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An 11-year-old girl has died of bird flu in Cambodia, and multiple others who live in her area sickened, according to media reports, marking the first known H5N1 human infections in the country since 2014—and potentially setting the stage for sustained human-to-human transmission.
The girl, from the southeastern province of Prey Veng, reportedly became ill Feb. 16, suffering from a 102-degree fever, cough, and throat pain. She died shortly after arriving at a hospital in the capital, Phnom Penh, the Associated Press reported, citing the country’s health ministry.
The Khmer Times, a Cambodian news outlet, reported Thursday that 12 additional people from Prey Veng had been infected, citing the health ministry. Four of the 12 have begun to show symptoms, and results of lab testing should be released tomorrow, according to the Times, making it unclear if any have been officially diagnosed so far.
There have been increased reports of H5N1 bird flu spreading among groups of mammals throughout the world in recent days—a situation that must be “monitored closely” due to their physiological similarities with humans, World Health Organization Director General Tedros Adhanom Ghebreyesus said earlier this month.
H5N1 avian flu, rare in humans, is almost always transmitted by direct contact with sick birds. Only rarely have human cases occurred over the quarter century it’s been known to exist, with no sustained transmission reported among humans.
But “we cannot assume that will remain the case,” Ghebreyesus said at a Feb. 8 news conference. If birds have transmitted the virus to small mammals and it’s spreading among them—as seems to be the case, given recent mass mortality events among minks—it could signal that the virus has evolved to more easily spread among humans, experts caution.
The report “does raise the concern that we are transitioning from what has been a bird-to-human status quo to more of a human-to-human transmission scenario,” Rajiv Chowdhury, senior epidemiologist and professor of global health at Florida International University, told Fortune.
While 22 chickens and 3 ducks at the now-deceased girl’s home had recently died, and there has been an unusual number of deaths among wild birds in the area as of late, it has not yet been determined how the girl was infected, BNO News reported Wednesday, citing Cambodian government officials. It’s also unclear if the individuals experiencing symptoms who live near the girl had contact with birds.
“I recommend that people do not touch dead or sick birds,” Chowdhury said, adding that children, especially, should be prevented from collecting eggs and/or playing with domestic poultry.
Pathogen surveillance systems must be “strengthened worldwide to prepare and act for any further outbreak,” he added.
A pattern of spill-overs
Even if sustained human-to-human transmission is not taking place in Cambodian, Chowdhury is concerned about a recent pattern of spill-overs from birds to humans “in entirely different parts of the world. A previously healthy Ecuadorian girl was been hospitalized with the virus, and was under sedation and on a ventilator, the WHO reported in January. Just how she contracted the virus was uncertain and under investigation, but poultry her family had recently purchased died without apparent cause. The girl was recovering, WHO officials told Fortune earlier this month.
While the risk to people remains low, public health officials must prepare “to face outbreaks in humans, and be ready also to control them as soon as possible,” Dr. Sylvie Briand, director of Global Infectious Hazard Preparedness and Emergency Preparedness at the WHO, told Fortune at the time.
Ghebreyesus cautioned against touching or collecting sick or dead animals, and encouraged those who encounter such to report them to local authorities. Countries must strengthen their avian flu surveillance in areas where humans and wild animals interact, he insisted. And public health officials must work with manufacturers to ensure that vaccines and antivirals are available for global use, he said at the news conference.
This is a developing report and will be updated.
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