subject: Outbreak Investigation of Avian Influenza in Human- Nangarhar, Afghanistan 2007 [print this page] Outbreak Investigation of Avian Influenza in Human- Nangarhar, Afghanistan 2007
Background
The laboratory of the Afghanistan Ministry of Agriculture (MOAI) confirmed an H5N1 case in backyard poultry in a district in Jalalabad city--Nangarhar province on 20th February 2007. These samples were collected from Jalalabad on 12th Feb after reports of sudden deaths of chicken in that area.This was the first avian Influenza experience of Disease Early Warning System of Afghanistan, which was established in December 2006.
Afghanistan has alsodetected outbreaks ofH5N1 influenza in 2006, in nine provinces of the country but Ministry of Public Health could not investigate these outbreaks because of having no epidemiological capacity in the Ministry of Public Health. Ministry of Public Health Afghanistan with the technical support of World Health Organization established, Disease Early Warning System in the country. Main time National Influenza Center of Afghanistan established with the assistance of NAMRU-3, Center for Disease Control and Prevention and UNICEF.
Methodology:
A random sample of 510 families was checked for Influenza like Illness (ILI) (fever 38C, cough, sore throat and difficulty in breathing) by 30 teams of three people. Teams visited every seventh household from house of index case (IC) plus all neighboring households of IC to the predetermined borders of 3Km in all direction. Target population was almost 14% of residence in 3 Km radius from IC. To identify all patients with fever who may have been missed during home visits, a fever monitoring clinic was established in the area. Suspected cases were checked for Influenza type A, and if positive, further investigated by Real time polymerase chain reaction (RT-PCR).
Results
We investigated the target households for fever and other signs and symptoms of ILI, and found one suspected case. Throat swab and blood samples were collected. Subsequently, the suspect patient was hospitalized and Tamiflu was administered. Laboratory examination revealed that the patient was negative for Type A influenza. Convalescent samples, collected after six days, showed no H5N1 antibodies.
Conclusion
A thorough joint investigation was performed and no human cases of H5N1 were detected. In the affected areas, MOAI culled more than 8500 chickens and decontaminated all infected areas with bleaching powder. The success of this investigation was due to a positive and coordinated response between the Ministries of Public Health and Agriculture.
