Current Avian influenza (H5N1) affected areas

Human infection with avian influenza H5N1 viruses

Human infection with the H5N1 virus remains a rare event. Direct contact with infected poultry, or surfaces and objects contaminated by their faeces, is presently considered the main route of human infection. Exposure is considered most likely during slaughter, defeathering, butchering, and preparation of poultry for cooking.

There is no evidence to suggest that the avian influenza virus can be transmitted through the consumption of poultry and poultry products as long as standard precautions regarding food storage, handling, preparation are followed. Consumers should ensure that poultry is thoroughly cooked (juice runs clear and no visible pink meat). Internal temperatures for whole chicken should reach 85°C, for chicken parts should reach 74°C and eggs should be cooked until the yolk is no longer runny.

For poultry preparation guidelines please visit: Avian Influenza & Poultry .

Table 1, below, provides an up-to-date list of countries experiencing human cases of H5N1 avian influenza.

The Asian strain of avian influenza H5N1 virus has been confirmed in poultry and wild birds in several countries in the following regions: Asia, Europe, Africa and the Middle East. While this demonstrates the rapid and ongoing geographical spread of the virus, information to date has shown that the greatest risk to humans arises when the virus becomes established in small backyard poultry flocks, which allow continuing opportunities for close human contact, exposures, and infections to occur.

Table 2 and Table 3 below, provide an up-to-date list of countries experiencing H5N1 avian influenza outbreaks or activity in domestic poultry and wild birds. These tables include only those countries officially reporting avian influenza H5N1 activity to the World Organisation for Animal Health (OIE) and do not necessarily include all countries experiencing such activity in poultry and wild birds. When using these tables, please consider that some countries have not reported outbreaks in poultry or wild birds but have reported human cases, implying that there may be a risk of infection upon exposure to poultry or wild birds in some regions even if this country is not found in the tables below.

Tables 2 and 3 below contain information for the period September 1, 2010 to the present. For previous data, please go to archives:

• September 2006 – August 2007
• September 2007 – August 2008
• September 2008 – August 2009
• September 2009 – August 2010

For detailed information on H5N1 activity in poultry and wild birds please refer to this website:

• World Organisation for Animal Health

Table 2: OIE² confirmed Avian Influenza H5N1 Activity in Poultry (1 Sept. 2011 - present)

Country	Date of Outbreaks		Total number of Outbreaks since 1 Sept. 2011 - Present3
	Initial	Most recent
2 OIE: Office International des Epizooties (World Organisation for Animal Health ) 3 Country grouping is based on United Nations Environment Programme mapping
Asia & the Pacific
Japan	2009-04-01	2011-03-16	0
Vietnam	2006-12-07	2011-08-26	4
Korea (Rep. Of)	2010-11-29	2011-05-16	0
Nepal	2010-10-25	2010-10-25	1
Hong Kong	2010-03-26	2011-02-03	0
Bangladesh	2007-02-05	2011-09-06	4
Myanmar	2010-03-26	2011-03-16	0
Cambodia	2010-01-10	2011-07-21	2
India	2010-06-02	2011-08-29	2
Indonesia	2007-06-01	2011-04-06	0
West Asia (Middle East)
Palestinian Auton. Territories	2006-04-19	2011-02-27	0
Israel	2010-02-01	2011-03-05	0
Iran	2008-08-03	2011-09-13	3
Africa
Egypt	2006-02-17	2010-12-30	0
South Africa	2006-07-01	2011-08-09	6
Europe

• Month-by-month OIE confirmed avian influenza H5N1 activity in poultry, by country

Table 3: OIE² confirmed Avian Influenza H5N1 Activity in Wild Birds (1 Sept. 2011 - present)

Country	Date of Outbreaks		Total number of Outbreaks since 1 Sept. 2011- Present3
	Initial	Most recent
2 OIE: Office International des Epizooties (World Organisation for Animal Health ) 3 Month-by-month OIE confirmed AI H5N1 outbreak activity by country
Asia & the Pacific
Korea (Rep. Of)	2010-11-29	2010-12-30	0
Japan	2009-04-01	2011-03-25	0
Hong Kong	2010-03-26	2011-03-01	0
Mongolia	2010-06-14	2011-04-05	0
Cambodia	2010-01-7	2011-07-13	0
West Asia (Middle East)
Israel	2010-02-01	2011-04-06	0
Africa
Europe

• Month-by-month OIE confirmed avian influenza H5N1 activity in poultry, by country

PHAC recommendations for public health professionals

Health professionals are reminded to refer to their provincial/territorial Ministry of Health for specific recommendations on surveillance and public health.

The Public Health Agency of Canada (PHAC) continues to monitor the global influenza situation and will continue to make recommendations as new official information becomes available, including providing ongoing updates to provinces and territories (P/Ts).

PHAC RECOMMENDATIONS:

1. Public Health authorities in Canada are advised to continue vigilance for the recognition, reporting and prompt investigation of patients with severe respiratory illness (SRI) (PDF, 80 Kb, 7 page) and/or severe influenza-like illness (ILI)^* (for national case definitions refer to the SRI protocol (PDF, 80 Kb, 7 page)).
2. Front line health care providers in hospitals should be advised of the following SRI and severe ILI patient encounters:

THINK – TELL – TEST appropriately:

• THINK
  • query travel
  • implement best practices for triage, infection control and patient management as indicated
• TELL
  • Consult your local Public Health for assistance in SRI/severe ILI patients with the following:
    • Recent travel or contact with travelers to an affected area with confirmed H5N1 activity in humans and/or domestic poultry
• TEST
  • Consult your local Public Health for guidance on appropriate testing, recommended procedures and prioritization for H5N1 investigation IF significant exposure history has been established which may include:
    
    • Close contact (within 1 metre, i.e. touching distance) with a confirmed human case of H5N1
      
      OR
      
    • Close contact with sick or dead domestic poultry or wild birds

For detailed background and recommendations on enhanced SRI surveillance in hospitals, please consult your local or provincial/territorial health authorities. Also see the Public Health Agency of Canada's Emerging Respiratory Illness website for health professionals

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^* Influenza-like illness (ILI) in the general population (FluWatch national case definition): Acute onset of respiratory illness with fever and cough and with one or more of the following - sore throat, arthralgia, myalgia, or prostration which could be due to influenza virus. In children under 5, gastrointestinal symptoms may also be present. In patients under 5 or 65 and older, fever may not be prominent.

Severe ILI may include complications such as: pneumonia, Acute Respiratory Distress Syndrome (ARDS), encephalitis and other severe and life threatening complications requiring hospitalization or resulting in death of otherwise healthy individuals.