March 24, 2014

 

Cambodia to tighten measures in controlling bird flu

Today, March 24, health officials are scheduled to meet in Phnom Penh to discuss Cambodia's increase in the number of cases of avian influenza in humans of which the most recent victim, a two-year-old girl, died on March 14, bringing the number of confirmed fatalities this year to four.

 

Last year, 14 Cambodians died from the H5N1 strain of avian influenza, more than half of the global total.

 

The women's lack of understanding is no great surprise. Since H5N1 was first detected here in poultry in January 2004, the authorities and donors have tried to get people to change their behaviour when handling birds. Experts say that effort has largely failed.

 

That is partly because some 80% of the country's 20 million chickens and ducks are raised in close proximity to humans. The UN's Food and Agriculture Organization, or FAO, believes H5N1 is endemic in Cambodia's poultry.

 

However, the government will not pay compensation to villagers who lose their poultry to the disease. As a consequence, when birds fall ill, the incentive for impoverished villagers is either to sell them or to eat them - not to report the outbreak.

 

The FAO's Lotfi Allal says prevention efforts should try to focus on further measures to ensure early reporting of the bird flu virus.

 

With 18 fatalities from H5N1 over the past 15 months, Cambodia has reported the worst statistics of any country in the world. More than half of Cambodia's 56 confirmed cases of H5N1 infection in humans to date have occurred since the start of last year. The main concern of health experts is that H5N1 will mutate to allow human-to-human transmission.

 

Most of Cambodia's cases of H5N1 have been in the country's southeast, an area that shares a porous border with Vietnam through which birds are smuggled with few inspections. But where Cambodia reported more than 30 cases in humans since the start of 2013, Vietnam reported just four.

 

Dennis Carroll, who heads the pandemic influenza and other emerging threats unit at US Agency for International Development (USAID) - the US government's development arm - says that is puzzling because the H5N1 variant is the same on both sides of the border.

 

"The epidemiology, the genetics, of both the virus and the presentation both in poultry and in humans are pretty much shared. But we're seeing a huge inequity between what's showing up on the Cambodia side versus what's showing up on the Vietnam side without any real obvious explanation," said Carroll.

 

There are several possibilities for the increase in human infections in Cambodia.  It could be due to better monitoring and reporting, or it could be there really are more infections, or it could be some combination of the two.

 

At this stage, the experts simply do not know, which is why USAID is meeting with officials from Vietnam and Cambodia, in part to improve information-sharing and responses to outbreaks.

 

Cambodia already has built a much-improved surveillance and testing programme for H5N1. But it still has neither poultry vaccination programme nor a plan to compensate farmers who cull their birds. Experts say that if the situation worsens, that might have to change.