Therefore, the risk to humans may continue for some time,
and a prolonged collaboration with the Turkish Government is foreseen. This
will require substantial investment, a point which is now being addressed
by the Turkish authorities with support from the European Union and international
agencies such as the World Bank.
A number of international organisations responded to the request for
assistance by the Turkish authorities and the WHO, and formed the International
Team: ECDC, European Commission, UNICEF, the Food and Agriculture Organization
of the United Nations (FAO), World Organisation for Animal Health (OIE).
There was close cooperation incountry with the World Bank, the United Nations
Development Programme (UNDP), the Delegation of the Europe Commission to
Turkey, and the EU Presidency (currently Austria) and WHO itself.
Experts from national institutions were brought together through the
Global Outbreak Alert and Response Network (GOARN, http://www.who.int/csr/outbreaknetwork/en/)
and the veterinary bodies represented by the European Commission, FAO and
OIE. These included the Institute de Veille Sanitaire (France,) the Centers
for Disease Control and Prevention (USA), the Swedish Central Field Epidemiology
Group (Sweden), Tel Aviv University (Israel), the State Veterinary Service
(UK) and the Veterinary Laboratory Agency (UK).