12 May 2006
H5N1 in the Horn of Africa: First human infection in Djibouti and new poultry infections in Sudan confirmed.
The WHO reported May 12 the first confirmed patient with H5N1 infection in the Horn of Africa. A 2 year old girl from a rural village in the district of Arta became ill April 23, was tested for H5N1 virus on May 10 at the NAMRU-3 reference lab in Cairo, apparently after the deaths of some chickens resulted in increased surveillance for this virus. At least three chickens in Djibouti have also tested positive for H5N1. Fortunately, the child is alive and still under medical care. Djibouti is working with the WHO to expand their response to this H5N1 outbreak.
Djibouti is now the 8th African nation to report avian infections with the H5N1 virus. These 8 nations are: Nigeria, Egypt, Niger, Cameroon, Burkina Faso, Cote d’Ivoire, Sudan, and Djibouti.
Sudan confirmed on May 8, 2006 the presence of H5N1 avian influenza virus in poultry in its first follow-up report to the OIE (world Animal Health Organization in Paris). The initial report April 19 was of an H5 virus (Neuraminidase undetermined) in the states of Khartoum and Gezira. The May 8 report to OIE reported two new outbreaks, in Atabara in River Nile state, 250 km north of Khartoum and in Gezira state, ~ 45 km south of Khartoum. The H5N1 virus was confirmed at the OIE/FAO avian influenza lab in Padova, Italy by virus isolation and RT-PCR sequencing to prove the characteristic amino acid sequence in the cleavage site of the H5 protein seen with highly pathogenic avian influenza (HPAI).
The Horn of Africa includes Sudan, Djibouti, Eritrea, Ethiopia, and Kenya. Earlier in 2006 the WHO called attention to the ongoing health crisis in the Horn of Africa. This crisis is related to multiple factors including drought, malnutrition, economic and political instability, and increased infectious diseases, including HIV/AIDS and other communicable diseases (see: www.who.int/hac/crises/international/hoafrica/en/index.html
The addition of H5N1 avian influenza to the ongoing health crises in the Horn of Africa will worsen matters considerably if it is not controlled as soon as possible. Increased surveillance for H5N1 in both avian and human populations is needed to determine the extent of spread of this virus. International assistance should be provided when requested by member nations of this region, such as that being provided by the WHO at the recent invitation of Djibouti.
Director, Center for Biologic Counterterrorism and Emerging Infectious Diseases
EROne Institutes, Washington Hospital Center
Co-Director, Master of Science graduate school program
Biohazardous Threat Agents and Emerging Infectious Diseases
Georgetown University Medical Center