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Cablegate: Cambodia - New Case of Avian Influenza

R 130218Z DEC 08
FM AMEMBASSY PHNOM PENH
TO SECSTATE WASHDC 0201
INFO ASEAN REGIONAL FORUM COLLECTIVE
ASEAN PACIFIC ECONOMIC COOPERATION
DEPT OF HHS WASHINGTON DC
CDC ATLANTA GA
USDA FAS WASHDC
DIRAFMIC FT DETRICK MD//MA-1//

UNCLAS PHNOM PENH 000990


STATE FOR CA/OCS/ACS, EAP/EX, EAP/MLS, MED
STATE ALSO FOR OES/PDAS/PCI ASTEWART AND OES/IHA DSINGER
HHS FOR OGHA STEIGER AND ELVANDER
CDC FOR NCID COX
USAID FOR ANE/AA KUNDER, GH/HIDN CARROLL, OFDA LEVY
BEIJING FOR ESTH - SELIGSOHN AND SHAPIRO
BANGKOK FOR CDC MALISON AND WETTRICH, USAID FOR BRADSHAW
JAKARTA FOR NAMRU JONES, USAID KRAMER
HANOI FOR USAID ZVINAKIS, HHS IADEMARCO AND DENNIS
VIENTIANE FOR BAUER AND CORWIN
RANGOON FOR TIDWELL

E.O. 12958: N/A
TAGS: TBIO KFLU ECON PREL SOCI CASC CB

SUBJECT: CAMBODIA - NEW CASE OF AVIAN INFLUENZA

1. Summary: On December 12, 2008, the Cambodian Ministry of Health
(MOH) reported a new case of laboratory-confirmed H5N1 avian
influenza (AI) in a 19-year-old male from Kandal Province who also
worked in Kampong Speu Province. The patient is currently
hospitalized in Phnom Penh but is clinically stable and improving.
This patient represents the first evidence of H5N1 disease activity
in either humans or animals in Cambodia since April 2007. The MOH
has rapidly assembled an outbreak investigation and response team
composed of individuals from MOH's Cambodian Communicable Disease
Control division (CCDC), World Health Organization (WHO), Institut
Pasteur in Cambodia (IPC), US Naval Medical Research Unit 2
(NAMRU-2), US Centers for Disease Control and Prevention (CDC), the
National Veterinary Research Institute (NaVRI), and Food and
Agriculture Organization (FAO). Human and veterinary Rapid Response
Teams (RRTs) under CCDC and NaVRI, respectively, have been
dispatched to the affected provinces to perform contact tracing,
active surveillance, sample collections, and immediate control
measures. Interviews of the patient are also ongoing to obtain more
detailed clinical and epidemiological information. End Summary.

2. On December 2, 2008, the patient presented to a hospital clinic
in Kandal Province with a 4-day history of fever, cough, sore
throat, headache, muscle aches, and malaise. On presentation, his
measured temperature was 39.00C, and he was enrolled in a febrile
illness study conducted on-site by NAMRU-2. On December 10, 2008,
respiratory samples collected from the patient tested positive for
H5 influenza by real time polymerase chain reaction (rt-PCR) at the
NAMRU-2 laboratory. On December 11, 2008, a sample aliquot was sent
to the IPC laboratory, and rt-PCR results later that day confirmed
H5N1 infection.

3. Retrospectively, it was determined that on December 3, 2008, the
patient was evaluated at Chantrea Clinic in Phnom Penh after his
clinical condition worsened. He was diagnosed as having possible
tuberculosis and was subsequently admitted to CENAT Hospital on the
same day for further evaluation and treatment. On December 11, 2008,
he was transferred to Calmette Hospital in Phnom Penh, a national AI
referral hospital, after the diagnosis of H5N1 infection was made.

4. Eleven days prior to his illness onset, the patient had a
history of defeathering and/or consuming chickens found dead in his
village. Eight days prior to onset, he traveled to Kampong Speu
Province to help relatives harvest rice. He remained in Kampong Speu
Province up until the time of onset, and reported defeathering
chickens during this interval. It is unclear whether poultry that he
was exposed to had any signs of illness. H5N1 infection has not yet
been laboratory-confirmed in animals from or nearby his villages in
Kandal or Kampong Speu Provinces. No other laboratory-confirmed
human infections have been reported. Animal and human field
investigations are ongoing.

RODLEY

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