Two clusters of human infection with influenza A/H5N1 virus in the Republic of Azerbaijan, February–March 2006

A Gilsdorf; N Boxall; V Gasimov; I Agayev; F Mammadzade; P Ursu; E Gasimov; C Brown; S Mardel; D Jankovic; G Pimentel; I Amir Ayoub; E Maher Labib Elassal; C Salvi; D Legros; C Pessoa da Silva; A Hay; R Andraghetti; G Rodier; B Ganter

doi:10.2807/esm.11.05.00620-en

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Two clusters of human infection with influenza A/H5N1 virus in the Republic of Azerbaijan, February–March 2006
A Gilsdorf^1,2 , N Boxall^3,4 , V Gasimov⁵ , I Agayev , F Mammadzade^5,6 , P Ursu⁷ , E Gasimov⁷ , C Brown⁸ , S Mardel⁸ , D Jankovic⁸ , G Pimentel¹⁰ , I Amir Ayoub¹⁰ , E Maher Labib Elassal¹⁰ , C Salvi⁸ , D Legros¹¹ , C Pessoa da Silva¹¹ , A Hay¹² , R Andraghetti^8,11 , G Rodier⁸ , B Ganter⁸
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Affiliations: ¹ Robert Koch Institute, Berlin, Germany ² Field Epidemiology Training Program (FETP) ³ National Institute of Public Health, Prague, Czech Republic ⁴ European Programme for Intervention Epidemiology Training (EPIET) ⁵ Ministry of Health of the Republic of Azerbaijan, Baku, Azerbaijan ⁶ National Anti-Plague Station, Baku, Azerbaijan ⁷ World Health Organization, Azerbaijan ⁸ World Health Organization Regional Office for Europe, Copenhagen, Denmark ⁹ World Health Organization, Ukraine ¹⁰ United States Naval Medical Research Unit 3, Cairo, Egypt ¹¹ World Health Organization, Geneva, Switzerland ¹² National Institute for Medical Research, Mill Hill, United Kingdom

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Citation style for this article: Gilsdorf A, Boxall N, Gasimov V, Agayev I, Mammadzade F, Ursu P, Gasimov E, Brown C, Mardel S, Jankovic D, Pimentel G, Amir Ayoub I, Maher Labib Elassal E, Salvi C, Legros D, Pessoa da Silva C, Hay A, Andraghetti R, Rodier G, Ganter B. Two clusters of human infection with influenza A/H5N1 virus in the Republic of Azerbaijan, February–March 2006. Euro Surveill. 2006;11(5):pii=620. https://doi.org/10.2807/esm.11.05.00620-en

Abstract

Following the appearance of influenza A/H5 virus infection in several wild and domestic bird species in the Republic of Azerbaijan in February 2006, two clusters of potential human avian influenza due to A/H5N1 (HAI) cases were detected and reported by the Ministry of Health (MoH) to the World Health Organization (WHO) Regional Office for Europe during the first two weeks of March 2006. On 15 March 2006, WHO led an international team, including infection control, clinical management, epidemiology, laboratory, and communications experts, to support the MoH in investigation and response activities. As a result of active surveillance, 22 individuals, including six deaths, were evaluated for HAI and associated risk infections in six districts. The investigations revealed eight cases with influenza A/H5N1 virus infection confirmed by a WHO Collaborating Centre for Influenza and one probable case for which samples were not available. The cases were in two unrelated clusters in Salyan (seven laboratory confirmed cases, including four deaths) and Tarter districts (one confirmed case and one probable case, both fatal). Close contact with and de-feathering of infected wild swans was considered to be the most plausible source of exposure to influenza A/H5N1 virus in the Salyan cluster, although difficulties in eliciting information were encountered during the investigation, because of the illegality of some of the activities that might have led to the exposures (hunting and trading in wild birds and their products). These cases constitute the first outbreak worldwide where wild birds were the most likely source of influenza A/H5N1 virus infection in humans. The rapid mobilisation of resources to contain the spread of influenza A/H5 in the two districts was achieved through collaboration between the MoH, WHO and its international partners. Control activities were supported by the establishment of a field laboratory with real-time polymerase chain reaction (RT-PCR) capacity to detect influenza A/H5 virus. Daily door-to-door surveillance undertaken in the two affected districts made it unlikely that human cases of influenza A/H5N1 virus infection remained undetected.